A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from the Cognition and Motivation in Everyday Life (CAMEL) Scale from population and clinical samples

ABSTRACT

A new parent-completed questionnaire, the Cognition and Motivation in Everyday Life (CAMEL) scale, was developed to provide a comprehensive assessment of neuropsychological impairment in children related to attention-deficit/hyperactivity disorder (ADHD) across diverse cognitive, motivational and energetic domains. Its psychometric properties were investigated. A total of 60 items were generated to cover a wide range of putative ADHD-related neuropsychological processes. A clinical (n = 142) and community (n = 810) sample of parents with children between 6 and 16 years of age completed the questionnaire. Data on ADHD symptoms were also collected with a commonly-used, validated parent rating scale to explore the associations between CAMEL scores and dimensional measures of child ADHD and conduct problems. Factor analysis identified six factors which we labeled (i) Cognition, (ii) Self-Direction and Organization, (iii) Effort Engagement, (iv) Arousal Regulation, (v) Motivational Responsiveness, and (vi) Cautiousness. Self-Direction and Organization and Arousal Regulation were the strongest predictors for ADHD symptomatology. Self-Direction and Organization was strongly associated with inattention and Arousal Regulation with hyperactivity-impulsivity symptoms. Parents distinguished between broad neuropsychological domains in reliable and plausible ways, making distinctions between key aspects of functioning. However, the boundaries between these domains did not map directly onto the distinctions drawn within traditional models of ADHD deficits. Further research is required to examine the predictive validity and cost-effectiveness of the CAMEL scale compared to direct objective testing using laboratory measures in predicting prognosis and treatment outcome.

KEYWORDS:

• Attention-deficit/hyperactivity disorder
• Causal heterogeneity
• Neuropsychological assessment
• Executive function
• Memory
• Reinforcement
• Delay aversion
• Arousal
• Effort
• CAMEL

Acknowledgements

We are grateful to all the families who took part in this study and to the schools for helping to recruit them. We also would like to thank Sandra McElroy for helping with the translation of the CAMEL scale and all the students who helped with data collection and data entry.

Disclosure statement

Professor Sonuga-Barke declares the following competing interests: Fees for speaking, consultancy, research funding and conference support from Shire Pharma; Speaker fees from Janssen Cilag, Medice & Qbtech; Book royalties from OUP and Jessica Kingsley; Consultancy from Neurotech solutions. Dr. van der Oord has been involved in the development, implementation, and trialing of Braingame Brian, an executive functioning game training for children with ADHD, and Zelf Plannen, a cognitive behavioral planning intervention for adolescents with ADHD. She has no financial interests in either of these interventions. She has been a paid consultant for Janssen Pharmaceuticals, for the development and evaluation of the game HealSeeker, which is aimed at training cognitive functions. And was a speaker for Medice & Shire. Professor Danckaerts declares the following competing interests: Fees for speaking, consultancy, research funding and conference support from Shire and Janssen Cilag Pharma; Book royalties from OUP and Van Gorcum; Consultancy from Neurotech solutions. The present study is unrelated to the above grants and relationships. The other author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.

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