_8875ca3baa024c341bab62e3afede7e6_MOD-2_PART-III

Attention-deficit hyperactivity disorder (ADHD)
Part III.
Aligning Assessment with Treatment

Impact of ADHD - Impairment
Assessment of impairment is a critical part of ADHD diagnosis and treatment:
Impairment is integrated into every aspect of a DSM diagnosis
Impaired areas of functioning predict referral to treatment providers
Impaired areas of functioning are socially valid targets of treatment
Improvement in impaired areas (e.g., academic functioning; peer relationships) mediates positive outcomes
(Anastopoulos & Shelton, 2001; Evans et al., 2005; Fabiano et al., 2006; Pelham et al., 2005)

Impairment Measures
Columbia Impairment Rating
(Bird et al., 1993, 1996)
Children’s Global Assessment of Functioning
(Bird et al., 1987, 1990; Shaffer, 1983)
Child and Adolescent Functional Assessment Scale
(Hodges et al., 1999; Hodges & Wong, 1996)
Impairment Rating Scale
(Evans et al., 2005; Fabiano et al., 2006; Pelham & Hoza, 1996; Wolraich et al., 1998)
Plus many measures of individual domains of impairment (e.g., academic achievement, peer relationships/social skills, parenting, family fx).

Impairment Rating Scale
Raters (parents and teachers) describe what they see
as the child's primary problems in narrative format. Raters then rate how the child's symptoms have affected each of the following domains:
(1) relationship with peers/siblings
(2) relationship with parents or teachers,
(3) his or her academic progress,
(4) your classroom/family in general
(5) his or her self-esteem , and
(6) overall problem/need for treatment
Fabiano et al., 2006; available for free at www.ccf.buffalo.edu

Assessments Beyond Diagnosis
Diagnosis is only one aspect of assessments for ADHD.
With the assessment technology available, diagnosing ADHD has become relatively efficient and it is backed by a strong psychometric evidence base.

Once a diagnosis is established, the focus should shift to the rest of the assessment process including:
Identifying impaired areas of functioning
Operationalizing target behaviors within these domains
Conducting a functional analysis of the antecedents, settings, and targets of the target behavior(s)
Implementing treatment and constructing measures to monitor and evaluate treatment progress
(Pelham, Fabiano, & Massetti, 2005)

Identifying Impaired Areas of Functioning/Operationalizing Target Behaviors

Example of Teacher Progress Monitoring Measure
23/27 = 87%
See http://ccf.buffalo.edu; www.jimwrightonline.com; www.directbehaviorratings.com

Summary and Recommendations
There is considerable psychometric information available to support ADHD assessments.
Diagnostic procedures for ADHD can be conducted relatively easily using evidence-based methods.
Parent and Teacher Rating Scales
Clinical interview to determine onset of symptoms and rule out other potential diagnoses.
Structured diagnostic interviews for ADHD do not add incremental validity for assessments.