{{Short description|Self-reported ADHD assessment}} {{For|other topics with the initialism ARS|Ars (disambiguation){{!}}Ars}} {{Wikiversity|ADHD Rating Scale}} {{Page numbers needed|date=November 2016}} {{Psychology sidebar}} The '''ADHD Rating Scale''' ('''ADHD-RS''') is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid<ref name=":4" /> consisting of 18–90 questions regarding a child's behavior over the past 6 months.<ref name=":4">{{cite book|last1=DuPaul|first1 =G. J.|last2=Power|first2=T. J.|last3=Anastopoulos|first3=A. D.|last4=Reid|first4=R.|title=ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation.|date=1998|publisher=Guilford|location=New York|url=http://www.guilford.com/books/ADHD-Rating-Scale-5-for-Children-and-Adolescents/DuPaul-Power-Anastopoulos-Reid/9781462524877|access-date=9 September 2016}}</ref> The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.<ref name=":4" />
The ADHD-RS is currently in its fifth version in correlation with the ''DSM-5''.
== Overview == The ADHD-RS, is an 18-question self-report assessment that takes about five minutes to complete.<ref name=":4" /> Each question measures the frequency of the behavior, in which the respondent is asked to indicate whether the behavior occurs "always or very often", "often", "somewhat", or "rarely or never". The questionnaire is intended to be filled out by parents and teachers of the child or adolescent.<ref name=":4" /> The first nine items ask questions about behavior related to inattention (e.g., "has difficulty organizing task and activities"). The second set of nine items ask questions about behavior related to symptoms of hyperactivity and impulsivity (e.g., "talks excessively"). The last question asks if the behaviors were present before age seven.<ref name=":4" /> Some examples of ADHD behaviors measured by the scale include difficulty focusing on tasks, trouble with organizing, inability to pay attention, squirming, fidgeting, impatience, difficulty waiting their turn, and frequently interrupting others.<ref name=":4" /> The ADHD Rating scale has impacted the world of clinical psychology by providing an accurate and valid measure that is able to identify the presence of ADHD in children.<ref name=":6" /> It is also helpful in identifying the subtype (predominantly Inattentive, predominantly Hyperactive-Impulsive, and Combined) of the disorder.<ref name=":6">{{cite journal |last1=Taylor|first1=Abigail |last2=Deb|first2=Shoumitro |last3=Unwin|first3=Gemma |title=Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): A systematic review|journal=Research in Developmental Disabilities|date=February 12, 2011|volume=32|issue=3|pages=924–38|pmid=21316190|doi=10.1016/j.ridd.2010.12.036}}</ref> The ADHD Rating Scale has a high sensitivity and specificity for diagnosis based on teacher reports and a low specificity and high sensitivity for diagnosis based on parental reports.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/attention-deficit-hyperactivity-disorder/research |title=ADHD Diagnosis and Treatment in Children and Adolescents |last=Peterson |first=Bradley S. |last2=Trampush |first2=Joey |last3=Maglione |first3=Margaret |last4=Bolshakova |first4=Maria |last5=Brown |first5=Morah |last6=Rozelle |first6=Mary |last7=Motala |first7=Aneesa |last8=Yagyu |first8=Sachi |last9=Miles |first9=Jeremy |date=2024-03-25 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/AHRQEPCCER267|url-access=subscription }}</ref>
==Development and history== Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurological disorders found in children.<ref name=":4" />
The ADHD-RS was created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid to address the need for an effective evaluation for children and adolescents suspected of having ADHD.<ref name=":4" /> The diagnostic criteria were developed through a selection of items from general rating scales such as the Child Behavior Checklist.<ref name=":0">{{Cite journal |last1=DuPaul |first1=George J. |last2=Rapport |first2=Mark D. |last3=Perriello |first3=Lucy M. |date=1991-06-01 |title=Teacher Ratings of Academic Skills: The Development of the Academic Performance Rating Scale |url=https://www.tandfonline.com/doi/full/10.1080/02796015.1991.12085552 |journal=School Psychology Review |language=en |volume=20 |issue=2 |pages=284–300 |doi=10.1080/02796015.1991.12085552 |issn=2372-966X|url-access=subscription }}</ref> The list initially contained 14 items and grew to the 18 questions we have today.<ref name=":4" /><ref name=":0" />
The assessment largely serves the purpose of matching parent and teacher observations of ADHD symptoms to DSM-IV criteria of ADHD.<ref name=":52">{{Cite book |last1=Dupaul |first1=George |title=The fifteenth mental measurements yearbook |last2=Power |first2=Thomas |last3=Anastopoulos |first3=Arthur |last4=Reid |first4=Robert |publisher=Guilford Publications, Inc |year=1998 |location=New York, NY |chapter=ADHD Rating Scale-IV |via=EBSCOhost}}</ref> It was developed in tandem with the Academic Performance Rating Scale (APRS) to be used as a complementary system of identification for potential behavioral disorders in the classroom.<ref name=":0" /> Class performance is still a diagnostic factor though evaluated through the more comprehensive DSM-5 criteria;<ref name=":1">{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=5th |language=en |doi=10.1176/appi.books.9780890425596}}</ref> as children with ADHD are likely to find issue in scholastic performance, personal conduct, and maintaining social relationships.<ref name=":4" /><ref name="Smith(2007) in Mash & Barkley EBA22">{{Cite book |last1=Smith |first1=B.H. |title=Assessment of Childhood Disorders |last2=Barkley |first2=R.A. |last3=Shapiro |first3=C.J. |publisher=Guilford Press |year=2007 |isbn=978-1593854935 |editor-last=Mash |editor-first=Eric J. |edition=4th |location=New York, NY |pages=53–131 |chapter=Attention-Deficit/Hyperactivity Disorder |editor-last2=Barkley |editor-first2=Russell A.}}</ref>
DSM-IV outlines three subtypes of ADHD: ADHD combined type, ADHD predominantly inattentive, and ADHD predominantly hyperactive-impulsive. The ADHD-RS separates domain scores of "Inattention" and "Hyperactivity-Impulsivity" which ultimately results in three scores for "Inattention," Hyperactivity-Impulsivity", and "Total".<ref name=":52" /> DSM-IV also organizes diagnostic criteria into two categories of Inattention and Hyperactivity-Impulsivity, each of which includes nine symptoms.<ref name=":4" /> The eighteen questions of the ADHD-RS were written to reflect each symptom of both categories.<ref name=":4" />
With the release of DSM-5, the questionnaire was adjusted to be in line with the new criteria established.<ref name=":1" />
== Questionnaire versions == The four versions ask age-appropriate questions about hyperactivity and inattention in specific settings.<ref name=":4" /> ; Home : There are two home versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at home by a parent or guardian. The questions are specific to situations and activities in the home setting.<ref name=":4" /> ; School : There are two school versions — Child (ages 5–10) and Adolescent (ages 11–17). These are intended to be completed at school by a teacher. The questions are specific to situations and activities in the school setting, such as staying in one's seat or completing schoolwork.<ref name=":4" />
== Reliability and validity ==
=== Reliability === {| class="wikitable" |+ Rubric for evaluating norms and reliability for the ADHD Rating Scale{{efn|group=RandV|name=table_source|Table from Youngstrom et al.,<ref>{{cite web |last=Youngstrom |first=E.A. |display-authors=etal |title=Evidence-Based Assessment |url=https://ericyoungstrom.web.unc.edu/evidence-based-assessment/ |website=Eric A. Youngstrom, Ph.D. |publisher=The University of North Carolina at Chapel Hill}}</ref> extending Hunsley & Mash, 2008.<ref>{{Cite book|title=A Guide to Assessments that Work|last1=Hunsley|first1=John|last2=Mash|first2=Eric|publisher=Oxford Press|year=2008|isbn=978-0195310641|location=New York, NY}}</ref>{{pages needed|date=November 2016}} }} ! Criterion !! Rating (adequate, good, excellent, too good{{efn|group=RandV|name=newConstruct|New construct or category.}}) !! Explanation with references |- | Norms || Adequate || |- |Internal consistency (Cronbach's alpha, split half, etc.) || Excellent || Alphas were > .90 for the School and Home versions.<ref name=":4" /> |- |Inter-rater reliability ||Less than adequate ||reliability between parents and teachers was =.41<ref name=":4" /> |- |Test-retest reliability (stability) || Adequate ||Total score =.85 over a 4-week period<ref name=":4" /> |- |Repeatability || Not published || No published studies formally checking repeatability |}
=== Validity === {| class="wikitable" |+ Evaluation of validity and utility for the ADHD Rating Scale{{efn|name=table_source}} ! Criterion !! Rating (adequate, good, excellent, too good{{efn|name=newConstruct}}) !! Explanation with references |- | Content validity ||Adequate|| Covers DSM diagnostic symptoms for both hyperactivity and impulsivity subtypes and combined type.<ref name=":4" /> |- |Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity) || Excellent ||In the clinical setting the predictive validity for the combined subscale for parents and teachers were 60% and 65% accuracy, respectively. This indicates that the assessment has statistically significant accuracy at identifying the diagnosis.<ref name=":5">{{Cite book |last1=Dupaul |first1=George |title=The fifteenth mental measurements yearbook |last2=Power |first2=Thomas |last3=Anastopoulos |first3=Arthur |last4=Reid |first4=Robert |publisher=Guilford Publications, Inc |year=1998 |location=New York, NY |chapter=ADHD Rating Scale-IV |via=EBSCOhost}}</ref> |- |Discriminative validity ||Adequate ||Statistically significant discrimination in mean rating between three groups of participants that identified as ADHD Combined, ADHD Inattentive and no ADHD.<ref name=":5" /> |- |Validity generalization || Good || Used as other-report from both teachers and parents; used in school settings as well as clinical setting; assessment was normed on a random sample of the population that included many different ethnic and demographic backgrounds.<ref name=":5" /> |- |Treatment sensitivity ||Adequate||Can be used in order to access progression of ADHD symptoms throughout treatment.<ref name=":5" /> |- |Clinical utility ||Good|| Easily accessible through the purchase of the handbook that includes the assessment and scoring information with permission to photocopy, strong psychometrics. Completion and scoring are quick and easy.<ref name=":4" /> |} {{notelist|group=RandV}}
==Impact== The ADHD Rating Scale has provided a quick and easy assessment for clinicians to use in order to diagnose ADHD according to the DSM criteria.<ref name=":4" /> The creation of this assessment also provided a consistent way for clinicians to diagnose ADHD in children. This assessment is used in both clinical and school settings to measure the presence of ADHD as well as the subtype that may be present.<ref name=":4" /> The measure can also be used to measure the presence and continuation of symptoms throughout treatment.<ref name="Smith(2007) in Mash & Barkley EBA2">{{Cite book |last1=Smith |first1=B.H. |title=Assessment of Childhood Disorders |last2=Barkley |first2=R.A. |last3=Shapiro |first3=C.J. |publisher=Guilford Press |year=2007 |isbn=978-1593854935 |editor-last=Mash |editor-first=Eric J. |edition=4th |location=New York, NY |pages=53–131 |chapter=Attention-Deficit/Hyperactivity Disorder |editor-last2=Barkley |editor-first2=Russell A.}}</ref> This assessment has also been used as the basis for studies covering a wide variety of topics related to ADHD.<ref>{{Cite journal|url= |title=Analysis of individual items on the attention-deficit/hyperactivity disorder symptom rating scale in children and adults: the effects of age and sex in pivotal trials of lisdexamfetamine dimesylate|last1=Weisler|first1=Richard H.|last2=Adler|first2=Lenard A.|date=2013-12-09|journal=Neuropsychiatric Disease and Treatment|language=en|last3=Kollins|first3=Scott H.|last4=Goodman|first4=David W.|last5=Hamdani|first5=Mohamed|last6=Dirks|first6=Bryan|last7=Childress|first7=Ann C.|volume=10|pages=1–12|doi=10.2147/NDT.S47087|pmid=24363557|pmc=3862743 |doi-access=free }}</ref>
While the ADHD Rating Scale is widely used to assess ADHD symptoms in children and adolescents, a systematic review by Peterson et al. (2024) highlights its variable diagnostic performance and emphasizes the need for its use alongside clinician judgment and multiple informant inputs.<ref>{{Cite journal |last1=Peterson |first1=Bradley S. |last2=Trampush |first2=Joey |last3=Brown |first3=Morah |last4=Maglione |first4=Margaret |last5=Bolshakova |first5=Maria |last6=Rozelle |first6=Mary |last7=Miles |first7=Jeremy |last8=Pakdaman |first8=Sheila |last9=Yagyu |first9=Sachi |last10=Motala |first10=Aneesa |last11=Hempel |first11=Susanne |date=2024-04-01 |title=Tools for the Diagnosis of ADHD in Children and Adolescents: A Systematic Review |url=https://publications.aap.org/pediatrics/article/153/4/e2024065854/196923/Tools-for-the-Diagnosis-of-ADHD-in-Children-and |journal=Pediatrics |language=en |volume=153 |issue=4 |doi=10.1542/peds.2024-065854 |pmid=38523599 |issn=0031-4005|url-access=subscription }}</ref>
==Use in other populations==
=== ADHD Rating Scale-IV === The ADHD RS- IV is widely used in the U.S. in English; however, because of the increasing population of Latino-Americans in the U.S., the ADHD Rating Scale was also translated into Spanish to accommodate those speaking Spanish as their first language.<ref name=":4" /> Also, many other countries have already translated and validated the ADHD scale into their primary spoken language. According to the Archives of Clinical Psychiatry in São Paulo, the TDAH (Portuguese abbreviation for ADHD)<ref>{{Cite journal|last1=Mattos|first1=Paulo|last2=Segenreich|first2=Daniel|last3=Saboya|first3=Eloísa|last4=Louzã|first4=Mário|last5=Dias|first5=Gabriela|last6=Romano|first6=Marcos|date=2006|title=Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos|journal=Archives of Clinical Psychiatry (São Paulo)|language=pt|volume=33|issue=4|pages=188–194|doi=10.1590/S0101-60832006000400004|issn=0101-6083|doi-access=free}}</ref> was fully validated in Brazil by the end of 2006.
==Limitations== Ratings of ADHD symptoms on rating scales in general are subjective. Teachers and parents may use different subjective criteria to define symptoms, and may not take context of symptoms into account when making ratings.<ref name="Smith(2007) in Mash & Barkley EBA2"/> Furthermore, the validity of the ARS is acceptable,<ref name=":4" /> but the normative sample used to calculate this statistic was composed of children aged 5 to 14, and thus it cannot be generalized beyond age range.<ref name=":5" />
According to an accuracy study performed Pediatrics Association in 2016, from all scales they examined the ASQ is the most effective scale that can be used to diagnose the disease, due to its high brevity and high diagnostic accuracy.<ref>{{Cite journal|last1=Chang|first1=Ling-Yin|last2=Wang|first2=Mei-Yeh|last3=Tsai|first3=Pei-Shan|date=2016-03-01|title=Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis|url=https://pediatrics.aappublications.org/content/137/3/e20152749|journal=Pediatrics|language=en|volume=137|issue=3|pages=e20152749|doi=10.1542/peds.2015-2749|issn=0031-4005|pmid=26928969|doi-access=free|url-access=subscription}}</ref> A Manual called "Conners Comprehensive Behavior Rating Scales", released in 2017, states that results from discriminative validity analysis showed that the accuracy of the scores to be at 78% across all forms used to diagnose the disease.<ref>{{Cite web|url=https://issuu.com/mhs-assessments/docs/connerscbrs_brochure2017_insequence|title=Conners CBRS 2017 |website=issuu.com|date=13 February 2017 |access-date=2019-12-10}}</ref>
There are also questions about how well items on the ARS follow explicit DSM criteria. Specifically, one of the hyperactivity items does not specify that in adolescents, thoughts of restlessness are sufficient, rather than excessive behavioral movement. This lack of specification does not map directly onto DSM criteria.<ref name=":5" />
This assessment can be accessed by purchasing the ADHD Rating Scale handbook, which includes copies of the Teacher and Parent versions with permission to photocopy for clinical use.
==Also see== * Attention-Deficit/Hyperactivity Disorder Investigator Symptom Rating Scale
== References == {{reflist|30em}}
==External links== * [https://sccap53.org Society of Clinical Child and Adolescent Psychology] * [http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/inattention-and-hyperactivity-adhd/ EffectiveChildTherapy.Org information on ADHD] * Adult ADHD Self-Report Scale)[https://www.psychiatrictimes.com/clinical-scales-adhd/asrs-adult-adhd-self-report-scale] {{Webarchive|url=https://web.archive.org/web/20191006221006/https://www.psychiatrictimes.com/clinical-scales-adhd/asrs-adult-adhd-self-report-scale |date=2019-10-06 }} * [https://www.medicalnewstoday.com/articles/321867.php#adhd-rating-scale-tests The Conners CBRS] * [https://tematherapy.com/testing-evaluation/adhd-screening/ ADHD Testing NJ]
Category:Diagnostic and Statistical Manual of Mental Disorders Category:Questionnaire construction Category:Screening and assessment tools in child and adolescent psychiatry Category:ADHD screening and assessment tools