The Conners Rating Scale - Revised (CRS-R) (Conners, 1997) is one of the oldest and most widely used instruments to assess children with ADHD. The CRS-R (27–87 items, depending on the version; long and short versions are available) includes parent, teacher (CTR-S), and adolescent self-report behavioral ratings scales used to evaluate problem behavior experienced by children and adolescents. The parent and teacher rating scales are appropriate for youth ages 3–17 years, and the self-report measure is completed by adolescents of ages 12–17 years. The parent and teacher rating scales include the following subscales: Oppositional, Cognitive–Problems/Inattention, Hyperactivity, Anxiety–Shy, Perfectionism, Social Problems, Psychosomatic Concerns (parent scale only), Conner’s Global Index (including Restless–Impulsive and Emotional Liability), ADHD index, and DSM-IV Symptoms (including Inattentive, Hyperactive–Impulsive). Parents and teachers have to rate the frequency of behaviours described in each item in a 4-point Likert scale (0=never; 4=too often). The adolescent self-report (CASS:L) has includes the following subscales: Conduct, Cognitive, Family, Anger Control, Emotional Problems and Hyperactivity, ADHD index, and DSM-IV Symptoms.
The MTA version of the Swanson, Nolan and Pelham questionnaire (SNAP-IV) (Swanson et al., 2001) contains 26 items covering the core symptoms of ADHD and ODD specified in the DSM-IV (APA, 2000). It has subscales measuring hyperactivity/impulsivity (9 items), inattention (9 items) and ODD (8 items). For the teacher report version, Cronbach’s alphas of 0.92 for the inattention subscale, 0.96 for the hyperactivity/impulsivity subscale and 0.92 for the ODD subscale have been reported (Bussing et al., 2008). Inter-rater reliability between parent and teacher ratings were 0.49 (inatt), 0.43 (hyp/imp) and 0.47 (ODD) suggesting that parents and teachers may differ somewhat in their report of child behaviour on the SNAP-IV.
The ADHD Rating Scale – IV (Du Paul et al., 1998) is a parent and/or teacher rated measure of symptoms of ADHD in children aged 5–18 years. The measure includes 18 items subdivide in two subscales: Inattention (9 items) and Hyperactivity–Impulsivity (9 items). The scale help to obtain parent and/or teacher ratings regarding the frequency of each ADHD symptom based on DSM-IV criteria. Parents and/or teacher are asked to determine symptomatic frequency that describes the child’s home/school behaviour over the previous 6 months. The ADHD Rating Scale-IV is completed independently by the parent/teacher and scored by a clinician. The scale consists of two subscales: inattention (9 items) and hyperactivity-impulsivity (9 items).
The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997; Goodman et al., 1998) is a brief behavioral screening questionnaire for children aged 3 – 16 years old. The scale have 25 items designed to gather information about the child’s emotional symptoms (5 items), conduct problems (5 items), hyperactivity or inattention (5 items), peer relationship problems (5 items), and pro-social behaviour (5 items). There are different versions for parents and teachers. Questionnaires for self-completion are available for adolescents aged 11 – 16 years old.
The manual and measure are available at http://www.sdqinfo.org/.
The Child Behaviour Checklist (CBCL) (Achenbach, 1991a; 1991b) is available in both teacher and parent report forms, consisting of 113 questions reporting on child behaviors in the past six months. These are scored on a three-point Likert scale (0=absent, 1= occurs sometimes, 2=occurs often). The 2001 CBCL revised version is structured around eight syndrome scales: 1) anxious/depressed, 2) depressed, 3) somatic complaints, 4) social problems, 5) thought problems, 6) attention problems, 7) rule-breaking and 8) aggressive behavior, grouped into two higher order factors–internalizing and externalizing behaviors. The CBCL revised scale includes six scales consistent with DSM diagnostic categories, namely affective problems, anxiety problems, somatic problems, ADHD, oppositional defiant problems, conduct problems. Optional competence scales for activities, social relations, school and total competence are also available. The revised scales allow for multicultural norms where scale scores can be displayed in relation to different sets of cultural/societal norms. Scales were also added for obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD).
The Vanderbilt ADHD Teacher and Parent Rating Scales (VARS) (Wolraich et al., 1998) include both teacher (VADTRS) and parent (VADPRS) report versions. Both the CRS-R and the VAR include items measuring ODD and CD as well as a subscale for anxiety and depression, however the VARS includes items that assess school functioning and the VADPRS includes an analogous subscale to assess parents’ perceptions of the child’s school and social functioning. The VADTRS consists of 4 subscales relating to behaviour problems at school: Inattention, Hyperactivity/Impulsivity, Oppositional Defiant/Conduct Disorder and Anxiety/Depression and two measuring school functioning: Academic Performance and Behavioural Performance. The VADPRS includes these and two additional subscales of Inattention and Hyperactivity/Impulsivity (Wolraich et al. 2003). The frequency of behaviours are rated on a 4 point scale from never (0) to very often (3). In addition, the questionnaire includes a separate performance scale that rates functioning in the classroom including both social relationships with teachers and classmates as well as academic performance. This performance is rated on a scale of 1 to 5 from problematic (scored 1) to above average (scored 5).
The Brown Attention-Deficit Disorder Scales for Children and Adolescents (BADDS) (Brown, 2001) measures underlying concerns in executive functioning in ADHD that are not detected by DSM-IV checklists. It includes separate rating scales for children 3- 7 years, 8 – 12 years, and youths aged12 – 18 years old. The items in each subdivision of the scale are carefully worded to reflect developmentally appropriate expressions of ADHD. Separate versions are available for teachers and parents rating the behaviours of children aged 3 – 7 years old. There is a separate self-report scale for children aged 8 – 12 years, while the adolescent’s version can be completed as both a self-report measure and as a parent rates report. All 3 versions of the BADDS include 5 clinically derived subscales: 1) Organising, Prioritising and Activating to work, 2) Focusing, Sustaining and Shifting Attention to tasks, 3) Regulating, Alertness, Sustaining Effect and Processing Speed 4) Managing Frustrations and Modulating Emotions, and 5) Utilising Working Memory and Accessing Recall. The versions for 3 – 7 year olds and 8 – 12 year olds include and additional subscale: Monitoring and Self Regulating Action, producing a total inattention score for these subscales. The BADDS may uniquely detect nuances of ADHD that are not reflected in DSM-IV rating scales and is especially useful for assessing the inattentive form of ADHD.
The Impairment Rating Scales (IRS) (Fabiano, 2006) is a parent and teacher rating scale for assessing child functioning in domains such as academic performance, classroom functioning, family functioning, and relationships. Teachers/parents mark a visual analogue line representing a continuum of impairment from 0 (no problem/definitely does not need treatment) to 6 (extreme problem/definitely needs treatment) to indicate the child's impairment in each domain. The IRS was highly effective in discriminating between children with and without ADHD. There is evidence that the parent and teacher IRS identifying a unique variance beyond ratings of ADHD symptoms. The scale is brief, practical, and available in the public domain. It exists in both an English version and Italian version.
The teacher version of the Disruptive Behavior Disorders Rating Scale (DBDRS) (Pelham, Gnagy, Greenslade, & Milich, 1992) is an indirect rating scale measure of the disruptive behavior disorder symptoms of children. It allows parents to rate children in four subscales: Inattention, Hyperactivity/Impulsivity, ODD, and CD. The 45 items are rated on a 4-point scale ranging from 0 (not at all present) to 3 (very much present). The validity of the scale has been evidenced by its ability to discriminate between children with and without ADHD (Pelham, Fabiano, & Massetti, 2005). 25
The School Situations Questionnaire (SSQ) (Barkley, R., 1997) consist in a set of 12 questions to which teachers answer in a 9-point Likert scale according to the severity of the problem described in question (1=mild; 9=severe). The SSQ evaluates the children’s behaviour in terms of self-control and the maintenance of attention, allowing the exploration of the most problematic behaviours during typical situations of day-to-day school. The SSQ is reported as an important instrument that must be complemented with other of broader scope for the assessment of children with ADHD in schools.
The Rutter Teacher Questionnaire (Rutter, 1967) is a 26-item scale covering a variety of behavioural problems. The factors contain items representing hyperactivity/conduct (factor 1), anxiety/depressive (factor 2) and truancy/stealing (factor 3). The pattern of the items contained in factor 1 appears to be related with the category of hyperkinetic conduct disorder used by the International Classification of Diseases-10 so it can be a useful instrument for measuring children’s behaviour problems.
The Attention-Deficit Hyperactivity Disorder Evaluation Scale (EDAH) Portuguese version (Lopes, 2009; Gomes, Lopes & Silva, 2010). The EDAH was developed by Farré and Narbona (2003) and consists of 20 items (close questions) to which teachers answer based on their observation of the child’s behaviour during the last six months using a 4-point Likert scale. EDAH is structured in two sub-scales: hyperactivity/attention deficit and behavioural problems.
Test of Everyday Attention for Children (TEA-Ch) (Manly et al., 2001) is a battery of psychological tests for the assessments of attention in children. It can be used with children between the ages of 6 and 16 years old. It is a non-computerised measure that uses game like tests to assess three different forms of attention. It allows the comparison of a child’s performance to the average performance of children their own age within age bands. The reliability and validity of the measure are established. There are 9 subtests in total and the TEA-Ch assess 3 different types of attention; Focused, Sustained and Controlling/Switching.
The K-SADS-PL – Kiddie Schedule for Affective Disorder and Schizophrenia-Present and Lifetime version (Kaufmann, 1997) is a diagnostic interview which aims to evaluate psychopathological disorders in children and adolescents, both in their past and in the present. It consists of a detailed and meticulous collection of the required symptoms to satisfy the diagnostic criteria according to DSM-IV and ICD-10. The above-mentioned interview has to be considered an integration and not a substitution of the clinical psychiatric assessment which is essential for making a diagnosis and a reliable prognosis.
It is composed of:
- An introductory interview
- A diagnostic screening interview
- A supplement completion checklist
- Five diagnostic supplements supporting the criteria expressed by DSM-IV (mood disorders, anxiety disorders, psychotic disorders, attention-deficit and hyperactivity disorders, alcohol/drugs abuse)
- A completion checklist of the patient clinical history
- A scale for child global assessment of functioning (GAF).
The Parent-Child Relationship Questionnaire (Furman & Giberson, 1995). A 40-item questionnaire articulated in five overarching factors (a) Personal Relationship—companionship and intimacy (e.g., “How often do you and this child do nice things for each other?”); (b) Warmth—nurturing and affection (e.g., “How often do you feel proud of this child?”); (c) Disciplinary Warmth—praise, prosocial behaviors, and shared decision making (e.g., “How often do you tell your child that he or she did a good job?”); (d) Power Assertion—quarreling and forceful punishment (e.g., “How often do you yell at this child for being bad?”); and (5) Possessiveness—control and protectiveness (e.g., “How much do you want this child to be around you all of the time?”). Respondents use a 5-point Likert scale.
The Child Health Questionnaire 4 (CHQ-PF50) (Landgraf et al., 1999) is a questionnaire organized in two physical and psychosocial domains. It allows parents to evaluate the well-being and state of health of children and self-evaluate how the severity of a disorder impacts on their emotional state, time management, family cohesion. The Physical dimensions are: physical functioning (PF), effect of physical health on social relationships (RP), bodily pain/discomfort (BP), general health perception (GH). The Psychosocial domains are: effect of emotional-behavioral problems on social relationship (REB), self-esteem (SE), mental health (MH), general behavior (BE), emotional impact on parent (PTE), and time impact on parents (PTT). A final domain reveals the level of restriction on family activities and cohesion.
The Family Environment Scale (FES) (Moos & Moos, 1981) is used to describe the family environment in terms of three underlying dimensions: Family Relationship, Personal Growth, System Maintenance and Change. Three forms allow us to measure the family climate in real, ideal and expected form.
The McMaster Family Assessment Device (FAD) (Epstein et al., 1983). The Family Assessment Device is a questionnaire that reveals the overall level of family function using the seven dimensions of McMaster Family functioning model: Problem Solving, Communication, Roles, Affective Responsiveness, affective Involvement, Behavior Control, General Functioning. It is composed by 60-statements each of them assigned only to one dimension. Each dimension includes between 7 to 12 statements. Each family member over the age of 12 evaluates his or her level of agreement among 4-point Likert scale: strongly agree, agree, disagree, strongly and disagree. It requires 15 to 20 minutes to complete. The general functioning scale has been demonstrated have excellent psychometric properties (Byles et al., 1988) as a brief measurement tool of overall family functioning.
The Five Minute Speech Sample (FMSS) (Daley, Sonuga-Barke, & Thompson, 2003) provides a good proxy measure of the parent-child relationship. Parents are asked to talk freely about their thoughts and feelings towards their child and the relationship that they have with their child for five minutes. Speech samples are recorded and later rated on global scales of warmth, relationship and initial statement and frequency counts of positive and negative comments. High parental EE is indicated by the presence of a negative rating on one of the global scales or a higher number of negative comments than positive comments.
The Alabama Parenting Questionnaire (Frick, 1991) includes 35 questions to assess some important dimensions which could be directly involved in the conduct problems and delinquency in youth: Positive Reinforcement, Parental Involvement, Poor monitoring and Supervision, Inconsistent Discipline and Corporal Punishment. Different versions are available: Child Global Report, Parent Global Report, Child Telephone Interview, and Parent Telephone Interview. Researchers can download and use the APQ free of charge in their research activity (http://psyc.uno.edu/Frick%20Lab/APQ.html).
The Parenting Sense of Competency Scale (PSOC) (Johnston & Mash, 1989) is one of the most frequently used measures of parenting efficacy (Jones & Prinz, 2005). The PSOC contains two subscales measuring parenting efficacy (how competent and capable parents feel in the parenting role; 7 items) and satisfaction (how motivated do parents feel in their parenting role; 9 items).
The Family Strain Index (FSI) (Riley et al., 2006) is a short 6 item questionnaire that measures the impact of having a child with ADHD on the family experience. Parents are asked to rate the frequency of occurrence of each item over the past four weeks on a 5-point scale (0= never, 1= almost never, 2= sometimes, 3= almost always, and 4= always).
The 12-item General Health Questionnaire (GHQ-12) (Goldberg & Williams, 1988) provides a brief self-report measure of common mental health problems that can be used to measure parental well-being. A study comparing the proposed factor structures favours the GHQ-12 as a one-factor scale measuring psychological distress with an emphasis on depressive symptoms (Romppel et al., 2012).
The Parent Stress Index (PSI) (Abidin, 1995) is a screening and diagnostic measure. The assumption is that both child and parent characteristics contribute to stress in the interaction. It is used to assess parental stress due to parent characteristics, child characteristics, and their interactions.
The PSI identifies 3 main domains of stressors: 1. Parental distress (PD) (assesses the level of distress that a parent is experiencing in his parental role, resulting from personal factors directly related to that role); 2. Interaction parent - child dysfunctional (P-CDI) (indicating the degree of perception that a parent has that the child is not meeting their expectations and interactions with the child who does not strengthen it as a parent whishes). There are two forms of self-report questionnaire, the full version and the short one. It aim is to investigate the general stress of the parent in relation to the characteristics of the child, the specific situation of the complexity of management, the specific anxious responses to the exercise of the parental role of the parent and the parent-child relationship. In the short version you will get some indices converted into percentiles related to parental distress (anxiety, discomfort, negative coping, stressful life events, etc.), parent-child dysfunctional interaction, characteristics of the Difficult Child, and a general index of Total Stress.
The version of Abidin & Santos (2003) includes 108 questions distributed between two domains: parent’s domain and child’s domain. The parent’s domain evaluates the parents personal characteristics and variables from the familiar context that have impact in the parent’s capacity to deal with tasks and requirement from parental actions:
- sense of competence
- attachment
- role restriction
- depression
- relation husband/wife
- social isolation
- health
The child’s domain assess the child’s characteristics and the manner which parents perceive the consequences of their child’s characteristics on themselves:
- distraction/hyperactivity
- reinforcement to parents
- humour
- acceptance
- adaptation
- autonomy.
The Parenting Scale (PS) (Arnold et al., 1993) is a measure of parents’ style in discipline situations. It uses three dimensions: Laxness (permissive discipline); Over-reactivity (authoritarian discipline, displays of anger, meanness, and irritability); and Verbosity (overly long reprimands or reliance on talking). It is a self-report that consists of 30-questions, on a 7-point Likert scale where 7 indicates a high probability of making the discipline mistake and 1 indicates a high probability of using an effective, alternative discipline strategy. The internal consistency and reliability of the measure is adequate. Higher score indicate more effective discipline stile.
The Parent Problem Checklist (Dadds & Powell, 1991) is a checklist that measures parental disagreement regarding the education of children, i.e. the ability to cooperate in family management. It consists of 16 questions and provides an index of disagreement (disagreement) of parents about the discipline of their children.
The Egna Minnen Beträffande Uppfostran (EMBU-P) (Perris et al., 1980, revised by Castro, Pablo, Gómez et al., 1997). The EMBU examines parents perceptions about their own educative practices concerning their child. It includes the evaluation of: (1) emotional support; (2) rejection; (3) and control.
The School Situations Questionnaire (SSQ) (Barkley & Edelbrock., 1987) consist of a set of 12 questions which teachers answer in a 9-point Likert scale according to the severity of the problem described in question (1=mild; 9=severe). The SSQ evaluates the children’s behaviour in terms of self-control and the maintenance of attention, allowing the exploration of the most problematic behaviours during typical situations of day-to-day school. The SSQ is reported as an important instrument that must be completed with other instruments of broader scope for the assessment of children with ADHD in schools.
The Social Support Satisfaction Scale (Ribeiro, 1999) evaluates the individuals’ satisfaction with social support. It includes the evaluation of: (1) satisfaction with friends; (2) satisfaction with intimacy; (3) satisfaction with family; (4) satisfaction with social activities.
The Life Experiences Survey (Sarason, Johnson e Siegel, 1978) evaluates the stress through life events that happened in the last year, the desirability of these events and the intensity of their impact perceived by the individual.
The Parenting Styles Inventory (Gomide, 2006) evaluates practices used by parents in their child’s education that can lead to the development of anti-social or pro-social behaviors. It includes the following sub-scales: (1) positive monitoring; (2) moral behavior; (3) negligence; (4) inconsistent punishment; (5) relaxed discipline; (6) negative monitoring; (7) physical abuse.
The Adult-Adolescent Parenting Inventory (AAPI-2) (Bavolek & Keene, 1999). Answers to this questionnaire allow the identification of a risk index for behaviors and practices of maltreatment and negligence in 5 different scales: (i) inappropriate expectations; (ii) lack of empathy, (iii) Physical punishment; (iv) role inversion; (v) Autonomy.
The Knowledge about Attention Deficit Disorder Questionnaire (KADD-Q) (Sciutto et al., 2000) is a 41-item rating scale aimed at measuring teachers’ knowledge and misperceptions of ADHD in three specific areas: symptoms/diagnosis of ADHD, general knowledge about the nature, causes and outcome of ADHD and possible interventions with regard to ADHD. Correct, don’t know, and incorrect responses to the questions indicated, respectively, knowledge, a lack of knowledge and misperceptions concerning ADHD.
The Student-Teacher Tension Checklist (STTC) (Greene, Marchant, & Beszterczey, 1997) lists DSM-IV behaviours for ADHD and ODD. Teachers are asked to indicate the extent to which these behaviours frustrate them on a scale from 1 (the behaviour causes no tension or frustration) to 5 (the behaviour causes extreme tension or frustration).
The Index of Teaching Stress (Greene et al., 1997) was originally developed to be a teacher version of the Parenting Stress Index. Teachers respond to the questions about a target child. The questionnaire contains two parts: Part A lists common child behavior problems, teachers are asked to frequency of behaviors for a particular child and Part B of the questionnaire asks teachers about the impact of a student’s behavior on teaching efficacy and satisfaction in their teaching role (ibidem). This may therefore provide a useful measure of the teacher-child relationship.
Objective classroom observations may provide the most reliable measure of child behavior in the classroom, since teacher report of behavior may be subject to ‘halo effects’ (Lauth et al., 2006). Over the past decade, systematic observation codes have been developed and psychometrically tested to identify the specific classroom behaviors that distinguish students with ADHD from their same-aged peers without ADHD (Abikoff et al., 2002; Platzman et al., 1992; Skansgaard & Burns, 1998).
Generally, the child’s behavior is observed across settings (e.g., classroom and playground) on several occasions to establish the frequency and/or duration of various target behaviors. Behavioral frequencies are usually compared to those displayed by several of the student’s classmates to determine the deviance of the referred child’s behavior.
The direct observation codes used most widely are:
The Classroom Observation Code (COC) (Abikoff & Gittelman, 1985) provides behavioral categories for assessing children during academic tasks in the classroom. The code measures childrens behavioral dimensions including distracting others, distracting teachers, verbal aggression and inappropriate motor movements. The behavioral categories of the COC have been shown to differentiate elementary school-aged “hyperkinetic” youngsters and normal children (Abikoff et al., 1977, 1980).
The COC assesses the appearance of 12 mutually independent behaviors during structured academic work time:
– interference (e.g., clowning, interrupting others, talking during work)
– interference to teacher (e.g., interrupting teacher)
– off-task (sustained inattention or distractibility)
– noncompliance (not complying with teacher requests or instructions)
– aggression (physical aggression or destruction of property)
– verbal aggression to children (e.g., name calling, taunting, teasing)
– verbal aggression to teacher (e.g., name calling, arguing)
– minor motor movement (inseat buttock or rocking movements)
– gross motor – standing (getting up from seat without permission)
– gross motor - vigorous (e.g., running, skipping)
– out-of-chair (extended time out of seat)
– solicitation (e.g., going up to teacher, calling out to teacher)
– A 13th category, absence of behavior, is scored if none of the code categories occurs during an observational interval.
For most categories, a modified time-sampling strategy is used such that only the first occurrence of the behavior in the 15-s interval is scored. For other categories (off-task, noncompliance, out-of-chair), a timed criterion is required and the behavior is scored if it occurs throughout the entire 15-s interval.
The Behavioral Observation of Students in Schools (BOSS) (Shapiro, 1996) is an observational code aimed at assess two categories of engagement, active engaged time (AET) and passive engaged time (PET) and three categories of non-engagement: off-task motor (OFT-M), off-task verbal (OFT-V), Off task (OFT-P). An additional category is included to evaluate the type of instructional setting (e.g. student during independent seatwork, teacher in small group not including target student).
“ … active engagement is defined as those times when a student is actively attending and responding to a true academic task (i.e., writing, reading aloud, talking to a teacher or peer about the academic material), while passive engagement is defined as those times when the student is passively attending to assigned academic work (i.e., listening to a lecture, looking at a worksheet, silently reading a book)” (Junode, DuPaul, Jitendra, Volpe & Cleary, 2006, p. 92).
The frequency of two classes of on-task behavior were recorded and then converted to rates for each participant: active engaged time (AET) and passive engaged time (PET). The period of each observation interval is 15 min and is divided into 60 intervals, each of which was 15-s in length; the frequency of AET and PET is collected utilizing a momentary time sampling procedure at the beginning of each 15-s interval. OFT behaviors are coded utilizing a partial interval recording schedule, where the occurrence of each behavior was recorded only once during each interval.
The Behavior Assessment System for Children (BASC) (Reynolds & Kamphaus, 1998) is a multidimensional assessment tool aimed at measure many aspects of maladaptive and adaptive behaviors from positive peer interaction to repetitive motor movements, in children aged two and half years and 18. It includes five main components: Structured Developmental History, Parent Rating Scale, Teacher Rating Scale, Self Report of Personality and Student Observation System (SOS). Each of them can be used separately or in combination. Regarding the observation methodology is possible to code and record direct observations of a child's behavior using a momentary time sampling procedure.
This tool is particularly useful in the clinical contexts and research situations. It can also be used for the direct observation portion of a Functional Behavioral Assessment.
In order to formulate precise and effective academic interventions a variety of others coding schemes are described in Volpe, R. J., Di Perna, J. C., Hintze, J. M., & Shapiro, E. S. (2005). Observing Students in Classroom Settings: A review of Seven Coding Schemes. School Psychology Review, 34(4), 454-474.