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To examine psychometric properties of the SNAP-IV, parent (N = 1,613) and teacher data (N = 1,205) were collected from a random sample of elementary school students in a longitudinal study on detection of attention deficit hyperactivity disorder (ADHD). Reliability, factor structure, predictive validity, and effect sizes (ES) for differences in ratings across age, gender, and race were examined. Performance as a screening and diagnostic tool was evaluated through calculation of likelihood ratios (LR) and posttest probabilities. Reliability of the parent and teacher SNAP-IV was acceptable. Factor structure was consistent with a two-factor solution of ADHD symptoms and a third ODD factor. Parent and teacher scores varied significantly by gender and poverty status (d = .49 to .56), but not by age; only teacher scores varied by race (d = .25 to .55). SNAP-IV parent and teacher ratings satisfactorily distinguished children by increasing levels of ADHD concerns, but only parent ratings by diagnostic status. Parent SNAP-IV scores above 1.2 increased the probability of concern (LR > 10) and above 1.8 of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased the probabilities of concern (LR = 4.2 and > 5, respectively), but teacher SNAP-IV scores did not usefully change the probability of diagnosis. Further research should address reasons for higher teacher scores for African American children and the differences in measurement models by race. Keywords assessment; attention deficit hyperactivity disorder; children; likelihood ratios; norms; SNAP-IV; reliability; validity Behavior rating scales as assessment tools for diagnosing attention deficit hyperactivity disorder (ADHD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) have been used for many years, starting with the assessment of symptoms listed in the DSM-III (American Psychiatric Association, 1980) manual (Swanson, Sandman, Deutsch, & Baren, 1983). These scales have changed along with revisions in the DSM to match definitions of ADHD as a three-dimensional construct in DSM-III (APA, 1980), a unidimensional construct in the DSM-III-R (APA, 1987), and the current two-dimensional construct in the DSM-IV (APA, 1994) manual (Pillow, Pelham, Hoza, Molina, & Stultz, 1998). The rating scales are comparable in content (using either the exact DSM symptom NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript descriptions or variants slightly reworded to improve readability) and measurement approaches (four-point rating intervals) but differ in the assessment of comorbid disorders. Some focus on ADHD only, such as the ADHD Rating Scale IV DuPaul et al., 1997) or the DSM-IV ADHD Rating Scale (Gomez, Harvey, Quick, Scharer, & Harris, 1999). Still others, such as the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating scales (Wolraich, Feurer, Hannah, Baumgaertel, & Pinnock, 1998;Wolraich et al., 2003), assess both externalizing and internalizing ...

Predictors of attrition from individual parent-child interaction therapy were examined for 99 families of preschoolers with disruptive behavior disorders. Seventy-one percent of treatment dropouts were identified by lower SES, more maternal negative talk, and less maternal total praise at pretreatment. Following PCIT, families were randomly assigned to an Assessment-Only or Maintenance Treatment condition. Higher maternal distress predicted 63% of dropouts in the Assessment-Only condition. Lower maternal intellectual functioning predicted 83% of dropouts from Maintenance Treatment. Findings highlight a continuing need for evidence-based retention strategies at various phases of engagement in PCIT.

Obsessive-compulsive disorder is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for obsessive-compulsive disorder are exposure and response prevention therapy and the serotonin reuptake inhibitors. Many patients do not experience complete symptom resolution with either modality and require augmentation approaches. Recent animal and clinical data suggest that D-cycloserine, a partial agonist that acts at the strychnine-insensitive glycine-recognition site of the N-methyl-D-aspartate receptor complex, may enhance extinction learning that occurs in exposure-based psychotherapies. Given this, this study examined if D-cycloserine (250 mg) enhances the overall efficacy and rate of change of exposure and response prevention therapy for adult obsessive-compulsive disorder. Participants were 24 adults meeting Diagnostic and Statistical Manual of Mental Disorders-IV criteria for obsessive-compulsive disorder. The study design was a randomized, double-blinded, placebo-controlled augmentation trial examining exposure and response prevention therapy+D-cycloserine versus exposure and response prevention therapy+placebo. All patients received 12 weekly sessions of exposure and response prevention treatment. The first session involved building a ritual hierarchy and providing psychoeducation about obsessive-compulsive disorder. The second session involved a practice exposure. Sessions 3-12 involved exposure and response prevention exercises. D-cycloserine or placebo (250 mg) was taken 4 h before every session. No significant group differences were found across outcome variables. The rate of improvement did not differ between groups. The present results fail to support the use of D-cycloserine with exposure and response prevention therapy for adult obsessive-compulsive disorder. As this study is the first to explore this question and a number of methodological issues must be considered when interpreting the findings, the conclusions that may be drawn from our results are limited.

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This study examines the basic psychometric properties of the Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale (SKAMP), a measure intended to assess functional impairment related to attention deficit hyperactivity disorder, in a sample of 1,205 elementary students. Reliability, factor structure, and convergent, discriminant and predictive validity are evaluated. Results provide support for two separate but related subscales, Attention and Deportment, and provide evidence that the SKAMP predicts school functioning above and beyond symptoms alone. Boys, African American children, and children living in poverty are rated as having higher impairment scores than girls, Caucasian children, and more advantaged peers. Norm-referenced data are provided by gender, race, and parental concern level. This study supports the reliability and validity of the SKAMP in a large, diverse community sample and broadens its clinical utility. Keywords ADHD; teacher ratings; impairment; psychometricsA number of rating scales have been developed and validated for assessing symptoms of attention-deficit/hyperactivity disorder (ADHD) that are helpful in informing diagnostic decision making and detecting behavioral changes over time (Collett, Ohan, & Myers, 2003). However, increased attention is being directed at the assessment of impairment, reflecting how a child functions across different domains of day-to-day activities. Although symptoms and impairment overlap, these constructs may be distinguished conceptually in that symptoms and their severity are thought to describe disorders, whereas functional impairment represents a