Journal of Abnormal Child Psychology

, Volume 36, Issue 5, pp 771–778 | Cite as

The Impact of Impairment Criteria on Rates of ADHD Diagnoses in Preschoolers

  • Dione M. Healey
  • Carlin J. Miller
  • Katia L. Castelli
  • David J. Marks
  • Jeffrey M. Halperin


Behaviors characteristic of ADHD are common among preschool children, and as such, their clinical significance is oftentimes difficult to ascertain. Thus a focus on impairment is essential in determining the clinical significance of these behaviors. In order to explore the impact of impairment criteria on rates of diagnoses in inattentive/hyperactive children aged 36 through 60-months-old, we first developed, and psychometrically evaluated, the Children’s Problem Checklist (CPC) which was designed to assess psychosocial impairment associated with ADHD in a community sample of preschoolers (n = 394), and found its reliability and validity to be acceptable. We then examined the impact of the inclusion of various CPC-determined impairment criteria, over and above symptom criteria measured by the ADHD-RS-IV, using various cut points ranging from the 75th to 90th percentile of our community sample. This reduced the number of children meeting criteria for ADHD by 46–77%. These findings are discussed in terms of the importance of using impairment criteria, rather than just severity of inattention, impulsivity and hyperactivity, when diagnosing ADHD in preschool children.


ADHD Impairment Preschool Rating scale 


  1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: American Psychiatric Association (text revision).Google Scholar
  2. Bird, H. R., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., et al. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of General Psychiatry, 45, 1120–1126.Google Scholar
  3. Breton, J., Bergeron, L., Valla, J. P., Berthiaume, C., Gaudet, N., Lambert, J., et al. (1999). Quebec child mental health survey: Prevalence of DSM-III-R mental health disorders. Journal of Child Psychology and Psychiatry, 40, 375–384.Google Scholar
  4. Campbell, S. B. (2002). Behavior problems in preschool children: Clinical and developmental issues (2nd ed.). New York: Guilford.Google Scholar
  5. Campbell, S., Ewing, L., Breaux, A., & Szumowski, E. (1986). Parent-referred problem three-year olds: Follow-up at school entry. Journal of Child Psychology and Psychiatry, 27, 473–488.PubMedCrossRefGoogle Scholar
  6. Costello, E. J., Costello, A. J., Edelbrook, C., Burns, B. J., Dulcan, M. K., Brent, D., et al. (1988). Psychiatric Disorders in pediatric primary care. Archives of General Psychiatry, 45, 1107–1116.Google Scholar
  7. DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretations. New York: Guilford.Google Scholar
  8. Fabiano, G. A., Pelham, W. B., Waschbusch, D. A., Gnagy, E. M., Lahey, B. B., Chronis, A. M., et al. (2006). A practical measure of impairment: Psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.PubMedCrossRefGoogle Scholar
  9. Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: Is it an American Condition. World Psychiatry, 2, 104–113.PubMedGoogle Scholar
  10. Gordon, M., Antshel, K., Faraone, S., Barkley, R., Lewandowski, L., Hudziak, J. J., et al. (2006). Symptoms versus impairment: The case for respecting DSM-IV’s criterion D. Journal of Attention Disorders, 9, 465–475.PubMedCrossRefGoogle Scholar
  11. Graetz, B. W., Sawyer, M. G., Hazell, P. L., Arney, F., & Baghurst, P. (2001). Validity of DSM-IV ADHD subtypes in a nationally representative sample of Australian children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1410–1417.PubMedCrossRefGoogle Scholar
  12. Healey, D. M., & Rucklidge, J. J. (2006). An investigation into the relationship among ADHD, creativity, and neuropsychological functioning in children. Child Neuropsychology, 12, 421–438.Google Scholar
  13. Loughran, S. B. (2003). Agreement and stability of teacher rating scales for assessing ADHD in preschoolers. Early Childhood Education Journal, 30, 247–253.CrossRefGoogle Scholar
  14. McClellan, J. M., & Speltz, M. L. (2003). Psychiatric diagnosis in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 127–128.PubMedCrossRefGoogle Scholar
  15. McGoey, K. E., DuPaul, G. J., Haley, E., & Shelton, T. L. (2007). Parent and teacher ratings of Attention Deficit/Hyperactivity Disorder in Preschool: The ADHD Ratings Scale-IV Preschool Version. Journal of Psychopathology and Behavioral Assessment, 29, 269–276.CrossRefGoogle Scholar
  16. Nakao, K., & Treas, J. (1994). Updating occupational prestige and socioeconomic scores: How the new measures measure up. Sociological Methodology, 24, 1–72.CrossRefGoogle Scholar
  17. Romano, E., Tremblay, R. E., Vitaro, F., Zoccolillo, M., & Pagani, L. (2001). Prevalence of psychiatric diagnoses and the role of perceived impairment: Findings from an adolescent community sample. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 451–462.Google Scholar
  18. Rowland, A. S., Umbach, D. M., Catoe, K. E., Stallone, L., Long, S., Rabiner, D., et al. (2001). Studying the epdemiology of attention-deficit hyperactivity disorder: screening method and pilot results. Canadian Journal of Psychiatry, 46, 931–940.Google Scholar
  19. Simonoff, E., Pickels, A., Meyer, J. M., Silberg, J. L., Males, H. H., Loeber, R., et al. (1997). The Virginia twin study of adolescent behavioral development: influences of age, sex, and impairment on rates of disorder. Archives of General Psychiatry, 54, 801–808.CrossRefGoogle Scholar
  20. Sonuga-Barke, E. J. S., Auerback, J., Campbell, S. B., Daley, D., & Thompson, M. (2005). Varieties of preschool hyperactivity: multiple pathways from risk to disorder. Developmental Science, 8, 141–150.PubMedCrossRefGoogle Scholar
  21. Wolraich, M. L., Feurer, I. D., Hannah, J. N., Baumgaertel, A., & Pinnock, T. Y. (1998). Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV. Journal of Abnormal Child Psychology, 26, 141–152.PubMedCrossRefGoogle Scholar
  22. Zito, J. M., Safer, D. J., dosReis, S., Gardner, J. F., Boles, M., & Lynch, F. (2000). Trends in prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283, 1059–1060.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Dione M. Healey
    • 1
  • Carlin J. Miller
    • 2
  • Katia L. Castelli
    • 3
  • David J. Marks
    • 4
  • Jeffrey M. Halperin
    • 3
    • 4
  1. 1.Department of PsychologyUniversity of OtagoDunedinNew Zealand
  2. 2.Department of PsychologyUniversity of WindsorWindsorCanada
  3. 3.Department of PsychologyQueens College of the City University of New YorkFlushingUSA
  4. 4.Department of PsychiatryMount Sinai School of MedicineNew YorkUSA

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