Academic journal article
By McKinney, James D.; Montague, Marjorie; Hocutt, Anne M.
Exceptional Children , Vol. 60, No. 2
* In this article, we (1) briefly review existing literature and practices regarding the assessment and identification of children with attention deficit disorder (ADD), and (2) discuss this literature in light of issues relevant to the educational assessment and identification of ADD. Since September 1991, when the U.S. Department of Education issued a policy clarification on issues involved in educating students with ADD, local education agencies have become more aware of statutory requirements regarding assessment of children with ADD under either Section 504 of Public Law 93-112 or P. L. 94-142, the Individuals with Disabilities Education Act (IDEA) (Davila, Williams, & MacDonald, 1991). Despite this awareness, we need solid information on which to base assessment and identification practices. We hope to focus professional dialogue on the general issue of what constitutes a comprehensive assessment of ADD for educational purposes.
OVERVIEW OF COMMONLY USED INSTRUMENTS TO IDENTIFY ADD
Typical practice in research and the clinical assessment of ADD involves teacher and parent rating scales, observational techniques, and interviews. Some researchers have used laboratory tasks and psychometric measures of attention, impulse control, and hyperactivity; but these measures are used primarily to validate the behavioral constructs underlying the core features of ADD and are not typically used in clinical or school practice to identify children with ADD. We describe some instruments and procedures that are used in practice, to illustrate what is available.
DSM Symptom Checklists
Although the Diagnostic and Statistical Manuals of Mental Disorders (DSM; American Psychiatric Association [APA], 1980, 1987) have provided the most generally accepted definition of the disorder based on current research and clinical practice in the field of mental health, they have significant limitations when applied to educational assessment. For example, DSM-III-R (APA, 1987) requires 8 of 14 symptoms as the threshold for diagnosis, and the severity of ADD is evaluated subjectively (many vs. few symptoms above the threshold). The same threshold and behavioral description of each symptom is applied to all age levels and to boys as well as girls. Because of the wording of the symptoms, using this threshold is likely to overidentify younger children and underidentify girls (who typically present few symptoms but may be as impaired educationally as boys) (Barkley, 1990a).
Several rating scales are available to quantify DSM diagnosis by collecting parent and teacher ratings on the behavioral symptoms of ADD described in DSM-III and DSM-III-R. In general, these instruments use a 4-point scale from "not at all" to "very much." The SNAP rating scale (Swanson & Pelham, 1988), provides separate scores for the three behavioral constructs of ADD in DSM-III (i.e., inattention, impulsivity, and hyperactivity) and ratings of problems with peers (fights, bossiness, is disliked). Similarly, the ADHD Rating Scale (DuPaul, 1991) gathers teacher and parent ratings on the 14 symptoms of ADD as specified in DSM-III-R. Both the SNAP and ADHD Rating Scale can be scored to assess ADD with and without hyperactivity, both can assess the number of symptoms that meet the threshold for DSM diagnosis, and both have norms for quantitatively assessing severity.
Other Measures of Primary Characteristics
Several instruments have been developed that are not specific to DSM criteria, but measure the primary features of ADD. The ADD-H Comprehensive Teacher Rating Scale (ACTeRS; Ullman, Sleator, & Sprague, 1984) measures oppositional behavior, attention problems, hyperactivity, and social problems. A less comprehensive, but similar scale, measuring only inattention and overactivity, is the Child Attention Problems (CAP) Scale developed by Edelbrock (cited by Barkley, 1990b). A relatively new instrument is the Yale Children's Inventory (YCI; Shaywitz, Schnell, Shaywitz, & Towle, 1986). …