Vanderbilt ADHD Screenings

adhd

Introduction *

The Vanderbilt ADHD Rating Scales were developed by Mark Wolraich and were placed in the public domain.   They may be freely copied, and they 285x171_Resources_Mark-Wolraich are widely used by pediatricians and/or distributed by other health service providers and parent ADHD support organizations, including   CHADD.

They are designed for use with children six to twelve, but authors suggest they might also be useful for preschoolers.

Teacher and Parent Scales are available, but there is no Self Report.   Preliminary studies have documented adequate reliability, and those same studies suggest that there is only a two percent chance that the scales will result in a false negative (saying that the child does not have ADHD when he or she actually does.) However, those same studies (abstracts below) also suggest when the presence of ADHD is indicated as being positive, less than twenty percent actually are actually diagnosed with ADHD after a comprehensive evaluation.

For that reason we are currently only recommending their use in public school systems for the monitoring of symptoms and performance improvement;  and recommending the scale be used with caution as a screening instrument. The only caution being that according to the studies below, many children the scales suggest have ADHD will not, after a comprehensive evaluation, actually be diagnosed with ADHD.  Therefore no child should be diagnosed with ADHD based on Vanderbilt scores alone!  In the studies below, one study showed that the Parent Rating Scale only had a positive predictive value of .19, and the teacher scale a positive predictive value of .32.  With respect to the Parent scale particularly, Pubfacts wrote, “VADPRS is suitable for a general population screen for ADHD and it is helpful in the clinical diagnosis of ADHD, but its results can be influenced by parents’ awareness and perception of children’s behavior, and cannot replace the interview and judgment of professionals.”

In other words, the scales are effective in ruling out ADHD but not as a stand alone scale for making a diagnosis.  This writer’s recommendation to schools when confronted with a prescription pad diagnosis of ADHD from an outside source is that they explain to parents that the VADPRS has low predictive value for ADHD and that federal laws require them to provide every child with a comprehensive evaluation before labeling him as disabled.  If the parents ask for “proof” of the school’s assertions, the IDEA requirements are described in Section 34 CFR 300.304.   Section 504 requirements for an evaluation are found at 34 CFR 104.35 .   Section 504 applies to all children with disabilities, including children being considered for eligibility under the IDEA.  The regulatory impact with respect to medical diagnoses are further explained in an OCR FAQ  Questions 24 and 25.

  1. Can a medical diagnosis suffice as an evaluation for the purpose of providing FAPE?

No. A physician’s medical diagnosis may be considered among other sources in evaluating a student with an impairment or believed to have an impairment which substantially limits a major life activity. Other sources to be considered, along with the medical diagnosis, include aptitude and achievement tests, teacher recommendations, physical condition, social and cultural background, and adaptive behavior.  As noted in FAQ 22, the Section 504 regulations require school districts to draw upon a variety of sources in interpreting evaluation data and making placement decisions.

  1. Does a medical diagnosis of an illness automatically mean a student can receive services under Section 504?

No. A medical diagnosis of an illness does not automatically mean a student can receive services under Section 504. The illness must cause a substantial limitation on the student’s ability to learn or another major life activity. For example, a student who has a physical or mental impairment would not be considered a student in need of services under Section 504 if the impairment does not in any way limit the student’s ability to learn or other major life activity, or only results in some minor limitation in that regard.

nichq

The Teacher and Parent Scales *

Downloadable copies of the  Vanderbilt Parent ADHD Rating Scale (55 questions) and for the Vanderbilt ADHD Teacher Rating Scale (43 questions)  are available at the links provided. .    Both scales, according to an August, 2015 article by the author, Mark Wolraith,  remain in the public domain and, according to NICHQ, may be distributed freely as long as they are given credit.

There is also a Spanish version of the Parent scale.

The 2002 Toolkit may be downloaded free of charge from NICHQ but you must complete a survey.  They are also available from  non NICHQ websites but without completing a survey, e.g.,  the A.D.D. Resource Center  and the National Capitol Consortium  Pediatrics

There is no difference between the rating scales offered in the 2002 Toolkit and the scales offered in the 2011 AAP Toolkit below   However, the Second Edition Toolkit is only available for a fee.  Neither scale is recommended by this website for use in making a definitive diagnosis of ADHD as we view their main utility lying in the easy availability as screening instruments or for a quick and easy monitoring tool.

Users may distribute any of the 2002 Toolkit materials free of charge as long as credit is givien to NICHQ.

Scoring criteria keyed to the DSM 5 criteria may be found by clicking on NICHQ Scoring Criteria for the Vanderbilts .  The scoring rubric in Word format is the one currently recommended on the test author’s website.

Vanderbilt Follow Up Scales are also available for monitoring.

Parent Version

Teacher Version

Scoring Criteria

Additionally, as part of the 2002 Toolkit, a Daily Report Card  is available.  “The Daily Report Card is a method for systematically tracking the child’s improvement on a daily and weekly basis and rewarding good behavior. This document details how to set up a Daily Report Card system.” The card would ideally be utilized to monitor the effectiveness of a behavior modification and rewarding system.

Scoring criteria keyed to the DSM IV may be found by clicking on Scoring Instructions for the NICHQ Vanderbilt Assessment Scale.  The use of this scoring rubric is NOT recommended.

aap adhd

The DSM 5  AAP Toolkit *

Caring for Children with ADHD – A Toolkit for Clinicians   is available for $94.95  in a CD/DVD format.

Although the rating scales themselves do not differ, the AAP Toolkit itself has been changed substantially from 2002.   If a user is using the scales for screening or monitoring, purchasing the new Toolkit is not a necessity.   Changes and updates from the 2002 Toolkit reported by the American Association of Pediatricians include:

The 2nd edition includes 

  • Broader scope–resources now cover an expanded age range of 4 to 18 years.
  • Focus on comorbid conditions–tools have been added for identification, assessment, diagnonsis, and management of common mental health symptons, inattention, impulsivity, and more.
  • Monitoring and follow-up tools–includes expanded resources to assist with medication management and treatment.
  • ADHD care process algorithm
  • Parent resources–for behavioral therapies and complementary and alternative medicine approaches. 

Caring for Children With ADHD: A Resource Toolkit for Clinicians, bring these updated AAP recommendations to your practice. It provides a full set of ready-to-use tools many in Spanish and English for 

  • Assessment and Diagnosis including the Vanderbilt Assessment Scales
  • Treatment and Medication
  • Monitoring and Follow-up
  • Parent Education and Support
  • Coding and Payment

In contrast to the first edition, “If you wish to use any materials provided in the 2nd Edition, you must contact the AAP (csc@aap.org or 866-843-2271) in order to request the appropriate copyright/reproduction permissions.”

research

Research Studies (Abstracts) *

J Dev Behav Pediatr. 2013 Feb;34(2):72-82. doi: 10.1097/DBP.0b013e31827a3a22.

The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population.
Bard DE1Wolraich MLNeas BDoffing MBeck L.

Author information

  • 1Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.

Abstract

OBJECTIVE:To examine the psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) using a community-based sample of primarily elementary and middle school-aged children.

METHOD:Participants were initially recruited from 41 elementary schools in 5 Oklahoma school districts including urban, suburban, and rural students. Vanderbilt rating scales were obtained from all teachers (n = 601) and sampled parents (n = 587) of the participating children. Construct validity was assessed by confirmatory factor analysis of the 45 items that made up the 4 scales of inattention, hyperactivity, conduct/oppositional problems, and anxiety/depression problems. Reliability was evaluated from internal consistency, test-retest, and interrater agreement perspectives. Criterion validity was evaluated via comparisons to a structured psychiatric interview with the parents using the Diagnostic Interview Schedule for Children-IV.

RESULTS:A 4-factor model (inattention, hyperactivity, conduct/oppositional problems, and anxiety/depression problems) fit the data well once discarding conduct items that were infrequently endorsed. The estimates of coefficient alpha ranged from .91 to .94 and the analogous KR20 coefficient for a binary item version of the scale ranged from .88 to .91. Test-retest reliability exceeded .80 for all summed scale scores. The VADPRS produced a sensitivity of .80, specificity of .75, positive predictive value of .19, and negative predictive value of .98 when predicting an attention-deficit hyperactivity disorder (ADHD) case definition that combined teacher’s Vanderbilt ADHD Diagnostic Teacher Rating Scale and parent diagnostic interview responses.

CONCLUSION:The confirmation of the construct and concurrent criterion validities found in this study further support the utility of the VADPRS as a diagnostic rating scale for ADHD.

 

J Dev Behav Pediatr. 2013 Feb;34(2):83-93. doi: 10.1097/DBP.0b013e31827d55c3.The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population.

Wolraich ML1Bard DENeas BDoffing MBeck L.Author information

  • 1Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA. mark-wolraich@ouhsc.edu

ABSTRACT_Cover_1500

Abstract

OBJECTIVE:This study examined the psychometric properties of the Vanderbilt AD/HD Diagnostic Teacher Rating Scale (VADTRS).
METHODS:Information was collected from teachers and parents in 5 school districts (urban, suburban, and rural). All teachers in participating schools were asked to complete the VADTRS on all their students. Construct validity was evaluated through an exploratory factor analysis investigation of the 35 items that made up the 4 scales of inattention, hyperactivity, conduct/oppositional problems, and anxiety/depression problems. Convergent validity was assessed among a subsample of participants whose teachers completed the Strengths and Difficulties Questionnaire (SDQ). Finally, predictive validity was examined for another subsample of high- and low-risk children whose parents completed a structured psychiatric interview, the Diagnostic Interview Schedule for Children-IV.
RESULTS:For construct validity, a 4-factor model (inattention, hyperactivity, conduct/oppositional, and anxiety/depression problems) fits the data well. The estimates of the KR20 coefficient for a binary item version of the scale ranged from .85 to .94. Convergent validity with the SDQ was high (Pearson’s correlations > .72) for these 4 factors. For predictive validity, the VADTRS produced a sensitivity of .69, specificity of .84, positive predictive value of .32, and negative predictive value of .96 when predicting future case definitions among children whose parents completed a diagnostic interview.

CONCLUSION:The confirmation of the construct and convergent validity and acceptable scale reliabilities found in this study further supports the utility of the VADTRS as a diagnostic rating scale for attention-deficit hyperactivity disorder. The low predictive validity further demonstrates the need for multiple observers in establishing the diagnosis.

PMID:
23363973
[PubMed – indexed

The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population

The psychometric properties of the Vanderbilt attention-deficit hyperactivity disorder diagnostic teacher rating scale in a community population.

Positive Predictive value

Definitions of  Positive and Negative Predictive Value *

  • Positive predictive value is the probability that subjects with a positive screening test truly have the disease.
  • Negative predictive value is the probability that subjects with a negative screening test truly don’t have the disease.

Those terms and others used above are also discussed in an on-line publication by Boston Univesity  and Michigan State University (among others.)