Choosing an attention-deficit/hyperactivity disorder rating scale: Is item randomization necessary?

Objective: Although behavior rating scales are generally considered de riguer for best clinical practices in the diagnosis and medical management of children with attention-deficit/hyperactivity disorder (ADHD), they are often time consuming to score, especially if items are arranged in random order. This study compares two methods of ordering rating scale items; namely, diagnostic-cluster versus randomized-order formats. Methods: Participants were the parents of 207 consecutive referrals (5-17 years) to a child psychiatry outpatient service who were diagnosed as having a variety of emotional and behavioral disorders. Children were assessed with a battery of standardized assessment instruments and clinical interviews, including the ADHD Symptom Checklist-4. Half completed a diagnostic-cluster version and half completed a randomized-order version. Results: Findings indicated that the internal consistency reliability, clinical utility (for identifying children with ADHD and oppositional defiant disorder), and concurrent validity of the two-item arrangement formats were virtually identical. Conclusion: Item arrangement does not appear to impact the reliability or validity of a commonly used ADHD rating scale.