A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
Additional Criteria
TABLE/DATA FOR THE SAME INFO ON ADULT ADHD?? MISSING CLINICAL GENERALIZEABILITY LEVEL FOR MINI-KID
Screening Measure (Primary Reference) | AUC | LR+ Score | LR- Score | Clinical Generalizeability | Reference |
---|---|---|---|---|---|
Child Behavior Checklist (CBCL) - Attention Problems T-Score (Achenbach, 1991a) | .84
(N=187) |
6.92(>55), 12.2 (>60),
47 (>65), 34 (>70) |
0.19 (<55), 0.41 (<60),
0.53 (<65), 0.66 (<70) |
Somewhat High: Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. | Hudziak, Copeland, Stranger, & Wadsworth, 2004 [1] |
Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score (Achenbach, 1991a) | Boys: .86
(N=111) Girls: 0.90 (N=108) |
10.2 (>55)
11.2 (>55) |
0.41 (>55)
0.35 |
Somewhat High: Utilized sample ages 6-18 which consisted of 219 brothers and sisters of children who were referred to a hospital pediatric unit for ADHD or other symptoms. Half of these siblings had brothers and sisters who had ADHD, half did not. | Chen, Faraone, Biederman, & Tsuang, 1994 [2] |
Teacher Response Form (TRF) - Attention Problems T-Score (Achenbach, 1991a) | Not reported
(N=184) |
3.66 (>70) | 0.73 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Teacher Response Form (TRF) - Attention and Aggression Problems T-Score (Achenbach, 1991a) | Not reported
(N=184) |
4.33 (>70) | 0.89 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Composite International Diagnostic Interview (CIDI) 3.0 (Merikangas et al., 2009) | Adolescent Reported: .57
(N=321) Parent Reported: .71 (N=321) |
8.36 (when classified positive by CIDI)
9.67 (when classified positive by CIDI) |
0.86 (when classified negative by CIDI)
0.56 (when classified negative by CIDI) |
Moderate: Utilized the NCS-A sample of 10,148 adolescents aged 13-17 and their parents. | Green, Avenevoli, Finkelman, Gruber, Kessler et. al, 2010 [4] |
Disruptive Behavior Disorder (DBD) Rating Scale - Parent Report (Pelham et. al, 1992) | 0.78
(N=232) |
5.06 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.20 (<9) (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High; Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. | NEED TO FIND ON PUBMED or maybe some other source? Shemmassian & Lee, 2012] [5] |
Disruptive Behavior Disorder (DBD) Rating Scale - Teacher Report (Pelham et. al, 1992) | 0.63
(N=232) |
1.97 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.24 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High; Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. | NEED TO FIND ON PUBMED or maybe some other source? Shemmassian & Lee, 2012] [5] |
Vanderbilt ADHD Diagnostic Rating Scale (VADRS) - Parent Report (Wolraich et. al, 1998) | Not reported | 4.79 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.38 (Endorsed < 6 symptoms of inattention or hyperactivity) | Moderate: Sample consists of 582 children ages 5-15 recruited through schools in Oklahoma. Sample includes children screened as "high risk" for ADHD and "low risk" for ADHD. | Bard, Wolraich, Neas, Doffing, & Beck, 2013 [6] |
Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS; Wolraich et. al, 1998) | Not reported | 2.91 (Positive VADTRS Risk Score) | 0.657 (Negative VADTRS Risk Score) | Moderate: Sample consisted of 370 children ages 5-15 recruited though schools in Oklahoma. Sample was representative community sample. | Bard, Wolraich, Neas, Doffing, & Beck, 2013 [6] |
Conners Rating Scale (Revised) - Long Form Parent Report (Conners, 1997) | Not reported | 15.33 (>93rd percentile) | 0.09 (<93rd percentile) | Moderate: Data come from normative sample of 2482 children ages 3 to 17 across the United States and Canada. LRs here discriminate ADHD from Non-Clinical. | Collett, Ohan, & Myers, 2003 [7] |
Conners Parent Rating Scale-48 (CPRS-48) Impulsive-Hyperactive Subscale T-Score (Conners, 1990) | Not reported | 1.26 (>70) | 0.79 (>70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Conners Teacher Rating Scale (Revised) - Long Form (Conners, 1997) | Not reported | 8.66 (>93rd percentile) | 0.24 (<93rd percentile) | Moderate: Data come from normative sample of 1973 children ages 5 to 17 across the United States and Canada. LRs discriminate ADHD from non-clinical. | Collett, Ohan, & Myers, 2003 [7] |
Conners Teacher Rating Scale-39 Hyperactivity Subscale T-Score (Conners, 1990) | Not reported | 5.2 (>70) | 0.53 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
ADHD Symptom Checklist-4 (ADHD-SC4) - Parent Report (Gadow & Sprafkin, 1997) | Not reported | 1.45 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.70 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High: Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. | Sprafkin & Gadow, 2007 [8] |
ADHD Symptom Checklist-4 (ADHD-SC4) - Teacher Report (Gadow & Sprafkin, 1997) | Not reported | 1.53 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.60 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High: Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. | Sprafkin & Gadow, 2007 [8] |
ADHD RS-IV - Home (DuPaul et. al, 1998b) | Not reported | 1.63 (>80th percentile) | 0.35 (<80th percentile) | Moderate: Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. | Collett, Ohan, & Myers, 2003 [7] |
ADHD RS-IV - School (DuPaul et. al, 1998b) | Not reported | 4.5 (>80th percentile) | 0.42 (<80th precentile) | Moderate: Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. | Collett, Ohan, & Myers, 2003 [7] |
Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID; Sheehan et. al, 2009) | 0.83 (N=225 ) | 4.14 (Diagnosis of ADHD on MINI-KID) | 0.16 (No Diagnosis of ADHD on MINI-KID) | MISSING LEVEL: MODERATE? HIGH? Sample of 225 children and adolescents ages 6-17 which included 190 outpatients and 36 controls, recruited from South Florida psychiatric center. | Sheehan, Sheehan, Shytle, Janavas, Bannon et. al, 2009 [9] |
Note: All studies with one exception used structured or semi-structured clinical interviews to establish diagnosis of ADHD. The exception, the Sprafkin & Gadow study (2007), used a combination of CBCL rating scales, clinician review, and clinician consensus to confirm ADHD diagnosis. “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).
Executive Summary:
1. If intervening with children ages 4-5, behavior therapy should be the first line of treatment.
2. If intervening with children ages 6-11, behavior therapy should be the first line of treatment, in conjunction with medication.
3. If intervening with children ages 12-18, medication should probably be the first line of treatment, though behavior therapy could be used in combination.
4. Three types of therapeutic interventions have well established evidence-bases:
5. If considering a classroom management intervention:
American Academy of Pediatrics Clinical Practice Guidelines for ADHD by Age (Subcommittee on AD/HD Disorder, 2011)
1. For preschool-aged children (ages 4-5), primary care clinicans should prescribe evidence-based parent and/or teacher-administered behavior therapy as the first line of treatment, and may prescribe methylphenidate if behavioral interventions are not effective
2. For elementary-aged children (ages 6-11), primary care clinicians should prescribe FDA-approved medications for ADHD and/or evidence based parent and teacher administered behavior therapy. Preferably, both medication and behavior therapy will be prescribed.
3. For adolescents (ages 12-18), primary care clinicians should prescribe FDA approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as a treatment for ADHD, preferably both.
Different Types of Behavioral Therapies which meet American Academy of Pediatrics and American Psychological Association Task Force criteria for well-established Evidence-Based Treatments
*Descriptions and Effect sizes taken from (Subcommitte on AD/HD Disorder, 2011; Pelham & Fabiano, 2008)
Behavioral Parent Training:
Behavior modification principles provided to parents for implementation in home settings. Typical outcomes include improved compliance with parental commands, improved parental understanding of behavioral principles, high levels of parental satisfaction with treatment.
Median effect size: 0.55
Behavioral Classroom Management:
Behavior-modification principles provided to teachers for implementation in classroom settings. Typical outcomes include improved attention to instruction, improved compliance with classroom rules, decreased disruptive behavior, improved work productivity, and improved academic achievement.
Median effect size: 0.61
Behavioral Peer Interventions:
Interventions focused on peer interactions/relationships. These could include group-based interventions provided weekly and include clinic-based social skills training used either alone or concurrently with behavioral parent training and/or medication. Typical outcomes are more mixed with these interventions. Some clinical-office based interventions have produced minimal effects, while some studies of behavioral peer intervention coupled with behavioral parent training found positive effects on parental ratings of ADHD symptoms. No studies of this type of intervention reveal differences on social functioning or parental ratings of social behavior. Behavioral Peer Interventions implemented in peer group/recreational settings (e.g. summer camps) have the most evidence of being
effective.
Median effect size: None reported, effect sizes found are considered moderate.
Findings from DuPaul and colleagues review of school based interventions (DuPaul, Eckert, & Vilardo, 2012)
-Academic intervention (Interventions that focus primarily on manipulating antecedent conditions via things like peer tutoring, computer- aided instruction, and organizational skills interventions) and combined academic and contingency management interventions were associated with greater effects on academic outcomes.
Table 3.11: Single Subject Design Effect Sizes for Academic Outcomes
Intervention Type | Effect Size |
---|---|
Academic | 4.73 |
Cognitive Behavioral | 3.77 |
Contingency Management | 2.29 |
Combined | 2.29 |
-Contingency management (Interventions that use reinforcement and punishment) and cognitive behavioral interventions (Interventions
focused on development of self-control skills and reflective problem-solving strategies) were associated with greater effects for behavior outcomes.
Table 3.12: Single Subject Design Effect Sizes for Behavioral Outcomes
Intervention Type | Effect Size |
---|---|
Academic | 1.53 |
Cognitive Behavioral | 3.31 |
Contingency Management | 2.40 |
Combined | 1.31 |
ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. (2011). Pediatrics, 128 (5),
Pelham, W. R., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of
DuPaul, G. J., Eckert, T. L., & Vilardo, B. (2012). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis 1996-2010. School
Christophersen, E. R., & VanScoyoc, S. (2013). Treatments that work with children: Empirically supported strategies for managing childhood problems (2nd ed.). Washington, DC
Eiraldi, R. B., Mautone, J. A., & Power, T. J. (2012). Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder.
Hodgkins, P., Dittmann, R. W., Sorooshian, S., & Banaschewski, T. (2013). Individual treatment response in attention-deficit/hyperactivity disorder: Broadening perspectives and
Neef, N. A., Perrin, C. J., & Madden, G. J. (2013). Understanding and treating attention- deficit/hyperactivity disorder. In G. J. Madden, W.V. Dube, T. D. Hackenberg, G. P. Hanley,
Schultz, B. K., Storer, J., Watabe, Y., Sadler, J., & Evans, S. W. (2011). School-based treatment of attention-deficit/hyperactivity disorder. Psychology In The Schools,48(3),
Measure | Cut Scores* | Critical Change (Unstandardized Scores) | |||||
A | B | C | 95% | 90% | SEdifference | ||
Benchmarks Based on Published Norms | |||||||
CBCL T-scores (2001 Norms) |
Total | 49 | 70 | 58 | 5 | 4 | 2.4 |
Externalizing |
49 | 70 | 58 | 7 | 6 | 3.4 | |
Internalizing |
n/a | 70 | 56 | 9 | 7 | 4.5 | |
Attention Problems |
n/a | 66 | 58 | 8 | 7 | 4.2 | |
TRF T-Scores (2001 Norms) |
Total | n/a | 70 | 57 | 5 | 4 | 2.3 |
Ext |
n/a | 70 | 56 | 6 | 5 | 3.0 | |
Int |
n/a | 70 | 55 | 9 | 7 | 4.4 | |
Attention Problems |
n/a | 66 | 57 | 5 | 4 | 2.3 | |
Conners 3-Teacher Rating Scale T-Scores | ADHD Inattentive | 36 | 74 | 57 | 11 | 10 | 5.6 |
ADHD Hyperactive-Impulsive | 36 | 74 | 57 | 11 | 9 | 5.5 | |
Conners 3-Parent Rating Scale T-Scores | ADHD Inattentive | 37 | 72 | 58 | 10 | 10 | 5.6 |
ADHD Hyperactive-Impulsive | 37 | 72 | 58 | 10 | 8 | 4.7 | |
Benchmarks Based on ADHD Samples (Shemmassian & Lee, 2012) | |||||||
Disruptive Behavior Disorders Rating Scale | 1.4 | 8.6 | 5.7 | 12 | 10 | 0.9 |
* “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.
Sources Consulted:
Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO
1. CBCL Attention Problems Subscale: Could be used on a weekly basis to track changes in ADHD symptomotology. T-scores from this
measure could also be recorded on a weekly basis to determine if reliable and clinically significant changes in ADHD symptoms are
occuring. The CBCL Attention Problems Subscale has repeatedly demonstrated good-to-excellent convergence with diagnostic interviews
for diagnosing ADHD (Pelham et al., 2005; Lampert, Polanczyk, Tramontina, Mardini, & Rohde, 2004; Hudziak et al, 2004; Chen et al.,
1994). The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.
2. Daily Report Card: Several scholars have pointed out that it is equally important to track changes in the functional behaviors that a child
with ADHD engages in, in addition to their ADHD symptoms, to capture the full range of adaptive changes that are made by children with
ADHD throughout the course of treatment (Pelham et. al, 2005; Sowerby & Tripp, 2009). The daily report card is a mechanism by which
such adaptive behavioral changes can be tracked. When implementing the daily report card, problematic child behaviors at home and at
school are targeted for change. Rewards are offered to the child for reaching daily and weekly goals for reducing maladaptive behaviors and
increasing adaptive behaviors. Parents and Teachers track child behaviors on a daily basis and provide feedback to one another and the child
with behavior frequency counts and/or daily "grades" on how well the child behaved. Daily report cards are a mainstay of cognitive-behavioral and behavioral modification evidence-based intervention strategies for ADHD (DuPaul et al., 2012; Eiraldi et al., 2012) and are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1.
Lampert, T. L., Polanczyk, G. G., Tramontina, S. S., Mardini, V. V., & Rohde, L. A. (2004). Diagnostic performance of the CBCL-
Sowerby, P., & Tripp, G. (2009). Evidence-based assessment of attention-deficit hyperactivity disorder (ADHD). In J. L. Matson, F.
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Additional Criteria
TABLE/DATA FOR THE SAME INFO ON ADULT ADHD?? MISSING CLINICAL GENERALIZEABILITY LEVEL FOR MINI-KID
Screening Measure (Primary Reference) | AUC | LR+ Score | LR- Score | Clinical Generalizeability | Reference |
---|---|---|---|---|---|
Child Behavior Checklist (CBCL) - Attention Problems T-Score (Achenbach, 1991a) | .84
(N=187) |
6.92(>55), 12.2 (>60),
47 (>65), 34 (>70) |
0.19 (<55), 0.41 (<60),
0.53 (<65), 0.66 (<70) |
Somewhat High: Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD. | Hudziak, Copeland, Stranger, & Wadsworth, 2004 [1] |
Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score (Achenbach, 1991a) | Boys: .86
(N=111) Girls: 0.90 (N=108) |
10.2 (>55)
11.2 (>55) |
0.41 (>55)
0.35 |
Somewhat High: Utilized sample ages 6-18 which consisted of 219 brothers and sisters of children who were referred to a hospital pediatric unit for ADHD or other symptoms. Half of these siblings had brothers and sisters who had ADHD, half did not. | Chen, Faraone, Biederman, & Tsuang, 1994 [2] |
Teacher Response Form (TRF) - Attention Problems T-Score (Achenbach, 1991a) | Not reported
(N=184) |
3.66 (>70) | 0.73 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Teacher Response Form (TRF) - Attention and Aggression Problems T-Score (Achenbach, 1991a) | Not reported
(N=184) |
4.33 (>70) | 0.89 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Composite International Diagnostic Interview (CIDI) 3.0 (Merikangas et al., 2009) | Adolescent Reported: .57
(N=321) Parent Reported: .71 (N=321) |
8.36 (when classified positive by CIDI)
9.67 (when classified positive by CIDI) |
0.86 (when classified negative by CIDI)
0.56 (when classified negative by CIDI) |
Moderate: Utilized the NCS-A sample of 10,148 adolescents aged 13-17 and their parents. | Green, Avenevoli, Finkelman, Gruber, Kessler et. al, 2010 [4] |
Disruptive Behavior Disorder (DBD) Rating Scale - Parent Report (Pelham et. al, 1992) | 0.78
(N=232) |
5.06 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.20 (<9) (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High; Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. | NEED TO FIND ON PUBMED or maybe some other source? Shemmassian & Lee, 2012] [5] |
Disruptive Behavior Disorder (DBD) Rating Scale - Teacher Report (Pelham et. al, 1992) | 0.63
(N=232) |
1.97 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.24 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High; Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups. | NEED TO FIND ON PUBMED or maybe some other source? Shemmassian & Lee, 2012] [5] |
Vanderbilt ADHD Diagnostic Rating Scale (VADRS) - Parent Report (Wolraich et. al, 1998) | Not reported | 4.79 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.38 (Endorsed < 6 symptoms of inattention or hyperactivity) | Moderate: Sample consists of 582 children ages 5-15 recruited through schools in Oklahoma. Sample includes children screened as "high risk" for ADHD and "low risk" for ADHD. | Bard, Wolraich, Neas, Doffing, & Beck, 2013 [6] |
Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS; Wolraich et. al, 1998) | Not reported | 2.91 (Positive VADTRS Risk Score) | 0.657 (Negative VADTRS Risk Score) | Moderate: Sample consisted of 370 children ages 5-15 recruited though schools in Oklahoma. Sample was representative community sample. | Bard, Wolraich, Neas, Doffing, & Beck, 2013 [6] |
Conners Rating Scale (Revised) - Long Form Parent Report (Conners, 1997) | Not reported | 15.33 (>93rd percentile) | 0.09 (<93rd percentile) | Moderate: Data come from normative sample of 2482 children ages 3 to 17 across the United States and Canada. LRs here discriminate ADHD from Non-Clinical. | Collett, Ohan, & Myers, 2003 [7] |
Conners Parent Rating Scale-48 (CPRS-48) Impulsive-Hyperactive Subscale T-Score (Conners, 1990) | Not reported | 1.26 (>70) | 0.79 (>70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
Conners Teacher Rating Scale (Revised) - Long Form (Conners, 1997) | Not reported | 8.66 (>93rd percentile) | 0.24 (<93rd percentile) | Moderate: Data come from normative sample of 1973 children ages 5 to 17 across the United States and Canada. LRs discriminate ADHD from non-clinical. | Collett, Ohan, & Myers, 2003 [7] |
Conners Teacher Rating Scale-39 Hyperactivity Subscale T-Score (Conners, 1990) | Not reported | 5.2 (>70) | 0.53 (<70) | Somewhat High: Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups. | Tripp, Schaughency, & Clarke, 2006 [3] |
ADHD Symptom Checklist-4 (ADHD-SC4) - Parent Report (Gadow & Sprafkin, 1997) | Not reported | 1.45 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.70 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High: Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. | Sprafkin & Gadow, 2007 [8] |
ADHD Symptom Checklist-4 (ADHD-SC4) - Teacher Report (Gadow & Sprafkin, 1997) | Not reported | 1.53 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) | 0.60 (Endorsed < 6 symptoms of inattention or hyperactivity) | Somewhat High: Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders. | Sprafkin & Gadow, 2007 [8] |
ADHD RS-IV - Home (DuPaul et. al, 1998b) | Not reported | 1.63 (>80th percentile) | 0.35 (<80th percentile) | Moderate: Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. | Collett, Ohan, & Myers, 2003 [7] |
ADHD RS-IV - School (DuPaul et. al, 1998b) | Not reported | 4.5 (>80th percentile) | 0.42 (<80th precentile) | Moderate: Sample of 2000 children ages 5 to 18 years old from geographically representative normative base. | Collett, Ohan, & Myers, 2003 [7] |
Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID; Sheehan et. al, 2009) | 0.83 (N=225 ) | 4.14 (Diagnosis of ADHD on MINI-KID) | 0.16 (No Diagnosis of ADHD on MINI-KID) | MISSING LEVEL: MODERATE? HIGH? Sample of 225 children and adolescents ages 6-17 which included 190 outpatients and 36 controls, recruited from South Florida psychiatric center. | Sheehan, Sheehan, Shytle, Janavas, Bannon et. al, 2009 [9] |
Note: All studies with one exception used structured or semi-structured clinical interviews to establish diagnosis of ADHD. The exception, the Sprafkin & Gadow study (2007), used a combination of CBCL rating scales, clinician review, and clinician consensus to confirm ADHD diagnosis. “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).
Executive Summary:
1. If intervening with children ages 4-5, behavior therapy should be the first line of treatment.
2. If intervening with children ages 6-11, behavior therapy should be the first line of treatment, in conjunction with medication.
3. If intervening with children ages 12-18, medication should probably be the first line of treatment, though behavior therapy could be used in combination.
4. Three types of therapeutic interventions have well established evidence-bases:
5. If considering a classroom management intervention:
American Academy of Pediatrics Clinical Practice Guidelines for ADHD by Age (Subcommittee on AD/HD Disorder, 2011)
1. For preschool-aged children (ages 4-5), primary care clinicans should prescribe evidence-based parent and/or teacher-administered behavior therapy as the first line of treatment, and may prescribe methylphenidate if behavioral interventions are not effective
2. For elementary-aged children (ages 6-11), primary care clinicians should prescribe FDA-approved medications for ADHD and/or evidence based parent and teacher administered behavior therapy. Preferably, both medication and behavior therapy will be prescribed.
3. For adolescents (ages 12-18), primary care clinicians should prescribe FDA approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as a treatment for ADHD, preferably both.
Different Types of Behavioral Therapies which meet American Academy of Pediatrics and American Psychological Association Task Force criteria for well-established Evidence-Based Treatments
*Descriptions and Effect sizes taken from (Subcommitte on AD/HD Disorder, 2011; Pelham & Fabiano, 2008)
Behavioral Parent Training:
Behavior modification principles provided to parents for implementation in home settings. Typical outcomes include improved compliance with parental commands, improved parental understanding of behavioral principles, high levels of parental satisfaction with treatment.
Median effect size: 0.55
Behavioral Classroom Management:
Behavior-modification principles provided to teachers for implementation in classroom settings. Typical outcomes include improved attention to instruction, improved compliance with classroom rules, decreased disruptive behavior, improved work productivity, and improved academic achievement.
Median effect size: 0.61
Behavioral Peer Interventions:
Interventions focused on peer interactions/relationships. These could include group-based interventions provided weekly and include clinic-based social skills training used either alone or concurrently with behavioral parent training and/or medication. Typical outcomes are more mixed with these interventions. Some clinical-office based interventions have produced minimal effects, while some studies of behavioral peer intervention coupled with behavioral parent training found positive effects on parental ratings of ADHD symptoms. No studies of this type of intervention reveal differences on social functioning or parental ratings of social behavior. Behavioral Peer Interventions implemented in peer group/recreational settings (e.g. summer camps) have the most evidence of being
effective.
Median effect size: None reported, effect sizes found are considered moderate.
Findings from DuPaul and colleagues review of school based interventions (DuPaul, Eckert, & Vilardo, 2012)
-Academic intervention (Interventions that focus primarily on manipulating antecedent conditions via things like peer tutoring, computer- aided instruction, and organizational skills interventions) and combined academic and contingency management interventions were associated with greater effects on academic outcomes.
Table 3.11: Single Subject Design Effect Sizes for Academic Outcomes
Intervention Type | Effect Size |
---|---|
Academic | 4.73 |
Cognitive Behavioral | 3.77 |
Contingency Management | 2.29 |
Combined | 2.29 |
-Contingency management (Interventions that use reinforcement and punishment) and cognitive behavioral interventions (Interventions
focused on development of self-control skills and reflective problem-solving strategies) were associated with greater effects for behavior outcomes.
Table 3.12: Single Subject Design Effect Sizes for Behavioral Outcomes
Intervention Type | Effect Size |
---|---|
Academic | 1.53 |
Cognitive Behavioral | 3.31 |
Contingency Management | 2.40 |
Combined | 1.31 |
ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. (2011). Pediatrics, 128 (5),
Pelham, W. R., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of
DuPaul, G. J., Eckert, T. L., & Vilardo, B. (2012). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis 1996-2010. School
Christophersen, E. R., & VanScoyoc, S. (2013). Treatments that work with children: Empirically supported strategies for managing childhood problems (2nd ed.). Washington, DC
Eiraldi, R. B., Mautone, J. A., & Power, T. J. (2012). Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder.
Hodgkins, P., Dittmann, R. W., Sorooshian, S., & Banaschewski, T. (2013). Individual treatment response in attention-deficit/hyperactivity disorder: Broadening perspectives and
Neef, N. A., Perrin, C. J., & Madden, G. J. (2013). Understanding and treating attention- deficit/hyperactivity disorder. In G. J. Madden, W.V. Dube, T. D. Hackenberg, G. P. Hanley,
Schultz, B. K., Storer, J., Watabe, Y., Sadler, J., & Evans, S. W. (2011). School-based treatment of attention-deficit/hyperactivity disorder. Psychology In The Schools,48(3),
Measure | Cut Scores* | Critical Change (Unstandardized Scores) | |||||
A | B | C | 95% | 90% | SEdifference | ||
Benchmarks Based on Published Norms | |||||||
CBCL T-scores (2001 Norms) |
Total | 49 | 70 | 58 | 5 | 4 | 2.4 |
Externalizing |
49 | 70 | 58 | 7 | 6 | 3.4 | |
Internalizing |
n/a | 70 | 56 | 9 | 7 | 4.5 | |
Attention Problems |
n/a | 66 | 58 | 8 | 7 | 4.2 | |
TRF T-Scores (2001 Norms) |
Total | n/a | 70 | 57 | 5 | 4 | 2.3 |
Ext |
n/a | 70 | 56 | 6 | 5 | 3.0 | |
Int |
n/a | 70 | 55 | 9 | 7 | 4.4 | |
Attention Problems |
n/a | 66 | 57 | 5 | 4 | 2.3 | |
Conners 3-Teacher Rating Scale T-Scores | ADHD Inattentive | 36 | 74 | 57 | 11 | 10 | 5.6 |
ADHD Hyperactive-Impulsive | 36 | 74 | 57 | 11 | 9 | 5.5 | |
Conners 3-Parent Rating Scale T-Scores | ADHD Inattentive | 37 | 72 | 58 | 10 | 10 | 5.6 |
ADHD Hyperactive-Impulsive | 37 | 72 | 58 | 10 | 8 | 4.7 | |
Benchmarks Based on ADHD Samples (Shemmassian & Lee, 2012) | |||||||
Disruptive Behavior Disorders Rating Scale | 1.4 | 8.6 | 5.7 | 12 | 10 | 0.9 |
* “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.
Sources Consulted:
Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO
1. CBCL Attention Problems Subscale: Could be used on a weekly basis to track changes in ADHD symptomotology. T-scores from this
measure could also be recorded on a weekly basis to determine if reliable and clinically significant changes in ADHD symptoms are
occuring. The CBCL Attention Problems Subscale has repeatedly demonstrated good-to-excellent convergence with diagnostic interviews
for diagnosing ADHD (Pelham et al., 2005; Lampert, Polanczyk, Tramontina, Mardini, & Rohde, 2004; Hudziak et al, 2004; Chen et al.,
1994). The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.
2. Daily Report Card: Several scholars have pointed out that it is equally important to track changes in the functional behaviors that a child
with ADHD engages in, in addition to their ADHD symptoms, to capture the full range of adaptive changes that are made by children with
ADHD throughout the course of treatment (Pelham et. al, 2005; Sowerby & Tripp, 2009). The daily report card is a mechanism by which
such adaptive behavioral changes can be tracked. When implementing the daily report card, problematic child behaviors at home and at
school are targeted for change. Rewards are offered to the child for reaching daily and weekly goals for reducing maladaptive behaviors and
increasing adaptive behaviors. Parents and Teachers track child behaviors on a daily basis and provide feedback to one another and the child
with behavior frequency counts and/or daily "grades" on how well the child behaved. Daily report cards are a mainstay of cognitive-behavioral and behavioral modification evidence-based intervention strategies for ADHD (DuPaul et al., 2012; Eiraldi et al., 2012) and are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1.
Lampert, T. L., Polanczyk, G. G., Tramontina, S. S., Mardini, V. V., & Rohde, L. A. (2004). Diagnostic performance of the CBCL-
Sowerby, P., & Tripp, G. (2009). Evidence-based assessment of attention-deficit hyperactivity disorder (ADHD). In J. L. Matson, F.
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