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Next, the clinical utility of various thresholds were examined for each comorbidity screening scale (i.e., ODD, CD, ANX/DEP). According to the NICHQ/AAP cutoff recommendations, a child is considered to screen positive if 4 of 8 ODD symptoms are present, 3 of 14 CD symptoms are present, or 3 of 7 ANX/DEP symptoms are present, and at least one performance item is endorsed at a 4 or 5.Īfter establishing DSM-IV diagnoses with the DISC-IV, we first examined functional impairment and academic achievement scores as a function of ADHD diagnosis and comorbidity in order to examine whether participants with comorbid ADHD were more impaired than noncomorbid ADHD or nondiagnosed participants. Last, the VADPRS includes a set of performance items that assess functional impairment rated on a 5-point scale (1 = excellent performance, 5 = problematic performance) across academic and social domains.Īccording to NICHQ/AAP scoring algorithms, an item score of 2 or 3 indicates symptom presence and a score of 4 or 5 on one of the performance items indicates impairment presence. The comorbidity screening scales have adequate reliability, factor structure, and preliminary evidence of concurrent validity. ![]() The ODD and CD items correspond to their respective DSM-IV symptoms, whereas the ANX/DEP scale is not DSM-IV-based. In addition, the VADPRS includes ODD (8 items), CD (14 items), and ANX/DEP (7 items) comorbidity screening scales. 8, 9 The VADPRS includes the 18 DSM-IV ADHD symptoms rated on a 4-point scale that indicates how frequently each ADHD symptom occurs (0 = never, 1 = occasionally, 2 = often, 3 = very often). ![]() The VADPRS is a parent-report scale with good internal consistency, factor structure, and concurrent validity for the assessment of ADHD. Vanderbilt ADHD Diagnostic Parent Rating Scale Therefore, the purposes of the present study were to (1) evaluate the clinical utility of the cutoff recommendations for the VADPRS comorbidity screening scales provided in the AAP/NICHQ ADHD toolkit, and (2) establish whether alternative cutoff recommendations may improve clinical utility. ![]() 13 However, the cutoff recommendations for the VADPRS comorbidity screening scales provided in the AAP/NICHQ ADHD toolkit have not been thoroughly evaluated for their clinical utility. Promising evidence to date shows the VADPRS comorbidity screening scales to be reliable 8 and broadly correlated with corresponding diagnoses of a structured diagnostic interview. While the VADPRS has strong psychometric properties for the assessment of ADHD 8, 9 and is frequently used by physicians, 10 the comorbidity screening scales have not received adequate attention regarding their clinical utility, 11, 12 that is, the extent to which the dimensional scales of the VADPRS are useful for detecting the presence or absence of corresponding DSM-IV- based diagnoses. Further, VADPRS scoring algorithms provide recommended scoring thresholds which may indicate the possible presence of these comorbid disorders. 8 Screenings for each domain contain a select group of behaviors for each comorbidity (the ODD and CD screens include DSM-IV-based symptoms, whereas the ANX/DEP screen consists of items modified from another pediatric scale). 8 In addition to items corresponding to the ADHD diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the VADPRS includes symptom screens for three common comorbidities: oppositional defiant disorder (ODD), conduct disorder (CD), and anxiety/depression (ANX/DEP). In 2002, the AAP and the National Initiative for Children’s Healthcare Quality (NICHQ) jointly published a toolkit to be used in the assessment and treatment of ADHD in primary care settings (available at This toolkit includes a standardized measure of ADHD symptoms, the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). 6 Still, over half of pediatricians remain uncertain as to whether they have the requisite training for assessing ADHD comorbidities. ![]() 5 Indeed, the American Academy of Pediatrics (AAP) guidelines which provide primary care physicians with evidence-based recommendations for the assessment and diagnosis of children with ADHD emphasize the importance of simultaneously evaluating common comorbid mental health problems. 2, 3 Coexisting mental health problems in children with ADHD is the norm rather than the exception, 4 with approximately three-quarters of children with ADHD meeting criteria for another psychiatric disorder. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, 1 and primary care physicians (PCPs) are frequently involved in the evaluation and diagnosis of youth with ADHD.
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