The Adolescent Behavior Checklist: development and initial psychometric properties of a self-report measure for adolescents with ADHD

Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth

OBJECTIVE

Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents.

METHOD

We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability.

RESULTS

Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized.

CONCLUSIONS

Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.

Review of Clinical Validation of ADHD Behavior Rating Scales

The purpose of this review is to assess the range of overall accuracies for Attention Deficit/Hyperactivity Disorder (ADHD) behavior rating scales evaluated in clinical validation studies. Studies were characterized according to the evidence standards of the American Academy of Neurology (AAN). Studies were excluded due to major design problems such as overfitting by discriminant analysis. The 13 included evaluations of rating scales revealed overall accuracy in the range of 59%–79% with a pooled mean of 69% (±7%, standard deviation) and a pooled sample size of 2,228 subjects from nine studies. While some of the excluded studies demonstrated higher overall accuracies (>79%), these studies were observed to have factors in experimental design and statistics that are known to unduly inflate accuracy. We recommend further research following the full AAN standards, namely well-designed, blinded, prospective studies of rating scales applied to clinically representative samples evaluated with a clinical standard.

Development and Validation of Disruptive Behavior Scales for the Student Behavior Survey (SBS)

This study evaluated the 102 items of the Student Behavior Survey (SBS; Lachar, Kline, Wingenfeld, & Gruber, 1995). The SBS is a teacher behavioral rating scale that can be used with the parent-informant Personality Inventory for Children, the student-informant Personality Inventory for Youth (Lachar & Gruber, 1995; Wirt, Lachar, Klinedinst, & Seat, 1984), or as a stand-alone instrument. Three disruptive behavior scales (Attention Deficit Hyperactivity, Oppositional Defiant, and Conduct Problems), developed through consensual nomination to DSM-IV criteria, obtained empirical support for item placement and demonstrated positive psychometric properties. These scales possessed excellent internal consistency and adequate temporal stability and interrater reliability. Student gender, age, and referral status affected scale elevation in expected ways. These three SBS scales also obtained strong correlations with conceptually related independent measures and discriminated among subgroups of clinical and special education students.

Patterns of Sensory Processing in Children with Attention Deficit Hyperactivity Disorder

The researchers conducted this study to compare the sensory responses of children whose primary diagnosis was Attention Deficit Hyperactivity Disorder (ADHD) and children without disabilities on the Sensory Profile, a parent-reporting measure of children's sensory responses in daily life (Dunn, 1999). Parents of 70 children 3 to 15 years old with a primary diagnosis of ADHD and parents of children without disabilities matched by age and gender completed the Sensory Profile. Researchers completed a series of Multivariate Analyses of Variance (MANOVA) with post hoc testing to compare the performance of the two groups of children. Children with ADHD differed significantly from children without disabilities in their sensory responsiveness based on Sensory Profile results. The Sensory Profile can contribute to diagnostic and program planning processes and increase understanding of the nature of the disorder of ADHD.

Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey

The objective of the study was to examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in a representative population survey of adults and the association of these factors with health outcomes. Hierarchical and correlated factor analysis models were compared, and regression analyses with these models were used to determine the associations with psychological distress and substance use problems. A total of 1449 adults 18-65 years of age participated in a cross-sectional survey over the phone. ADHD symptom data came from an ADHD screener (10 items), and health outcomes were assessed using a questionnaire measuring psychological distress and two measures of substance use problems. The hierarchical general factor models with specific factors best represented the structure of ADHD in this representative population survey. The general factor and residual inattention factor were significantly associated with psychological distress, and the general factor was associated with substance use problems. From the correlated factor models, the inattention factor was associated with psychological distress and the hyperactivity factor was related to substance use problems. The hierarchical and correlated factor models explained similar levels of variance in outcomes. The results replicate previous studies indicating that a model of ADHD symptoms with a unitary dimension and separable dimensions of residual inattention and hyperactivity/impulsivity demonstrates a better fit than correlated factor models. The ADHD general factor was consistently significantly related to outcomes.

Evidence for a general factor model of ADHD in adults

OBJECTIVE

To examine factor structures of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptoms of ADHD in adults.

METHOD

Two sets of models were tested: (a) models with inattention and hyperactivity/impulsivity as separate but correlated latent constructs and (b) hierarchical general factor models with a general factor for all symptoms and separate specific factors for inattention and hyperactivity/impulsivity. Participants were 751 adults with ADHD. Two models with correlated factors and two general factor models of ADHD symptoms were tested.

RESULTS

The general factor model provided a better fit of the data than the correlated models. The general factor model with one general and three (inattention, motoric, and verbal hyperactivity/impulsivity) specific factors best accounted for the adults' symptoms.

CONCLUSION

These results suggest a unitary component to ADHD symptoms as well as dimensional specific factors. The replication of a general factor in adults suggests continuity of symptom presentation from childhood into adulthood. Clinical implications are discussed.

The hierarchical factor model of ADHD: invariant across age and national groupings?

OBJECTIVE

To examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) in a clinical sample of 1,373 children and adolescents with ADHD and their 1,772 unselected siblings recruited from different countries across a large age range. Hierarchical and correlated factor analytic models were compared separately in the ADHD and sibling samples, across three different instruments and across parent and teacher informants. Specific consideration was given to factorial invariance analyses across different ages and different countries in the ADHD sample.

METHOD

A sample of children and adolescents between 5 and 17 years of age with ADHD and their unselected siblings was assessed. Participants were recruited from seven European countries and Israel. ADHD symptom data came from a clinical interview with parents Parental Account of Childhood Symptoms and questionnaires from parents and teachers (Conners Parent and Teacher).

RESULTS

A hierarchical general factor model with two specific factors best represented the structure of ADHD in both the ADHD and unselected sibling groups, and across informants and instruments. The model was robust and invariant with regard to age differences in the ADHD sample. The model was not strongly invariant across different national groups in the ADHD sample, likely reflecting severity differences across the different centers and not any substantial difference in the clinical presentation of ADHD.

CONCLUSIONS

The results replicate previous studies of a model with a unitary ADHD component and separable specific traits of inattention and hyperactivity/impulsivity. The unique contribution of this study was finding support for this model across a large developmental and multinational/multicultural sample and its invariance across ages.

Acupuncture for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood psychiatric disorder with features of inattention, hyperactivity and impulsivity. There is increasing interest in complementary and alternative therapies such as acupuncture; however, it remains unclear whether the use of acupuncture in children and adolescents with ADHD is supported by the existing evidence.

OBJECTIVES

To assess the efficacy and safety of acupuncture as a treatment for ADHD in children and adolescents.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2010, Issue 2); MEDLINE (21 May 2010); CINAHL (21 May 2010); EMBASE (21 May 2010); ERIC (21 May 2010); PsycINFO (21 May 2010), Chinese Biological Medicine Database (10 May 2010); Chinese Scientific Periodical Database of VIP INFORMATION (10 May 2010); China Periodical in China National Knowledge Infrastructure (10 May 2010); and Chinese Evidence-Based Medicine Database (10 May 2010). We handsearched Chinese language journals and conference proceedings.

SELECTION CRITERIA

Randomised controlled trials and quasi-randomised controlled trials comparing acupuncture with placebo or sham acupuncture, or conventional treatment. Participants under the age of 18 years with any type of ADHD were included. Papers in any language were included.

DATA COLLECTION AND ANALYSIS

Two review authors (S Li, B Yu) independently determined the studies to be included in the review based on inclusion and exclusion criteria and extracted the data using pre-developed extraction forms. The risk of bias within the trials was assessed by the same review authors in relation to allocation concealment, blinding and withdrawals. The measures of ADHD outcomes were extracted from core symptoms rating scales and additional secondary outcomes were considered.

MAIN RESULTS

No studies met the inclusion criteria for this review.

AUTHORS' CONCLUSIONS

A comprehensive search showed that there is no evidence base of randomised or quasi-randomised controlled trials to support the use of acupuncture as a treatment for ADHD in children and adolescents. Due to the lack of trials, we cannot reach any conclusions about the efficacy and safety of acupuncture for ADHD in children and adolescents. This review highlights the need for further research in this area in the form of high quality, large scale, randomised controlled trials. 

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population.

OBJECTIVES

To assess the effectiveness of meditation therapies as a treatment for ADHD.

SEARCH STRATEGY

Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010.

SELECTION CRITERIA

Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form.

MAIN RESULTS

Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients).

AUTHORS' CONCLUSIONS

As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

The unity and diversity of inattention and hyperactivity/impulsivity in ADHD: evidence for a general factor with separable dimensions

To examine the unity and diversity of inattention and hyperactivity/impulsivity symptom domains of Attention-Deficit/Hyperactivity Disorder (ADHD) in a clinical sample of adolescents with ADHD. Parents and adolescents were administered a semi-structured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL), to assess adolescent ADHD. Data from 201 parent interviews and 189 adolescent interviews were examined. Four potential factor structures for the 18 ADHD symptoms were tested using confirmatory factor analysis: two models with correlated factors and two bifactor models. A bifactor model with two specific factors best accounted for adolescent symptoms, according to both parent and adolescents' reports. Replication of these findings from behavioral rating scales completed for this sample by parents and teachers indicates that the findings are not method- or informant-specific. The results suggest that there is an important unitary component to ADHD symptoms and separable dimensional traits of Inattention and Hyperactivity/Impulsivity.

Ist das Selbsturteil Jugendlicher bei der Diagnostik von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen hilfreich?

Zusammenfassung. Fragestellung: Die Informationen von Eltern und Lehrern sind Grundlage für die Diagnostik von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen (ADHS). Das Selbsturteil Jugendlicher wurde bislang als wenig relevant eingeschätzt, einerseits, weil die Selbstwahrnehmungsfähigkeit von Jugendlichen mit ADHS bezweifelt wurde, andererseits, weil vermutet wurde, daß Jugendliche, die wegen Verhaltensproblemen zur Diagnostik vorgestellt werden, in ihren Selbstberichten zur Dissimulation neigen. Die vorliegende Studie untersucht anhand verschiedener Stichproben die internen Konsistenzen der Selbsteinschätzungen Jugendlicher und der Elterneinschätzungen von Symptomen einer ADHS sowie die Übereinstimmung dieser Einschätzungen. Meßinstrumente: Zur Erfassung von Symptomen einer ADHS werden der Fremdbeurteilungsbogen für Hyperkinetische Störungen (FBB-HKS) und der Selbstbeurteilungsbogen für Hyperkinetische Störungen (SBB-HKS) aus dem Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ) eingesetzt. Stichprobe: Die Fragebögen wurden einer Feldstichprobe (n = 166), einer klinischen Stichprobe (n = 15) und einer Unauffälligenstichprobe (n = 14) von Jugendlichen im Alter von 11 bis 18 Jahren bzw. ihren Eltern vorgegeben. Ergebnis: Die a priori-Skalen beider Fragebögen sind intern konsistent, die Skalen innerhalb eines Instrumentes korrelieren im mittleren bis höheren Bereich, zwischen den korrespondierenden Skalen von Eltern- und Selbsturteil lassen sich mittlere bis höhere Korrelationen errechnen. In der Feldstichprobe liegt das Selbsturteil eher über dem Elternurteil; in klinischen Stichproben ist das Gegenteil der Fall. Schlußfolgerung: Der Selbstbeurteilungsbogen und der Fremdbeurteilungsbogen für Hyperkinetische Störungen eignen sich zur Diagnostik von Jugendlichen mit ADHS. Auch das Selbsturteil ist bei der Diagnostik von ADHS hilfreich, es sollte jedoch nicht die einzige Informationsquelle sein.

Validity of the Brown ADD scales: an investigation in a predominantly inattentive ADHD adolescent sample with and without reading disabilities

The Brown ADD Scale for Adolescents is widely used in clinical settings, yet, no published studies have investigated divergent and concurrent validity and specificity and sensitivity to inattentive ADHD symptomatology. Ninety-eight participants (13 to 16 years) were classified as ADHD/I and/or reading disabled (RD) using Kiddie Schedule for Affective Disorder and Schizophrenia (K-SADS), Conners' Rating Scales (CRS-R), and Ontario Child Health Study Scales (OCHSS), WRAT3, and WRMT-R. The results were: 29 ADHD/I; 12 RD, 16 ADHD/I with RD; and, 41 controls. The RD group was included to evaluate specificity. The Brown was administered but not used in classification. The ADHD groups scored higher on the Brown subscales compared with the other two groups. The recommended cutoffs resulted in high rates of false negatives but few false positives; this suggests good specificity but poor sensitivity. There were moderate correlations among the Brown, CRS-R, and OCHSS. The Brown can be useful in screening out ADHD; however, its low sensitivity precludes its usefulness in diagnosing ADHD.

Adolescent motor vehicle crashes: the relationship between behavioral factors and self-reported injury

PURPOSE

To examine the relative importance of demographic and behavioral factors, as well as alcohol use, in motor vehicle crash (MVC)-related injuries in an adolescent sample.

METHODS

Data were collected from two samples of adolescents. In Study 1, a total of 1576 9th through 12th graders from three different high schools provided information on risk-taking behavior and injuries experienced during the previous six months. Study 2 involved a more fine-grained analysis of behavioral factors related to MVC-related injuries. A sample of 573 adolescent males from an all-boys parochial high school completed questionnaires assessing risk-taking, attention and behavior problems, alcohol use, driving behavior, and self-reported injury.

RESULTS

Rates of self-reported MVC-related injuries for a 6-month period were consistent across the two studies, ranging from 10% in the mixed-gender sample to 16% in the all-male sample. Consistent with previous findings, males reported more frequent MVC-related injuries and higher rates of risk-taking behavior. In Study 1, age and risk-taking behaviors were predictive of injuries while riding or driving in a car. In the all-male sample, risk-taking behavior and conduct problems were significant predictors of MVC-related injuries.

CONCLUSIONS

Risk-taking is a consistent predictor of both general and MVC-related injuries. Intervention efforts with adolescents may be targeted at increasing safe driving strategies as well as decreasing risk-taking behaviors.