Innovations in Assessing ADHD: Development, Psychometric Properties, and Factor Structure of the ADHD Symptoms Rating Scale (ADHD-SRS)

This research involved the development of a behavior rating scale designed to measure ADHD and the investigation of the scale's psychometric properties and factor structure. This scale, the ADHD Symptoms Rating Scale (ADHD-SRS), was developed for the assessment of ADHD in the school-age (K–12) population. Participants were 1006 children and adolescents (in grades K–12) who were rated by their parents and/or teachers. The results indicate that the ADHD-SRS possesses strong internal consistency reliability and test–retest reliability and moderate cross-informant reliability. The data also suggest that the ADHD-SRS has strong content validity. Convergent validity of this instrument was also high, as demonstrated by correlations with three previously validated behavior rating scales. Significant age and gender differences in ADHD symptoms were found with both the parent and teacher respondent populations. Finally, the factor analysis of the ADHD-SRS suggested a two factor oblique rotation as the best fit for both the parent and the teacher data. After a visual inspection of the items which loaded on each factor, Factor 1 was named Hyperactive-Impulsive and Factor 2 was named Inattention. These two factors, along with the items which loaded on each factor, appear to be remarkably similar to the two categories listed in the DSM-IV for ADHD. Directions for future research, as well as clinical implications and limitations of the research are discussed.     

Assessing Stress in Families of Children with ADHD: Preliminary Development of the Disruptive Behavior Stress Inventory (DBSI)

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure.     

Investigating the Impact of Strength-Based Assessment on Youth with Emotional or Behavioral Disorders

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness.     

Strengths and Subjective Wellbeing in Adolescence: Strength-Based Parenting and the Moderating Effect of Mindset

Recent research suggests that strength-based parenting—the tendency for parents to see and encourage children to use their strengths—relates to lower stress and higher life satisfaction in adolescents. The current study tests whether strength-based parenting, in conjunction with a teenager’s strengths use, influences the teenager’s subjective wellbeing, and whether a growth mindset moderates the relationship between strength-based parenting and strengths use. Three hundred and sixty three adolescents (M _age = 13.74, 51% female) completed questionnaire measures of strength-based parenting, strengths use, subjective wellbeing (life satisfaction, positive affect, and negative affect), Extraversion, Neuroticism, and two aspects of growth mindset. A hierarchical regression using latent variables found that strengths use and strength-based parenting were both significant independent predictors of subjective wellbeing, over and above the effects of extraversion and neuroticism. A mediation analysis found that strengths use partially mediated the relationship between strength-based parenting and subjective wellbeing. Finally, a novel measure of strengths mindset significantly moderated the relationship between strength-based parenting and strengths use. These results suggest that adolescents who see their parents as strength-based report greater strengths use (especially when they have a growth mindset about their strengths) and greater subjective wellbeing.     

An examination of the RCMAS-2 scores across gender, ethnic background, and age in a large Asian school sample

The present study investigated the factor structure, reliability, convergent and discriminant validity, and U.S. norms of the Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS-2; C. R. Reynolds & B. O. Richmond, 2008a) scores in a Singapore sample of 1,618 school-age children and adolescents. Although there were small statistically significant differences in the average RCMAS-2 T scores found across various demographic groupings, on the whole, the U.S. norms appear adequate for use in the Asian Singapore sample. Results from item bias analyses suggested that biased items detected had small effects and were counterbalanced across gender and ethnicity, and hence, their relative impact on test score variation appears to be minimal. Results of factor analyses on the RCMAS-2 scores supported the presence of a large general anxiety factor, the Total Anxiety factor, and the 5-factor structure found in U.S. samples was replicated. Both the large general anxiety factor and the 5-factor solution were invariant across gender and ethnic background. Internal consistency estimates ranged from adequate to good, and 2-week test-retest reliability estimates were comparable to previous studies. Evidence providing support for convergent and discriminant validity of the RCMAS-2 scores was also found. Taken together, findings provide additional cross-cultural evidence of the appropriateness and usefulness of the RCMAS-2 as a measure of anxiety in Asian Singaporean school-age children and adolescents.     

Teacher and parent perceptions of behavior problems among a sample of African American,Hispanic, and non-Hispanic white studients

A multiracial/multiethnic sample of middle school adolescents and their teachers was used to assess whether teacher ratings of student behavior problems varied according to teacher-student racial/ethnic differences and students' perception of teachers' attitudes toward them. No significant mean score differences were found for Hispanic or non-Hispanic white students according to the race/ethnicity of the teachers doing the ratings. However, African American students rated by Hispanic and non-Hispanic white teachers had significantly higher mean total behavior problem scores than African American students rated by African American teachers. Teacher ratings were also compared to those made by parents. The percentage of students rated as cases by teachers but not by parents differed significantly by race/ethnicity of student. Other findings indicated highly significant relationships between student-perceived teacher disparagement and the assignment of high behavior problem scores to students by teachers. This research was supported by a grant from the National Institute on Drug Abuse, R01DA05912; William A. Vega, Principal Investigator. The authors express their appreciation to Superintendent Octavio Visiedo, Dr. James Mennes, Dr. Sylvia Rothfarb, and the cooperating staff and teachers of the Dade County Public Schools for their support in the conduct of this research.     

Psychometric Properties and Convergent Validity of the Dependency-Oriented and Achievement-Oriented Psychological Control Scale (DAPCS) with Italian Adolescents

This study is aimed to validate the Italian version of the dependency-oriented and achievement-oriented psychological control scale (DAPCS), a self-report questionnaire designed to assess the adolescent’s perception of the two dimensions of psychological control. In Study 1, we assessed factorial validity and reliability of the Italian version of DAPCS with a sample of adolescents. In Study 2, we examined the convergent validity of the Italian version of the DAPCS analyzing the associations between the two domains of psychological control and well-established measures related to them such as strictness/supervision, overprotection, non dependency on parents, and family functioning. Confirmatory factor analyses confirmed the hypothesized two-factor solution of the DAPCS, with a 16 items’ version better fitting the data, for paternal as well as for maternal ratings. High indices of internal consistency indicated that both subscales produced reliable scores. Convergent validity was confirmed by positive associations between the DAPCS’ subscales and measures of strictness and negative associations between the DAPCS’ subscales and measures of global family functioning, both for maternal and paternal ratings. Finally, results evidenced significant effects for adolescents’ and parental gender on achievement-oriented psychological control, with mothers rated higher than fathers by males and fathers rated higher than mothers by females. Overall, the results of these studies indicated that the Italian form of the DAPCS might be a useful instrument to assess the two domain-specific types of parental psychological control among Italian-speaking adolescents.     

Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of degree of impairment in functioning. Interrater reliability data are presented for lay raters, graduate students, and frontline staff. Reliability was high for the total score and behaviorally-oriented scales. Construct, concurrent, and discriminant validity were assessed with the sample of children and adolescents evaluated at the Fort Bragg Demonstration Evaluation Project. Youth and their caregivers were evaluated via interview and selfcompleted instruments at four time points. Significant correlations were found between the CAFAS and other related constructs. Concurrent validity was demonstrated by logistic regression analyses examining the relationship between CAFAS ratings and problematic behaviors endorsed on measures completed by parents, teachers, or the youth. Youth with higher CAFAS total scores were much more likely to have poor social relationships, difficulties in school, and problems with the law. Discriminant validity was assessed with a repeated measures analysis of variance with intensity of care at intake and time as factors. Youth who were inpatients or in residential treatment centers at intake had higher CAFAS scores than those who were outpatients. These findings provide strong evidence for the reliability and validity of the CAFAS.     

The Infant–Toddler Social and Emotional Assessment (ITSEA): Factor Structure, Reliability, and Validity

In this paper the refinement and psychometric properties of the Infant–Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence domains as well as the 17 individual scales that comprise the ITSEA. Findings for 3 additional indices useful in identifying significant psychopathology are presented. Subgroup analyses revealed structural invariance and expected mean level differences across both child sex and 6-month age bands. Child sex differences emerged for some problem and most competence scales, with boys rated as higher on Activity–Impulsivity and girls rated higher on Anxiety and most Competence scales. All competence scores increased across age groups. Problem behaviors showed a more mixed developmental pattern. Test–retest and interrater reliability were acceptable. Associations between the ITSEA and independent evaluator ratings and parental ratings of child behavior problems, temperament, and parental distress support the validity of the instrument.     

Anxiety in Children and Adolescents Rated by Patients,Parents, and Teachers: Factor Structure and Psychometric Properties of an ICD-10 and DSM-IV-based Rating Scale in a Large Clinical Sample

This study examined the psychometric properties of the German Self-Report and Parent Report Rating Scale for Anxiety Disorders (SRS-AD and PRS-AD), and a shortened teacher version of the PRS-AD (TRS-AD) in a large clinical sample. Data were collected from 585 children, adolescents and young adults with psychiatric disorders (aged 6–21 years), 821 parents and 378 teachers. Factorial validity, reliability and discriminating validity of the scales were examined and the agreement between different informants was assessed. Analyses were performed in the complete sample including a wide range of different psychiatric disorders as well as in a subsample of children, adolescents and young adults with anxiety disorders. Confirmatory factor analyses mostly supported a model with first-order factors according to the subscales and a second-order overall anxiety factor. Only for the SRS-AD analysed in the sample of participants with anxiety disorders, the results did not clearly favour a first-order solution with correlated factors according to the subscales or the second-order solution adopted for the other questionnaires. Internal consistencies for the total scale and subscales were mostly satisfactory. Significant mean differences between anxious and non-anxious participants were found for the mean total scores of the SRS-AD and PRS-AD, but not for the TRS-AD. The informant agreement was low-to-moderate. We concluded that the SRS-AD, PRS-AD and TRS-AD demonstrate satisfactory psychometric properties for use with clinically-referred children and adolescents.     

Childhood Schizophrenia and Autism: An Empirical Study of Perceived Social Support

Although there is an abundance of literature focusing on social support for children and adults with mental illness, there is a paucity of research examining social support for individuals diagnosed with childhood and adolescent onset schizophrenia. Literature suggests that measuring social support in youth with schizophrenia poses unique challenges, which may be why it is so under-represented in existing research. In an effort to learn more about the availability of social support for children in this population, the current study compared measures of social support for children and adolescents, 5 to 17 years old, diagnosed with childhood schizophrenia to those for children diagnosed with autism spectrum disorder. The study surveyed parents of children with schizophrenia and autism using the Family Needs Questionnaire to measure perceived social support, and a subsection of the Ohio Youth Problem, Functioning, and Satisfaction Scales to measure the parent’s assessment of children’s level of functioning. A Family Questionnaire was also administered to collect demographic information about the children and their families. Results indicated, contrary to the original hypothesis, that parents of children with schizophrenia perceived their offspring as having more social support than children with autism, even though overall parents of children in the schizophrenia group rated their children as having a lower level of functioning. However, the study also found that when assessing the importance of social support needs, parents of children with schizophrenia rated their children’s needs as being significantly more important than parents of children with autism. A discussion of the research findings and limitations of the study are offered, in addition to suggestions for future research.     

Factor Structure and Criterion Validity of Secondary School Teacher Ratings of ADHD and ODD

Attention-Deficit Hyperactivity Disorder (ADHD) is currently viewed as a heterogeneous disorder with two factors: inattention and impulsivity–hyperactivity. This conceptualization of ADHD is based primarily on research with children or samples that mix children and adolescents. To examine if the 2-factor ADHD model is appropriate for adolescents and if the ADHD factors are distinct from Oppositional Defiant Disorder (ODD) in adolescents, teacher rating data were collected for 2 samples of adolescents. The results of a confirmatory factor analysis supported the convergent and divergent validity of a model with separate but correlated factors for inattention, impulsivity–hyperactivity, and defiant behavior. Further evidence of construct validity was found when factor scores were examined relative to the criterion variables of academic performance and rule-breaking behavior. The results support the utility of teacher ratings of ADHD and ODD in the assessment of adolescents, and the applicability of the DSM-IV conceptualization of these disorders to adolescents.     

Childhood anxiety sensitivity index factors predict unique variance in DSM-IV anxiety disorder symptoms

Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower-order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower-order factors. We examined the concurrent and incremental validity of the CASI and its lower-order factors in a non-clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM-IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State-Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.     

Examining the Cultural Validity of Fear Survey Schedule for Children: The Contemporary Fears of Turkish Children and Adolescents

The authors examined the cultural validity of Fear Survey Schedule for Children (FSSC-AM) developed by J. J. Burnham (2005) with Turkish children. The relationships between demographic variables and the level of fear were also tested. Three independent data sets were used. The first data set comprised 676 participants (321 women and 355 men) and was used for examining factor structure and internal reliability of FSSC. The second data set comprised 639 participants (321 women and 318 men) and was used for testing internal reliability and to confirm the factor structure of FSCC. The third data set comprised 355 participants (173 women and 182 men) and used for analyses of test–retest reliability, inter-item reliability, and convergent validity for the scores of FSSC. The sum of the first and second samples (1,315 participants; 642 women and 673 men) was used for testing the relationships between demographic variables and the level of fear. Results indicated that FSSC is a valid and reliable instrument to examine Turkish children's and adolescents’ fears between the ages of 8 and 18 years. The younger, female, children of low-income parents reported a higher level of fear. The findings are discussed in light of the existing literature.     

Assessment of Interpersonal Influences on Adolescents: The Parent and Peer Influence Scale

Peer influence is a common topic of interest for parents, clinicians, and researchers, but results from research on the relative importance of parents’ versus peers’ influence on adolescents and young adults has been contradictory. For example, some research suggests that peer attitudes about school influences future academic aspirations, other research suggests that parents and peers differ on their level of influence based on topic (e.g., parents’ are the primary source of influence about moral issues), and other research suggests that peer-oriented children are a product of parental disregard. A reliable and valid measure of the relative strength of parent versus peer influence could enhance research in this area. As a result, the Parent and Peer Inventory Scale (PPI) was developed, which demonstrates strong reliability as well as face and concurrent validity. The PPI can be used both by researchers to address contradictions in the literature, as well as clinicians seeking to evaluate level of peer influence in a family.     

Reliability and validity of an auditing tool for person-centred psychotherapy and counselling for young people: The PCEPS-YP

The present study aimed to test the reliability and validity of the Person Centred and Experiential Psychotherapy Scale–Young Person version (PCEPS-YP). This is a newly developed and adapted 9-item scale which aims to measure counsellor competences in, and adherence to, person-centred practice, when working with adolescents. Counselling practice was assessed for 19 counsellors by randomly selecting 20-min audio segments from 142 recorded counselling sessions. Audio material was independently rated by eight raters using the PCEPS-YP to produce an average adherence rating per counsellor. Scale reliability was assessed via interrater reliability and internal consistency testing. Convergent validity was tested using ratings from the observer-rated Barrett-Leonard Relationship Inventory (BLRI Obs 40), and the scale was subjected to exploratory factor analysis. Results showed a high degree of internal consistency within raters (α = 0.95), marginally acceptable reliability across grouped raters (α = 0.58) and weaker reliability between pairs of raters (α = 0.50). Exploratory factor analysis revealed one strong factor for the scale with no subscales. Small-to-moderate correlations existed between the PCEPS-YP and the BLRI subscales and mean total score (rs = .12 to .40). Our findings suggest that the PCEPS-YP has potential as an effective, reliable and valid tool for assessing competence and adherence in person-centred practice with young people, both for research and for clinical purposes. However, training procedures need to be established that can enhance interrater reliability, and more evidence of convergent validity is needed.     

Attention-Deficit/Hyperactivity symptoms in Icelandic schoolchildren: assessment with the Attention Deficit/Hyperactivity Rating Scale-IV

Four hundred and twenty-seven normal Icelandic children, six and eight years of age, were rated by their parents and three hundred and sixteen children by their teachers with the Teacher and Parent versions of the Attention Deficit/Hyperactivity Disorder Rating Scale-IV (AD/HDRS-IV). For two hundred and sixty-five of the children both parent and teacher ratings were obtained. The factor structures of the AD/HDRS-IV for parents and teachers were in line with theoretical expectations. A Hyperactivity-Impulsivity factor and an Inattention factor were thus well supported. The subscale reliabilities were high. Boys scored higher than girls on all measures and there was a decrease of symptoms with age for boys, as expected. There was evidence of convergent validity for all scales, but discriminant validity of the AD/HDRS-IV subscales is less certain. Generally the instruments seem promising for further research. Some differences are noted in comparison with earlier studies. Thus scores obtained in this study were somewhat lower than those found in American studies, especially for teachers. Also the prevalence of ADHD based on rating scales was lower than in comparable previous studies. The similarity in symptom structure between this and previous studies is emphasized, but the possible role of cultural homogeneity in explaining different results with regard to teachers' ratings of symptoms is suggested.     

Assessing adolescent mindfulness: validation of an adapted Mindful Attention Awareness Scale in adolescent normative and psychiatric populations

Interest in mindfulness-based interventions for children and adolescents is burgeoning, bringing with it the need for validated instruments to assess mindfulness in youths. The present studies were designed to validate among adolescents a measure of mindfulness previously validated for adults (e.g., Brown & Ryan, 2003), which we herein call the Mindful Attention Awareness Scale-Adolescent (MAAS-A). In 2 large samples of healthy 14- to 18-year-olds (N = 595), Study 1 supported a single-factor MAAS-A structure, along with acceptably high internal consistency, test-retest reliability, and both concurrent and incremental validity. In Study 2, with a sample of 102 psychiatric outpatient adolescents age 14-18 years, participants randomized to a mindfulness-based stress reduction intervention showed significant increases in MAAS-A scores from baseline to 3-month follow-up, relative to nonsignificant score changes among treatment-as-usual participants. Increases in MAAS-A scores among mindfulness-based stress reduction participants were significantly related to beneficial changes in numerous mental health indicators. The findings support the reliability and validity of the MAAS-A in normative and mixed psychiatric adolescent populations and suggest that the MAAS-A has utility in mindfulness intervention research.     

Parental assessment of temperament in handicapped children

The New York Longitudinal Study (NYLS) Parent Questionnaire assesses parental report of children's temperament on nine variables: Mood, distractibility, persistence, activity, rhythmicity, adaptability, approach-withdrawal, threshold and intensity. The present research was designed to assess the interrater reliability of this instrument and to provide cross-validation data regarding the nine scales. Questionnaires were validly completed by both parents of 47 children who had previously been evaluated at the Neuropsychology Laboratory of the Louisiana State University Medical Center. For each of the nine temperament variables, the scores obtained by each child when rated by his or her mother was significantly correlated with the score received on that variable when rated by the father. Thus, under the limitation imposed by the research design, it appears that parents are relatively consistent when evaluating the temperamental characteristics of their children. The correlations between each individual item and the factor it loads on were consistently highly significant. The nine temperamental variables are adequately assessed by the items included in the NYLS Questionnaire.     

Childhood Anxiety Sensitivity Index Factors Predict Unique Variance in DSM‐IV Anxiety Disorder Symptoms

Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower‐order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower‐order factors. We examined the concurrent and incremental validity of the CASI and its lower‐order factors in a non‐clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM‐IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State‐Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.