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Vanderbilt ADHD

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VANDERBILT ASSESSMENT SCALES 1

Introduction

The National Institute for Children’s Health Quality (NICHQ) published the first

edition of the Vanderbilt Assessment Scales to help diagnose children between the ages of 6

to 12 years with ADHD. Ever since the first edition of Vanderbilt Assessment Scales was

published in 2002, subsequent editions came out in 2011 (2nd edition) and 2019 (3rd edition).

The Vanderbilt Assessment Scales consist of the primary caregivers' scale (usually the

parent's) and the teacher's scale. These scales are further divided into baseline and follow-up

assessments for both, the parent and teacher version. The Vanderbilt Attention Deficit/

Hyperactive Disorder Parent Rating Scale (VADPRS) consists of 55 total items. Out of

which, 18 items (1-18) are DSM-4 ADHD symptom items (1-9: inattention subtype; 9-18:

hyperactive/impulsive subtype), 8 (19-26) are Oppositional Defiant Disorder (ODD)

screening items, 14 (27-40) are Conduct Disorder (CD) screening items, and 7 (41-47) are

anxiety or depression behavior items. Except for the initial 18 items, the following 29 items

are ODD, CD, and anxiety or depression behavior comorbid screening items. All of the items

are on a 4-point scale of frequency (0 = never, 3 = very often). An additional functioning

performance subscale consists of 8 items (48-55) that examine academic performance and

social relationships on a 5-point scale (1 = excellent, 5 = problematic). The symptom items

and functioning items have been incorporated keeping the DSM-4 criteria in mind. However,

they are also consistent with the DSM-5 version, since the criteria did not change between

these versions. As per the manual, scores of 2 or 3 on a single symptom question reflect

often-occurring behavior. Scores of 4 or 5 on performance/ functioning items are indicative of

severe problems in adaptive functioning. To meet the diagnostic criteria, it is necessary to

have at least 6 positive responses (2 or 3) to the inattentive 9 or hyperactive 9 core symptoms,

or both. For ODD symptom screener items, it is necessary to have at least 4 positive

responses (2 or 3) out of 8 behaviors. For CD symptom screener items, it is necessary to have


VANDERBILT ASSESSMENT SCALES 2

at least 3 positive responses (2 or 3) out of 14 behaviors. For the performance subscales, an

impairment in adaptive functioning occurs when an individual scores a 4 on at least 2 items

or a 5 on at least 1 item. However, the VADPRS is not enough to confirm a diagnosis of

ADHD; information from multiple sources (teachers, other primary caregivers, detailed case

history) should be considered. Moreover, the Vanderbilt Scales have baseline and follow-up

assessments to understand the individual's response to medications, and interventions.

The VADPRS has a high internal consistency of more than 0.90 for the ADHD

subscale, as well as the externalizing (ODD/CD) subscale and internalizing

(anxiety/depression) subscale (Wolraich et al., 2003). The VADPRS was also compared to the

Computerized Diagnostic Interview Schedule for Children (C-DISC-4) and displayed a

concurrent validity of r = 0.79 for the total ADHD score (r = 0.73 for the inattentive subtype

and r = 0.83 for the hyperactive/impulsive subtype) (Wolraich et al., 2003). Research

suggests that the VADPRS, along with its symptom screening scales has improved clinical

utility for children who are at a risk of comorbidities accompanying their ADHD diagnosis

(Anderson et al., 2022).

Report

Demographic Details

Test Date: 23/12/2023

Initials: T.K.

Gender: Female

DOB: 14/03/2013

Age: 10 years and 10 months

Education: 5th Standard


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Rater’s Initials: S.K.

Informant (relation): Mother

Background Information and Purpose of Testing

T.K., a 10-year-old female has been tested with the instrument. Presently, she did not

show any significant clinical features of ADHD or its comorbid features. The test was

administered for academic purposes and keeping in mind feasibility.

Test Administered

Vanderbilt Attention Deficit/ Hyperactive Disorder Parent Rating Scale (VADPRS).

Behavioral Observations

An easy rapport could be established with T.K. Her attention could be easily initiated

and maintained during the interview. She maintained consistent eye contact throughout the

interview. T.K. did not display any behavioral disturbances, fidgeting, hyperactivity, or

inattention during the interview.

Test Findings

Results

Symptom/Comorbid Cut-off Scores No of items Symptoms

Symptom Scales Features

(Present/Absent)

Predominant Inattention • A 2 or 3 on 6 out 0 Absent

subtype of 9 items (1 – 9).


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• A 4 or 5 on any of

the Performance

items (48 – 55).

Predominantly • A 2 or 3 on 6 out 3 Absent

Hyperactive/Impulsive of 9 items (10 –

subtype 18).

• A 4 or 5 on any of

the Performance

items (48 – 55).

ADHD Combined Requires the above … Absent

Inattention/Hyperactivity criteria on both

inattention and

hyperactivity/impulsivity.

ODD Screen • A 2 or 3 on 4 out 1 Absent

of 8 items (19 –

26).

• A 4 or 5 on any of

the Performance

items (48 – 55).

CD Screen • A 2 or 3 on 3 out 0 Absent

of 14 items (27 –

40).

• A 4 or 5 on any of

the Performance

items (48 – 55).


VANDERBILT ASSESSMENT SCALES 5

Anxiety/Depression • A 2 or 3 on 3 out 0 Absent

Screen of 7 items (41 –

47).

• A 4 or 5 on any of

the Performance

items (48 – 55).

Interpretation

Based on the above table, T.K. has an absence of ADHD (Inattention and

Hyperactivity) symptoms, ODD features, CD features, and anxiety/depression features.

Impressions

These scores are characteristic of a child with a complete absence of ADHD and other

comorbid features (ODD, CD, and anxiety/depression).

Recommendations

Since no ADHD or comorbid symptoms were established, no assessments or

interventions could be recommended in this case. Nevertheless, in the case of hypothetical

ADHD symptoms, optimized interventions specific to the child could be advised. According

to a review by Caye et al. (2019), behavioral and psychosocial interventions like social skills

training, provision of parental guidance, school-based behavioral interventions, structured

CBT programs for emotional regulation, relaxation, and mindfulness practices, cognitive

training targeting specific neuropsychological functions (attention, inhibitory control,

working memory) through a multiple process training, neurofeedback mechanisms to train

individuals to increase beta waves and reduce theta waves, and dietary modifications of
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reducing artificial food coloring and increasing poly-unsaturated fatty acids (PUFA)

supplements are commonly proposed strategies. Besides these behavioral and psychosocial

interventions, pharmacological interventions like psychostimulants (modafinil, bupropion,

methylphenidate, antidepressants, etc.) could be incorporated in moderate to severe cases of

ADHD (Caye et al., 2019). For ODD/CD, multimodal interventions specifically focused on

social skills and prosocial behavior training could be considered (Doepfner et al., 2020).

Overall, in both ADHD and behavioral disturbances (ODD/CD), problems in inhibitory

control have been prominent, and thus, interventions like collaborative problem-solving

approaches help in targeting control in social settings (Bonham et al., 2021). Technologically

delivered cognitive behavioral and attentional bias modification training are a few

interventions for managing and alleviating anxiety and depression in young children (Grist et

al., 2019).
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References

Anderson, N. P., Feldman, J. A., Kolko, D. J., Pilkonis, P. A., & Lindhiem, O. (2022).

National norms for the Vanderbilt ADHD diagnostic parent rating scale in children.

Journal of Pediatric Psychology, 47(6), 652-661.

Bonham, M. D., Shanley, D. C., Waters, A. M., & Elvin, O. M. (2021). Inhibitory control

deficits in children with oppositional defiant disorder and conduct disorder compared

to attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.

Research on Child and Adolescent Psychopathology, 49, 39-62.

Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for

ADHD: an evidence-based guide to select optimal treatment. Molecular psychiatry,

24(3), 390-408.

Doepfner, M., Goertz‐Dorten, A., Hanisch, C., & Steinhausen, H. C. (2020). Treatment and

management of oppositional defiant disorders and conduct disorders in children and

adolescents. The Wiley International Handbook on Psychopathic Disorders and the

Law, 729-777.

Grist, R., Croker, A., Denne, M., & Stallard, P. (2019). Technology delivered interventions

for depression and anxiety in children and adolescents: a systematic review and meta-

analysis. Clinical Child and Family Psychology Review, 22, 147-171.

NICHQ. (2002). NICHQ – Vanderbilt Assessment Scale – Parent Information. AAP and

NICHQ

Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K.

(2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating

scale in a referred population. Journal of Pediatric Psychology, 28(8), 559-568.

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