Contribution of the Behavioral Observation of Students in Schools to ADHD Assessment

  • Yuanyuan JiangEmail author
  • Matthew Capriotti
  • Allyson Beaulieu
  • Mary Rooney
  • Keith McBurnett
  • Linda J. Pfiffner
Original Paper


Classroom observations have long been considered a necessary component of Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations. Yet, research evaluating the utility of observational ratings in ADHD assessment is limited. This study examined the contributions of the Behavioral Observation of Students in Schools (BOSS) to ADHD assessment by investigating associations between BOSS scores with ADHD symptom clusters and symptoms of frequently co-occurring externalizing and internalizing disorders. The utility of BOSS scores in predicting future ADHD-related impairment beyond standard parent and teacher ratings was also examined. One hundred and thirty-five children in grades 2–5 across 23 public schools participated in a randomized controlled trial examining a psychosocial treatment for ADHD. BOSS ratings were collected at baseline. Parent and teacher ratings of child symptoms and impairment were collected at baseline, post-treatment (3–4 months later), and follow-up (8–12 months later). Multiple regressions investigated the associations between the BOSS subscale of Task Engagement (TE) and parent and teacher ratings of ADHD symptoms and related disorders. Multi-level modeling accounted for school cluster effects. Results showed that lower BOSS TE was related to higher teacher-rated inattention but not hyperactivity/impulsivity symptoms. Lower BOSS TE was also associated with higher teacher-rated Oppositional Defiant Disorder (ODD) and depression symptoms, but not anxiety symptoms. Further, BOSS TE predicted higher future impairment beyond baseline teacher and parent ratings of ADHD symptoms and impairment, controlling for treatment. The BOSS appears sensitive to symptoms of child inattention, ODD, and depression, and may have utility in informing future impairment beyond standard informant ratings of ADHD.


Attention-Deficit/Hyperactivity Disorder (ADHD) Behavioral Observation of Students in Schools (BOSS) Task Engagement Systematic direct observations 



The authors thank John DuBois and Melissa Plageman for their contributions to data entry and management, as well as many research assistants and study staff who served as coders.


This work was supported by the Institute of Education Sciences, U.S. Department of Education Award Grant R324A120358 (Principal Investigator: Linda J. Pfiffner).

Compliance with Ethical Standards

Conflict of interest

Dr. McBurnett has received research support from Akili Interactive and Shire Pharmaceuticals. Dr. Capriotti receives grant funding from the American Academy of Neurology, Tourette Association of America (Clinical Research Training Fellowship in Tourette Syndrome), and Center for California Studies at Sacramento State University. Dr. Capriotti has received honoraria from Sanofi Genzyme for presenting on mindfulness at events for individuals with Multiple Sclerosis and from the Tourette Association of America for leading workshops on behavioral treatment of Tourette Syndrome. Drs. Jiang, Beaulieu, Rooney, and Pfiffner report no potential conflicts of interest.

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Yuanyuan Jiang
    • 1
    • 2
    Email author
  • Matthew Capriotti
    • 1
    • 3
  • Allyson Beaulieu
    • 1
  • Mary Rooney
    • 1
  • Keith McBurnett
    • 1
  • Linda J. Pfiffner
    • 1
  1. 1.Department of PsychiatryUniversity of California, San Francisco401 Parnassus Ave., San FranciscoUSA
  2. 2.Department of Educational PsychologyUniversity of AlbertaEdmontonCanada
  3. 3.Department of PsychologySan José UniversitySan JoseUSA

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