A Retrospective: The Development and Use of the Vanderbilt ADHD Behavior Rating Scales

Posted August 24, 2015 by NICHQ

The rate of attention deficit hyperactivity disorder (ADHD) diagnosis has jumped 15 percent in the last six years according to recent data from the Center for Disease Control and Prevention. The NICHQ Vanderbilt Assessment Scale, developed through the ADHD Learning Collaborative, remains a foremost tool for helping healthcare professionals diagnose the disease. We recently invited Mark Wolraich, MD, from the University of Oklahoma Health Sciences Center, the creator of the Vanderbilt Rating Scales (from which the NICHQ version was adapted), to share the story of the scales’ development, utility and their continued relevancy.

I initially became interested in information about community based samples of children with ADHD in the 1980’s while I was at the University of Iowa when I had a National Institute of Mental Health grant to study the role of primary care clinicians in providing their care. I continued these interests when I moved to Vanderbilt University and started examining the prevalence rates of ADHD in elementary school age children. I needed to find an inexpensive method of obtaining defined population based samples since I only had a small amount of funding. 
Mark Wolraich Utilizing teacher ratings, as long as I kept the rating scale simple, enabled me to have all the teachers complete the scales on all the children in the classes. Based on that need, I developed the teacher Vanderbilt ADHD rating scale1. Looking at existing scales at that time, they did not include the common co-morbid conditions associated with ADHD or any assessment of function which I added to the Vanderbilt. With this scale we assessed several school districts in Tennessee2, 3 and then Germany with the help of a colleague, Anna Baumgaertel, who was on sabbatical there, and we also assessed a sample from Barcelona4.

Further study trying to improve communication between physicians and teachers regarding their patients/students with ADHD required obtaining information from the both parents and teachers and resulted in my development of the parent form5. The American Academy of Pediatrics (AAP) decided to include it in its recommendations on how to implement its clinical guidelines on ADHD and it was employed in the NICHQ national collaborative on ADHD and was included in the AAP ADHD Toolkit.

Since then, our site in Oklahoma and one in South Carolina have used it in a CDC prevalence study6 and it has been employed in a larger research/quality improvement program in Cincinnati7 where they have also validated its use to screen for learning disabilities8. It has been considered as part of the quality measures of ADHD treatment9, has be translated into a number of different languages, and integrated into a number of electronic medical records.

Since the changes in criteria for ADHD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) did not include any of the information captured on the Vanderbilt Rating Scale, it remains valid for clinical use and was revalidated recently10, 11. I also developed a shorter form of both the parent and teacher scales to use for following treatment.

From the beginning, I put the scales in the public domain so that they can be easily and inexpensively used by clinicians and modified as needed. I am proud of the fact that they have helped clinician to more accurately diagnose and monitor children with ADHD based on DSM criteria.

1. Wolraich ML, Feurer I, Hannah JN, Pinnock TY, Baumgaertel A. Obtaining systematic teacher report of disruptive behavior disorders utilizing DSM-IV. J Abnorm Child Psychol. 1998;26:141-52.
2. Wolraich ML, Hannah JN, Baumgaertel A, Pinnock TY, Feurer I. Examination of DSM-IV critieria for ADHD in a county-wide sample. Journal of Developmental and Behavioral Pediatrics. 1998;19:162-8.
3. Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J. Comparison of diagnostic criteria for attention deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry. 1996;35:319-23.
4. Wolraich ML, Lambert EW, Baumgaertel A, Garcia-Tornel S, Feurer ID, Bickman L, et al. Teachers’ screening for Attention Deficit/Hyperactivity Disorder: Comparing multinational samples on teacher ratings of ADHD. J Abnorm Child Psychol. 2003;31:445-55.
5. Wolraich ML, Lambert W, Worley K, Doffing MA, Bickman L, Simmons T. Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale. Journal of Pediatric Psychology. 2003;28:559-68.
6. Wolraich ML, McKeown, R., Visser, S., Bard, D., Cuffe, S., Abramowitz, A.J., Neas, B., James, L., Bottai, M., et al, . The prevalence of attention-deficit/hyperactivity disorder: its diagnosis, and treatment in four school districts in two states. Journal of Attention DisordersJournal of Attention Disorders. 2014;18(7):563-75
7. Epstein J, Langberg J, Lichtenstein P, Kolb R, Altaye M, Simon J. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011 128(5):e1201-8.
8. Langberg J, Vaughn, AJ, Brinkman, WB, Froehlich, T, Epstein, JN. Clinical utility of the Vanderbilt ADHD Rating Scale for ruling out comorbid learning disorders. Pediatrics. 2010;126(5):e1033-8.
9. Woods D, Wolraich, M., Pierce, K., DiMarco, L., Muller, N., Sachdeva, R .Considerations and Evidence for an ADHD Outcome Measure. Academic Pediatrics 2014;14(5 Suppl):S54-60.
10. Wolraich ML, Bard, D., Neas, B., Doffing M., Beck, L. The Psychometric Properties of the Vanderbilt ADHD Diagnostic Teacher Rating Scale in a Community Population Journal of Developmental and Behavioral Pediatrics. 2013;34(2):83-93.
11. Bard D, Wolraich, M.L., Neas, B., Doffing M., Beck, L. The Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Community Population. Journal of Developmental and Behavioral Pediatrics. 2013 34(2):72-82.


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