Assessment of ADHD

Each case presented with symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) comes with its own set of circumstances. Not unlike any other diagnosis, each presenting individual will have issues that sets them apart from the others, thereby requiring clinicians to act not on memory of certain methods but the knowledge of resources they have available. For this reason, over the years there have been innovations of assessment tools designed to help clinicians determine how closely these individuals align with the ADHD diagnosis. Ranging from checklists to clinical interviews, there are many options clinicians can choose from when forming their diagnostic impression. This paper will seek to determine the tools that have been used in the past as well as which ones are currently being used, along with their levels of efficacy in distinguishing ADHD symptomology; using the Connners, Child Behavior Checklist, Behavior Assessment System for Children, and an objective testing tool (Qbtest).

History of Assessment

In the 1980's there was a surge of research regarding ADHD and its diagnosis. The need at this time was to clarify specificity over which symptoms were truly being assessed within assessments such as the Conners 10-Item Hyperactivity List (Barkley, 2006). The Conners assessment consisted of two rating scales for teacher as well as two rating scales for parents. The rating scales used a 4-point scale of: Not at all, just a little, pretty much, and very much. This assessment was one of main tools being used to identify potential ADHD cases, possibly in cases involving people of color and young girls but was normed for a mostly white male population. In addition, the Conners scale was normed for children ranging between the ages of 3 and 14, potentially excluding adolescents who may have fit the criteria for ADHD. Another critique of this tool would be the subjectivity of the assessment itself. The parent/teacher scales require observations from each individual that may not match up to one another. In fact, the interrater reliability for parent-teacher comparisons were the lowest of the measures of reliability.

Later on, it would be found that the assessment was in fact determining aggressive symptoms as opposed to symptoms of hyperactivity. Because of this, new criteria emerged requiring individuals who were selected for ADHD research to meet: (1) problems with activity and attention reported by adults in at least two different settings such as home and school, (2) confirmation of three out of four difficulties with activity as well as attention, (3) symptoms began before the age of 7, (4) has been occurring for at least 2 years, (5) significant scores on parent and teacher reports, and (6) differentiated from autism or other psychosis (Barkley, 2006). Though that process is still being perfected and developed by clinicians, this step would lead to differentiations between ADD, ADHD, and eventually ODD.

Of course, along with research came new assessments built off the old. The Child Behavior Checklist (CBCL) became one of the more prominent assessment tools in the 80's (Barkley, 2006). Compared to the Conners rating scales as mentioned previously, the CBCL was regarded as a better alternative to the Conners assessments because of its rigorous development and more comprehensive evaluation of the ADHD symptomology.

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