ADHD Rating Scale—5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation 1462524877, 9781462524877

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ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

Also Available ADHD in the Schools, Third Edition: ,--\ssessment and Intenention Strategies Geo1gc J. D11Pcwl allCl Cw) S/ul{n Homework Success for Children with ADHD: A FamilY-School InterYention Program ThomasJ. Pown;James L. Karustis, and Dina F Habboushe

Promoting Children's Health: Integrating School, Family, and Community ThomasJ. Powr1; Gro1geJ. DuPaul, Edward S. Shapiro, and Annr E. Kazah

Strategy Instruction for Students with Learning Disabilities, Second Edition Robert Rrid, Torri Ortiz Lienemann, andJrssica L. Hagaman

Teacher's Guide to ADHD Robert Reid andJoseph Johnson

RATING SCALE-5

for Children and Adolescents

George J. DuPaul Thomas J. Power Arthur D. Anastopoulos Robert Reid

THE GUILFORD PRESS New York London

,f• 20Hi George). DuPaul. Thomas]. Po\\er. Arthur D. Anastopoulos. and Robert Rt'icl Published lw The Guilford Press ..\ Di,·ision of Guilford Publications. Inc. 370 Se\emh .-'\senue. Suite 1200. �e"· York. �y 10001 11"1n,·.guilford.com All rights resen·ed Except as indicated. no part of this book may be reproduced. translated. stored in a retrie\al S\stem. or translllitted. in an\ form or b\ am· means. electronic, mechanical. photocop\ing. microfilming, recording. or othendse, \\·ithout \\Titten permission from the publisher. P rinted in the Cnited Stares or ..\lllerica Thi;; book is printed on 3.cirl-free p:-i.p0i-.

Last digit is print number:

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U\!ITED DCPLICXrIO:\ LICE:\Sf These materials are intended for use onl\ ))\· qualified professionals. The publisher grams LO indi, idual purchasers of this book nonassignable perlllission 10 reproduce onh· materials fr,r ,,·hich permission is specificall\ granted in a footnote. This license is limited to \OU. the indiddual purchaser. for personal use or use ,dth indi\idual clients. This license does not grant the right to reproduce these materials for resale. redisrribution. electronic clispla,·. or a1w other purposes (including bur nor limited lO books. pamphlets. articles. \ideoor audiotapes. blogs. file-sharing sites. Internet or intranet sites. and handouts or slides for lectures. \\·orkshops. or 1\'ehinars. \\·hether or not a fee is charged). Permission to reproduce these materials for these and a111· other purposes must he obtained in ,niting from the Permissions Department of Guilford Publications. and may also he rec1uired lw the proprietors of source material. The aurhors ha\e checked \l'ith sources belie,·ed Lo be reliable in their efforts to pro,·icle information that is complete and general],· in accord \l'ith tht> standards of practice that are accepted at the Lime of publication. Hm\'e\er. in \ie1\' of tlw possibilit\ of human error or changes in behal'ioral. mental health. or medical sciences, neither the authors. nor the editors and p11hlislwr. nor a,n- otlwr p;in,· ,d10 has been i11n1ln·cl in the preparation or publication of this work warrants that the inforn1ation contained herein is in eYery respect accurate or complete. and tht'\ are not responsible for am· errors or omissions or the results obtainer! from the use of such infonnation. Readers arc encouraged to confinn the infonnatinn contained in this book \\·ith other sources. Library of Congress Cataloging-in-Publication Data DuPaul. George J.. author. ..\DHD rating scale-:i for children and adolescents: chcckli.sls. norms. and clinical interpretation George.[. DuPaul. Thomas.[. Pm,·cr..\nhur D...\nastopoulo.s. Robert Reid. p.: cm. Preceded lw .\DHD rating scale-I\. Ceorge.J. DuPaul [ct al.]. l'l'l8. Include:-. bibliographicz-tl 1-c!"crence:-. ;_uid index.

!SB:\' 978- 1---1625-'.2--187-7 (paperback : alk. paper) I. Pml'er. Thomas.).. author. II. ..\nastopoulos...\rthur D .. 19:i--l-. author. Ill. Reid. Robert (Rohen Charles). Hl:SO-. author. n·. Title. [D:\L\l: 1. ..\ttentiun Deficit Disorder ,dth H1-peracti1ir,diagnosis. 2. Adolescent. :,. Child. +. PsH"hiatric Status Rating Scales. \\"S '.>:i0.8.A8] RJ:"i06.H9 618. 92'8,,89-dc'.2'., 20Ei025998

About the Authors

George J. DuPaul, PhD, is Professor of School Psychology at Lehigh UniYersity. He is author or coauthor of numerous publications on the assessment and treat­ ment of children, adolescents, and young adults with ADHD, including ADHD in the Schools, Third Edition. Thomas J. Power, PhD, is Director of the Center for Management of ADHD at The Children's Hospital of Philadelphia and Professor of School Psychology in Pediatrics, Psychiatry, and Education at the Uni,·ersity of Pennsykania. He has published widely on the assessment and treatment of children and adolescents with ADHD. Arthur D. Anastopoulos, PhD, is Professor in the Department of Human DeYel­ opment and Family Studies at the UniYersity of North Carolina at Greensboro, where he also directs the ADHD Clinic. He regularly presents his work at scientific meetings and has published widely on the assessment and treatment of children, adolescents, and young adults with ...\DHD. Robert Reid, PhD, is Professor in the Department of Special Education and Communication Disorders at the lJniYersitY of Nebraska-Lincoln. His research interests center on treatment of attention-related problems and cognitiYe strategy instruction. He is coauthor of Strategy Instructionfor Students with Leaming Disabili­ ties, Second Edition.

V

Preface

A

ttention-cleficit/hyperacti,it, disorder (:\DHD) is one of the most common beha,ior disorders of childhood. lVIental health and school practitioners fre­ quently face the challenge of assessing children and adolescents who might ha,e ADHD. After the publication of the Diagnostic and Statistical iviamwl of Aiental Disorders, fourth edition (DSl'v1-IV; ..\merican Psychiatric Association, 1994), we set out to create a brief questionnaire (i.e., the ADHD Rating Scale-IV) that would allow clinicians to quickly determine the frequency and se,erity of ..\DHD symp­ toms. The ADHD Rating Scale-IV has been used in dozens of assessment and research studies since its publication in 1998. Furthermore, the scale is widely used by medical, mental health, and educational practitioners for a ,ariet, of acti,ities including screening, diagnostic assessment, and e,aluation of treatment outcome. Subsequent to the publication of DSM-5 (American Psychiatric Association, 2013 ), "·e updated the content of the scale in two ways. First, consistent with word­ ing changes in ADHD symptoms for assessment of adolescents and adults, we cre­ ated adolescent ,ersions of the parent and teacher ratings to include wording that was specific for this age group (i.e., symptoms are described in de,elopmentally appropriate ways). Second, gi,en the critical importance of functional impairment for assessing ADHD, two sets of impairment items were added to the scale, one set reflecting impairment due to inattention symptoms and the other set e,aluat­ ing impairment clue to lwperacti,e-impulsi,e symptoms. In addition to changes in content, \Ye ha,e collected extensi,e data from two normati,e samples (one for parent ratings and one for teacher ratings) that are representati,e of the U.S. pop­ ulation with respect to region. racial and ethnic background, and socioeconomic status. ';\'e also present information about the concurrent ,aliditv of the newly created scale. Finally, we ha,e pro,iclecl comprehensi,e data regarding the clinical utility of this scale for screening, diagnosis, and treatment e,·aluation purposes. vii

Vlll

Preface

Of course, a project of this magnitude could not be completed without the support and assistance of many indiYiduals. First, normatiYe data collection was conducted through the GfK Knowledge PanelE . We are especially grateful to Carolyn Chu with GfK for her oYersight of data collection and consistent support in proYiding us \\·ith detailed information regarding the data collection and analy­ sis process. Second, the efforts of co-inYestigators :\1atthe"· Lambert and Marley vVatkins were integral to the completion of this project, particularly with respect to statistical analyses and interpretation of the normatiYe data. A.dditional co­ i1westigators Matthe\\· GonnleY, Brittany Pollack, Kristina Puzino, and Tia Bassano proYided Yaluable contributions in the collection, analysis, and interpretation of reliability and Yalidity data. \;\"e would also like to thank Dr. Brenda Tracy and the teachers of Norris School District, in Norris, Nebraska, and Bethlehem Area School District in Bethlehem. Pennsy]yania. for their help with reliability data. The assistance of Brittany vVoods in the preparation of Chapter 6 was im·aluable. Finally, we appreciate the willingness of the thousands of parents and teachers who completed the A.DHD Rating Scale-5 as part of our deYelopment and Yalida­ tion of this scale.

Contents

Chapter I. Introduction to the ADHD Rating Scales Purpose of the :Manual 1 Background and Description of the ,\DHD Rating Scale-5 ,\dministration and Scoring 3

1 2

7

Chapter 2. Factor Analysis General Procedures 8 Sample and Procedures: Factor ,\nalYses of the Home Version 8 Sample and Procedures: Factor Ana!Yses of the School Version 9 Confinnatorv. Factor AnalYses . of the Home and School Sn11ptom Scales 10 Confirmatory Factor Analyses of the Home and School Impairment Scales 12

Chapter 3. Standardization and Normative Data DeYelopment of�ormatiYe Data: Samples and Procedures 16 DeYelopment of�ormatiYe Data: Results 2'.1 Relationships bet\\·een ADHD Symptom and Impairment Ratings 27 Gender, ,\ge, and Racial/Ethnic Group Differences 29 Epidemiology of ,.\DHD Presentations 41 IX

16

X

Contents

Chapter 4. Reliability and Validity

46

Samples, Procedures, and Results: Internal Consistency

46

Sample and Procedures: Test-Retest Reliability, Criterion-Related Validity, and Interrater Agreement 47 TesL-Retest Reliabilit, and Interrater ..\greement 49 Relationships bet\\·een Teacher ADHD Symptom Ratings and Criterion :Measures 50 Relationships bet\\·een Parent .\DHD Sn11ptom Ratings and Criterion ;\Ieasures 52 Relationships bet\1·een Teacher ADHD Impairment Ratings and Criterion ;\leasures 54 Relationships benreen Parent ..\DHD Impairment Ratings and Criterion :\Ieasurcs 55 Sample and Procedures: Discriminant Validitv 56 Discriminant Validit, of Parent and Teacher Ratings 57 Prcdicti,e Validit, 58 Summan and Conclusions 64

65

Chapter 5. Interpretation and Use of the Scales for Diagnostic and Screening Purposes Diagnosing ADHD 65 Screening for ..\DHD 66 Selecting the Optimal Cutoff Score 66 Research on the Clinical Uti!itY of the .\DHD Rating Scale-IV Prediction in a Clinic-Based Setting 67 Prediction in a School-Based Setting 75 Case Examples 83

67

86

Chapter 6. Interpretation and Use of the Scales for Evaluating Treatment Outcome Assessing the Clinical Significance of Treatment Outcome Case Example 89

87

93

Appendix. Rating Scales and Scoring Sheets Attention and Beha,ior Rating Form, ..\ttention and BehaYior Rating Form, (English) 97 .\ttention and Beha,ior Rating Form, ..\ttention ,md Beha,ior Rating Form, (Spanish) 101

Home \'ersion: Child (English) Home Version: ..\dolescent

95

Home Version: Child (Spanish) Home Venion: ..\dolncent

99

Contents

XI

ADHD Rating Scale-:3, Home Version: Symptom Scoring Sheet for Bovs 103 A.DHD Rating Scale-5, Home Version: Symptom Scoring Sheet for Girls 104 ADHD Rating Scale-5, Home Version: Impairment Scoring Sheet for Boys 105 ADHD Rating Scale-5, Home Version: Impairment Scoring Sheet for Girls 106 Attention and BehaYior Rating Form, School Version: Child 107 Attention and BehaYior Rating Form, School Version: .-\clolescent 109 ADHD Rating Scalc-:5, School Version: Symptom Scoring Sheet for BoYs 111 ADHD Rating Scale-5, School Version: Sn11ptom Scoring Sheet for Girls 112 .-\DHD Rating Scale-5, School Version: Impairment Scoring Sheet for Bovs 113 ADHD Rating Scale-5, School Version: Impairment Scoring Sheet for Girls 114

References

115

Index

119

Introduction to the ADHD Rating Scales

A

ttention-deficit/hyperactiYity disorder (ADHD) is a diagnostic category used to describe indiYiduals who display dnelopmentally inappropriate leYels of inattention, impulsiYity, and/or motor actiYity (American Psychiatric Association, 2013). Epidemiological studies haYe found that ADHD affects approximately 5.97.1% of children and adolescents (Willcutt, 2012). In the United States, parents report that around 11 % of children haYe receiYed an ..\DHD diagnosis from com­ munity practitioners (Visser et al., 2014). GiYen the pre,alence, chronicity, and myriad difficulties associated with this disorder, it is important for clinicians to use psychometrically sound instruments ,rhen eYaluating children and adolescents suspected of haying ADHD.

Purpose of the Manual The purpose of this manual is to describe the ADHD Rating Scale-5, Home Ver­ sion, and the ADHD Rating Scale-3, School Version. With the permission of the American Psychiatric Association, both rating scales are based on the diagnostic criteria for ADHD as described in the fifth edition of the Diagnostic and Statisti­ cal 1Wanual of l'vlental Disorders (DSM-5; American Psychiatric ..\ssociation, 2013). Information is presented about the deYelopment and standardization of these scales, collection of normatiYe data, factor structure, psychometric properties (i.e., reliability and , alidity), as "·ell as the interpretiYe uses of these scales in clinical and school settings.

2

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

Background and Description of the ADHD Rating Scale-5 O\·er the past three decades, the diagnostic criteria for ADHD haYe under­ gone se;-eral changes that ha;-e significantly altered the clinical assessment of this disorder. Research over the last 30 years has consistently demonstrated that ADHD symptoms can be divided into two separate factors of inattention and hyperactivity-impulsivity (e.g., Bauermeister et al., 1995; DuPaul, Power, Anasto­ poulos, & Reid, 1998). Based, in part, on these findings, DSM-5 prm·ides diag­ nostic criteria organized into two dimensions of inattention and hyperactivity­ impulsivity, each of which consists of nine symptoms. Recent research has also demonstrated that there was a need for slightly different symptom descriptors for children and adolescents. In particular, symptom descriptions that are deYel­ opmentally releYant for adolescents and adults were added to the DSM-5 crite­ ria for ADHD. Thus the ADHD Rating Scale-5 has incorporated the DSM-5 changes by creating separate forms for children and adolescents, with the ado­ lescent form prm·iding developmentally relevant examples of problem behavior based on DSM-5 descriptions. Finally, recent research stressed that it is crucial that symptoms result in functional impairment in common home and/or school situations. In fact, the DSM-5 requires symptoms to be associated with impair­ ment in at least one functional area ( e.g., academic performance, social rela­ tionships) for an ADHD diagnosis to be warranted. For this reason, the ADHD Rating Scale-5 has incorporated two impairment scales keyed to the inattention and hyperacti\·ity-impulsivity dimensions. This allows users to assess the extent to which .-\DHD-related problems adversely affect the home and/or school func­ tioning of children and adolescents. An evaluation of ADHD typically involves multiple components that may include diagnostic inteniews with the child and his or her parents and teachers, behaYior rating scales completed by parents and teachers, direct observations of school behavior, and clinic-based testing (Barkley, 2015; DuPaul & Stoner, 2014). Although many behavior questionnaires are available for use in such evaluations, very few of the currently available instruments specifically include items directly adapted from the DSM-5 criteria for .-\DHD. Thus our purpose in creating the ADHD Rating Scale-5 was to prm·ide clinicians with a method to obtain parent and teacher ratings regarding the frequency of each of the symptoms of ADHD based on DSJ\if-5 criteria. Eighteen scale items were \\Titten to reflect DSM-5 criteria as closely as pos­ sible ·while maintaining brevity. The primary change made to each symptom was to omit the word "often" from the symptomatic description because respondents are asked to indicate the frequency of each symptom on a 4-point Liken scale ("never or rareh·,'' "sometimes," "often," or "very often"). Adapted descriptions of ADHD symptoms, based on wording used in DSM-5, are included for the ado­ lescent version. Parents are asked to determine symptomatic frequency that best describes the child's or adolescent's home behavior over the previous 6 months (in accordance with DSM-5 guidelines), and teachers rate the frequency that best describes the student's school behavior over the previous 6 months or since the beginning of the school year. English and Spanish \'ersions of the ADHD Rating Scale-5, Home Version: Child and Home Version: Adolescent are presented in the

Introduction to the ADHD Rating Scales

3

Appendix, as is the School Version of the ADHD Rating Scale-5 for children and adolescents (English only).

Administration and Scoring All versions of the ADHD Rating Scale-5 are designed to be completed indepen­ dently by a child's parent or teacher. The respondent is instructed to provide demo­ graphic information (i.e., name of child, age, grade, and name of respondent) and to circle the number for each item that best describes the child's or adolescent's home (or school) behavior over the previous 6 months (or since the beginning of the school year if the teacher has known the student for less than 6 months). If the respondent skips any item, he or she should be asked to proYide a rating for this item. If the respondent indicates a lack of opportunity to obsene the behavior and skips an item, then this item is not included in the scoring of the scale. If three or more items are omitted, the clinician should use extreme caution in interpreting the scale for screening, diagnostic, or treatment evaluation purposes. The home and school versions of the ADHD Rating Scale-5 consist of two symptom subscales: Inattention (nine items) and Hyperactivity-lmpulsiYity (nine items). These subscales are empirically derived (see Chapter 2) and conform to the two symptomatic dimensions described in the DSM-5. Thus three symptom scores (Inattention, Hy peractivity-Impulsivity, and total) are derived from each version. The Inattention subscale ra,\' score is computed by summing the item scores for Items 1-9. The Hvperactivity-Impulsivity subscale raw score is computed by sum­ ming the item scores for Items 10-18. The Total Scale raw score is obtained by adding the Inattention and Hyperactivity-Impulsivity subscale raw scores. The ADHD Rating Scale-5 "·as designed to include items reflecting six domains of impairment that are common among children with ADHD. One domain assessed by the ADHD Rating Scale-5 is relationships "·ith significant others (family members for the home version and teachers for the school Yersion). A second domain is peer relationships, "·hich are frequently impaired among chil­ dren with ADHD (Barkley, 2015). A third domain is academic functioning, which is perhaps the most common impairment among children with ADHD (DuPaul & Stoner, 2014). A fourth domain is behavioral functioning; impairment due to disruptive behavior has been universally recognized and is extremely common among children "·ith the hyperactive-impulsive and combined presentations of ADHD. A fifth domain is homework functioning, which is commonly impaired among children with ,\DHD and is associated with academic problems, emotional difficulties, and disruptive behavior (Power, v\'erba, Watkins, Angelucci, & Eiraldi, 2006). A sixth domain is self-esteem, which is often impaired among children with ADHD due to the disproportionate amount of punitive feedback these children receive from adults and peers (Barkley, 2015). ·when using the ADHD Rating Scale-5, respondents complete each set of six impairment items twice, first after rating the inattention symptom items and again after rating the hyperactivitv-impulsi,itv items. They are asked, "'Huw much do the above behaviors cause problems for your child (this studem)?" Items are rated on a 4-point scale (no, minor, moderate, severe problem).

4

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

Raw scores are c01werted to percentile scores by using the appropriate scoring profile (presented in the :\ppendix) based on the child's gender and age. The raw score for a particular gender, age, and scale is circled in the body of the profile. The corresponding percentile score is displayed in the extreme right- and left­ hand columns of the profile. Figure 1.1 displays a sample profile for symptom scoring the A.DHD Rating Scale-5, Home Version, for a 7-year-old boy. This boy's mother prO\·ided ratings resulting in the following raw scores and percentiles: HyperactiYity-ImpulsiYity = 17 (93rd percentile), Inattention = 15 (91st percen­ tile), and Total = 32 (94th percentile). Note that when a raw score is associated with more than one percentile score, the clinician should report the lowest of the possible percentile scores. Figure 1.2 displays a sample profile for scoring impair­ ments using the ADHD Rating Scale-5, Horne Version, for a 7-year-old boy. Note

that a child's score on each impairment dimension reflects the higher of the two

ratings on items pertaining to symptom-related impairment for that dimension. For example, if the child receiYed a rating of l for homework impairment related to inattention and a rating of 2 for homework impairment related to hyperactiYity­ irnpulsiYity, the child's score on the horne,rnrk impairment dimension would be a 2. In this case, the child receiYed the following ratings from his mother: Family Relations = 0 (65th percentile), Peer Relations = 2 (98th percentile), Homework = 1 (90th percentile), Academics = 1 (90th percentile), Behavior = 3 (99.5th+ percen­ tile), and Self-Esteem = 1 (95th percentile). In Chapter 2, we describe the factor analyses used to derive the subscales of the ADHD Rating Scale-5. Descriptions of the normatiYe samples, as well as gen­ der, age, and ethnic differences in scale scores, are gi\·en in Chapter 3. The reli­ ability and validity of yarious Yersions of the ADHD Rating Scale-5 are detailed in Chapter 4. Chapters 5 and 6 proYide clinicians with guidelines for the interpreta­ tion and use of the scales for diagnostic and treatment eYaluation purposes.

Introduction to the ADHD Rating Scales Child's name: Cilevu'\ l3rowVi HI

%ile

99+

5-7 27

5

Date: J1me q, 20:1-5 Age: _7___

HI

HI

HI

27

26

21

IA

8-10 11-13 14-17

5-7 27

IA

IA

IA

Total

27

27

27

50

8-10 11-13 14-17

5-7

Total

Total

Total

53

52

47

99+

8-10 11-13 14-17 %ile

99

24

26

22

16

25

27

27

26

45

49

47

39

99

98

19

20

19

15

23

25

27

25

41

44

43

37

98

97

18

20

18

13

22

21

25

21

38

38

38

34

97

96

17

19

17

12

21

20

22

20

38

36

36

30

96

95

17

18

15

10

18

17

21

19

35

35

34

27

95

94

17

17

14

9

17

16

21

18

33

31

26

94

16

13

9

17

16

19

18

31

31

30

25

93

16

16

12

9

16

16

18

17

29

30

28

25

92

91

15

15

11

8

15

18

16

27

29

26

22

91

90

15

14

10

8

14

14

17

16

27

28

25

21

90

89

13

13

10

7

14

12

16

15

26

25

24

20

89

88

13

11

9

7

12

12

15

14

25

24

23

19

88

87

12

10

9

6

11

12

15

13

24

22

22

18

87

86

12

10

9

5

11

11

15

12

22

21

22

18

86

85

10

9

9

5

10

11

14

11

20

19

21

17

85

84

10

9

9

5

10

11

13

11

20

19

21

16

84

80

9

8

7

4

9

9

12

10

18

17

19

14

80

75

8

7

6

3

9

9

10

9

16

14

17

11

75

50

5

3

2

1

5

4

6

4

10

8

8

5

50

25

2

1

0

0

2

2

1

1

4

3

2

2

25

10

0

0

0

0

0

0

0

0

0

1

0

0

10

1

0

0

0

0

0

0

0

0

0

0

0

0

1

93 92

@

@

@

_ _

FIGURE 1.1. Sample symptom scoring profile on the .-\DHD Rating Scale-5, Home Version, for a 7-year-old bm-. HI, HYperactiYitY-ImpulsiYitY; IA, Inattention.

Date: Jun.e .01 and �R:VISEA > .015) than alternatiYe models (Cheung & Rensrnld. 2002).

Attention to details

I

Sustaining attention

.89 Does not seem to listen 9 � 4 Follow instructions

I

1--_ss

.92 �93 i--,90 Sustained mental effort 90 9 Loses things � 4 Difficulty organizing

Distracted

r,:.93

~--, Forgetful Fidgets

Leaves seat Runs about

Playing quietly On the go Talks excessively Blurts out answers Awaiting turns

�-87 �92 i-_89 .90 j.-.90 86 v87 v-:9 4

Inattention

\

.80

)

HyperactivityI mpu lsivity

r,:94

Interrupts or intrudes

FIGURE 2.2. T,rn-factor rnoclel: teacher report. From DuPauL Reid, et al. (2015). Copn-ight �015 hY the ,-\rnerican Psychological ,-\ssociation. Reprinted b, permission.

14

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

TABLE 2.2. CFA Results for Parent and Teacher Impairment Ratings

l

d/

CF!

i'1C:FI

R\ISE.-\ (90'fi CI)

i'lRI\ISE_-\

Home \'ersion (parents) .136 (.E,1-.161)

Single-factor model

277D.88

:S-!

.D3D

T"·o-facror model

2:'i:,li.98

.'i:l

.%2

.on:,

.1:,1 (.1-Hi-.l:Sli)

.000

Six-factor model

2-llJ.-J.tj

3()

.CJCJ7

.030

.O:iO (.0H-.036)

.101

Teachers .E,7 (.l.,2-.162)

Single-factor model

2900.38

:S-l

.971

T,rn-factor model

2707.72

5'.>

.97:,

.002

.1:i:l (.1-18-.138)

.00-l

Six-factor model

.il 7.86

:,CJ

.CJCJ:i

.022

.076 (.070-.082)

.077

.\'otr. From Po11er el al. {�015). Cop\Tight '.!OlS T:l\lor :iml Fr:incis Croup. Reprinted 111· permission.

Results

Table 2.2 shcrn-s the results of the CE-\ for the Home and School impairment scale ratings. Figure 2.3 shows the relationship between the obtained factors. The model using the six-factor structure that combined items ( e.g., Peer Relationships, Beha\'ior Problems) across source of impairment proYed to be the best-fitting structure for both Home and School ,ersions. The one- and two-factor models were roughly equi,alent in fit, and neither model exhibited acceptable fit. Both the two-factor structure based on source of impairment (i.e., due to Inattention, due to Hyperacti,in·-Impulsi,ity) and the single-factor structure were inferior to the six-factor model. Summary and Conclusions

,-\ six-factor structure emerged for both parent and teacher impairment ratings wherein each factor represented a specific functioning area (e.g., Homework) affected b, both Inattention and Hyperacti,e-ImpulsiYe symptoms. A..lthough areas of impairment are correlated, they represent separate domains, each of which is affected by both Inattention and Hyperacti,·itY-lrnpulsi,ity symptoms. The results further indicate that more Yariance in impairment is accounted for by ADHD as a "·hole rather than by each separate symptom dimension. It appears that respon­ dents are able to identify the existence of impairment in separate domains but less able to identify the primary source of the impairment.

15

Factor Analysis

Parents

� �

. % 00

� 00

� 00

� %

-� 00

-� �

ro . %

ro w

% w

m �

0�0�0�0�0�0� Teachers

.oo oo

0EJ 0EJ ct]§] 0� 0[§] 0§1 FIGURE 2.3. Six-factor structure of parent ancl teacher impairment items. Teach, Teacher

Relations dimension; ,\cacl, Academic dimension; BehaY, Bcha\·ioral dimension; Self, Sel!� Esteem dimension. From PcJ\\·er et al. (2015 ). Copnight 2015 b\· Tm-lor ancl Francis Group. Reprinted bY permission.

Standardization and Normative Data

T

he primary purpose of this chapter is to describe the process of obtaining nonnatiYe data for the Home and School Versions of the ADHD Rating Scale­ s. T\\·o nationally representatiYe samples were used to deriYe nonnatiYe data (as reported in DuPaul et al., 201:j; Pm,·er et al., 2015). Furthermore, the relationships ben,·een ADHD snnptom and impairment ratings are described. Differences in ratings as a function of child age, gender, and race/ethnicity as \\-ell as teacher race/ethnicity are also discussed. The degree to ,rhich ADHD symptom ratings predict impairment scores aboye and beyond child demographic factors (e.g., gen­ der, age, race/ethnicitY) is also explored. Finalh-, ,re present epidemiological data regarding the preYalence of ADHD clinical presentations in our normatiYe sam­ ples.

Development of Normative Data: Samples and Procedures ADHD Rating Sca/e-5, Home Version

Participants As described in Chapter 2, the normatiYe sample for the ADHD Rating Scale-5, Home Version \\·as composed of 2,079 parents and guardians (1,131 female, 948 male) ,\'110 completed A.DHD symptom and impairment ratings for one of their children selected at random (see "Procedures"). Parents and guardians were pre­ dominantly white non-Hispanic (64.1%) and ranged in age from 20 to 77 years (M = 41.57; SD = 8.23). (See Table 3.1 for demographic characteristics of parent rating sample.) Most parents ,,-ere married (79.7%), had at least high school education or greater (89.9%). and \\ere employed (72.3%). Household income ranged from less than S5,000 (2.7%) to S175,000 or more (5.7%), \\'ith median income between 16

Standardization and Normative Data

17

TABLE 3.1. Parent Ratings: Demographic Characteristics of Parents and Children Y

Children and adolescents (. = 2,079)

Parents (S = 2.079) Gender \[ale Female

C)l() (-±'.H,c}) 1.169 (56.2'()

.\ge (wars) 18-29

7.oc:,

:C\1)- l l

G0.2'i

-±:1-:'',C) (i()+

l.G',

Race/ethnicit ,. \\"hitc. 11011-Ilisp,rnic

:,9.l 'i

Black. non-Hispanic

]'l.l 'i

Other. non-Hispanic Hispanic

5.0'i 20.S'i

T,rn or more races. non-Hispanic

2.-cl'"i

Education Less than high school High school Some college Bachelor's degree or higher

():-' -� C' ---! . ._> C

2li.ri'i 3--1-.s cc

\larital status \Ianiecl \\'idm1·ecl Dinircecl Separated :\:e,-cr married LiYing ,rith panner Household income Cnclc1· 525.000 S2:S.000-S-cl(l.999 550.0 0 0-S7-cl.99Sl S7:'i.000 and ewer

0.-cl'i

:s.�n 2.-cl'( 6.:l'i

6.6 '}

L�..')r (_ 21Yc 2-cl.9'i

L'.S. geographic region ;\;ortheast

l(i.!i'i

\licke.st

21.Yi �1, __1c;r 2-±.-±'i

South \\'est

Gender \!ale Female

1.062 (51.F7c) 1.017 (-±8.9'!l-)

JI age (Years)

11.12 ('.i.80)

Race ethnicin· \\'hire. non-Hispanic Black. non-Hispanic

53.9'7c l'.l.l'/c

Other. non-Hispanic Hispanic

5.9c c 2:1.--19[

T,10 or more races. non-Hispanic

:l.Yii

18

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

$60,000 and $74,999 and mean income between $50,000 and $59,999. The parent sample was recruited from all regions of the united States and included house­ holds from both metropolitan (86.4%) and nonmetropolitan (13.6%) locations. English i\'as spoken in most (89.4%) households. The children (N = 2,079; 1,037 males, 1,042 females) rated bY the parents ranged in age from 5 to 17 years (1\1 = 10.68; SD = 3.75). Children i\·ere from white non-Hispanic (53.9%), black non­ Hispanic (13.l %), Asian non-Hispanic (5.7%), Hispanic (23.4%), and other (3.9%) backgrounds. Measures

Parents reported their gender, age, race, ethnicitY, marital status, leYel of educa­ tion, employment status. household income, and language spoken in the house­ hold. They also prm·ided information about the children they rated including gender, age, race, and ethnicity. Parents reported the frequency i\·ith which each child displayed the 18 snnptomatic behm iors of ..\DHD using one of four Yersions of the ADHD Rating Scale-5 depending on parent language (English or Spanish) or child's age (child or adolescent). \'\'ith the permission of the American Psychi­ atric Association, items were created based on the wording of ADHD symptoms from DS�J-5. Parents indicated the frequency of each symptomatic behaYior on a 4-point Likert scale including 0 (neYer or rarely), 1 (sometimes), 2 (often), and 3 (Yery often). They i\·ere asked to select the number that best described their child's behaYior o\'er the preYious 6 months. For adolescents ages 11 and older, additional wording (from DSl\1-5) was proYidcd for some items to make these deYelopmen­ tally rele\'ant. For example, the inattention item "has difficulty sustaining atten­ tion in tasks or pla\' actiYities" was amended to include the following parentheti­ cal text (e.g., "has difficult\' remaining focused during lectures, conYersations, or lengthy reading"). Parents i\·hose primary language was Spanish (n = 236; 11.4%) completed a Yersion of the ..\DHD Rating Scale-5 that included 18 symptom items using wording from the Spanish edition of DSM-5 (American Psychiatric: Associa­ tion, 2014). The translation process inYoh-ed (1) initial translation into Spanish, (2) independent reYiew by nm specialists trained in language elements of di\·erse cultures, (3) collaboration ben,·een independent reyiewers, and (4) inYoh-ement of a senior translatm/researcher, if necessarY, to reso!Ye differences. The ADHD Rating Scale-5 contains items reflecting six domains of impai r ­ ment that are common among children ,,·ith ..\DHD, including relationships with family members, peer relationships, academic functioning, behaYioral function­ ing, homei\·ork performance, and self-esteem. Parent respondents completed a set of six impairment items ndce, first after rating the inattention symptom items and again after rating the hYperactiYity-impulsiYitv items. They were asked, "How much do the abo\'e beha\·iors cause problems for your child?" Items "·ere rated on a 4-point scale (no, minor, moderate, se\'ere problem). Procedures

..\s described in Chapter 2, a large sample (S = 4,219) of parents were recruited through the GfK KnmdedgePanel" to prm·ide a sample of children and adolescents

19

Standardization and Normative Data

that was representatiYe of the C".S. population in terms of race, ethnic:it y, geo­ graphic region, and family income (see Table 3.2). KnowledgePanel is a large national, probability-based panel that proYides online research for measurement of public opinion, attitudes, and behaYior. Panelists were selected using address­ based sampling (ABS) that allm\·s probability-based sampling of addresses from the U.S. Postal Senice's De!iYery Sequence File. IndiYiduals residing at randomly sampled addresses were inYited to join KnmdedgePanel through a series of mail­ ings (in English and Spanish); nonresponders \\·ere phoned when a telephone num­ ber could be matched to the sampled address. Household members who were randomly selected indicated their willingness to join the panel by returning a com­ pleted acceptance form in a postage-paid enYelope, calling a toll-free hotline and speaking to a bilingual recruitment agent, or accessing a dedicated recruitment website. If more than one child bet,reen the ages of 5 and 17 was present in a giYen household, then parents were asked to prm·ide ratings for one randomly selected

TABLE 3.2. Parent Ratings: Sample versus U.S. Census Category Race/ethnicitY \\"hite. non-Hispanic Black. non-Hispanic Hispanic Other. non-Hispanic T,l"o or more races. non-Hispanic Region �onheast :\lich,·est South 1\"esl

Percent sample

Percent Census"

3'1.9 13.1 23.-lI

3S\.:"i5 13.75 2:\.30 !>.85

:1.9

3.:J:)

lli.6

Hi .."i7 2L-i0 '.17.Gl 2--!-.32

;).

21.7

o- :""

,, I .. )

2-l-.-l-

lnconw k,·el Cnclcr S25.000 S25.000-S-l9.000 S:"i0.000-S7-l.999 S75.000 and m-cr

18.g 21.7 2-l-.9

,\ge (,·ears) sex ::i-7/bm .)-7/girl 8-10/bm 8-10/gid ll-13-1 bOY 11-1 '.Vgirl 1-1-17-1])()\" l-l--17/girl

11.73 I 1.15 11.-l--l10.87 11.78 11.21 15.87

3,i.l

15.'.)9

18.li'.1 21.71 17.(i:i -l-2.01

11.6-l11.l'l 11.-l-3 11.09 11.79 ll.17 16.21 15.5-l-

Sot,,. Fron1 Du Paul. Rt'icl er al. (20L)). Copyri g-lu '.!015 bY the .--\merican P�ychological .-\s,ociation. Reprimecl b,· permission. · LS. PopuLttion 13enclunarks. \1'1rch '.21Jl:',. C:PS Snpplemenr Data.

20

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

child such that the number of cases \\·as balanced across gender and age range. Of the 4,219 parents contacted to participate, 2,708 (64.2%) completed ratings and 2,079 (49.3%) qualified based on quotas for child demographic characteristics (e.g., grade, race/ethnicity, geogTaphic region). Parent ratings were completed through a ·web-based SllrYev that took approxi­ mately 5 minutes. Respondents receiYed small stipends (less than S5) for complet­ ing ratings. If respondents left one or more items blank, they were prompted to complete missing items. T hus complete data sets \\·ere produced for> 99% of child ratings. All ratings \\ere collected during April-�fay 2014. ADHD Rating Scale-5, School Version

Participants

A.s described in Chapter 2, 1,070 teachers (766 female, 304 male) completed A.DHD symptom and impairment ratings for two randomly selected students (one male, one female) on their class rosters (see ''Procedures"). Teachers were pre­ dorninantk white non-Hispanic (87.3%) and reported a mean of 17.88 years of TABLE 3.3. Teacher Ratings: Demographic Characteristics of Teachers and Students Students( \·= _ 2.1-!0)

Teachers (S= 1,070) Gender :--1a1c Female

:)(H (28'i) 7lili (71.(5'i)

.\gc 18-2l] '.)0-H -!:'i-:jC) 60+

] ] _2r.;· '."12.Yi 11.w·, lHir,

Race/ethnicir, \\'hite. non-Hispanic Black. non-Hispanic Other. non-Hispanic Hispanic T,"o or more races. non-Hispanic

87_,, c; '.C\.l r, '1.2 Cii 5.0"c 1.:;c·,

.H ,ears of teaching experience

17.88 ( 10.7)

General education Special education

1.070 (50'1c) 1,070 (50\i,)

jJ age

l·.s. geographic region :\"orthcast :--lich,-cst South \\'est

Gender :--Iale Female

2�1_2c,,t �,.1 \�c 2l5.6S,,

891 (8'.U1c) 176 ( l(i_-!r,)

Race 1cLlmicitY \\'hite. non-Hispanic Black. non-Hispanic Other. non-Hispanic Hispanic T\\o or more races. non-Hispanic Grade le,cl E.-2 :\-5 li-8 9-12 General education Special education

5-!.89, 12.7'1c 7.07' 2-!'i l .:"i'{

510 (23.SSi) 517(2-!.29,) 517 (2+.2o/r) 5% (27.9'7c) 1.782 ( 8�.29c) �:">2 (16.-!S1c,)

Standardization and Nonnative Data

21

teaching experience (SD = 10.7). (See Table 3.3 for demographic characteristics of teacher rating sample.) Teachers were recruited from all regions of the United States and included general (83.3%) and special education (16.4%) teachers. T he students (N = 2,140; 1,070 males, 1,070 females) rated by the teachers ranged in age from 5 to 17 vears (kl = 11.53; SD = 3.54) and attended kindergarten through 12th grade. Most students attended general education classrooms (83.2%) and were from white non-Hispanic (54.8%), black non-Hispanic (12.7%), other non­ Hispanic (7.0%), Hispanic (24%), or biracial non-Hispanic (1.5%) backgrounds. Measures Teachers reported their gender, age, race, ethnicitY, years of teaching experience, and primary teaching assignment (i.e., general education or special education). They also provided information about the students they rated including gender, age, race, ethnicity, grade, and priman classroom placement (i.e., general educa­ tion or special education). Teachers reported the frequency with \\·hich each stu­ dent displayed the 18 symptomatic beha,iors of A.DHD using either the Child or Adolescent iteration of the ADHD Rating Scale-:3, School Version based on the student's age (i.e., Adolescent ,ersion completed for students in grades 6-12)..-\s \\·as the case for parents, teachers indicated the frequency of each behasior oyer the past 6 months or since the beginning of the school year on a 4-point Likert scale including 0 (neYer or rareh'), 1 (sometimes), 2 (often), and 3 (Yery often). .-\s was the case for parents, teachers rated student functioning across six domains including relationships ,dth teachers, peer relationships, academic func­ tioning, behaYioral functioning, home\\·ork performance, and self-esteem. Teacher respondents completed a set of six impairment items twice, first after rating the inat­ tention symptom items and again after rating the hyperacti,·ity-impulsi,ity items. They were asked, "How much do the abo,e beh,ffiors cause problems for this stu­ dent?" Items \\·ere rated on a 4-point scale (no, minor, moderate, seYere problem). Procedures As described in Chapter 2, teacher data ,,·ere collected Yia t\\·o national research firms: GfK Knmdedge Panel and e-Re,rards. Initially, 1,309 teachers on the Knowl­ edgePanel" were contacted and 1,019 (67.3%) completed ratings. To obtain the desired sample size of 2,000 students, 12,610 additional teachers \\·ere recruited through e-Rewards market research; e-Re,rnrd panelists are selected based on haying a relationship \\·ith a business (e.g., Pizza Hut, Hertz, ·Macy's). A double opt-in is required; panelists must reph· to the initial email irn·itation and then to a follow-up confirmation email. Potential panelists' physical addresses are then , erified against postal records. All respondents are required to haYe a Yalid and unique email address. Respondents ans\\·er a profiling questionnaire "·hen enroll­ ing and proYide information regarding employment status. The e-Rewards respon­ dents indicated employment as a full-time, regularly emploved (i.e., not substi­ tute) teacher. .-\ total of 1,399 teachers (11.1% return rate) from the e-Re"\\·ards contact group completed ratings with 596 qualified based on quotas for child

22

ADHD RATING SCALE-5 FOR CHILDREN AND ADOLESCENTS

demographic characteristics (e.g., grade, race/ethnicity, geographic distribution). To ensure equal child gender representation, all teachers were asked to prm·ide symptom ratings for one randomh· selected bm· and one randomly selected girl on their class roster. Each student selected was based on a randomly generated number prm·ided in the instructions. Thus, for example, the teacher might be asked to select the seYenth girl on the class roster. This procedure was used for both students rated. Secondan school teachers ,rere instructed to proYide ratings for one randomh·. selected male and one randomh·. selected female in a randomly. selected class. Furthermore, the sample ,ras recruited such that the number of cases was balanced across age and grade range and ,ras representatiYe of the U.S. child population in terms of race/ ethnicity, geographic region, and age/sex (see Table 3.4). Teacher ratings were completed through a \;\'eh-hased suney that took approx­ imately 9 minutes (i.e., less than 5 minutes per student). Respondents receiYed small stipends (less than S 5) for completing ratings. If respondents left one or more items blank, theY "·ere prompted to complete missing items. Thus complete data sets were produced for> 99% of child ratings. A.11 ratings were collected dur­ ing April-�fay 2014.

TABLE 3.4. Teacher Ratings: Sample versus U.S. Census Category Racc."cthnicit,· \\.hite. non-Hispanic Rlack. non-Hispanic Hispanic Other. nun-Hispanic T,rn or more races. nun-Hispanic

Percent

Percent

sample

Census''

.:i--1-.8

53.55

] ') -· I

1��.,s

2--1-.0

2'.L'I0

7.0

5.85

1.5

- :-,_lq ••J.)

Region :\'ortheast :\licl11-cst South \\-est

2''1.2 27.1 26.li �:�. l

16.81 21.68 '.'17.5'.l '.2�.�)7

. \ge (Years) • sex 5-7/boY ;)-/,.' girl 8-10 'bm· 8-10 girl 11-1'.VhoY 11-13/girl l-!-17.lhoY l-l-17 'girl

11. l 10.6 11.8 11.-l 1 �.:, 11. .:i 15.9 15.1

11.li..J. 11.1,l 11...J."I 11.09 11.7() 11.17 16.21 Ei.:'i-l

.\.o/e. From DuPaul. Reid. ct al. i:!IIL,). Copnighr 'Z()Jj bY the "-\mcri­ can Psychological .--\.':'..-;ociation. Reprinted h�· permission. ''l".S. l'opulation Benchmarks. \Lirch :'01:',. CPS Supplement Data.

Standardization and Normative Data

23

Development of Normative Data: Results Nonnati,·e data for snnptom ratings on the :-\.DHD Rating Scale-5 are reported by age and gender for three scores: Inattention (IA), Hyperacti,it:·-Impulsi,ity (III), and total. Scores for IA and HI were calculated by summing item responses for the nine inattention and nine h,peracti,it,-impulsi,·ity items, respecti,elv. These two subscales reflect DS:vI-5 conceptualization of two domains for :-\.DHD symptoms, and this structure has been confirmed empiricalh' through factor analyses (see Chapter '2). Total score \\·as calculated b, summing responses for all 18 symptom items. ADHD Rating Sca/e-5, Home Version Normati,e data were computed separately for weighted parent ratings and pre­ sented for eight gender x age (5-7, 8-10, 11-13, 14-li ,ears) groups. Table 3.5 prm·icles the means, standard de·iations, and percentile scores for the L\, HI, and total scores for parent ratings. Four cutoff points are presented: 80th, 90th, 93rd, and 98th percentiles. These cutoff points can be used for screening risk (80th and 90th percentiles) and identification purposes (93rd and 98th percentiles) (Pm,·er, Dobert,, et al., 1998; see Chapter 5). :\!though racial/ethnic differences in parent ratings ,rere obtained (as described later in this chapter), nonnati,e data ,,·ere not presented bv race or ethnic group because there \\·ere insufficient numbers of participants for normati,e data to be displayed by gender, age, and racial/ethnic group. Based on the findings from the confirmatory factor analyses (see Chapter '2) for the impairment items indicating that the optimal model had six factors, each consisting of the two items pertaining to impairment clue to IA and HI corre­ sponding \\·ith the six areas of impairment assessed, normati,·e data are presented for each impairment factor. Scores for each impairment factor \\·ere created by selecting the higher of the t\rn ratings on each factor. Frequency distributions for parent ratings on each impairment dimension as a function of age and gender are presented in Table 3.6. �lost children had no or minor impairment problems, resulting in positi,·ely ske,red distributions. Parent ratings indicated that 19.5% of the sample displa,ed moderate to se,ere problems on at least one impairment dimension (Table 3.6). ADHD Rating Scale-5, School Version Norrnati,e data were computed separately for \\·eighted teacher ratings and pre­ sented for eight gender x age (5-7, 8-10, 11-13, 14-17 ,ears) groups. Table 3.7 provides the means, standard de,iations, and percentile scores for the L\, HI, and total scores for teacher ratings. Four cutoff points are presented: 80th, 90th, 9�rd, and 98th percentiles. T hese cutoff points can be used for screening risk ( 80th and 90th percentiles) and identification purposes (9�rd and 98th percentiles) (Power, Dohertv, et al., 1998; see Chapter 5). ,.\lthough racial/ethnic differences in teacher ratings were obtained (as described later in this chapter), normatiYe data were

TABLE 3.5. Normative Data for Parent Ratings P,·1n·11tilc

l',Tn·nt ik

N

,.i,..

SOth

()()tit

'1'.\rd

'l:-lth

M

:i.7'1

!l. 11

1r,.o

17.0

2'.l.O

:l.78

r; .)

:>. \()

'l.11

12.0

\(i.O

21. I

I. IS :L(l:'>

M

SI>

(i.11 r,.71

Tot:d Scorl'

1 lypnact iv it y-1lllJHI lsivit)

lnattcntio11

i'tT(Tllt iic

SOtli

')()th

!l'.kd

'ISth

;\/

Sf)

SOth

!lOth

'l'.\nl

!ISth

..•>r; ).)

!l.O

1,-,.0

17.0

IS.'I

I I.'12

IO.'.)!

JS_()

no

:11.0

10.0

:>.r)s

S.O

1:U)

I(,_()

20.0

10.21

I0.20

l(j_()

�r).1

'.\0.0

12.1

1.7:l

7.0

10.0

11.r,

I')_()

10.(Fi

\1.S2

IH.O

2:',.0

l)r; .._,).;)

:',8.0

,),_)_

l) r; ')

1.0

S.O

\I.()

1:1.s

7.71

S.7:)

t:I.O

20.0

2r,.o

:l(i.O ··I '.2.>�

Sf)

(j_,11

(i.t:\

I I.II

l:>.0

17.0

'.2:). l

,,/12

:) . �)

:',

'l. 11

I I.I

IS.O

21.1

()

\.(i2

5.'-2'.Z

S.11

12.0

1:\.0

20.H

1.21

l.')H

7.0

11.0

l'\.O

1'1.7

S.Sl

\1.12

l:>.0

20.S

21.r,

1.7')

r,.'-2·1

'I.II

12.0

l'.UI

20.7

:L:C)K

-1.�>�

(i.11

S.O

()_()

l(i,'I

S.17

8.():)

le\.()

18.0

20.:,

:'>li.O

·I.ff>

:">.11.()

!l.11

12.1

l:l.:i

20.()

2.HO

1.02

!J.0

S.O

11.0

l!i.O

7.

I:,

S.'.ZS

l'.\.0

20.0

2:LO

t, 741 cutoff score for, (i6-67, 74-75, 741, 81-82, 8lt overview, 65-66 screening for ADHD and, (i(i See also Diagnostic criteria for ADHD Diagnoslir: and Statistical i\ilanual of Mental Disorders, Fifth Edition (DSM-5) background of" the ADHD Rating Scale-5 and, 2-:l changes in diagnostic criteria and, 7-8 ovcrvic,v, 1

prevalence and, 41-42, 44-45 Diagnostic criteria for ADHD background or the ADHD Rating Scale-5 and, 2-:l changes in, 7 predictive validity and, 58-60, 591, 60t See also Diagnosing ADHD Diagnostic Interview for Children and AdolescentsRevised (DICA-R) discriminant validity and, 56 predictive validity and, (il Discriminant validity, 56-57, 57-58, 571. See also Validity Disruptive behavior, ?,_ Ser: also Behavioral functioning

E Emotional difficulties, :l Epidemiology, 41-45, 4:lt e-Rewards, 18-20, 19/, 21-22

Index Ethnicity, 29-41, 31J; 33/; 361, 371, 381, 401, 44-45. See also Demographic characteristics Evidence-based treatments, 86

gender, age, and racial/ethnic group differences and, 29-35, 31J; 33/ predictive validity and, 59-60, 601, 62-63, 631 prevelance and, 42-43, 431 relationships between ADHD symptoms and impairment scales and, 281 reliability and validity and, 50-52, 501, 511, 52-53, 521, 53t test-retest reliability and interrater agreement and,49-50 See also Attention-deficit/hyperactivity disorder (ADI-ID); Symptoms of ADHD

F Fact.or analysis confirmatory factor analysis, 10-14, llt, 12/; 13/, 141, 15/, 25 gender, age, and racial/ethnic group differences and, '.lO of the home version, 8-9 overview, 7-8 of the school version, 9-10 Family relationships administration and scoring of the ADHD Rating Scalc-5 and, 3 gender, age, and racial/ethnic group differences and, 35-41, 361, 371, 38t, 401 relationships between ADI-ID symptoms and impairment scales and, 281 test-retest reliability and interrater agreement and,49-50 Ser; also Relationships with significant others

G Gender complete rating scales and scoring sheets, 103-106, 111-114 overview, 29-41, 31/; 33/; 361, 371, '.l8t, 401 prevalence and, 43-44 See also Demographic characteristics

H Home version. Set ADHD Rating Scale-5, F!ome Version Homework functioning administration and scoring of the ADHD Rating Scale-5 and, 3 gender, age, and racial/ethnic group differences and, 35-41, 36t, 371,381,401 relationships between ADI-ID symptoms and impairment scales and, 281 test-retest reliability and interrater agreement and,49-50 See also Academic functioning Hyperactivity background of the ADI-ID Rating Scalc-5 and, 2-3 case examples, 83-85 changes in diagnostic criteria and, 7 clinical utility of the Hyperactivity-Impulsivity suhscalc, 71-75, 71t, 731, 741, 77-83, 781, 79t, 801,811 cutoff srnre for diagnosis and, 74-75, 741, 81-82, 811 diagnostic criteria for ADI-ID and, 2

121

I Impairment Rating Scale (IRS) parent ratings and, 52-53, 521, 531, 55-56, 551 reliability and validity and, 47-49, 64 teacher ratings and, 50-52, 501, 511, 54-55, 541, 551 Sec also Impairment scales Impairment scales confirmatory factor analysis of, 12-14, l'.-lj; Mt, 15/ gender, age, and racial/ethnic group differences and, 35-41, 3Gt, 371, 381, 401 internal consistency and, 46-47 prevelance and, 42 relationships between symptom scores and, 27-29, 281 reliability and validity and, 53, 531, 54-56, 541, 551 test-retest reliability and interrater agreement and,49-50 Sa also ADI-ID Rating Scale-5, Home Version; ADHD Rating Scale-5, School Version; Impairment Rating Scale (IRS) Impulsivity background of the ADI-ID Rating Scale-5 and, 2-3 case examples, 83-85 clinical utility oft.he 1-Iyperactivity-Irnpulsivity subscalc, 71-75, 7lt, 731, 74t, 77-83, 78t, 79t, 801,811 cutoff score for diagnosis and, 74-75, 741, 81-82, 811 diagnostic criteria for ADHD and, 2, 7 gender, age, and racial/ethnic group differences and, 29-35, 31J; 3'.-lf overview, 1

predictive validity and, 59-60, 60t, 62-63, 63t prevelance and, 42-43, 43t relationships between ADI-ID symptoms and impairment scales and, 28t reliability and validity and, 50-52, 50t, 511, 52-53, 521, 53t test-retest reliability and interrater agreement ancl,49-50 Sce also Attention-deficit/hyperactivity disorder (ADI-ID); Symptoms of ADI-ID Inattention background of the ADI-ID Rating Scalc-5 and, 2-3 case examples, 83-85

122

Index

Inattention (amt.) clinical utility of the Inattention subscale, 67-70, 68t, 701, 7:"i-77, 76t cutoff score for diagnosis and, 74-75, 74t, 81-82, 811 diagnostic criteria for ADHD and, 2, 7, 65-66 gender, age, and racial/ethnic group differences and, 29-35, 31[, 3'.lf overview, l

predictive validity and, 58-59, 591, 61-62, 621 prevelancc and, 42-43, 431 relationships between ADHD symptoms and impairment scales and, 281 reliability and validity and, 50-5,l, 50/, 511, 521, 53t test-retest reliability and interrater agreement and,49-50 Sa also Attent ion-dc!'icil/hyperactivity disorder (ADHD); Symptoms of ADHD Internal consistency, 46-47 lnterrater agreement, 47-49, 49-50

K Kaufman Rrief Intelligence Test (KBIT), 56 KnowledgePanel, 18-20, Ell, 21-22

L Logistic regression analyses clinical utility of the Hypcractivity-lmpulsivity suhscale, 72 predictive validity and, 62-63, 621, 631

N Negative predictive power (NPP) ADHD Rating Scale-IV and, 67 clinical utility of the Hypcractivity-lmpulsivity subscalc, 71-75, 7lt, 73t, 74t, 77-83, 78t, 79t, 80t, 811 clinical utility of the Inattention subscale, 67-70, 681, 70t, 761 cutoff score for diagnosis and, 66-67 overview, 65 screening for ADHD and, G6 Sec also Prediction Normative data internal consistency and, 46-47 overview, 16 prevelance and, 42 relationships between ADHD symptoms and impairment scales and, 27-29, 281 results, 23-27, 24t, 251, 26t, 271 samples and procedures, 16-22, 171, 19t, 201, 221

0 Outcomes. See Treatment outcome

p Parent ratings background of the ADHD Rating Scalc-5 and, 2 clinical ut.i Iit y oft he Hyperactivity-I mpu lsivity subscale, 71-75, 711,731,741, 79-81, sot clinical utility of the Inattention subscale, 67-70, 681, 701, 77 complete rating scales and scoring sheets, 95-106 discriminant validity, 56-58, 57t factor analysis of, 8-9 gender, age, and racial/ethnic group differences and, ,lO, '.ll/; ,\4, 35-41, 361, 37t, 38t, 40t normative data and, 23, 24t, 251 prevelance and, 41-42, 43,431, 44 relationships between ADHD symptoms and impairment scales and, 27-29, 281 reliability and validity and, 46-49, 52-5.'l, 521, 53t, 55-56, 55t, G4 Ste also ADHD Rating Scale-5, Home Version Parent-child relationships. See Family relationships; Relationships with significant others Peer relationships administration and scoring of the ADHD Rating Scale-5 and, 3 gender, age, and racial/ethnic group differences and, 35-4 l, %1, 37t, 381, 401 relationships between ADHD symptoms and impairment scales and, 28t test-retest reliability and int.errater agreement and,49-50 See also Relationships with significant others Positive predictive power (PPP) ADHD Rating Scale-JV and, 67 clinical utility of the Hyperactivity-Impulsivity subscale, 71-75, 7lt, 73t, 74t, 77-83, 78t, 791, SOt, 8lt clinical utility of the Inauention subscale, 67-70, 681, 701, 761 cutoff score for diagnosis and, 66-67 diagnosing ADHD and, 65-66 overview, 65 screening for ADHD and, 66 Sn, also Prediction Prediction clinical utility of the Hyperactivity-Impulsivity subscale, 71t, 73t, 74t, 77-83, 781, 79t, 801, 811 clinical utility of the lnauention subscale, 67-70, 681, 70t in a clinic-based set.ting, 67-75, 68t, 70t, 7lt, 731, 741 in school-based set.ting, 75-83, 76t, 78t, 79t, 80t, 8lt See also Negative predictive power (NPP); Positive predictive power (PPP) Predictive validity, 58-(J'.\, 591, 60t, 62t, 63t. Sa also Validity Prevalence, 41- 015, ,131 Procedures discriminant \'alidity, 56-57 overview, 46-47 reliability and \·alidity and, 47-49 Pupil Assistance Committee (PAC), 60-61

Index R Racial considerations, 29-4 l, '!>]J; ?,?,J; ?,6/, '!>71, ?,81, '10/, 44-45. Set also Demographic characteristics Regression analyses clinical utility of' the Hyperact ivit.y-1 mpulsivity subscale, 72 predictive validity and, 62-6?,, 62/, 6'!,/ Relationships with significant. others administ.rat.ion and scoring or the ADHD Rating Scalc-5 and, 8 gender, age, and racial/ethnic group differences and, ?,5-41, ?,6t, ?,7t, ?,8t, 40/ relationships bet.ween ADHD symptoms and impairment. scales and, 28t test-retest reliability and interrater agreement and,49-50 Se,• also Family relationships; Peer relationships Reliability impairment ratings and, 54-56, 54/, 55t internal consistency and, 46-47 overview, 64 parent ratings and, 52-5?,, 52t, 5?,t, 55-56, 551 samples and procedures, 47- 119 symptom scales and, 50-52, 50/, 511, 521, 5?,t teacher ratings and, 50-52, 50/, 51/ test-retest reliability and int.errater agreement and,49-50 Reliable Change Index (RC!) procedure, 88-89, 88/, 89/, 91

s Samples discriminant. validity, 56-57 overview, 46-47 reliability and validity and, 47-4\l School functioning. Sec Academic functioning; Homework functioning School version. Ste ADHD Rating Scale-5, School Version School-based setting case examples, 8?,-85 prediction in, 75-8?,, 76t, 781, 79t, 80t, 8 lt Scoring or the ADHD Rating Scalc-5, '!,- 11, 5f-6/; %-114 Screening case examples, 8'!>-85 cutoff score for diagnosis and, 66-67, 74-75, 741, 81-82, 8lt m·erview, 66 predictive validity and, 61 Sci f'.cst eem administration and scoring of the ADHD Rating Scale-5 and,?, gender, age, and racial/ethnic group differences and.?,;"i- 011, ?,Gt, :\71, ?,Rt, 40/ relationships between ADHD symptoms and impairment scales and, 281, 2\l test-retest reliability and int.errat.er agreement ancl,49-50

123

Sensitivity ADHD Rating Scale-IV and, 67 clinical utility of'the Hyperactivity-Impulsivity subscalc, 71-75, 711, 741, 77-8?,, 781, 79/, 80/, 8)/ clinical ut ilit.y or the Inat.tent ion subscale, 67-70, 68/, 70/, 76/ cutoff score for diagnosis and, 67 diagnosing ADHD and, 66 screening for ADHD and, 66 Severity ratings, 67 Specificity ADHD Rating Scale-IV and, fi7 clinical utility of' the Hyperactivit.y-Impulsivity suhscalc, 71-75, 711, 7:lt, 74/, 77-8?,, 78t, 79t, 80t, Sit clinical utility of' the lnattent.ion subscale, 67-70, 68t, 70t, 7Gt cutoff score for diagnosis and, 67 diagnosing ADI-ID and, 65-66 Symptom scales ADI-ID Rating Scale-IV and, 67 confirmatory fact.or analysis of', 10-11, lit, 12/ gender, age, and racial/ethnic group differences and, 29-:\5, :l lj; '!>?,/ internal consistency and, 4(i-47 normative data and, 2'!>-27, 2'1/, 251, 2Gt, 27t prevalence and, 42-4?, relationships between impairment scales and, 27-29, 281 reliability and validity and, 50-52, 50/, 511, 52-5?,, B2t, 5:)t test-retest reliability and interrater agreement and,49-50 Sn, also ADHD Rating Scale-5, I-Jome Version; ADHD Rating Scale-5, School Version; Symptoms of' ADI-ID Symptoms of' ADIi I) diagnosing ADHD and, G5-66 treatment. outcome and, 87-89, 88/, 8!)/ SN, also Attention-deficit/hyperactivity disorder (ADHD); I-Iypcract.ivity; Impulsivity; Inattention; Symptom scales

n,,

T Teacher ratings background ol' the ADHD Rating Scale-5 and,

2 clinical utility of the 1-Iyperactivity-Irnpulsivity subscale, 71-75, 7It, 7'!>1, 74t clinical utility of the Inattention subscale, 67-70, 681, 701, 761 complete rating scales and scoring sheets, 107-11'1 discriminant validity, 5G-58 !'actor analysis of', \J-10 gender, age, and racial/ethnic group differences and, :l2, ?,?,J; ?,4-41, :\fit, ?,7t, ?,St, 40/ normative data and, 2:l, 25-27, 2Gt, 27t

124

Index

Teacher ratings (cont.) prevelance and, 42, 43, 131, 44 relationships between ADHD symptoms and impairment scales and, 27-29, 281 reliability and validity and, 46-49, 50-52, 501, 511, 54-55, 541, 551, 64 Sa also ADHD Rating Scale-5, School Version Test-retest reliability, 47-50. Se!! also Reliability Treatment outcome case examples, 89-91 clinical significance of", 87-89, 881, 891 overview, 86-87 See also Clinical decision making Tripartite model, 7

V Validity discriminant. validity, 56-58, 571 impairment ratings and, 54-56, 541, 551 internal consistency and, 46-47 overview, 64 parent ratings and, 52-53, 521, 531, 55-56, 551 predictive validity, 58-63, 591, 601, 621, 631 samples and procedures, 47-49 symptom scales and, 50-52, 501, 51 I, 521, 531 teacher ratings and, 50-52, 501, 511 test-retest reliability and int.crratcr agreement ancl,49-50

PSYCHOLOGY

AD D RATING SCALE-5 tor Children and Adolescents Checklists , Norms, and Clinical Interpretation

G eorge J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid "DuPaul and colleagues have created another excellent, psychometrically sound parent and reacher raring scale . ... Like rhe previous version , rhis scale will soon become the standard in th e field. " - Steven W Evans, PhD , Department of Psychology, Ohio University " or only is the scale quick and easy ro adminis ter and score, bur irs brevity and thoroughness make ir an excepti onal rool for assessi ng ADHD and measuring treatment effects. Unlike the majority of other instruments ro assess ADHD, it contains current DSM terminology, and has both child and adolescent versions of the parent and reacher ratings. " - Julie Schweitzer, PhD, Director, ADHD Program, MIND Institute, University of California, Davis "The release of the ADHD Rating Scale- 5 is cause for celebration. Like prior versio ns, which are widely used in clinical an d research settings , rhe updated scale is psychomerrically sound and is based on extensive reliabi lity and validity data .... The chapter on interpretation and use provides an unusually clear and cogent discussion of how the scale sho uld be used for diagnosis and screening." - Stephen V. Faraone, PhD , Distinguished Professor of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University "C linical management of ADHD demands strong assessment tools, and the ADHD Rating Scale-5 meets rhis need. " - Charlotte Johnston, PhD , Professor and Director of Clinical Training, Department of Psychology, University of British Columbia, Canada

rounded in more than 20 years of research , this valid, reliable, easy-co-administer instrument is widely used by mental health, educational, and medical practitioners in screening, di agnosis, and treatment evaluation. Parent questionnaires on home behaviors (English and Spanish) and reacher questionnaires on classroom behaviors are keyed ro DS M -5 diagnostic criteria for attention-deficit/ hyperactivity disorder (ADHD). Each scale rakes just 5 minutes to complete and comes in borh a child (5-10) and adolescent (11-1 7) ve rsion , wirh developmentally appropriate symprom descriptions. Complete insuucrions are provided for scori ng and interpretation, including separate scoring profiles for symptoms and impairments in boys and gi rls.

G

New to This Edition: • Updated for DSM-5 . • Separate adolescent ve rsions of both home an d school rating scales. I • Includes functional impairment items linked to each symprom dimension (inattention symproms and hyperactiveimpulsive symptoms). • Full analysis of rhe revised scale's psychometric properties. Includes Permission to Photocopy: Enhancing rhe convenience an d value of the ADHD Rating Scale- 5, the limited duplication license (see copyright page for details) allows individual purchase rs ro reproduce the fo rms and score sheets for use wi th their clients or patients, yielding co nsiderable cost savings over other available scales. The large for mat and sturdy wire binding facilitate phorocopyi ng. ALSO FRO M

GEORGE J. DuPAu-Now

IN

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ADHD in the Schools, Third Edition Assessment and Intervention Strategies George J. Du Paul and Gary Stoner 366 Pages, 2014. Paperback (2016), ISBN 978-1-4625-2600-0

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