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Abstract
Background and Objective: Attention Deficit Hyperactivity Disorder (ADHD) remains among highly controversial psychiatric diagnoses due to its complex nature and co-occurrence with several comorbid disorders and/or symptoms making differential diagnosis especially difficult (if not impossible). Over-diagnosis of ADHD and in turn over-prescription of psycho-stimulant drugs to these children are the most important part of ADHD controversy. The fact that accurate and timely diagnosis of ADHD has been evidenced to be specially complex and challenging and that over-diagnosis or misdiagnosis is not uncommon, is one of the main barriers in the treatment of this disorder. Unfortunately, there is no accurate diagnostic method to help professionals to correctly diagnose ADHD, and therefore they have been recommended to use multiple methods and information sources such as interviews with parents and teacher, behavioral rating scales, direct observational methods, and neurological and neuropsychological examinations to help them ensure correct diagnosis. This study aimed to investigate the diagnostic power of behavioral rating scales responded by parent in diagnosing ADHD as well as their other psychometric properties. Pursuing this goal is especially important in Iran due to lack of proper diagnostic tools for ADHD assessment. 
Methods: This was a descriptive and psychometric study. The statistical population included all boy students in Mashhad in 2014-15 academic year and our sample consisted of 40 boy students selected through direct observation of children in their classroom, interviews with their teachers and parents and examining children’s educational records. Parents and teachers both signed informed consent forms and they were informed about the confidentiality of the results. Of these boys, 20 were normal and 20 had previously received ADHD diagnosis by a physician before they take part in our study. We administered a short three-subscale form of the Wechsler’s Intelligence Scale for Children-Revised (WISC-R) with all these 40 children to ensure they are not mentally retarded and as well the two groups are matched in Intelligent Quotient (IQ). Then we trained blind interviewers to administer semi-structured interviews with these 40 children’s parents to verify their initial ADHD diagnoses, and they also asked the parents to rate the children’s classroom behavior using Conner’s parent Rating Scale (CPRS) and Swanson, Nolan and Pelham’s fourth revision scale (SNAP-IV) two times with one-month interval based on their information about these 40 children’s classroom behavior. We used Receiver Operating Characteristic (ROC) analysis to calculate sensitivity and specificity as well as false positive rate (FPR) and false negatives rate (FNR) for these rating scales. Also we used Chronbach’s Alpha and Pearson Correlation methods to investigate internal consistency and test-retest reliability of these rating scales.
Results: MANOVA analyses followed by separate ANOVA’s as Post-hoc tests indicated that all the subscales of both CPRS and SNAP-IV are able to significantly distinguish between ADHD and non-ADHD children. Cronbach’s alpha’s for total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive subscale (second 9 items) of SNAP-IV were .99, .97, and .98 respectively, indicating excellent internal consistencies. Test-retest reliabilities for total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive subscale (second 9 items) of SNAP-IV were .72, .77, and .68 respectively, indicating acceptable test-retest reliabilities. For CPRS rating scale, Cronbach’s alpha’s were , .95, .89 and .88, .90  for cognitive (6 items) , hyperactive (6 items), oppositional(6 items), and total(9 items) subscales respectively. Test-retest reliabilities for cognitive, hyperactive, oppositional, and for total  subscales respectively were .94, .74 and .77, .86 respectively. Results of ROC analyses, also, showed excellent to acceptable sensitivity and specificity for all the subscales of both CPRS and SNAP-IV rating scales. All sensitivities ranged between .70 and .85, all specificities between .70 and .90 and all areas under curve (AUC’s) between .80 and 89 which indicated excellent diagnostic power with low FPR and FNR rates.
Conclusion: Our results suggested excellent to acceptable diagnostic accuracy and sound psychometric properties for Persian translations of both CPRS and SNAP-IV subscales. These two rating scales can successfully reduce both FPR and FNR rates and therefore can be considered as useful and complementary diagnostic tools in multi-method assessment of ADHD. Of course, it should be noted that although CPRS and SNAP-IV showed excellent diagnostic accuracy in this study, using them in isolation could not be recommended.
 
     
Type of Study: Original Research Article | Subject: Psychology
Received: 2019/05/4 | Accepted: 2020/03/4

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