The ADHD rating scale uses questions about a person's behavior to evaluate their likelihood of having attention deficit hyperactivity disorder. Rating scales are a crucial part of the diagnostic process and are particularly necessary when it comes to diagnosing a child.
When responding to the rating scale questions, most people will only be able to base their observations on how the individual behaves in one setting (for instance at home or school). These people are probably not aware of specific behaviors that the person displays in other settings. To get a complete picture of an individual, it is essential that a variety of people, including relatives and teachers, complete the rating scale forms.
Doctors use the information collected from the rating scale forms to help them make a diagnosis and recommendations for treatment. Doctors may also recommend using multiple rating scales.
A range of different ADHD scales is available.
They will often include a selection of questions about how often the person in question displays ADHD-related behaviors and symptoms of hyperactivity, impulsivity, and inattentiveness.
The ADHD rating scale will contain questions about typical behaviors including:
- frequent fidgeting
- squirming in the chair
- difficulty focusing on one task
- trouble with organization
- making careless mistakes
- difficulty staying still or remaining seated
- difficulty paying attention, even when specifically asked to
- an inability to wait their turn
- impatient behavior
- regularly interrupting others, talking over them, or disrupting conversations
- difficulty completing tasks even when they are given direct instructions
Some tests will also ask about classroom performance or performance at work. Typical questions will include rating how often someone:
- has trouble remembering directions, appointments, or direct tasks
- interrupts others or themselves while talking
- gets distracted from the task at hand or is unable to keep their mind on one topic
- avoids homework, class assignments, or projects at work
- leaves many projects unfinished or has difficulty finishing a project
Most questions use a scale from either 0 to 3 or 0 to 4, with 0 meaning the behavior never happens and 3 or 4 meaning it occurs frequently.
There are different ADHD rating scale tests designed specifically for children, teenagers, and adults.
Common rating scales for children include:
- Behavior Assessment System for Children (BASC-3), designed for people aged 2 to 21
- National Institute for Children's Health Quality (NICHQ) Vanderbilt Assessment Scale, intended for ages 6 to 12
- Conners Comprehensive Behavior Rating Scale (CBRS), intended for ages 6 to 18
- Child Behavior Checklist (CBCL), created for ages 6 to 18
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), for children aged 6 to 18
- Conners-Wells' Adolescent Self-Report Scale, specifically for teenagers
There may also be some behavioral variations between children of different sexes, so some forms will have separate questions based on sex.
ADHD behaviors present differently in adults. Tests specifically designed to measure signs of ADHD in adults include:
- Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS)
- Adult ADHD Clinical Diagnostic Scale (ACDS)
- ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV)
- Adult ADHD Self-Report Scale (ASRS)
How does scoring work?
The scoring for ADHD rating scales varies according to the choice of test and the age of the person under consideration. Two of the most commonly used tests are the NICHQ Vanderbilt Assessment Scale and the CBRS.
The Vanderbilt ADHD diagnostic rating scale
The Vanderbilt scale is popular with healthcare professionals who are diagnosing children between 6 and 12. It consists of two different forms for parents or teachers, which vary slightly.
If a child displays at least six behaviors suggesting inattention or hyperactivity with a score of 2 or 3, the healthcare professional will consider diagnosing ADHD.
The Vanderbilt scale also asks questions relating to performance.
The Conners CBRS rating scale
The Conners CBRS is designed to determine whether or not young students qualify for inclusion in special education. It may also be used to find a treatment plan for symptoms or to find out if a particular treatment for symptoms has been effective.
There are separate forms available for the child, their parent, and a teacher. The shorter version of the test, used for following up on progress or symptoms, includes 25 questions and may only take about 5 minutes to complete.
Scores above 60 indicate signs of ADHD, but a doctor will want to break down these scores more thoroughly before making a diagnosis.
The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes criteria for ADHD including a checklist of symptoms.
The Centers for Disease Control and Prevention (CDC) has compiled the lists to help people understand what extent of behavioral change may lead to an ADHD diagnosis.
An ADHD diagnosis is a possibility for people showing six or more signs of hyperactivity, impulsivity, or inattention.
In addition to a person having multiple symptoms for more than 6 months, the following conditions must also apply:
- the behaviors must be present in two or more settings
- the behaviors must be inappropriate for the person's age
- the behaviors must interfere with and reduce the quality of a person's daily life or basic functioning in social settings
- there should be no other condition that could better explain the symptoms
- the person must have presented several behaviors before the age of 12
If a person notices six or more signs of ADHD that meet these requirements in themselves or their child, they should see a doctor for a more thorough diagnosis.
Anyone can take a test and analyze themselves or their child online, but a thorough diagnosis from a qualified doctor is the only acceptable way to diagnose ADHD.
A doctor may request that parents ask their child's teachers to fill out rating scales forms. This will give the doctor several different perspectives on the child's behavior.
If the scores indicate ADHD, doctors are likely to begin a conversation about various ADHD treatment options.
Following an ADHD diagnosis, a person may receive treatments such as:
- behavioral therapy
- special education
Children with ADHD may find that their symptoms stay with them throughout life, but it is also possible that they will fade away with age.
Most of the time ADHD is highly manageable, especially when following a multifaceted treatment plan under the guidance of a mental health professional.