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How to use: a rating score to diagnose attention deficit hyperactivity disorder
  1. S Carter1,
  2. H Syed-Sabir2
  1. 1
    Child Development Centre, Allenscroft Children’s Centre, King’s Heath, Birmingham, UK
  2. 2
    Child and Adolescent Mental Health Service, Birmingham Children’s Hospital NHS Trust, Birmingham, UK
  1. Dr Sophie Carter, Child Development Centre, Allenscroft Children’s Centre, King’s Heath, Birmingham B14 6RP, UK; sophcarter{at}

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Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition where affected children have problems with attention, impulsiveness and hyperactivity. The Diagnostic and statistical manual of mental disorders: fourth edition (DSM-IV) requires the presence of at least six out of nine behavioural features that must have been present for at least 6 months, are present in all settings, had onset before the age of 7 and are causing significant distress or impairment.1 The UK prevalence is thought to be between 3% and 5%.24 A diagnosis of ADHD will have significant implications for education, the family setting and possible drug therapy, and therefore should be made with confidence.

Box 1 Selecting a behaviour rating scale – useful questions

  • Is it broad band (looking at a range of child psychiatric diagnoses) or narrow band (looking to identify one or two child psychiatric diagnoses)?

  • How long will it take a parent/teacher/child to fill in?

  • How long will it take the clinician to score and is there accompanying computer software to aid this?

  • How valid is the rating scale – are the sensitivities and specificities available?

  • Are normative data available for the scale?

However, a diagnosis of ADHD cannot be made quickly with a blood test, brain scan or recognition of obvious clinical signs. Rather, it requires an assessment process whereby information is gathered on the child’s behaviour and functioning in a number of settings and situations. Much of this information can be gained at a detailed clinical interview, but the use of behaviour rating scales has become common practice. This is partly because such scales allow data to be gathered in a systematic fashion often from absent parties (eg, parents not attending the clinic appointment, school teachers or support workers) in a time efficient manner. Currently, the SIGN guideline5 mentions rating scales but does not specifically comment on their …

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  • Competing interests: None.