Parent versus Teacher Ratings of Attention-Deficit/Hyperactivity Disorder Symptoms in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS)

Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA.
Journal of Child and Adolescent Psychopharmacology (Impact Factor: 2.93). 11/2007; 17(5):605-20. DOI: 10.1089/cap.2007.0060
Source: PubMed


To assess parent-teacher concordance on ratings of DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD) in a sample of preschool children referred for an ADHD treatment study.
Parent and teacher symptom ratings were compared for 452 children aged 3-5 years. Agreement was calculated using Pearson correlations, Cohen's kappa, and conditional probabilities.
The correlations between parent and teacher ratings were low for both Inattentive (r = .24) and Hyperactive-Impulsive (r = .26) symptom domains, with individual symptoms ranging from .01-.28. Kappa values for specific symptoms were even lower. Conditional probabilities suggest that teachers are only moderately likely to agree with parents on the presence or absence of symptoms. Parents were quite likely to agree with teachers' endorsement of symptoms, but much less likely to agree when teachers indicated that a symptom was not present.
Results provide important data regarding base rates and concordance rates in this age group and support the hypothesis that preschool-aged children at risk for ADHD exhibit significant differences in behavior patterns across settings. Obtaining ratings from multiple informants is therefore considered critical for obtaining a full picture of young children's functioning.

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Available from: Kelly Posner, Dec 27, 2013
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    • "Consistent with this idea, despite what appear to be differences in raters' observations, when multiple informants' reports are integrated , we are able to account for a greater proportion of the variance in children's behavioral outcomes (Grietens et al. 2004). Thus, multiple informants contribute unique information regarding the behavior of any given child and a multiinformant approach is essential for understanding the behavior of children in different contexts (e.g., Achenbach et al. 1987; Murray et al. 2007; Verhulst and Akkerhuis 1989). This is particularly important for ADHD, which requires crosssituational impairment. "
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    ABSTRACT: To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N = 104, 75 % boys, Mean (SD) age = 4.37 (0.47) years] were followed over 2 years (mean = 26.44 months, SD = 5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age = 6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers' behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians' ratings of preschoolers' inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.
    Full-text · Article · Oct 2013 · Journal of Abnormal Child Psychology
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    • "In addition, Tripp et al.11 suggested that the teacher's report outperforms parental report with regard to the sensitivity and specificity for the accuracy of the ADHD differential diagnosis. Therefore, to obtain a more complete assessment of patients with ADHD, data gathering from multiple informants is essential for both clinicians and researchers.8,12 Nevertheless, there has been no prior study comparing the differences in the assessments of symptoms associated with ADHD observed by the patients' parents, teachers and clinicians. "
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    ABSTRACT: The aim of this study was to determine changes in behaviour among patients with attention deficit/hyperactivity disorder (ADHD) by different informants during treatment in the clinical setting. Seventy-nine patients with ADHD were recruited. They completed 12-months of treatment with oral short-acting methylphenidate, two-to-three times per day, at a dose of 0.3-1.0 mg/kg. Among the 79 patients (mean age, 9.1±1.9 years), 39 were classified as the ADHD-C/H type (hyperactive-impulsive type and combined type) and 40 as the ADHD-I type (inattentive type). At baseline, and after 12 months, their behaviour was assessed using the Child Behaviour Checklist (CBCL), Teacher's Report Form (TRF), ADHD Rating Scale (ADHD-RS), and Clinical Global Impression-Severity (CGI-S). Patients classified as the ADHD-C/H type had higher scores on three CBCL subscales, on the ADHD-RS and CGI-S compared to the ADHD-I type patients. After 12-months of treatment, for all patients, there were significant improvements in the four subscales of the TRF as well as the ADHD-RS and CGI-S scores, but not on the CBCL. In addition, the patients with the ADHD-C/H type had greater improvements on the four subscales of the TRF after treatment. However, there were no differences noted on the CBCL, ADHD-RS and CGI-S. The results of this study showed that during treatment, in the clinical setting, there are different assessments of behaviour symptoms, associated with ADHD, reported by different informants. Assessments of behaviour profiles from multiple informants are crucial for establishing a fuller picture of patients with ADHD.
    Full-text · Article · Mar 2013 · Psychiatry investigation
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    • "Despite using the same items to identify children as exhibiting hyperactive/impulsive and inattentive behaviors, there were no significant relations between teacher ratings and parent ratings of either component of ADHD-characteristic behaviors, even when controlling for the high withininformant correlations between subscales. This finding is consistent with past research findings of little or no correlation between teacher and parent ratings of ADHDcharacteristic behaviors in preschool samples (Murray et al., 2007). Also, the indices of each component of ADHD did not demonstrate the expected pattern of convergent and discriminant relations across measures. "
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    ABSTRACT: Several forms of assessment tools, including behavioral rating scales and objective tests such as the Continuous Performance Test (CPT), can be used to measure inattentive and hyperactive/impulsive behaviors associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, research with school-age children has shown that the correlations between parent ratings, teacher ratings, and scores on objective measures of ADHD-characteristic behaviors are modest at best. In this study, we examined the relations between parent and teacher ratings of ADHD and CPT scores in a sample of 65 preschoolers ranging from 50 to 72 months of age. No significant associations between teacher and parent ratings of ADHD were found. Parent-ratings of both inattention and hyperactivity/impulsivity accounted for variance in CPT omission errors but not CPT commission errors. Teacher ratings showed evidence of convergent and discriminant validity when entered simultaneously in a hierarchical regression. These tools may be measuring different aspects of inattention and hyperactivity/impulsivity.
    Preview · Article · Jun 2012 · Early Childhood Research Quarterly
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