توان تشخیصی مقیاس‌های درجه‌بندی معلم در تفکیک کودکان مبتلا به اختلال نارسایی‌توجه/فزون‌کنشی از کودکان فاقد این اختلال

هدف: اختلال نارسایی توجه/فزون‌کنشی به‌دلیل ماهیت پیچیده جزو تشخیص‌های روان‌پزشکی مجادله‌انگیز باقی می‌ماند. هدف پژوهش حاضر بررسی توان تشخیصی مقیاس‌های درجه‌بندی معلم در تفکیک کودکان مبتلا به اختلال نارسایی توجه/فزون‌کنشی از کودکان فاقد این اختلال بود.روش‌بررسی: پژوهش حاضر از نوع توصیفی و روش شناختی بود. جامعهٔ آماری را دانش‌آموزان پسر ابتدایی شهر مشهد در سال تحصیلی 94-1393 تشکیل دادند. نمونهٔ پژوهش چهل نفر از دانش‌آموزان پسر (بیست نفر بهنجار و بیست نفر دارای اختلال نارسایی توجه/‌فزون‌کنشی) بودند که با روش نمونه‌گیری دردسترس انتخاب شدند. برای جمع‌آوری داده‌ها از نسخهٔ معلم پرسشنامهٔ کانرز و مقیاس اسنپ-4 در دو مرحله با فاصلهٔ چهار هفته استفاده شد. داده‌ها ازطریق میانگین و انحراف معیار، آلفای کرونباخ و همبستگی پیرسون (برای اعتبار بازآزمایی)، آزمون تحلیل واریانس چندمتغیری و تحلیل راک در سطح معناداری 0٫05 با استفاده از نسخهٔ 25 نرم‌افزار spss تحلیل شدند.یافته‌ها: نتایج پژوهش نشان داد، نسخهٔ معلم دو پرسشنامهٔ اسنپ و کانرز می‌تواند به‌طور معناداری کودکان نارساتوجه/فزون‌کنش را از کودکان فاقد این اختلال متمایز کند (0٫001≥p). برای تمام خرده‌مقیاس‌ها اندازه‌های حساسیت با مقادیر بیشتر از0٫80 و ویژگی بیشتر از 0٫75 بوده است.نتیجه‌گیری: براساس یافته‌های این پژوهش دو مقیاس اسنپ و کانرز دارای خصوصیات روان‌سنجی عالی تا پذیرفتنی بودند؛ لذا از این دو مقیاس می‌توان به‌طور سودمند در تشخیص اختلال نارسایی توجه/فزون‌کنشی استفاده کرد.

Diagnostic Accuracy of Teacher Rating Scales in Discriminating Children with and without Attention-Deficit/Hyperactivity Disorder

Background & Objectives: The accurate and timely diagnosis of Attention–Deficit Hyperactivity/Disorder (ADHD) has been evidenced to be especially complex and challenging. This study aimed to investigate the diagnostic power of behavioral rating scales responded by teachers in diagnosing ADHD as well as their other methodological properties. Pursuing this goal is especially important in Iran due to the lack of proper diagnostic tools for ADHD assessment.Methods: This was a descriptive and methodological study. The statistical population included all male students in Mashhad City, Iran, in the 2014–2015 academic year. Besides, our study sample consisted of 40 male students selected through the direct observation of children in their classroom, interviews with their teachers and their parents, and examining children’s educational records. Parents and teachers signed informed consent forms and they were informed about the confidentiality of the obtained data. Of the study samples, 20 were healthy and 20 had received ADHD diagnosis by a physician before participating in our study. We administered a short three–subscale form of the Wechsler’s Intelligence Scale for Children–Revised (WISC–R) on all study participants to ensure they have no Intellectual Disability (ID) and that the two groups were matched by Intelligence Quotient (IQ). Then, we trained blind interviewers to administer semi–structured interviews on the children’s teachers to verify their initial ADHD diagnoses. Moreover, the teachers were requested to rate the children’s classroom behavior using Conner’s Teacher Rating Scale (CTRS) (1969) and Swanson, Nolan and Pelham’s Fourth Revision Scale (SNAP–IV) (1980) two times with one–month interval. We used Receiver Operating Characteristic (ROC) analysis to calculate sensitivity and specificity as well as False Positive Rate (FPR) and False Negatives Rate (FNR) for these scales. Additionally, we used Cronbach’s alpha coefficient and Pearson correlation coefficient methods to investigate the internal consistency and test–retest reliability of these inventories.Results: Multivariate Analysis of Variance (MANOVA) followed by separate Analysis of Variance (ANOVA) as post–hoc test indicated that all the subscales of CTRS and SNAP–IV could significantly distinguish ADHD and non–ADHD children. Cronbach’s alpha coefficient for the total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive subscale (second 9 items) of SNAP–IV were measured as 0.99, 0.98, and 0.89, respectively; these data indicated excellent internal consistencies of the subscales. Test–retest reliabilities for the total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive subscale (second 9 items) of SNAP–IV were computed as 0.95, 0.96, and, 0.93 respectively, indicating excellent test–retest reliabilities. For CTRS rating scale, Cronbach’s alpha coefficients were calculated as 0.96, 0.87, and 0.52 for classroom behavior, group participation, and attitude toward authority subscales, respectively. Test–retest reliabilities for classroom behavior, group participation, and attitude toward authority subscales were 0.92, 0.85, and 0.69, respectively. The ROC analyses data also revealed an excellent to acceptable sensitivity and specificity for all the subscales of CTRS and SNAP–IV. All achieved sensitivities ranged between 0.80 and 0.95, all specificities between 0.75 and 0.95, and all Areas under Curve (AUC) between 0.85 and 0.99; these findings indicated an excellent diagnostic power with low FPR and FNR rates.Conclusion: The present research results suggested excellent to acceptable diagnostic accuracy and proper methodological properties for the Persian versions of CTRS and SNAP–IV. These scales could successfully reduce FPR and FNR rates; therefore, they could be considered as beneficial and complementary diagnostic tools in the multi–method assessment of ADHD. Although CTRS and SNAP–IV presented excellent diagnostic accuracy in this study, using them in isolation is recommended.