Agreement Between Parent and Teacher Ratings of Disruptive Behavior Disorders in Children with Clinically Diagnosed ADHD

This study investigated the agreement between parent and teacher ratings of DSM-IV symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and related disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A sample of 55 children in the age range of 6–12 years with clinically diagnosed ADHD participated in the study. Parents and teachers were asked to complete the Disruptive Behavior Disorder Rating Scale (DBDRS; W. E., Pelham, E. M., Gnagy, K. E., Greenslade, & R. Milich, 1992). No association was found between parent and teacher ratings of inattention and hyperactivity/impulsivity. However, moderate to high levels of agreement were obtained for ratings of symptoms that characterized ODD and CD. The observed low levels of agreement between parent and teacher ratings of ADHD symptoms may be attributed to different perceptions of the problem behavior by parents and teachers, medication effects, or the situation specificity of children's behavior. It is recommended that the diagnostic criterion of symptom pervasiveness for the diagnosis of ADHD be operationalized more clearly.     

Do Executive Function Deficits Differentiate Between Adolescents with ADHD and Oppositional Defiant/Conduct Disorder? A Neuropsychological Study Using the Six Elements Test and Hayling Sentence Completion Test

Two neuropsychological measures of executive functions—Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)—were administered to 110 adolescents, aged 12–15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35), ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.     

The structure of childhood disruptive behaviors

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) frequently co-occur. Comorbidity of these 2 childhood disruptive behavior domains has not been satisfactorily explained at either a structural or etiological level. The current study evaluated a bifactor model, which allows for a "g" factor in addition to distinct component factors, in relation to other models to improve understanding of the structural relationship between ADHD and ODD. Participants were 548 children (321 boys, 227 girls) between the ages of 6 years and 18 years who participated in a comprehensive diagnostic assessment incorporating parent and teacher ratings of symptoms. Of these 548 children, 153 children were diagnosed with ADHD (without ODD), 114 children were diagnosed with ADHD + ODD, 26 children were diagnosed with ODD (without ADHD), and 239 children were classified as non-ADHD/ODD comparison children (including subthreshold cases). ADHD symptoms were assessed via parent report on a diagnostic interview and via parent and teacher report on the ADHD Rating Scale. ODD symptoms were assessed via teacher report. A bifactor model of disruptive behavior, comprising a "g" factor and the specific factors of ADHD and ODD, exhibited best fit, compared to 1-factor, 2-factor, 3-factor, and 2nd-order factor models of disruptive behaviors. It is concluded that a bifactor model of childhood disruptive behaviors is superior to existing models and may help explain common patterns of comorbidity between ADHD and ODD.     

Evidence for the Trait-Impulsivity Etiological Model in a Clinical Sample: Bifactor Structure and Its Relation to Impairment and Environmental Risk

The trait-impulsivity etiological model assumes that a general factor (trait-impulsivity) underlies attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and other externalizing disorders. We investigated the plausibility of this assumption by testing the factor structure of ADHD and ODD in a bifactor framework for a clinical sample of 1420 children between 6 and 18 years of age (M = 9.99, SD = 3.34; 85% male). Further, the trait-impulsivity etiological model assumes that ODD emerges only if environmental risk factors are present. Our results support the validity of the trait-impulsivity etiological model, as they confirm that ADHD and ODD share a strong general factor of disruptive behavior (DB) in this clinical sample. Furthermore, unlike the subdimensions of ADHD, we found that the specific ODD factor explained as much true score variance as the general DB factor. This suggests that a common scale of ADHD and ODD may prove to be as important as a separate ODD subscale to assess externalizing problems in school-age children. However, all other subscales of ADHD may not explain sufficient true score variance once the impact of the general DB factor has been taken into consideration. In accordance with the trait-impulsivity model, we also showed that all factors, but predominantly the general factor and specific inattention factor, predicted parent-rated impairment, and that predominantly ODD and impulsivity are predicted by environmental risk factors.     

A Multitrait–Multisource Confirmatory Factor Analytic Approach to the Construct Validity of ADHD and ODD Rating Scales with Malaysian Children

Confirmatory factor analysis (CFA) was used to model a multitrait by multisource matrix to determine the convergent and discriminant validity of measures of attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and oppositional defiant disorder (ODD) in 917 Malaysian elementary school children. The three trait factors were ADHD-IN, ADHD-HI, and ODD. The two source factors were parents and teachers. Similar to earlier studies with Australian and Brazilian children, the parent and teacher measures failed to show convergent and discriminant validity with Malaysian children. The study outlines the implications of such strong source effects in ADHD-IN, ADHD-HI, and ODD measures for the use of such parent and teacher scales to study the symptom dimensions.     

Diversity in Pathways to Common Childhood Disruptive Behavior Disorders

Oppositional-Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are highly comorbid, a phenomenon thought to be due to shared etiological factors and mechanisms. Little work has attempted to chart multiple-level-of-analysis pathways (i.e., simultaneously including biological, environmental, and trait influences) to ODD and ADHD, the goal of the present investigation. 559 children/adolescents (325 boys) between the ages of 6 and 18 participated in a multi-stage, comprehensive diagnostic procedure. 148 were classified as ODD; 309 were classified as ADHD, based on parent, teacher, and clinician ratings. Children provided buccal or salivary samples of DNA, assayed for select markers in DRD4 and 5HTT. Parents completed the Alabama Parenting Questionnaire and the California Q-Sort. Children completed the Child Perception of Interparental Conflict Scale. Correlational associations consistent with multiple-level-of-analysis pathways to ODD and ADHD emerged. For ODD, children with the short allele of the 5HTT promoter polymorphism had higher neuroticism and ODD symptoms regardless of level of self-blame in relation to inter-parental conflict, whereas children without this allele had more ODD symptoms only in the context of more self-blame for inter-parental conflict. For ADHD (and ODD), children homozygous for the long allele of DRD4 120?bp insertion polymorphism had lower conscientiousness when exposed to inconsistent parenting, whereas children without this genotype were more resilient to effects of inconsistent discipline on conscientiousness. Thus, ODD and ADHD appear to demonstrate somewhat distinct correlational associations between etiological factors and mechanisms consistent with pathway models using a multiple-level-of-analysis approach.     

The influence of ADHD-hyperactivity/impulsivity symptoms on the development of oppositional defiant disorder symptoms in a 2-year longitudinal study

The structural relations among ADHD–inattention (IN), ADHD–hyperactivity/impulsivity (H/I), and oppositional defiant disorder (ODD) factors were examined in a 2-year longitudinal study with 752 children. Structural equation procedures showed that higher scores on the H/I factor in Year 1 were associated with higher scores on ODD factor in Years 2 and 3. Higher scores on the H/I factor in Year 2 were also associated with higher scores on ODD factor in Year 3. The ODD factor did not predict the H/I and IN factors in subsequent years. The IN factor did not predict the ODD and H/I factors in subsequent years and the H/I factor did not predict the IN factor. The ability of the H/I factor to predict the subsequent ODD factor occurred even after taking into account the ability of the ODD, H/I, and IN factors to predict themselves across time. These results suggest that the H/I aspect of ADHD influences the development of ODD behavior.     

Construct Validity of ADHD/ODD Rating Scales: Recommendations for the Evaluation of Forthcoming DSM-V ADHD/ODD Scales

Exploratory structural equation modeling (SEM) was applied to a multiple indicator (26 individual symptom ratings) by multitrait (ADHD-IN, ADHD-HI and ODD factors) by multiple source (mothers, fathers and teachers) model to test the invariance, convergent and discriminant validity of the Child and Adolescent Disruptive Behavior Inventory with 872 Thai adolescents and the ADHD Rating Scale-IV and ODD scale of the Disruptive Behavior Inventory with 1,749 Spanish children. Most of the individual ADHD/ODD symptoms showed convergent and discriminant validity with the loadings and thresholds being invariant over mothers, fathers and teachers in both samples (the three latent factor means were higher for parents than teachers). The ADHD-IN, ADHD-HI and ODD latent factors demonstrated convergent and discriminant validity between mothers and fathers within the two samples. Convergent and discriminant validity between parents and teachers for the three factors was either absent (Thai sample) or only partial (Spanish sample). The application of exploratory SEM to a multiple indicator by multitrait by multisource model should prove useful for the evaluation of the construct validity of the forthcoming DSM-V ADHD/ODD rating scales.     

Construct Validity of ADHD-IN,ADHD-HI,ODD toward Adults,Academic and Social Competence Dimensions with Teacher Ratings of Thai Adolescents: Additional Validity for the Child and Adolescent Disruptive Behavior Inventory

Confirmatory factor analysis was used to test the construct validity of an attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder toward adults, academic and social competence factor model with teacher ratings of Thai adolescents (n = 872) with the Child and Adolescent Disruptive Behavior Inventory. The five-factor model resulted in an adequate fit in an absolute sense (i.e., CFI = .960; TLI = .985; RMSEA = .065; and WRMR = .883). All the items had significant and substantial loadings on their respective factors (i.e., > .78) with the five-factors showing discriminant validity. The five-factor model also resulted in similar results for boys and girls separately as well as younger and older adolescents. The current findings with the teacher version of the measure in conjunction with earlier research with mothers’ and fathers’ ratings of Brazilian, Thai, and American children (Burns et al., Psychological Assessment, 20, 121-130, 2008) and Thai adolescents (Burns et al., Psychological Assessment, 21, 635-641, 2009) provide increasing support for the construct validity of Child and Adolescent Disruptive Behavior Inventory within multiple cultures. Procedures are also outlined to improve the content validity as well as test the construct validity of forthcoming parent and teacher DSM-V ADHD/ODD rating scales.     

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.     

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent–child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.     

Experiences of physical and relational victimization in children with ADHD: The role of social problems and aggression

The social risk factors for physical and relational peer victimization were examined within a mixed‐gender sample of children with and without attention‐deficit/hyperactivity disorder (ADHD). Participants were 124 children (ages 8–12 years; 48% boys), with 47% exhibiting sub‐clinical or clinical elevations in ADHD symptoms. ADHD and oppositional defiant disorder (ODD) symptom counts were assessed based on parent‐ and teacher‐reports; parents rated children's social problems and teachers rated children's use of physical and relational aggression and experiences of physical and relational victimization. A multiple mediator model was used to test whether there were indirect effects of ADHD or ODD symptoms on physical and relational victimization through social problems, physical aggression, or relational aggression. At the bivariate level, ADHD and ODD symptoms were both significantly associated with higher rates of physical and relational victimization. In the mediational model, there were significant indirect effects of ADHD symptoms on relational victimization via social problems, of ODD on relational victimization via relational aggression, and of ODD symptoms on physical victimization via physical aggression. Results suggest that there are distinct risk factors implicated in the physical and relational victimization of youth with ADHD and that the co‐occurrence of ODD symptoms is important to assess. Clinical implications for addressing victimization in children with ADHD are discussed.

     

Teachers' screening for attention deficit/hyperactivity disorder: comparing multinational samples on teacher ratings of ADHD

This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.     

Paired-Associate Learning in Attention-Deficit/Hyperactivity Disorder as a Function of Hyperactivity-Impulsivity and Oppositional Defiant Disorder

A paired-associate learning (PAL) test was administered to 22 community volunteers without disruptive disorders and 197 children (7.5–13.5 years-old) presenting with the inattentive and combined subtypes of attention-deficit/hyperactivity disorder (ADHD) either in combination with or without oppositional defiant disorder (ODD). Participants were screened for learning disorders. In comparison to non-ADHD participants, children with ADHD achieved worse PAL and made errors rated as more acoustically and less semantically similar to the correct paired associates. These deficits were not related to hyperactivity–impulsivity or comorbid ODD. These results suggest that ADHD children are less competent at PAL and use less efficient learning strategies than their non-ADHD peers.     

Externalizing Symptomatology Among Adoptive Youth: Prevalence and Preadoption Risk Factors

The extent of symptomatology related to attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) was examined in a statewide sample of adopted youth, aged 4–18 years (n = 808). The use of normed questionnaires in a nonclinical sample decreased biases associated with past research on adopted children. According to parental report, a striking number of the youth qualified as manifesting significant symptom levels of externalizing behavior problems: 21% met symptom cutoffs for ADHD (with or without ODD) and 20% met criteria for ODD (with or without ADHD), for a combined total of 29% of the sample. A number of parent-reported, preadoptive risk factors distinguished these groups from one another and from the nonexternalizing youth. The clearest associated factors included histories of preadoption abuse/neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption. We discuss implications regarding both etiology and current controversies surrounding the disproportionate levels of behavioral difficulties in adopted youth.     

Exploration of the Factor Structure of ADHD in Adolescence through Self,Parent, and Teacher Reports of Symptomatology

Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant’s best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.     

Structure and Validity of Sluggish Cognitive Tempo Using an Expanded Item Pool in Children with Attention-Deficit/Hyperactivity Disorder

We evaluated the latent structure and validity of an expanded pool of Sluggish Cognitive Tempo (SCT) items. An experimental rating scale with 44 candidate SCT items was administered to parents and teachers of 165 children in grades 2–5 (ages 7–11) recruited for a randomized clinical trial of a psychosocial intervention for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. Exploratory factor analyses (EFA) were used to extract items with high loadings (>0.59) on primary factors of SCT and low cross-loadings (0.30 or lower) on other SCT factors and on the Inattention factor of ADHD. Items were required to meet these criteria for both informants. This procedure reduced the pool to 15 items. Generally, items representing slowness and low initiative failed these criteria. SCT factors (termed Daydreaming, Working Memory Problems, and Sleepy/Tired) showed good convergent and discriminant validity in EFA and in a confirmatory model with ADHD factors. Simultaneous regressions of impairment and comorbidity on SCT and ADHD factors found that Daydreams was associated with global impairment, and Sleepy/Tired was associated with organizational problems and depression ratings, across both informants. For teachers, Daydreams also predicted ODD (inversely); Sleepy/Tired also predicted poor academic behavior, low social skills, and problem social behavior; and Working Memory Problems predicted organizational problems and anxiety. When depression, rather than ADHD, was included among the predictors, the only SCT-related associations rendered insignificant were the teacher-reported associations of Daydreams with ODD; Working Memory Problems with anxiety, and Sleepy/Tired with poor social skills. SCT appears to be meaningfully associated with impairment, even when controlling for depression. Common behaviors resembling Working Memory problems may represent a previously undescribed factor of SCT.     

Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample

To examine Swanson, Nolan, and Pelham-IV (SNAP-IV) psychometric properties, parent (N = 1,613) and teacher (N = 1,205) data were collected from a random elementary school student sample in a longitudinal attention deficit hyperactivity disorder (ADHD) detection study. SNAP-IV reliability was acceptable. Factor structure indicated two ADHD factors and an oppositional defiant disorder (ODD) factor. Parent and teacher scores varied by gender and poverty status (d = .49-.56) but not age; only teacher scores varied by race (d = .25-.55). Screening and diagnostic utility was evaluated with likelihood ratios (LRs) and posttest probabilities. Parent SNAP-IV scores above 1.2 increased probability of concern (LR > 10) and above 1.8, of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only (LR = 4.2 and >5, respectively). Higher teacher scores for African American children and race differences in measurement models require future study.     

Executive Functioning and Engagement in Physical and Relational Aggression among Children with ADHD

Although evidence suggests that executive functioning (EF) impairments are implicated in physically aggressive behavior (e.g., hitting) these cognitive impairments have rarely been examined with regard to relational aggression (e.g., gossip, systematic exclusion). Studies also have not examined if EF impairments underlie the expression of aggression in children with attention-deficit/hyperactivity disorder (ADHD) and if child gender moderates risk. Children with and without clinical elevations in ADHD symptoms (N = 124; ages 8–12 years; 48 % male) completed a battery of EF tests. Parent and teacher report of ADHD and oppositional defiant disorder (ODD) symptoms and teacher report of engagement in physical and relational aggression were collected. Models tested the unique association of EF abilities with physical and relational aggression and the indirect effect through the expression of ADHD or ODD behaviors; child gender was also tested as a moderator. EF impairment was uniquely associated with physical aggression, but better EF ability was associated with relational aggression. For boys, poor EF also was indirectly associated with greater physical aggression through the expression of ADHD behaviors. However, ADHD symptoms were unrelated to relational aggression. ODD symptoms also predicted physical aggression for boys but relational aggression for girls. Results suggest that there are multiple and distinct factors associated with engagement in physical and relational aggression and that better EF may actually promote relational aggression. Established models of physical aggression should not be assumed to map on to explanations of relational aggression.