Validity of Adolescent and Parent Reports on the Six-Item ADHD Self-Report Scale (ASRS-6) in Clinical Assessments of Adolescent Social Anxiety

Adolescents experiencing social anxiety often experience co-occurring attention-deficit/hyperactivity disorder (ADHD) symptoms. Yet, assessing for social anxiety poses challenges given the already time-consuming task of distinguishing social anxiety from other commonly co-occurring internalizing conditions (e.g., generalized anxiety, major depression). Assessors need short screening devices to identify socially anxious adolescents in need of intensive ADHD assessments. A six-item version of the ADHD Self-Report Scale (ASRS-6) was originally developed to identify adults who likely meet diagnostic criteria for ADHD, but its psychometric properties have yet to be examined among adolescents. We tested the psychometric properties of the ASRS-6 when administered in clinical assessments for adolescent social anxiety. Eighty-nine 14–15 year old adolescents and their parents (67.4% female; 62.1% African American; 30 Clinic-Referred; 59 Community Control) completed the ASRS-6, measures of adolescent social anxiety and depressive symptoms, and parent-adolescent conflict. Adolescent self-reported and parent-reported ASRS-6 positively related with scores from established measures of social anxiety, depressive symptoms, and parent-adolescent conflict. Further, adolescent self-reported (but not parent-reported) ASRS-6 scores significantly discriminated adolescents on referral status. Adolescent self-reported (but not parent-reported) ASRS-6 scores incrementally predicted social anxiety over-and-above depressive symptoms, which commonly co-occur with social anxiety. Conversely, parent-reported (but not adolescent self-reported) ASRS-6 scores incrementally predicted parent-adolescent conflict over-and-above depressive symptoms, which commonly co-occur with conflict. When assessing adolescent ADHD symptoms, adolescents’ and parents’ reports meaningfully vary in their links to validity indicators. As such, among adolescents assessed for social anxiety, clinical assessments of adolescent ADHD symptoms should include both parent reports and adolescent self-reports.     

常见肺栓塞评分方法及临床应用

肺栓塞评分方法是国际上肺栓塞诊断策略的重要基础。本文简要介绍国际上常用肺栓塞评分方法,即Wells法、Geneva法、Geneva改良法、Pisa法和Claudia法,并评价和比较这些方法在临床上的应用,建议建立并规范使用适合我国国情的肺栓塞评分方法。     

Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

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.     

The Use of the Devereux Scales of Mental Disorders in the Assessment of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder

The present study was designed to gather validity data on the Devereux Scales of Mental Disorders (DSMD) for distinguishing among children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 32), Conduct Disorder (CD; N = 34), or no clinical diagnosis (NC; N = 65). Three types of indicators were compared: (a) DSMD scale, composite, and total scores, (b) the number of ADHD or CD-related items endorsed, and (c) diagnostic efficiency statistics (e.g., sensitivity, positive and negative predictive power). The clinical groups did not differ significantly from each other, but both were significantly higher than the NC group on all DSMD scales. Moreover, there were significant differences between the ADHD and the CD groups on the number of respective ADHD and CD-related items endorsed. A cut-off of seven to eight items yielded the best discrimination between the two diagnostic groups. Diagnostic efficiency statistics indicate that the DSMD may be effective at differentiating between similar disruptive behavior disorders.     

心理干预对轻中度脑瘫儿童综合功能和生活质量的影响*

采用对照组和干预组前测、后测设计,对80名脑瘫儿童的综合功能和生活质量进行了测量,分析了心理干预对脑瘫儿童康复疗效的影响。结果表明:(1)四组脑瘫儿童后测综合功能评定效果存在显著差异。(2)生活质量问卷中,在使用特殊器具感觉维度上,四个组别间的追踪水平逐级显著递增;在对疼痛和困扰感觉维度上,四个组别间的后测水平、追踪水平均逐级显著递减;在其它四个维度上,四个组别间的后测水平、追踪水平均逐级显著递增。(3)在使用特殊器具感觉维度上,三个干预组内的追踪水平显著高于前测和后测水平;在对疼痛和困扰感觉维度上,三个干预组内的前测、后测和追踪水平均呈逐级显著递减趋势;在其它四个维度上,三个干预组内的前测、后测和追踪水平均逐级显著递增。干预组比对照组能显著提升脑瘫患儿的综合功能和生活质量。     

Effectiveness of Rational Emotive Behavior Therapy on Psychological Well-Being of People with Late Blindness

The aim of the present study was to investigate the effectiveness of Rational Emotive Behavior Therapy (REBT) on improving the psychological wellbeing of people with late blindness. The design of this study was organized into pre-test, post-test and follow-up with two groups; experimental and control. After choosing qualified individuals, they were replaced into experimental and control groups at random (30 clients in each group). Pre-test was conducted for both groups. Thereafter, the experimental group received REBT training. Both groups, took part in post-test at the end of the training course. After 1 month, follow-up test was taken. Tools such as demographic particulars, IBT questionnaire, depression, anxiety and stress 21 inventory, Eysenck questionnaire were used for gathering information of the study. All the analytical process has been done by SPSS18 program. The scores of both groups (experimental and control groups) were not different significantly in pre-test. The scores gained by the experimental group in post-test showed a significant increase compared with the pre-test result. It proved the effectiveness of REBT with experimental group. And also, in comparing post-test with follow-up experimental group no significant difference were yield. So, as a result the effectiveness interference through group training of REBT with experimental group can be evaluated as constant. In control group there were no significant difference among the scores gained in pre-test, post-test and follow up. The findings of this research indicate the effectiveness of group coaching of REBT with enhancing the indices of psychological well being of people with late blindness.     

The Adolescent Behavior Checklist: Validation Using Structured Diagnostic Interviews

The purpose of this study was to evaluate the discriminant validity of scores from the Adolescent Behavior Checklist (ABC), a self-report measure of ADHD symptomatology for adolescents ages 11–17 years. Validity was assessed through correlational, univariate, and discriminant function analyses using three groups: (1) adolescents diagnosed with ADHD, (2) adolescents currently experiencing a mood and/or anxiety disorder, and (3) adolescents with no major psychological disorder. Convergent and divergent validity of the ABC factor scores was demonstrated through correlational results with (1) parent and adolescent report of ADHD symptoms during structured psychiatric interviews and (2) scores on questionnaires measuring related and nonrelated constructs. Univariate analyses indicated that the ADHD group obtained significantly higher scores than did the nonclinical adolescents across all ABC factors. Additionally, the ADHD group scored significantly higher than did the psychiatric controls on the following ABC factors: Conduct Problems, Impulsivity/Hyperactivity, and Social Problems. Results from discriminant analyses supported the reliability of ABC scores in correctly classifying participants into groups. Compared to the Youth Self-Report, the ABC was found to be somewhat better at classifying when used in a multiinformant discriminant analysis. Therefore, overall results from the current study suggest that the ABC is a valid and useful self-report screening measure for ADHD symptoms and related difficulties.     

Effects of a Cognitive-Behavioral Self-Help Program on Depressed Mood for People with Peripheral Arterial Disease

The aim of the present study was to examine whether a new low-cost psychological self-help intervention program with minimal coaching could be effective in improving depressed mood in people with peripheral arterial disease (PAD). Thirteen persons with PAD and depressive symptoms participated in the self-help program, grounded in cognitive-behavioral therapy. They completed pre-test, post-test and follow-up questionnaires, including the PHQ-9, to measure symptoms of depression. To evaluate changes in depression scores from pre- to post-test to follow-up measurement, non-parametric repeated measures Wilcoxon signed rank tests were performed. The results showed that participants’ depression scores significantly improved from pre-test to post-test and that there was no relapse from post-test to follow-up. The cognitive-behavioral self-help intervention could be an effective tool in people with PAD, to reduce symptoms of depression.     

Assessing Growth in a Diagnostic Classification Model Framework

A common assessment research design is the single-group pre-test/post-test design in which examinees are administered an assessment before instruction and then another assessment after instruction. In this type of study, the primary objective is to measure growth in examinees, individually and collectively. In an item response theory (IRT) framework, longitudinal IRT models can be used to assess growth in examinee ability over time. In a diagnostic classification model (DCM) framework, assessing growth translates to measuring changes in attribute mastery status over time, thereby providing a categorical, criterion-referenced interpretation of growth. This study introduces the Transition Diagnostic Classification Model (TDCM), which combines latent transition analysis with the log-linear cognitive diagnosis model to provide methodology for analyzing growth in a general DCM framework. Simulation study results indicate that the proposed model is flexible, provides accurate and reliable classifications, and is quite robust to violations to measurement invariance over time. The TDCM is used to analyze pre-test/post-test data from a diagnostic mathematics assessment.     

The Gordon Diagnostic System and WISC-III Freedom from Distractibility Index: validity in identifying clinic-referred children with and without ADHD

Gordon Diagnostic System and WISC-III scores for clinic-referred 6- to 16-yr.-olds (184 with ADHD Combined Type and 46 without ADHD) were analyzed to evaluate the combination of scores and cutpoints that maximized diagnostic accuracy. Using an "ADHD cutpoint" of IQ minus the GDS Composite score > or = 13, 87.8% of the children were correctly identified as having or not having ADHD. IQ minus Freedom from Distractibility > 0 yielded 73.5% accuracy. When the two meaures were combined to create new criteria (IQ minus GDS Composite > or = 13 or IQ minus Freedom from Distractibility > or = 11), diagnostic accuracy increased to 90.9% and negative predictive power improved substantially. Diagnostic agreement between the Gordon Diagnostic System and Freedom from Distractibility was 70%, suggesting that the two tests measure both similar and unique traits.     

The specificity of the Stroop interference score of errors to ADHD in boys

The Stroop Interference Test is widely used to assess the inhibition function; however, divergent results have emerged from meta-analyses in children with ADHD. This has led to conflicting results as to whether the Stroop test detects the level of inhibition in these children. We hypothesized that the general approach to include interference scores depending on response time causes conflicting results, whereas recordings of errors may prove a superior measure of the inhibition function in children with ADHD. In the present study, 39 children with an ADHD diagnosis, two subgroups with and without another comorbid mental health disorder, were compared with respect to their interference scores of response time and errors with two subgroups of children with no ADHD. The two subgroups comprised 33 children with another mental health disorder other than ADHD and 56 children with no psychiatric disorder. The between-group analyses detected a multivariate, marginal main effect of an ADHD diagnosis on the Stroop interference scores, and a univariate main effect of an ADHD diagnosis on the interference score of errors. Further, only the interference score of errors predicted significantly the parent reported scores on the Inhibit scale from the Behavior Rating Inventory of Executive Function. These findings support that a Stroop interference score of errors is sensitive for inhibition problems in children with ADHD and encourages the use of Stroop versions including error recordings independent of response time.     

The effects of yoga on the attention and behavior of boys with Attention-Deficit/ hyperactivity Disorder (ADHD)

Boys diagnosed with ADHD by specialist pediatricians and stabilized on medication were randomly assigned to a 20-session yoga group (n = 11) or a control group (cooperative activities; n = 8). Boys were assessed pre- and post-intervention on the Conners' Parent and Teacher Rating Scales-Revised: Long (CPRS-R:L & CTRS-R:L; Conners, 1997), the Test of Variables of Attention (TOVA; Greenberg, Cormna, & Kindschi, 1997), and the Motion Logger Actigraph. Data were analyzed using one-way repeated measures analysis of variance (ANOVA). Significant improvements from pre-test to post-test were found for the yoga, but not for the control group on five subscales of the Conners' Parents Rating Scales (CPRS): Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive and ADHD Index. Significant improvements from pre-test to post-test were found for the control group, but not the yoga group on three CPRS subscales: Hyperactivity, Anxious/Shy, and Social Problems. Both groups improved significantly on CPRS Perfectionism, DSM-IV Hyperactive/ Impulsive, and DSM-IV Total. For the yoga group, positive change from pre- to post-test on the Conners' Teacher Rating Scales (CTRS) was associated with the number of sessions attended on the DSM-IV Hyperactive-Impulsive subscale and with a trend on DSM-IV Inattentive subscale. Those in the yoga group who engaged in more home practice showed a significant improvement on TOVA Response Time Variability with a trend on the ADHD score, and greater improvements on the CTRS Global Emotional Lability subscale. Results from the Motion Logger Actigraph were inconclusive. Although these data do not provide strong support for the use of yoga for ADHD, partly because the study was under-powered, they do suggest that yoga may have merit as a complementary treatment for boys with ADHD already stabilized on medication, particularly for its evening effect when medication effects are absent. Yoga remains an investigational treatment, but this study supports further research into its possible uses for this population. These findings need to be replicated on larger groups with a more intensive supervised practice program.     

Assessment of short-term verbal memory impairments in adolescents and adults with ADHD

The purpose of this study was to determine whether a brief measure of verbal memory can assess short-term verbal memory impairments relative to verbal abilities in adolescents and adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and to ascertain whether significant differences between short-term verbal memory and verbal abilities are more common among persons with ADHD than in the general population. One hundred seventy-six adolescents and adults diagnosed with ADHD (DSM-IV criteria) were assessed with a measure of short-term verbal memory. The short-term verbal memory score of each subject was compared with the verbal abilities on two measures. Percentages of ADHD subjects with "significant discrepancy" between verbal IQ and short-term verbal memory were compared with the standardization sample for the verbal memory measure. A majority of adolescents and adults diagnosed with ADHD demonstrated significant discrepancy between performance on the short-term verbal memory measure and verbal IQ. The percentage of ADHD subjects with a significant discrepancy between these two measures greatly exceeded the percentage of persons in the general population showing such a discrepancy. This brief measure of short-term verbal memory may be a useful measure to include in a comprehensive assessment for ADHD symptoms in adolescents and adults. Replication in other groups of ADHD patients is needed to test the generalizability of the findings.     

父母自主支持、父母心理控制和青少年网络成瘾的关系：一项交叉滞后研究

对1222名青少年进行六个月的追踪测查,以探讨父母自主支持、父母心理控制和青少年网络成瘾之间的相互预测关系。结果表明：（1）前、后测父母自主支持均与网络成瘾呈负相关。（2）前、后测父母心理控制均与网络成瘾呈正相关。（3）前测父母自主支持可以预测后测网络成瘾,前测网络成瘾也可以预测后测父母自主支持。（4）前测父母心理控制可以预测后测网络成瘾,但前测网络成瘾不能显著预测后测父母心理控制。本研究揭示了父母因素与青少年行为之间的相互作用,这对改善青少年网络成瘾有一定的实践意义。     

Interrater agreement on behavioral executive function measures in adolescents with Attention Deficit Hyperactivity Disorder

Background/ObjectiveThough most children with Attention Deficit Hyperactivity Disorder (ADHD) show difficulties in behavioral measures of executive functions (EF), few studies have examined interrater agreement in these measures.Objective: To analyze the agreement between parents, teachers and self-reports of behavioral EF in adolescents with ADHD and controls. Method: A sample of 118 adolescents (75 with ADHD and 43 controls) was rated by parents, teachers and the adolescents themselves using the Comprehensive Executive Function Inventory. The intraclass correlation coefficient (ICC) and Bland and Altman methods were used to evaluate agreement. Results: The ICC between parents, teachers and self-report was poor or moderate in the group with ADHD; in the control group the agreement was fair to good. The Bland and Altman graphs show that, in the control group, most of the scores are below to the clinical cut-off point, while in the group with ADHD they are above. Conclusions: Agreement between all raters was low. Parents, teachers and adolescents agreed on the absence of deficits in behavioral EF in the control group, and on the presence of deficits in the group with ADHD, although they did not agree on the frequency of these deficits.     

Evaluating the Utility of Sluggish Cognitive Tempo in Discriminating Among <Emphasis Type="Italic">DSM-IV</Emphasis> ADHD Subtypes

The objective of the current study was to evaluate how the inclusion of 3 Sluggish Cognitive Tempo (SCT) symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD) diagnostic criteria influences the external validity of the ADHD subtypes. The sample comprised 228 children (166 boys, 62 girls) ranging in age from 5–18 years who were referred to clinics for attentional, behavioral, and/or learning problems and diagnosed with DSM-IV ADHD (124 Combined type, 81 Inattentive type, 23 Hyperactive-Impulsive type). Parent ratings of ADHD symptoms were obtained using the Emory Combined Rating Scale (ECRS), which assesses symptoms of the common DSM-IV childhood psychiatric disorders. Regression analyses incorporating planned comparisons were conducted to examine how the inclusion of SCT symptoms affects differences among ADHD subtypes on several external validity indicators (i.e., gender, age-of-onset, and overlapping conditions). The regression analyses did not yield any significant differences in gender ratios, mean age-of-onset, or overlapping externalizing or internalizing problems when the ADHD Inattentive type was subdivided into high- versus low-SCT groups. In conclusion, the current results suggest that the inclusion of parent-reported SCT symptoms in the ADHD diagnostic criteria has limited utility for isolating diagnostically meaningful subgroups of the Inattentive type or for enhancing the external validity of the ADHD subtypes in clinic-referred samples.     

Examining the Validity of ADHD as a Diagnosis for Adolescents with Intellectual Disabilities: Clinical Presentation

Children with intellectual and developmental disabilities are at heightened risk for mental disorders. Using current diagnostic criteria, disruptive behavior disorders, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), appear to be the most prevalent co-occurring disorders. However, the validity of ADHD as a diagnosis for children and adolescents with intellectual disabilities remains unclear. The present study examined the clinical presentation of ADHD (prevalence, sex differences, and comorbidity) among adolescents with and without intellectual disability (ID) as well as investigated the validity of ADHD for adolescents with ID by examining similarities in terms of symptom presentation, developmental course, and associated functional impairment. The sample included 142 adolescents and their families, about a third of whom were classified in the ID group and the remaining were in the typically developing (TD) group. Findings indicated that adolescents with ID continue to be at elevated risk for ADHD (risk ratio: 3.38:1) compared to their typically developing peers. Additionally, the presentation of ADHD appeared similar among adolescents with and without ID, supporting the validity of an ADHD diagnosis for this population of adolescents. Implications for public policy and intervention are discussed.     

The Assessment and Diagnosis of Attention Deficit Hyperactivity Disorder in Adult Forensic Psychiatric Outpatients

The primary purpose of the present study was to examine the validity of commonly utilized ADHD rating scales within an adult forensic population. Participants were 120 patients assessed for dysfunctional anger and impulsive aggression at a hospital-based clinic. Two psychiatrists made independent diagnoses about the presence or absence of ADHD among individuals presenting with symptoms consistent with this disorder. Following the diagnoses, participants were assessed with multiple ADHD measures, including measures based on self-report, observer-report, or a computerized neuropsychological measure (IVA + Plus). With the exception of the IVA + Plus, the ADHD measures significantly differentiated individuals diagnosed with ADHD from individuals who were not so diagnosed. These measures also demonstrated good diagnostic utility via test specific parameters (sensitivity, specificity, positive predictive power, and negative predictive power). A sub-set of measures demonstrated particularly good classification accuracy, with high sensitivity (91 %) and good specificity (81 %). Implications of these findings for the effective assessment and diagnosis of ADHD in adult outpatient psychiatric settings are discussed.     

Quality of life of adolescent males with attention-deficit hyperactivity disorder

Most psychosocial research on attention-deficit/hyperactivity disorder (ADHD) has focused on deficits in school, family, or behavioral functioning without incorporating perceived quality of life (QoL) or the adolescents' perspective. The Youth Quality of Life Instrument--Research Version (YQOL-R), was used to assess self-perceived QoL in a community sample of adolescents aged 11-18 years. Fifty-five adolescent males with a clinical diagnosis of ADHD were compared to a group of 107 adolescents with no chronic conditions (NCC) and a group of 52 adolescents with mobility impairments (MI). The adolescents with ADHD reported significantly lower perceived QoL scores, particularly in the Self and Relationship domains, than the NCC group. Their scores were similar to those from the group with MI, a group previously shown to have a substandard QoL. Interventions to improve self-esteem and social interactions might use QoL outcomes in evaluating effectiveness.