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-re-test 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.