Validity and Diagnostic Accuracy of Broad Symptom Measures and ADHD Symptom Ratings for Identifying Individuals with ADHD Combined and ADHD Inattentive
Creators: name: Graves, Stacy Jean
Publisher: name: University of Nevada, Las Vegas
Year: 2017

description: Neuropsychological assessments conducted with children with Attention Deficit Hyperactivity Disorder (ADHD) often includes broad measures of behavioral disturbances, as well as specific measures of ADHD symptomatology. However, it is unclear the extent to which these two types of measures share substantial common variance or are useful in improving diagnostic accuracy. In efforts to increase efficiency, the current study examined these matters to provide clinicians with information that might help improve the selection of behavioral ratings for evaluation purposes.
Participants included in this study were evaluated for clinical purposes at a community based private practice. Participants included 253 of these children diagnosed with ADHD- Inattentive (n=163) or ADHD-Combined (n=90). Children were an average of 10.4 years old (range = 6 Ð 16 years, SD=2.9), 70.4% male, and had an average Full Scale IQ of 98.7 (SD = 12.7). ADHD diagnoses were established through comprehensive evaluations, including administration of the Behavior Assessment System for Children, Second Edition (BASC-2) and DSMÐIV ADHD Symptom Rating Scale (SRS).
Convergent and discriminate validity were examined between the respective mothers' ratings of Attention Problems/Inattention and Hyperactivity on the BASC-2 and SRS parent ratings by correlating the SRS and BASC-2 scores. Examination of the pattern of the correlations provides direct evidence for the convergent and discriminant validity of the SRS. Receiver Operating Characteristic (ROC) analysis was used to determine differences in sensitivity and specificity when the BASC-2 and SRS scores were used to differentiate ADHD Inattentive and Combined subtypes. Results indicated that SRS Impulsivity, SRS Hyperactivity, and BASC-2 Hyperactivity had significantly better classification accuracy than BASC-2 Attention Problems
and SRS Inattention, although they did not differ from each other. Finally, mixed model iii
repeated measures ANOVA's were conducted to identify if there were significant interactions between ADHD Inattentive and Combined subtypes and the BASC-2 and SRS scores. Results of the analyses indicated the presence of significant interaction effects for the SRS and BASC-2 that were accounted for by both ADHD subtypes receiving similar scores on inattention but the Combined subtype demonstrating higher impulsivity and hyperactivity scores than the Inattentive subtype.
Results of the current study support using the BASC-2 and SRS in the evaluation of children of ADHD. Both measures appear to be sensitive to differences in symptomatology based on ADHD Inattentive and Combined subtypes. Both subtypes had elevated scores on ratings of inattention, although children who are diagnosed with ADHD inattentive subtype received lower scores on ratings of hyperactivity and impulsivity. These data suggest that scores reflecting hyperactive and impulsive symptoms from the SRS and BASC-2 have greater predictive discrimination than scores reflecting inattentive symptoms when diagnosing ADHD Combined and ADHD Inattentive subtypes.
From a clinical perspective, these results suggest that the selection of behavioral rating scales to evaluate children with ADHD should be guided by the reason for referral. In cases where the primary referral question is to establish a diagnosis of ADHD, the ADHD-SRS may be more efficient as its items map directly on DSM symptoms used to make a diagnosis of ADHD.
When a broader assessment of cognitive and behavior disturbances are required, the BASC-2 not only provides measures of inattention and hyperactivity, but additional information on behavioral disturbances that commonly occur in ADHD and are important for treatment and educational planning. Both scales may be used together when diagnostic questions and more general assessment is needed.