ADHD Rating Scale

The ADHD Rating Scale is a self-report inventory consisting of 18 questions regarding a child’s behavior over the past 6 months. It can be used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD), and to measure improvement in symptoms following treatment. Each question measures the frequency of the behavior, in which the respondent is asked to indicate whether the behavior occurs “always or very often”, “often”, “somewhat”, or “rarely or never”.

The rating scale can be completed by a child, parent, teacher or clinician. The scores of the scale have shown good reliability and validity across multiple different study samples.^[1][2]

Development and history

The ADHD Rating Scale was developed to allow clinicians to quickly and easily assess the presence, severity, and impairment related to ADHD symptoms in children between ages 5–17.^[3] It has been directly adapted from the DSM-IV criteria for ADHD^[4] and has also been updated to reflect the changes in the DSM-5. Separate forms exist for children (ages 5–10) and adolescents (ages 11–17), with age-appropriate items on each version, and multiple versions of the test are available in English and Spanish.^[5]

Scoring and interpretation

Scoring

Items in the questionnaire measures the following on a scale from 0 (don't experience the symptom at all) to 3 (experience the symptom very often):

• items 1-9 measure inattention symptoms
• items 10-18 measure impulsivity and hyperactivity symptoms
• item 19 asks if some of the behaviors were present in the child before the age of 7

Interpretation

Scoring is based on the DSM-IV-TR criteria for Attention-Deficit/Hyperactivity Disorder. For all subtypes, the DSM-IV requires that some symptoms be present in the child before the age of 7. The information required to meet criteria is as follows:

• ADHD inattentive sub-type: 6 or more of the 9 responses in the “Inattention” section must be either “often” or “always or very often”.
• ADHD hyperactive sub-type: 6 or more of the 9 responses in the “Impulsivity and Hyperactivity” section must be either “often or “always or very often”.
• ADHD combined subtype: 6 of the 9 responses must be marked as either “often” or “always or very often” in both the “Inattention” and “Impulsivity and Hyperactivity” sections.

In order to meet the DSM-IV criteria for ADHD, symptoms must be present in two or more settings. It is recommended and common for a parent and a teacher to both complete the ADHD Rating Scale.

DSM-5 changes

The most recent version of the DSM has modified the age of onset from "some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years" to "several inattentive or hyperactive-impulsive symptoms were present prior to age 12."^[6] The ADHD Rating Scale has been modified to include these changes in criteria.

Psychometrics

The reliability and validity of the parent and teacher versions of the ADHD Rating Scale have shown to be comparable to other ADHD measures; the clinician version has also shown good reliability and validity.^[1]

Limitations

Ratings of ADHD symptoms on rating scales in general are subjective. Teachers and parents may use different subjective criteria to define symptoms, and may not take context of symptoms into account when making ratings.^[7] Furthermore, the validity of the ARS is acceptable,^[1] but the normative sample used to calculate this statistic was composed of children aged 5 to 14, and thus it cannot be generalized beyond age range.^[4]

There are also questions about how well items on the ARS follow explicit DSM criteria. Specifically, one of the hyperactivity items does not specify that in adolescents, thoughts of restlessness are sufficient, rather than excessive behavioral movement. This lack of specification does not map directly onto DSM criteria.^[4]

See also

• AACAP practice parameter for ADHD
• Attention deficit hyperactivity disorder
• EffectiveChildTherapy.org guidelines on ADHD
• Cognitive Behavioral Therapy for Adult ADHD

References

1. Faries, D. E.; Yalcin, I.; Harder, D.; Heiligenstein, J. H. (1 January 2001). "Validation of the ADHD Rating Scale as a clinician administered and scored instrument". Journal of Attention Disorders 5 (2): 107–115. doi:10.1177/108705470100500204.
2. Pelham WE, Jr; Fabiano, GA; Massetti, GM (September 2005). "Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents.". Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 34 (3): 449–76. doi:10.1207/s15374424jccp3403_5. PMID 16026214.
3. DuPaul, George J. (September 1991). "Parent and Teacher Ratings of ADHD Symptoms: Psychometric Properties in a Community-Based Sample". Journal of Clinical Child Psychology 20 (3): 245–253. doi:10.1207/s15374424jccp2003_3.
4. DuPaul, George J. (1998-01-01). "ADHD Rating Scale–IV". Mental Measurements Yearbook with Tests in Print.
5. "ADHD Rating Scale—5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation". Guilford Press. Retrieved 2016-03-31.
6. "Highlights of Changes From DSM-IV to DSM-5". American Psychiatric Association. doi:10.1176/appi.books.9780890425596.changes.
7. "ADD/ADHD Alternatives in the Classroom".