ADD-H-Comprehensive Teacher’s Rating Scale (ACTeRS): A Measure for Attention Deficit Hyperactivity Disorder Among Children with Intellectual Disability in India

Abstract

Objective: There is no validated measure for assessing Attention Deficit Hyperactivity Disorder (ADHD) in India, and therefore, the authors validated the ADD-H Comprehensive Teacher ’ s Rating Scale (ACTeRS).

Methods: Teachers/parents/clinicians of 110 children with ADHD completed the ACTeRS. The diagnosis of ADHD was confirmed by an independent multi-disciplinary team using ICD-10 diagnosis for diagnostic accuracy and criterion validity. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately.

Results: An ACTeRS score of ≥ 61 [Sensitivity (Sn) =85.51 %; Specificity (Sp)=90.24 %; Area under the curve (AUC)= 0.94] is appropriate for the diagnosis of ADHD. The test-retest reliability [Intra-class correlation coefficient (ICC)=0.87], internal consistency (Cronbach ’ s α =0.80; range of 0.89 – 0.93), section-total correlation, face and content validity for the ACTeRS were good. Convergent validity of attention deficit, hyperactivity and oppositional subscales of ACTeRS with the corresponding subscales of Swanson, Nolan & Pelham Rating Scale - Revised (SNAP-IV) was moderate ( r =0.60, P =0.005; r =0.49, P =0.02; r =0.58, P =0.008 respectively), and negative correlation with the Childhood Autism Rating Scale ( r = − 0.36; P =0.1) for divergent validity was found. The criterion validity analysis showed a high concordance rate of 82.52 % between ACTeRS and International Classification of Diseases, Edition10 (ICD-10) diagnosis of ADHD. A 4-factor structure was replicated.

Conclusions: The ACTeRS has adequate psychometric properties for use in the Indian population for identifying ADHD.