Report: Vanderbilt ADHD Rating Scale

Arunima Jha 22223027

Department of Psychology, Christ (deemed to be) University, Delhi-NCR

MPS451N- Psychodiagnostic Lab-II

Dr. Saswati Bhattacharya

07 February 2023
 Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder

that is characterized by a chronic pattern of hyperactivity, impulsivity, and/or inattention that

impairs functioning or development (Olfson, 1992). The behavioural manifestation of

inattention in individuals with ADHD includes straying from the task at hand, not following

directions or completing tasks, experiencing trouble maintaining focus, being disorganized,

and not being able to understand or defy orders. Excessive motor activity (such as a

youngster running about) or excessive talking, tapping, or fidgeting are examples of

hyperactivity. Impulsivity is the term for rash, unplanned, spontaneous behaviours that could

be harmful to the person (e.g., darting into the street without looking). An impulse could

indicate a need for instant gratification or a failure to postpone satisfaction. Impulsive

behaviors might appear as social intrusiveness (such as frequently interrupting others) or as

making significant decisions without thinking through the long-term effects (such as

accepting a job offer before gathering sufficient information). Impulsivity can also manifest

as difficulty controlling emotions, leading to outbursts or temper tantrums. Additionally,

impulsive individuals may engage in risky behaviours without considering the potential

consequences, such as reckless driving or substance abuse. ADHD first manifests in

childhood. The necessity of many symptoms existing before the age of twelve highlights the

significance of a significant clinical manifestation throughout childhood. However, due to the

challenges in pinpointing the exact age of childhood commencement in hindsight, an earlier

age at onset is not indicated. Since adult recall of symptoms from infancy is sometimes

erratic, it is helpful to gather additional information. Before the age of twelve, ADHD cannot

be diagnosed if there are no symptoms. However, it is important to note that the presence of

symptoms before the age of twelve does not guarantee a diagnosis of ADHD (DSM-5 TR,

2023; Furman, 2005).

 Prevalence of ADHD in India

The world prevalence of ADHD is 7.6% for children aged 3 to 12 years and 5.6% of

teenagers aged 12 to 18 years. The prevalence of ADHD in children and adolescents

according to the DSM-V criterion is also higher than previous diagnostic criteria, according

to studies (Salari et al., 2023). ADHD prevalence for children in India is consistent with the

condition's occurrence worldwide. The frequency of ADHD varies from 0.1% to 8.1%

worldwide, more men than women (9.40%) have a higher prevalence of ADHD (5.20%). It is

noteworthy that there may be regional variations in the prevalence of ADHD in India. It's

crucial to keep in mind that access to healthcare and cultural variables may have an impact on

the stated incidence rates of ADHD in various communities. For male children and female

children, the age range where ADHD is most prevalent in children and adolescents is 8 to 15

years, and 7.6 to 15 years, respectively (Joseph & Devu, 2019).

Clinical Picture of ADHD

The clinical picture of Attention Deficit /Hyperactivity Disorder, or ADHD, presents a

complex picture of a neurodevelopmental disorder that affects millions of people globally as

understood by DSM 5 TR (2023). Imagine a spectrum featuring the three separate realms of

impulsivity, hyperactivity, and inattention, which frequently overlap. For those with ADHD,

each domain presents differently, resulting in a varied tapestry of experiences.

Inattention

The mind of a butterfly: it flits from thought to thought, finds it difficult to focus on

one thing at a time, overlooks important details, and misplaces things easily. Daydreaming is

the state of losing oneself in complex mental landscapes as outside stimuli recede.
Organizational issues include trouble setting priorities, scheduling, and planning, which can

result in missing deadlines and misplaced goods.

Hyperactivity

A persistent hum of activity, fidgeting, tapping, wriggling, and an inability to sit still

for long are signs of restless energy. This frequently disturbs other people and makes it hard

to focus. Excessive chatting, answering inquiries out of the blue, and having trouble waiting

one's turn are examples of motor overflow.

Unending energy

A constant state of "being on the go," is sometimes likened to a motor.

Impulsivity

Behaving without thinking: making rash remarks, taking needless chances, and having

trouble waiting for satisfaction.

Obstacles in decision-making

Inability to consider options carefully before acting, which results in snap decisions

that could go wrong.

Emotionally vulnerable

Often agitated, prone to outbursts, and having trouble controlling emotions.

It's crucial to remember that not everyone with ADHD has all of these symptoms, and

there can be large variations in their intensity. While some people may struggle primarily

with inattention, others may show a more balanced combination of all three domains.
Additionally, some symptoms may become less noticeable as people age, changing the

overall clinical picture.

Diagnostic Criteria according to DSM V TR

The diagnostic criteria for ADHD according to DSM 5 TR are as follows:

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with

functioning or development, as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6

months to a degree that is inconsistent with developmental level and that negatively impacts

directly social and academic/occupational activities: Note: The symptoms are not solely a

manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or

instructions. For older adolescents and adults (age 17 and older), at least five symptoms are

required.

a. Often fails to give close attention to details or makes careless mistakes in

schoolwork, at work, or during other activities (e.g., overlooks or misses details, work

is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has

difficulty remaining focused during lectures, conversations, or lengthy reading).

c. Often does not seem to listen when spoken to directly (e.g., the mind seems

elsewhere, even in the absence of any obvious distraction). d. Often does not follow

through on instructions and fails to finish schoolwork, chores, or duties in the

workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
 e. Often has difficulty organizing tasks and activities (e.g., difficulty managing

sequential tasks; difficulty keeping materials and belongings in order; messy,

disorganized work; has poor time management; fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained

mental effort (e.g., schoolwork or homework; for older adolescents and adults,

preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils,

books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents and adults,

may include unrelated thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older

adolescents and adults, returning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for

at least 6 months to a degree that is inconsistent with developmental level and that negatively

impacts directly social and academic/occupational activities: Note: The symptoms are not

solely a manifestation of oppositional behaviour, defiance, hostility, or a failure to understand

tasks or instructions. For older adolescents and adults (age 17 and older), at least five

symptoms are required.

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his

or her place in the classroom, in the office or other workplace, or in other situations

that require remaining in place).

 c. Often runs about or climbs in situations where it is inappropriate. (Note: In

adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly. e. Is often “on the go,”

acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for

an extended time, as in restaurants, meetings; may be experienced by others as being

restless or difficult to keep up with).

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or

uncomfortable being still for extended time, as in restaurants, meetings; may be

experienced by others as being restless or difficult to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been completed (e.g., completes

people’s sentences; cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or

activities; may start using other people’s things without asking or receiving

permission; for adolescents and adults, may intrude into or take over what others are

doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings

(e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social,

academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another

psychotic disorder and are not better explained by another mental disorder (e.g., mood

disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication

or withdrawal).

Specify whether:

F90.2 Combined presentation: If both Criterion A1 (inattention) and Criterion A2

(hyperactivity-impulsivity) are met for the past 6 months.

F90.0 Predominantly inattentive presentation: If Criterion A1 (inattention) is met but

Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

F90.1 Predominantly hyperactive/impulsive presentation: If Criterion A2

(hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6

months.

Specify if:

In partial remission: When full criteria were previously met, fewer than the full criteria have

been met for the past 6 months, and the symptoms still result in impairment in social,

academic, or occupational functioning.

Specify current severity:

Mild: Few, if any, symptoms over those required to make the diagnosis are present, and

symptoms result in no more than minor impairments in social or occupational functioning.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms in excess of those required to make the diagnosis, or several

symptoms that are particularly severe, are present, or the symptoms result in marked

impairment in social or occupational functioning.

Need for Assessment of ADHD

There are several important reasons why an ADHD assessment is necessary as

discussed by Weiss et al. (2003):

1. Accurate diagnosis

An evaluation aids in distinguishing ADHD from other disorders such as learning

impairments, depression, or anxiety that share similar symptoms. Targeted treatment is

possible when the particular form of ADHD—combined, inattentive, or

hyperactive-impulsive—is identified. An inaccurate diagnosis might exacerbate symptoms

and result in ineffective treatment.

2. Suitable Intervention

Important details regarding a person's strengths, weaknesses, and unique ADHD

issues can be found in a thorough assessment. The creation of a successful treatment plan,

which could involve medication, counseling, and lifestyle modifications, is guided by this

information. Effective therapy alternatives may be overlooked in the absence of a thorough

examination.

3. Improved Achievement
 People who receive treatment for the underlying symptoms of ADHD can see notable

gains in a number of aspects of their lives, such as: academic achievement, Workplace

efficiency, Connections, Self-worth and psychological health, Everyday life abilities.

4. Education Accommodations

An evaluation can yield information for kids and teenagers with ADHD that supports

the need for modifications in the classroom, like: longer testing periods, First-class seating,

Those who take notes, Redesigned assignments.

5. Obtaining Resources

A formal diagnosis can provide access to a range of networks and services, such as

support groups led by experts on ADHD, funding for medical care, and advocacy

organizations for education.

6. Early Intervention

Early identification and intervention for ADHD can significantly improve long-term

outcomes. Untreated ADHD can lead to academic difficulties, behavioural problems, and

mental health challenges later in life.

7. Stigma around ADHD

An ADHD diagnosis can provide both individuals and their families with a better

understanding of the challenges they face. This can increase acceptance, empathy, and

support within the family and social circle. In summary, an ADHD assessment is not just

about getting a label. It's a crucial step towards understanding, managing, and ultimately

thriving with ADHD.

 Available Assessment tools (Kollins et al., 2011)

For children

NICHQ Vanderbilt Assessment Scales for Children

The NICHQ Vanderbilt Assessment Scales are tools used by healthcare professionals

to help diagnose ADHD (Attention Deficit /Hyperactivity Disorder) in children between the

ages of 6 and 12 years. First published in 2002 by the National Institute for Children's Health

Quality (NICHQ), these scales have undergone several updates with the most recent edition

being the 3rd Edition in 2019. They are widely recognized and utilized for their effectiveness

in supporting children and families affected by ADHD.

Conners Comprehensive Behavior Rating Scale (CBRS)

For children and teenagers. the Conners Comprehensive Behavior Rating Scales

(CBRS) were developed by Dr C. Keith Conners to evaluate a range of behavioural,

academic, emotional, and social issues in children and adolescents aged 6 to 18 years.

Behavior Assessment System for Children (BASC-3)

For children and teenagers. The Behavior Assessment System for Children, Third

Edition (BASC-3) is a comprehensive set of rating scales and forms designed to assess the

behaviours and emotions of children and adolescents. It was developed by Dr. Cecil R.

Reynolds, and Dr. Randy W. Kamphaus, and published in 2015. The BASC-3 provides a

complete picture of a child's behaviour from three perspectives – teacher, parent, and

self-report – and is used for screening, assessing, intervening, and monitoring behavioural

and emotional strengths and weaknesses in individuals aged 2 to 21 years.

For Adults

Adult ADHD Self-Report Scale Symptom Checklist Version 1.1 (Adult ASRS)

The Adult ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist was developed

by the World Health Organization (WHO) workgroup as part of the WHO World Mental

Health (WMH) Survey Initiative. This initiative was led by Ronald C. Kessler and his team.

The ASRS was developed to provide a valid self-assessment tool for current ADHD

symptoms in adults and was first introduced in 2005.

Conners Adult ADHD Rating Scales (CAARS)

The Conners' Adult ADHD Rating Scales (CAARS) were developed by C. Keith

Conners, Drew Erhardt, and Elizabeth Sparrow. The CAARS is designed to measure the

presence and severity of ADHD symptoms in adults aged 18 and older. It is used in various

settings, including clinical, research, rehabilitation, and correctional environments.

Brown Attention Deficit Disorder Scales (BADDS)

The Brown Attention-Deficit Disorder Scales were first published in 1996 and 2001.

Developed by Thomas E. Brown, these scales provide a comprehensive assessment of

ADD/ADHD across various age groups. The scales are specifically designed to measure

executive cognitive functioning associated with ADHD

Development of Vanderbilt ADHD Rating Scale

Vanderbilt's ADHD Rating Scales, designed to aid in the diagnosis of

Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents, were

developed by Dr. Mark Wolraich and his colleagues, 2003. These scales come in two main
versions: one for parents, known as the Vanderbilt Parent Rating Scale, and another for

teachers, known as the Vanderbilt Teacher Rating Scale.

The developmental process of the Vanderbilt ADHD Rating Scales began with a

thorough literature review on ADHD symptoms and related behaviors. This review informed

the generation of an initial set of items reflecting the various facets of ADHD. To ensure the

relevance and comprehensiveness of these items, the researchers sought input from experts in

the field of ADHD during the early stages of development.

Pilot testing was then conducted with a small sample to identify any issues with item

clarity, wording, or content. The feedback from this initial testing phase guided the selection

and refinement of items for inclusion in the final scales. Subsequently, the scales underwent

large-scale validation, where they were administered to a diverse sample to establish their

reliability of 0.94 alpha coefficient and concurrent validity of 0.79 was found (Wolraich et al.,

2003).

Test description

The Vanderbilt ADHD Rating Scale, Parent Version, (Wolraich et.al, 2003) is a

comprehensive tool designed to assess and evaluate the presence of

Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in children. This scale is filled

out by parents or caregivers to provide valuable insights into the child's behaviour across

various settings. The assessment covers a range of ADHD-related behaviours, including

inattention, hyperactivity, impulsivity, and other associated difficulties. Parents are asked to

rate the frequency and severity of specific behaviours based on their observations, allowing

for a thorough analysis of the child's overall functioning. Structured as a questionnaire, the

Vanderbilt ADHD Rating Scale Parent Version typically includes a series of questions that

cover a spectrum of behaviours associated with ADHD. The questions are designed to assess
both inattentive and hyperactive-impulsive symptoms, addressing key criteria outlined in the

DSM for an accurate ADHD diagnosis. The scale has a good reliability of 0.94 alpha

coefficient (Wolraich et al.,2003).

Parents or caregivers are asked to provide their observations on various aspects of

their child's behavior. Questions may focus on the child's ability to sustain attention, handle

impulsivity, organize tasks, complete assignments, and manage daily activities. The scale

aims to capture a comprehensive view of the child's behavior across different situations.

To quantify the observed behaviours, parents assign ratings based on a standardized

Likert scale. This scale typically ranges from "Never" to "Very often," allowing for a graded

assessment of the severity of each symptom. This numerical representation aids healthcare

professionals in understanding the extent of the child's challenges.

Healthcare professionals, including paediatricians, psychiatrists, or clinical

psychologists, use the information gathered from the parent version of the Vanderbilt ADHD

Rating Scale as part of a comprehensive diagnostic assessment. The scale's results contribute

to the overall evaluation of ADHD, helping to inform treatment planning and interventions.

By incorporating parental perspectives, the Vanderbilt ADHD Rating Scale Parent Version

complements other assessment tools, such as teacher ratings and direct observations, to form

a holistic view of the child's behaviour across various settings. This multi-faceted approach

enhances the accuracy of the diagnostic process.

It is important to emphasize that while the Vanderbilt ADHD Rating Scale Parent

Version is a valuable tool, it should be interpreted by qualified healthcare professionals in

conjunction with other assessment methods to ensure a comprehensive understanding of the

child'.
 Administration

The administration of the Vanderbilt ADHD Rating Scale (Wolraich et.al, 2003)

involves introducing the purpose of the assessment to parents or caregivers and providing

clear instructions for completing the questionnaire. Parents are asked to consider their child's

behaviour over the past week and use a Likert scale to rate the frequency and severity of

various ADHD-related behaviours, encompassing inattention, hyperactivity, and impulsivity.

The structured questions, often aligned with DSM criteria, aim to gather comprehensive

information. Some versions may include space for open-ended responses. Once completed,

the questionnaire is collected for scoring and analysis, with healthcare professionals

interpreting the results in conjunction with other assessment methods. Feedback is then

provided to parents, facilitating discussions about potential interventions or further

evaluation. Trained professionals typically oversee this process, ensuring a thorough and

accurate evaluation of the child's ADHD symptoms.

Scoring

The scoring of Vanderbilt ADHD Rating scale (Wolraich et.al, 2003) is scored in a

4-point Likert scale ranging from 0 to 3. The ratings are as follows: 0 stands for Never, 1 is

for occasionally, 2 is for Often and 3 is for Very Often. The rating for the symptoms is to be

done keeping in mind, the behaviours observed in the past 6 months.

Interpretation of the scores

The interpretation for scoring this particular scale are as follows:

Predominately Inattentive Subtype: An individual is considered to match the diagnostic

criteria if they score 1 or 2 on any of questions 48 to 55 which are performance items and

have six or more "Often" or "Very Often" responses on items 1 through 9.

Predominately Hyperactive/Impulsive Subtype: A child is considered to meet diagnostic

criteria if they score 1 or 2 on any of questions 48 to 55 which are performance items and

have six or more "Often" or "Very Often" responses on items 10 through 18.

Combined Subtype: If a child satisfies the requirements listed above for both the Inattentive

and Hyperactive/Impulsive subtypes, then they meet the diagnostic criteria.

Oppositional Defiant Disorder Items 19 to 26 are associated with oppositional defiant

disorder. having at least four of the eight behaviors on questions 19–26 score higher than the

clinical cutoff score of two or three, as well as receiving a 1 or 2 on any of the performance

questions 48–55.

Order of Conduct Disorder: 27–40. In order to surpass the clinical cutoff, one must score a

2 or 3 on three or more of the 14 behaviors on questions 27–40 and 1 or 2 on any

performance question. Between 48 and 55

Depression/Anxiety = items 41–47. In order to surpass the clinical cutoff, one must score a 2

or 3 on three or more of the seven behaviors on questions 41–47, as well as a 1 or 2 on any

performance question 48–55.

Scoring and Interpretation

Rating for behaviours in the past 6 months

0=never

1=ocassionally

2=often

3=very often
Interpretation of the scores

Predominately Inattentive Subtype: An individual is considered to match the diagnostic

criteria if they score one or two on questions 48 to 55 and have six or more "Often" or "Very

Often" responses on items 1 through 9.

Predominately Hyperactive/Impulsive Subtype: A child is considered to meet diagnostic

criteria if they score one or two on questions 48 to 55 and have six or more "Often" or "Very

Often" responses on items 10 through 18.

Combined Subtype: If a child satisfies the requirements listed above for both the Inattentive

and Hyperactive/Impulsive subtypes, then they meet the diagnostic criteria.

Oppositional Defiant Disorder Items 19 to 26 are associated with oppositional defiant

disorder. having at least four of the eight behaviors on questions 19–26 score higher than the

clinical cutoff score of two or three, as well as receiving a one or two on any of the

performance questions 48–55.

Order of Conduct Disorder: 27–40. To surpass the clinical cutoff, one must score a 2 or 3

on three or more of the 14 behaviors on questions 27–40 AND a 1 or 2 on any performance

question. Between 48 and 55

Depression/Anxiety = items 41–47. To surpass the clinical cutoff, one must score a 2 or 3 on

three or more of the seven behaviors on questions 41–47, as well as a 1 or 2 on any

performance question 48–55.

 Methodology

Tools and Materials

Vanderbilt ADHD Rating Scale
Pen
Paper (for Introspective Report)
Notebook (for Observation Report)

Socio-Demographic Details
Name- AB
Date of Birth- 12th July 2017
Age- 6 years
Sex- Male
Current Class- 1st Grade
Address- Nirvana Country, Gurgaon
Informant- Mother

Preliminary Set-Up
The set-up was in a quiet well-lit room. The participant was made to sit opposite of
the administrator. The questionnaire was kept on hand and a bottle of water was kept on the
table. The room was ensured to be conducive to a smooth administration with minimal
distractions. The participant was briefed about the test. All doubts and questions were
answered. After making sure the subject was clear with the instructions, verbal informed
consent was obtained, after which the administration commenced.

Procedure

The assessment was to be administered at the home of the assessor's house. After

developing a rapport, the case summary and demographic information were gathered. The

participant sat comfortably, and the space was soundproof. The instructions were delivered

once the participant's permission was requested. The test subject received spoken instructions

before beginning the assessment. The participant was then asked to fill out the form. A
stopwatch was used to keep track of time. At the conclusion, the informant’s participation

was acknowledged.

Instructions
After the rapport was established, the participant was given the following
instructions, “I will hand you a form where you will see a list of statements pertaining to your
child’s behaviour. Please read each of them carefully and choose one among the following
ratings, “Never,” “Occasionally,” “Often,” or “Very Often,” based on your how often have
you seen that particular behaviour in your child in the last six months. Each rating should be
considered regarding what is appropriate for the child's age. There are no right or wrong
answers, so you can choose whichever option best applies to your child.”

Precautions

1. The client should be comfortable.

2. Before beginning the test, the participant should be properly briefed about the test.
3. The participant should be briefed that this is not a diagnosis and the test results are not
definitive in any manner.
4. It should be made sure that the room is well-illuminated, quiet, and has proper
ventilation.

Result Table

Table 1

Total Score of the AB for each domain. For item-wise score, refer to the Appendix.

Specifier Score Counted Scores (1 or 2 in

Performance and Often or
Very Often in rating scale)
 Inattentive Subtype 9 2

Hyperactive/Impulsive 6 1
Subtype

Combined Subtype 15 3

Operational Defiant 5 1
Disorder

Conduct Disorder 1 0

Anxiety/Depression 4 0

Interpretation

Inattentive Subtype: 9
Interpretation
AB does not meet the criteria for the Inattentive Subtype, as the score is much below
the threshold (one or two on questions 48 to 55 (Performance) and six or more "Often" or
"Very Often" responses on items 1 through 9). AB only scored 2 counted scores in this
domain, where a counted score of 6 is required to match the criterion.

Hyperactive/Impulsive Subtype: 6
Interpretation
AB does not meet the criteria for the Hyperactive/Impulsive Subtype, as the score is
much below the threshold (one or two on questions 48 to 55 and six or more "Often" or "Very
Often" responses on items 10 through 18).AB only scored 2 counted scores in this domain,
where a counted score of 6 is required to match the criterion.

Combined Subtype: 15
Interpretation
 The participant does not meet the criteria for the Combined Subtype, as they do not
satisfy the requirements for either the Inattentive or Hyperactive subtype.

Oppositional Defiant Disorder: 05

Interpretation
The client does not meet the criteria for Oppositional Defiant Disorder (ODD), as he
does not meet the required number of behaviours required. AB received only 1 counted score
in this domain, where a counted score of 4 is required to match the criterion.

Conduct Disorder: 01
Interpretation
The client does not meet the criteria for Conduct Disorder, as the score is below the
cutoff (scoring a 2 or 3 on three or more of the 14 behaviours on questions 27–40 AND a 1 or
2 on any performance question 48–55).

Anxiety/Depression: 04
Interpretation
The client does not meet the criteria for Anxiety/Depression, as the score is below the
cutoff (scoring a 2 or 3 on three or more of the seven behaviours on questions 41–47, and a 1
or 2 on any performance question 48–55).

Discussion
The administration of the Vanderbilt ADHD Diagnostic Parent Rating Scale on AB,
provides valuable insights into the assessment of Attention Deficit Hyperactivity Disorder
(ADHD) symptoms across different domains. The results, categorized based on inattention,
hyperactivity/impulsivity, and overall ADHD symptoms, contribute to a comprehensive
understanding of AB's behavioural patterns.

However, AB’s scores across various domains indicate that he doesn’t seem to
struggle significantly with concentration, inattention or hyperactivity. His profile mainly
consists of scores of 0 or 1 (“Never” or “Occasionally”). Based on the scores interpreted after
the completion of Vanderbilt ADHD Diagnostic Parent Rating scale and the additional
information received by the clinical history, AB’s behaviours do not seem to indicate towards
the presence of Attention Deficient-Hyperactive Disorder. AB’s temperament seems to be
easy going and he has been described as “interactive and warm” by his mother. He displays
bouts of irritableness, heightened distractability, and over-talkativeness at times but not to the
level that can be considered deviant from the typical behaviour of a child his age.
Furthermore, there have not been specific complaints from school regarding his conduct and
performance in class that might indicate the presence of ADHD. AB also seems to get along
well with his friends and is able to follow all the rules, wait his turn and play cooperatively.
He has achieved all developmental milestones on time and has received all required
vaccinations.

It is essential to acknowledge the limitations of relying solely on a parent-rated scale

for ADHD assessment. Factors such as situational variability, parent subjectivity, and
potential co-occurring conditions may influence the results. Future assessments could benefit
from a multi-method approach, including teacher ratings, direct observations, and clinical
interviews, to provide a more comprehensive understanding of AB's behaviour. The
symptoms of ADHD—hyperactivity, inattention, and impulsivity—can cause behavioural,
emotional, social, academic, and occupational issues if they are not treated early on (Davids
et al., 2004; Ginsberg et al., 2014). However, there also exists the problem of overdiagnosing
ADHD, oftentimes due to diagnostic inflation or incorrectly medicalizing behaviours that
might actually be typical for children of that age (Safer et al., 2018). Furthermore, boys are at
a greater risk of being over-diagnoses due to certain gender stereotypes that exist in society
that depict boys as more inattentive, underachieving and impulsive than girls (Fresson et al.,
2018; Brown & Stone, 2016)
While it is crucial to understand that an assessment tool such as Venderbilt’s scores is
not definitive by nature, these scores can help in possibly ruling out ADHD for AB’s case,
especially since no salient information from the history as well indicated otherwise.

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