Assessing Functional Impairment in ADHD: Concerns for Validity of Self-Report

Comprehensive diagnostic assessment of attention deficit hyperactivity disorder (ADHD) should include consideration of degree of impairment, and documentation of impairment is necessary to make service and accommodation determinations. While there has been increasing use of self-report as a way to document impairment, self-reported impairment could be just as vulnerable to invalid report as self-reported symptoms. We examined the influence of invalid self-report and invalid performance on report of functional impairment in a sample of 49 adults referred for evaluation for ADHD and/or learning disorder concerns. Overall, 26–59% of participants referred for evaluation endorsed at least moderate levels of impairment in the domains of understanding and communicating, household, and school/work. Individuals with evidence of invalid self-report of ADHD symptoms endorsed significantly higher levels of disability/impairment on the WHODAS, particularly in the domains of understanding and communicating, household, school/work, and participation in society. Further, individuals who failed a measure of performance validity reported significantly higher levels of impairment/disability, particularly in the domains of understanding and communicating, school/work, and participation in society. Results emphasize the need to assess for validity of self-report and performance in ADHD assessment. Since self-report of impairment may be suspect, clinicians should include data such as school records, past performance on high-stakes standardized testing, evidence of prior accommodations, and collateral reports before making diagnoses and/or recommendations regarding treatment or academic/workplace accommodations.     

An evaluation of the effectiveness of positive behavioural support within a medium secure mental health forensic service

A number of recent influential reports recommend the use of proactive and preventative approaches such as Positive Behavioural Support (PBS) in the management of challenging behaviours. Although evidence supporting the use of PBS is mainly drawn from studies of learning disability and child populations, it is recognised that PBS could have a much wider utility. In this study, PBS was implemented in a medium secure forensic mental health service, a novel context. Impact was evaluated using an adapted version of the Checklist of Challenging Behaviour at baseline and then at 3 monthly intervals for a year. Significant reductions were observed in aggression frequency, management difficulty and severity and other challenging behaviour frequency and management difficulty. Reductions in challenging behaviour were still evident after six months for the full group and twelve months for the sub-group with the exception of other challenging behaviour management difficulty. In contrast, no such significant differences were found for a control group. This study indicated that PBS was an effective intervention in the management of challenging behaviour in this forensic mental health context.     

The Process is the Rule and the Punishment is the Process

Andrew Ashworth, The Criminal Process: An Evaluative Study , Oxford: Clarendon Press, 1994, 315 pp, hb £45.00, pb £12.95. Andrew Sanders and Richard Young, Criminal Justice , London: Butterworths, 1994, 496 pp, pb £18.95.     

Medicine in Africa as I have seen It

This address by Dr. Smith was given before a joint meeting ofthe Royal African Society and the Royal Empire Society withLt.-Col. Sir Stewart Symes in the chair. Dr. Smith is May Readerin Medicine at Oxford University and Physician-in-Charge ofthe tuberculous Meningitis Unit at the United Oxford Hospitals.She formerly worked with Sir Hugh Cairns at the Radcliffe Infirmary,and was associated with him in starting certain research projectsin Africa concerned with various aspects of tuberculosis.