Response – NICH Vanderbilt Assessment Scale

Response – NICH Vanderbilt Assessment Scale

Hello Evelyne,

This is a great post. Your detailed analysis of the NICH Vanderbilt Assessment Scale has proved the importance of the scale in the diagnosis of ADHD among children with significant input from both parents and teachers. And yes, I agree that one should not solely depend on this scale for diagnosis since ADHD diagnosis is holistic, using other scales and interviews too. Although the Vanderbilt Assessment can present a global perspective of symptoms that occurred in different environments, one of its disadvantages to be discussed is the potential to be subjected to bias by the parents or teachers, where the diagnosis may be rendered less precise.

On the other hand, the toolkit that I used, the Mini-Mental State Examination (MMSE) is aimed at identifying patients with cognitive disorders instead of behavioral ones. MMSE’s simplicity differs from the Vanderbilt scale’s complexity as it provides a brief assessment of mental impairment without other people’s statements (Gallegos et al., 2022; Truong et al., 2023). Could behavioral scales like Vanderbilt aid in the early identification of cognitive-behavioral dynamics, thereby enhancing the steps of diagnosis?

References

Gallegos, M., Morgan, M. L., Cervigni, M., Martino, P., Murray, J., Calandra, M., Razumovskiy, A., Caycho-Rodríguez, T., & Gallegos, W. L. A. (2022). 45 Years of the mini-mental state examination (MMSE): A perspective from Ibero-America. Dementia & Neuropsychologia, 16(4). https://doi.org/10.1590/1980-5764-dn-2021-0097

Truong, Q. C., Cervin, M., Choo, C. C., Numbers, K., Bentvelzen, A., Kochan, N. A., Brodaty, H., Sachdev, P. S., & Medvedev, O. N. (2023). Examining the validity of the Mini‐Mental State Examination (MMSE) and its domains using network analysis. Psychogeriatrics, 24(2). https://doi.org/10.1111/psyg.13069

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Reply from Evelyne

Week 2: Initial Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

The ADHD rating scale for this discussion is the NICH Vanderbilt Assessment Scale. This Scale has been used to screen for the diagnosis criteria of ADHD and to track symptoms and response to treatment (Torres et al., 2022). However, this Scale is inadequate to be used alone to determine diagnosis (Torres et al., 2022). Studies support that it takes multiple rating scales and interviews to obtain collateral information about the presence and severity of ADHD. For example, evidence-based practice supports that information from multiple resources such as Conners 3rd Edition and ADHD Rating Scale V have been identified to help in screening, evaluating, and monitoring the symptoms of ADHD in both children and adults (Christiansen et al., 2020).

Response – NICH Vanderbilt Assessment Scale

The NICH Vanderbilt Assessment Scale is meant for children ages 6 to 12 years old, and it is based mainly on contributions from both parents and teachers (Torres et al., 2022). The Vanderbilt ADHD Assessment involves the “Vanderbilt ADHD Diagnostic Parent Rating Scale and the Vanderbilt ADHD Diagnostic Teacher Rating Scale.” The result from both rating scales enhances clinicians’ ability to have a “broad picture of a child’s behavior at home and in the school environment” (Christiansen et al., 2020).

The Parent Rating Scale must have up to 55 questions that “measure several aspects of the child’s behavior, such as symptoms of inattention, hyperactivity, and impulsivity” (Torres et al., 2022). It also “consist of questions about performance in academic and social settings, as well as screens for common comorbid conditions such as oppositional defiant disorder and conduct disorder”, (Torres et al., 2022). On the other hand, the Teacher Rating Scale is completed by the “child’s teacher and contains 43 questions that parallel those on the parent form, allowing for comparing the child’s behavior across home and school environments” (Torres et al. 2022).

The scoring method must indicate that it meets the DSM-5 criteria, revealing that the patient has positive results for ADHD (Naguy et al., 2022). The initial scale requires both parent and teacher and must have two components: “symptom assessment and impairment in performance” (Naguy et al., 2022). The result from both parent and teacher initial scales must meet DSM-IV criteria for the diagnosis (Naguy et al., 2022). The studies support that one must have at least “six positive responses to either the inattentive nine or hyperactive nine core symptoms, or both, and a positive response is a 2 or 3” (Naguy et al., 2022).

The most reported strength of the Vanderbilt Assessment Scale is its capability to identify comorbidity (Kapogiannis et al., 2022). For example, while using this Scale to screen ADHD, the information about the child’s symptoms is gathered, and the elevated score may also help to screen and identify other disorders such as “oppositional defiant disorder, conduct disorder, anxiety, and depression” (Kapogiannis et al., 2022).

The Vanderbilt assessment’s limitations include caregiver or teacher’s biases and interpretation. Cultural differences between parents and teachers also affect the evaluation results due to cultural variations in behavior and expectations. Fluctuations may influence gaps in the time of evaluation of symptoms; as a result, some behaviors may be missed or disregarded. This Scale is too long compared to other scales used to screen ADHD.

Conclusion

NICH Vanderbilt Assessment Scale plays a vital role in clinical practice. It allows clinicians to diagnose and “make more informed decisions about ADHD diagnosis and treatment” (Kapogiannis et al., 2022).

Reference

Christiansen, H., Chavanon, M.-L., Hirsch, O., Schmidt, M. H., Meyer, C., Müller, A., Rumpf, H.-J., Grigorev, I., & Hoffmann, A. (2020). Machine learning is used to classify adult ADHD and other conditions based on the Conners’ Adult ADHD Rating Scales. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-75868-y

Kapogiannis, A., Makris, G., Darviri, C., Artemiadis, A., Klonaris, D., Tsoli, S., Bachourou, T., Stefani, C., Papanikolaou, K., Chrousos, G., & Pervanidou, P. (2020). The Greek Version of the Vanderbilt ADHD Diagnostic Parent Rating Scale for follow-up assessment in prepubertal children with ADHD. International Journal of Disability, Development and Education, 69(5), 1–10. https://doi.org/10.1080/1034912x.2020.1802647

‌Naguy, A., El-Sheshaie, A., Elsori, D. H., & Alamiri, B. (2022). Solriamfetol for attention deficit hyperactivity disorder. CNS Spectrums, 27(6), 662–663. https://doi.org/10.1017/S1092852921000328

‌Torres, M., Miller, L., Payment, E., Patel, K., Pawlowski, C., Cortright, L., Moore, J., Tumin, D., Higginson, A., & Chinn, D. (2021). Effect of a parent agreement on return rates of Vanderbilt assessments and treatment adherence in pediatric attention-deficit/hyperactivity disorder patients. Experimental Results, 2. https://doi.org/10.1017/exp.2021.23