Assessment and Rating Scales- Attention-deficit and Disruptive Behavior Disorders

Assessment

The clinical evaluation of a child with possible AD-DBD re-quires a multisource, multimethod approach. In addition to clini-cal interviews of parents and children, supplemental information may be obtained from school reports, rating scales completed by teachers and parents, neuropsychological test data and direct observations of the child. Generally, adults are considered to be the best informants of disruptive behaviors, although children and adolescents may provide important data regarding internal-izing symptoms and some infrequent behavior problems, such as antisocial acts (American Academy of Child and Adolescent Psychiatry, 1997; Barkley et al., 1991; Loeber et al., 1991).

Rating Scales

Rating scales facilitate the systematic acquisition of informa-tion about the child’s behavior in different settings in a cost-ef-fective manner. Most are standardized and provide scores that are norm-referenced by age and gender. The systematic use of these instruments ensures that a complete set of specific behav-iors is assessed at different points in time, enabling comparisons over the course of treatment. Teacher and parent rating scales are complimentary because they yield data from different situ-ations. Parents are knowledgeable about their child’s day-to-day behavior, and present information related to the child’s behavior at home and his/her interaction with siblings. Teachers are often a valuable source of information regarding attentional problems and disruptive behaviors in a classroom setting.

The most commonly used rating scales are the Con-ners (1998a, 1998b), and the Achenbach (1991a, 1991b) scales, which are available in parent and teacher versions. The Conners Teachers Rating Scale – Revised (CTRS-R) is a 28-item scale that is normed for children from 3 to 17 years of age and is sensitive to medication effects. The Conners Parent Rating Scale (CPRS-R) contains 48 items is also sensitive to treatment effects and can differentiate groups of ADHD children from normals. The Child Behavior Checklist (CBCL) assesses a broad range of behavioral problems and is useful with children from ages 4 to 16 years. The CBCL is also available in a more recently developed Teacher Report Form (Achenbach, 1991b), which is similar to the parent form and applicable for children aged 4 to 18 years.

Rating scales have several limitations, and diagnoses should not be made on the bases of these data alone. It has been consistently found that elevations on discrete scale factors do not necessarily coincide with specific psychiatric disorders.