Clinical Assessment of Child and Adolescent Personality and ...

396CHAPTER 17 Assessment of Attention Deficit HyperactivityOne final note is in order for assessing thecore features of ADHD. Despite widespreadcautions against the practice (e.g., Barkley, 1990;Kamphaus, 2001; Kaufman, 1994), clinical assessorscontinue to use the Freedom from Distractibility(FD) factor from the Wechsler IntelligenceScales for Children (Wechsler, 1991) as an indicatorof the presence of ADHD symptoms. Thisinappropriate use of FD is largely maintainedsimply because of the name given to the factor,which is a significant source of distress to the personwho first applied the FD label to the WISCsubtests. Alan Kaufman states, “The label shouldhave been trashed years ago. I cringe whenever Iread it” (Kaufman, 1994, p. 212).As Kaufman goes on to explain, theuse of the FD as a measure of inattentionor distractibility is inappropriatebecause these scales are affected by multipleemotional and behavioral factors, notjust distractibility. To illustrate the point,Kaufman reviewed 19 studies in which theFD was lower in samples of children withlearning disabilities, children with leukemia,children with emotional difficulties,heterogeneous psychiatric samples ofinpatient or outpatient children, childrenwith autism, children with schizophrenia,children with Conduct Disorder, and childrenwith muscular dystrophy. The authorthen makes the cogent point that the FDfactor is important because of its robustability to differentiate the abnormal (medically,behaviorally, and educationally) fromthe normal population, but it is basicallymeaningless for identifying a specific typeof exceptionality, such as ADHD.Assessing Comorbid ProblemsMany of the problems that often co-occurwith ADHD can be assessed in conjunctionwith the assessment of the core ADHDbehaviors. For example, many of the omnibusrating scales and structured interviewsdiscussed in previous chapters includeitems that assess for conduct problems,anxiety, depression, self-esteem, and socialcompetence. Like the ADHD behaviorsthemselves, potential co-occurring problemsare best assessed through multipleinformants and using multiple formats.Given the overlap with learning problems,psycho-educational testing should also be apart of most ADHD assessments. Learningdifficulties are not reliably assessed throughrating scales, interviews, behavioral observations,or projective testing. As a result,standardized intelligence and achievementtests are often required as part of a comprehensiveevaluation for ADHD.Some omnibus behavior rating scalesinclude items that assess the degree of familyconflict and other aspects of a child’s familycontext. However, as discussed in Chap. 12,some assessments may require a more indepthassessment of specific areas of familyfunctioning that are better obtained throughmethods that specifically focus on the child’sfamily context. Each aspect of family functioningthat was highlighted in Chap. 12(parenting styles and behaviors, parentingstress, marital conflict, and parental adjustment)is important in understanding thefamily context of a child with ADHD.Assessing Potential AlternativeCausesOne of the most difficult aspects of assessingfor ADHD is ruling out alternative causes forthe symptoms. Probably, the most importantpiece of information for this purpose hasalready been discussed. If one has adequatelydetermined that the symptoms of ADHD areof sufficient number, severity, and durationand cause enough impairment to warrant adiagnosis, most of the alternative explanationsfor symptoms can be ruled out as a soleexplanation for the behaviors. Many of thealternative explanations for ADHD symptomsresult in behaviors similar to ADHD,but of lower intensity and of shorter durationthan is typical for children with ADHD.Given that some medical and neurologicaldisorders can manifest in problems of