According to the CDC, almost 1 in 10 children will be diagnosed with attention-deficit/hyperactivity disorder, and ADHD is associated with many of the mental, cognitive, and behavioural disorders that can affect quality of life children and their families. Healthcare providers who work with children often encounter ADHD, whether it is the main focus of treatment or not, so there is a strong need for a simple way to measure symptoms associated with attentional problems.
The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) was designed to assess ADHD in children ages 6 to 12. It is now available within CBS Health to administer alongside measures of cognitive function, allowing practitioners to efficiently measure ADHD, cognition, and comorbid disorders in one integrated protocol.
What are the VADRS and VADPRS?
The VADRS is a relatively new instrument, created in 2003 by Mark L. Wolraich, MD, and colleagues. They noted that other behaviour rating scales, like Conners and the Child Behavior Checklist, deviated from the DSM-IV’s diagnostic criteria for ADHD in key ways. As a response, the authors developed the VADRS as a simple instrument for teachers and parents to identify core symptoms of ADHD aligned with standard diagnostic criteria. The version of the VADRS included in CBS Health is designed for parents, and also known as the Vanderbilt ADHD Parent Rating Scale (VADPRS).
The scale includes 55 items covering the DSM-IV criteria for ADHD, criteria for oppositional defiant disorder (ODD), criteria for conduct disorder (CD), and criteria from the Pediatric Behavior Scale for anxiety and depression. Additional items cover performance in school and relationships with others. It takes about 10 minutes to complete. Parents rate the severity of each behaviour over the past 6 months on a 4-point scale from “never” to “very often,” then scores are tallied to provide guidance on whether or not the criteria for inattentive, hyperactive/impulsive, and combined types of ADHD have been met. Issues with oppositional-defiant disorder, conduct disorder, and anxiety/depression are also highlighted if cutoff scores are reached (see the National Institute for Children’s Health Quality for scoring details).
The CBS Health version of the VADRS allows a parent to rate the behaviours of children aged 6 to 12, and automatically calculates scores related to ADHD and comorbid conditions. The Vanderbilt Scale joins the ASRS, which measures symptoms of adult ADHD.
The VADRS has proven to be a reliable tool with strong psychometric properties. Wolraich et al. (2003) concluded that the internal consistency and factor structure of the parent version of the VADRS are acceptable, and consistent with other measures of ADHD as well as DSM-IV criteria. As a result, the scale is widely used in both research and clinical settings.
Note that clinical judgment should always be used when interpreting an individual’s VADRS scores. It is a screening scale, not a diagnostic test. A trained clinician must follow up with patients who reach the cutoff score for ADHD subtypes or comorbid disorders.
How is ADHD related to cognition in children?
Cognitive function assessments, like those included in CBS Health, are important tools to assist in the diagnosis, treatment, and management of childhood ADHD. As a diagnostic aid, cognition scores can complement ADHD tools like the VADRS, verifying self-reported symptoms with objective data, providing additional details on the specific cognitive domains affected, or ruling out broader cognitive impairment. As treatment progresses, many providers will administer cognitive assessments alongside self-report ADHD questionnaires and other specialized ADHD assessment tools in order to verify that treatments are not only moving patients away from the thresholds on the VADRS, but also showing up in objective cognitive measures.
Cognition has been linked with ADHD in children. For example, both the inattention and hyperactivity/impulsivity scores on the VADRS are correlated with parent-reported measures of executive function (Becker & Langberg, 2013), and other DSM-based ADHD scales have been linked with intellectual function (e.g., children diagnosed with predominantly inattentive ADHD tend to score lower in the processing speed index of the WISC-IV; Thaler, Bello, & Etcoff, 2012). Cognitive domains like inhibitory control (measured by Double Trouble in CBS Health), working memory (measured by Monkey Ladder and other tests in CBS Health), and short-term attention itself (measured by Feature Match in CBS Health) may be of particular interest to clinicians treating ADHD, and have been shown to be impaired in children diagnosed with ADHD (see Castellanos & Tannock, 2002).
When treating ADHD, cognition has been used as a key outcome measure to gauge progress and adjust intervention plans. In one study, children enrolled in a behavioural program for treating attentional issues improved on CBS Health measures of cognition more than a control group (Jackson & Wild, 2021), and the cognitive reports have been used to objectively demonstrate progress to parents.
For medication-based treatments such as methylphenidate, objective cognitive measures complement parent rating forms to help determine proper dosages and measure progress. In fact, cognition may mediate the effects of medication on behavioural outcomes such as productivity—that is, medication improves cognition, which goes on to improve visible symptoms of ADHD (see Hawk et al., 2018). Measuring cognition may also be beneficial for long-term follow up with ADHD patients, as maturation of cognitive function can predict ADHD remission (Halperin et al., 2008; Karalunas et al., 2017).
Because of the complex role of cognition in the treatment of and recovery from ADHD, it is essential to gain as much patient information as possible, including parent-reported information from the VADRS and objective cognitive data from CBS Health cognitive assessments.
Which healthcare providers will gain value from measuring ADHD with the VADRS?
Any healthcare provider who works with children may benefit from measuring ADHD, whether or not ADHD is the primary focus. Especially in children, the underlying reason for everyday difficulties that lead a parent to seek treatment may not be clear. ADHD and the comorbid disorders identified in the VADRS can be a key determinant of visible problems, such as poor academic achievement and concerning behaviour in school. Where that is the case, measuring, acknowledging, and treating ADHD can lead to significant improvements (Prasad et al., 2012).
The VADRS can also highlight issues related to oppositional defiant disorder, conduct disorder, and anxiety / depression, making it ideal for quickly addressing multiple areas of concern for children where scales designed for adults are not appropriate.
Nearly any psychiatrist, clinical psychologist, or neurologist with young patients may find value in administering the VADRS alongside CBS Health cognitive assessments to gain a fuller picture of a child’s mental and cognitive health in order to inform diagnoses and guide treatments. If parent-reported scales like the VADRS and objective cognitive measures of attention like the CBS Health cognitive tasks are both improving, they can provide strong evidence that treatments are having effects that will improve a child’s quality of life.
How to administer a computerized version of the Vanderbilt ADHD Diagnostic Rating Scale in CBS Health
It is easy for clinicians using CBS Health to include the VADRS in an assessment protocol. The scale can be sent on its own, or alongside a series of cognitive tasks. When creating a protocol within CBS Health, click the Questionnaires section, then check off the VADRS. You can check off tasks from the Cognitive Assessments section for an integrated flow. Remember, the VADRS is designed for a parent to complete, so it may require a heads-up to the parent to pass the device to the child when it is time to complete the cognitive assessment portion of the protocol.
For detailed instructions on administering questionnaires within CBS Health, please see our previous blog post on administering a computerized PHQ-9.
The version of the VADRS included in CBS Health is fully digital, and thus the questionnaire can be administered to parents in-clinic or at home, and requires no special training. The scale can also be added to a CBS Health schedule, allowing you to automatically send it via email at predefined times. The results are scored instantly, and if a patient completes the questionnaire more than once, results are added to the patient’s report to track changes in response to treatments, or to monitor for variations over time. For parents, completing the ASRS takes about ten minutes and no registration or login are required. With minimal effort, you as the healthcare provider, patients, and parents all benefit from the valuable information provided by a standardized, validated measure of ADHD symptoms.
Need more computerized health questionnaires and checklists?
If there are any questionnaires you would like in CBS Health, such as those you are currently administering in pen-and-paper form, please do not hesitate to let us know by commenting on this blog post or contacting us directly by email. We are always happy to hear your feedback.
Thanks, as always,
— The Cambridge Brain Sciences Team