Doctor of Philosophy (PhD)
First Committee Member
Daniel N. Allen
Second Committee Member
Third Committee Member
Michelle G. Paul
Fourth Committee Member
Leann G. Putney
Number of Pages
Specific rating scales of ADHD symptomatology are often included in neuropsychological assessments evaluating adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The Barkley Adult ADHD Rating Scale-IV (BAARS-IV) is a widely used symptom rating scale that includes four questionnaires: self-report current, self-report childhood, other-report current, and other-report childhood. In addition to ADHD symptoms, each of the forms include items that assess functional impact and developmental history of symptomatology. While similar symptom rating scales have been found to have high validity and diagnostic utility in children, it is unclear the extent to which the BAARS-IV shares substantial common variance with other adult ADHD measures and if improves diagnostic accuracy when assessing for ADHD. The current study will examine these concerns in order to provide clinicians with evidence that may improve the diagnostic accuracy of ADHD evaluations.Participants included approximately 379 adults who completed psychodiagnostic evaluations for clinical purposes at a community mental health clinic. Of these, approximately 156 were diagnosed with ADHD-Combined or ADHD-Inattentive, 201 were diagnosed with other disorders, and 22 had no diagnosis. The ADHD group had either a primary or secondary diagnosis of ADHD. There were 201 individuals diagnosed with other disorders including Specific Learning Disability (n=107), Major Depressive Disorder (n=26), Anxiety Disorder (n=23), and other clinical diagnoses (n=45). Finally, the group with no diagnosis (n=22) was included as a control sample. Comprehensive evaluations that included the administration of the BAARS-IV questionnaire, clinical interviews, cognitive functioning, and thorough review of medical and mental health history were utilized to establish diagnoses. The BAARS-IV self-report for current symptoms were the focus of this investigation. Pearson correlations was used to examine convergent and discriminant validity between the participants’ ratings of Attention Problems/Inattention and Hyperactivity on the BAARS-IV and the ASEBA, a broader behavioral measure containing ADHD symptom rating subscales assessing symptoms of ADHD (convergent) as well as other domains that were not expected to be highly correlated with ADHD symptoms (discriminant). In order to evaluate differences in sensitivity and specificity, Receiver Operating Characteristic (ROC) analysis was used for the BAARS-IV scores to differentiate between adult ADHD subtypes, as well as other psychiatric and healthy control groups. Support for the discriminant validity was determined by examining the pattern of correlations between the BAARS-IV subscales. However, evidence of the pattern of correlations did not support convergent validity for the BAARS-IV subscales. Regarding discriminant validity, the ASEBA Anxiety and Depression subscales had lower correlations with the BAARS-IV subscales than with the ASEBA Inattention and Hyperactivity-Impulsivity subscales. The BAARS-IV Hyperactivity subscale had the lowest correlation with the ASEBA Anxiety subscale. However, in terms of convergent validity, the correlations between the BAARS-IV subscales and ASEBA Inattention and Hyperactivity-Impulsivity subscales provided weak support for the scales assessing three distinct symptom domains of ADHD. Similarly, the results of the Receiver Operating Characteristic (ROC) analyses indicated that BAARS-IV had poor discrimination between ADHD and a healthy, no psychiatric diagnosis group. Similarly, results revealed weak evidence for the BAARS-IV ability to discriminate between ADHD subtypes or between ADHD and other psychiatric groups, such as depression or anxiety. Notably, when differentiating between ADHD and Specific Learning Disorder, the BAARS-IV demonstrated significantly better classification accuracy compared to the other comparison groups. Findings from the current study support using the BAARS-IV cautiously as a screening measure when there is a question of ADHD, rather than as a stand-alone diagnostic measure. The results indicate that the BAARS-IV is not sensitive to differences in ADHD symptomatology based on the three core ADHD symptom domains of inattention, hyperactivity and impulsivity. Therefore, the BAARS-IV is not an effective measure for determining ADHD subtypes. Furthermore, when there is a potential for the presence of psychiatric disorders other than ADHD, a broader behavioral measure should be used. The BAARS-IV may be utilized as a screening measure for assessing the presence of general ADHD symptomatology or as a part of a broader assessment. The BAARS-IV is also an appropriate measure to use when the referral question is focused on the differential diagnosis of ADHD and Specific Learning Disorder symptoms.
ADHD; Psychometrics; ROC; Symptom rating scales
University of Nevada, Las Vegas
Graves, Stacy Jean, "Validity and Diagnostic Accuracy of an ADHD Symptom Rating Scale for Identifying Adults with ADHD" (2020). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4054.
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