Evidence based assessment/Attention deficit hyperactivity disorder (assessment portfolio)

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Preparation phase[edit]

Demographic information[edit]

Diagnosis[edit]

ICD-10 Criteria

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Specify whether:

314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
314.00 (F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
314.01 (F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.
Specify if:
In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.

Specify current severity:

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.[1]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of ADHD that they are likely to see in their clinical practice.

Base rates of ADHD in different populations and clinical settings
Setting (Reference) Base Rate(s) Demography Diagnostic Method Best Recommended For
Meta-Analysis of worldwide prevalence of Child/Adolescent ADHD[2] 6.1% (parent rating)
7.1% (teacher rating)
10.5% (ages 3-5)
11.4% (ages 6-12)
8.0% (ages 13-18)
Worldwide, Ages 3-18 Multiple, but each focused on DSM-IV criteria
Epidemiological NHIS (US CDC, 2011) 8.4% (Overall)
12.0% (Male)
4.7% (Female)
2.1% (ages 3-5)
8.4% (ages 6-11)
11.9% (ages 12-17)
10.3% (southern region of US)
USA Nationally Representative, Ages 3-17 Parent-report of whether child had ever been diagnosed
Child and Adolescent Epidemiological National Survey of Children's Health (US CDC, 2007) 9.5% (overall)
12.3% (male)
5.3% (female)
1.5% (ages 3-5)
9.1% (ages 6-11)
12.4% (ages 12-17)
15.6% (North Carolina)
USA Nationally Representative, Ages 4-17 Parent-report of whether child had ever been diagnosed
Adolescent Epidemiological National Comorbidity Survey-Adolescent Supplement[3] 8.7% USA Nationally Representative, Ages 13-18 CIDI 3.0 structured diagnostic interview
Johnston County, North Carolina Sample[4] 15.5% Representative Sample of Johnston County School Children, North Carolina, Ages 6-12 Combined parent and teacher report (NTRS and DISC) with DSM-IV criteria
North Carolina Community Sample[5] 0.9% (3-month prevalence)
4.1% (estimated by age 16)
Sample drawn from 11 counties in Western NC, Ages 9-16 CAPA structured diagnostic interview
High-Risk Community Sample[6] 14.3% Sample recruited at Durham, NC, Seattle, Nashville, and Central Pennsylvania sites. Sample was followed longitudinally and identified as at high risk for externalizing disorders in kindergarten. 50% African American, ages 12-15 Diagnostic Interview Schedule for Children (DISC)
Meta-Analysis of Clinical Samples[7] 38% Ages 6-90 Structured Diagnostic Interviews
Meta-Analysis of Clinical Samples[7] 23% Ages 6-90 Clinical Evaluations
Teacher-Reported Prevalence of ADHD[8] 5.25% (overall)
5.58% (elementary schoolers)
3.53% (middle schoolers)
7.1% (one county in rural NC)
USA Nationally Representative, Ages 5-14 Teacher report of number of children who have been identified with ADHD in their class

Prediction phase[edit]

Screening and diagnostic instruments for attention deficit hyperactivity disorder[edit]

Measure Format (Reporter) Age Range Administration/
Completion Time
Inter-rater reliability Test-retest reliability Construct validity Content validity Cost Highly recommended
ADHD Rating Scale (ADHD-RS) IV Teacher, Parent Not applicable A G A
Conners Rating Scale-Revised (CRS-R) ADHD Teacher, Parent Not applicable G G A Green tickY
Attention Deficit Disorder Evaluation Scales (ADDES-3) Teacher, Parent Not applicable A A G
Diagnostic Interview Schedule for Children-IV (DISC-IV) Interview Parent Unavailable A G G

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent

Psychometric properties of screening measures for attention deficit hyperactivity disorder[edit]

Screening Measure (Primary Reference) AUC LR+ Score LR- Score Clinical generalizeability Study description
Child Behavior Checklist (CBCL) - Attention Problems T-Score[9] .84 (N=187) 6.92 (>55) 0.19 (<55) Somewhat High Utilized sample ages 6-18 recruited from local pediatricians, psychiatrists, and community advertisements. Included 95 children who met criteria for ADHD. 70 of these children also met criteria for ODD/CD.[10]
12.2 (>60) 0.41 (<60)
47 (>65) 0.53 (<65)
34 (>70) 0.66 (<70)
Child Behavior Checklist (CBCL) - Attention and Aggression Problems T-Score[9] Boys: .86 (N=111) 10.2 (>55) 0.41 (<55) Somewhat High Utilized sample ages 6-18 which consisted of 219 brothers and sisters of children who were referred to a hospital pediatric unit for ADHD or other symptoms. Half of these siblings had brothers and sisters who had ADHD, half did not.[11]
Girls: 0.90 (N=108) 11.2 (>55) 0.35 (<55)
Teacher Response Form (TRF) - Attention Problems T-Score[9] Not reported (N=184) 3.66 (>70) 0.73 (<70) Somewhat High Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups.[12]
Teacher Response Form (TRF) - Attention and Aggression Problems T-Score[9] Not reported (N=184) 4.33 (>70) 0.89 (<70) Somewhat High
Disruptive Behavior Disorder Rating Scale (DBDRS) - Parent Report (Pelham et. al, 1992) 0.78 (N=232) 5.06 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.20 (<9) (Endorsed < 6 symptoms of inattention or hyperactivity) Somewhat High Sample consisted of 232 ethnically diverse children ages 5-10 with (n = 121) and without (n=111) ADHD recruited through advertisements at school and through self-help groups.[13][14]
Disruptive Behavior Disorder Rating Scale (DBDRS) - Teacher Report (Pelham et. al, 1992) 0.63 (N=232) 1.97 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.24 (Endorsed < 6 symptoms of inattention or hyperactivity) Somewhat High
Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS)[15] Not reported 4.79 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.38 (Endorsed < 6 symptoms of inattention or hyperactivity) Moderate Sample consists of 582 children ages 5-15 recruited through schools in Oklahoma. Sample includes children screened as "high risk" for ADHD and "low risk" for ADHD.[16]
Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS)[17] Not reported 2.91 (Positive risk score) 0.657 (Negative risk score) Moderate Sample consisted of 370 children ages 5-15 recruited though schools in Oklahoma. Sample was representative community sample.[18]
Conners Rating Scale (Revised) - Long Form Parent Report (Conners, 1997) Not reported 15.33 (>93rd percentile) 0.09 (<93rd percentile) Moderate Data come from normative sample of 2482 children ages 3 to 17 across the United States and Canada. LRs here discriminate ADHD from Non-Clinical.[19]
Conners Parent Rating Scale-48 (CPRS-48) Impulsive-Hyperactive Subscale T-Score (Conners, 1990) Not reported 1.26 (>70) 0.79 (>70) Somewhat High Utilized sample ages 5-12 years referred to a research clinic for assessment of ADHD. 108 children were ultimately diagnosed with ADHD, while 76 were not. LR's are calculated for discriminating between those two groups.[12]
Conners Teacher Rating Scale-39 Hyperactivity Subscale T-Score (Conners, 1990) Not reported 5.2 (>70) 0.53 (<70) Somewhat High
Conners Teacher Rating Scale (Revised) - Long Form (Conners, 1997) Not reported 8.66 (>93rd percentile) 0.24 (<93rd percentile) Moderate Data come from normative sample of 1973 children ages 5 to 17 across the United States and Canada. LRs discriminate ADHD from non-clinical.[19]
ADHD Symptom Checklist-4 (ADHD-SC4) - Parent Report[20] Not reported 1.45 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.70 (Endorsed < 6 symptoms of inattention or hyperactivity) Somewhat High Data come from sample of 207 children ages 5-17 years old who were referred to psychiatric outpatient service with variety of emotional and behavioral disorders.[21]
ADHD Symptom Checklist-4 (ADHD-SC4) - Teacher Report[20] Not reported 1.53 (Endorsed ≥ 6 symptoms of inattention or hyperactivity) 0.60 (Endorsed < 6 symptoms of inattention or hyperactivity) Somewhat High
ADHD RS-IV - Home (DuPaul et. al, 1998b) Not reported 1.63 (>80th percentile) 0.35 (<80th percentile) Moderate Sample of 2000 children ages 5 to 18 years old from geographically representative normative base.[19]
ADHD RS-IV - School (DuPaul et. al, 1998b) Not reported 4.5 (>80th percentile) 0.42 (<80th precentile) Moderate

Note: All studies with one exception used structured or semi-structured clinical interviews to establish diagnosis of ADHD. The exception, the Sprafkin & Gadow study (2007), used a combination of CBCL rating scales, clinician review, and clinician consensus to confirm ADHD diagnosis.[21] “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Prescription phase[edit]

Recommended Assessments[edit]

Process phase[edit]

Treatment[edit]

Executive summary[edit]

1. If intervening with children ages 4-5, behavior therapy should be the first line of treatment.

2. If intervening with children ages 6-11, behavior therapy should be the first line of treatment, in conjunction with medication.

3. If intervening with children ages 12-18, medication should probably be the first line of treatment, though behavior therapy could be used in combination.

4. Three types of therapeutic interventions have well established evidence-bases:

a. Behavioral Parent Training Interventions
b. Behavioral Classroom Management Interventions
c. Behavioral Peer interventions involving recreational peer groups (e.g. summer camps)

5. If considering a classroom management intervention:

a. Academic and Cognitive-Behavioral Interventions are most effective in changing academic outcomes
b. Cognitive Behavioral and Contingency Management Interventions are most effective in changing behavioral outcomes

Clinical practice guidelines[edit]

Published by the American Academy of Pediatrics in 2011.[22]

Preschool-aged children (ages 4–5)
Primary care clinicians should prescribe evidence-based parent and/or teacher-administered behavior therapy as the first line of treatment, and may prescribe methylphenidate if behavioral interventions are not effective.
Elementary-aged children (ages 6–11)
Primary care clinicians should prescribe FDA-approved medications for ADHD and/or evidence based parent and teacher administered behavior therapy. Preferably, both medication and behavior therapy will be prescribed.
Adolescents (ages 12–18)
Primary care clinicians should prescribe FDA approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as a treatment for ADHD, preferably both.

Behavioral therapies[edit]

These meet the American Academy of Pediatrics and American Psychological Association Task Force criteria for well-established evidence-based treatments. Descriptions and effect sizes are taken from the American Academy of Pediatrics' guidelines[22] and Pelham & Fabiano's review article.[23]

Behavioral Parent Training
Behavior modification principles provided to parents for implementation in home settings. Typical outcomes include improved compliance with parental commands, improved parental understanding of behavioral principles, high levels of parental satisfaction with treatment.
Median effect size: 0.55
Behavioral Classroom Management
Behavior-modification principles provided to teachers for implementation in classroom settings. Typical outcomes include improved attention to instruction, improved compliance with classroom rules, decreased disruptive behavior, improved work productivity, and improved academic achievement.
Median effect size: 0.61
Behavioral Peer Interventions
Interventions focused on peer interactions/relationships. These could include group-based interventions provided weekly and include clinic-based social skills training used either alone or concurrently with behavioral parent training and/or medication. Typical outcomes are more mixed with these interventions. Some clinical-office based interventions have produced minimal effects, while some studies of behavioral peer intervention coupled with behavioral parent training found positive effects on parental ratings of ADHD symptoms. No studies of this type of intervention reveal differences on social functioning or parental ratings of social behavior. Behavioral Peer Interventions implemented in peer group/recreational settings (e.g. summer camps) have the most evidence of being effective.
Median effect size: None reported, effect sizes found are considered moderate.

School based interventions[edit]

Single Subject Design Effect Sizes
Intervention type Effect size
Academic
outcomes
Behavioral
outcomes
Academic 4.73 1.53
Cognitive behavioral 3.77 3.31
Contingency management 2.29 2.40
Combined 2.29 1.31

Findings from a review by DuPaul and colleagues.[24]

Associated with greater effects on academic outcomes
Academic — interventions focus primarily on manipulating antecedent conditions via things like peer tutoring, computer-aided instruction, and organizational skills.
Combined academic and contingency management interventions.
Associated with greater effects for behavior outcomes
Contingency management — interventions use reinforcement and punishment.
Cognitive behavioral — interventions focus on development of self-control skills and reflective problem-solving strategies.

Process and outcome measures[edit]

Severity and outcome[edit]

Clinically significant change benchmarks with common instruments and ADHD rating scales
Measure Diagnostic category Cut Scores* Critical Change
(Unstandardized Scores)
A B C 95% 90% SEdifference
Benchmarks Based on Published Norms
CBCL T-scores
(2001 Norms)
Total 49 70 58 5 4 2.4
Externalizing 49 70 58 7 6 3.4
Internalizing N/A 70 56 9 7 4.5
Attention Problems N/A 66 58 8 7 4.2
TRF T-Scores
(2001 Norms)
Total N/A 70 57 5 4 2.3
Externalizing N/A 70 56 6 5 3.0
Internalizing N/A 70 55 9 7 4.4
Attention Problems N/A 66 57 5 4 2.3
Conners 3-Teacher Rating Scale T-Scores ADHD Inattentive 36 74 57 11 10 5.6
ADHD Hyperactive-Impulsive 36 74 57 11 9 5.5
Conners 3-Parent Rating Scale T-Scores ADHD Inattentive 37 72 58 10 10 5.6
ADHD Hyperactive-Impulsive 37 72 58 10 8 4.7
Benchmarks Based on ADHD Samples[13]
Disruptive Behavior Disorders Rating Scale 1.4 8.6 5.7 12 10 0.9

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO

Process measures[edit]

CBCL Attention Problems Subscale
Could be used on a weekly basis to track changes in ADHD symptomotology. T-scores from this measure could also be recorded on a weekly basis to determine if reliable and clinically significant changes in ADHD symptoms are occuring. The CBCL Attention Problems Subscale has repeatedly demonstrated good-to-excellent convergence with diagnostic interviews for diagnosing ADHD.[25][26][10][11] The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.
Daily Report Card
Several scholars have pointed out that it is equally important to track changes in the functional behaviors that a child with ADHD engages in, in addition to their ADHD symptoms, to capture the full range of adaptive changes that are made by children with ADHD throughout the course of treatment.[25][27] The daily report card is a mechanism by which such adaptive behavioral changes can be tracked. When implementing the daily report card, problematic child behaviors at home and at school are targeted for change. Rewards are offered to the child for reaching daily and weekly goals for reducing maladaptive behaviors and increasing adaptive behaviors. Parents and Teachers track child behaviors on a daily basis and provide feedback to one another and the child with behavior frequency counts and/or daily "grades" on how well the child behaved. Daily report cards are a mainstay of cognitive-behavioral and behavioral modification evidence-based intervention strategies for ADHD,[24][28] and they are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1.

External Links[edit]

References[edit]

Click here for references
  1. Cite error: Invalid <ref> tag; no text was provided for refs named DSM5-ADHD
  2. Willcutt, Erik G. (July 2012). "The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review". Neurotherapeutics 9 (3): 490-99. doi:10.1007/s13311-012-0135-8. PMID 22976615. PMC 3441936. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3441936/. 
  3. Merikangas, Kathleen Ries; He, Jian-Ping; Burstein, Marcy; Swanson, Sonja A.; Avenevoli, Shelli; Cui, Lihong; Benjet, Corina; Georgiades, Katholiki et al. (October 2010). "Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A)". Journal of the American Academy of Child and Adolescent Psychiatry 49 (10): 980-9. doi:10.1016/j.jaac.2010.05.017. PMID 20855043. PMC 2946114. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2946114/. 
  4. Rowland, Andrew S.; Skipper, Betty J.; Umbach, David M.; Rabiner, David L.; Campbell, Richard A.; Naftel, Albert J.; Sandler, Dale P. (11 December 2013). "The Prevalence of ADHD in a Population-Based Sample". Journal of Attention Disorders 19 (9): 741-54. doi:10.1177/1087054713513799. PMID 24336124. PMC 4058092. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4058092/. 
  5. Costello, E. Jane; Mustillo, Sarah; Erkanli, Alaattin; Keeler, Gordon; Angold, Adrian (August 2003). "Prevalence and development of psychiatric disorders in childhood and adolescence". Archives of General Psychiatry 60 (8): 837-44. doi:10.1001/archpsyc.60.8.837. PMID 12912767. http://jamanetwork.com/journals/jamapsychiatry/fullarticle/207725. 
  6. Jones, Damon E.; Foster, E. Michael (October 2009). "Service Use Patterns for Adolescents with ADHD and Comorbid Conduct Disorder". Journal of Behavioral Health Services & Research 36 (4): 436-49. doi:10.1007/s11414-008-9133-3. PMID 18618263. PMC 3534729. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3534729/. 
  7. 7.0 7.1 Rettew, David C.; Lynch, Alicia Doyle; Achenbach, Thomas M.; Dumenci, Levent; Ivanova, Masha Y. (September 2009). "Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews". International Journal of Methods in Psychiatric Research 18 (3): 169-84. doi:10.1002/mpr.289. PMID 19701924. 
  8. Fabiano, Gregory A.; Pelham, William E., Jr.; Majumdar, Antara; Evans, Steven W.; Manos, Michael J.; Caserta, Donald; Girio-Herrera, Erin L.; Pisecco, Stewart et al. (April 2013). "Elementary and Middle School Teacher Perceptions of Attention-Deficit/Hyperactivity Disorder Prevalence". Child & Youth Care Forum 42 (2): 87-99. doi:10.1007/s10566-013-9194-1. 
  9. 9.0 9.1 9.2 9.3 Achenbach, Thomas M. (1991). Child behavior checklist for ages 4-18. Burlington, VT: Department of Psychiatry, University of Vermont. ISBN 978-0-938565-08-6. 
  10. 10.0 10.1 Hudziak, James J.; Copeland, William; Stanger, Catherine; Wadsworth, Martha (October 2004). "Screening for DSM-IV externalizing disorders with the Child Behavior Checklist: A receiver-operating characteristic analysis". Journal of Child Psycholology and Psychiatry 45 (7): 1299-307. doi:10.1111/j.1469-7610.2004.00314.x. PMID 15335349. 
  11. 11.0 11.1 Chen, Wei J.; Faraone, Stephen V.; Biederman, Joseph; Tsuang, Ming T. (October 1994). "Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis". Journal of Consulting and Clinical Psychology 62 (5): 1017-25. doi:10.1037/0022-006X.62.5.1017. PMID 7806710. 
  12. 12.0 12.1 Tripp, Gail; Schaughency, Elizabeth A.; Clarke, Bronwyn (2006). "Parent and teacher rating scales in the evaluation of attention-deficit hyperactivity disorder: Contribution to diagnosis and differential diagnosis in clinically referred children". Journal of Developmental and Behavioral Pediatrics 27 (3): 209-18. PMID 16775518. 
  13. 13.0 13.1 Shemmassian, Shirag K.; Lee, Steve S. (March 2012). "Comparing Four Methods of Integrating Parent and Teacher Symptom Ratings of Attention-deficit/hyperactivity Disorder (ADHD) " (PDF). Journal of Psychopathology and Behavioral Assessment 34 (1): 1-10. doi:10.1007/s10862-011-9262-5. https://www.researchgate.net/profile/Steve_Lee11/publication/230888173_Comparing_Four_Methods_of_Integrating_Parent_and_Teacher_Symptom_Ratings_of_Attention-deficithyperactivity_Disorder_ADHD/links/09e41505caa13a5913000000.pdf. 
  14. Shemmassian, Shirag K.; Lee, Steve S. (2016). "Predictive Utility of Four Methods of Incorporating Parent and Teacher Symptom Ratings of ADHD for Longitudinal Outcomes". Journal of Clinical Child and Adolescent Psychology 45 (2): 176-87. doi:10.1080/15374416.2014.971457. PMID 25643854. 
  15. Wolraich, Mark L.; Lambert, Warren; Doffing, Melissa A.; Bickman, Leonard; Simmons, Tonya; Worley, Kim (December 2003). "Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Referred Population". Journal of Pediatric Psychology 28 (8): 559-68. doi:10.1093/jpepsy/jsg046. PMID 14602846. https://academic.oup.com/jpepsy/article/28/8/559/1020465/Psychometric-Properties-of-the-Vanderbilt-ADHD. 
  16. Bard, David E.; Wolraich, Mark L.; Neas, Barbara; Doffing, Melissa; Beck, Laoma (February 2013). "The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population". Journal of Developmental and Behavioral Pediatrics 34 (2): 72-82. doi:10.1097/DBP.0b013e31827a3a22. PMID 23363972. 
  17. Wolraich, ML; Feurer, ID; Hannah, JN; Baumgaertel, A; Pinnock, TY (April 1998). "Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV". Journal of Abnormal Child Psychology 26 (2): 141-52. PMID 9634136. 
  18. Wolraich, Mark L.; Bard, David E.; Neas, Barbara; Doffing, Melissa; Beck, Laoma (February 2013). "The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population". Journal of Developmental and Behavioral Pediatrics 34 (2): 83-93. doi:10.1097/DBP.0b013e31827d55c3. PMID 23363973. 
  19. 19.0 19.1 19.2 Collett, Brent R.; Ohan, Jeneva L.; Myers, Kathleen M. (September 2003). "Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder". Journal of the American Academy of Child and Adolescent Psychiatry 42 (9): 1015-37. doi:10.1097/01.CHI.0000070245.24125.B6. PMID 12960702. 
  20. 20.0 20.1 Gadow, Kenneth D.; Sprafkin, Joyce N. (1997). ADHD Symptom Checklist-4. Stony Brook, NY: Checkmate Plus. OCLC 49637921. 
  21. 21.0 21.1 Sprafkin, Joyce; Gadow, Kenneth D. (February 2007). "Choosing an attention-deficit/hyperactivity disorder rating scale: is item randomization necessary?". Journal of Child and Adolescent Psychopharmacology 17 (1): 75-84. doi:10.1089/cap.2006.0035. PMID 17343555. 
  22. 22.0 22.1 Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management; Wolraich, Mark; Brown, Lawrence; Brown, Ronald T.; DuPaul, George; Earls, Marian; Feldman, Heidi M. et al. (November 2011). "ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents". Pediatrics 128 (5): 1007-22. doi:10.1542/peds.2011-2654. PMID 22003063. PMC 4500647. //www.ncbi.nlm.nih.gov/pmc/articles/PMC4500647/. 
  23. Pelham, William E., Jr.; Fabiano, Gregory A. (January 2008). "Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder". Journal of Clinical Child and Adolescent Psychology 37 (1): 184-214. doi:10.1080/15374410701818681. PMID 18444058. 
  24. 24.0 24.1 DuPaul, George J.; Eckert, Tanya L.; Vilardo, Brigid (December 2012). "The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis 1996-2010". School Psychology Review 41 (4): 387-412. ERIC EJ1001907. ISSN 0279-6015. 
  25. 25.0 25.1 Pelham, William E., Jr.; Fabiano, Gregory A.; Massetti, Greta M. (September 2005). "Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents" (PDF). Journal of Clinical Child and Adolescent Psychology 34 (3): 449-76. doi:10.1207/s15374424jccp3403_5. PMID 16026214. https://www.researchgate.net/profile/Greta_Massetti/publication/7719090_Evidence-Based_Assessment_of_Attention_Deficit_Hyperactivity_Disorder_in_Children_and_Adolescents/links/09e415107e6e01c28e000000.pdf. 
  26. Lampert, TL; Polanczyk, G; Tramontina, S; Mardini, V; Rohde, LA (October 2004). "Diagnostic performance of the CBCL-Attention Problem Scale as a screening measure in a sample of Brazilian children with ADHD". Journal of Attention Disorders 8 (2): 63-71. PMID 15801336. 
  27. Sowerby, Paula; Tripp, Gail (2009). "Evidence-Based Assessment of Attention-Deficit/Hyperactivity Disorder (ADHD)". In Matson, Johnny L.; Andrasik, Frank; Matson, Michael L. Assessing Childhood Psychopathology and Developmental Disabilities. New York: Springer Science & Business Media. pp. 209–239. doi:10.1007/978-0-387-09528-8. ISBN 978-0-387-09528-8. OCLC 314175875. 
  28. Eiraldi, Ricardo B.; Mautone, Jennifer A.; Power, Thomas J. (January 2012). "Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder". Child and Adolescent Psychiatric Clinics of North America 21 (1): 145-59. doi:10.1016/j.chc.2011.08.012. PMID 22137818. PMC 3233687. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3233687/.