Evidence-based assessment/Attention deficit hyperactivity disorder (assessment portfolio)/extended version

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What is a "portfolio"? edit

For background information on what assessment portfolios are, click the link in the heading above.

Does all of this feel like TMI? Click here to go to a condensed version.

Preparation phase edit

Diagnostic Criteria of ADHD in youth edit

ICD-11 Diagnostic Criteria

  • General Definition:
    • Attention deficit hyperactivity disorder is characterized by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity, with onset during the developmental period, typically early to mid-childhood. The degree of inattention and hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of intellectual functioning and significantly interferes with academic, occupational, or social functioning. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. The relative balance and the specific manifestations of inattentive and hyperactive-impulsive characteristics varies across individuals, and may change over the course of development. In order for a diagnosis of disorder the behaviour pattern must be clearly observable in more than one setting.
  • Predominantly Inattentive Presentation:
    • All definitional requirements for attention deficit hyperactivity disorder are met and inattentive symptoms are predominant in the clinical presentation. Inattention refers to significant difficulty in sustaining attention to tasks that do not provide a high level of stimulation or frequent rewards, distractibility and problems with organization. Some hyperactive-impulsive symptoms may also be present, but these are not clinically significant in relation to the inattentive symptoms.
  • Predominantly Hyperactive-Impulsive:
    • All definitional requirements for attention deficit hyperactivity disorder are met and hyperactive-impulsive symptoms are predominant in the clinical presentation. Hyperactivity refers to excessive motor activity and difficulties with remaining still, most evident in structured situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences. Some inattentive symptoms may also be present, but these are not clinically significant in relation to the hyperactive-impulsive symptoms.


Base rates of youth ADHD in different populations and clinical settings edit

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rates of adolescent depression that they are likely to see in their clinical practices.

  • To find prevalence rates across multiple disorders, click here.
Demography Setting Base Rate(s) Diagnostic Method Best Recommended For
Worldwide, Ages 3-18 Meta-Analysis of worldwide prevalence of Child/Adolescent ADHD[1] 6.1% (parent rating)
7.1% (teacher rating)
10.5% (ages 3-5)
11.4% (ages 6-12)
8.0% (ages 13-18)
Multiple, but each focused on DSM-IV criteria
USA Nationally Representative, Ages 3-17 Epidemiological NHIS (US CDC, 2011) 8.4% (Overall)
12.0% (Male)
4.7% (Female)
2.1% (ages 3-5)
8.4% (ages 6-11)
11.9% (ages 12-17)
10.3% (southern region of US)
Parent-report of whether child had ever been diagnosed
USA Nationally Representative, Ages 4-17 Child and Adolescent Epidemiological National Survey of Children's Health (US CDC, 2007) 9.5% (overall)
12.3% (male)
5.3% (female)
1.5% (ages 3-5)
9.1% (ages 6-11)
12.4% (ages 12-17)
15.6% (North Carolina)
Parent-report of whether child had ever been diagnosed
USA Nationally Representative, Ages 5-14 Teacher-Reported Prevalence of ADHD[2] 5.25% (overall)
5.58% (elementary schoolers)
3.53% (middle schoolers)
7.1% (one county in rural NC)
Teacher report of number of children who have been identified with ADHD in their class
USA Nationally Representative, Ages 13-18 Adolescent Epidemiological National Comorbidity Survey-Adolescent Supplement[3] 8.7% CIDI 3.0 structured diagnostic interview
Ages 6-90 Meta-Analysis of Clinical Samples[4] 38% Structured Diagnostic Interviews
Ages 6-90 Meta-Analysis of Clinical Samples[4] 23% Clinical Evaluations
Representative Sample of Johnston County School Children, North Carolina, Ages 6-12 Johnston County, North Carolina Sample[5] 15.5% Combined parent and teacher report (NTRS and DISC) with DSM-IV criteria
Sample drawn from 11 counties in Western NC, Ages 9-16 North Carolina Community Sample[6] 0.9% (3-month prevalence)
4.1% (estimated by age 16)
CAPA structured diagnostic interview
Sample recruited at Durham, NC, Seattle, Nashville, and Central Pennsylvania sites.

Sample was followed longitudinally and identified as at high risk for externalizing disorders in kindergarten. 50%

African American, Ages 12-15

High-Risk Community Sample[7] 14.3% Diagnostic Interview Schedule for Children (DISC)

Prediction phase edit

Psychometric properties of screening instruments for youth ADHD edit

The following section contains a list of screening and diagnostic instruments for ADHD. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly-reaching screening instruments, click here.

Screening and diagnostic instruments for attention deficit hyperactivity disorder edit

Measure Format (Reporter) Age Range Administration/
Completion Time
Inter-rater reliability Test-retest reliability Construct validity Content validity Cost Highly recommended
ADHD Rating Scale (ADHD-RS) V[8] Teacher, Parent 5-17 y/o (Child 5-10, adolescent 11-17) 5 minutes A G
Conners Rating Scale-Revised (CRS-R) ADHD[9] Teacher, Parent A G G  Y
Attention Deficit Disorder Evaluation Scales (ADDES-3) Teacher, Parent A A
Diagnostic Interview Schedule for Children-IV (DISC-IV)[10] Parent Unavailable A G
Behavior Assessment System for Children[11] Self-report, Teacher-report, Parent-report 2:0 - 21:11 (TRS and PRS); 6:0 through college age (SRP) 10-20 minutes (TRS and PRS), 30 minutes (SRP) A G A A Purchase on website: BASC
Strengths & Difficulties Questionare[12] Self-report, Teacher-report, Parent report 4-17 y/o 5 minutes A A G G Free PDF: SDQ

-Strengths and Difficulties Questionnaire for parents or educators of 2-4 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire for parents or teachers of 4-10 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire for parents or teachers of 11-17 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire (Child Self-Report) [age 11-17] Assessment Center Link

-Strengths and Difficulties Questionnaire for self-report by those aged 18+ Assessment Center Link

-Strengths and Difficulties Questionnaire for informant report on those aged 18+ Assessment Center Link

Swanson, Nolan, & Pelham Rating Scale (SNAP)[13] Parent-report Free: PDF:[1], [2]

Assessment Center Online Link

Child and Adolescent Functional Assessment Scale[14] Parent-report, Self-report
Impairment Rating Scale[15] Parent-report, Teacher-report 4-12 y/o Free:
Weiss Functional Impairment Rating Scale[16] Parent-report, Self-report 5-19 y/o A A A Free: [3]  Y

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent [17]

Likelihood ratios and AUCs of screening measures for (insert portfolio name) edit

  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
Screening Measure (Primary Reference) AUC (sample size) DiLR+ (score) Score DiLR- (score) Score Clinical generalizeability Study description Download
Child Behavior Checklist (CBCL) - Attention Problems T-Score[18] .84 (N=187) 6.92 (>55) 0.19 (<55) 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.[19]
12.2 (>60) 0.41 (<60)
47 (>65) 0.53 (<65)
34 (>70) 0.66 (<70)
Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score[18] Boys: .86 (N=111) 10.2 (>55) 0.41 (<55) 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.[20]
Girls: 0.90 (N=108) 11.2 (>55) 0.35 (<55)
Teacher Response Form (TRF) - Attention Problems T-Score[18] 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.[21]
Teacher Response Form (TRF) - Attention and Aggression Problems T-Score[18] Not reported (N=184) 4.33 (>70) 0.89 (<70) Somewhat High
Disruptive Behavior Disorder Rating Scale (DBDRS) - 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.[22][23]
Disruptive Behavior Disorder Rating Scale (DBDRS) - 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
Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS)[24] 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.[25]
Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS)[26] Not reported 2.91 (Positive risk score) 0.657 (Negative risk score) Moderate Sample consisted of 370 children ages 5-15 recruited though schools in Oklahoma. Sample was representative community sample.[27]
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. Diagnostic likelihood ratios here discriminate ADHD from Non-Clinical.[28]
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.[21]
Conners Teacher Rating Scale-39 Hyperactivity Subscale T-Score (Conners, 1990) Not reported 5.2 (>70) 0.53 (<70) Somewhat High
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. Likelihood ratios discriminate ADHD from non-clinical.[28]
ADHD Symptom Checklist-4 (ADHD-SC4) - Parent Report[29] 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.[30]
ADHD Symptom Checklist-4 (ADHD-SC4) - Teacher Report[29] Not reported 1.53 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.60 (Endorsed < 6 symptoms of inattention or hyperactivity) Somewhat High
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.[28]
ADHD RS-IV - School (DuPaul et. al, 1998b) Not reported 4.5 (>80th percentile) 0.42 (<80th percentile) Moderate

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.[30] “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).

Interpreting ADHD screening measure scores edit

Prescription phase edit

Gold standard diagnostic interviews edit

  • For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic interviews for ADHD edit

****Depression instruments are placeholders

Diagnostic instruments for (insert portfolio name)
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Barkley Functional Impairment Scale—Children and Adolescents (BFIS-CA) Parent Report 6-17 5-7 minutes E (.81) G G G Link to purchase
Weiss Functional Impairment Rating Scale[31] Parent/Caregiver

Report

5-19 A A A A PDF

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable[32]

Severity interviews for ADHD edit

Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Rating Scale - Revised (CDRS-R) Structured Interview[33] 6-12 15-20 minutes G A G G X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable [34]

Process phase edit

The following section contains a brief overview of treatment options for ADHD and list of process and outcome measures for ADHD. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Process measures edit

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.[35][36][19][20] The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.
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.[35][37] 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,[38][39] and they are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1.

Outcome and severity measures edit

This table includes clinically significant benchmarks for ADHD specific outcome measures

  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments and ADHD rating scales
Measure Diagnostic category 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
Externalizing N/A 70 56 6 5 3.0
Internalizing 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[22]
Disruptive Behavior Disorders Rating Scale 1.4 8.6 5.7 12 10 0.9

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean. [40]

Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO

Treatment edit

Click here for ADHD Treatment Information

Executive summary edit

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:

a. Behavioral Parent Training Interventions
b. Behavioral Classroom Management Interventions
c. Behavioral Peer interventions involving recreational peer groups (e.g. summer camps)

5. If considering a classroom management intervention:

a. Academic and Cognitive-Behavioral Interventions are most effective in changing academic outcomes
b. Cognitive Behavioral and Contingency Management Interventions are most effective in changing behavioral outcomes

Clinical practice guidelines edit

Published by the American Academy of Pediatrics in 2011.[41]

Preschool-aged children (ages 4–5)
Primary care clinicians 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.
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.
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.

Behavioral therapies edit

These meet the American Academy of Pediatrics and American Psychological Association Task Force criteria for well-established evidence-based treatments. Descriptions and effect sizes are taken from the American Academy of Pediatrics' guidelines[41] and Pelham & Fabiano's review article.[42]

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.

School based interventions edit

Single Subject Design Effect Sizes
Intervention type Effect size
Academic
outcomes
Behavioral
outcomes
Academic 4.73 1.53
Cognitive behavioral 3.77 3.31
Contingency management 2.29 2.40
Combined 2.29 1.31

Findings from a review by DuPaul and colleagues.[38]

Associated with greater effects on academic outcomes
Academic — interventions focus primarily on manipulating antecedent conditions via things like peer tutoring, computer-aided instruction, and organizational skills.
Combined academic and contingency management interventions.
Associated with greater effects for behavior outcomes
Contingency management — interventions use reinforcement and punishment.
Cognitive behavioral — interventions focus on development of self-control skills and reflective problem-solving strategies.

External Links edit

References edit

Click here for references
  1. Willcutt, Erik G. (July 2012). "The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review". Neurotherapeutics 9 (3): 490-99. doi:10.1007/s13311-012-0135-8. PMID 22976615. PMC 3441936. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3441936/. 
  2. Fabiano, Gregory A.; Pelham, William E., Jr.; Majumdar, Antara; Evans, Steven W.; Manos, Michael J.; Caserta, Donald; Girio-Herrera, Erin L.; Pisecco, Stewart et al. (April 2013). "Elementary and Middle School Teacher Perceptions of Attention-Deficit/Hyperactivity Disorder Prevalence". Child & Youth Care Forum 42 (2): 87-99. doi:10.1007/s10566-013-9194-1. 
  3. Merikangas, Kathleen Ries; He, Jian-Ping; Burstein, Marcy; Swanson, Sonja A.; Avenevoli, Shelli; Cui, Lihong; Benjet, Corina; Georgiades, Katholiki et al. (October 2010). "Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A)". Journal of the American Academy of Child and Adolescent Psychiatry 49 (10): 980-9. doi:10.1016/j.jaac.2010.05.017. PMID 20855043. PMC 2946114. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2946114/. 
  4. 4.0 4.1 Rettew, David C.; Lynch, Alicia Doyle; Achenbach, Thomas M.; Dumenci, Levent; Ivanova, Masha Y. (September 2009). "Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews". International Journal of Methods in Psychiatric Research 18 (3): 169-84. doi:10.1002/mpr.289. PMID 19701924. 
  5. Rowland, Andrew S.; Skipper, Betty J.; Umbach, David M.; Rabiner, David L.; Campbell, Richard A.; Naftel, Albert J.; Sandler, Dale P. (11 December 2013). "The Prevalence of ADHD in a Population-Based Sample". Journal of Attention Disorders 19 (9): 741-54. doi:10.1177/1087054713513799. PMID 24336124. PMC 4058092. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4058092/. 
  6. Costello, E. Jane; Mustillo, Sarah; Erkanli, Alaattin; Keeler, Gordon; Angold, Adrian (August 2003). "Prevalence and development of psychiatric disorders in childhood and adolescence". Archives of General Psychiatry 60 (8): 837-44. doi:10.1001/archpsyc.60.8.837. PMID 12912767. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/207725. 
  7. Jones, Damon E.; Foster, E. Michael (October 2009). "Service Use Patterns for Adolescents with ADHD and Comorbid Conduct Disorder". Journal of Behavioral Health Services & Research 36 (4): 436-49. doi:10.1007/s11414-008-9133-3. PMID 18618263. PMC 3534729. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3534729/. 
  8. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD Rating Scale–IV: Checklists, norms, and clinical interpretation. New York: Guilford Press
  9. Kao, Grace S.; Thomas, Hillary M. (2010-12). "Test Review: C. Keith Conners Conners 3rd Edition Toronto, Ontario, Canada: Multi-Health Systems, 2008". Journal of Psychoeducational Assessment 28 (6): 598–602. doi:10.1177/0734282909360011. ISSN 0734-2829. http://journals.sagepub.com/doi/10.1177/0734282909360011. 
  10. Vaughn, Aaron J.; Hoza, Betsy (2012-02-17). "The Incremental Utility of Behavioral Rating Scales and a Structured Diagnostic Interview in the Assessment of Attention-Deficit/Hyperactivity Disorder". Journal of Emotional and Behavioral Disorders 21 (4): 227–239. doi:10.1177/1063426611427910. ISSN 1063-4266. http://dx.doi.org/10.1177/1063426611427910. 
  11. Reynolds, C. R., Kamphaus, R. W., & Vannest, K. J. (2015). BASC3: Behavior assessment system for children. PscyhCorp.
  12. Goodman, R.; Ford, T.; Simmons, H.; Gatward, R.; Meltzer, H. (2003-01). "Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample". International Review of Psychiatry 15 (1-2): 166–172. doi:10.1080/0954026021000046128. ISSN 0954-0261. http://www.tandfonline.com/doi/full/10.1080/0954026021000046128. 
  13. Swanson, J. M. (1992). School-based assessments and interventions for ADD students. KC publishing.
  14. Hodges, Kay; Wong, Maria M. (1996-12). "Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale". Journal of Child and Family Studies 5 (4): 445–467. doi:10.1007/bf02233865. ISSN 1062-1024. http://dx.doi.org/10.1007/bf02233865. 
  15. Fabiano, Gregory A.; Pelham, Jr., William E.; Waschbusch, Daniel A.; Gnagy, Elizabeth M.; Lahey, Benjamin B.; Chronis, Andrea M.; Onyango, Adia N.; Kipp, Heidi et al. (2006-07-01). "A Practical Measure of Impairment: Psychometric Properties of the Impairment Rating Scale in Samples of Children With Attention Deficit Hyperactivity Disorder and Two School-Based Samples". Journal of Clinical Child & Adolescent Psychology 35 (3): 369–385. doi:10.1207/s15374424jccp3503_3. ISSN 1537-4416. http://dx.doi.org/10.1207/s15374424jccp3503_3. 
  16. Thompson, Trevor; Lloyd, Andrew; Joseph, Alain; Weiss, Margaret (2017-02-20). "The Weiss Functional Impairment Rating Scale-Parent Form for assessing ADHD: evaluating diagnostic accuracy and determining optimal thresholds using ROC analysis". Quality of Life Research 26 (7): 1879–1885. doi:10.1007/s11136-017-1514-8. ISSN 0962-9343. http://dx.doi.org/10.1007/s11136-017-1514-8. 
  17. "Evidence-based assessment/Reliability - Wikiversity". en.wikiversity.org. Retrieved 2020-11-13.
  18. 18.0 18.1 18.2 18.3 Achenbach, Thomas M. (1991). Child behavior checklist for ages 4-18. Burlington, VT: Department of Psychiatry, University of Vermont. ISBN 978-0-938565-08-6. 
  19. 19.0 19.1 Hudziak, James J.; Copeland, William; Stanger, Catherine; Wadsworth, Martha (October 2004). "Screening for DSM-IV externalizing disorders with the Child Behavior Checklist: A receiver-operating characteristic analysis". Journal of Child Psycholology and Psychiatry 45 (7): 1299-307. doi:10.1111/j.1469-7610.2004.00314.x. PMID 15335349. 
  20. 20.0 20.1 Chen, Wei J.; Faraone, Stephen V.; Biederman, Joseph; Tsuang, Ming T. (October 1994). "Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis". Journal of Consulting and Clinical Psychology 62 (5): 1017-25. doi:10.1037/0022-006X.62.5.1017. PMID 7806710. 
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