PediatricAttentionDisordersDiagnosticScreener

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ThePediatricAttentionDisordersDiagnosticScreener(PADDS),createdbyDr.ThomasK.PedigoandKenneth
L.Pedigo,isasuiteofcomputeradministeredneuropsychologicaltestsofattentionandexecutivefunctioning.The
PADDSisusedinthediagnosisofAttentionDeficitHyperactivityDisorder(ADHD)inchildrenbetweentheages
of6to12years.ThePADDSsoftwareprogramrepresentsamultidimensional,evidencebasedapproachto
ADHDassessment,[1]consistingoftheComputerAdministeredDiagnosticInterview(CADI),theSwanson,
Nolan,andPelhamIV(SNAPIV)ParentandTeacherratingscales,[2]andthethreecomputeradministered
objectivemeasuresoftheTargetTestsofExecutiveFunctioning(TTEF).Itcalculatesadiagnosticlikelihoodratio,
whereeachuniquedatasourceisallowedtocontributeto(ordetractfrom)thepredictionofthediagnosis,[3]as
wellasnormalizedrelativestandardscores,tscores,zscores,andpercentileranksforcomparisontothenon
clinicalreferencegroup.

Contents
1 PADDShistoryanddevelopment
2 Screeningforpossiblecomorbidconditions
3 Screeningforinattentionandhyperactivity
4 Objectivemeasures
4.1 Demandsbasictoallthreetargetsubtests
4.2 Taskspecificdemandsfortargetrecognition
4.3 Taskspecificdemandsfortargetsequencing
4.4 Taskspecificdemandsfortargettracking
4.5 Scoringandreporting
5 ClinicaluseofthePediatricAttentionDisordersDiagnosticScreener(PADDS)
6 Seealso
7 References

PADDShistoryanddevelopment
OneofthemostcommonlydiagnosedchildhooddisordersreferredtomentalhealthcliniciansisADHD.[4]Itisa
complicatedneurodevelopmentalpsychiatricdisorderandhasanestimatedrangeofoccurrenceof2to3percentof
theschoolpopulationandupto10percentinothersettings.Thus,onaverageaminimumofatleastonechildwith
ADHDandexecutivefunctioningdisordersisineachclassroominAmericanschools.(Reddyetal.)[1](Rowland,
Leswesne,&Abramowitz,2002)[5]indicatedthatprevalenceratesforADHDvarymarkedlybasedonpresenting
symptoms,differentassessmentapproachesused,andthevarioussettingsinwhichthechildwastested.Alackof
aconsensusonwhatconstitutesthecoresetofsymptomsforADHDcomplicatesandconfoundsthescreeningand
assessmentprocess(Brown,2002).[6]

DuetotheseconcernsregardingprevalenceratesofADHD,theAmericanAcademyofPediatrics(AAP,2000)[7]
andtheNationalInstituteofHealth(NIH,1998)havestressedtheneedtodevelopnewstandardized,evidence
basedassessmentsthathavestrongpsychometricproperties,andareeasilyadministeredinschoolsandother
clinicalsettings.ThemajorconsiderationsguidingthedevelopmentofthePADDSisintegratinganupdated
constructofADHDassessment,whilefocusingonwaystoenhancediagnosticaccuracyinanefficientmanner.
ClinicaltestingofthePADDSTargetTestsofExecutiveFunctioningwasconductedononeofthelargestsamples
ofagespecific,ADHDandnonADHDsubjectscollected,with725children(240femalesand485males)age6to
12years(M=8.63,SD=1.72)splitapproximatelyevenlybetweenthosediagnosedwithADHD(n=395)and
agematchedNonADHD/Typicalpeers(n=330).Datawerecollectedinsevenstatesfromatotalof10data
collectionsites.InstitutionalReviewBoard(IRB)approvalfortheoverallprojectwasestablishedthrough
ArmstrongAtlanticStateUniversityinSavannah,Georgia.AllresearchsitesincludedspecialtyADHDassessment
centers,eachwithindependentIRBoversight,inIllinois,Georgia,Idaho,NewJersey,Tennessee,California,and
Florida.Pedigo,Pedigo&Scott(2008).[8]

Screeningforpossiblecomorbidconditions
TheComputerAdministeredDiagnosticInterview(CADI)isusedforcomorbidscreening,toassistclinicianswith
thecollectionandconsolidationofpertinentpatientinformation.Theclinicalprotocolconsistsof113questions
coveringthemajordomainsofcooccurringdisorders.Theseareasincludeamedicalanddevelopmentalhistory,
emotional/socialfunctioning,depressionandanxietysymptoms,behavioralissues,schoolhistory,and
attention/hyperactivitysymptoms.Thisinformationisnecessarytohelpstructureanindividualassessmentprocess
andtosupportrecommendationsthatmightbegenerated.Theinformationisreviewed,withtheparentorguardian,
forcrossvalidationofanyconcernspresented.

Screeningforinattentionandhyperactivity
TheSwanson,Nolan,andPelhamIV(SNAPIV)ratingscaleformsareincludedforparent/guardianand
teacherstocomplete.TheSNAPIVratingscalesoffercategoricalanddimensionalinputacrossthe18core
diagnosticitemsfromtheDiagnosticandStatisticalManualofMentalDisordersDSMIVFourthEditionRevised.
Eachitemisratedona4pointLikertscaleforseverity.Thesebehavioralcriteriawhenusedintheascribed
mannerhaveproducedreliablesensitivityandspecificityinidentifyingADHDcasesrelativetononclinical
referencegroups.(Power,T.J.,Andrews,T.J.,Eiraldi,R.B.,Doherty,B.J.,Ikeda,M.J.,DuPaul,G.J.,&
Landau,S.1998)[9](Zolotor,A.J.,&Mayer,J.2004)[10]

Objectivemeasures
TheTargetTestsofExecutiveFunctioning(TTEF)consistofthreetargetsubtests,TargetRecognition,Target
SequencingandTargetTracking.Theyaredesignedtoplacedistinctlydifferentdemandsonseveralkeyareasof
executivefunctioningthathavebeenidentifiedasimportanttoADHDassessment.(Biederman,J.,Monuteaux,M.
C.,Doyle,A.E.,Seidman,L.J.,Wilens,T.E.,Ferrero,F.,Morgan,C.L.,&Faraone,S.V.2004).[11]Theteststap
workingmemory,sequentialmemoryandproceduralmemoryfunctions,andhelpprovideanobjectiveassessment
ofasubjectsabilitytoemployvariousbutnotallexecutiveprocessessuchasplanning,attending,organizing
input,storingandretrievinginformation,modulatingemotionsandsustainingeffort.Thesetaskdemandshave
beenconsistentlyidentifiedasareasofdifficultyforchildrenknowntohaveADHD.(RussellBarkley1997)[12]

Demandsbasictoallthreetargetsubtests

Thechildispreloadedtosearchanddetectrelevantinformation
Thechildmustinhibitirrelevantstimuli
Thechildmustuseametacognitivestrategyforcingtheuseofinternaldialogue
Thechildmustwaitashortlagtimebeforeemployingtaskdemands
Thechildmustinhibitwhileformulatingaplanofaction
Thechildmustformulate,reconstituteandexecuteplansinthefaceofchangingornovelstimuli
Thechildmustbesensitiveandresponsivetofeedback
 Thechildmustbeabletodotheabovetodiscoverthattherearerecurrentpatternspresentedinthetask
demands
Thechildmustemploymotivationalandemotionalcontrolintheserviceofongoingactivity
Thechildmustevaluateoutcomeagainstplans,intentionsandfeedbacktodirectfutureeffortsaccurately

Taskspecificdemandsfortargetrecognition

TargetRecognitiontakesapproximately810minutestocomplete,thissubtestpresentsfivelargecoloredsquares
withsmallersquaresinsidethem.Belowthesquaresarefivesmallboxeslabeled1to5.Thecoloredsquares
simultaneouslyblinkonandoffthescreenat1secondintervals,indifferingpatternsforatotalof153
presentations.Thechildistaughtastrategytoreadfromlefttorightandtocountthenumberoflargesquareswith
smallsquaresinsidethemofthesamecolorandthentoclickonthecorrespondingnumberinthesmallboxbelow
labeled1to5.Specificrequirementsfortaskcompletionincludeamongothers:Attentiontodetail,avoiding
distraction,maintenanceofeffortorpersistence,holdinginformationinmindthroughtheuseofmetacognition,
feedback,andemotionalregulationwhiledevelopingaresponsetochangesinnovelstimuli.

Taskspecificdemandsfortargetsequencing

TargetSequencingtakesapproximately810minutestocomplete,thissubtestpresentsfivelargecoloredcircles.
Asmallcoloredsquaremovesthrougheachofthemstartinginthemiddleorateitheroftheendcircles.Thechild
istaughttoattendonlytocircleswhenthesquarematchesitincolorandtosaythenameofthecolortohimorher
selfwhileatthesametimedisregardingthecirclesthathavesquareswithadifferentcolor.Oncethesquareshave
movedthroughallfivecirclesthechildclicksoneachofthecirclesthathadmatchingcolorsinthesameorderthat
theystatedtohim/herself.Firstmatchfirst,secondmatchsecondandlastmatchlast.Specificrequirementsfor
taskcompletionincludeamongothers:Attentiontodetail,avoidingdistraction,maintenanceofeffortor
persistence,holdinginformationinmindthroughtheuseofmetacognition,feedback,andemotionalregulation
duringtheinitiationandfollowthroughofaresponsetocomplexsequenceswhileremainingsensitivetochanges
innovelstimuli.

Taskspecificdemandsfortargettracking

TargetTrackingtakesapproximately810minutestocomplete,thissubtestpresentsfourcoloredshapesatthetop
andbottomofthescreen.Thecomputercreatesonemoveatatimetwoandthreestepmovesthatthechildmust
repeat/recreateinthesameorderseen.Firstmovefirst,secondmovesecondandlastmovelast.Specific
requirementsfortaskcompletionincludeamongothers:Attentiontodetail,maintainingdividedattention,holding
informationinmind,maintenanceofeffortorpersistenceandemotionalregulationwhilecompletingcomplextwo
andthreestepinstructions.

Scoringandreporting

ThePADDSSystemandSummaryReportspresentstheincrementalinputofmultipleformsofinformationthat
researchhasshowntobemostreliableandvalidforADHDassessment.(Frazier&Youngstrom2006).[3]The
PADDSsystemusesacomparisonoftwowelldefinedreferencegroupsnamelyADHDandNonADHD.Each
componentiscalculatedinadditiveorsubtractivemannerforandagainstadiagnosisinconsiderationofthe
ADHDBaserate.TheinputsaredisplayedinarealtimeformatviaacomputergeneratedNomogrampresenting
anindividualandanoverallpredictiveindexoflikelihoodratiosestablishingevidencefororagainstadiagnosis.
Resultsarelikewisepresentedinanormalized,relativeStandardscore,Tscore,ZScore,andPercentilerank
formatforcomparisontothenonclinicalreferencegroup.
TheNomographicdisplayoftheindividualandcumulativeinputsareevaluatedstepwiseviathecalculationof
likelihoodratiosappliedincrementallywithaFagan'sNomogram,(FaganTJ1975)[13]toproduceanoverall
predictiveindexbeginningwithacalculatedbaserate,andcombiningtheresultsoftheothermeasures,ineitheran
additiveorsubtractivemanner,toprovideaposttestprobability.Whenthesecomponentsareusedinconjunction
withclinicaljudgmenttheyhaveproventobehighlyeffectiveforconsiderationofdiagnosis,inhighlightingand
documentinganeedforfurtherevaluationoractions,andmayallowthecliniciantoevaluatetheirowndiagnostic
practicesandeffectivenessovertime.

ClinicaluseofthePediatricAttentionDisordersDiagnosticScreener
(PADDS)
PADDSisusedby:ChildPsychiatrists,ChildPsychologists,Neuropsychologists,SchoolPsychologistsand
Pediatricians

ThePADDSispublishedbyandavailablefromTargetedTesting,Inc.andothermajorpsychologicaltest
publishers.

Seealso
Clinicalneuropsychology
Neuropsychologicaltests
ClinicalPsychology
Executivefunctioning

References
1.Reddy,LindaFumari,G.Pedigo,T.K.Scott,V.B.Jr(2008)."PediatricAttentionDisordersDiagnosticScreenerfor
ChildrenAtRiskforAttentionDeficit/HyperactivityDisorder."(PDF).APADivision16SchoolPsychology.62(3):93
98.Retrieved20090216.
2.Swanson,J.M.W.NolanW.E.Pelham(1992)."TheSNAPIVRatingScale"(PDF).Retrieved20090216.
3.Frazier,T.W.E.A.Youngstrom(2006)."Evidencebasedassessmentofattentiondeficit/hyperactivitydisorder:Using
multiplesourcesofinformation.".JournaloftheAmericanAcademyofChildandAdolescentPsychiatry.45(5):614
620.doi:10.1097/01.chi.0000196597.09103.25.PMID16670656.
4.NationalInstitutesofHealth."NationalInstitutesofHealthConsensusDevelopmentConferenceStatement".Archived
fromtheoriginalon19981118.Retrieved19981118.Checkdatevaluesin:|accessdate=(help)
5.Rowland,A.S.Leswesne,C.A.Abramowitz,A.J.(2002)."Theepidemiologyofattentiondeficit/hyperactivity
disorder(ADHD):Apublichealthview.".MentalRetardationandDevelopmentalDisabilitiesResearchReviews.8(3):
162170.doi:10.1002/mrdd.10036.PMID12216060.
6.Brown,T.E.(2002)."DiagnosticandStatisticalManualofMentalDisorders,fourthedition(DSMIV)criteriaforthe
disorder:impairmentsinregulationofemotion.".JohnsHopkinsUniversityAdvancedStudiesinMedicine.2(25):910
914.
7.AmericanAcademyofPediatrics(20000505)."ClinicalPracticeGuideline:DiagnosisandEvaluationoftheChildWith
AttentionDeficit/HyperactivityDisorder.".Pediatrics.105(5):11581170.doi:10.1542/peds.105.5.1158.
PMID10836893.Retrieved20090216.
8.Pedigo,T.K.Pedigo,K.L.Scott,V.B.(2008).PADDSADHDScreenerClinicalManual(PDF).TargetedTesting,Inc.
pp.3840.
9.Power,T.J.,Andrews,T.J.Eiraldi,R.B.Doherty,B.J.Ikeda,M.J.DuPaul,G.J.Landau,S.(1998)."Evaluating
attentiondeficithyperactivitydisorderusingmultipleinformants:Theincrementalutilityofcombiningteacherwith
parentreports.".PsychologicalAssessment.10(3):250260.doi:10.1037/10403590.10.3.250.
10.Zolotor,A.J.Mayer,J.(2004)."DoesshortsystemchecklistsaccuratelydiagnoseADHD.".JournalofFamilyPractice.
53(5):412416.PMID15125829.
 11.Biederman,J.,JosephMonuteaux,M.C.Doyle,A.E.Seidman,L.J.Wilens,T.E.Ferrero,F.Morgan,C.L.
Faraone,S.V.(2004)."Impactofexecutivefunctiondeficitsandattentiondeficit/hyperactivitydisorder(ADHD)on
academicoutcomesinchildren.".JournalofCounselingandClinicalPsychology.72(5):757766.doi:10.1037/0022
006X.72.5.757.PMID15482034.
12.Barkley,RussellA.(1997)."Behavioralinhibition,sustainedattention,andexecutivefunction:".PsychologicalBulletin.
121(1):6594.doi:10.1037/00332909.121.1.65.PMID9000892.
13.Fagan,T.J.(1975)."NomogramforBayestheorem".NewEnglandJournalofMedicine.293(5):257.
doi:10.1056/NEJM197507312930513.PMID1143310.

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Categories: Neuropsychologicaltests Attentiondisorders

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