Theses and Dissertations

Date of Award

2014

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Center for Psychological Studies

First Advisor

Charles Golden

Second Advisor

Barry Schneider

Third Advisor

Ryan Black

Keywords

ADHD, Attention, Behavior Rating Scales, Conners, CRS-R, Hyperactivity

Abstract

This study involves an examination of the neurocognitive correlates of subscales of the Conners' Rating Scale - Revised (CRS-R), an ADHD behavioral rating form, in both a child (n=72) and an adolescent (n=49) sample. While both behavioral rating forms and neuropsychological measures are commonly employed in pediatric clinical evaluations, these two forms of assessment do not generally converge as expected. The purpose of the current research was to examine and compare the abilities of intellectual, academic, attentional, and executive skills to account for variance in parent and teacher ratings of behavior across two pediatric age groups in a clinical setting. Additionally, the study compared the relationships between behavioral ratings and cognition in children versus adolescents. The study found parent and teacher ratings of cognitive problems and inattention to be better accounted for by general cognitive ability than by attention and executive skills in children. Conversely, ratings of child hyperactivity, as completed by both parents and teachers, were better explained by attention and executive skills. General cognitive and academic abilities best accounted for parent ratings of overall ADHD likelihood, whereas teacher ratings of ADHD likelihood were equally accounted for by general cognitive abilities and attentional and executive skills. Neither general cognitive and academic abilities nor attention and executive skills accounted for a significant proportion of the variance in the adolescent sample. Furthermore, results showed that the variance in parent and teacher ratings of behavior was significantly accounted for by neurocognitive test performance across ratings subscales for child, but not adolescent clients. Overall, the results suggest that ADHD behavioral rating form accuracy varies according to subscale, informant, and age group. In child clients, ADHD behavioral ratings converged with theoretically associated cognitive abilities for subscales assessing hyperactive, but not inattentive behaviors. Both parent and teacher informants appear to take children's overall cognitive and academic abilities into consideration more so than attentional and executive skills when rating inattentive behaviors. This suggests either rating form or informant inaccuracy in identifying specific problems in attention and organization. Parents, in particular, appear to be relatively poorer raters of child behavior than teachers as only teacher ratings of overall ADHD likelihood were accounted for by attentional and executive skills. Parent and teacher ratings of behavior appear to be of questionable accuracy across ADHD related behaviors in the assessment of adolescents. As behavioral ratings were not related to cognition in the 11-17-year-old sample, ADHD behavioral rating forms appear to demonstrate poor convergent validity in adolescents. The finding that ratings of behavior were significantly related to cognition in children, but not in adolescents, suggests the presence of age-dependent differences in the presentation of ADHD symptoms or the accuracy of assessment tools between children and adolescents. Clinicians are encouraged to use caution when interpreting ratings of adolescent ADHD behavior and ratings of child inattentive behavior, as these scales may often not assess their purported constructs.

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