Clinical Usefulness of Observational Assessment in the Diagnosis of DBD and ADHD in Preschoolers

Abstract

The aim of the present study was to investigate the clinical usefulness of an observational tool—the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)—in the diagnosis of disruptive behavior disorders (DBD) and attention deficit/hyperactivity disorder (ADHD) in preschoolers. We hypothesized that the DB-DOS may help support the presumption of a diagnosis generated by the information from parents and teachers (or other caregivers). Participants were referred preschool children with externalizing behavioral problems (N = 193; 83% male) and typically developing children (N = 58; 71% male). In view of the clinical validity study each child was given a diagnosis of either DBD (N = 40), or ADHD (N = 54) or comorbid (DBD + ADHD; N = 66) based on best-estimate diagnosis. The DB-DOS demonstrated good interrater and test–retest reliability for DBD and ADHD symptom scores. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of DBD symptom scores and a satisfactory fit of ADHD symptom scores. The DB-DOS demonstrated good convergent validity, moderate divergent validity, and good clinical validity on a diagnostic group level for DBD and ADHD symptom scores. The Receiver Operating Characteristic curve analyses revealed that for DBD the sensitivity and specificity are moderate and for ADHD good to excellent. The presumption of a diagnosis based on information from parents, teachers, and cognitive assessment was supported by the DB-DOS in 60% for DBD and 75% for ADHD. The DB-DOS can be used to help support a presumption of a DBD and/or ADHD diagnosis in preschool children.

Acknowledgments

We are grateful to the parents and children who participated in this study. We especially thank Lauren Wakschlag, at the Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, for her cooperation in providing assessment procedures used in this study and in training the Utrecht research group in administering and scoring the DB-DOS. We also thank Eva van der Kleij, Justa Kamstra, and Susanne van Reedt Dortland, at the Department of Psychiatry, University Medical Center Utrecht, for their assistance with the data collection.

Notes

Note. IQ ^a is an estimate based on mean Raven and Peabody. DBD = disruptive behavior disorder; ADHD = attention deficit/hyperactivity disorder; CBCL = Child Behavior Checklist; TRF = Teacher Report Form.

^a N = 40.

^b N = 54.

^c N = 66.

***p < .001 (compared with the typically developing group).

Note. ICC = intraclass correlation coefficient; ADHD = attention deficit/hyperactivity disorder.

^a N = 251.

^b Examiner Engaged (N = 39); Examiner Busy (N = 47); and Parent Context (N = 28).

^c N = 24.

Note. ADHD = attention deficit/hyperactivity disorder; EE = Examiner Engaged context; EB = Examiner Busy context. PC = Parent context; K-DBDS = Kiddie Disruptive Behavior Disorder Schedule; CGAS = Clinical Global Assessment Scale. CBCL = Child Behavior Checklist; IFS = Impact on Family Scale; SSRS = Social Skills Rating Scale; IFS (M) = Impact on. Family Scale (Mother); ECI (PDD) = Early Child Inventory (Pervasive Developmental Disorder).

 *p < .05. **p < .01.

Note. TD = typically developing; DBD = disruptive behavior disorder; ADHD = attention deficit/hyperactivity disorder; DBD total = DBD only and DBD + ADHD; ADHD Total = ADHD only and ADHD + DBD; BR = Behavior Regulation; AM = Anger Modulation; EE = Examiner Engaged context; EB = Examiner Busy context; PC = Parent context; tot = total; a = DBD vs. TD; b = ADHD vs. TD; c = DBD + A DHD vs. TD; d = DBD total vs. TD; e = ADHD total vs. TD; e.g., (ae)*means p value for a and e lower than .05.

^a N = 58.

^b N = 40.

^c N = 54.

^d N = 66.

^e N = 106.

^f N = 120.

*p < .05. **p < .01. ***p < .001.

Note. Bold numbers indicate maximized sensitivities and specificities depending on criteria used in selecting cut-off scores. DBD = disruptive behavior disorder; DBD total = DBD only and DBD +ADHD;  ADHD = attention deficit/hyperactivity disorder; ADHD Total = ADHD only and ADHD + DBD; BR = Behavior Regulation.

^a N = 106.

^b N = 120.