GIVEN THE ADHD BASERATE 4%

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

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Dr. Ron P. Dumont
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• 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),

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• Sensitivity proportion of children with disorder
  who received abnormal test scores

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• Specificity proportion of children without
  disorder and who received normal test scores

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

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

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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

BASERATE
BASERATE
BASERATE
04
50
100
MAXIMUM POWER
MAXIMUM POWER
MAXIMUM POWER
.20
.90
.40
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POSITIVE NEGATIVE PREDICTIVE POWER

• COMBINED ADHD AND NON-CLINICALS
• N200
• 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
  TESTS SUITABILITY FOR CLINICAL USE.

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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
• LETS SEE HOW MEASURES WITH GOOD SENSITIVITY
  SPECIFICITY PERFORM WITH THE CONSERVATIVE BASE
  RATE

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EBA CALCULATOR
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GIVEN THE ADHD BASE RATE OF 4 VARIED
PRESENTATIONS RELIABLE AND VALID ASSESSMENT
REQUIRES1.MULTIPLE INPUTS2. EACH WITH
ADEQUATE PSYCHOMETRICS3.DEMONSTRATED DIAGNOSTIC
UTILITYEX ACCEPTABLE PPPNPP4.MUST HAVE
CLINICAL AND CONTROL GROUPS
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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

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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 TESTS INDIVIDUAL SCORE POINTS NOT
  JUST THE OVERALL STATED PERFORMANCE.
• 4. USES SCIENCE CLINICAL EXPERIENCE

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EVIDENCE BASED ASSESSMENT

• HAS BEEN ADVOCATED SINCE MID1990S INVOLVES
  SCRUTINIZING EVIDENCE FOR
• SOUNDNESS
• POWER OF INFERENCE
• DIAGNOSTIC UTILITY
• DEVELOPING AN ATTITUDE OF ENLIGHTENED SKEPTICISM
  TOWARD DIAGNOSTIC PRACTICES

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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)

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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 lt 1 OR gt 1 FOR A
  RANGE OF PROBABILITY FROM 0 TO 99

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EBA CALCULATOR
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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

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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, 455 MAY (2006)

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STRATEGIES CONTINUED

• Web resources for EBA
• (http//www.childrensmercy.org/stats/category/Diag
  nosticTesting.asp),
• (Centre for Evidence-based Medicine (nd).
  Likelihood Ratios. Oxford-Centre for
  Evidence-based Medicine, http//www.cebm.net/likel
  ihood_ratios.asp

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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

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BASICS 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 RS20 T-SCORE 50 50TH 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

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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 RS20 T-SCORE 50 50TH 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

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DEVELOPING LRS 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.

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DEVELOPING LRS CONT
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/(ac))/(b/(bd))
Likelihood ratio (LR-) (1-sensitivity)/specifici
ty (c/(ac))/(d/(bd)) . The reference
information provided above was adapted from the
following Web resources for EBA (http//www.child
rensmercy.org/stats/category/DiagnosticTesting.asp
), (Centre for Evidence-based Medicine (nd).
Likelihood Ratios. Oxford-Centre for
Evidence-based Medicine, http//www.cebm.net/likel
ihood_ratios.asp
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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

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CADI

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

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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
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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 
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Barkleys Model of Behavioral Inhibition
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 Emoti
onal 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
Used with permission 1/18/2008
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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.

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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 PHYSICIANS 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.

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Psychometric Properties of the Pediatric ADHD
Screener (PADDS)

• Vann B. Scott, Jr., Ph.D.
• Armstrong Atlantic State University
• Savannah, Georgia

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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

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Means, standard deviations, standard errors,
standard error of measurement, cut points of
three subtests by population
Typical and Clinical participants differed
significantly on each of the three subtests, all
ts gt 19, p lt .001.
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Reliability estimates
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Validity
Note. Brown Scales and PADDS are inversely scaled
therefore, negative correlations are expected.
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Diagnostic Utility of PADDS relative to other
diagnostic tests
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PADDS SUBTESTS POSITIVE AND NEGATIVE PREDICTIVE
POWER
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
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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.
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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.

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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 BS TO C-D RANGE

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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)

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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

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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 60 60 ATRISK 58 45
• TEACHER 70 70 HIGH 50 50

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ADHD EVIDENCE

• OBSERVATIONS SEN/SPEC
• WRAML-2 ATT/INDEX 79 N/A
• DSM-IV TEACHER ADHD-C .90/.90
• TT CUT POINT114 SCORE 101 .39/.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 60 60 ATRISK N/A
• TEACHER 70 70 HIGH N/A

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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

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

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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)

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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

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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 ATRISK 55 48
  
• TEACHER 60 ATRISK 50 50

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ADHD EVIDENCE

• SEN/SPEC
• WRAML-2 N/A
• DSM-IV PARENT ADHD-I .90/.90
• DSM-IV TEACHER ADHD-I .90/.90
• TT CUT POINT114 SCORE 120 .16/.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

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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

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PADDS Results Parent Teacher Reports meeting
DSM-IV Criteria
And Scores from the Target Tests of Executive
Functions
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COMBINING DSM IV BRIEF
Calculate the Parent and Teacher ratings
indicating ADHD Which has Sensitivity of .90 and
Specificity of .90 each
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COMBINING DSM IV BRIEF
Next we add in the results of the BRIEF
Measures With Sensitivity of .93/.86 and
Specificity of .63/.75 each
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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
COMBINING DSM IV, BRIEF PADDS
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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

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NASP 2008 ANNUAL CONVENTION