This study describes 4 help-seeking steps among children at high risk for attention deficit hyperactivity disorder (ADHD), and identifies barriers to ADHD symptom detection and treatment. Using a district-wide stratified random sample of 1615 elementary school students screened for ADHD risk, predictors of 4 help-seeking steps among a high-risk group (n = 389) and parent-identified barriers to care among children with unmet need for ADHD care (n = 91) were assessed. Study findings indicate that although 88% of children were recognized as having a problem, only 39% had been evaluated, 32% received an ADHD diagnosis, and 23% received current treatment. Older children and those with more severe behavior problems were more likely to be perceived by their parents as having a problem. Additionally, gender and ethnic disparities in the subsequent help-seeking process emerged. Boys had over 5 times the odds than girls of receiving an evaluation, an ADHD diagnosis, and treatment. Compared to African American youth, Caucasian children had twice the odds of taking these help-seeking steps. For those children with unmet need for ADHD care, poverty predicted lower treatment rates and was associated with the most pervasive barriers. The gap between parental problem recognition and seeking services suggests that thresholds for parental recognition of a child behavior problem and for seeking ADHD services may be different. Future research examining the help-seeking process for ADHD should include a qualitative component to explore the potential mechanisms for gender and ethnic differences.

To examine psychometric properties of the SNAP-IV, parent (N = 1,613) and teacher data (N = 1,205) were collected from a random sample of elementary school students in a longitudinal study on detection of attention deficit hyperactivity disorder (ADHD). Reliability, factor structure, predictive validity, and effect sizes (ES) for differences in ratings across age, gender, and race were examined. Performance as a screening and diagnostic tool was evaluated through calculation of likelihood ratios (LR) and posttest probabilities. Reliability of the parent and teacher SNAP-IV was acceptable. Factor structure was consistent with a two-factor solution of ADHD symptoms and a third ODD factor. Parent and teacher scores varied significantly by gender and poverty status (d = .49 to .56), but not by age; only teacher scores varied by race (d = .25 to .55). SNAP-IV parent and teacher ratings satisfactorily distinguished children by increasing levels of ADHD concerns, but only parent ratings by diagnostic status. Parent SNAP-IV scores above 1.2 increased the probability of concern (LR > 10) and above 1.8 of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased the probabilities of concern (LR = 4.2 and > 5, respectively), but teacher SNAP-IV scores did not usefully change the probability of diagnosis. Further research should address reasons for higher teacher scores for African American children and the differences in measurement models by race. Keywords assessment; attention deficit hyperactivity disorder; children; likelihood ratios; norms; SNAP-IV; reliability; validity Behavior rating scales as assessment tools for diagnosing attention deficit hyperactivity disorder (ADHD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) have been used for many years, starting with the assessment of symptoms listed in the DSM-III (American Psychiatric Association, 1980) manual (Swanson, Sandman, Deutsch, & Baren, 1983). These scales have changed along with revisions in the DSM to match definitions of ADHD as a three-dimensional construct in DSM-III (APA, 1980), a unidimensional construct in the DSM-III-R (APA, 1987), and the current two-dimensional construct in the DSM-IV (APA, 1994) manual (Pillow, Pelham, Hoza, Molina, & Stultz, 1998). The rating scales are comparable in content (using either the exact DSM symptom NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript descriptions or variants slightly reworded to improve readability) and measurement approaches (four-point rating intervals) but differ in the assessment of comorbid disorders. Some focus on ADHD only, such as the ADHD Rating Scale IV DuPaul et al., 1997) or the DSM-IV ADHD Rating Scale (Gomez, Harvey, Quick, Scharer, & Harris, 1999). Still others, such as the parent and teacher versions of the Vanderbilt ADHD Diagnostic Rating scales (Wolraich, Feurer, Hannah, Baumgaertel, & Pinnock, 1998;Wolraich et al., 2003), assess both externalizing and internalizing ...

Background/aim-Alkali generation by oral bacteria plays a key role in plaque pH homeostasis and may be a major impediment to the development of dental caries. To determine if the capacity of oral samples to produce ammonia from arginine or urea was related to caries experience, the arginine deiminase system (ADS) and urease activity in saliva and dental plaque samples were measured in 45 adult subjects.

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