Pediatric Attention Disorders Diagnostic Screener

Last updated

The Pediatric Attention Disorders Diagnostic Screener (PADDS), created by Dr. Thomas K. Pedigo and Kenneth L. Pedigo, is a suite of computer administered neuropsychological tests of attention and executive functioning. The PADDS is used in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children between the ages of 6 and 12 years. [1] The PADDS software program represents a multi-dimensional, evidence-based approach to ADHD assessment, [2] consisting of the Computer Administered Diagnostic Interview (CADI), the Swanson, Nolan, and Pelham—IV (SNAP-IV) Parent and Teacher rating scales, [3] and the three computer-administered objective measures of the Target Tests of Executive Functioning (TTEF). It calculates a diagnostic likelihood ratio, where each data source is allowed to contribute to (or detract from) the prediction of the diagnosis, [4] as well as normalized relative standard scores, t-scores, z-scores, and percentile ranks for comparison to the non-clinical reference group.

Contents

PADDS history and development

One of the most commonly diagnosed childhood disorders referred to mental health clinicians is ADHD. [5] It is a complicated neurodevelopmental psychiatric disorder and has an estimated range of occurrence of 2 to 3 percent of the school population and up to 10 percent in other settings. Thus, on average a minimum of at least one child with ADHD and executive functioning disorders is in each classroom in American schools. (Reddy et al.) [2] Rowland, Leswesne, & Abramowitz (2002) [6] indicated that prevalence rates for ADHD vary markedly based on presenting symptoms, assessment approaches used, and the setting in which the child was tested. A lack of a consensus on what constitutes the core set of symptoms for ADHD confounds the screening and assessment process (Brown, 2002). [7]

Due to the concerns regarding prevalence rates of ADHD, the American Academy of Pediatrics (AAP, 2000) [8] and the National Institute of Health (NIH, 1998) have stressed the need to develop new standardized, evidence-based assessments that have strong psychometric properties, and are easily administered in schools and other clinical settings. The major consideration guiding the development of the PADDS is integrating an updated construct of ADHD assessment, while focusing on ways to enhance diagnostic accuracy in an efficient manner. Clinical testing of the PADDS Target Tests of Executive Functioning was conducted on one of the largest samples of age specific, ADHD and non-ADHD subjects collected, with 725 children (240 females and 485 males) age 6 to 12 years (M = 8.63, SD = 1.72) split approximately evenly between those diagnosed with ADHD (n = 395) and age matched Non-ADHD peers (n = 330). Data were collected in seven states from 10 data collection sites. Institutional Review Board (IRB) approval for the overall project was established through Armstrong Atlantic State University in Savannah, Georgia. All research sites included specialty ADHD assessment centers, each with independent IRB oversight, in Illinois, Georgia, Idaho, New Jersey, Tennessee, California, and Florida. (Pedigo, Pedigo & Scott 2008) [9]

Screening for possible comorbid conditions

The Computer Administered Diagnostic Interview (CADI) is used for comorbid screening, to assist clinicians with the collection and consolidation of pertinent patient information. The clinical protocol consists of 113 questions covering the major domains of co-occurring disorders. These areas include a medical and developmental history, emotional/social functioning, depression and anxiety symptoms, behavioral issues, school history, and attention/hyperactivity symptoms. [10] This information is necessary to help structure an individual assessment process and to support recommendations for treatment. The information is reviewed, with the parent or guardian, for cross validation of any concerns. [11]

Screening for inattention and hyperactivity

The Swanson, Nolan, and Pelham—IV (SNAP-IV) rating scale forms are included for parent/guardian and teachers to complete. The rating scales offer categorical and dimensional input across the 18 core diagnostic items from the Diagnostic and Statistical Manual of Mental Disorders DSM-IV Fourth Edition-Revised. Each item is rated on a 4-point Likert scale for severity. These behavioral criteria have produced reliable sensitivity and specificity in identifying ADHD cases relative to non-clinical reference groups. (Power, T. J., Andrews, T. J., Eiraldi, R. B., Doherty, B. J., Ikeda, M. J., DuPaul, G. J., & Landau, S.; 1998) [12] (Zolotor, A. J., & Mayer, J.; 2004) [13]

Objective measures

The Target Tests of Executive Functioning (TTEF) consist of three target subtests: Target Recognition, Target Sequencing and Target Tracking. They are designed to place distinctly different demands on areas of executive functioning important to ADHD assessment.(Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L. J., Wilens, T. E., Ferrero, F., Morgan, C. L., & Faraone, S. V.; 2004). [14] The tests tap working memory, sequential memory and procedural memory functions, and help provide an objective assessment of a subject's ability to employ executive processes such as planning, attending, organizing input, storing and retrieving information, modulating emotions and sustaining effort. These task demands have been consistently identified as difficult for children known to have ADHD.(Russell Barkley; 1997) [15]

Demands basic to all three target subtests

Task specific demands for target recognition

Target Recognition takes approximately 8–10 minutes to complete. This subtest presents five large colored squares with smaller squares inside them. Below the squares are five small boxes labeled 1 to 5. The colored squares simultaneously blink on and off the screen at 1 ½ second intervals in differing patterns, for a total of 153 presentations. The child is taught a strategy to read from left to right and to count the number of large squares with small squares inside them of the same color and then to click on the corresponding number in the small box below. Specific requirements for task completion include among others: attention to detail, avoiding distraction, maintenance of effort or persistence, holding information in mind through the use of metacognition, feedback, and emotional regulation while developing a response to changes in novel stimuli.

Task specific demands for target sequencing

Target Sequencing takes approximately 8–10 minutes to complete. This subtest presents five large colored circles. A small colored square moves through each of them starting in the middle or at either of the end circles. The child is taught to attend only to circles when the square matches it in color and to say the name of the color to him or herself while disregarding the circles that have squares with a different color. Once the squares have moved through all five circles the child clicks on each of the circles that had matching colors in the same order that they stated to him/herself—first match first, second match second and last match last. Specific requirements for task completion include among others: attention to detail, avoiding distraction, maintenance of effort or persistence, holding information in mind through the use of metacognition, feedback, and emotional regulation during the initiation and follow through of a response to complex sequences while remaining sensitive to changes in novel stimuli.

Task specific demands for target tracking

Target Tracking takes approximately 8–10 minutes to complete, This subtest presents four colored shapes at the top and bottom of the screen. The computer creates, one move at a time, two and three-step moves that the child must repeat/recreate in the same order seen—first move first, second move second and last move last. Specific requirements for task completion include among others: attention to detail, maintaining divided attention, holding information in mind, maintenance of effort or persistence and emotional regulation while completing complex two and three-step instructions.

Scoring and reporting

The PADDS System and Summary Reports presents the incremental input of multiple forms of information that research has shown to be most reliable and valid for ADHD assessment. (Frazier & Youngstrom; 2006) [4] The PADDS system uses a comparison of two well-defined reference groups, namely ADHD and Non-ADHD. [16] Each component is calculated in an additive or subtractive manner for and against a diagnosis in consideration of the ADHD Base rate. The inputs are displayed in a real time format via a computer generated Nomogram presenting an individual and an overall predictive index of likelihood ratios establishing evidence for or against a diagnosis. Results are likewise presented in a normalized, relative Standard score, T-score, Z-Score, and Percentile rank format for comparison to the non-clinical reference group.

The nomographic display of the individual and cumulative inputs is evaluated stepwise via the calculation of likelihood ratios applied incrementally with a Fagan's Nomogram (Fagan TJ; 1975) [17] to produce an overall predictive index beginning with a calculated base rate, and combining the results of the other measures, in either an additive or subtractive manner, to provide a post-test probability. When used in conjunction with clinical judgment, these components have proven to be highly effective for consideration of diagnosis and in highlighting and documenting a need for further evaluation or actions, and may allow the clinician to evaluate their own diagnostic practices and effectiveness over time.

Clinical use of the Pediatric Attention Disorders Diagnostic Screener (PADDS)

PADDS is used by: Child Psychiatrists, Child Psychologists, Neuro-psychologists, School Psychologists and Pediatricians

The PADDS is published by and available from Targeted Testing, Inc. and other major psychological test publishers.

See also

Related Research Articles

<span class="mw-page-title-main">Attention deficit hyperactivity disorder</span> Neurodevelopmental disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate.

Adult attention deficit hyperactivity disorder is the neurological condition of attention deficit hyperactivity disorder (ADHD) in adults. About one-third to two-thirds of children with symptoms from early childhood continue to demonstrate ADHD symptoms throughout life.

Nonverbal learning disability (NVLD) is proposed category of neurodevelopmental disorder characterized by core deficits in visual-spatial processing and a significant discrepancy between verbal and nonverbal intelligence. A review of papers found that proposed diagnostic criteria were inconsistent. Proposed additional diagnostic criteria include intact verbal intelligence, and deficits in the following: visuoconstruction abilities, speech prosody, fine-motor coordination, mathematical reasoning, visuospatial memory and social skills. NVLD is not recognised by the DSM-5 and is not clinically distinct from learning disorder.

The Wechsler Intelligence Scale for Children (WISC) is an individually administered intelligence test for children between the ages of 6 and 16. The Fifth Edition is the most recent version.

Sluggish cognitive tempo (SCT) is a syndrome related to attention deficit hyperactivity disorder (ADHD) but distinct from it. Typical symptoms include prominent dreaminess, mental fogginess, hypoactivity, sluggishness, staring frequently, inconsistent alertness and a slow working speed.

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". This behavior is usually targeted toward peers, parents, teachers, and other authority figures. Unlike conduct disorder (CD), those with ODD do not show patterns of aggression towards people or animals, destruction of property, theft, or deceit. One half of children with ODD also fulfill the diagnostic criteria for ADHD.

Attention deficit hyperactivity disorder predominantly inattentive, is one of the three presentations of attention deficit hyperactivity disorder (ADHD). In 1987–1994, there were no subtypes and thus it was not distinguished from hyperactive ADHD in the Diagnostic and Statistical Manual (DSM-III-R).

<span class="mw-page-title-main">Attention deficit hyperactivity disorder controversies</span>

Despite the scientifically well-established nature of attention deficit hyperactivity disorder (ADHD), its diagnosis, and its treatment, each of these has been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.

NEPSY is a series of neuropsychological tests authored by Marit Korkman, Ursula Kirk and Sally Kemp, that is used in various combinations to assess neuropsychological development in children ages 3–16 years in six functional domains.

Attention deficit hyperactivity disorder management options are evidence-based practices with established treatment efficacy for ADHD.

The Test of Variables of Attention (T.O.V.A.) is a neuropsychological assessment that measures a person's attention while screening for attention deficit hyperactivity disorder. Generally, the test is 21.6 minutes long and is presented as a simple, yet boring, computer game. The test is used to measure a number of variables involving the test taker's response to either a visual or auditory stimulus. These measurements are then compared to the measurements of a group of people without attention disorders who took the T.O.V.A. This test should be used along with a battery of neuropsychological tests, such as a detailed history, subjective questionnaires, interviews, and symptom checklists before a diagnosis should be concluded.

Joseph Biederman was Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, professor of psychiatry at Harvard Medical School. Biederman was Board Certified in General and Child Psychiatry.

<span class="mw-page-title-main">Borderline intellectual functioning</span> Medical condition

Borderline intellectual functioning, previously called borderline mental retardation, is a categorization of intelligence wherein a person has below average cognitive ability, but the deficit is not as severe as intellectual disability. It is sometimes called below average IQ (BAIQ). This is technically a cognitive impairment; however, this group may not be sufficiently mentally disabled to be eligible for specialized services.

<span class="mw-page-title-main">Adult ADHD Self-Report Scale</span> Self-reported questionnaire used to assist in the diagnosis of ADHD in adults

The Adult ADHD Self-Report Scale (ASRS) Symptom Checklist is a self-reported questionnaire used to assist in the diagnosis of adult ADHD. ADHD is a neurological disorder that can present itself in adolescence and adulthood. Adults with ADHD may experience difficulties in relation to cognitive, academic, occupational, social and economic situations.

The Behavior Rating Inventory of Executive Function (BRIEF) is an assessment of executive function behaviors at home and at school for children and adolescents ages 5–18. It was originally developed by Gerard Gioia, Ph.D., Peter Isquith, Ph.D., Steven Guy, Ph.D., and Lauren Kenworthy, Ph.D.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the DSM-5 as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble those of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder.

The Delis–Kaplan Executive Function System (D-KEFS) is a neuropsychological test used to measure a variety of verbal and nonverbal executive functions for both children and adults. This assessment was developed over the span of a decade by Dean Delis, Edith Kaplan, and Joel Kramer, and it was published in 2001. The D-KEFS comprises nine tests that were designed to stand alone. Therefore, there are no aggregate measures or composite scores for an examinee's performance. A vast majority of these tests are modified, pre-existing measures ; however, some of these measures are new indices of executive functions.

<span class="mw-page-title-main">Vanderbilt ADHD diagnostic rating scale</span>

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.

<span class="mw-page-title-main">ADHD rating scale</span>

The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid consisting of 18–90 questions regarding a child's behavior over the past 6 months. The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.

<span class="mw-page-title-main">Child Mania Rating Scale</span>

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

References

  1. ↑ Reddy, Linda A.; Newman, Erik; Pedigo, Thomas K.; Scott, Vann (2010-09-03). "Concurrent Validity of the Pediatric Attention Disorders Diagnostic Screener for Children with ADHD". Child Neuropsychology. 16 (5): 478–493. doi:10.1080/09297041003705479. ISSN   0929-7049. PMID   20485995. S2CID   205625891.
  2. 1 2 Reddy, Linda; Fumari, G.; Pedigo, T. K.; Scott, V. B. Jr (2008). "Pediatric Attention Disorders Diagnostic Screener for Children At-Risk for Attention-Deficit/Hyperactivity Disorder" (PDF). APA Division 16 School Psychology. 62 (3): 93–98. Retrieved 2009-02-16.
  3. ↑ Swanson, J. M.; W. Nolan; W.E. Pelham (1992). "The SNAP-IV Rating Scale" (PDF). Retrieved 2009-02-16.
  4. 1 2 Frazier, T. W.; E. A. Youngstrom (2006). "Evidence-based assessment of attention-deficit/hyperactivity disorder: Using multiple sources of information". Journal of the American Academy of Child and Adolescent Psychiatry. 45 (5): 614–620. doi:10.1097/01.chi.0000196597.09103.25. PMID   16670656.
  5. ↑ National Institutes of Health. "National Institutes of Health Consensus Development Conference Statement".
  6. ↑ Rowland, A. S.; Leswesne, C. A.; Abramowitz, A. J. (2002). "The epidemiology of attention-deficit/hyperactivity disorder (ADHD): A public health view". Mental Retardation and Developmental Disabilities Research Reviews. 8 (3): 162–170. doi:10.1002/mrdd.10036. PMID   12216060.
  7. ↑ Brown, T. E. (2002). "Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for the disorder: impairments in regulation of emotion". Johns Hopkins University Advanced Studies in Medicine. 2 (25): 910–914.
  8. ↑ American Academy of Pediatrics (2000-05-05). "Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder". Pediatrics. 105 (5): 1158–1170. doi:10.1542/peds.105.5.1158. PMID   10836893 . Retrieved 2009-02-16.
  9. ↑ Pedigo, T. K.; Pedigo, K. L.; Scott, V. B. (2008). PADDS ADHD Screener Clinical Manual (PDF). Targeted Testing, Inc. pp. 38–40.
  10. ↑ Keiser, Ashley; Reddy, Linda (2013-10-01). "Clinical Use of the Pediatric Attention Disorders Diagnostic Screener for Children At Risk for Attention Deficit Hyperactivity Disorder: Case Illustrations". Journal of Applied School Psychology. 29 (4): 350–374. doi:10.1080/15377903.2013.836777. ISSN   1537-7903. S2CID   145320904.
  11. ↑ Newman, Erik; Reddy, Linda A. (2017-03-01). "Diagnostic Utility of the Pediatric Attention Disorders Diagnostic Screener". Journal of Attention Disorders. 21 (5): 372–380. doi:10.1177/1087054714526431. ISSN   1087-0547. PMID   24639402. S2CID   8460518.
  12. ↑ Power, T. J.; Andrews, T. J.; Eiraldi, R. B.; Doherty, B. J.; Ikeda, M. J.; DuPaul, G. J.; Landau, S. (1998). "Evaluating attention deficit hyperactivity disorder using multiple informants: The incremental utility of combining teacher with parent reports". Psychological Assessment. 10 (3): 250–260. doi:10.1037/1040-3590.10.3.250.
  13. ↑ Zolotor, A. J.; Mayer, J. (2004). "Does short system checklists accurately diagnose ADHD". Journal of Family Practice. 53 (5): 412–416. PMID   15125829.
  14. ↑ Biederman, J., Joseph; Monuteaux, M. C.; Doyle, A. E.; Seidman, L. J.; Wilens, T. E.; Ferrero, F.; Morgan, C. L.; Faraone, S. V. (2004). "Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children". Journal of Consulting and Clinical Psychology. 72 (5): 757–766. doi:10.1037/0022-006X.72.5.757. PMID   15482034.
  15. ↑ Barkley, Russell A. (1997). "Behavioral inhibition, sustained attention, and executive function". Psychological Bulletin. 121 (1): 65–94. doi:10.1037/0033-2909.121.1.65. PMID   9000892.
  16. ↑ Huang, Leesa V. (2009). "Test and Product Review: Pediatric Attention Disorders Diagnostic Screener". Journal of Attention Disorders. 13 (3): 310–314. doi:10.1177/1087054709346681. ISSN   1087-0547. PMID   19834127. S2CID   33737447.
  17. ↑ Fagan, T. J. (1975). "Nomogram for Bayes theorem". New England Journal of Medicine. 293 (5): 257. doi:10.1056/NEJM197507312930513. PMID   1143310.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.