Differential utility of teacher and parent–teacher combined information in the assessment of Attention Deficit/Hyperactivity Disorder symptoms

Abstract

Background Consistent research findings indicate that parents and teachers observe genuinely different Attention Deficit/Hyperactivity Disorder (ADHD) behaviours in their respective settings. Objective To evaluate the utility of information provided by teacher informant assessments (INFAs) of ADHD symptoms, and the implications of aggregation algorithms in combing parents’ information, i.e. using ‘or-rule’ (endorsement by either one informant) versus ‘and-rule’ (endorsement by both informants). Method Teacher ratings on Conners scales and clinical data from parental accounts on 1383 probands and their siblings from the IMAGE study were analysed. The psychometric properties of teacher and combined ratings using the item response theory model (IRT) are presented. Kappa coefficients, intraclass correlations and linear regression were employed. Results First, teacher endorsement of symptoms is located in a narrow part of the trait continuum close to the average levels. Symptoms exhibit comparable perception in the measurement of the trait(s) with similar discrimination ability and information (reliability). Second, the IRT properties of the ‘or-rule’ ratings are predominantly influenced by parent-INFAs; and the ‘and-rule’ ratings predominantly by teacher-INFAs ratings. Third, parent-teacher INFAs agreement was low, both for individual items (κ = 0.01–0.15) and for dimensional scores (r = 0.12–0.16). The ‘or-rule’ captured milder expressions of ADHD symptoms, whereas the ‘and-rule’ indexed greater severity of ADHD. Conclusions Parent and teacher-INFAs provide different kinds of information, while both are useful. Teacher-INFA and the ‘and-rule’ provide a more accurate index of severity than an additive symptom count. Parent-INFA and the ‘or-rule’ are more sensitive for detecting cases with milder ADHD.

Distance Learning in Children with and without ADHD: A Case-control Study during the COVID-19 Pandemic

“…Parents and teachers genuinely observe different ADHD behaviors with unique aspects of expression in their respective setting. Even with a low level of parentteacher agreement, information from both is important in detecting symptoms, defining trait levels and severity of impairment, and defining the diagnosis (Garcia-Rosales et al, 2021;McGrath, 2020). In particular, parents endorse more accurate information concerning low to moderate symptoms.…”

Attention deficit hyperactivity disorder: A pilot study for symptom assessment and diagnosis in children in Chile

“…Children’s families and schools are generally the first to distinguish the symptoms of ADHD, which is why most of the instruments used for a diagnosis involve an initial assessment of the child’s behavior by their teachers and parents ( Garcia-Rosales et al, 2020 ). Also, it is likely that the high expectations of school performance, which parents and teachers place on children, increase the need to find clinical explanations for school failure ( Santana-Vidal et al, 2020 ).…”

Attention-deficit hyperkinetic disorder among children and adolescents with type 1 diabetes: a cross-sectional study

“…Several studies (from Egypt and worldwide) have shown that parents report ADHD symptoms more frequently than teachers [19,20,[23][24][25][26][27][28][29] and that parents may not have age-appropriate behavioral expectations for their children causing overdiagnosis of ADHD. Parents were found to be more reliable in ratings of forgetfulness, whereas teachers were found to be more reliable reporters of deficits in sustained attention (teachers can quickly compare students and detect those poorly performing in a class task) [23,30]. In addition, mothers (the main informants in our study) were found to consistently report more inattention and hyperactivity symptoms than fathers (mothers spend longer times with children than fathers and many children behave better in the presence of their father) [23,24,28,31].…”