SPSP 2003 poster

1
Assessing Attention-Deficit/Hyperactivity
Disorder Using an RTI Approach
Renée M. Tobin W. Joel
Schneider Steven Landau
Abstract School psychologists are
increasingly adopting a response to intervention
(RTI) approach to the assessment and treatment of
children. This presentation describes
evidence-based assessment of ADHD based on a
chapter to appear in the fifth edition of Best
Practices in School Psychology (Tobin, Schneider,
Reck, Landau, in press). Specifically, an ADHD
assessment strategy is presented that follows
guidelines prescribed by Pelham, Fabiano, and
Massetti (2005). This presentation also describes
assessment in the context of RTI and three-tier
model of service delivery for children with ADHD.
It is important to note, that current law
is not written in an RTI framework for the
assessment of behavior disorders however, this
approach is expected for the assessment of
learning disabilities, and many students with
ADHD have learning disabilities. Therefore, we
advocate that school psychologists move closer to
an RTI approach as it pertains to assessment and
intervention-planning for students with ADHD. As
such, assessment data collected within the RTI
framework may identify clear links to
intervention targets and provide data regarding
meaningful changes in childrens behaviors in
response to assessment-based interventions.
Based on findings from over 30 years of
research on the topic, Pelham and his colleagues
(2005) provide guidelines for best practices in
assessment of ADHD, and these guidelines map
readily onto the RTI model. Using Pelham et al.s
suggestions, we align traditional and
contemporary methods of assessment for ADHD with
the current RTI approach, as shown in Figure 1.
Table 1. Selected List of Evidence-Based
Assessment Methods for ADHD
Measure Relevant references
Narrow-band Behavior Rating Scales Narrow-band Behavior Rating Scales
Conners Rating Scales-Revised (CRS-R) Conners (1997)
ADHD-IV Rating Scale DuPaul, Power, Anastopoulos, Reid (1998)
Broad-band Behavior Rating Scales Broad-band Behavior Rating Scales
Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) from the Achenbach System of Empirically Based Assessment (ASEBA) Achenbach Rescorla (2004)
Parent Report Form (PRS) and the Teacher Report Form (TRS) from the Behavior Assessment System for Children (BASC-2) Reynolds Kamphaus (2004)
Direct Observations Direct Observations
Direct Observation Form McConaughy Achenbach (2004)
Student Observation System from the BASC-2 Reynolds Kamphaus (2004)
Individualized Target Behavior Evaluation (ITBE) Pelham et al. (2005)
Functional Assessments Functional Assessments
No specific form DuPaul, Eckert, McGoey (1997) Gresham, Watson, Skinner (2001)
Interviews Interviews
Unstructured Parent Interview (no specific form) Barkley (2006) ONeill et al. (1997)
Introduction Following the now
universally embraced movement towards
evidence-based treatment (EBT) for childrens
behavior disorders, there has been a recent call
for evidence-based assessment (EBA). In line
with this movement, an ADHD assessment strategy
is presented that follows guidelines prescribed
by Pelham, Fabiano, and Massetti (2005), and
involves four assessment objectives assessment
for diagnosis (i.e., the categorical/psychiatric
determination), assessment of impairment (i.e.,
specification of impaired domains of
functioning), assessment for intervention
planning, and outcome evaluation of treatment.
Within these domains, several assessment
methods are available. These procedures have been
used in a traditional, diagnosis-driven approach
to the assessment of ADHD however, they are also
appropriate for use in a dynamic and fluid
problem-solving approach to assessment. These
procedures are based on the Pelham et al. (2005)
model, are consistent with the School Psychology
Blueprint for Training and Practice III, and
focus on the childs areas of impairment at
school, in peer relations, and in the family. The
difference between what we prescribe and the
traditional, diagnosis-driven assessment of ADHD
does not involve a difference in methods
selected, but a difference in the questions to be
addressed throughout the assessment process. This
method also allows for a more frequent
examination of the assessment data informing
decisions to remove interventions that are no
longer necessary as well as those involved in
exiting children from services. Table 1 presents
a list of evidence-based methods for the
assessment of ADHD. Although purposes may
differ, many of the same assessment strategies
are employed in both the RTI model and
traditional models. Differences lie in the
formality of the process through which levels of
services and the method of special education
eligibility are determined. If the intervention
produces a desirable change in behavior at one of
the lower tiers of intervention and returns the
childs behavior within normal limits, the child
will no longer require intervention. If, however,
the child progresses through the tiered model of
research-based interventions, and significant
progress is not apparent, the child may be a
viable candidate for more intensive intervention,
ultimately at the level of special education
services. Thus, these methods allow for
continuous hypothesis generation and testing
throughout the process.
Source Tobin, R. M., Schneider, W. J., Reck, S.
G., Landau, S. (in press). Best practices in
the assessment of children with
attention-deficit/hyperactivity disorder Linking
assessment to response-to-intervention. To appear
in A. Thomas J. Grimes (eds.), Best Practices
in School Psychology Vol. V. Washington, D.C.
National Association of School Psychologists.
Figure 1. An RTI approach to the assessment of
ADHD in children