What are the recommended questionnaires for Attention Deficit Hyperactivity Disorder (ADHD) in children in Canada?

Recommended Questionnaires for ADHD in Children in Canada

The most effective approach for ADHD assessment in Canadian children requires standardized rating scales with multiple informants (parents, teachers, and self-report for adolescents) that document cross-situational impairment according to DSM-5 criteria, rather than relying on any single questionnaire alone. 1

Core Assessment Requirements

Diagnostic Framework

• ADHD diagnosis must follow DSM-5 criteria, requiring:
  • At least 6 symptoms of inattention and/or hyperactivity/impulsivity
  • Symptoms present in multiple settings (home, school, social)
  • Clear evidence of clinically significant impairment
  • Symptoms not better explained by another mental disorder 1

Multiple Informant Approach

• Information must be obtained from multiple sources:
  • Parents/guardians
  • Teachers and other school personnel
  • Mental health clinicians involved in the child's care 2
  • Self-report for adolescents 1

Recommended Questionnaires

Parent Rating Scales

1. Conners' Parent Rating Scale-Revised (CPRS-R)

   • Widely used and validated in Canada 3, 4
   • Good sensitivity (83.5%) but limited specificity (35.7%) when used alone 3
   • Available in short and long forms

2. Behavior Rating Inventory of Executive Function (BRIEF)

   • Effectively discriminates between children with ADHD and typically developing children 5
   • Assesses behavioral aspects of executive functions
   • Shows good correlation with other ADHD rating scales 5

Teacher Rating Scales

1. Conners' Teacher Rating Scale-Revised (CTRS-R)

   • Provides essential cross-situational data 3, 4
   • Similar to parent version in psychometric properties
   • Critical for documenting school-based symptoms

2. Vanderbilt ADHD Rating Scale (VARS)

   • Includes performance items that help identify potential comorbid learning disorders
   • A cutoff score of 4 for teacher reading and writing items has excellent utility for ruling out comorbid reading and spelling learning disorders 6

Diagnostic Interviews

1. Parent Interview for Child Symptoms (PICS)

   • Demonstrated high sensitivity (91.8%) and specificity (70.7%) in Canadian samples 3
   • More accurate than questionnaires alone

2. Teacher Telephone Interview (TTI)

   • Complements parent interviews
   • Provides structured assessment of classroom behavior 3

Important Clinical Considerations

Limitations of Questionnaires

• Rating scales alone are insufficient for diagnosis
• The Conners' scales show high sensitivity (83.5%) but poor specificity (35.7%) 3
• Questionnaires should be part of a comprehensive assessment that includes:
  • Detailed developmental history
  • Academic/occupational functioning evaluation
  • Social relationships assessment
  • Family history
  • Environmental factors analysis 1

Comorbidity Screening

• Questionnaires should help identify common comorbidities:
  • Emotional/behavioral conditions
  • Developmental conditions
  • Physical conditions 1
  • Learning disorders 6

Common Pitfalls to Avoid

1. Relying solely on questionnaires

   • Low specificity of rating scales (35.7%) means they cannot be used alone for diagnosis 3
   • Best practice requires comprehensive assessment including diagnostic interviews

2. Failing to assess multiple settings

   • DSM-5 criteria require documentation of symptoms in more than one major setting 2
   • Both home and school environments must be evaluated

3. Not ruling out alternative causes

   • Medical conditions that can mimic ADHD symptoms must be excluded
   • Other psychiatric conditions need to be distinguished from ADHD 1

4. Ignoring age-specific considerations

   • Different questionnaires may be more appropriate for different age groups
   • Insufficient evidence exists for diagnosis in children younger than 4 years 2

By following this structured approach using multiple validated questionnaires from different informants, Canadian clinicians can achieve more accurate ADHD assessments that meet diagnostic standards while identifying potential comorbidities.