Informant Discrepancies in the Assessment of Attention-Deficit/Hyperactivity Disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is characterised by developmentally inappropriate levels of hyperactivity, impulsivity, and/or inattention, leading to significant impairment across multiple domains of functioning. To receive a diagnosis, symptoms must be present across two or more settings; thus requiring information to be collected from multiple informants, typically parents and teachers. Research consistently shows low to moderate agreement between parent and teacher reports; however, mechanisms underlying these discrepancies remain unclear. The present study aimed to: (1) describe patterns of reporting children's ADHD symptoms by parents and teachers in New Zealand; (2) replicate previous research examining agreement between parents and teachers; and (3) investigate the role of several potential mechanisms for informant discrepancies; those being contextual influences (i.e. situational specificity) or biases in informants' reports (i.e. source biases). Fifty five children and their parents/guardians and teachers participated. Parent and teacher ratings were measured using standardised questionnaires (i.e. ADHD-RS-IV, BASC-2) and children's off-task behaviour using a clinician-rated classroom observation scheme (i.e. BOSS). T-tests showed that overall parents rated their children as more symptomatic of ADHD than teachers. Diagnostically, the choice of informant and the rule for combining information from multiple informants dramatically altered the ADHD subtype assigned to the child.Correlations and kappa statistics showed that parent-teacher agreement was slightly higher than previous studies; however, it remained within the moderate range. The level of agreement differed across the type of symptoms reported, with hyperactive/impulsive symptoms being rated more concordantly than inattentive. Finally, results concerning the mechanisms underlying discrepancy suggest a combination of factors. Implications for the assessment of ADHD in clinical practice are discussed. ACKNOWLEDGEMENTS

Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth

“…In order for a diagnosis of ADHD to be made, the behaviors and symptoms may not solely be a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions [13]. The true prevalence of ADHD is challenging to measure as diagnosis is dependent on individual interpretations of behavior as well as the manner in which a clinician integrates multiple informant reports from parents, caregivers, and teachers [17]. Additionally, the reliability of one individual's self-report of their ADHD symptoms in adolescence and adulthood may be inconsistent with multiple-informant reports [18].…”

Interrater agreement and discrepancy when assessing problem behaviors, social‐emotional skills, and developmental status of kindergarten children

“…For instance, Kennerley et al (2018) investigated parent and teacher ratings of attention-deficit/hyperactivity symptoms and compared those ratings with observations made by a clinician at school. The teacher ratings, but not the parent ratings, of the total symptoms correlated with the respective observer ratings.…”

Disagreeing about development: An analysis of parent-teacher agreement in ADHD symptom trajectories across the elementary school years

“…Previous research has generally found that parents report higher levels of ADHD symptoms (e.g. Antrop et al, 2002;Hart et al,1995;Kennerley et al, 2016;Murray et al, 2007;Narad et al, 2015;Yeguez & Sibley, 2016), although there have also been some cases where teachers have reported higher levels (e.g. Jester et al, 2005).…”

“…It is known from cross-sectional analyses that cross-informant discrepancies in psychopathology, including ADHD symptoms, abound (e.g. Achenbach, 2005;Kennerley et al, 2016). Discrepancies are also seen in the substantive conclusions of research studies with, for example, significant associations or treatment effects observed according to one informant but not another (e.g.…”

“…The prevalence of cross-informant disagreements thus adds an additional layer of complexity to the already challenging process of diagnosis (e.g. Kennerley et al, 2016).…”