1

Vanderbilt ADHD Diagnostic Parent Rating Scale Handout

MPS351 - Psychodiagnostics Lab-II

Department of Psychology

Prof. Suchitra

18th July,2025

Urvashi Arora (2422358)

3 MPCL-C

Christ (Deemed to Be University) Delhi NCR

2

Vanderbilt ADHD Diagnostic Parent Rating Scale

Purpose

The Vanderbilt ADHD Parent Rating Scale is intended to assess behavioural issues such

as Conduct Disorder and Oppositional Defiant Disorder, and ADHD symptoms in children.

Introduction

ADHD is a neurodevelopmental condition marked by impaired levels of inattention,

disorganisation, and/or hyperactivity-impulsivity. Disorganisation and inattention include losing

task-related documents, appearing not to listen, and being unable to focus at levels that align

with developmental stage or age. Overactivity, fidgeting, difficulty staying seated, interfering

with other people's activities, and an unwillingness to wait are all signs of hyperactivity-

impulsivity disproportionate to a person's age or developmental stage. ADHD commonly co-

occurs in children with conditions including conduct disorder and oppositional defiant disorder,

which are frequently referred to as "externalising disorders." Social, intellectual, and professional

functioning are all negatively impacted by ADHD, which frequently lasts into adulthood

(American Psychiatric Association, 2022).

Attention Deficit Hyperactivity Disorder (ADHD) has a history extending over two

hundred years. Although Sir Alexander Crichton, in 1798, was likely unable to diagnose ADHD

accurately, he was able to characterise behaviours resembling ADHD as "an incapacity of

attending with a necessary degree of constancy." He suggested he could see "much

distractibility" and impulsivity in several children (Lange [Link]. 2010).

The understanding of ADHD captured national attention in the 20th century as we

became more aware of the issues linking brain injury to behaviours that led to "defect, minimal
3

brain damage as well as its successor, "minimal brain dysfunction," when someone pointed out

that encephalitis lethargica had caused the subsequent or lingering behavioural changes. In 1937,

Charles Bradley began the first use of stimulant medications for hyperactivity. As medications

were developed, "diagnostic labels" also emerged through the progression of DSM manuals from

"Hyperkinetic Reaction of Childhood" (1968), "Attention Deficit Disorder" (1980), to "Attention

Deficit Hyperactivity Disorder" (ADHD) (1987), and subtypes in 1994. From the original

characterisations of ADHD, an entire diagnostic system emerged to characterise ADHD as a

complex neurodevelopmental disorder that affects both children and adults in varying conditions

with biological, psychological, and social domains (Lange [Link]. 2010).

Prevalence in India

In a study done by Sharma et. al (2020), it was found that 6.34% of people have ADHD

(13/205). The majority of children with ADHD (69.3%) lived in joint families and were from

the lower/lower middle class.

Clinical picture

The symptoms of inattention include not paying close attention, hurrying through tasks,

missing details, not seeming to listen while someone is speaking, having trouble organising

things, not finishing work, avoiding or not enjoying tasks that require much mental effort, losing

things, or forgetting things.

Fidgeting, leaving their seat, climbing on objects, being loud, answering questions too

quickly, talking too much or out of turn, having difficulties waiting their turn, interrupting or

intruding on others, and feeling like an "internal motor" is always running are all signs of

hyperactivity. These symptoms need to appear in several contexts. (Magnus, 2023).

Diagnostic criteria (DSM-5-TR)

4

“A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with

functioning or development, as characterised by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a

degree that is inconsistent with developmental level and that negatively impacts directly on

social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility,

or failure to understand tasks or instructions. At least five symptoms are required for older

adolescents and adults (age 17 and older).

a. Often fails to give close attention to details or makes careless mistakes in schoolwork,

at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty

remaining focused during lectures, conversations, or lengthy reading).

c. Often does not listen when spoken to directly (e.g., mind seems elsewhere, even

without obvious distraction).

d. Often does not follow instructions and fails to finish schoolwork, chores, or duties in

the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

e. Often has difficulty organising tasks and activities (e.g., difficulty managing sequential

tasks; difficulty keeping materials and belongings in order; messy, disorganised work;

has poor time management; fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental

effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports,

completing forms, reviewing lengthy papers).

5

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils,

books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. It is often easily distracted by extraneous stimuli (for older adolescents and adults, it

may include unrelated thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older

adolescents and adults, returning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at

least 6 months to a degree that is inconsistent with developmental level and that negatively

impacts social and academic/occupational activities:

Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility,

or a failure to understand tasks or instructions. At least five symptoms are required for older

adolescents and adults (age 17 and older).

a. Often fidgets with or taps hands or feet, or squirms in their seat.

b. Often leaves seat when remaining seated is expected (e.g., leaves his or her place in the

classroom, in the office or other workplace, or in other situations that require remaining

in place).

c. Often runs about or climbs in situations where it is inappropriate. (Note: It may be

limited to feeling restless in adolescents or adults.)

d. Often unable to play or engage in leisure activities quietly.

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or

uncomfortable being still for an extended time, as in restaurants, meetings; may be

experienced by others as being restless or difficult to keep up with).

f. Often talks excessively.

6

g. Often blurts out an answer before a question has been completed (e.g., completes

people’s sentences; cannot wait for a turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or

activities; may start using other people’s things without asking or receiving permission;

for adolescents and adults, may intrude into or take over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings

(e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social,

academic, or occupational functioning.

E. The symptoms do not occur exclusively during schizophrenia or another psychotic disorder.

They are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder,

dissociative disorder, personality disorder, substance intoxication or withdrawal).

Specify whether:

F90.2 Combined presentation: If both Criterion A1 (inattention) and Criterion A2

(hyperactivity-impulsivity) have been met for the past 6 months,

F90.0 Predominantly inattentive presentation: If Criterion A1 (inattention) is met but

Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

F90.1 Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-

impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

Specify if:
7

In partial remission: When full criteria were previously met, fewer than the full criteria have

been met for the past 6 months, and the symptoms still result in impairment in social, academic,

or occupational functioning.

Specify current severity:

Mild: Few, if any, symptoms over those required to make the diagnosis are present,

resulting in no more than minor impairments in social or occupational functioning.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms over those required to make the diagnosis, or several symptoms

that are particularly severe, are present, or the symptoms result in marked impairment in

social or occupational functioning. (APA, 2022)”

Diagnostic criteria Description (ICD-11)

Attention deficit hyperactivity disorder

“Attention deficit hyperactivity disorder is characterised by a persistent pattern (at least 6

months) of inattention and/or hyperactivity-impulsivity (prior to age 12), with onset during the

developmental period, typically early to mid-childhood. The degree of inattention and

hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of

intellectual functioning and significantly interferes with academic, occupational, or social

functioning. Inattention refers to significant difficulty in sustaining attention to tasks that do not

provide a high level of stimulation or frequent rewards, distractibility and problems with

organisation. Hyperactivity refers to excessive motor activity and difficulties remaining still,

most evident in structured situations requiring behavioural self-control. Impulsivity is a

tendency to act in response to immediate stimuli, without deliberation or consideration of the

risks and consequences. The relative balance and the specific manifestations of inattentive and
8

hyperactive-impulsive characteristics vary across individuals and may change throughout

development. In order to diagnose a disorder, the behaviour pattern must be observable in

multiple settings (WHO, 2019).

Diagnostic criteria Description (ICD-10)

Hyperkinetic Disorder

“A group of disorders characterised by an early onset (usually in the first five years of

life), lack of persistence in activities that require cognitive involvement, and a tendency to move

from one activity to another without completing any one, together with disorganised, ill-

regulated, and excessive activity. Several other abnormalities may be associated. Hyperkinetic

children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary

trouble because of unthinking breaches of rules rather than deliberate defiance. Their

relationships with adults are often socially disinhibited, lacking normal caution and reserve. They

are unpopular with other children and may become isolated. Impairment of cognitive functions is

common, and specific motor and language development delays are disproportionately frequent.

Secondary complications include dissocial behaviour and low self-esteem (WHO, 2019).”

Differential Diagnosis

Autism spectrum disorder

Individuals diagnosed with ADHD or ASD exhibit difficulty in sustaining attention,

social dysfunction, and behaviour which is challenging to manage. However, ASD symptoms

like isolation, avoiding social interaction and indifference to non-verbal cues like tone, facial

expression can be distinguished from peer rejection, social dysfunction seen in individuals who

are diagnosed with ADHD. Both children diagnosed with ASD and ADHD may display
9

tantrums, but for different reasons- children with ASD may not be able to adapt to changes in

their routine. In contrast, children with ADHD may behave in this way due to a lack of control or

impulsivity.

Personality disorder

In adults and adolescents, it is challenging to differentiate ADHD from borderline,

narcissistic, and other personality disorders. The personality disorders have characteristics such

as intrusiveness in interpersonal relationships, emotional dysregulation, disorganisation, and

cognitive dysregulation. In contrast, ADHD is not characterised by fear of abandonment, self-

injury, or extreme ambivalence, which are personality disorder features. Extensive clinical

observation, complete history, or informant interview may be needed to differentiate impulsive,

socially intrusive, or inappropriate behaviour from domineering, aggressive, or narcissistic

behaviour to make this differential diagnosis.

Substance use disorders

If recurrent substance abuse precedes the onset of ADHD symptoms, it may be

challenging to differentiate ADHD from substance use disorders. Thus, it is essential to gather

information regarding the presence of symptoms of ADHD before substance misuse from an

informant for an appropriate differential diagnosis.

Oppositional defiant disorder

Individuals with ODD, characterised by negativity, hostility, and defiance, may resist

instructions or demands from others and thus may refuse to engage in school or work tasks.

Unlike ADHD, these symptoms are not due to inattention, forgetting instructions or impulsivity.

Reactive attachment disorder

10

Children with reactive attachment disorder may show social disinhibition and inability to

maintain or form enduring relationships, which is not characteristic of ADHD.

Intermittent explosive disorder

Individuals with ADHD or Intermittent explosive disorder are impulsive. However,

individuals with intermittent explosive disorder show high levels of aggression towards others,

which is not seen in Individuals with ADHD, and they do not show difficulties in maintaining

attention, which is a characteristic symptom of individuals with ADHD. It should be noted that

intermittent explosive disorder can be diagnosed in the presence of ADHD.

Specific learning disorder

Children diagnosed with SLD may show signs of inattentiveness due to frustration, lack

of interest or due to the reduced capacity in neurocognitive processes. It has been seen that their

inattention is much reduced in situations where they need to perform a skill that does not require

an impaired cognitive process.

Intellectual developmental disorder

When children with intellectual developmental disorders are placed in academic

environments that are not appropriate for their level of intelligence, they frequently exhibit signs

of ADHD, which are not apparent in non-academic tasks. The symptoms of hyperactivity or

inattention must be out of proportion to mental age in order for ADHD to be diagnosed in

intellectual developmental disorders.

Anxiety disorder

Individuals with ADHD exhibit symptoms of inattentiveness due to their preoccupation

with novel, stimulating, enjoyable activities, which is distinguished from the inattentiveness

caused by constant worry and rumination, which is often seen in individuals diagnosed with
11

anxiety disorders. In children under age 6 years, PTSD can manifest as irritability, inattention,

restlessness, etc, which can be mistaken for ADHD. Thus, it is essential to rule out PTSD by

doing a comprehensive assessment of the history of traumatic experiences.

Bipolar disorder

Individuals with bipolar disorder may exhibit difficulty in concentrating, increased

activity or impulsivity, but these symptoms are episodic, unlike ADHD. Moreover, in bipolar

disorder, these symptoms are accompanied by elevated mood, grandiosity, and other specific

bipolar features, which can help distinguish between the two. Children with ADHD can show

several mood fluctuations within the same day, which is not similar to a manic or hypomanic

episode, which should be four or more days in duration to qualify as a clinical indicator of

bipolar disorder. Furthermore, unlike ADHD, Bipolar disorder is not common in younger

children.

Individuals with depressive episodes may present with an inability to concentrate, which

occurs mainly during these episodes.

Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder is characterised by pervasive irritability and

intolerance of frustration. However, impulsivity and disorganised attention, which are

characteristic of ADHD, are not required for the diagnosis of Disruptive mood dysregulation

disorder. However, most children and adolescents with the disorder also have symptoms that

meet the criteria for ADHD, which is diagnosed separately.

Psychotic disorder

If the symptoms of hyperactivity and inattention only manifest during a psychotic

disease, ADHD is not diagnosed.

12

Medication-induced symptoms of ADHD

Suppose symptoms of ADHD, like hyperactivity, impulsivity or inattention, are caused

by the use of medicines (e.g., bronchodilators, isoniazid, neuroleptics, thyroid replacement

medication). In that case, they are diagnosed as other specified or unspecified other (or

unknown) substance–related disorders.

Neurocognitive disorder

Complex attention impairment can be an affected cognitive domain in a neurocognitive

disorder. However, in order to diagnose it as a significant or mild neurocognitive disorder, it

must show a decline from a previous level of functioning, and it usually has an onset in

adulthood. For example, Alzheimer's disease shows a progressive decline in attention and

memory from a previous level of functioning, with onset in adulthood. However, the inattention

in ADHD must have been present prior to age 12 and does not represent a decline from previous

functioning. (APA,2022)

Other neurodevelopmental disorders

Individuals with ADHD may exhibit increased motor activity, they may show symptoms

of restlessness or fidgetiness, and this should be distinguished from repetitive motor behaviour

that characterises stereotypic movement disorder and some cases of autism spectrum disorder. In

Tourette’s disorder, the presence of frequent multiple tics may be misinterpreted as the general

restlessness or fidgetiness seen in ADHD.

Comorbidity

ADHD can show high comorbidity with oppositional defiant disorder, autism spectrum

disorder, and personality and substance use disorders. About 50% of children with the mixed

presentation and 25% of children with the primarily inattentive presentation had both ADHD and
13

oppositional defiant disorder. Conduct disorder co-occurs in about 25 per cent of children or

adolescents with the combined presentation, depending on age and setting. While a smaller

percentage of children with ADHD exhibit symptoms, the majority of children and adolescents

with disruptive mood dysregulation disorder (DMDD) also exhibit symptoms that fit the criteria

for ADHD. Even though it has been said that, as compared to the general population, individuals

with ADHD are more likely to develop substance abuse disorder, it is common in only a

minority of adults with ADHD. ADHD may co-occur with other neurodevelopmental disorders,

including SLD, ASD, IDD, language disorders, and developmental coordination disorder

(APA,2022)

Need for assessment

Early Identification and Diagnosis

The Vanderbilt assessment aids in the early detection of symptoms of ADHD according

to DSM-5 criteria for the timely diagnosis of children and adolescents.

Symptom Type Differentiation

It aids in classification into one of the ADHD subtypes: Inattentive, Hyperactive-

Impulsive, or Combined, while also evaluating possible coexisting disorders such as

Oppositional Defiant Disorder, Anxiety, and Depression.

Planning Intervention and Support Services

Upon interpretation of the Vanderbilt test results, mental health professionals, educators,

and caregivers proceed to customise therapeutic interventions and behavioural management

strategies geared toward the child's particular symptom presentation.

Educational Placement and Academic Support

14

Based on assessment outcomes, consideration can be given to what accommodations may

be most helpful for the child at school, for example, extended time, a highly structured routine,

or a classroom behaviour support system.

Monitoring Treatment Progress

The tool monitors whether symptoms progress or disappear over time and allows

treatment plans to be updated regularly, e.g., whether medications or behavioural therapies are

effectively working.

Parent and Teacher Collaboration

Promoting collaboration by the teacher/parent reports helps get a more balanced view of

the child's behaviour in different settings and is essential for building consistent support

strategies.

Culturally Sensitive Application in India

Though developed for Western contexts, the scale is usually modified for Indian settings,

with clinicians ensuring a contextually relevant interpretation with school staff and caregivers.

Vanderbilt Attention Deficit/Hyperactive Disorder Parent Rating Scale

Background of the test

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a screening tool for

teachers/parents of children aged 6 to 12, designed to measure the severity of attention deficit

hyperactivity disorder (ADHD) symptoms. A toolbox for evaluating and treating ADHD in

primary care settings was jointly released in 2002 by the American Academy of Paediatrics

(AAP) and the National Initiative for Children's Healthcare Quality (NICHQ) (Wolraich et al.,

2003).
15

Two versions of the assessment are available: Vanderbilt ADHD Parent Rating Scale

(VADPRS) and Vanderbilt ADHD Teacher Rating Scale (VADTRS). Both versions are used to

assess ADHD symptoms and related impairments in children. The VADPRS has 55 items, while

the VADTRS has 43 items. Both offer ADHD symptom checks as well as screenings for

common comorbidities such as conduct disorder, anxiety/depression, and oppositional-defiant

disorder. The combined use of VADPRS and VADTRS helps clinicians identify whether

functional impairment exists across settings, distinguish between situational versus pervasive

difficulties, and develop more targeted intervention strategies that address setting-specific needs.

Mark L. Wolraich of Vanderbilt University's Oklahoma Health Sciences Centre created

the Vanderbilt Attention Deficit/Hyperactive Disorder Parent Rating Scale (VADPRS). Rooted

in the criteria established by the Diagnostic and Statistical Manual of Mental Disorders, Fourth

Edition (DSM-IV), the assessment assesses core ADHD symptoms, including inattention,

hyperactivity, and impulsivity, as well as additional domains relevant to childhood behaviour

disorders such as oppositional-defiant behaviour, conduct disorder, and anxiety/depression.

Although the VADPRS was created for the DSM-IV criteria, it is important to note that

diagnosing ADHD, ODD, and CD in children remained the same across editions, making the

VADPRS compatible with the current version (DSM-5) for these diagnoses. In a single

environment (the home), the VADPRS can be used to evaluate the degree of impairment,

comorbidities, and the presence of diagnostic behaviours. To aid in diagnosing ADHD, this data

can be compared with supporting data from the Vanderbilt Attention Deficit/Hyperactive

Disorder Teacher Rating Scale (VADTRS) or another source (Wolraich et al., 2003).

Description of the test

16

There are a total 55-item in VADPRS, it has two main components: symptom assessment

(47 items) and performance impairment (8 items) to assess parents' perceptions of youth school

and social functioning, consisting of 18 DSM-IV ADHD symptom items as well as subscales

that screen for eight ODD behaviors, fourteen CD behaviors, and seven anxiety or depression

behaviors. Academic performance is measured by four factors: (a) general academic

performance; (b) reading comprehension; (c) math; and (d) writing expression. Another four

items evaluate relationships: (e) peers, (f) siblings, (g) parents, and (h) participation in organised

activities to assess parents’ perceptions of the youth's school and social functioning.

Reliability

The reliability of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) is

strong, with Cronbach’s alpha ranging from 0.90 to 0.94 for ADHD subscales and above 0.80 for

ODD, CD, and anxiety/depression subscales, indicating excellent internal consistency.

Validity

High correlations with structured clinical interviews such as the C-DISC-IV (r = 0.70–

0.79, concurrent validity), distinction of ADHD from non-ADHD cases (discriminant validity),

and agreement with DSM criteria (construct validity) all support the validity of the VADPRS. It

also shows good diagnostic accuracy with a sensitivity of 0.80–0.85 and a specificity of 0.75–

0.90.

Strengths and Limitations of the Test

Strength of the VADPRS

Psychometric Strength. Preliminary studies indicate that the VADPRS demonstrates

strong internal consistency and reliability in assessing core ADHD symptoms. Its structure aligns

with DSM criteria, which supports its use in clinical screening and diagnosis. Although further
17

validation is needed, existing evidence suggests it is a dependable instrument for initial ADHD

assessment.

Comprehensive Symptom Coverage. The scale goes beyond ADHD core symptoms by

including screening sections for comorbid externalising and internalising disorders such as

Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and anxiety/depression. This

helps clinicians identify co-occurring problems that can influence diagnosis and treatment

planning.

Functional Impact Assessment. The Academic and Behavioural Performance subscales

are unique features of the VADPRS. These items help assess how symptoms affect real-life

functioning in educational and social settings, supporting the diagnosis of impairment, which is a

DSM requirement for ADHD.

Clinical Utility of Total Scores. Using total sum scores rather than just counting positive

symptoms enhances the clinical application of the scale. As Becker et al. (2012) supported, sum

scores provide a more straightforward overview of symptom severity and allow better screening

of comorbid conditions, particularly in busy primary care settings.

International Applicability. The VADPRS is available in empirically supported

translations such as Spanish and German, increasing its accessibility for non-English-speaking

populations and promoting global use in diverse clinical settings.

Limitations of the VADPRS

Subjectivity in Parent Reporting. One key limitation is its dependence on parent-

reported data, which is inherently subjective. Parents may misinterpret behavioural items or

reports based on personal expectations, emotional state, or social pressures. This can introduce

bias and reduce reliability, especially without corroborating information.

18

Lack of Normative Data. Unlike the Vanderbilt Teacher Rating Scale (VADTRS), the

VADPRS lacks comprehensive normative data, particularly at the national level. This restricts its

ability to provide standardised comparisons across populations and limits generalizability.

Limited Validation for Comorbid Screens. The comorbidity subscales (ODD, CD,

anxiety/depression) have not undergone extensive validation. While they are helpful for

screening, their diagnostic precision remains unclear, and they should not be used as standalone

diagnostic tools for these conditions.

Insufficient Evidence for Long-Term Use. There is a lack of strong evidence regarding

the stability and discriminant validity of the VADPRS over time. This limits its utility in long-

term follow-up assessments or in clearly distinguishing ADHD from other developmental or

behavioural disorders.

Should Not Be Used in Isolation. The VADPRS is not a substitute for a complete

diagnostic workup. It must be used alongside other assessment tools such as teacher ratings,

clinical interviews, and observational methods to ensure an accurate and well-rounded diagnosis.

Clinical Application of the Test

Diagnostic Accuracy and DSM Alignment

The Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) is closely aligned

with DSM-IV and DSM-5 diagnostic criteria, making it a clinically reliable tool for identifying

ADHD. It aids in differentiating among the three ADHD subtypes, Inattentive, Hyperactive-

Impulsive, and Combined, based on the required symptom thresholds. By including both

symptom frequency and impairment ratings, the scale ensures that diagnoses are not made solely

on behavioural presence, thus reducing the risk of overdiagnosis and promoting more accurate

clinical judgment.
19

Behavioural Baseline and Progress Monitoring

The VADPRS allows clinicians to establish a behavioural baseline for tracking the child's

progress over time. It is beneficial for evaluating the effectiveness of interventions, including

medication or behavioural therapy. The follow-up version of the scale focuses on core ADHD

symptoms and performance impairments, helping clinicians monitor

Identification of Comorbid Conditions

In addition to ADHD symptoms, the VADPRS includes subscales that screen for

common comorbidities such as oppositional defiant disorder (ODD), conduct disorder (CD), and

anxiety/depression. According to Becker et al. (2012), while symptom-count thresholds have

limited sensitivity, using sum scores significantly improves the ability to rule out these

conditions in primary care. This makes the VADPRS especially helpful in identifying children

who may not require specialised referrals, thereby improving efficiency in clinical decision-

making.

Enhancing Parent Involvement

The scale is completed by parents or primary caregivers, which provides valuable

observational data and fosters their involvement in the assessment process. This engagement

improves the accuracy of diagnosis and increases parental participation in treatment planning and

monitoring, ultimately leading to better treatment adherence and outcomes.

Support for Individualised Treatment Planning

By providing detailed information about symptom severity and impairment, the

VADPRS supports clinicians in developing individualised treatment plans. It helps determine the

necessity of medication, therapy, or school accommodations and informs clinical decisions based

on symptom patterns and functional needs.

20

Educational and Collaborative Use

The results from the VADPRS can inform educational interventions by identifying areas

where the child may need support. The scale encourages collaboration between clinicians,

parents, and teachers, promoting a coordinated and comprehensive approach to managing

ADHD. This team-based strategy is especially beneficial in ensuring consistency across home,

school, and clinical settings.

Alternative Assessment

Conners Rating Scales

The Conners Rating Scales are among the most widely used tools in Indian clinical

practice, especially in urban hospitals, private clinics, and educational institutions. They are

available in parent, teacher, and self-report forms and assess ADHD symptoms along with

related behavioural and emotional issues such as oppositional defiant behaviour, conduct

problems, and learning difficulties. While the original tool is based on Western norms, Indian

clinicians often adapt the interpretation based on contextual understanding. Some translated

versions are informally used in regional languages like Hindi and Tamil to make them accessible

to non-English-speaking populations.

SNAP-IV (Swanson, Nolan, and Pelham Questionnaire)

SNAP-IV is widely used in Indian schools and community health centres. It is freely

available, DSM-based, and includes items that assess ADHD and Oppositional Defiant Disorder

(ODD). Both parents and teachers can complete the scale. Due to its accessibility and simplicity,

it has been extensively used in Indian research and clinical practice. Translated and validated

versions of SNAP-IV are available in several regional languages, including Hindi, Tamil,

Kannada, and Malayalam, allowing its use in diverse linguistic settings.

21

Child Behaviour Checklist (CBCL)

CBCL is a broadband behavioural assessment tool used primarily in private clinics and

research institutions in India. They provide a comprehensive profile of a child's behavioural and

emotional functioning, including attention problems. Though more complex than symptom-

specific tools, they are especially helpful in identifying comorbid conditions. Their use is more

common in urban, research-oriented settings, where detailed psychological evaluation is

possible.

Behaviour Assessment System for Children (BASC)

A comprehensive tool that evaluates a wide range of behavioural and emotional

functioning, including attention problems and hyperactivity. Available in parent, teacher, and

self-report forms; used to assess ADHD symptoms and comorbid conditions in school-age

children.

Method

Participant Details:

Name: SK

Age: 11

Sex: Female

Standard/grade: 6th grade

Informant Details:

Name: AR

Age: 38

Sex: Female

Occupation: Housewife
22

Materials required

The materials required for the assessment are the Vanderbilt ADHD Diagnostic Parent Rating

Scale, a Pencil, an Eraser, and a Scoring Key.

Procedure

The participant was called inside the room, and all the distractions were removed. She

was made to sit on a comfortable chair, and rapport was established by obtaining demographic

information and discussing topics of their interest. After the participant was relaxed and

comfortable participating in the study, informed consent was obtained. Instructions were given to

the informant, and they were encouraged to ask questions. After the completion of the test,

scoring was done.

Instructions

The parent was instructed to rate their child’s behaviour over the past 6 months using

Vanderbilt scale from 0 (never) to 3 (very often) and 1 (problematic) to 5 (excellent) for

performance in school. The environment should be quiet, and the parents were told that there are

no correct or incorrect answers. The parents were encouraged to ask questions.

Precautions

● The room had proper lights and ventilation

● All the external noises and disturbances were controlled

● All the questions should be attempted

● To check that the participant has understood the instruction properly

Scoring and Interpretation

The Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) is scored based on

two main components: symptom assessment and performance impairment. Each of the 47
23

symptom items is rated on a 4-point scale (0 = never to 3 = very often), and a score of 2 or 3 is

considered a positive response. The child must receive six or more affirmative answers in either

the hyperactive/impulsive domain (items 10–18), the inattentive domain (items 1–9), or both for

the combined presentation to meet the diagnostic criteria for the ADHD subtypes. The scale

contains symptom screenings for conduct disorder (CD), anxiety/depression, and oppositional

defiant disorder (ODD). A diagnosis for these comorbid conditions requires a minimum number

of positive responses within the relevant item sets, four for ODD (items 19–26), three for CD

(items 27–40), and three for anxiety/depression (items 41–47), along with evidence of

performance impairment.

The performance section assesses academic and social functioning using a 5-point scale

(1 and 2 = problematic, to 4 and 5 = above average), where a child scores 1 or 2 on any of the

performance questions 48-55, indicating some impairment. For any ADHD or comorbid

diagnosis to be considered, at least one performance item must be rated as 4 or 5, reflecting

functional impairment. The average performance score is obtained by summing the scores for

items 48–55 and dividing by the number of items answered. This is useful for monitoring

changes over time, especially during follow-up.

Result

Table 1

Domain-wise

Domains Raw score Counted behaviors

Predominantly inattentive 21 7
subtype
Predominantly 18 7
hyperactive/impulsive
24

subtype
Combined subtype 39 14
Oppositional defiant disorder 13 5
Conduct disorder 2 0
Anxiety or depression 7 1

Table 2

Performance Score

Domains Raw score interpretation

Academic performance

1. Reading 3 Average
2. Mathematics 2 Problematic
3. Written expression 3 Average
Classroom behavior

1. Relationship with 4 Above Average

peers
2. Following 3 Average
directions/rules
3. Disrupting class 3 Average
4. Assignment 3 Average
completion
5. Organisational skills 2 Problematic

Interpretation

The Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) results indicate that the child

displays significant symptoms in both the inattentive and hyperactive/impulsive domains.

25

Specifically, the raw score for the Predominantly Inattentive subtype is 21, with seven counted

behaviours, while the Predominantly Hyperactive/Impulsive subtype shows a raw score of 18

and 7 counted behaviours. Both domains meet the clinical threshold (≥6 counted behaviours),

suggesting the presence of ADHD Combined Type.

The Combined subtype yields a total raw score of 39 with 14 counted behaviours, further

supporting the diagnosis of combined presentation of ADHD. Additionally, the child presents

with symptoms associated with Oppositional Defiant Disorder (ODD), reflected in a raw score of

13 and 5 counted behaviours, meeting the clinical criteria for concern in this area.

In contrast, the scores for Conduct Disorder (raw score: 2; counted behaviours: 0) and

Anxiety/Depression (raw score: 7; counted behaviours: 1) fall below the clinical threshold,

indicating that these concerns are not prominent now.

In the Performance domain, academic scores reveal average performance in Reading (score: 3)

and Written Expression (score: 3). In contrast, performance in Mathematics is rated as

problematic (score: 2), suggesting the need for additional academic support in this subject area.

In the Classroom Behavior domain, the child demonstrates above-average ability to maintain

relationships with peers (score: 4). Performance in following directions/rules, avoiding class

disruptions, and completing assignments are all within the Average range (score: 3 each).

However, organisational skills are rated as Problematic (score: 2), indicating challenges in

managing materials and tasks effectively.

Overall, the findings suggest a clinical profile consistent with ADHD Combined Type,

accompanied by oppositional behaviours and specific difficulties in mathematics and

organisation. Social functioning appears to be a strength, with relatively intact peer relationships

and classroom behaviour.

26

Discussion

The current behavioural assessment was conducted for SK, an 11-year-old female student enrolled

in the 6th grade. Her mother, AR, a 38-year-old housewife, was the primary informant for the

Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). The assessment aimed to evaluate

SK’s current behavioural, academic, and emotional functioning in light of past concerns related to

attention and hyperactivity.

SK was first diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) at the age of six

and underwent occupational therapy for three months, after which, according to the informant, the

symptoms appeared to subside. AR shared, “After therapy, she seemed calmer and was able to

focus better in class. We thought she had outgrown it.” However, as SK progressed into middle

childhood, her academic responsibilities and environmental demands increased, leading to a

resurgence of concerning behaviours.

The VADPRS results reveal that SK currently meets the diagnostic criteria for ADHD Combined

Presentation, as she exhibited 7 out of 9 counted behaviours in both the inattentive and

hyperactive/impulsive domains. Her inattentive behaviours include difficulty sustaining attention,

forgetfulness, poor task follow-through, and frequent distractibility. Her mother reported, “Even

when reading her favourite storybook, her eyes are on the page but her mind is elsewhere. It is

like she is physically present but mentally absent.”

In the hyperactive/impulsive domain, SK shows frequent fidgeting, excessive talking, and

difficulty remaining seated. AR shared, “During homework, she will tap her pencil, swing her

legs, and even get up randomly to look out the window. She cannot sit still for more than five
27

minutes.” These behaviours interfere with her learning and classroom functioning, especially

during tasks that require sustained mental effort.

In line with literature on ADHD, symptoms often persist into adolescence and manifest more

prominently as cognitive and social demands increase (Barkley, 2015). Though SK appeared to

have improved in earlier childhood, the developmental mismatch between her cognitive control

and her current environmental expectations may contribute to the present symptom escalation.

Her Combined subtype score on the VADPRS was 39, with 14 counted behaviours well above the

clinical threshold, highlighting the co-occurrence of attentional deficits and hyperactive/impulsive

tendencies. This suggests that SK struggles not only with regulating her attention but also with

controlling motor behaviour, emotional responses, and impulses, as is typical of ADHD Combined

Type.

In the Oppositional Defiant Disorder (ODD) subscale, SK scored 13 with 5 counted behaviours,

which also meets the clinical criteria. This indicates persistent oppositional and defiant behaviours,

such as arguing, refusing to comply with adult requests, and deliberately annoying others. Her

mother expressed concern, saying, “Even if I ask her to do small things like put her clothes away

or wash her hands before dinner, she will either argue or say ‘You always scold me,’ and walk

away.” While these behaviours may sometimes be interpreted as age-appropriate resistance, the

frequency and intensity suggest a pattern of oppositionality.

Her scores on Conduct Disorder and Anxiety/Depression were below the clinical threshold,

suggesting that SK is not presently exhibiting severe behavioural aggression or internalising

symptoms. However, given the academic and behavioural challenges she faces, there is a potential

risk for developing secondary emotional issues like low self-esteem, school avoidance, or

frustration if her symptoms remain unsupported (Chronis-Tuscano et al., 2010).

28

From a performance perspective, SK's academic scores show average abilities in Reading and

Written Expression, but her performance in Mathematics was rated as problematic. AR noted,

“She does not understand math problems easily, and even when she does, she forgets the steps

midway. It leads to a lot of tears and frustration.” These challenges may be reflective of executive

functioning deficits, such as poor working memory and cognitive flexibility, which are commonly

associated with ADHD (Willcutt et al., 2005).

Her classroom behaviour scores depict a relatively balanced picture. Her relationship with peers is

above average, indicating strong social engagement skills. This protective factor suggests that SK

can maintain friendships and interact appropriately with her peers, which can help buffer the

impact of ADHD symptoms on self-concept and emotional well-being (Hoza et al., 2005). The

rest of her classroom behaviour, including following rules, avoiding disruption, and completing

assignments, falls within the average range, though organisational skills were again rated

problematic. Her mother reported, “She keeps losing her notebooks, forgets to bring homework,

or mixes up class schedules. Even packing her school bag is a task she struggles with.”

These organisational challenges may stem from impairments in planning, sequencing, and

attention to detail, often seen in children with ADHD (DuPaul & Stoner, 2014). Despite her

strengths in social relationships, these academic and executive functioning issues will likely

interfere with her long-term academic performance and self-efficacy if not addressed through

targeted interventions.

In conclusion, the findings indicate that SK exhibits a clinical profile consistent with ADHD –

Combined Type, along with features of Oppositional Defiant Disorder and academic

underachievement in mathematics and organisation. Although she demonstrates relatively

29

preserved classroom behaviour and superior social functioning with peers, these strengths may not

mitigate her cognitive and behavioural challenges.

Given her history and current presentation, a multidisciplinary approach involving behavioural

therapy, executive function training, school accommodations, and parent training programs is

recommended. These interventions have shown evidence-based efficacy in improving ADHD-

related outcomes (DuPaul & Stoner, 2014; Chronis-Tuscano et al., 2010). Moreover, ongoing

collaboration between home and school environments is essential to consistently reinforce positive

behaviour and support academic growth.

30

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders

(5th ed., text rev.). [Link]

Anderson, N. P., Feldman, J. A., Kolko, D. J., Pilkonis, P. A., & Lindhiem, O. (2022). National

Norms for the Vanderbilt ADHD Diagnostic Parent Rating Scale in Children. Journal of

Pediatric Psychology, 47(6), 652–661.

[Link]

Becker, S. P., Langberg, J. M., Vaughn, A. J., & Epstein, J. N. (2012). Clinical utility of the

Vanderbilt ADHD diagnostic parent rating scale comorbidity screening scales. Journal of

developmental and behavioural paediatrics: JDBP, 33(3), 221–228.

[Link]

Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis

And Treatment (4th ed.). Guilford Press.

Chronis-Tuscano, A., Seymour, K. E., Stein, M. A., Jones, H. A., & Rooney, M. E. (2010).

Psychosocial interventions for children and adolescents with ADHD. In A. E.

Kazdin & J. R. Weisz (Eds.), Evidence-Based Psychotherapies for Children and

Adolescents (2nd ed., pp. 263–281). Guilford Press.

Collett, B., Ohan, J., & Myers, K. (2003). Ten-Year Review of Rating Scales. V: Scales

Assessing Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy

of Child and Adolescent Psychiatry. 42. 1015–37. 10.1097/[Link].0000070245.

24125.B6

DuPaul, G. J., & Stoner, G. (2014). ADHD in the Schools: Assessment and Intervention
31

Strategies (3rd ed.). Guilford Press.

Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., ... &

Arnold, L. E. (2005). What aspects of peer relationships are impaired in children

with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical

Psychology, 73(3), 411.

Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention

deficit hyperactivity disorder. Attention deficit and hyperactivity disorders, 2(4), 241–

255. [Link]

Magnus, W., Anilkumar, A. C., & Shaban, K. (2023). Attention Deficit Hyperactivity Disorder.

In StatPearls. StatPearls Publishing.

NICHQ Vanderbilt ADHD Assessment Scale | NC-PAL. (n.d.). NC-PAL.

[Link]

scale#:~:text=The%20NICHQ%20Vanderbilt%20Assessment%20includes,Scoring%20Guidanc

e%20

Sharma, P., Gupta, R. K., Banal, R., Majeed, M., Kumari, R., Langer, B., Akhter, N., Gupta, C.,

& Raina, S. K. (2020). Prevalence and correlates of Attention Deficit Hyperactive

Disorder (ADHD) risk factors among school children in a rural area of North India.

Journal of family medicine and primary care, 9(1), 115–118.

[Link]

Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005).

Validity of the executive function theory of ADHD: A meta-analytic review. Biological

Psychiatry, 57(11), 1336–1346.

32

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(8), 559–567.

[Link]

World Health Organisation. (2019). International statistical classification of diseases and related

health problems (10th Revision). [Link]

World Health Organisation. (2019). International statistical classification of diseases and related

health problems (11th Revision).