The clinical utility of standardized test observation in diagnosis of ADHD

The purpose of this study was to investigate the clinical utility of a standardized observation measure in the diagnostic assessment of ADHD in children. Evidenced-based assessment of ADHD recommends the use of multiple informants and multiple methods, and ADHD diagnostic criteria requires impairment in at least two settings. Commonly, parent and teacher reports of child behavior differ and blur the diagnostic picture, so standardized observations during testing may provide additional useful diagnostic information. Archival data from 140 children (age 5 -- 12) referred to a university-based ADHD evaluation clinic was utilized in the present study. Testing observations measured by the Test Observation Form (TOF) were most strongly associated with parent and teacher ratings of hyperactivity on the Behavior Assessment Scale for Children, 2nd edition (BASC-2). The TOF-DSM oriented scales (Hyperactivity/Impulsivity and Inattention) showed a stronger pattern of correlation with parent and teacher ratings on the BASC-2 as compared to the TOF Attention Problems scale (which combines inattentive and hyperactive behaviors). Parent ratings of inattention were not significantly associated with any of the TOF scales. Contrary to prediction, the TOF Attention Problems scale was not a significant predictor of ADHD research diagnosis. Results do not provide support for the clinical utility of the TOF in assessment for ADHD among children. Rather, it appears that short-term standardized testing observations measure a different type of information about child behaviors that distinctly differ from information gathered from parents and teachers about child behaviors over a longer period of time in naturalistic home and school settings.