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The Relation Between Change in Symptoms and Functioning in Children with ADHD Receiving School-Based Mental Health Services

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Abstract

This study examined the relation between reliable change in symptoms and reliable change in functioning in children with attention deficit hyperactivity disorder (ADHD; N = 64) who were enrolled in a school-based mental health program that included a daily report card intervention, teacher consultation, and behavioral parenting sessions. Parents and teachers completed the disruptive behavior disorders rating scale and the impairment rating scale at pre- and post-treatment. Group-level analyses indicated that symptom improvers demonstrated significant improvement in multiple domains of functioning, whereas symptom no-changers and deteriorators did not. However, individual-level analyses revealed that up to 40% (depending on the domain and the informant) of children achieved reliable symptom change without reliable improvement in functioning, and up to 16% achieved reliable change in functioning without reliable change in symptoms. The results have implications for measurement of treatment outcome.

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Notes

  1. Of the 25 children for whom there are teacher data but not parent data, 19 (76%) are due to lack of parent completion of one of the rating scales (as ratings of symptoms and impairment at both time points are needed to remain in the parent analyses). This was primarily due to the fact that parents were not paid for rating scale completion in the first year of the program, resulting in more missing data in year 1 (for 7 of 19 cases) than in other years (12 spread across the remaining 5 years). The remaining 6 children (24%) were not included in the parent analyses because parent ratings of symptoms fell within the normal range. Early identification and early intervention are priorities of the school mental health program (e.g. 73% of the sample is in K through 3rd grade). As such, it is common for teacher ratings to be more severe than parent ratings at baseline, as this is often the first time that parents have been informed that their child is impaired or having difficulty. Similarly, in our clinical experience with this low-income rural sample, it is common for parent report of child symptoms to be slightly less severe on paper rating scales than during the face-to-face diagnostic interview (perhaps due to greater comfort or less defensiveness in a face-to-face meeting). Because multiple sources of information (i.e., interviews, rating scales of symptoms and impairment, and observation of the child) are synthesized to determine the child’s diagnosis, these children meet the criteria for ADHD. However, to remain consistent with the criteria for the within-informant teacher analyses, these children are not included in the within-informant parent analyses due to the parent rating of symptoms at baseline. Thus, the sample sizes vary analyses by analyses.

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Authors and Affiliations

  1. Department of Psychology, Ohio University, Porter Hall 200, Athens, OH, 45701, USA

    Julie Sarno Owens, Lindsay M. Johannes & Veronika Karpenko

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  1. Julie Sarno Owens
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  2. Lindsay M. Johannes
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  3. Veronika Karpenko
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Correspondence to Julie Sarno Owens.

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Owens, J.S., Johannes, L.M. & Karpenko, V. The Relation Between Change in Symptoms and Functioning in Children with ADHD Receiving School-Based Mental Health Services. School Mental Health 1, 183–195 (2009). https://doi.org/10.1007/s12310-009-9020-y

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