Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD,validity, and reliability in a Brazilian sample

ObjectiveTo investigate the psychometric properties of the short or multimodal treatment study version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scale, which measures attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms.MethodsParticipants were 765 parents of children from 4 to 16 years old (641 non-attention-deficit/hyperactivity disorder and 124 attention-deficit/hyperactivity disorder children) from Belo Horizonte, Brazil, who reported sociodemographic characteristics and answered the SNAP-IV. Parents of the clinical sample also underwent the K-SADS-PL interview.ResultsAge was significantly associated with SNAP-IV hyperactivity-impulsivity problems (r = ?0.14), but not with inattention or oppositional defiant disorder. Sex was a significant influence on attention-deficit/hyperactivity disorder and oppositional defiant disorder severity (all p < 0.001), with boys showing higher scores in the full sample, but not within the attention-deficit/hyperactivity disorder group. Exploratory and confirmatory factor analysis supports a three-factor structure of the SNAP-IV scale. Moderate-to-strong correlations were found between SNAP-IV and K-SADS-PL measures. All SNAP-IV scales showed very high internal consistency coefficients (all above 0.91). SNAP-IV inattention scores were the most predictive of attention-deficit/hyperactivity disorder diagnosis (AUC: 0.877 for the averaging rating method and the raw sum method, and 0.874 for the symptom presence/absence method).ConclusionThe parent SNAP-IV showed good psychometric properties in a Brazilian school and clinical sample.
     

Psychometric Evaluation of the ‘Evidence Based Practice Competencies Questionnaire – Cerebral Palsy’

Aim: To understand whether knowledge translation activities are effective, good measurement of practice is required. This study investigated the psychometric properties of a self-report measure of allied health practitioner (AHP) evidence-based behaviors when working with children with cerebral palsy. Methods: Construct validity and reliability studies were undertaken for the 12-item Evidence Based Practice Competency Questionnaire – Cerebral Palsy (EBP-CQ-CP) using the Consensus-based Standards of Measurement Instruments methods. Factor analysis tested construct validity. Weighted Kappa tested chance-corrected agreement for each item and intra-class correlation coefficients (ICC) the reliability of factors derived in the validity study. Results: In the validity study 259 AHP completed the EBP-CQ-CP on occasion 1, and 228 on occasion 2. In the reliability study 46 AHP completed the questionnaire twice. Exploratory factor analysis determined the EBP-CQ-CP contained two scales: ‘communicating evidence based expectations’ and ‘evidence based assessment practices’. Confirmatory factor analysis using data from the second occasion of assessment supported the findings. Excellent consistency in ratings across factor scores were obtained from 46 pairs of raters: Factor 1, ICC = 0.93 (95% Confidence Interval 0.88–0.96); Factor 2, ICC = 0.94 (95% Confidence Interval 0.88–0.97). Conclusions: This study supports the interpretation of the EBP-CQ-CP in a clinically meaningful and psychometrically robust manner.     

Development of an instrument to measure parents' preferences and goals for the treatment of attention deficit-hyperactivity disorder

ObjectivesTo describe the development and validation of an instrument to measure parents’ attention deficit–hyperactivity disorder (ADHD) treatment preferences and goals.MethodsParents of children 6 to 12 years of age diagnosed with ADHD in the past 18 months were recruited from 8 primary care sites and an ADHD treatment center (autism excluded). A 16-item medication, 15-item behavior therapy preference scale and a 23-item goal scale, were developed after a review of the literature, 90 parent and clinician semistructured interviews, and input from parent advocates and professional experts were administered to parents. Parent cognitive interviews confirmed item readability, clarity, content, and response range. We conducted an exploratory factor analysis and assessed internal consistency and test-retest reliability and construct and concurrent validity.ResultsWe recruited 237 parents (mean child age 8.1 years, 51% black, 59% from primary care, 61% of children medication naive). Factor analyses identified 4 medication preference subscales (treatment acceptability, feasibility, stigma, and adverse effects, Cronbach’s α 0.74–0.87); 3 behavior therapy subscales (treatment acceptability, feasibility, and adverse effects, α 0.76–0.83); and 3 goal subscales (academic achievement, behavioral compliance, and interpersonal relationships, α 0.83–0.86). The most strongly endorsed goal was academic achievement. The scales demonstrated construct validity, concurrent validity (r = 0.3–0.6) compared with the Treatment Acceptability Questionnaire and Impairment Rating Scale and moderate to excellent test–retest reliability (intraclass coefficient = 0.7–0.9).ConclusionsWe developed a valid and reliable instrument for measuring preferences and goals for ADHD treatment, which may help clinicians more easily comply with new national treatment guidelines for ADHD that emphasize shared decision making.     

A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder

OBJECTIVE: To determine whether docosahexaenoic acid (DHA) supplementation for 4 months decreases the symptoms of attention-deficit/hyperactivity disorder (ADHD). STUDY DESIGN: Sixty-three 6- to-12-year-old children with ADHD, all receiving effective maintenance therapy with stimulant medication, were assigned randomly, in a double-blind fashion, to receive DHA supplementation (345 mg/d) or placebo for 4 months. Outcome variables included plasma phospholipid fatty acid patterns, scores on laboratory measures of inattention and impulsivity (Test of Variables of Attention, Children's Color Trails test) while not taking stimulant medication, and scores on parental behavioral rating scales (Child Behavior Checklist, Conners' Rating Scale). Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance, controlling for age, baseline value of each outcome variable, ethnicity, and ADHD subtype. RESULTS: Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group (4.85 +/- 1.35 vs 1.86 +/- 0.87 mol % of total fatty acids; P <.001). Despite this, there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms. CONCLUSION: A 4-month period of DHA supplementation (345 mg/d) does not decrease symptoms of ADHD.     

Integrating Mental Health Services in Primary Care Continuity Clinics: A National CORNET Study

ObjectiveTo determine whether pediatric continuity clinics integrate mental health (MH) services into care delivery; and to determine whether the level of MH integration is related to access to MH services, types of MH screening performed, self-efficacy, satisfaction with referral sites, and communication with the primary care provider.MethodsPediatric Residency Integrated Survey of Mental Health in Primary Care (PRISM_PC) is a newly designed cross-sectional, Web-based survey of continuity clinic directors participating in a national network of pediatric continuity clinics (CORNET). Definitions of MH models included integrated or nonintegrated MH models or traditional care. The survey included questions regarding access, screening that was performed at sites, comfort with MH management as well as provider satisfaction and communication with referral sites.ResultsSeventy-eight percent (57 of 73) of CORNET site directors responded, representing input from 30% of US pediatric residency continuity programs. Thirty-five percent (n = 20) reported an integrated MH model while 65% (n = 37) reported a nonintegrated MH model. Seventy-nine percent screened for attention-deficit/hyperactivity disorder, 44% for behavioral-emotional issues, and 19% for pediatric depression. No differences were found in terms of screening or tools used on the basis of the level of MH integration. Those with integrated programs were more likely to have access to an on-site psychologist (P = .001) or psychiatrist (P = .006).ConclusionsDirectors from one-third of training programs surveyed reported some level of MH integration in their primary care teaching clinics. Future studies are needed to compare patient and resident education outcomes between integrated and nonintegrated sites.     

Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children - an open study of collaborative problem solving

Aim: To evaluate collaborative problem solving (CPS) in Swedish 6–13‐year‐old children with attention‐deficit/hyperactivity disorder and oppositional defiant disorder (ODD). Methods: Seventeen families completed 6–10 sessions of CPS training. Primary outcome measures were SNAP‐IV [attention‐deficit/hyperactivity disorder (ADHD) and ODD scores] and Clinical Global Impression‐Improvement (CGI‐I) scores at baseline, post‐intervention and 6 months later. Secondary outcome measures were the Conners’ 10‐item scale and the Family Burden of Illness Module (FBIM). Results: All 17 participants completed the intervention. The whole group had significant reductions in SNAP‐IV ODD, ADHD, total Conners’ and FBIM scores, both at post‐intervention and at 6‐month follow‐up. Eight of the children, although significantly improved on ODD scores and the Conners’ emotional lability subscale at post‐intervention, had almost no improvement in hyperactivity/impulsivity. Post‐intervention, this group received stimulant medication for their ADHD. CGI‐I scores of much improved or very much improved were reached by 53% (9/17) of all at post‐intervention, and by 81% (13/16) at 6‐month follow‐up. Conclusion: Collaborative problem solving significantly reduced ODD, ADHD and emotional lability symptoms. A subgroup improved in their ADHD symptoms only after adding stimulant medication.     

Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain measurement in children 1-7 years of age.

OBJECTIVE: Pain measurement is a necessity in pain treatment but can be difficult in young children. The aim of this study was to evaluate the validity and reliability of the Behavioural Observational Pain Scale (BOPS) as a postoperative pain measurement scale for children aged 1-7 yrs. The scale assesses three elements of pain behaviors: facial expression, verbalization, and body position. DESIGN: A prospective study. SETTING: A day surgery care unit for children and a neurosurgical postoperative care unit. PATIENTS: Seventy-six children aged 1-7 yrs (4.5 +/- 1.8) undergoing elective surgical procedures were observed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study was divided into interrater reliability, concurrent validity, and construct validity. The interrater reliabilities of the observers were very good with a high agreement between the different nurses' BOPS scores. Each item of the BOPS scale ranged from kappa(w) 0.86 to 0.95. In the concurrent validity, BOPS and Children's Hospital of Eastern Ontario Pain Scale scores had a positive correlation indicating that both tools described similar behaviors (r(s) = .871, p < .001). In construct validity, the effect of analgesic was tested before analgesic administration and at 15, 30, and 60 mins after analgesic administration. The differences in BOPS score between the time intervals were significant (p < .01) before administration of analgesia and at 15, 30, and 60 mins. There was also statistical significance in the BOPS score (p < .01) between 15 and 60 mins after administration of analgesia. CONCLUSIONS: With BOPS, the caretaker can evaluate and document pain with high reliability and validity and thereby improve postoperative pain treatment in preschool children. The simple scoring system makes BOPS easy to incorporate in a postoperative unit.     

INCLEN diagnostic tool for attention deficit hyperactivity disorder (INDT-ADHD): development and validation

Objective

To develop and validate INCLEN Diagnostic Tool for Attention Deficit Hyperactivity Disorder (INDT-ADHD).

Design

Diagnostic test evaluation by cross sectional design. Setting: Tertiary care pediatric centers.

Participants

156 children aged 65–117 months.

Methods

After randomization, INDT-ADHD and Connor’s 3 Parent Rating Scale (C3PS) were administered, followed by an expert evaluation by DSM-IV-TR diagnostic criteria.

Main outcome measures

Psychometric evaluation of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency.

Results

INDT-ADHD had 18 items that quantified symptoms and impairment. Attention deficit hyperactivity disorder was identified in 57, 87 and 116 children by expert evaluation, INDT-ADHD and C3PS, respectively. Psychometric parameters of INDT-ADHD for differentiating attention deficit hyperactivity disorder and normal children were: sensitivity 87.7%, specificity 97.2%, positive predictive value 98.0% and negative predictive value 83.3%, whereas for differentiating from other neuro-developmental disorders were 87.7%, 42.9%, 58.1% and 79.4%, respectively. Internal consistency was 0.91. INDT-ADHD has a 4-factor structure explaining 60.4% of the variance. Convergent validity with Conner’s Parents Rating Scale was moderate (r =0.73, P= 0.001).

Conclusions

INDT-ADHD is suitable for diagnosing attention deficit hyperactivity disorder in Indian children between the ages of 6 to 9 years.     

Pediatric Caregiver Version of the Shared Decision Making Process Scale: Validity and Reliability for ADHD Treatment Decisions

ObjectiveShared decision making (SDM) is recommended for common pediatric conditions; however, there are limited data on measures of SDM in pediatrics. This study adapted the SDM Process scale and examined validity and reliability of the scale for attention-deficit/hyperactivity disorder (ADHD) treatment decisions.MethodsCross-sectional survey of caregivers (n = 498) of children (aged 5–13) diagnosed with ADHD, who had made a decision about ADHD medication in the last 2 years. Surveys included the adapted SDM Process scale (scores range 0–4, higher scores indicate more SDM), decisional conflict, decision regret, and decision involvement. Validity was assessed by testing hypothesized relationships between these constructs. A subset of participants was surveyed a week later to assess retest reliability.ResultsPediatric Caregiver version of the SDM Process scale (M = 2.8, SD = 1.05) showed no evidence of floor or ceiling effects. The scale was found to be acceptable (<1% missing data) and reliable (intraclass correlation coefficient = 0.74). Scores demonstrated convergent validity, as they were higher for those without decisional conflict than those with decisional conflict (2.93 vs 2.46, P < .001, d = 0.46), and higher for caregivers who stated they made the decision with the provider than those who made the decision themselves (3.0 vs 2.7; P = .003). Higher scores were related to less regret (r = ?0.15, P < .001), though the magnitude of the relationship was small.ConclusionsThe adapted Pediatric Caregiver version of the SDM Process scale demonstrated acceptability, validity and reliability in the context of ADHD medication decisions made by caregivers of children 5–13. Scores indicate pediatricians generally involve caregivers in decision making about ADHD medication.     

Parent experiences of paediatric care (PEPC) questionnaire: reliability and validity following a national survey

AIM: To describe the development and evaluation of a parent completed questionnaire to measure parent experiences of inpatient paediatric care, the parent experiences of paediatric care (PEPC). METHODS: Literature review, parent interviews, pre-testing and a national survey of 6144 parents of children who were inpatients at one of the 20 paediatric departments within Norway in 2005. RESULTS: Three thousand three hundred and eight (53.8%) parents responded to the questionnaire. Low levels of missing data suggest that the PEPC is acceptable. The questionnaire includes six scales as supported by the results of factor analysis: nursing services (seven items), doctor services (five items), organisation (four items), information--examinations and tests (two items), information--discharge (three items) and hospital facilities (four items). Cronbach's alpha and test-retest correlations ranged from 0.7 to 0.9. Comparisons of scale scores with several variables including overall satisfaction with care and pain control, supported validity. CONCLUSION: The PEPC questionnaire includes important aspects of hospital care from the perspective of the parent. It has good evidence for internal consistency, test-retest reliability and validity and is recommended in surveys of parent experiences of paediatric inpatient care.     

Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants.

OBJECTIVE: To develop and validate a scale suitable for use in clinical practice as a tool for assessing prolonged pain in premature infants. METHODS: Pain indicators identified by observation of preterm infants and selected by a panel of experts were used to develop the EDIN scale (Echelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale). A cohort of preterm infants was studied prospectively to determine construct validity, inter-rater reliability, and internal consistency of the scale. RESULTS: The EDIN scale uses five behavioural indicators of prolonged pain: facial activity, body movements, quality of sleep, quality of contact with nurses, and consolability. The validation study included 76 preterm infants with a mean gestational age of 31.5 weeks. Inter-rater reliability was acceptable, with a kappa coefficient range of 0.59-0.74. Internal consistency was high: Cronbach's alpha coefficients calculated after deleting each item ranged from 0.86 to 0.94. To establish construct validity, EDIN scores in two extreme situations (pain and no pain) were compared, and a significant difference was observed. CONCLUSIONS: The validation data suggest that the EDIN is appropriate for assessing prolonged pain in preterm infants. Further studies are warranted to obtain further evidence of construct validity by comparing scores in less extreme situations.     

The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure,Reliability, and Validity

ObjectiveNational consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Questionnaire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQ's reliability and validity.MethodsWe surveyed youth from 3 academic clinics in Jacksonville, Florida; Chapel Hill, North Carolina; and Boston, Massachusetts. Participants were AYA with special health care needs aged 14 to 21 years. From a convenience sample of 306 patients, we conducted item reduction strategies and exploratory factor analysis (EFA). On a second convenience sample of 221 patients, we conducted confirmatory factor analysis (CFA). Internal reliability was assessed by Cronbach's alpha and criterion validity. Analyses were conducted by the Wilcoxon rank sum test and mixed linear models.ResultsThe item reduction and EFA resulted in a 20-item scale with 5 identified subscales. The CFA conducted on a second sample provided a good fit to the data. The overall scale has high reliability overall (Cronbach's alpha = .94) and good reliability for 4 of the 5 subscales (Cronbach's alpha ranging from .90 to .77 in the pooled sample). Each of the 5 subscale scores were significantly higher for adolescents aged 18 years and older versus those younger than 18 (P < .0001) in both univariate and multivariate analyses.ConclusionsThe 20-item, 5-factor structure for the TRAQ is supported by EFA and CFA on independent samples and has good internal reliability and criterion validity. Additional work is needed to expand or revise the TRAQ subscales and test their predictive validity.     

Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder

This study examines the impact of interrater reliability on the diagnosis of attention-deficit hyperactivity disorder (ADHD). A screening of 6171 elementary school children identified 1573 children with a high risk for ADHD according to teacher rating. Follow-up parent interviews and information from teachers were collected on 243 children. Before screening, health care professionals had diagnosed ADHD in 40% of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms according to DSM-IV-based questionnaires: Inattentive (r =.34, kappa = 0.27), Hyperactive/Impulsive (r =.27, kappa = 0.22), and Performance Impairment (r =.31, kappa = 0.07). When the two-setting requirement was strictly enforced, poor interrater agreement decreased diagnostic rates for all three types of ADHD in this clinical sample: Inattentive (15%-5%), Hyperactive/Impulsive (11%-3%), and Combined (23%-7%). Parent and teacher agreement was low concerning ADHD symptoms and performance. The recommendation of multiple informants significantly decreased the prevalence. Allowing for observer disagreement by using more lenient core symptom scores could reduce the effect.     

Psychometric Properties of the Revised Developmental Coordination Disorder Questionnaire

The Developmental Coordination Disorder Questionnaire (DCDQ) is a parent-completed measure designed to identify subtle motor problems in children of 8 to 14.6 years of age. The purpose of this study was to extend the lower age range to children aged 5 to 7 years, revise items to ensure clarity, develop new scoring, and evaluate validity of the revised questionnaire. Additional items with improved wording were generated by an expert panel. Analyses of internal consistency, factor loading, and qualitative/quantitative feedback from researchers, clinicians, and parents were used to select 15 items with the strongest psychometric properties. Internal consistency was high (alpha =. 94). The expanded questionnaire was completed by the parents of 287 children, aged 5–15 years, who were typically developing. Logistic regression modeling was used to generate separate cutoff scores for three age groups (overall sensitivity = 85%, specificity = 71%). The revised DCDQ was then compared to other standardized measures in a sample of 232 children referred for therapy services. Differences in scores between children with and without DCD (p <. 001) provide evidence of construct validity. Correlations between DCDQ scores and Movement Assessment Battery for Children (r =. 55) and Test of Visual-Motor Integration (r =. 42) scores support concurrent validity. The results provide evidence that the revised DCDQ is a valid clinical screening tool for DCD.     

Oppositional defiant behavior toward adults and oppositional defiant behavior toward other children: evidence for two separate constructs with mothers' and fathers' ratings of Brazilian children

Background:  Confirmatory factor analysis (CFA) was used to determine if oppositional defiant behavior (ODB) toward adults and oppositional defiant behavior toward other children were constructs distinct from each other as well as from attention-deficit/hyperactivity disorder–hyperactivity/impulsivity (ADHD-HI), attention-deficit/hyperactivity disorder–inattention (ADHD-IN), and academic competence.
Methods:  Mothers and fathers rated the occurrence of the DSM-IV oppositional defiant disorder (ODD) symptoms where the target was an adult (e.g., argues with adults) and the ODD symptoms where the target was another child (brothers, sisters, or peers) (e.g., argues with other children) along with ADHD-IN, ADHD-HI, and academic competence in a sample of 894 Brazilian children on the Portuguese version of the Child and Adolescent Disruptive Behavior Inventory (CADBI).
Results:  The ODB-Adults' and ODB-Children's factors showed invariance (i.e., equality of like item loadings, intercepts, residuals; as well as like factor variances, covariances, and means), convergent validity, and discriminant validity from each other as well as from ADHD-IN, ADHD-HI, and academic competence between mothers' and fathers' ratings.
Conclusions:  With the Portuguese parent version of the CADBI, the evidence indicated that ODB-Adults and ODB-Children represent two constructs rather than one. The distinction between ODB-Adults and ODB-Children allows for a more specific study of the development of ODB in children.     

Effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder

A 3-year-old child was referred to consultation for hyperactivity, attention deficit, impulsivity, and sleep problems. He met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for attention-deficit/hyperactivity disorder. At baseline, the Conners' Parent Rating Scale and the Conners' Teacher Rating Scale raw total scores were 30 and 32, respectively. The child had low a serum ferritin level (13 ng/mL). After 8 months of treatment with Tardyferon (ferrous sulfate, 80 mg/day), his serum ferritin increased to 102 ng/mL. Both parents and teachers reported considerable behavioral improvement. The Conners' Parent and Teacher Rating Scale raw total scores decreased to 19 and 13, respectively. This is the first report of the effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder.     

Family Quality of Life Survey (FQOLS-2006): Evaluation of Internal Consistency,Construct, and Criterion Validity for Socioeconomically Disadvantaged Families

Aims: The purpose of this study was to test the psychometric properties of the Family Quality of Life Survey (FQOLS-2006) when used with urban families predominantly from socioeconomically disadvantaged backgrounds. Methods: Data gathered from 193 family caregivers using the FQOLS-2006 were subjected to reliability analyses, confirmatory factor analyses, and correlational analyses to test the internal consistency of the scales (reliability), factor structure of the scales (construct validity), and convergence between the long and short versions of the tool (criterion validity). Results: Internal consistency of the 54-item total FQOL scale was excellent (α = .89), while that of the six-item domain subscales ranged from moderate to strong (α = .46–.81). Although the subscale-level FQOL factor structure demonstrated good fit, some of the item-level factor loadings within each of the domains were low. Correlations between scores derived from the long and short versions ranged from moderate to strong (r = .37–.73). Conclusions: Although the internal consistency of the scales ranged from moderate to strong, the FQOLS-2006 had only a moderate degree of construct and criterion validity when used with a sample consisting predominantly of minorities from socioeconomically disadvantaged backgrounds.     

The Medical Home Index: development and validation of a new practice-level measure of implementation of the Medical Home model.

OBJECTIVE: The Medical Home is a clinical practice concept that sets new standards for pediatric primary care. This study describes the development and validation of a tool to measure the Medical Home. METHODOLOGY: The Medical Home Index (MHI) consists of 25 themes arranged among 6 domains of primary care office activity. A national panel of experts on the Medical Home reviewed a prototype of the instrument. Pediatric primary care offices completed the MHI and participated in 90-minute on-site interviews with two of the authors (J.W.M., K.S.). The study examined interrater reliability between the 2 project staff and between the practices and project staff and the internal consistency of MHI domains and themes. RESULTS: On a 100-point scale, 43 practices demonstrated a range of MHI summary scores from 18.9 to 75.4, with a mean of 43.9. Kappa coefficients of interrater reliability between two Center for Medical Home Improvement project staff were above.50 for all 25 themes. Kappa scores comparing each staff member and the practice sites' self-assessment found 80% of the themes at.65 or better for one interviewer (J.W.M.) and 60% of the themes at.65 or better for the second interviewer (K.S.). Intraclass correlation coefficients between the summary scores of the interviewers were.98 and between the scores of the two interviewers and the scores of the practices was.97. The internal consistency reliability standardized alpha coefficients across the 6 domains of the MHI ranged from.81 to.91, and the overall standardized alpha coefficient was.96. CONCLUSIONS: In the sample of practices studied, the MHI was an internally consistent instrument with acceptable reliability and validity for pediatric primary care practices to assess their implementation of the Medical Home concept. Further work is needed to study its correlation with other process and outcome measures and its performance in a wider range of practices.     

Development of a culturally appropriate health-related quality of life measure for human immunodeficiency virus-infected children in Thailand

Aim: Develop a reliable and valid self-report health-related quality of life (HRQOL) instrument for human immunodeficiency virus (HIV)-infected children in Thailand. Methods: The Thai Quality of Life for HIV-infected Children instrument, the ThQLHC (an HRQOL measure that uses the Pediatric Quality of Life Inventory as a generic core and a 17-item HIV-targeted scale), was developed and administered cross-sectionally to 292 HIV-infected children in Thailand. The disease-targeted scale included HIV-related symptoms, ability to adhere with their treatment regimens and self-image. The internal consistency reliability (Cronbach's α) and construct validity of the ThQLHC scales were then evaluated. Results: Internal consistency reliability coefficients ranged from 0.57 to 0.82, with four of five scales reaching the minimal acceptable level (>0.70). Significant associations were found between poor HRQOL and poor self-rated disease severity, care giver's rated overall quality of life, cluster of differentiation (CD) 4 percent and plasma HIV ribonucleic acid level. Conclusion: Reliable and valid disease-targeted HRQOL measures for HIV-infected children are essential in the assessment of therapeutic effectiveness. The findings of this cross-sectional survey provide support for the reliability and validity of the ThQLHC as an HRQOL outcome measure for HIV-infected Thai children.     

Autistic traits in a population-based ADHD twin sample

BACKGROUND: Most diagnostic nomenclatures do not allow for the concurrent diagnosis of autism and attention-deficit/hyperactivity disorder (ADHD). Clinic-based studies suggest autistic symptoms are common in children with ADHD, but such studies are prone to referral bias. This study assesses whether children with ADHD selected from the general twin population have elevated levels of autistic traits. METHODS: Nine hundred forty-six twins identified by Missouri birth records were assigned to DSM-IV ADHD diagnoses and seven population-derived ADHD subtypes defined through latent class analysis of DSM-IV ADHD symptoms. The Social Responsiveness Scale (SRS) was used as a quantitative measure of autistic traits. Linear regression was used to evaluate whether mean SRS scores differed between ADHD diagnostic groups. RESULTS: Mean SRS scores for DSM-IV predominantly inattentive subtype and combined subtype ADHD groups were significantly higher than for subjects without DSM-IV ADHD (p < .001, both comparisons). Five of the population-derived ADHD subtypes (talkative-impulsive, mild and severe inattentive, mild and severe combined) had significantly higher mean SRS scores compared to the latent class subtype with few ADHD symptoms (p < .001, all comparisons). DSM-IV combined subtype and the population-derived severe combined subtype had the highest mean total SRS scores and the highest mean scores for each of the three autism symptom domains, with a substantial proportion of individuals scoring in the clinically significant range. CONCLUSIONS: This study provides population-based evidence for clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These results have implications for the design and interpretation of studies of both disorders.