Assessment of Attention-Deficit/hyperactivity Disorder: An Evaluation of Six Published Rating Scales

Article excerpt

Abstract. Two key characteristics of Attention-Deficit/Hyperactivity Disorder (ADHD), problems with attention and behavioral control, represent the most common reasons for school referrals (Barkley & Edwards, 1998). This makes it essential for school psychologists to acquire the knowledge and skills necessary to conduct a comprehensive assessment of ADHD and ADHD-related symptoms. The current article reports a critical analysis of six published behavior rating scales commonly utilized in a best practices approach to a school-based comprehensive assessment of ADHD (DuPaul & Stoner, 1994). Each of the rating scales was evaluated for strengths and limitations with regard to purpose, content, standardization, and psychometric properties. Recommendations are delineated regarding the use of each rating scale with specific target populations (i.e., culturally diverse students) as well as specific stages of assessment within a problem-solving process.

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Behavior rating scales represent an efficient method for gathering information about children and youth (Wilson & Reschly, 1996). Information obtained from rating scales can be used for several purposes including screening, diagnosis, or monitoring the effects of treatment. As a result of their utility, rating scales completed by adult informants have become a common method for identifying children with behavior problems including Attention-Deficit/Hyperactivity Disorder (ADHD; Power & Eiraldi, 1998). ADHD is a neurological disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity and occurs in 3 to 7% of school-age children (American Psychiatric Association [APA], 2000). A diagnosis of ADHD is determined by establishing the developmental deviance and pervasiveness of symptoms, level of impairment, age of onset, and ruling out of alternative explanations for deviations in child behavior (APA, 2000). Used within this context, behavior rating scales help establish the severity of ADHD-related behaviors across settings relative to a normative sample of children of the same age and gender.

Pediatricians and psychiatrists historically have assumed the primary role in diagnosis and treatment of ADHD (Barkley & Edwards, 1998). However, two of the most common reasons for school referrals, problems with attention and behavioral control, make it essential for school psychologists to acquire knowledge and skills in the assessment of ADHD symptomatology (Landau & Burcham, 1995). Best practices in the school-based assessment of ADHD recommend that school-based practitioners use an ongoing, problem-solving process that leads to the development of effective interventions (Hoff, Doepke, & Landau, 2002). DuPaul and Stoner (1994) recommend several specific stages of assessment for ADHD, and rating scales are considered relative to three of these: (a) screening, (b) multimethod assessment/ comprehensive evaluation, and (c) progress monitoring or program evaluation.

Considerations in Conducting a School-Based Assessment of ADHD

Selecting an appropriate rating scale can be a confusing task given the extensive array of rating scales currently available. In addition to the purpose or stage of assessment and age of the child, the psychometric integrity of instruments and the adequacy of normative data with respect to the child's culture are essential considerations when selecting an appropriate instrument.

Purpose of assessment. Information obtained from screening activities, such as interviews and rating scales, helps determine the need for a more comprehensive evaluation (i.e., multimethod assessment). A multimethod assessment is designed to determine the developmental deviance of the child's behavior as well as pervasiveness of impairment across settings. Strategies used in this stage include behavior ratings, direct observations, interviews, review of school records, and assessment of academic skills (DuPaul & Stoner, 1994). …