Send to

Choose Destination
J Child Adolesc Psychopharmacol. 2019 Oct;29(8):592-598. doi: 10.1089/cap.2019.0035. Epub 2019 Aug 2.

A Novel Assessment Tool for Impulsive Aggression in Children with Attention-Deficit/Hyperactivity Disorder.

Author information

Department of Clinical Research, Supernus Pharmaceuticals, Inc., Rockville, Maryland.
Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut.
Department of Research Science, Endpoint Outcomes, Boston, Massachusetts.
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Baltimore, Maryland.
Department of Medical Affairs, Supernus Pharmaceuticals, Inc., Rockville, Maryland.
Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, Washington, District of Columbia.
Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, District of Columbia.
Department of Research and Development, Supernus Pharmaceuticals, Inc., Rockville, Maryland.


Objective: To establish the validity and reliability of a provisional 30-item impulsive aggression (IA) diary in children (ages 6-12 years, inclusive) with attention-deficit/hyperactivity disorder (ADHD). Methods: The provisional 30-item IA diary was administered for 14 days to parents of children with ADHD and IA symptoms (n = 103). Key inclusion criteria: confirmed ADHD diagnosis; signs of IA as measured by a Retrospective-Modified Overt Aggression Scale (R-MOAS) score ≥20 and an Aggression Questionnaire score of -2 to -5. Analyses included inter-item correlations, exploratory factor analysis (EFA), item response theory (IRT) modeling, internal consistency, test-retest reliability (TRT), concurrent validity (estimated by correlation between the IA diary and the R-MOAS/Nisonger Child Behavior Rating Form), and known-groups methods. Results: The prevalence rates of 15 (50.0%) items were found to be too low (<1%) for analysis; three items with prevalence rates ≤1% were retained, as content validity was deemed high by clinical experts. The remaining 12 behavior items had prevalence rates of 2.7%-73.6%. EFA and IRT models confirmed two subdomains in the IA diary included within a general domain of IA behavior frequency, yielding a single total behavioral frequency score (TBFS). Internal consistency was high for this TBFS (marginal reliability = 0.86 and α = 0.73). TRT for the TBFS, based on the intraclass correlation coefficient, was 0.8. Concurrent validity of TBFS with R-MOAS ranged from r = 0.49 to r = 0.62. Conclusion: The final 15-item IA diary is a reliable, psychometrically validated IA measurement tool that will allow clinicians and researchers to assess the frequency of IA behavior.


aggression; assessment tool; attention-deficit/hyperactivity disorder; impulsive aggression diary; psychometrics

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center