Directly Administered Tools in ADHD Screening
Directly administered tools are developmental screening instruments that combine direct observation of the child by a clinician with parent report, providing more in-depth information than parent-completed questionnaires alone. 1
Definition and Characteristics
Directly administered tools differ fundamentally from parent-completed screening instruments in their methodology and application:
- They require direct clinician observation and interaction with the child in conjunction with gathering parent-reported information, rather than relying solely on questionnaire responses 1
- These tools take longer to complete than parent-completed alternatives and require dedicated time for individual patient assessment 1
- They provide more comprehensive, in-depth developmental information compared to questionnaires that parents fill out independently 1
Clinical Role and Application
Directly administered tools function best as second-stage screening instruments rather than initial screening tools in primary care settings 1:
- They are most appropriately used when there is adequate time to work individually with patients in a clinical setting 1
- They are less time-efficient and practical in busy primary care offices compared to parent-completed alternatives 1
- These tools are more expensive than parent-completed screening tools for both negative and positive screening results 1
Examples of Directly Administered Tools
While the evidence focuses primarily on developmental screening rather than ADHD-specific tools, examples of directly administered instruments include:
- Bayley Scales of Infant and Toddler Development (third edition) - used in diagnostic developmental evaluations 1
- Stanford-Binet Intelligence Scale - employed for comprehensive developmental assessment 1
- Woodcock-Johnson Psychoeducational Battery - utilized for diagnostic evaluation 1
Contrast with Parent-Completed Tools
Parent-completed tools are more appropriate for initial ADHD screening in primary care because they offer distinct practical advantages 1:
- Parents can complete them while waiting for appointments or at home before visits, improving workflow efficiency 1
- They are more cost-effective for routine screening purposes 1
- The Vanderbilt ADHD Rating Scales are specifically recommended by the American Academy of Pediatrics as parent- and teacher-completed forms for children ages 6-12 years 1, 2
Important Clinical Caveats
No screening tool—whether directly administered or parent-completed—can diagnose ADHD by itself 2:
- A comprehensive evaluation is always required, including information from multiple sources (parents, teachers, other observers) 2, 3
- Functional impairment must be documented in more than one major setting (home, school, work, social) 2, 3
- Alternative causes must be ruled out through clinical interview and examination 2, 3
- Systematic screening for comorbid conditions (anxiety, depression, learning disabilities) is essential 2, 3