Abstract
Attention-deficit/hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are highly comorbid, with symptoms that share some similarities. The evidence-based diagnostic process for these disorders includes ratings from adults in the child’s life to assess behavior across settings, so it is important to understand how these raters think about potentially overlapping symptoms. Researchers have identified negative halo effects in ratings of ADHD and ODD symptoms, but ratings of CD have not been examined in these prior studies. Thus, the current study extended past research to examine negative halo effects in parent ratings of the predominantly hyperactive-impulsive presentation of ADHD (i.e., ADHD/HI), ODD, and CD. Parent participants read one of four vignettes that portrayed an 11-year-old boy displaying symptoms of ADHD/HI, ODD, CD, or typical development, and then completed a disruptive behavior scale. The general trend we found was that the presence of a relatively more severe disorder (i.e., CD) artificially inflated ratings of - or showed a negative halo effect for - the relatively less severe disorder (i.e., ADHD/HI), but with some nuance as discussed in the paper. These findings explain and validate how important it is that clinicians conduct evidence-based psychological assessments to decrease the chance of misdiagnosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abikoff, H. B., Courtney, M., Pelham, W. E., & Koplewicz, H. S. (1993). Teachers’ ratings of disruptive behaviors: The influence of halo effects. Journal of Abnormal Child Psychology, 21, 519–533. https://doi.org/10.1007/BF00916317.
American Academy of Pediatrics. (2000). Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105, 1158–1170. https://doi.org/10.1542/peds/105.5.1158.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Azeredo, A., Moreria, D., & Barbosa, F. (2018). ADHD, CD, and ODD: Systematic review of genetic and environmental factors. Research in Developmental Disabilities, 82, 10–19. https://doi.org/10.1016/j.ridd.2017.12.010.
Baglivio, M. T., Wolff, K. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2017). Racial/ethnic disproportionality in psychiatric diagnoses and treatment in a sample of serious juvenile offenders. Journal of Youth and Adolescence, 46, 1424–1451. https://doi.org/10.1007/s10964-016-0573-4.
Baltar, F., & Brunet, I. (2012). Social research 2.0: Virtual snowball sampling method using facebook. Internet Research, 22, 57–74. https://doi.org/10.1108/1066224121199960.
Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York, NY: Guilford Press.
Bornstein, R. F. (2017). Evidence-based psychological assessment. Journal of Personality Assessment, 99, 435–445. https://doi.org/10.1080/00223891.2016.1236343.
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80, 128–138. https://doi.org/10.1037/a0026582.
Connor, D. F., Steeber, J., & McBurnett, K. (2010). A review of attention-deficit/hyperactivity disorder complicated by symptoms of oppositional defiant disorder or conduct disorder. Journal of Developmental & Behavioral Pediatrics, 31, 427–440. https://doi.org/10.1097/DBP.0b013e3181e121bd.
De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141, 858–900. https://doi.org/10.1037/a0038498.
DeVries, L. N., Hartung, C. M., & Golden, T. L. (2017). Negative halo effects in parent ratings of ADHD and ODD. Journal of Psychopathology and Behavioral Assessment, 39, 179–188. https://doi.org/10.1007/s10862-016-9560-z.
Duhig, A. M., Renk, K., Epstein, M. K., & Phares, V. (2000). Internal agreement on internalizing, externalizing and total behavior problems: A meta-analysis. Clinical Psychology: Science and Practice, 7, 435–453. https://doi.org/10.1093/clipsy.7.4.435.
Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47, 157–198. https://doi.org/10.1080/15374416.2017.1390757.
Faraone, S. V. (2013). Attention-deficit hyperactivity disorder and the shifting sands of psychiatric nosology. British Journal of Psychiatry, 203, 81–83. https://doi.org/10.1192/bjp.bp.113.126524.
Faraone, S. V., Biederman, J., Spencer, T. J., & Aleardi, M. (2006). Comparing the efficacy of medications for ADHD using meta-analysis. MedGenMed : Medscape general medicine, 8, 4.
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 17581–83191. https://doi.org/10.3758/BF03193146.
Handler, M. W., & DuPaul, G. J. (2005). Assessment of ADHD: Differences across psychology specialty areas. Journal of Attention Disorders, 9, 402–412. https://doi.org/10.1177/108705278762.
Hartung, C. M. & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145, 390–409. https://doi.org/10.1037/bul0000183
Hartung, C. M., Van Pelt, J. C., Armendariz, M. L., & Knight, L. A. (2006). Biases in ratings of disruptive behavior in children: Effects of sex and negative halos. Journal of Attention Disorders, 9, 62081–83630. https://doi.org/10.1177/1087054705284233.
Hartung, C. M., Lefler, E. K., Tempel, A. B., Armendariz, M. L., Sigel, B. A., & Little, C. S. (2010). Halo effects in ratings of ADHD and ODD: Identification of susceptible symptoms. Journal of Psychopathology and Behavioral Assessment, 32, 128–137. https://doi.org/10.1007/s10862-009-9135-3.
Jackson, D. A., & King, A. R. (2004). Gender differences in the effects of oppositional behavior on teacher ratings of ADHD symptoms. Journal of Abnormal Child Psychology, 32, 215–224. https://doi.org/10.1023/B:JACP.0000019772.71251.ff.
Johnston, O. G., & Burke, J. D. (2019). Parental problem recognition and help-seeking for disruptive behavior disorders. The Journal of Behavioral Health Services & Research, 24, 1–18. https://doi.org/10.1007/s11414-018-0948-y.
Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: Issues in measurement development and clinical application. Journal of Clinical Child and Adolescent Psychology, 34, 548–558. https://doi.org/10.1207/s15374424jccp3403_10.
Kimonis, E. R., Frick, P. J., & McMahon, R. J. (2014). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (3rd ed., pp. 145–179). New York: The Guilford Press.
McCart, M. R., & Sheidow, A. J. (2016). Evidence-based psychosocial treatments for adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 45, 529–563. https://doi.org/10.1080/15374416.2016.1146990.
McMahon, R. J., & Frick, P. J. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 477–505. https://doi.org/10.1207/s15374424jccp3403_6.
Nisbett, R. E., & Wilson, T. D. (1977). The halo effect: Evidence for unconscious alteration of judgments. Journal of Personality and Social Psychology, 35, 250–256. https://doi.org/10.1037/0022-3514.35.4.250.
Perugini, M., Gallucci, M., & Costantini, G. (2018). A practical primer to power analysis for simple experimental designs. International Review of Social Psychology, 31, 1–23. https://doi.org/10.5334/irsp.181.
Power, T. J., Costigan, T. E., Leff, S. S., Eiraldi, R., & Landau, S. (2001). Assessing ADHD across settings: Contributions of behavioral assessment to categorical decision making. Journal of Clinical Child & Adolescent Psychology, 30, 399–412. https://doi.org/10.1207/S15374424JCCP3003_11.
Power, T. J., Watkins, M. W., Anastopoulos, A. D., Reid, R., Lambert, M. C., & DuPaul, G. J. (2017). Multi-informant assessment of ADHD symptom-related impairments among children and adolescents. Journal of Clinical Child and Adolescent Psychology, 46, 661–674. https://doi.org/10.1080/15374416.2015.1079781.
Pringsheim, T., Hirsh, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behavior, conduct problems, and aggression in children and adolescents with ADHD, ODD, and CD: A systematic review and meta-analysis. Part 1: Psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60, 42–51. https://doi.org/10.1177/070674371506000202.
Pringsheim, T., Andrade, B., Doja, A., & Gorman, D. A. (2017). Assessment and treatment of oppositional behaviour, conduct problems, and aggression in children and adolescents: Creation and dissemination of a national curriculum. The Canadian Journal of Psychiatry, 62, 431–432. https://doi.org/10.1177/0706743716679818.
Ramos-Quiroga, J. A., Nasillo, V., Richarte, V., Corrales, M., Palma, F., Ibanez, P., Michelsen, M., de Glind, G. V., Casas, M., & Kooij, J. J. S. (2016). Criteria and Concurrent Validity of DIVA 2.0: A Semi-Structured Diagnostic Interview for Adult ADHD. Journal of Attention Disorders, 23, 1126–1135. https://doi.org/10.1177/1087054716646451.
Rimvall, M. K., Jeppesen, P., & Verhulst, F. (2018). The problem of same-rater bias. Journal of the American Academy of Child & Adolescent Psychiatry, 57, 700–701. https://doi.org/10.1016/j.jaac.2018.04.019.
Sanders, M. R., Markie-Dadds, C., Rinaldis, M., Firman, D., & Baig, N. (2007). Using household survey data to inform policy decisions regarding the delivery of evidence-based parenting intervention. Child: Care, Health and Development, 33, 768–783. https://doi.org/10.1111/j.1365-2214.2006.00725.
Schachar, R. J., Sandberg, S., & Rutter, M. (1986). Agreement between teachers’ ratings and observations of hyperactivity, inattentiveness, and defiance. Journal of Abnormal Child Psychology, 14, 331–345. https://doi.org/10.1007/BF00915450.
Silva, R. R., Alpert, M., Pouget, E., Silva, V., Trosper, S., Reyes, K., & Dummit, S. (2005). A rating scale for disruptive behavior disorders, based on the DSM-IV item pool. Psychiatric Quarterly, 76, 327–339. https://doi.org/10.1007/s11126-005-4966-x.
Social Security Administration. (2018). Top names of the period 2010—2017. Retrieved from https://www.ssa.gov/oact/babynames/decades/names2010shtml.
Stevens, J., Quittner, A. L., & Abikoff, H. (1998). Factors influencing elementary school teachers’ ratings of ADHD and ODD behaviors. Journal of Clinical Child Psychology, 27, 406–414. https://doi.org/10.1207/s15374424jccp2704_4.
Thorndike, E. L. (1920). A constant error in psychological ratings. Journal of Applied Psychology, 4, 25–29. https://doi.org/10.1037/h0071663.
Tuvblad, C., Zheng, M., & Baker, L. A. (2008). A common genetic factor explains the covariation among ADHD ODD and CD symptoms in 9-10 year old boys and girls. Journal of Abnormal Child Psychology, 37, 153–167. https://doi.org/10.1007/s10802-008-278-9.
Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28, 559–567. https://doi.org/10.1093/jpepsy/jsg046.
Wolraich, M. L., Hagan, J., Allan, C., Chan, E., Davison, D., Earls, M., et al. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528.
Wright, K. D., Waschbusch, D. A., & Frankland, D. W. (2007). Combining data from parent ratings and parent interview when assessing ADHD. Journal of Psychopathology and Behavioral Assessment, 29, 141–148. https://doi.org/10.1007/s10862-006-9039-4.
Funding
We received funding from the University of Northern Iowa Intercollegiate Academics Fund.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
We have no known conflict of interest to report.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This study was pre-registered using the Open Science Framework (https://osf.io/w86nd/)
Rights and permissions
About this article
Cite this article
Alacha, H.F., Lefler, E.K. Negative Halo Effects in Parent Ratings of ADHD, ODD, and CD. J Psychopathol Behav Assess 43, 466–477 (2021). https://doi.org/10.1007/s10862-020-09860-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-020-09860-1