Step 1: An Assessment of Academic, Social, and Emotional Functioning
Because information is gathered from so many sources, one professional must guide and coordinate this evaluation process. It is usually a psychologist. Once sufficient information is gathered, the evaluator will examine details about the child's functioning in different areas of life. The checklists, detailed history, and the clinical interviews, will be compared to typical children of similar age, culture, and, developmental level. This comparison enables the evaluator to sort out what is normal and what is not, given a particular child's age and culture. This evaluation process also provides clues about the best treatment approach.
Assessment instruments: Behavioral checklists completed by multiple reporters:
Self-report instruments are questionnaires and checklists that identify ADHD symptoms in both children and adults. Self-report instruments are generally a series of questions people answer about their own symptoms, thoughts, and feelings. Behavioral checklists are sometimes referred to as "report-by-other" scales. As the name suggests, these scales are filled out by a person who spends a significant amount of time with the child suspected of having ADHD. Teachers, and family members, spend a significant amount of time observing the child. Therefore, they possess key information that aids the evaluation process.
Once observations and reports are completed, the child's scores are compared to average scores of children in the same age group. This helps to identify what is average and ordinary, and what is not. Higher scores on both types of scales indicate a higher degree of ADHD-associated symptoms.
Clinicians use standardized rating scales to gain hard-to-observe detailed information. Guidelines suggest that behavior checklists are an important part of a comprehensive assessment. However, reports of this type can only tell part of the story. Clinical guidelines suggest gathering information from many sources. The following is a list of some commonly used checklists along with descriptive information about each. Links to information about these checklists can be found in the Resource List.
ACTeRS is a rating scale used to identify ADHD and ADD children, teens, and adults (with and without hyperactivity). It evaluates four factors: 1) hyperactivity, 2) oppositional behavior, 3) attention, and 4) social skills. It comes in three versions: 1) teacher report, 2) parent report, and 3) self-report for teens and adults. The children's version is designed for kindergartners through eighth graders. There are paper and pencil, and computerized formats. It was developed at the University of Illinois Institute for Child Behavior and Development. It can be used as a part of the diagnostic process or to evaluate medication response (www.metritech.com).
Brown Attention Deficit Disorder Scales - Adolescent Version
This 40-item, self-report measure is a quick way to screen for adolescent ADD (a specific type of ADHD LINK). The instrument highlights 6 key abilities:
1. Sustains attention;
2. Sustains effort to complete tasks;
3. Active and organized during work tasks;
4. Recalls learned material;
5. Utilizes short-term memory; and,
6. Ability to regulate moods.
Connors' Rating Scales - 3rd Edition
This instrument was one of the first rating scales developed to evaluate children and adolescents with ADHD. The Connors' system includes scales for parents/caregivers, teachers, and adolescents. Parent and teacher forms can be used for children and adolescents ages 3 to 17, while the adolescent form can be used for children ages 12 to 17. The 80-item parent form includes questions about behavioral symptoms in categories such as oppositional defiance, social problems, anxiety and inattention.
Copeland Symptom Checklist for Attention Deficit Disorders - Child and Adolescent Version
This checklist determines whether a child or adolescent has symptoms characteristic of ADHD; the severity of symptoms; and, which functional areas are most affected. The checklist addresses 10 key areas, including: emotional difficulties, peer relationships, family-interaction issues, maturity level, distractibility, activity level, impulsivity, degree of compliance, attention-seeking behaviors, and cognitive and visual-motor achievement.
The Vanderbilt Assessment Scale
The Vanderbilt Assessment Scale has two components: symptom assessment and an assessment of impaired functioning at home, school, and other social settings. The parent rating scale version contains 55-items. The teacher version has 43-items and focuses on behavioral observations at school. This rating scale is used by professionals to screen for ADHD, oppositional defiant disorder, conduct disorder, anxiety, and depression in children.
The Wender Utah Rating Scale
The Wender Utah Rating Scale is useful for retrospective analysis of childhood symptoms. The questions require people to look back over time and identify ADHD symptomatology from their past. This is a 61-item survey that is often used to clarify the diagnosis of adult ADHD.