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A New Look at Evidence Based Approaches in ADHD Assessment EVIDENCE Thomas K. Pedigo Ed.D., NCSP Vann B. Scott, Jr., Ph.D. Ron P. Dumont Ed.D., NCSP.

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Presentation on theme: "A New Look at Evidence Based Approaches in ADHD Assessment EVIDENCE Thomas K. Pedigo Ed.D., NCSP Vann B. Scott, Jr., Ph.D. Ron P. Dumont Ed.D., NCSP."— Presentation transcript:

1 A New Look at Evidence Based Approaches in ADHD Assessment EVIDENCE Thomas K. Pedigo Ed.D., NCSP Vann B. Scott, Jr., Ph.D. Ron P. Dumont Ed.D., NCSP

2 » DISCLOSURES THOMAS K. PEDIGO, ED.D., NCSP DIRECTOR SAVANNAH CHILD STUDY CENTER, SAVANNAH GEORGIA. PLEASE NOTE THAT DR. PEDIGO IS THE CO-AUTHOR OF THE PEDIATRIC ATTENTION DISORDERS DIAGNOSTIC SCREENING SYSTEM AND CO-OWNER OF TARGETED TESTING INC. WHICH ARE REFERENCED IN THIS PRESENTATION. VANN B. SCOTT JR., PH.D. ASSOCIATE PROFESSOR OF PSYCHOLOGY ARMSTRONG ATLANTIC STATE UNIVERSITY, SAVANNAH GEORGIA. PLEASE NOTE THAT DR. SCOTT HAS SERVED AS A RESEARCH CONSULTANT TO TARGETED TESTING INC. DURING THE DEVELOPMENT OF THE PEDIATRIC ATTENTION DISORDERS DIAGNOSTIC SCREENING SYSTEM. RON P. DUMONT, ED.D., NCSP ASSOCIATE PROFESSOR OF PSYCHOLOGY & DIRECTOR OF THE DOCTORAL TRAINING PROGRAM IN SCHOOL PSYCHOLOGY AT FAIRLEIGH DICKENSON UNIVERSITY, TEANECK NEW JERSEY. PLEASE NOTE THAT DR. DUMONT DOES NOT HAVE PERSONAL OR FINANCIAL INTEREST IN THE PEDIATRIC ATTENTION DISORDERS DIAGNOSTIC SYSTEM OR WITH TARGETED TESTING INC. WHICH ARE REFERENCED IN THIS PRESENTATION.

3 Dr. Ron P. Dumont

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5 Suppose a test was used as a screening measure on a population of 1000 children in which 4% (40) of the children have ADHD, and that test gives an abnormal score for 90% of the children with ADHD (i.e., sensitivity) and gives a normal score for 90% of children without ADHD (i.e., specificity),

6 with disorderSensitivity: proportion of children with disorder who received abnormal test scores

7 without disorderSpecificity: proportion of children without disorder and who received normal test scores

8 Positive Predictive Power (PPP): probability that one who receives an abnormal test score is correctly classified

9 Negative Predictive Power (NPP): probability that one who does not have an abnormal test score is not classified

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11 CONSIDERATION OF BASE RATES A GIVEN TESTS PREDICTIVE POWER MUST BE CONSIDERED IN LIGHT OF THE GIVEN BASE RATE IN THE POPULATION FROM WHICH IT IS USED. A TEST WITH.90 SENSITIVITY & SPECIFICITY 100%.90 50%.40 BASERATE MAXIMUM POWER BASERATE MAXIMUM POWER BASERATE 04% MAXIMUM POWER.20

12 POSITIVE & NEGATIVE PREDICTIVE POWER COMBINED ADHD AND NON-CLINICALS N=200 SINCE WE COMBINED THE GROUPS BEFORE TESTING THE KNOWN CLASSIFICATION OR BASE RATE IS NOW 50% HALF ADHD AND HALF NONADHD. PPP= RATIO OF ADHD SUBJECTS CONSIDERING ALL WHO TESTED POSITIVE. HIGH PPP MEANS THAT A POSITIVE RESULT RULES IN THE CONDITION NPP= RATIO OF NON/CLINICAL SUBJECTS CONSIDERING ALL WHO TESTED NEGATIVE. HIGH NPP MEANS THAT A NEGATIVE RESULT RULES OUT THE CONDITION * ALONG WITH ACCEPTABLE RELIABILITY & VALIDITY, SOLID SENSITIVITY & SPECIFICITY & PPP & NPP HELP TO ESTABLISH THE EVIDENCE NEEDED TO DETERMINE A TEST’S SUITABILITY FOR CLINICAL USE.

13 ADHD POPULATION BASE RATE HOWEVER, THE BASE RATE FOR ADHD IS WELL BELOW THAT OF THE GROUPS IN OUR EXAMPLES ESTIMATES VARY WIDELY BUT ARE OFTEN REPORTED BETWEEN 3 AND 7% FOR OUR WORK AND DEMONSTRATION WE HAVE SELECTED THE CONSERVATIVE ESTIMATE OF 4% LET’S SEE HOW MEASURES WITH GOOD SENSITIVITY & SPECIFICITY PERFORM WITH THE CONSERVATIVE BASE RATE

14 EBA CALCULATOR

15 GIVEN THE ADHD BASE RATE OF 4% & VARIED PRESENTATIONS RELIABLE AND VALID ASSESSMENT REQUIRES: 1.MULTIPLE INPUTS 2. EACH WITH ADEQUATE PSYCHOMETRICS 3.DEMONSTRATED DIAGNOSTIC UTILITY EX: ACCEPTABLE PPP&NPP 4.MUST HAVE CLINICAL AND CONTROL GROUPS

16 INCREMENTAL VALIDITY TENETS: MULTIPLE SOURCES OF EVIDENCE USED IN ORDER TO IMPROVE DIAGNOSTIC ACCURACY THE MULTIPLE INPUTS MUST BE JUSTIFIED IN THAT EACH PROVIDES ADDITIONAL NON-REDUNDANT INFORMATION

17 EBA & LIKELIHOOD RATIOS 1. ALLOWS INCREMENTAL INPUTS 2. CAN PROVIDE EVIDENCE FOR OR AGAINST DX 3. CAN CONSIDER EVIDENCE RELATIVE TO THE KNOWN BASE RATE ALLOWS YOU TO CONSIDER THE RELATIVE PREDICTIVE POWER OF A TEST’S INDIVIDUAL SCORE POINTS NOT JUST THE OVERALL STATED PERFORMANCE. 4. USES SCIENCE & CLINICAL EXPERIENCE

18 EVIDENCE BASED ASSESSMENT HAS BEEN ADVOCATED SINCE MID1990’S & INVOLVES SCRUTINIZING EVIDENCE FOR: SOUNDNESS POWER OF INFERENCE DIAGNOSTIC UTILITY DEVELOPING AN ATTITUDE OF ENLIGHTENED SKEPTICISM TOWARD DIAGNOSTIC PRACTICES

19 LIKELIHOOD RATIOS FEW TESTS ARE ACCURATE ENOUGH TO RULE IN OR OUT DIAGNOSIS ALONE. BEST APPROACH IS TO LOOK AT A GIVEN TEST RESULT AS ALTERING THE PROBABILITY OF AN EXISTENT CONDITION. REQUIRES THE ESTIMATION OF A PRE-TEST PROBABILITY (BASE RATE)

20 LR CONTINUED THE PRE-TEST BASE RATE WILL THEN BE ADJUSTED UP OR DOWN BY THE INPUT OF EACH MEASURE/TEST RESULT ALSO REFERRED TO AS APPLICATION OF BAYESIAN LOGIC. PRODUCES AN ADJUSTMENT FACTOR 1 FOR A RANGE OF PROBABILITY FROM 0 TO 99%

21 EBA CALCULATOR

22 LR CONTINUED CONVERTING TEST SCORE RESULTS INTO LIKELIHOOD RATIOS HELPS DETERMINE HOW USEFUL A DIAGNOSTIC TEST IS HELPS IN SELECTING A SERIES OR SEQUENCE OF TESTS CONSIDERS THE RESULTS IN LIGHT OF THE KNOWN BASE RATE ALLOWS ADDITIVE AND SUBTRACTIVE INPUT TOWARDS THE PREDICTIVE INDEX/OUTCOME

23 STRATEGIES FOR DEVELOPING LIKELIHOOD RATIOS FRAZIER, T.W. & YOUNGSTROM (2006) EVIDENCED-BASED ASSESSMENT OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER: USING MULTIPLE SOURCES OF INFORMATION. JOURNAL AM. ACAD. CHILD ADOLESCENT PSYCHIATRY, 45:5 MAY (2006)

24 STRATEGIES CONTINUED Web resources for EBA: (http://www.childrensmercy.org/stats/categ ory/DiagnosticTesting.asp), &http://www.childrensmercy.org/stats/categ ory/DiagnosticTesting.asp (Centre for Evidence-based Medicine (nd). Likelihood Ratios. Oxford-Centre for Evidence-based Medicine,

25 BASIC STRATEGIES BASICS: –LITERATURE REVIEW LOOKING FOR SENSITIVITIES & SPECIFICITIES PUBLISHED FOR GIVEN MEASURES –REVIEW CLINICAL MANUALS: –EXAMPLES: CDI, RCMAS, BRIEF, COLOR TRAILS, MANY OTHERS –LOOK FOR TWO GROUPS CLINICAL AND CONTROLS

26 BASIC’S CONTINUED –DETERMINE SENSITIVITY= % TESTING POSITIVE FROM THE CLINICAL GROUP. –FIND THE RELATIVE PERCENTILE OF A GIVEN SCORE POINT(RAW SCORE OR STANDARD SCORE) TO DETERMINE WHAT PERCENTAGE OF THE CLINICAL GROUP FALLS AT THAT GIVEN SCORE POINT. –FIND THE NEXT LOWEST RAW SCORE (SCORE POINT) AND SUBTRACT THE CORRESPONDING PERCENTILE FROM 100% –EX: RS=20 T-SCORE= 50 %= 50 TH FIND THE PERCENTILE FOR RAW SORE OF 19 AND SUBTRACT THAT CORRESPONDING PERCENTILE FROM 100%. RS 19=% 45 (100-45= 55) SENSITIVITY OF RS 20 =.55

27 BASICS CONTINUED SPECIFICITY= THE PERCENTAGE OF SUBJECTS WITH A NEGATIVE TEST RESULT FROM THE NON-CLINICAL GROUP. WHAT PERCENTILE OF THE NON- CLINICAL GROUP FALLS AT A GIVEN RAW SCORE OR SCORE POINT FIND THE NEXT LOWEST RAW SCORE AND SUBTRACT THE CORRESPONDING PERCENTILE FROM 100% EX: RS=20 T-SCORE= 50 %= 50 TH FIND THE PERCENTILE FOR RAW SORE OF 19 AND SUBTRACT THAT CORRESPONDING PERCENTILE FROM 100%. RS 19=% 45 (100-45= 55) SENSITIVITY OF RS 20 =.55 IN THIS EXAMPLE THE SENSITIVITY AND SPECIFICITY ARE EQUAL AT.55 TO CALCULATE A CORRESPONDING POSITIVE LIKELIHOOD RATIO USE THE FOLLOWING FORMULA SENSITIVITY/(1-SPECIFICITY).55/(1-.55).55/45 = LR 1.22

28 DEVELOPING LR’S FROM RESEARCH DATA Group a : # of subjects with ADHD, and a positive Test Score. Group b : # of subjects without ADHD, and a positive Test Score. Group c : # of subjects with ADHD, and a negative Test Score. Group d : # of subjects without ADHD, and a negative Test Score.

29 DEVELOPING LR’S CON’T Sensitivity is the proportion of patients with ADHD who have a positive test. Sensitivity = a / (a + c) Specificity is the proportion of patients without ADHD who have a negative test. Specificity = d / (b + d) Calculate the Ratios: Likelihood ratio (LR+) = sensitivity/(1-specificity) = (a/(a+c))/(b/(b+d)) Likelihood ratio (LR-) = (1-sensitivity)/specificity = (c/(a+c))/(d/(b+d)). The reference information provided above was adapted from the following Web resources for EBA: (http://www.childrensmercy.org/stats/category/DiagnosticTesting.asp), & (Centre for Evidence-based Medicine (nd). Likelihood Ratios. Oxford-Centre for Evidence-based Medicine,

30 PEDIATRIC ADD SCREENING SYSTEM: (SUMMARY OF THE PADDS INPUTS) COMPUTER ASSISTED INTERVIEW ASSESSMENT OF PARENT AND TEACHER DSM-IV RATINGS FOR ADHD COMPLETION OF THE TARGET TESTS OF EXECUTIVE FUNCTIONING COMBINED INPUTS TO ESTABLISH A PROBABILITY INDEX REVIEW OF COMORBIDITY

31 CADI MEDICAL HISTORY/SYSTEMS REVIEW DEVELOPMENTAL HISTORY SOCIAL EMOTIONAL FUNCTIONING DEPRESSION/ANXIETY ATTENTION/HYPERACTIVITY BEHAVIOR/SCHOOL HISTORY

32 Computer Administered/Scored Diagnostic Interview (CADI) EFFECTIVELY ASSESSES FOR COMORBIDITY ESTABLISHES A PRELIMINARY TREATMENT PLAN CAN PROVIDE DOCUMENTATION TO SUPPORT REFERRALS AND OTHER TESTING REQUESTS

33 PEDIATRIC ADD SCREENING SYSTEM Target Tests of Executive Functioning (TTEF) ASSESSES EXECUTIVE FUNCTIONS COMPARES TO ADHD & TYPICAL PEERS CAN EFFECTIVELY RULE IN & OUT ADHD EFFECTIVELY CROSS VALIDATES BEHAVIOR RATINGS

34 Behavioral Inhibition Inhibit Prepotent response Stop an ongoing response Interference control Working Memory Holding events in mind Manipulating or acting on the events Initiation of complex behavior sequences Retrospective function (hindsight) Prospective function (foresight) Anticipatory set Sense of Time Cross-temporal organization of behavior Self-regulation of affect/motivation/arousal Emotional self-control Objectivity / social perspective taking Self regulation of drive and motivation Regulation of arousal in the service of Goal – directed action Internalization of speech Description and reflection Rule-governed behavior (instruction) Problem solving / self-questioning Generation of rules and meta-rules Moral reasoning Reconstitution Analysis and synthesis of behavior Verbal fluency / behavioral fluency Goal directed behavioral creativity Behavioral simulations Syntax of behavior Motor control / fluency / syntax Inhibiting task – irrelevant responses Excluding goal directed responses Execution of novel / complex motor sequences Goal directed persistence Sensitivity to response feedback Task re-engagement following disruption Control of behavior by internally Represented information Barkley’s Model of Behavioral Inhibition Used with permission 1/18/2008

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38 WHY ADD OBJECTIVE MEASURES WHY NOT JUST USE RATING SCALES: –SUBJECTIVITY/CAN BE SKEWED –DEMAND CHARACTERISTICS MAY ENHANCE PERSONAL LEANINGS –CAN BE INCONSISTENT EVEN BETWEEN PARENTS AND MULTIPLE TEACHERS –MULTIPLE RATINGS MAY BE CONSIDERED AS REDUNDANT INFORMATION IN SOME CASES –BIAS MAY REFLECT MORE ABOUT THE RELATIONSHIP OF THE CHILD & RATER THAN ABOUT THE ORGANIC FUNCTIONING OF THE CHILD.

39 WHY ADD OBJECTIVE MEASURES IF OBJECTIVE MEASURES CAN DEMONSTRATE ACCEPTABLE PSYCHOMETRICS (RELIABILITY & VALIDITY), ALONG WITH ACCEPTABLE PPP & NPP,(DIAGNOSTIC UTILITY) THEY COULD SERVE TO ADD INCREMENTAL EVIDENCE (NON- REDUNDANT) FOR OR AGAINST DX. –CAN SERVE TO CROSS VALIDATE THE RESULTS FROM BEHAVIORAL RATINGS –ALLOWS FOR BEHAVIORAL OBSERVATIONS –CAN HELP LOOK AT EFFECTS OF TREATMENT OR INTERVENTION –PARENT AND PHYSICIAN’S MAY MORE READILY ACCEPT RESULTS IF THEY REALIZE THAT MULTIPLE LINES OF EVIDENCED WERE CONSIDERED IN THE ASSESSMENT/DIAGNOSTIC PROCESS. –OBJECTIVE MEASURES FIT WELL INTO A MULTI-METHOD OR EBA APPROACH.

40 Psychometric Properties of the Pediatric ADHD Screener (PADDS) Vann B. Scott, Jr., Ph.D. Armstrong Atlantic State University Savannah, Georgia

41 Clinical sample 629 (265 females & 364 males) children ages 6 to 12 years (M = 8.66, SD = 1.71) Data obtained from 10 sites in 7 states GA35% ID35% TN10% CA10% FL5% NJ3% IL2%

42 Means, standard deviations, standard errors, standard error of measurement, & cut points of three subtests by population Typical vs. Clinical TRTSTTTRTSTT M SD SE SEM % CI Cut Score > 114> 27> 8≤ 114≤ 27≤ 8 Typical and Clinical participants differed significantly on each of the three subtests, all ts > 19, p <.001.

43 Reliability estimates Cronbach’s α.86n = 515 Cronbach’s α.80n = 27 Cronbach’s α.92n = 27 Test-retest (Phi coefficient).73 1 to 2 yrs n = 27 Test-retest (Kappa coefficient).70 1 to 2 yrs n = 27 Stability.85n = 27

44 Validity Convergent (PADDS & TOVA).38n = 124 Construct (Brown Teacher Inattentive type & PADDS – TR) -.35n = 35 Construct (Brown Teacher Combined type & PADDS – TR) -.36n = 35 Construct (Brown Teacher Inattentive type & PADDS – TS) -.39n = 35 Construct (Brown Teacher Combined type & PADDS – TS) -.41n = 35 Note. Brown Scales and PADDS are inversely scaled therefore, negative correlations are expected.

45 Diagnostic Utility of PADDS relative to other diagnostic tests PADDS Target Tests (2 of 3 tests in clinical direct.) Brown ADD Scales (Parent or Teacher T score ≥ 65) CPTII (T score ≥ 65) Hit rate / N36/3825/3826/38 Percentage94%66%68%

46 PADDS SUBTESTS POSITIVE AND NEGATIVE PREDICTIVE POWER N=629ADHDTYPTOTALS TEST POSITIVE TEST NEGATIVE TOTALS CUT SCORES Target Recog= 114 Target Seq= 27 Target Track= 8 DECISION RULE 2/3 IN PREDICTED DIRECTION Sensitivity of.85 Specificity of.90 Positive Predictive Power of.90 Negative Predictive Power of.85

47 Incremental Validity Incremental validity – the information added to the diagnostic process through the use of the test beyond what is already known. Incremental validity is demonstrated when the use of a test provides information over and above that demonstrated through other methods for making the same prediction. The PADDS system adds much incremental validity to the diagnosis of ADHD in that it performs as key criterion that provides unique information that improves the accuracy of diagnosis over and above the other sources of information practitioners use to diagnose ADHD.

48 Evidenced Based Assessment – Case Studies Incremental validity is demonstrated in the PADDS system in the context of the Evidenced Based Approaches highlighted in the following case studies using a variety of diagnostic measures. Dr. Pedigo will discuss these with you now.

49 CASE STUDY 1 W/M 8-7 THIRD GRADE REFERRED FOR ADHD SCREENING HX OF DISRUPTING CLASS WITH COMMENTS NOT COMPLETING ASSIGNMENTS MAKES CARELESS ERRORS DIFFICULTY COMPLETING HOME WORK RECENT DROP IN GRADES B’S TO C-D RANGE

50 CASE STUDY 1 MEASURES PROCEDURES USED: PARENT INTERVIEW (BACKGROUND) CHILD INTERVIEW (BK & OBSERVATION) RIAS) (IQ SCREENING) WRAML-2 (IMMEDIATE MEMORY) PADDS (SCREEN COMORBIDITY) (OBJ ASSESSMENT EF) BRIEF (PAR/TEA RATINGS OF EF) BASC-2 (ASSESS SEVERITY OF C0-M) EDDT (SCREEN EBD)

51 CASE STUDY 1 FINDINGS PARENT INTER- INTACT FMLY, NO FIGHTING OR FINANCIAL ISSUES. NO HX OF ADHD, ROUTINE DISCP, NO CHANGE IN BEH. CHILD INTER- AVG VERBAL, SPEECH, AFFECT, PRODUCT AGE APPRO, OBSERVATION TENDENCY TOWARDS IMPULSIVE RESPONSES, ACTIVE, FIDGETY. RIAS- IQ-86 VER-88 VIS-87, MEMORY-87 WRAML-2- GEN- 90 VER-95 VISUAL-95 & ATT/CON-79 DSM-IV (LIT REVIEW J.FMLY PRACT 05/04 V53. N-5) ADHD-I ADHD-C ADHD-H SEN/SPEC PA NEG TE +.90/.90

52 CASE STUDY FINDINGS PADDS- NO MAJOR AREA OF COMORBIDITY IDENTIFIED TARGET TESTS OF EXECUTIVE FUNC. ALL + ADHD RAW SC SEN/SPEC TARGET RECOGNTION 101/153.39/.92 TARGET SEQUENCING 15/39.65/.96 TARGET TRACKING 05/20.62/.97 STD SC SEN/SPEC STD SC SEN/SPEC BRIEF- PA WM-48 N/A INHIB-50 N/A TE WM-70.78/.80 INHIB-70.78/.79 BASC-2 T-SCR HYP INATT DEPRESSION ANXIETY PARENT ATRISK TEACHER HIGH 50 50

53 ADHD EVIDENCE OBSERVATIONS SEN/SPEC WRAML-2 ATT/INDEX =79N/A DSM-IV TEACHER ADHD-C.90/.90 TT CUT POINT=114 SCORE /.92 TS CUT POINT= 28 SCORE 15.65/.96 TT CUT POINT= 08 SCORE 05.62/.97 BRIEF-TE WM-70 INHIB-70.78/.80.78/.79 BASC-2 T-SCR HYP INATT PARENT ATRISK N/A TEACHER HIGH N/A

54 EBA LEVELS OF REVIEW DX PROBABILITY PADDS SYSTEM TTE & DSM-IV 99% DSM-IV & BRIEF 81% TARGET TESTS ALONE AS CROSS 97% VALIDATION OF BEHAVIOR RATINGS

55 PADDS Results: Teacher Report meeting DSM-IV Criteria And Scores from the Target Tests of Executive Functions

56 COMBINING DSM IV & BRIEF We begin with a Teacher Report for DSM IV Criteria Which has Sensitivity of.90 and Specificity of.90 Then we add one of the components of the BRIEF Which has Sensitivity of.78 and Specificity of.80 And then we add the other component of the BRIEF Which has Sensitivity of.78 and Specificity of.79

57 TARGET TESTS OF EXECUTIVE FUNCTIONS SCORES ALONE Result of a Target Recognition Raw Score of 101 Result of a Target Sequencing Raw Score of 15 Result of a Target Tracking Raw Score of 5

58 CASE STUDY 2 W/FM 9-5 FOURTH GRADE FREQUENTLY OFF TASK NOT COMPLETING ASSIGNMENTS DIFFICULTY WITH COMPREHENSION OF INSTRUCTIONS DIFFICULTY COMPLETING HOME WORK TAKES A LONG TIME DOES NOT LIKE TO ENGAGE READING ACTIVITIES BARLEY PASSED CRCT READING

59 CASE STUDY 2 MEASURES PROCEDURES USED: PARENT INTERVIEW (BACKGROUND) CHILD INTERVIEW (BK & OBSERVATION) RIAS) (IQ SCREENING) WRAML-2 (IMMEDIATE MEMORY) PADDS (SCREEN CO-MORBIDITY) (OBJ ASSESSMENT EF) BRIEF (PAR/TEA RATINGS OF EF) BASC-2 (ASSESS SEVERITY OF C0-M)

60 CASE STUDY 2 FINDINGS PARENT INTER- INTACT FMLY, NO FIGHTING OR FINANCIAL ISSUES. ? FMLY HX OF ADHD (MOTHER FEELS SHE HAD SIMILAR DIFFICULTY WITH OFF TASK BEHAVIOR, CHILD IS WELL BEHAVED CHILD INTER- AVG VERBAL, SPEECH, AFFECT, PRODUCT AGE APPRO, TYPICAL RANGE OF INTERESTS, HAS FRIENDS, SAYS SCHOOL IS HARD PROBLEMS WITH INSTRUCTIONS AND HATES READING. SAMPLE SHOWS WEAK COMMAND OF PHONICS AND SLOW READING PACE RIAS- IQ-90 VER-88 VIS-95, MEMORY-87 WRAML-2- GEN- 82 VER-85 VISUAL-90 & ATT/CON-90 DSM-IV (LIT REVIEW J.FMLY PRACT 05/04 V53. N-5) ADHD-I ADHD-C ADHD-H SEN/SPEC PA +.90/.90 TE +.90/.90

61 CASE STUDY FINDINGS PADDS- NO MAJOR AREA OF CO-MORBIDITY IDENTIFIED TARGET TESTS OF EXECUTIVE FUNC. ALL - ADHD RAW SC SEN/SPEC TARGET RECOGNTION 120/153.16/.77 TARGET SEQUENCING 32/39.13/.63 TARGET TRACKING 12/20.18/.64 STD SC SEN/SPEC STD SC SEN/SPEC BRIEF- PA WM-65.93/.63 INHIB-50 N/A TE WM-70.86/.75 INHIB-55 N/A BASC-2 T-SCR HYP INATT DEPRESSION ANXIETY PARENT 60 ATRISK55 48 TEACHER 60 ATRISK50 50

62 ADHD EVIDENCE SEN/SPEC WRAML-2 N/A DSM-IV PARENT ADHD-I.90/.90 DSM-IV TEACHER ADHD-I.90/.90 TT CUT POINT=114 SCORE /.77 TS CUT POINT= 28 SCORE 32.13/.63 TT CUT POINT= 08 SCORE 12.18/.64 BRIEF-TE WM-65.93/.63 PA WM-60.86/.75

63 EBA LEVELS OF REVIEW DX PROBABILITY PADDS SYSTEM TTE & DSM-IV 27% DSM-IV & BRIEF 95% TARGET TESTS DSM-IV & BRIEF 71% IN THIS INSTANCE OBJECTIVE MEASURES MODIFY THE PREDICTIVE INDEX AWAY FROM A DIAGNOSIS AND SUGGESTS THAT CONDITIONS OTHER THAN ADHD-I BE GIVEN STRONG CONSIDERATION. REVIEW OF THIS CASE SHOWS THAT SUBSEQUENT TESTING REVEALED A SPECIFIC LEARNING DISABILITY IN THE AREA OF READING AND READING COMPREHENSION CLINICAL EXPERIENCE WITH THE PADDS HA SHOWN THAT THIS PROFILE IS OFTEN RELATED TO READING WEAKNESSES, EMOTIONAL/MOOD PROBLEMS OR HYPERACTIVITY IN BRIGHT CHILDREN

64 PADDS Results: Parent & Teacher Reports meeting DSM-IV Criteria And Scores from the Target Tests of Executive Functions

65 COMBINING DSM IV & BRIEF Calculate the Parent and Teacher ratings indicating ADHD Which has Sensitivity of.90 and Specificity of.90 each

66 Next we add in the results of the BRIEF Measures With Sensitivity of.93/.86 and Specificity of.63/.75 each COMBINING DSM IV & BRIEF

67 COMBINING DSM IV, BRIEF & PADDS Next we add in the results of the Target Tests of Executive Functions Target Recognition Sensitivity of.16 and Specificity of.77 Target Sequencing Sensitivity of.13 and Specificity of.63 Target Tracking Sensitivity of.18 and Specificity of.64

68 EBA LEVELS OF REVIEW DX PROBABILITY PADDS SYSTEM TTE & DSM-IV 27% DSM-IV & BRIEF 95% TARGET TESTS DSM-IV & BRIEF 71% IN THIS INSTANCE OBJECTIVE MEASURES MODIFY THE PREDICTIVE INDEX AWAY FROM A DIAGNOSIS AND SUGGESTS THAT CONDITIONS OTHER THAN ADHD-I BE GIVEN STRONG CONSIDERATION. REVIEW OF THIS CASE SHOWS THAT SUBSEQUENT TESTING REVEALED A SPECIFIC LEARNING DISABILITY IN THE AREA OF READING AND READING COMPREHENSION CLINICAL EXPERIENCE WITH THE PADDS HA SHOWN THAT THIS PROFILE IS OFTEN RELATED TO READING WEAKNESSES, EMOTIONAL/MOOD PROBLEMS OR HYPERACTIVITY IN BRIGHT CHILDREN

69 NASP 2008 ANNUAL CONVENTION


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