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McDonagh MS, Peterson K, Thakurta S, et al. Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder: Final Update 4 Report [Internet]. Portland (OR): Oregon Health & Science University; 2011 Dec.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder: Final Update 4 Report [Internet].

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Appendix CScales used to assess efficacy and adverse events

The following narrative briefly describes the most commonly used assessment scales and summarizes methods of scoring and validation.

Aberrant Behavior Checklist (ABC) is a symptom checklist for assessing problem behaviors of children and adults with mental retardation at home, in residential facilities, ICFs/MR, and work training centers. It is also useful for classifying problem behaviors of children and adolescents with mental retardation in educational settings, residential and community-based facilities, and developmental centers. The ABC asks for degree of retardation, the person's medical status, and current medication condition. Then 58 specific symptoms are rated and an extensive manual gives comprehensive descriptions for each assessed behavior. The checklist can be completed by parents, special educators, psychologists, direct caregivers, nurses, and others with knowledge of the person being assessed.

Extensive psychometric assessment of the ABC has indicated that its subscales have high internal consistency, adequate reliability, and established validity. Average subscale scores are available for both United States and overseas residential facilities and for children and adults living in the community.1

ADHD Behavior Checklist/ADHD Rating Scale evaluates inattentive and hyperactive-impulsive symptoms, is based on DSM criteria for diagnosing ADHD. DSM-III uses a 14-item checklist while DSM-IV updated it to an 18-item checklist with two nine-item subscales. Items are rated for severity from zero to three according to how often the symptoms are present (0=never/rarely, 1=sometimes, 2=often, and 3=very often). The maximum scores are 42 points and 54 points for DSM-III and DSM-IV respectively. The test-retest reliability was demonstrated. The intraclass correlation coefficient was .90s (P<0.001). The content validity and construct validity were proved as well. The checklist has established validity, reliability, and age-matched cut-off values 2, 3

ADHDRS- IV or ADHD rating scale IV: an 18-item scale based on a semistructured interview with the patient's parent by the investigator to assess symptom severity. Each item, corresponding to one of the 18 DSM-IV diagnostic criteria, is rated on a 4-point scale (0 =never or rarely; 1 = sometimes; 2 =often; 3 = very often). This scale has been shown to be a reliable and valid instrument of ADHD symptom severity.4

The ADHDRS-IV-PI is an 18-item scale assessing ADHD symptoms over the past week based on clinician interviews with patients and parents. Items correspond to symptoms in the DSM-IV diagnosis of ADHD and are scored from 0 to 3 (0 = rarely or never, 3 = very often). The total score is the sum of all of the item scores.5

ADD-H Comprehensive Teacher Rating Scale (ACTeRS) contains both parent and teacher forms. Both versions are used to assess attention, hyperactivity, social skills, and oppositional behavior in children and adolescents ages 6-14. Each form contains 24 items and takes 5-10 minutes to complete, and measures 4 areas of behaviors. This scale can be used for screening or to measure response to treatments.6

The ADHD Investigator Symptom Rating Scale (AISRS) is an 18-item scale that helps assess the impact and severity of ADHD among adults. It is clinician-administered scale that assesses each of the 18 individual criteria symptoms of ADHD in DSM-IV on a scale from 0 to 3 (0 =not present; 3= severe). The total score ranges from a minimum of 0 to a maximum of 54.

The Adult Self-Report Scale (ASRS) is a checklist of 18 questions about symptoms that are based on the diagnostic criteria of DSM-IV (Diagnostic and Statistical Manual –IV). The scales are rated on a range from 0 to 4 with o being never and 4 being very often. Higher scores on this scale indicate greater symptom severity. This scale has been shown to be valid for assessing ADHD symptom severity.7

The Alabama Parenting Questionnaire (APQ) is used to assess the five areas of parenting practices that are commonly associated with conduct disorders. The APQ has four components and contains formats for parent and child to respond to questions about “typical” parenting practices used in the home and rate them on a Likert-type scale with 1(Never) to 5 (Always). The APQ also includes a phone interview where the informant is requested to estimate the frequency of parenting behavior over the past 3 days. This questionnaire has been shown to be valid and reliable in assessing parental practices.8

Barkley's Attention Deficit Hyperactivity Disorder Checklist and Scale is a self-report rating system that measures the occurrence of symptoms. The range of the scale is 0=never or rarely, 1=sometimes, 2=often, and 3=very often. The checklist is used as a measurement to define symptoms of the disorder. No reliability or validity information available. 9

Barkley's Stimulants Side Effects Rating Scale is a 17-item questionnaire that evaluates the severity and the frequency of common side affects in individuals taking stimulant medications. It can be completed by a parent, teachers or child. The side effects scale ranges from 0 (absent) to 9 (severe).10

Barratt Impulsiveness Scale (BIS-10) is a 34-item scale that covers three types of impulsiveness: motor, cognitive, and non-planning. It consists of a four-point scale ranging (“rarely/never”, “occasionally”, “often”, and “almost always/always”). These three factors are considered reliable under a study with an alpha coefficient range from 0.89 to 0.92. No validity information available.11

Beck Anxiety Inventory (BAI) quickly assesses the severity of patient anxiety. It was specifically designed to reduce the overlap between depression and anxiety scales by measuring anxiety symptoms shared minimally with those of depression. Both physiological and cognitive components of anxiety are addressed in the 21 items describing subjective, somatic, or panic-related symptoms. In the assessment, the respondent is asked to rate how much he or she has been bothered by each symptom over the past week on a 4-point scale ranging from 0 to 3, and takes about 5 to 10 minutes to complete. The scale obtained high internal consistency and item-total correlations ranging from 0.30 to 0.71 (median=0.60).12, 13

Brown ADD scale is a 40-item self report scale for assessing the executive function aspects associated with ADHD. The scale has been proved with good internal consistency and good test-retest reliability. The total score ranges from 0 to 120: patients with score >55 = highly probable ADHD; score 40-54 = ‘probable’ ADHD; score <40 = ‘possible’ ADHD.14

Child Behavior Checklist (CBCL) originally had three axes, the parent report form, teacher report form, and self-report form for children over 11 years of age.15 But it had been added to have two more axes, which are cognitive assessment and physical assessment from observations and interviews. It was demonstrated to have high reliability and validity through various studies.16

Child Autism Rating Scale or Childhood Autism Rating Scale (CARS) is a 15 item behavioral rating scale developed to identify children ages 2 years and older with autism, and to distinguish them from developmentally handicapped children without the autism syndrome. It provides quantifiable ratings based on direct behavior observation. The CARS is especially effective in discriminating between autistic children and those children who are considered trainable mentally retarded; it distinguishes children with autism in the mild to moderate range from children with autism in the moderate to severe range. It can also be used to evaluate adolescents or adults who have never received a diagnosis of autism. The CARS includes items drawn from five of the most widely used systems for diagnosing autism. Each item covers a distinct characteristic, ability, or behavior.17

Children's Depression Rating Scale-Revised (CDRS-R) is a clinician rated instrument that covers 17 symptom areas of depression and used to diagnose depression and can be repeated to measure response to treatments. CDRS-R total scores range from 17 to 113 and Fourteen of the 17 items are rated on a scale from 1 to 7, with an item score of 3 suggestive of mild, 4 or 5 moderate, and 6 or 7 severe symptoms. The other 3 items are rated on a scale from 1 to 5. Both children and their parents provide input into the first 14 items of the scale. A child's nonverbal behavior is rated by the observer for items 15 through 17. A CDRS-R ≥ 40 suggests the presence of depressive disorder. CDRS-R was administered to determine the convergent validity of BDI.18

Children's Global Assessment Scale (CGAS) is an adaptation of the Global Assessment Scale (GAS). This scale is designed to measure the lowest level of functioning during a specific time period for children aged 4 to 16. Children are rated on a scale of 1 (needs constant supervision) to 100 (superior functioning) with anchor points in between. Scores above 70 indicate normal function. The CGAS has demonstrated discriminate validity (P=0.001) in detecting the level of impairment between inpatients and outpatients. The CGAS has also demonstrated concurrent validity with the Conners' ten-item Abbreviated Parent Checklist; the correlation was −0.25 (P >.05, df=17) when used in outpatients.19

Child Health and Illness Profile – Child Edition (CHIP-CE) is a self-report health status instrument for children 6 to 11 years old that is designed to assess the health and well-being of children. It includes 5 domains: Satisfaction (with self and health), Comfort (emotional and physical symptoms and limitations), Resilience (positive activities that promote health), Risk Avoidance (risky behaviors that influence future health), and Achievement (of social expectations in school and with peers). The internal consistency and test-retest reliability of the domains are good to excellent, with a definite age gradient such that younger children's responses are less reliable although still acceptable. Validity is supported through criterion and construct validity tests and structural analyses. Standard scores (mean, 50; standard deviation, 10) were established. The survey takes about 30 minutes.20

Children's Psychiatric Rating Scale (CPRS) is a comprehensive, 63-item scale that aims to assess a broad spectrum of psychopathology for children up to age 15. Therefore, items on the CPRS will have varying degrees of relevance when used in a specific diagnostic group. Each item is rated from one (not present) to 7 (extremely severe). But unfortunately, we can't find any information about the reliability and validity of the scale.21

Clinical Global Impression Scale (CGI) is used in both children and adults and consists of three global scales for rating mental illness. The first two items (severity of illness and global improvement) are rated on a 7-point scale (1 = very much improved, 7 = very much worse). The third item (efficacy index) uses a matrix to rate the effectiveness of therapy in relation to adverse reactions.27 The CGI includes Global Severity (from 1 to 7; 1 = not ill, 3 = mildly ill, 5 = markedly ill, and 7 = extremely ill) and Global Improvement (1 = very much improved and 7 = very much worse) scales.

Clinical Global Impression - Improvement Scale (CGI-I) is a 7-point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention. Patients are rated as: 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse.

Clinical Global Impression - Severity Scale (CGI-S) is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. Considering total clinical experience, a patient is assessed on severity of mental illness at the time of rating 1, normal, not at all ill; 2, borderline mentally ill; 3, mildly ill; 4, moderately ill; 5, markedly ill; 6, severely ill; or 7, extremely ill.

CGI-ADHD-S is a single-item rating of the clinician's assessment of the global severity of ADHD symptoms in relation to the clinician's total experience with other ADHD patients. Severity was rated on a 7-point scale (1 =normal, not at all ill; 7 = among the most extremely ill).4

Conners' Abbreviated Questionnaires (ASQ-P) is an abbreviated version of the CPRS. It contains 10 items only, and is known as the Hyperactivity Index. The inter co-relation of ASQ–P and CPRS-R was high as 0.87 in the hyperactive factor that demonstrated the ASQ-T's ability to identify children's hyperactive behaviors.28 Parents rate their child's symptoms from zero to three (0=not at all present, 1=just a little present, 2=pretty much present, 3=very much present), which yields a range of possible total scores between 0 and 30.

Conners' Abbreviated Questionnaires (ASQ-T) is an abbreviated version of the CTRS. It contains 10 items only, and is known as the Hyperactivity Index. The intercorrelation of ASQ –T and CTRS-R was high from .79-.90 that demonstrated the ASQ-T's ability to identify children's problem behaviors.28

Conners' Adult ADHD Rating Scale (CAARS) was used to assess adult symptomatology. The scale consists of 66-items that are rated using a 4-point Likert scale (ranging from “0” for “not at all true” to “3” for “very much true”). Four factors emerge from this 66-item scale: Inattention/Cognitive Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability, and Problems with Self-Concept. An ADHD index score comprised of 12 CAARS items can also be derived that is highly related to ADHD diagnosis. Sensitivity and specificity of the ADHD Index score are 71% and 75% respectively (Conners et al., 1999). The reliability and validity of the CAARS factors are satisfactory; internal reliability of the factor scales ranged between .86 and .92; test-retest reliabilities ranged between .88 and .91.29

Conners, Loney and Milich Rating (CLAM) Scale is a 13-item questionnaire that measures classroom ADHD symptoms and yields the IOWA Conners' Scale, with divergently valid factors of inattention/overactivity and aggression/defiance. It has been shown to be sensitive to medication effects in the analog classroom and in the natural environments of home and school.30

Conners' Parent Rating Scale (CPRS) is a 93-item parent rating scale to evaluate children's psychiatric symptoms. It is the original version of the CPRS. Parents rate their child's symptoms from one to four (1=not at all present, 2=just a little present, 3=pretty much present, 4=very much present).22 A newer version of this scale is now available (CPRS-R).31

The 48-item Conners' Parent Rating Scale – Revised (CPRS-R) is a revised version of the 93-item Conners' Parent Rating Scale and includes norms down to age three. Parents rate their child's symptoms from zero to three (0=not at all present, 1=just a little present, 2=pretty much present, 3=very much present).28

Conners' Teacher Rating Scale (CTRS) is a 39-item teacher rating scale teachers use to evaluate children's symptoms and behaviors before and after medication. The four-points scale (1-not at all, 2-just a little, 3-quite a bit, and 4-very much) was rated. Factor analysis was used to prove the stability of the scale. It is highly sensitive to drug effectiveness.22 Teachers rate their child's symptoms from zero to three (0=not at all present, 1=just a little present, 2=pretty much present, 3=very much present), which yields a range of possible total scores between 0 and 30.

The 28-item Conners' Teacher Rating Scale – Revised (CTRS-R) is a revised version of the 48-item Conners' Teacher Rating Scale and includes norms down to age three. Teachers rate their child's symptoms from zero to three (0=not at all present, 1=just a little present, 2=pretty much present, 3=very much present). 28

Conners' Teacher Rating Scale Revised Short-Form (CTRS-R-S) & Conners' Parent Rating Scale Revised Short-Form (CPRS-R-S) each contains four subscales that are approximately one-third to one-half the length of their longer counterparts: 27 items comprise the CPRS-RS and 28 items comprise the CTRS-RS. Parents and teachers are asked to consider the child's behavior during the past month and rate their occurrence on a 4 point scale (not at all true, just a little true, pretty much true or very much true.32

The Consensus Clinical Response (CCR) measures the overall improvement of the patient for each week of a trial. It is scored on a 4-point scale ranging from 0 (nonresponder) to 3 (moderate response). The CCR combines and assesses multiple factors that can possibly affect and be relevant to the patient's improvement.

Continuous Paired-Associate Learning Test (CPALT) is a paired-associate learning task that uses consonant pairs as stimulus terms (S) and digits (0-9) as response terms (R). At each session, the computer randomly generates the pairing of stimulus and response, and the sequence in which the pairs are presented. The subject is instructed to memorize the digit (R) associated with each pair of consonants (S). The task begins with the presentation of an S-R pair for study for 8 seconds, followed by a test sequence in which only the stimulus term is presented. The subject is allowed 5 seconds to key in the corresponding response term. If the response is correct, the S-R pair is presented again simultaneously with a “YES”. Then a new S-R pair is presented for study and added to the S-R pool. This sequence continues until an error is made. If the response was incorrect or not forthcoming in the allotted time, the correct answer is displayed. The earliest presented pair is then dropped from the active S-R string and the subject is immediately tested on the remaining pairs. If two errors are made, the two earliest presented pairs are dropped, and so forth. Although the presentations are uninterrupted, this test format permits the subdivision of the total block of trials into a set of comparable epochs for subsequent scoring. The test continues for 30 minutes. It is arbitrarily subdivided into 10 epochs, each of which lasts 3 minutes.33

Continuous Performance Test (CPT) is a monitoring task in which subjects are given a series of visual or auditory stimuli and are asked to press a button when certain infrequent target stimuli appear. There is no standardized version. There is usually a “low-level” version and a more sophisticated version where the stimulus may or may not be a target depending on what precedes it in the series.22-26

Copeland Symptom Checklist for Adult Attention Deficit Disorder, an 8-category, 63-item checklist with each item rated on a severity scale from 0 (symptoms not present) through 4 (very much present). It contains the information about cognitive, emotional and social symptoms. Its validity and reliability have been established, but we were unsuccessful in retrieving the original source, “Copeland Symptom Checklist for Adult Attention Deficit Disorders”.34

Diagnostic Interview Schedule for Children (DISC-IV) was developed by the National Institute of Mental Health and is a highly structured psychiatric diagnostic interview designed to assess DSM-IV psychiatric disorders and symptoms in children and adolescents aged 6 to 17 years. The DISC was designed to be given by lay interviewers for epidemiological research. It has a parent and a child version, both of which ask about the child's psychiatric symptoms. The majority of DISC questions have been worded so that they can be answered “yes,” “no,” and “somewhat” or “sometimes”.35

Driver behavior survey (DBS) is a 26-item scale in children and adults with attention deficit hyperactivity disorder (ADHD). Questions are rated on a scale of 1 to 4 with a possible maximum score of 104. The items assess the driving and safety behaviors of the driver with scores ranging from 1 = not at all or rarely and 4= very often. The questionnaire can be completed by the patient or by an individual that is familiar with the patient's driving. Lower scores on the DBS indicates less safe driving behaviors. The survey has been shown to be valid in assessing driver behaviors.36

DuPaul ADHD Rating Scale IV consists of 18 items adapted from the symptom list for ADHD delineated in the DSM-IV. Factor analytic studies have indicated that the nine-item Inattention factor and the nine-item Hyperactivity-Impulsivity factor of this measure closely correspond to the two-dimensional structure in the DSM-IV. Estimates of internal consistency, test--retest reliability, and concurrent validity strongly support the psychometric integrity of this measure.37

Global Assessment Scale (GAS) is a single rating scale for assessing the overall functioning of a patient. The scale values range from 1 to 100, with 1 being the hypothetical sickest person and 100 being the hypothetical healthiest person. There are ten equal intervals ranging from 1-10, 11-20, 21-30 and so on up until 91-100; if a patient falls in the upper two intervals, it is considered “positive mental health.” A patient is rated based on observing his behavior during the preceding week and comparing it to the current time period, and adjustments are made to base on specific characteristics defined in each interval. The GAS is found to have good reliability based on five studies with an intraclass correlation coefficient range of 0.61 to 0.95 and an associated standard error of measurement range of 5.0 to 8.0 units. Strong concurrent validity was proved as well. 38

Hamilton Anxiety Scale (HAMA or HAM-A) is a rating scale developed to quantify the severity of anxiety symptomatology, often used in psychotropic drug evaluation. It consists of 14 items, each defined by a series of symptoms. Each item is rated on a 5-point scale, ranging from 0 (not present) to 4 (severe).39

“How I Feel” Questionnaire, a 28-item scale, is an adaptation of the van Kammen-Murphy Mood Scale, which has been proved to be sensitive to the effects of amphetamine. It uses 4-point scale: 0= “not at all”; 1=”a little”; 2=”some”; 3=”a lot”. No reliability or validity information is available.40

Impaired Driving Score (IDS) is used to compare the various aspects of driving poorly, and the score represents an accumulative effect size across the multiple driving variables: summed SDs of steering, driving off the road, veering across the midline, inappropriate braking while on the open road, missed stopped signals, collisions, exceeding speed limit, SD of speed, time at stop sign deciding when to turn left, and time to complete left turns. A higher IDS reflects poorer driving skill, with more driving across midline and off road, more speeding, higher SD of speed, less time spent at stop signs and executing left turns, and more crashes. An IDS of 0 represents average driving, an IDS less than 0 represents better than average driving (e.g., an IDS of -1 represents driving performance 1 SD better than average), and an IDS greater than 0 represents worse than average driving.41

Inattention/Overactivity With Aggression Conners' Teacher Rating Scale (IOWA CTRS) is revised from the 39-item Conners' Teacher scale. 10 items were devised to determine Inattention-Overactivity (IO) and aggression (A) behaviors. Teachers rate their child's symptoms from zero to three (0=not at all, 1=just a little, 2=pretty much, 3=very much). Coefficient alpha was tested as .89 for the IO scale and .86 for the A scale. They only tested the sensitivity and specificity scores of the IO scale, and the scores depend on the screen score being rated. Therefore, it recommended the use of an IO scale for at least 11 points for research purpose, and 7 points for clinical purpose.42 The differential validity of IO and A factors had been tested as well.43

Life Participation Scale for ADHD-Revised (LPS-ADHD-R) is a 24- item, parent-rated scale assessing changes in adaptive functioning related to ADHD treatment.5

Mental Component Summary (MCS) provides the clinician with information on the patient's HRQL summarized in just two values, thereby reducing the number of statistical analyses needed and offering easier interpretation of the data. The MCS have been demonstrated to have good discriminant validity for identifying differences between clinically meaningful groups.44

Montgomery Asberg Depression Rating Scale (MADRS): The MADRS was originally a subscale of Comprehensive Psychopathological Rating Scale, developed by Montgomery and Asberg in 1979. This scale measures the effect of treatment on depression severity, and as such requires a baseline assessment (before treatment) with subsequent assessments during course of treatment. The MADRS measures the severity of a number of symptoms on a scale from 0-6 (Table 2), including mood and sadness, tension, sleep, appetite, energy, concentration, suicidal ideation and restlessness.45

Multidimensional Anxiety Scale for Children (MASC) is a 39-item self-report scale assessing physical symptoms, social anxiety, harm avoidance, and separation anxiety using an anchored ordinal scale from 0 (never true) to 3 (often true) that shows excellent internal and test-retest reliability (score range 0-117).5

Pediatric Anxiety Rating Scale (PARS) assesses frequency, severity, and associated impairment of separation anxiety, social phobia, and generalized anxiety symptoms based on clinician interviews with patients and parents. Items were derived from DSM-IV criteria for anxiety disorders. A checklist is used to assess symptoms experienced during the preceding 7 days. The clinician then integrates child and parent reports to rate each symptom on 7 dimensions using a 6-point scale (0 = none, 1Y5 = minimal to extreme). The PARS total score (ranging from 0 to 25) is the sum of scores on five of the 7 dimensions.5

Permanent Product Measure of Performance (PERMP) is an age-adjusted collection of math problems that measures a child's ability to pay attention and stay on task as demonstrated by an increase in the number of attempted and successfully completed problems.46 It is a validated 10-min math test developed to evaluate response to stimulant medication. Con taining 400 age-appropriate math problems, the test is scored to obtain an objective measure of academic performance by grading the number of attempted (PERMP-A) and completed problems. Subjects are given different levels of the math test based on their ability, as determined by a math pretest completed during the practice visit. Different versions of the math tests for a given level are used across the multiple classroom sessions so that subjects did not repeat the same test more than once during the classroom day. PERMP has been shown to be sensitive to dosage and time effects of stimulant medications.47

Personality Inventory for Children-Revised (PIC-R): This empirically derived 280-item true/false instrument (caregiver report) assesses psychosocial adjustment in preschool through adolescent youths. Twelve scales measure three development dimensions (achievement, development, intelligence) and nine adjustment dimensions (anxiety, depression, delinquency, family relations, hyperactivity, psychosis, social skills, somatic concern, and withdrawal). The scales are interpreted through actuarial guidelines derived for T-score ranges that vary by scale.48

Physician's Global Rating Scale is a 7-point rating of the overall functioning of a patient. The physician rates the patient improvement on a scale from −3 to +3. The number measures the change seen in the patient (–3=marked worsening, −2=moderate worsening, −1=slight worsening, 0=no change, +1=mild improvement, +2=moderate improvement, +3=marked improvement). No validity or reliability information is available.49

Physician's Target Symptom Scale is a four-point rating scale, ranging from 0 to 3 (0=not at all, 1=mild, 2=moderate, 3=marked). It measures specific symptoms of attention deficit disorder: conduct disorder (CD), disorganization, depression, temper, short attention span, and hyperactivity. No validity or reliability information is available. 49

Preschool Behavior Questionnaire (PBQ) represents a modification to the Children's Behavior Questionnaire (Rutter, 1967). Developed as a screening instrument for use by mental health professionals, the PBQ identifies preschoolers who indicate symptoms of emotional problems. This instrument can also be used as a pre- and post test measure of children to show changes in behavior over time. During the 34-month period since its publication in late 1974, the scale has been used to a considerable extent in the screening of young children. Those who have used the scale evaluate it highly. However, the variations in the application of the scale provide clear indications that additional normative data are needed, as well as additional research in the area of the relationship between behavior rating scales and behavior observation techniques.50-52

Profile of Mood States (POMS) is a self-report measure of mood states that can be used to monitor transient or fluctuating affective states in therapeutic and research environments. The items on the scale were derived from a list of 100 different adjective scales using repeated factor analysis. There are three versions: the POMS Standard which includes 65 items, the POMS Brief which includes 30 items, and the POMS Bipolar version (POMS-Bi) which includes 72 items. Respondents rate a series of mood states (such as “Untroubled” or “Sorry for things done”) based on how well each item describes the respondent's mood during one of three time frames (i.e., during the past week, including today; right now; other). Normative data are based on the “during the past week, including today” time frame. The POMS Standard form takes approximately 10 minutes to complete, and the respondent rates each item on a 5-point scale ranging from “Not at all” to “Extremely”. The POMS Brief form, which is ideal for use with patients for whom ordinary tasks can be difficult and time-consuming, uses the same scale as the POMS Standard form, but contains only 30 items. It takes only 5 minutes to complete. Both the POMS Standard and POMS Brief assessments measure 6 identified mood factors: tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment. They are designed for people ages 18 and older. Numerous studies have shown it to be a valid and strong measure of mood states. Internal consistency for all items was 0.90 or above, test-retest reliability ranged between 0.65 for Vigor and 0.74 for Depression.53, 54

The Restricted Academic Situation Scale (RASS) is a tool that measures and assesses 5 specific behaviors (off-task, playing with objects, out of seat, vocalizing and fidgeting) of a child as the child performs specific academic tasks, within a clinical setting, that are appropriate for the child's current grade. This scale assesses a child's sustained attention while performing academic work with potential distractions present and lacking adult supervision. The score for this scale is the total number of recorded behavioral events of the child during the task in the 15 minute period. This scale has been validated for determining children with ADHD according to behavioral conduct.55

Revised Behavioral Problem Checklist (RBPC) is used to rate problem behaviors observed in adolescents and young children. The RBPC has been used for a variety of purposes: to screen for behavior disorders in children; as an aid in clinical diagnosis; to measure behavior change associated with psychological and pharmacological interventions; as part of a battery to classify juvenile offenders; and to select subjects for research on behavior disorders in children and adolescents. The RBPC yields factorially 6 independent subscales: CD, AP, AW, SA, PB and ME. Alpha reliabilities for the 6 scales from 6 different samples have ranged from .70 (for ME) to .95 (for CD). Teacher ratings over a 2 month interval on a sample of 149 public school children in grades 1 to 6 produced reliabilities ranging from .83 (for AP) to .49 (for SA). Although the values for SA and PB were attenuated for very limited variances for these subscales, 85% and 94% of the sample received exactly the same score at both times for SA and PB respectively. 50, 56

Safe Driving Behavior Rating Scale contains 26 items that assess the participant's driving behavior and skills in a number of areas including braking properly at intersections, driving within the speed limit, keeping the radio at reasonably low volume, using mirrors properly, staying a safe distance from other vehicles, and so forth. Each item is rated on a 1 to 4 Likert-type scale (corresponding to not at all, sometimes, often, and very often, respectively). Higher scores reflect better driving behavior and use of sound driving habits. This scale has been validated.57

SCL-90 Rating Scale is a self-report clinical rating scale. It uses a 90-item checklist that covers nine symptom constructs, and three global indices of pathology. It consists of a five-point scale that measures the amount of distress a patient has felt to identify symptomatic behavior of psychiatric outpatients: 0=not at all, 1=a little bit, 2=moderately, 3=quite a bit, 4=extremely. There is evidence of strong convergent validity when compared to MMPI. No reliability information is available.58, 59

Selective Reminding Test (SRT): The SRT as developed by Buschke, measures verbal learning and memory during a multiple-trial list-learning task. Participants are read a list of 12 common words and are immediately asked to recall as many of these words as possible. Participants are given a minute for recall, which is immediately followed by the next trial. Each subsequent learning trial involves the selective presentation of only those items that were not recalled on the immediately preceding trial. After the selective presentation (or “reminding”) of the missed words, the subject is asked to recall as many words as possible from the whole list. There are 12 trials in all. There are multiple forms of the word list. The SRT is included as a measure of immediate recall and learning and allows for a fine-grained analysis of encoding, storage and retrieval mechanisms.60

Sheehan Disability Scale (SDS), a three-item instrument for assessing psychiatric impairment in occupational, social and family functioning, each rated from 0 to 10 (0-3: mild impairment; 4-6: moderate impairment; 7-10: severe impairment). Internal consistency reliability was demonstrated with the coefficient alpha was 0.89 for three-item scale. Reliability of each item ranged from 0.67 for work impairment to 0.77 for family impairment and 0.81 for social impairment. The construct validity was proved as well.61

SF-36 Health Survey is a 36-item instrument for measuring health status and outcomes from the patient's point of view. Designed for use in surveys of general and specific populations, health policy evaluations, and clinical practice and research, the survey can be self administered by people 14 years of age or older, or administered by trained interviewers either in person or by telephone. The SF-36® measures the following 8 health concepts, which are relevant across age, disease and treatment groups: limitations in physical activities because of health problems; limitations in usual role activities because of physical health problems; bodily pain; general health perceptions; vitality (energy and fatigue); limitations in social activities because of physical or emotional problems; limitations in usual role activities because of emotional problems; and mental health (psychological distress and well-being). The survey's standardized scoring system yields an 8-scale profile of functional health and well-being scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index. It is a generic measure, as opposed to one that targets a specific age, disease, or treatment group. Accordingly, the SF-36 has proven useful in surveys of general and specific populations, comparing the relative burden of diseases, and in differentiating the health benefits produced by a wide range of different treatments.62, 63

The Social Skills Rating System (SSRS) is a self-report instrument with each item having fixed choices for the rater to select. The SSRS comes in many different versions because it depends on who the rater is and the age and grade of the child being rated. There are different forms for teachers, parents and children. The number of items for the scales range between 34 to 55 and they are all rated on a 3-point Likert scale.64

The Strengths and Weaknesses of ADHD symptoms and Normal behavior scale (SWAN) consist of 18 items and is derived from the DSM-IV-TR. The scale measures attention problems and positive attention skills. It uses a 7-point scale to rate behavior with the following options: − 3=far below average, −2=below average, −1=slightly below average, 0=average, 1=slightly above average, 2=above average and 3=far above average. Scores are averaged to range from −3 to 3 with negative scores indicating better attention behaviors.

Swanson, Conners, Milich and Pelham Scale is a 13-item questionnaire that measures the ability to function in the classroom, follow instructions, complete tasks, and perform accurately. Its two variables, attention and deportment, are sensitive to stimulant medication time-response effects in multiple cycle assessments.30

Swanson, Kotlin, Agler, M-Flynn and Pelham (SKAMP) scale is a 15-item scale. Ten items describe typical behaviors in a classroom setting and other five items were used for recording specific behavior. 65 Items are rated on a 7-point impairment scale (none, slight, mild, moderate, severe, very severe, and maximal). The reliabilities were from .70 to .78 for the SKAMP Attention ratings, and were from .63 to .73 for the SKAMP Deportment ratings. The concurrent validity was established by calculating correlations with Conners and the IOWA Conners' Rating scale.66 SKAMP comprises of two subscales (deportment [SKAMPDS] and attention [SKAMP-AS]).47

Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV Rating Scale) was the first of many scales to present DSM criteria in a rating scale format and has been updated with each DSM revision. It has been widely used in research. The shortened and most frequently used version of the SNAP-IV includes core DSM-IV-derived ADHD subscales along with summary questions in each domain. An extended version adds symptom criteria for comorbid DSM-IV disorders, making it more like the CRS-R. The SNAP-IV and scoring information are conveniently provided free at www.ADHD.net. Its free availability has made the SNAP-IV popular in clinical practice and an alternative to the CRS-R. The SNAP-IV is sensitive to treatment effects and is frequently used for monitoring treatment. The full version has 90 items and takes 20-30 minutes to complete; the shorter ADHD + ODD version has 31 items for and takes 5-10 minutes to complete. The scale has 4 ratings, from “not at all” to “very much.” It was developed by Swanson, Nolan, and Pelham.67

Targeted Adult Attention Deficit Disorder Scale (TAADDS) is a semi-structured interview that consists of the seven target symptoms that are the defining attributes of the Utah Criteria: attention, hyperactivity, temper, mood instability, over-reactivity, disorganization and impulsivity. The instrument assesses core ADHD symptoms, as well as other associated symptoms such as anger and mood lability. Anchor points range from “0” (none) to “4” (very much).68

Wender Utah Rating Scale (WURS) is a 61-item scale for adults to evaluate childhood behavior. It has been demonstrated to be sensitive in identifying childhood attention deficit hyperactivity disorder. It is rated on the five-point scale: ‘not at all or slightly’, ‘mildly’, ‘moderately’, ‘quite a bit’, and ‘very much’. A subset of 25 of the items successfully identified 86% of patients diagnosed with ADHD and 99% of the normal, control individuals 69. The test-retest reliability was proved with Cronbach alpha ranged from .69 to .90. The validity was demonstrates as well with factor analysis.70, 71

Wechsler Intelligence Scale for Children, 3rd edition (WISC-III) is an instrument assessing the intellectual ability of children aged 6 to16 years. It consists of different measures to estimates individual's intellectual abilities. Each subtest is derived from four factors, verbal comprehension, perceptual organization, freedom from distractibility and processing speed. The reliability coefficients of the subscales are from .69-.96. Besides, it has been demonstrated in construct validity and internal validity.72 This scale supersedes the WISC-R scale.

Werry-Quay Direct Observational System assesses behaviors including out-of-seat; physical contact or disturbing others; audible noise; ninety-degree turn, seated; inappropriate vocalizations; other deviant behaviors; and daydreaming. Retrieval of reliability and validity findings 73 are pending and will be addressed in the updated report.

Wender-Reimherr Adult Attention Deficit Disorder Scale (WRADDS) is intended to measure the severity of the target symptoms of adults with ADHD using the Utah Criteria, which Wender developed. It measures symptoms in 7 categories: attention difficulties, hyperactivity/restlessness, temper, affective lability, emotional overreactivity, disorganization, and impulsivity. The scale rates individual items from 0 to 2 (0 = not present, 1 = mild, 2 = clearly present) and summarizes each of the 7 categories on a 0-to-4 scale (0 = none, 1 = mild, 2 = moderate, 3 = quite a bit, 4 = very much). The WRAADS may be particularly useful in assessing the mood lability symptoms of ADHD.74

Yale Global Tic Severity Scale (YGTSS) is a clinical instrument designed to be used by experienced clinicians for the assessment of TIC severity in children, adolescents, and adults. Clinicians rate the severity of motor and phonic Tics of the patient with respect to 5 dimensions: number, frequency, intensity, complexity and interference. A 6-point scale was developed for each area, which contains descriptive statements and examples. A higher YGTSS score indicates severe symptoms. This scale has been shown to be reliable and valid for the assessment of Tic severity. 75 The YGTSS supersedes the Tourette's Syndrome Global Scales (TSGS).

Young Mania Rating Scale (YMRS) This scale is used to assess disease severity in patients already diagnosed with mania. This 11-item scale is intended to be administered by a trained clinician who assigns a severity rating for each item based on a personal interview. 45

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