Utility of Behavior Ratings by Examiners During Assessments of Preschool Children With Attention-Deficit/Hyperactivity Disorder

This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and without (n = 125) AD/HD were utilized to test the internal, convergent, concurrent, and incremental validity of ratings completed by examiners on the Hillside Behavior Rating Scale (HBRS). Results indicated that HBRS ratings were internally consistent, possessed sufficient interrater reliability, and were significantly associated with parent and teacher reports of AD/HD when controlling for age, gender, intelligence, and symptoms of other psychopathology. HBRS ratings also were significantly associated with other measures of functioning, and provided a significant increment in the prediction of impairment over parent and teacher report alone. These findings suggest that behavioral ratings during testing provide a unique source of clinical information that may be useful as a supplement to parent and teacher reports.     

Dimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

The present study examined Sluggish Cognitive Tempo (SCT) in relation to ADHD symptoms, clinical diagnosis, and multiple aspects of adjustment in a clinical sample. Parent and teacher reports were gathered for 322 children and adolescents evaluated for behavioral, emotional, and/or learning problems at a university clinic. Confirmatory factor analyses (CFA) supported the presence of three separate, but correlated factors (SCT, inattention, and hyperactivity/impulsivity) in both parent and teacher ratings. As expected, SCT symptoms were greatest in youth with ADHD Inattentive type, but were also found in non-ADHD clinical groups. SCT symptoms were related to inattention, internalizing, and social problems across both parent and teacher informants; for parent reports, SCT was also related to more externalizing problems. Findings support the statistical validity of the SCT construct, but its clinical utility is still unclear.     

The validity of vigilance tasks in differential diagnosis of children referred for attention and learning problems

This study was conducted to evaluate the convergent and discriminant validity of vigilance measures of attention and impulsivity in children. One hundred children referred for evaluation of attention and learning problems were administered a battery of tests including two vigilance tasks, other laboratory measures of inattention and impulsivity, and parent and teacher ratings. It was predicted that vigilance task performance would correlate with teacher ratings and laboratory measures of inattention while correlations with ratings of aggressive behavior were predicted to be lower. Moderate correlations were obtained between the vigilance task scores and other laboratory measures of inattention and impulsivity. However, the vigilance scores did not correlate with teacher or parent ratings of behavior. A factor analysis, conducted to identify underlying dimensions of attention in the battery of tests, revealed strong source effects. The implications for use of vigilance measures in diagnosis are discussed.Portions of this paper were presented at the 1990 Learning Disabilities Association of America International Conference, Anaheim, California.     

Peer and self-rating: Children's perception of behavior relevant to hyperkinetic impulse disorder

Children answered a yes/no 50-item questionnaire on child behavior for each of 23 classroom peers. Cluster analysis of the data facilitated the organization of the items into six scales, each of which showed high internal consistency. The emergence of a cluster of items corresponding to the clinical concept of hyperkinetic impulse disorder was particularly clear, and the derived scale showed substantial convergent and discriminant validity when peer and self ratings were compared. This finding refutes the view that hyperactivity is merely a pejorative term used by adults about child behavior. Clusters describing clearly approved and disapproved behavior (Popular and Bully) did not show such validity. Crossvalidation of peer ratings against those of teachers and parents, on previously defined measures, was more limited. However, the higher correlation between peer and teacher ratings of behaviors relevant to hyperactivity than between peer and parent or teacher and parent ratings supports the view that hyperactiveinattentive behavior is determined interactively by the person and the situation, rather than being a context-general trait.This article is based on a paper presented to the 14th Annual Conference of the Australian Psychological Society, Hobart, Tasmania, August 1979. Preparation of the paper was supported by the Nuffield Foundation, England.     

Book Review

Performance-based measures and ratings of executive functions were examined in a sample of adolescents with attention deficit/hyperactivity disorder (ADHD) and comparison controls. Performance-based measures of executive function included inhibition, working memory, set shifting, and planning, and ratings of these same executive functions were completed by parents and teachers. Adolescents with ADHD demonstrated lower executive function performance than controls and displayed elevated ratings on the executive function ratings by parents and teachers. Significant associations were obtained between the performance-based measures and the parent and teacher ratings, but each measure was not uniquely associated with its respective scale on the rating scales. When performance-based measures and ratings were examined as predictors of ADHD status, the parent and teacher ratings entered as significant predictors of ADHD status. Further commonality analyses indicated that performance-based measures accounted for little unique variance in predicting ADHD status and also displayed little overlap with the behavioral ratings. These findings highlight the diagnostic utility of behavioral ratings of executive function in predicting ADHD status; however, behavioral ratings should not be assumed to be a proxy for performance on measures of executive function in clinical practice.     

Incremental Validity of Teacher and Parent Symptom and Impairment Ratings when Screening for Mental Health Difficulties

Although universal screening for mental health difficulties is increasingly recognized as a way to identify children who are at risk and provide early intervention, little research exists to inform decisions about screening, such as the choice of informants and the type of information collected. The present study examined the incremental validity of teacher- and parent-rated (primarily mothers) symptoms and impairment in a non-referred sample of early elementary school children (n = 320, 49 % boys, ages 6 to 9) in terms of predicting impairment as rated by a different teacher 1 year later. Teacher-rated symptoms and impairment and parent-rated impairment were each unique predictors of later impairment; however, parent-rated symptoms did not contribute to the prediction of later impairment above and beyond these other indicators. The results indicate that, when screening for mental health difficulties in the school system, impairment ratings collected across settings add useful information, but it may not be necessary to use parent symptom ratings when teacher symptom ratings are available.     

Reliable Ratings or Reading Tea Leaves: Can Parent,Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six?

To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N?=?104, 75 % boys, Mean (SD) age?=?4.37 (0.47) years] were followed over 2 years (mean?=?26.44 months, SD?=?5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age?=?6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers’ behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians’ ratings of preschoolers’ inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.     

Parent and Teacher Ratings in the Assessment and Prediction of Antisocial and Delinquent Behaviors

ABSTRACT Subjects consisted of a sample of two cohorts of approximately 100 boys each whose behaviors were rated by their parents and teachers. Criterion variables included antisocial behavior, based on parent, child, teacher, and interviewer reports, and delinquency, based on parent and child reports in addition to cumulative arrest data taken from juvenile court records. The data suggest that mothers are focused on the daily, irritating behaviors of their sons. Teachers, on the other hand, appear to focus on a relatively small number of items (e.g., child physically attacks others, associates with deviant peers), and thereby provide ratings that are better predictors of delinquency and arrest. When the mothers' ratings were constrained to include only items that were salient for teachers, their predictive validity coefficients approached the magnitude of the teacher coefficients.     

Child functioning predictors of outcome among boys at risk for psychological disorder

This study examined the success of child functioning measures in predicting child outcome for 97 boys with one parent previously hospitalized for psychiatric illness. The best predictors of adaptive functioning at a 3-year follow-up were IQ and clinician ratings based on parent report. Peer and teacher assessments and clinician ratings from interviews were moderately successful.     

Predictors of physical aggression in children with attention-deficit/hyperactivity disorder

The present investigation examined factors that predict physical aggression in children with attention-deficit/hyperactivity disorder (ADHD). Stepwise, multiple regression-analyses were used to examine predictors of children's physical aggression as rated by parents at a 1-year follow-up point and by teachers at both 1- and 2-year follow-up points. Early parent and teacher ratings of verbal aggression (ie, cursing, teasing, and threatening) accounted for the greatest proportion of the variance in physical aggression ratings obtained at follow-up. None of the other predictor variables, including early ratings of physical aggression and ADHD behaviors, contributed significant additional variance beyond that accounted for by early verbal aggression ratings. Temporal and cross-informant analyses revealed that the relationship between verbal aggression and later physical aggression was situation-specific for teacher ratings but not parent ratings. Although physical aggression may emerge early in development, these data suggest that verbal aggression represents a stable, temperamental characteristic that may be of greater value than early physical aggression for predicting later physically aggressive acts.     

Television Viewing and Attentional Abilities in Fourth and Fifth Grade Children

To evaluate the common assumption that television viewing is related to attentional difficulties in school, 70 fourth and fifth grade students recorded a “television diary” for one week and reported their preferred television shows. Parents estimated their child's television viewing time and reported their child's preferred shows. Assessment of attentional difficulties included teacher ratings, parent ratings, standardized tests, and classroom observations. It was found that the amount of television a child viewed was significantly related to teacher ratings of attentional difficulties, but not to parent ratings, classroom observations or a standardized test. Type of shows viewed did not relate to any attentional outcome variable. There was a clear relationship between fourth and fifth grade children's ability to pay attention in school, as assessed by their teacher, and the amount of time they spent watching television.     

A Psychometric Evaluation of the Behavioral Inhibition Questionnaire in a Non-Clinical Sample of Israeli Children and Adolescents

This study examined the psychometric properties of a Hebrew version of the Behavioral Inhibition Questionnaire (BIQ) in a non-clinical sample of Israeli children and adolescents. We produced a Hebrew translation of the BIQ and collected 227 responses to it from parents of children aged 4–15. Some respondents in the larger sample also completed the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire (n?=?91) and the Conners’ Abbreviated Parent-Teacher (CONNERS) questionnaire (n?=?39), in addition to the BIQ. Lastly, 21 children of BIQ respondents (aged 8–14) completed a self-report version of the questionnaire. Confirmatory factor analysis (CFA) was performed to assess how well the established six correlated factor model of the BIQ applied to the sample data. The Hebrew BIQ demonstrated good internal consistency (Chronbach’s α?=?.94, n?=?227) and 3 month test–retest reliability, (r?=?.95, p?<?.001, n?=?21). It also showed both convergent validity, as scores on the BIQ were correlated with the SCARED (r?=?.66, p?<?.01. n?=?91), and discriminant validity, as BIQ scores were not correlated with the CONNERS (r?=?.24, n?=?39). Finally, mother reports of BI were significantly correlated to child reports of BI via the BIQ (r?=?.60, p?<?.01, n?=?21). Thus, through this preliminary study we demonstrated that the Hebrew version of the BIQ is an effective tool for screening for BI among Israeli children, making it a useful instrument for future research.     

Diagnostic importance of combined parent and teacher ratings on the Revised Behavior Problem Checklist

The Revised Behavior Problem Checklist (RBPC) was completed by parents and teachers for 105 child psychiatry outpatient boys aged 6 to 12 years. In addition, DSM-III diagnoses were determined independent of checklist results, and the children were divided into major diagnostic groups of externalizing, internalizing, and mixed disorders. Combined parent and teacher ratings proved more effective than separate ratings in distinguishing the externalizing and mixed groups from the internalizing group on the RBPC externalizing factors. The overall classification of individual boys with discriminant function analysis increased from 72% to 83% when the ratings of both parents, rather than one parent, were combined with teacher ratings. Enhancing diagnostic accuracy of type of psychiatric disorder by using combined parent and teacher behavior checklist ratings is discussed.     

The development and validation of the Body-Image Ideals Questionnaire

The Body-Image Ideals Questionnaire (BIQ) was developed as a unique attitudinal body-image assessment that considers one's perceived discrepancy from and degree of investment in personal ideals on multiple physical attributes. Reliability and validity of the 20-item instrument were examined for a sample of 284 college women. The results indicated that the BIQ consists of two relatively distinct and internally consistent Discrepancy and Importance subscales, as well as their multiplicative composite. The subscales' respective convergent validities vis-à-vis extant body-image measures and specific facets of personality (i.e., public self-consciousness and perfectionism) and psychosocial adjustment (i.e., social anxiety, depression, and eating disturbance) were confirmed. Evidence also supported the incremental validity of multiple self-ideal discrepancies. Effects due to socially desirable responding were inconsequential. Directions for needed basic and clinical research were identified.     

Parent–teacher agreement on 7‐Year‐old children's personality

Agreement between multiple informants on child personality has received limited attention. Focusing on factor structure, gender differences and the influence of socially desirable responding (SDR), we compared parent and teacher Big Five personality ratings of around 600 7‐year olds. Although parent ratings were more desirable than teacher ratings, differential agreement was generally similar to that found for adults, and especially high for ratings of boys. The more evaluative the personality item, the larger the mean‐level difference between parents and teachers on that item. However, undesirable items showed the highest levels of differential agreement. In parent ratings, the two poles of Agreeableness formed separate factors. To view Pro‐sociality as independent of Antagonism could enable parents to view their child more positively. Copyright © 2010 John Wiley & Sons, Ltd.     

Treatment of children with ADHD: psychopedagogical program at school versus psychostimulant medication

This study examined the impact of medication management compared to a psycho-educational program on parent and teacher ratings of children with combined type ADHD. The study lasted 14 weeks and included 50 children. 17 children took medication, 17 received psycho-educational intervention, and 16 children were assigned to the control group. The measures used were the IOWA Conners Scale, the School Problem Inventory, the Abbreviated Conners, and the DSM-IV Inattention-Disorganization and Hyperactivity-Impulsivity rating scales. Regarding teacher ratings, improvements were observed on: a) inattention and school problems in the medication group versus the control group; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and medication groups. Regarding to parent ratings, improvements were observed on: a)inattention in the psycho-pedagogical group versus the control and medication groups; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and the medication groups.     

Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings

Diagnostic assessment in Fetal Alcohol Spectrum Disorder (FASD) is informed by multidisciplinary assessment incorporating objective (i.e., test measures) and subjective means, such as parent and teacher behavior ratings. The purpose of this study was to extend our previous neuropsychological test findings by identifying parent and teacher ratings of academic achievement, attention, executive functioning, and adaptive functioning as predictors of an FASD diagnosis. The charts of 315 children and adolescents with prenatal alcohol exposure (PAE) who underwent assessment for FASD were retrospectively reviewed. Direct logistic regressions analyzed the contribution of different ratings on the likelihood of an FASD diagnosis. The results suggest that a number of rating measures do contribute toward accurately differentiating those with FASD from within a PAE population, including teacher ratings of learning problems, inattention, and adaptive skills. The classification accuracy for each regression was clinically significant (59.1–70.8%). Children with worse ratings on these variables are approximately 1.5 to 2 times more likely to receive an FASD diagnosis. Only teacher ratings (not parent) significantly contributed to whether a diagnosis was made, suggesting that teacher observational rating scales are a critical component of an FASD assessment. Together with our previous research examining neuropsychological evaluation and FASD diagnostic assessment, this study helps to further guide decisions to streamline care in multidisciplinary assessment and intervention planning.     

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.     

Development of consensus about child oppositional behavior: Increased convergence with entry into school

This study examines the relation between parent and teacher ratings of oppositional behaviors in children from kindergarten to second grade. One cross-sectional sample of 85 boys in kindergarten, first, and second grade was assessed for problem behavior on the basis of reports from the children, parents, teachers, and trained observers. The second sample consisted of parent and teacher ratings of both boys and girls in a longitudinal design at 5 and 7 years of age. Results from both studies indicate that agreement does increase around the time of the child's transition into school and that each informant influences the ratings of the others over time.     

Comparing Four Methods of Integrating Parent and Teacher Symptom Ratings of Attention-deficit/hyperactivity Disorder (ADHD)

Although parents and teachers are valid informants in the assessment of childhood attention-deficit/hyperactivity disorder (ADHD), there is relatively little systematic research on how these ratings should be optimally combined. We compared four methods of ADHD assessment to determine how well they identified impaired children: (1) parent only, (2) teacher only, (3) parent or teacher (‘or rule’), and (4) parent and teacher (‘and rule’). We obtained parent and teacher ratings of ADHD from the Disruptive Behavior Disorder Rating Scale on 232 5- to 10-year-old children (69% male; 47% Caucasian) with (n = 121) and without (n = 111) ADHD. We used receiver operating characteristic curves (ROC) and seemingly unrelated regression analyses (SUR) to evaluate how accurately each method identified categorically- and dimensionally-defined measures of functional impairment. Parent ratings of ADHD optimally identified globally impaired children based on categorical and dimensional measures. However, teacher ratings of ADHD most accurately identified children who were negatively regarded by peers using categorical, but not dimensional, measures. No ADHD assessment method effectively identified children with academic difficulties. Although multiple informants are valuable in the assessment of ADHD, no single method was consistently superior in identifying impaired children across domains. We consider alternative assessment strategies in ADHD as well as other potential factors that may contribute to modest agreement among informants.