Understanding ADHD | For Professionals | For Healthcare Professionals | Clinical Practice Tools
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Clinical Practice Tools

When evaluating for ADHD, clinicians will use a variety of clinical practice tools to gather information, including standardized clinical rating and self-report checklists, behavior questionnaires and/or rating scales. These tools are an essential component of a comprehensive evaluation for ADHD and provide information needed to screen, diagnose and develop a treatment plan.  During treatment, they can be used to track symptoms and monitor treatment progress.

These practice tools are typically completed for

  • Adults – by the individual client/patient and significant others (spouse, boss, co-worker)
  • Children – by their parent(s) or caregiver(s), other family members and/or educators
  • Teens – by the teen, their parent(s) or caregiver(s), other family members and/or educators

 

Rating Scales and Checklists

Scales and checklists help clinicians obtain information from adults, parents, teachers, and others about symptoms and functioning in various settings. Symptoms must be present in more than one setting (such as both at home and in school or work) to meet DSM-5 criteria for an ADHD disorder. Remember, however, that these instruments are only one component of a comprehensive evaluation.

The Agency for Healthcare Research and Quality (AHRQ) has noted that ADHD-specific rating scales are more accurate in distinguishing between children with and without the diagnosis of ADHD.  These are preferable to global, nonspecific questionnaires and rating scales that assess a variety of behavioral conditions. 

 

Child and Teen Rating Scales

The following rating scales are often used to screen, evaluate or monitor children and teenagers with ADHD. Due to the variability of a child’s behavior based on the setting, their relationship with the person completing the form, or the subjective nature of the responses, it is best to have several significant people in the child’s life (mother, father, grandparent, teacher, daycare provider, etc.) complete the forms for comparison.  The responses and scores are not sufficient for a diagnosis of ADHD but are an important component of the comprehensive evaluation process.

 

Child Behavior Checklist (CBCL/6-18)

  • Identifies problem behavior in youths ages 6-18 years, including possible disorders and internalizing or externalizing problems
  • Consists of a checklist of 120-questions
  • Scored on a 3-point scale that ranges from  0 (not true) to 2 (very true/often true)

 

Conners' Rating Scales

  • Conners' Parent Rating Scale-Revised for parents/caregivers
  • Conners' Teacher Rating Scale-Revised for teachers
    • Consist of 27/28 questions (short versions of the scale) divided into 4 subscales: 1)oppositional problems, 2) cognitive problems,3)  hyperactivity and 4) an ADHD index
    • Scoring is based on a 4-point scale
  • Conners-Wells' Adolescent Self-Report Scale for teenagers
    • Administered to teens for their self-report.

 

Vanderbilt ADHD Rating Scales

  • Vanderbilt ADHD Parent Rating Scale (VADPRS)
    • Provides information on a parent’s perception of social functioning and school performance
    • Consists of 45 questions
  • Teacher Rating Scale (VADTRS)
    • Provides information on school performance and ADHD symptoms
    • Consists of 43 questions
  • Based on 4- and 5-point scales with high scores indicating more severe symptoms, except for the performance section where higher scores indicate better performance in classroom behavior and academic achievement

 

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

  • Includes separate forms for parents/caregivers and teachers
  • Based on an 18-item scale divided into subscales for hyperactivity/impulsivity and inattentiveness
  • Scored on a 4-point frequency scale ranging from 0 = never/rarely to 3 = very often

 

Adult Rating Scales

The following scales have been developed to screen, evaluate and monitor adults with ADHD.  Because rating scales are based on self-reported perceptions, and therefore subjective, it is recommended that significant person’s in the adult’s life also complete the forms.  These can include the person’s spouse, a close relative, employer and/or colleague.

 

Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2

  • Provides information on current adult symptoms of ADHD
  • Based on a semi-structured clinical interview
  • Consists of 18 items

 

Adult ASRS Symptom Checklist v1.1

  • Used as an initial symptom assessment to identify adults who may have ADHD
  • Consists of 18 items

 

Adult ADHD Self-Report Scale (ASRS) v1.1

  • Developed as a 6-question subset of the ADHD ASRS Symptom Checklist
  • Used as an initial self-assessment tool
  • Consists of 6 items: 4 for inattentive symptoms and 2 for hyperactive-impulsive symptoms
  • Scoring is based on symptom frequency

 

Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults

  • Used as a self-report or as part of a clinical interview
  • Consists of 40 items representing 5 symptom areas: activation, attention, effort, affect and memory
  • Asks about the adult’s clinical history, work and/or school functioning, leisure, mood, and sensitivity to criticism
  • Scoring is based on a 4-point frequency scale  from 0 (never) to 3 (almost daily)

 

ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts

  • Rates the frequency and severity of ADHD symptoms
  • Consists of 18 items: 9 assess inattentive symptoms and 9 assess hyperactive-impulsive symptoms
  • Scoring is based on a 4-point frequency scale ranging from 0 (never) to 3 (very often)

 

References

Achenbach T. Child Behavior Checklist for Ages 6-18. Burlington, VT: ASEBA, University of Vermont. 2001.

Adler L, Cohen J. Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder. Psychiatric Clinics of North Am. 2004;27(2):187-201.

Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales, V: scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42(9):1015-1037.

Conners CK. Development of the CRS-R. In: Conners CK, ed. Conners' Rating Scales-Revised. North Tonawanda, NY: Multi-Health Systems. 2001:83-98.

Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology. 1998;26(4):257-268.

DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. New York, NY: The Guilford Press. 1998.

Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine. 2005;35(2):245-256.

Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods Psychiatry Research. 2007;16(2):52-65.

Murphy K, Adler LA. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. Journal of Clinical Psychiatry. 2004;65: 12-17.

Wolraich M. Vanderbilt ADHD Diagnostic Teacher Rating Scale. 1998.

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. Journal of Pediatric Psychology. 2003;28(8):559-567.

     


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