ADHD rating scale

The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by DuPaul and colleagues^[1] consisting of 18 questions regarding a child's behavior over the past 6 months.^[1] It is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.^[1]

The ADHD-RS is currently in its fifth version in correlation with DSM-V.

Overview

The ADHD-RS, a 18-question self-report assessment, takes about five minutes to complete.^[1] Each question measures the frequency of the behavior, in which the respondent is asked to indicate whether the behavior occurs “always or very often”, “often”, “somewhat”, or “rarely or never”. The questionnaire is intended to be filled out by parents and teachers of the child or adolescent.^[1] The first nine items ask questions about behavior related to inattention (e.g., "has difficulty organizing task and activities"). The second set of nine items ask questions about behavior related to symptoms of hyperactivity and impulsivity (e.g., "talks excessively"). The last question asks if the behaviors were present before age seven. The ADHD Rating scale has impacted the world of clinical psychology by providing an accurate and valid measure that is able to identify the presence of ADHD in children.^[2] It is also helpful in identifying the subtype (inattention or hyperactive) of the disorder.^[2]

Development and history

Attention Deficit/ Hyperactivity Disorder (ADHD) is one of the most prevalent neurological disorders found in children. Children with ADHD are at an increased risk for poor scholastic performance, problems with personal conduct, and maintaining social relationships.^[1]^[3]

The ADHD-RS was created to address the need for an effective evaluation for children and adolescents that are suspected of having ADHD, especially given the disorder's prevalence.^[1] The assessment also serves an additional purpose of matching parent and teacher observations of ADHD symptoms to DSM-IV criteria of ADHD.^[4]

DSM-IV outlines three subtypes of ADHD: ADHD combined type, ADHD predominantly inattentive, and ADHD predominantly hyperactive-impulsive. The ADHD-RS separates domain scores of “Inattention” and “Hyperactivity-Impulsivity” which ultimately results in three scores for “Inattention,” Hyperactivity-Impulsivity,” and “Total”.^[4] DSM-IV also organizes diagnostic criteria into two categories of Inattention and Hyperactivity-Impulsivity, each of which includes nine symptoms.^[1] The eighteen questions of the ADHD-RS were written to reflect each symptom of both categories.^[1]

Versions

The four versions ask age-appropriate questions about hyperactivity and inattention in specific settings.^[1]

Home: There are two home versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at home by a parent or guardian. The questions are specific to situations and activities in the home setting.^[1]
School: There are two school versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at school by a teacher. The questions are specific to situations and activities in the school setting, such as staying in ones seat or completing schoolwork.^[1]

Reliability and validity

Reliability

Rubric for evaluating norms and reliability for the ADHD Rating Scale^{[lower-alpha 1]}
Criterion	Rating (adequate, good, excellent, too good^{[lower-alpha 2]})	Explanation with references
Norms	Adequate
Internal consistency (Cronbach's alpha, split half, etc.)	Excellent	Alphas were > .90 for the School and Home versions.^[1]
Inter-rater reliability	Less than adequate	reliability between parents and teachers was =.41^[1]
Test-retest reliability (stability)	Adequate	Total score =.85 over a 4-week period^[1]
Repeatability	Not published	No published studies formally checking repeatability

Validity

Evaluation of validity and utility for the ADHD Rating Scale^{[lower-alpha 1]}
Criterion	Rating (adequate, good, excellent, too good^{[lower-alpha 2]})	Explanation with references
Content validity	Adequate	Covers DSM diagnostic symptoms for both hyperactivity and impulsivity subtypes and combined type.^[1]
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity)	Excellent	In the clinical setting the predictive validity for the combined subscale for parents and teachers were 60% and 65% accuracy, respectively. This indicates that the assessment has statistically significant accuracy at identifying the diagnosis.^[4]
Discriminative validity	Adequate	Statistically significant discrimination in mean rating between three groups of participants that identified as ADHD Combined, ADHD Inattentive and no ADHD.^[4]
Validity generalization	Good	Used as other-report from both teachers and parents; used in school settings as well as clinical setting; assessment was normed on a random sample of the population that included many different ethnic and demographic backgrounds.^[4]
Treatment sensitivity	Adequate	Can be used in order to access progression of ADHD symptoms throughout treatment.^[4]
Clinical utility	Good	Easily accessible through the purchase of the handbook that includes the assessment and scoring information with permission to photocopy, strong psychometrics. Completion and scoring are quick and easy.^[1]

1 2 Table from Youngstrom et al., extending Hunsley & Mash, 2008.^[5]
1 2 New construct or category.

Impact

The ADHD Rating Scale has provided a quick and easy assessment for clinicians to use in order to diagnose ADHD according to the DSM criteria.^[1] The creation of this assessment also provided a consistent way for clinicians to diagnose ADHD in children. This assessment is used in both clinical and school settings to measure presence of ADHD as well as the subtype that may be present.^[1] The measure can also be used to measure the presence and continuation of symptoms throughout treatment.^[3]

Use in other populations

ADHD Rating Scale- IV

The ADHD RS- IV is widely used in the U.S. in English; however, because of the increasing population of Latino-Americans in the U.S., the ADHD Rating Scale was also translated into Spanish to accommodate those speaking Spanish as their first language.^[1]

Limitations

Ratings of ADHD symptoms on rating scales in general are subjective. Teachers and parents may use different subjective criteria to define symptoms, and may not take context of symptoms into account when making ratings.^[3] Furthermore, the validity of the ARS is acceptable,^[1] but the normative sample used to calculate this statistic was composed of children aged 5 to 14, and thus it cannot be generalized beyond age range.^[4]

There are also questions about how well items on the ARS follow explicit DSM criteria. Specifically, one of the hyperactivity items does not specify that in adolescents, thoughts of restlessness are sufficient, rather than excessive behavioral movement. This lack of specification does not map directly onto DSM criteria.^[4]

This assessment can be accessed by purchasing the ADHD Rating Scale handbook, which includes copies of the Teacher and Parent versions with permission to photocopy for clinical use.

References

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DuPaul, G. J.; Power, T. J.; Anastopoulos, A. D.; Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford. Retrieved 9 September 2016.
1 2 Taylor, Abigail; Deb, Shoumitro; Unwin, Gemma (February 12, 2011). "Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): A systematic review". Research in Developmental Disabilities. 32. doi:10.1016/j.ridd.2010.12.036. PMID 21316190. Retrieved 13 September 2016.
1 2 3 Smith, B.H.; Barkley, R.A.; Shapiro, C.J. (2007). "Attention-Deficit/Hyperactivity Disorder". In Mash, Eric J.; Barkley, Russell A. Assessment of Childhood Disorders (4th ed.). New York, NY: Guilford Press. pp. 53–131. ISBN 978-1593854935.
1 2 3 4 5 6 7 8 Dupaul, George; Power, Thomas; Anastopoulos, Arthur; Reid, Robert (1998). "ADHD Rating Scale-IV". The fifteenth mental measurements yearbook. New York, NY: Guilford Publications, Inc – via EBSCOhost.
↑ Hunsley, John; Mash, Eric (2008). A Guide to Assessments that Work. New York, NY: Oxford Press. ISBN 978-0195310641.

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[table_source-6] 1 2 Table from Youngstrom et al., extending Hunsley & Mash, 2008.^[5]

[newConstruct-7] 1 2 New construct or category.

[:4-1] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DuPaul, G. J.; Power, T. J.; Anastopoulos, A. D.; Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford. Retrieved 9 September 2016.

[:6-2] 1 2 Taylor, Abigail; Deb, Shoumitro; Unwin, Gemma (February 12, 2011). "Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): A systematic review". Research in Developmental Disabilities. 32. doi:10.1016/j.ridd.2010.12.036. PMID 21316190. Retrieved 13 September 2016.

[Smith(2007)_in_Mash_&_Barkley_EBA2-3] 1 2 3 Smith, B.H.; Barkley, R.A.; Shapiro, C.J. (2007). "Attention-Deficit/Hyperactivity Disorder". In Mash, Eric J.; Barkley, Russell A. Assessment of Childhood Disorders (4th ed.). New York, NY: Guilford Press. pp. 53–131. ISBN 978-1593854935.

[:5-4] 1 2 3 4 5 6 7 8 Dupaul, George; Power, Thomas; Anastopoulos, Arthur; Reid, Robert (1998). "ADHD Rating Scale-IV". The fifteenth mental measurements yearbook. New York, NY: Guilford Publications, Inc – via EBSCOhost.

[5] Hunsley, John; Mash, Eric (2008). A Guide to Assessments that Work. New York, NY: Oxford Press. ISBN 978-0195310641.