Several studies have used direct behavioral observation in the assessment of the AD-DBDs. In a structured playroom setting, measures include counting the number of times a child crosses grids marked on the floor, recording the number of toys touched, the amount of time played with each toy and the amount of time the child spends focused on a particular task. In the school set-ting, typical measures include monitoring the amount of time the child spends on-task, remains in his/her seat and so on. These observational measures have consistently been found to differ-entiate ADHD children from normals, although their utility in discriminating among clinical groups is less clear.
At the present time, there are no laboratory measures that can serve as diagnostic tools for AD-DBDs. Similarly, findings from neuroimaging studies have neither been consistent enough nor specific enough to warrant their use as diagnostic tools.
Many children with AD-DBDs have impaired social skills and consequently experience difficulties with peer relationships. Data suggest that both hyperactivity and aggression often lead to peer rejection, which may occur as early as the preschool. The level of hyperactivity, age of onset of aggression and the devel-opmental level of the child, all affect the extent of peer rejection experienced. Information regarding social adjustment is crucial in treatment planning, since increased impairment in social and school function is predictive of poor outcome.
Parent–child interactions also play a role in the mainte-nance of disruptive behaviors, poor social skills, the presence of internalizing symptoms and response to treatment. It has been noted that robust reductions in negative and ineffective parenting practices at home mediate improvement in children’s social skills in the school setting (Hinshaw et al., 2000).