Assessment of ADHD Symptoms and the Issue of Cultural Variation: Are Conners 3 Rating Scales Applicable to Children and Parents With Migration Background?

OBJECTIVE: The objective was to evaluate whether Conners 3 ( Conners 3rd edition) ratings of ADHD symptoms are robust to distortion by cultural variation when applied to children with migration background living in Germany. METHOD: From 2010 to 2011, Conners 3 data (self-rating, parent rating, and teacher rating) of 243 children with Turkish migration background, aged 6 to 16 years, were collected in various German schools. Allocation of items to latent factors was tested with confirmatory analyses. Reliability and validity of resulting factors was calculated and influence of acculturation, gender, and age on rating-modalities was examined. RESULTS: Confirmatory factor analyses showed high model fits for all rating-modalities. Resulting scales had good reliability and validity. There was a small influence of acculturation on parent ratings of oppositional defiant disorder but not on ADHD core symptoms. CONCLUSION: Conners 3 ratings seem to be robust against influences of cultural variation. Their German translation can be utilized for children with Turkish migration background without limitation.

Behavioral Assessment of Core ADHD Symptoms Using the QbTest.

OBJECTIVE: Hyperactivity, one of the core symptoms of ADHD, has been mostly neglected in neuropsychological assessment of childhood ADHD. The neuropsychological Quantified behavior Test (QbTest) separately assesses all three core symptoms of ADHD on a behavioral level. Factor structure of the QbTest and its concurrent and discriminant validity are presented. METHOD: An exploratory factor analysis (n = 828 children) was performed. In a second sample (n = 102 children) a Multi-Trait-Multi-Method (MTMM) approach was used for validity analyses. RESULTS: A three factorial model explained 76 % of the total variance, with the resulting QbTest factors significantly influenced by age and gender. The MTMM approach yielded promising results for discriminant, yet inconsistent findings for concurrent validity between the QbTest and another attention test as well as for Conners' Parent and Teacher Rating Scales. CONCLUSION: Results indicate that the QbTest may be helpful for the behavioral assessment of childhood ADHD, yet further studies on its psychometric quality and clinical utility are needed.

Slow cortical potential neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial.

BACKGROUND: Treatment for children with attention deficit/hyperactivity disorder (ADHD) today is predominantly pharmacological. While it is the most common treatment, it might not always be the most appropriate one. Moreover, long term effects remain unclear. Behavior therapy (BT) and non-pharmacological treatments such as neurofeedback (NF) are promising alternatives, though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication. METHODS/DESIGN: This paper presents the protocol of a randomized controlled trial to compare the effectiveness of a Slow Cortical Potential (SCP) NF protocol with self-management (SM) in a high frequent outpatient care setting. Both groups (NF/SM) receive a total of 30 high frequent therapy sessions. Additionally, 6 sessions are reserved for comorbid problems. The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings. PRELIMINARY RESULTS: Untill now 58 children were included in the study (48 males), with a mean age of 8.42 (1.34) years, and a mean IQ of 110 (13.37). Conners-3 parent and teacher ratings were used to estimate core symptom change. Since the study is still ongoing, and children are in different study stages, pre-post and follow-up results are not yet available for all children included. Preliminary results suggest overall good pre-post effects, though. For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects (η (2) 0.175-0.513). Differences between groups (NF vs. SM) could not yet be established (p = 0.81). DISCUSSION: This is the first randomized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication. First preliminary results show positive effects. The rationale for the trial, the design, and the strengths and limitations of the study are discussed. TRIAL REGISTRATION: This trial is registered in www.clinicaltrials.gov as NCT01879644.

Preliminary evidence for altered motion tracking-based hyperactivity in ADHD siblings.

BACKGROUND: It is well-established that ADHD children have deficits in executive functions such as performance variability and sustained attention. It has been suggested that these deficits are intermediate phenotypes. Hyperactivity, a core symptom of ADHD, has not yet been explored as a potential intermediate phenotype in ADHD. The computerized Quantified behavior Test (QbTest) is a combined continuous performance and activity test that assesses hyperactivity, inattention, and impulsivity separately. The aim of the present study was to (1) investigate the utility of objectively measured motor activity as a potential intermediate phenotype in ADHD, and (2) explore intermediate phenotypes for ADHD at the factor instead of single variable level. METHOD: Forty-five ADHD children, 22 non-affected siblings, and 45 unrelated controls with no family history of ADHD performed the QbTest. Effects of familiality as well as influences of age and gender on QbTest symptom dimensions were tested. RESULTS: ADHD children showed the greatest impairments on all three QbTest factors, followed by their non-affected siblings, with control children showing the lowest scores. Group differences between the non-affected siblings and controls were only significant for the motion tracking-based Hyperactivity factor. Results were independent of age and gender. CONCLUSION: Hyperactivity assessed by a motion tracking system may be a useful intermediate phenotype in ADHD. Prospective research should use larger samples to further examine the QbTest factors, especially the motion tracking-based Hyperactivity factor which may be a candidate for an intermediate phenotype in ADHD.