Screening and Diagnostic Tools

Screening and Diagnostic Tools for Use With Children/Teenagers

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The following scales have been developed to help screen, diagnose, evaluate, and track symptoms of ADHD in children and teenagers.

Note that the answers patients, parents or caregivers provide to the questions on these scales are subjective, because they are based on personal observation that is influenced by a person's frame of reference and experience. For example, the scores of a rating scale may differ significantly when completed by a mother versus a father. When there are discrepancies about the possibility or severity of ADHD symptoms, it may be beneficial to ask someone with a different perspective (eg, a teacher) to complete a rating scale for the patient, to gain another frame of reference. The results of all rating scales must be interpreted in the context of the overall evaluation of the patient.1-2

Common Behavior Rating Scales Used in Children and Teenagers to Assess ADHD and Monitor ADHD Management1

Child Behavior Checklist (CBCL/6-18)

  • A widely used measure for identifying problem behavior in youths ages 6-18 years3
  • 120-question checklist with items scored on a 3-point scale from 0 = not true to 2 = very true or often true3
  • Scoring provides information about the presence of possible syndromes and internalizing/externalizing problems3

Conners-Wells' Adolescent Self-Report Scale

  • A self-reporting version of the Conners' Parent and Teacher Rating Scales is available for teenagers4
  • This is a broadband scale that is used for ADHD screening rather than to aid in diagnosis4

NICHQ Vanderbilt ADHD Teacher Rating Scale (VADTRS) and Vanderbilt ADHD Parent Rating Scale

  • Both scales are commonly used by health care professionals to evaluate ADHD symptoms1
  • The teacher version assesses symptoms and performance impairment at school; the parent/caregiver version assesses perceptions of school performance and social functioning6
  • Items (43 for the VADTRS and 45 for the VADPRS) are rated on 4- and 5-point scales7-8
  • Higher scores indicate more severe symptoms, except for the performance section, in which higher scores indicate greater performance in academics and classroom behavior7-8

ADHD Rating Scale-IV (ADHD-RS-IV)

  • An 18-item scale corresponding to the 18 items in the DSM criteria that is divided into 2 subscales: hyperactivity/impulsivity and inattentiveness9
  • Items scored on a 4-point frequency scale ranging from 0 = never/rarely to 3 = very often9
  • Available in a form for parents/caregivers and for teachers9

Conners' Rating Scales

  • Scales consisting of the Conners' Parent Rating Scale-Revised and the Conners' Teacher Rating Scale-Revised, filled out by parents/caregivers and teachers, respectively4
  • Short versions of the scales consist of 27 or 28 questions divided into 4 subscales of oppositional problems, cognitive problems, hyperactivity, and an ADHD index4
  • Questions scored on a 4-point scale (0-3), where a higher score indicates more severe symptom presentation4-5

References

  1. Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921.
  2. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011:128(5):1007-1022, SI1-SI21.
  3. Achenbach T. Child Behavior Checklist for Ages 6-18. Burlington, VT: ASEBA, University of Vermont. 2001.
  4. Conners CK. Development of the CRS-R. In: Conners CK, ed. Conners' Rating Scales-Revised. North Tonawanda, NY: Multi-Health Systems. 2001:83-98.
  5. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol. 1998;26(4):257-268.
  6. Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales, V: scales assessing attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2003;42(9):1015-1037.
  7. Wolraich ML, Feurer ID, Hannah JN, Baumgaertel A, Pinnock TY. Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV. J Abnorm Child Psychol. 1998;26(2):141-52.
  8. Wolraich Ml, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol. 2003;28(8):559-567.
  9. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. New York, NY: The Guilford Press. 1998.