Assessment of ADHD With Culturally Different Groups: The Use of Behavioral Rating Scales

Measurement Invariance of the ADHD Rating Scale-IV Home and School Versions Across Age, Gender, Clinical Status, and Informant

The present study aimed to investigate the measurement invariance across age, gender, clinical status, and informant of the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) Home and School versions. The participants were 1,106 Romanian children and adolescents (mean age = 12.74 years, standard deviation = 2.84, age range 6-18 years). Both parents and teachers assessed ADHD symptoms. The factorial structure of the scale was assessed using confirmatory factor analysis, and measurement invariance was assessed using multigroup confirmatory factor analysis. The results supported the reliability of the ADHD-RS-IV, with high internal consistency coefficients for both versions. Confirmatory factor analysis validated a two-factor model. Multigroup confirmatory factor analysis confirmed the measurement invariance of ADHD-RS-IV across age, gender, clinical status, and informant. ADHD-RS-IV had good psychometric properties in a sample of Romanian children and adolescents. It is a reliable instrument given its strong invariance. Implications for evidence-based assessment of ADHD are discussed.

Impact of Maternal and Child Race on Maternal Ratings of ADHD Symptoms in Black and White Boys

OBJECTIVE

Examine the influence of maternal and child race on ADHD symptom ratings.

METHOD

Participants were Black ( n = 63) and White ( n = 68) mothers randomly assigned to view a 13-min videotape of either a Black or White boy displaying similar levels of ADHD-related behaviors during free play and meal situations. Mothers then completed an ADHD rating scale.

RESULTS

With maternal age and socioeconomic status (SES) as covariates, Black mothers provided significantly higher ratings of inattentive and hyperactive-impulsive symptoms than did White mothers regardless of child race. The effect of child race was not statistically significant.

CONCLUSIONS

Maternal race appears to be more important than child race in accounting for differences in ADHD symptom ratings between Black and White boys. It is critical to understand variables related to these differences and develop assessment measures that lead to equivalent, accurate diagnostic decisions across racial subgroups.

Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale in European patients: comparison with patients from the USA

The adult attention-deficit/hyperactivity disorder (ADHD) quality-of-life (AAQoL) scale was previously validated in adult patients in the USA; here, the AAQoL is validated in adult European patients. Data from a 12-week open-label acute treatment period with atomoxetine (80-100 mg/day) in adults with ADHD were used. Patients (≥ 18 to ≤ 50 years old) had a score ≥ 2 on ≥ 6 items on the inattentive or hyperactive core subscales of Conners' Adult ADHD Rating Scale-Investigator Rated: Screening Version (CAARS-Inv:SV); a CAARS-Inv:SV 18-item total ADHD symptom score ≥ 20; and Conners' Adult ADHD Rating Scale-Observer: Screening Version 6-item inattentive or hyperactive core subscale scores ≥ 2. Data were stratified based on patients' geographic region (Europe vs USA). Scale validation psychometric properties results were very similar between European (n = 1,217; 57.7 % male; mean age 33.0 years) and US (n = 602; 62.1 % male; mean age 33.5 years) patients, including factor loading, internal consistency, convergent and discriminant validity, and responsiveness. Exploratory factor analysis confirmed four AAQoL subscales. Internal consistency was acceptable (Cronbach's alpha > 0.70 for all subscales). The AAQoL total score showed moderate convergent validity with CAARS-Inv:SV 18-item total ADHD symptom and clinical global impression-ADHD-severity (CGI-ADHD-S) scores; and strong convergent validity with Behavior Rating Inventory of Executive Function-Adult Version: Self-Report Global-Executive-Composite Index scores. Mean AAQoL total scores were significantly different among patients grouped by CGI-ADHD-S scores, suggesting good discriminant validity. The AAQoL total and subscale scores presented good responsiveness from baseline to 12 weeks. The AAQoL scale shows comparable validity in European and US adults with ADHD.

ADHD across cultures: is there evidence for a bidimensional organization of symptoms?

We examined the phenotypic expression of attention-deficit/hyperactivity disorder (ADHD) across cultures by assessing the factor/latent class structure of its core symptoms. We conducted a systematic review of the literature published from January 1987 to November 2008 using Medline and PsycINFO. We systematically reviewed 2,511 article abstracts, and 48 of these abstracts were included in this review. Research with school-age children from 15 countries including different samples, informants, and rating instruments supported a two-factor ADHD model consisting of inattention and combined hyperactivity and impulsivity. This model was not supported for preschool children. Cross-cultural equivalence for the two-factor model was suggested in some studies. Latent class analyses using parental data and more recent approaches like factor mixture modeling are generally consistent with factor analyses. These findings argue in favor of a cross-cultural validity of the syndrome. The implications of these findings for further research and classificatory systems in mental health like the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) are discussed.

Validation of the adult ADHD investigator symptom rating scale (AISRS)

OBJECTIVE

Validation of the Adult ADHD Investigator Symptom Rating Scale (AISRS) that measures aspects of ADHD in adults.

METHOD

Psychometric properties of the AISRS total and AISRS subscales are analyzed and compared to the Conners' Adult Attention-Deficit/Hyperactivity Disorder Rating Scale-Investigator Rated: Screening Version (CAARS-Inv:SV) and the Clinical Global Impression-ADHD-Severity Scale using data from a placebo-controlled 6-month clinical trial of once-daily atomoxetine.

RESULTS

The AISRS has high internal consistency, good convergent, and discriminant validities; modest divergent validity; and small ceiling and floor effects (<or=1%). It correlates highly with the CAARS-Inv:SV. Factor analysis confirms 2 AISRS subscales, hyperactivity-impulsive scale and inattention. The AISRS total and AISRS subscales perform stably. All scales demonstrate responsiveness to change with medication.

CONCLUSION

The AISRS and its subscales are robust, valid efficacy measures of ADHD symptoms in adult patients. Its anchored items and semistructured interview are advancements over existing scales.

Juan: a 9-year-old Latino boy with ADHD

Juan, a 9-year-old Latino male, was referred to a community clinic by his third-grade teacher for evaluation of classroom behavior problems. He is an only child and lives with both parents. At home, Juan speaks Spanish with his parents although he occasionally speaks English with his father. His father came to the U.S. from Mexico as a small child and completed the 12 grade in the U.S. Juan's mother completed 8 grade in Mexico and immigrated to the U.S. as a teenager.Juan's mother reported that he has had no significant medical problems. Her report of his behavior included an inability to focus on tasks at hand and easy distractibility. She was concerned that the principal of the school mentioned that Juan may be asked to repeat the 3 grade or change schools. In the clinic, Juan sat quietly but appeared to be daydreaming and attentive to the conversation. The pediatrician called the principal who expressed frustration with Juan's behavior. In class, he was very fidgety, did not pay attention and usually did not answer questions. He also bothered other students when they were working. The principal explained that because Juan's school was a Spanish language immersion school, there were no special education services available. If a student at the school required special education services, he or she would be transferred to another school in the same school district. An evaluation for an Individualized Education Plan (IEP) indicated that Juan had above average cognitive ability (90 percentile), with superior ability to problem solve and process information simultaneously (99 percentile). The Woodcock Johnson III (Spanish version) indicated average achievement in academic skills, with low average in reading fluency, comprehension and spelling. On the Test of Auditory-Perceptual Skills, Juan tested generally low average in all domains, and was at the 14 percentile for both auditory number and auditory word memory. On the Test of Visual-Perceptual Skills, Juan scored above the 92 percentile. Juan did not qualify for special education services on the basis on the standardized tests. However, because of the individual attention required by Juan, a transfer to another school was considered inevitable if his classroom behaviors did not improve. Juan's mother and teacher filled-out the NICHQ Vanderbilt Assessment Scale. Their responses were consistent with the diagnosis of ADHD, inattentive type. In discussion of treatment options with the family, the possibility of stimulant medication use was raised. Juan's mother was opposed to the medication because of what she had heard from her friends-that these medications had bad side effects and did not work most of the time. Juan's father, however, was in favor of the medication because it might assist Juan to stay at the school. After several clinical visits that included further information about ADHD, behavioral treatment, and reviewing information from the school, Juan's parents agreed to a trial of medication. Juan was evaluated for a follow-up visit 2 weeks after starting fourth grade; he had been taking a stimulant medication for one month. He seemed much happier about school and was proud to report that he has completed all of his assignments in school as well as homework assignments, and he did well on a math quiz. Juan's mother was also pleased with his progress. The pediatrician called the principal, who reported that Juan was an entirely different student. He now sat at his desk and wrote down the assignments. He seemed eager to learn and able to be attentive in the classroom. The principal was amazed at the difference.

A cross-cultural comparison between samples of Brazilian and German children with ADHD/HD using the Child Behavior Checklist

INTRODUCTION

This study aims to assess cross-cultural similarities and differences in broadband psychopathology in two naturalistic clinical samples of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) combined type according to DSM-IV criteria or with Hyperkinetic Disorder (HD) according to ICD-10 criteria.

METHODS

We compared two clinical samples of children with ADHD combined type (Brazil, N=248) and HD (Germany; N=154) to controls (Brazil N=71; Germany N=135) using the Child Behavior Checklist (CBCL). ROC-curves (Receiver Operating Characteristic) were determined to evaluate the discriminating validity of the CBCL Attention Problem scale. A two-factorial ANOVA was computed across all 8 scales of the CBCL.

RESULTS

Although Brazilian parents reported significantly higher scores on all CBCL scales than German parents (P<0.05), a similar CBCL profile was detected in both cultures.

CONCLUSION

Despite the use of different diagnostic systems (DSM-IV vs. ICD-10) and the presence of other clinical differences, the similar broadband psychopathological profile of the CBCL in the two samples provides evidence that dimensional symptoms associated with the categorical diagnosis of ADHD combined type might be comparable in two clinical settings with diverse cultural background.

Cross-cultural adaptation of the Sensory Profile: establishing linguistic equivalency of the Hebrew version

In the process of translating assessment tools from one language to another, researchers often run the risk of altering the intended meaning of the test items, and consequently affecting the validity of the assessment tool. In this study, the accuracy of a Hebrew translation of the Sensory Profile (Dunn, 1999) was validated. A multi-step process, based on back-translation and the bilingual method was undertaken to examine whether the Hebrew translation was linguistically equivalent to the original Sensory Profile. Quantitative and qualitative measures were used to detect and explain inconsistencies in the translation. The analysis of the back-translation revealed that the discrepancies found in a number of items stemmed from inaccurate translation or back-translation, erroneous substitution, omission, or addition of words/phrases, and from substitution of words/phrases because there was no equivalent in the Hebrew language. Of the 59 back-translated items, which were not linguistically equivalent to the original Sensory Profile items, only 12 items generated inconsistent responses by the bilingual parents. Overall, the responses of the bilingual parents to the Hebrew and the English version were inconsistent in 26 of the 125 Sensory Profile items. The coefficient alpha values in all sections of the Hebrew version (except for section N) were above.70, indicating a good overall reliability. Based on proposed criteria, results indicate that the Hebrew translation of the Sensory Profile is accurate. Inconsistencies found in a number of items may relate to connotation effect, language effect, and measurement errors.

Patterns of response to sensory stimuli encountered in daily activities: a comparison between 3–10-year-old Israeli and American children without disabilities

The purpose of this study was to examine the extent to which patterns of response of typical children aged 3 to 10 in Israel, as reported in the Sensory Profile (Dunn, 1999), were similar to typical children in the United States. The Sensory Profile is a caregiver questionnaire designed to assess sensory processing abilities. A translated Hebrew version of the Sensory Profile was completed by parents of 714 typically developing children who were recruited from across Israel. The mean scores of the Israeli children were compared to the published mean scores of the American children at the section and factor level to determine whether the scoring system of the Sensory Profile would be applicable for Israeli children. The findings revealed that, in some sections and factor clusters, the scores of Israeli children were lower than the scores of the American children across all ages. Although the Israeli children scored lower, overall, their scores were within the established range of typical performance. Initial support for the application of the scoring system of the Sensory Profile in Israel is suggested. Due to the nature of the sample of Israeli children, future studies are recommended with a national representative sample and with specific disability groups to further validate the clinical use of the Sensory Profile in Israel.

The role of children's ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior

Significant ethnic differences have been consistently documented on attention-deficit/hyperactivity disorder (ADHD) teacher rating scales. Whether these ethnic differences result from a teacher rating bias or reflect actual classroom behavior patterns is unknown. Ethnic differences between Caucasian and African American (AA) elementary schoolchildren on teacher ratings and codings of observed classroom behavior were examined with latent variables. In structural equation models, correlations between teacher ratings and observed classroom behavior suggested nonbiased teacher ratings of AA schoolchildren with diagnosed ADHD. Ethnic differences were documented for both teacher ratings of ADHD and classroom behavior. Differences in classroom behavior were attenuated when the behavior of an average child in the classroom was taken into account. Multiple explanations for this pattern of results are discussed.

Attention-deficit/hyperactivity disorder in a diverse culture: do research and clinical findings support the notion of a cultural construct for the disorder?

There is still some debate in the literature whether Attention-Deficit Disorder/Hyperactivity (ADHD) is best conceptualized as a biological disorder or if it is best understood as a cultural construct. This review aims to contribute to disentangle this issue assessing clinical and research data on ADHD in a complete diverse culture from a developing country. We performed a systematic computerized review of the literature on ADHD in Brazil. All investigations were included if dealing with ADHD prevalence, etiology, symptomatological construct, or treatment. Findings were compared to those from studies in developed countries. The prevalence rates of ADHD (5.8% using DSM-IV criteria, 1.5% using ICD-10), the bi-dimensional factor construct extracted from factor analyses (inattention and hyperactivity/impulsivity), the pattern of ADHD comorbidity in clinical samples, the family genetic data suggesting a 39% family transmission in clinical samples and the role of some potential candidate genes in dopaminergic and noradrenergic systems, as well as data on the efficacy of methylphenidate in the disorder are all very similar to findings from developed countries. Taken together, these findings suggest that ADHD is not a cultural construct, reinforcing the importance of applying similar research methodology in different cultures to make findings comparable.

What's in a name? A comparison of methods for classifying predominant type of maltreatment

OBJECTIVE

The primary aim of the study was to identify a classification scheme, for determining the predominant type of maltreatment in a child's history that best predicts differences in developmental outcomes.

METHOD

Three different predominant type classification schemes were examined in a sample of 519 children with a history of alleged maltreatment. Cases were classified into predominant maltreatment types according to three different schemes: Hierarchical regression analyses examined whether the HT, SFT, and EHT type classifications contributed to prediction of child behavior problems, trauma symptoms and adaptive functioning.

RESULTS

After controlling for demographic factors, the HT definitions predicted four outcomes, while the SFT definitions predicted three, and the EHT classifications contributed to the prediction of five child outcomes. The co-occurrence of multiple types of maltreatment was robustly related to outcomes. However, the HT and SFT classifications predicted outcomes even after accounting for the co-occurrence of multiple maltreatment subtypes.

CONCLUSION

A classification scheme that differentiates between type combinations and single maltreatment types may have the greatest predictive validity. Over and above knowing about co-occurrence of maltreatment sub-types, it is important to understand what type, or constellation of types, of maltreatment have been alleged in a child's history.

ADHD Rating Scale IV: psychometric properties from a multinational study as a clinician-administered instrument

The development of rating scales for attention-deficit/hyperactivity disorder (ADHD) has traditionally focused on parent-or teacher-rated scales. However, clinician-based instruments are valuable tools for assessing ADHD symptom severity. The ADHD Rating Scale IV (ADHD RS), clinician administered and scored, has been validated as a useful instrument to assess ADHD symptoms among American children and adolescents. In this study, we assessed the psychometric properties of the scale in a recent clinical trial conducted mainly in Europe with over 600 children and adolescents diagnosed with ADHD. The trial was conducted in 11 European countries plus Australia, Israel, and South Africa. Results based on data in the study indicate that this version of the scale has acceptable psychometric properties including inter-rater reliability, test-retest reliability, internal consistency, factor structure, convergent and divergent validity, discriminant validity, and responsiveness. There were low-to-moderate ceiling and floor effects. The psychometric properties were comparable with other validated scales for assessing ADHD symptom severity. These results were consistent across the 14 countries participating in this trial. Overall, the data from this study support the use of the ADHD RS as a clinician-rated instrument for assessing the severity of ADHD symptoms in children and adolescents in Europe.

Diagnostic performance of the CBCL-Attention Problem Scale as a screening measure in a sample of Brazilian children with ADHD

OBJECTIVE

To evaluate the diagnostic performance of the Attention Problem Scale of the Child Behavior Checklist (CBCL-APS) for the screening of Attention-Deficit/Hyperactivity Disorder (ADHD) in a sample of Brazilian children and adolescents.

METHODS

The CBCL-APS was given to 763 children and adolescents. Child psychiatrists using DSM-IV criteria confirmed the clinical diagnoses. Diagnostic performance was evaluated through Receiver-Operating Characteristic (ROC) curves.

RESULTS

Only moderate areas under the curve (AUC) were found for the general sample (AUC = 0.79; 95% CI = 0.76-0.82), and for the subsample of referred patients (AUC = 0.78; 95% CI = 0.74-0.82). The subsample of patients with ADHD of the combined type presented the largest AUC (AUC = 0.85; 95% CI = 0.82-0.88).

CONCLUSION

Our findings concur with previous studies of different cultures demonstrating adequate diagnostic performance of the CBCL-APS for the screening of ADHD, especially of the combined type.

The acute effect of methylphenidate in Brazilian male children and adolescents with ADHD: a randomized clinical trial

OBJECTIVE

To evaluate the acute efficacy of methylphenidate (MPH) in Brazilian male children and adolescents with ADHD.

METHOD

In a 4-day, double-blind, placebo-controlled, randomized, fix dose escalating, parallel-group trial, 36 ADHD children and adolescents were allocated to two groups: MPH (n = 19) and placebo (n = 17). Participants were evaluated pre- and posttreatment using the 10-item Conners Abbreviated Rating Scale (ABRS), the Children's Global Assessment Scale (CGAS), and a simplified version of the Continuous Performance Test (CPT).

RESULTS

The MPH group had a significantly greater decrease in ABRS scores and a significantly higher increase in CGAS scores than the placebo group (p < 0.01). The MPH group showed also a significantly higher proportion of patients with a robust improvement (decrement of at least 50% in the ABRS score after the intervention) than the placebo group (p < 0.01). The MPH effect size for the ABRS was 1.05 (95% CI = 0.73-1.37).

CONCLUSION

Our results extend the efficacy of MPH on the ADHD core symptoms extensively demonstrated in clinical trials with samples from some developed countries to a sample from a developing country where a diverse culture may modulate the clinical presentation of the disorder.

Neuropsychological performance in DSM-IV ADHD subtypes: an exploratory study with untreated adolescents

OBJECTIVE

To explore neuropsychological performance in untreated Brazilian adolescents suffering from attention-deficit hyperactivity disorder (ADHD).

METHOD

We assessed 30 untreated adolescents with ADHD and 60 healthy control subjects, aged 12 to 16 years, using a neuropsychological battery including the Wisconsin Card-Sorting Test (WCST), the Stroop Test (ST), the Digit Span, and the Word Span.

RESULTS

We found neuropsychological differences among the DSM-IV ADHD subtypes. Adolescents with the predominantly inattentive subtype (ADHD-I) performed more poorly than did control subjects on both the Digit Span and the ST. On both the Digit Span and the WCST, adolescents with the combined subtype (ADHD-C) presented significantly more impairments than did control subjects. Adolescents with the predominantly hyperactive-impulsive type (ADHD-HI) did not differ significantly from the control subjects in any measure assessed, but had a better performance than did those with ADHD-C on both the Digit Span and the WCST. In addition, adolescents with ADHD-HI performed better on the ST than did adolescents with ADHD-I.

CONCLUSIONS

These findings suggest cognitive differences among ADHD subtypes, supporting the diagnostic distinction among them. Adolescents with ADHD-HI do not seem to have significant cognitive deficits.

School dropout and conduct disorder in Brazilian elementary school students

OBJECTIVES

To evaluate the association between DSM-IV conduct disorder (CD) and school dropout in a sample of students from the third and fourth elementary grades at state schools in the capital of the southernmost state of Brazil.

METHODS

In this case-control study, students that dropped out of schools (n = 44) and a control group who continued attending schools (n = 44) were assessed for CD and other prevalent mental disorders, using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiological Version (K-SADS-E).

RESULTS

The prevalence of DSM-IV CD was significantly higher in the school-dropout group than in control subjects (P < 0.001), both in the entire sample and in a subsample including only subjects under age 12 years (P = 0.001). Also, the odds ratio (OR) for school dropout was significantly higher in the presence of DSM-IV CD, even after controlling for potential confounding factors (age, estimated IQ, school repetition, family structure, and income) (P < 0.01).

CONCLUSION

Our results extend to children and young adolescents previous findings from studies of older adolescents, suggesting an association between school dropout and CD.

Factor and latent class analysis of DSM-IVADHD symptoms in a school sample of Brazilian adolescents

OBJECTIVE

To evaluate the validity of the multidimensional construct proposed by DSM-IV for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents.

METHOD

An instrument including all 18 DSM-IVADHD symptoms was administered to 1,013 students aged 12 to 14 years at 64 state schools by trained research assistants. Each symptom was rated on a Likert scale with five levels of severity (never, almost never, sometimes, frequently, and always).

RESULTS

Using an exploratory factor analytic approach (principal components analysis), two factors were extracted. Factor I (hyperactivity-impulsivity) comprised eight DSM-IV hyperactive-impulsive symptoms with loadings > or =0.40. Factor II (inattention) included also eight DSM-IV symptoms of inattention. The two factors explained 34% of the total variance and had an interfactor correlation of 0.45. Latent class analysis demonstrated similar classes in males and females, but class structures were markedly different from previous analyses of parent report data.

CONCLUSION

The findings support the appropriateness of the multidimensional construct introduced by DSM-IV in the diagnosis of ADHD in a different culture but emphasize the possible impact of different reporters on the results of structural model-testing.

Population variation in children's behavioral symptomatology

Previous anthropological studies identified significant interpopulation consistencies in the frequency and symptoms of adult depression, anxiety, and schizophrenia. Tests of the degree of variation of such behavioral phenomena across contemporary populations are significant for the study of human evolution because universality or near universality suggests specific evolved aspects of human behavior. The aim of this research was to provide a preliminary test of whether cross-cultural consistencies in symptomatology associated with some psychiatric conditions are observable in children as they are in adults. We tested for interpopulation variation in degrees (intensity and frequency) of anxiety, depression, withdrawal, and somatization symptomatology in normal samples of children. Psychometric ratings scales allowed assessment of characteristic symptomatology of each child in the different contexts of home and school. The study populations comprised 1,208 6-11-year-old children from the Paisa community in Antioquia, Colombia, and African-American, Euro-American, and Hispanic children in the United States. We found interpopulation consistencies in some aspects of child behavioral symptomatology, especially depression and withdrawal. Mean degrees of symptomatology and percentages of children with clinically significant levels of symptomatology were consistent for both across populations, in home and school contexts, and for both girls and boys. Anxiety and somatization displayed more cross-cultural variability in expression. These patterns are in accordance with current understandings of cross-cultural variability and universals of adult psychiatric symptomatology.

Identification of elementary school children at risk for disruptive behavioral disturbance: validation of a combined screening method

OBJECTIVES

To examine the validity of the teacher-rated Inattention/Overactivity With Aggression (IOWA Conners) questionnaire followed by the Conners Abbreviated Symptom Questionnaire (CASQ) as a feasible, combined screening method to identify children at high risk for externalizing behavioral disturbance in a school setting.

METHOD

The IOWA Conners and CASQ were administered to the entire population of children, grades K through 6, in a single elementary school. Using a whole-number IOWA Conners threshold score of 18 (1.5 SD), coupled with a CASQ score of 18 (1.0 SD), a high-risk group and an age-, sex-, and classroom-matched low-risk control group were selected for comparison on the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), Child and Adolescent Functional Assessment Scale (CAFAS), and Diagnostic Interview for Children and Adolescents-Revised diagnoses.

RESULTS

The data showed significant intergroup differences in CBCL (p < .0002), TRF (p < .0006), and CAFAS (p < .0002) scores and higher numbers of DSM diagnoses (1.7 +/- 0.3 versus 0.1 +/- 0.3, p < .0007) between the high- and low-risk group. The positive predictive value for externalizing diagnoses for the IOWA Conners plus CASQ was 100% and negative predictive value was 70%.

CONCLUSIONS

The IOWA Conners combined with the CASQ is a useful initial screening strategy in the school setting for identification of children with disruptive behavioral difficulties.

Self-management as a strategy to improve the classroom behavior of adolescents with ADHD

This article reports on the application of a self-management strategy for improving the classroom behavior of students with attention-deficit/hyperactivity disorder (ADHD). Based on the work of Rhode, Morgan, and Young (1983), the intervention focuses on teaching students to systematically rate their own behavior according to the rating of their teacher. Although, historically, self-management strategies based on cognitive control have not been found to be effective for students with ADHD, strategies based on contingency management have not been widely reported in the literature. A description of the intervention and two case study illustrations are provided. Potential limitations and implications for research in using this strategy are discussed.