22 Assessment of Childhood Disruptive Behavior Disorders
and Attention-Deficit/Hyperactivity Disorder
CHRISTOPHER T. BARRY, REBECCA A. LINDSEY, AND ALYSSA A. NEUMANN
The focus of this chapter is to provide an updated presen-
tation of current evidence-based practices in the assess-
ment of attention-deficit/hyperactivity disorder (ADHD)
and disruptive behavior disorders (i.e., oppositional defi-
ant disorder [ODD] and conduct disorder [CD]) in children
and adolescents. In this chapter, the terms “disruptive
behavior disorders” (DBDs) and “conduct problems” will
be used interchangeably and are meant to reflect the array
of behaviors associated with ODD and CD. Approaches to
comprehensive, multi-informant, multimodal evaluations
will be discussed, and some of the particular challenges in
these evaluations and limitations of existing methods will
also be described. We will first provide a current overview
of principles of evidence-based assessment of ADHD,
ODD, and CD. Issues to be addressed include assessment
tools, informants, construct-relevant content, technologi-
cal advances, and cultural factors. Finally, we will discuss
directions for future research in this area as well as some
of the practical implications of the issues presented in the
chapter.
PRINCIPLES OF EVIDENCE-BASED ASSESSMENT
OF ADHD AND CONDUCT PROBLEMS
At its core, evidence-based assessment is that which
accounts for research on developmental psychopathology,
including differences in manifestations of behavioral pro-
blems across childhood and adolescence, as well as issues
involved in multimodal assessments that account for chil-
dren’s behavioral functioning in multiple settings (Mash &
Hunsley, 2005). Furthermore, these assessments should
provide a road map for intervention by accounting for
a child’s specific presentation of ADHD and/or conduct
problems (Barry, Golmaryami et al., 2013). This discus-
sion will center around the following principles: (1) the
need to assess for the presence of a variety of symptoms/
behaviors within the broad construct of externalizing
behaviors to account for heterogeneous manifestations
of ADHD, ODD, and CD (McMahon & Frick, 2005;
Pelham, Fabiano, & Massetti, 2005); (2) the developmental
context (e.g., onset, course, severity) of symptoms are
308
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crucial for diagnostic decisions and case conceptualiza-
tion (Barry, Golmaryami et al., 2013); (3) in addition to
core features of ADHD and DBDs, assessments should
evaluate for the presence of co-occurring or comorbid
difficulties; (4) assessment batteries should include tools
that add incremental validity to the understanding of
a child/adolescent’s presentation (see Johnston &
Murray, 2003); (5) the clinician should gather information
connecting the child/adolescent’s behavioral problems to
academic, emotional, legal, or social impairment (Power
et al., 2017); and (6) evidence-based assessment inherently
involves a scientific approach whereby the accumulation
of evidence about a case and relevant research inform the
answer to the referral question and the resulting recom-
mendations. Underlying each of these issues are consid-
erations of which assessment tools to use, the sources
from which to gather information, and the appropriate-
ness of interpretations generated from the results of the
assessment, all within ethical guidelines and potential
practical constraints of the setting in which assessments
are conducted.
As noted, one of the principal issues in the assessment of
ADHD and conduct problems in youth is the need to assess
for a wide array of symptoms and behaviors such that
evaluations account for the heterogeneity of these con-
structs (Barry, Golmaryami et al., 2013; McMahon &
Frick, 2005; Pelham et al., 2005). To do so, not only is
knowledge of ADHD, ODD, and CD symptoms necessary
but the clinician must also be aware of developmental
influences on the manifestations of these symptoms and
areas in which related impairment may be most pro-
nounced. A crucial aspect of assessing ADHD and conduct
problems both for diagnostic and for case conceptualiza-
tion purposes is determining the age of onset of the symp-
toms. For ADHD, onset of symptoms before age twelve is
necessary under the DSM-5 diagnostic criteria (American
Psychiatric Association, 2013), whereas, for conduct pro-
blems, including diagnoses of ODD and CD, a wealth of
evidence supports different etiological and prognostic
implications for childhood onset vs. adolescent onset of
problems (Frick & Viding, 2009; Moffitt, 1993).
 ASSESSMENT OF CHILDHOOD DISRUPTIVE BEHAVIOR DISORDERS AND ADHD
Furthermore, these assessments should include informa-
tion on important aspects of a child’s psychosocial context,
as situational or setting-specific factors may point to pro-
tective factors in a child’s environments, issues that serve
to maintain or exacerbate the child’s functioning, and
important targets for intervention.
Beyond assessing core symptomatology and contextual
factors related to ADHD and DBDs, clinicians should be
prepared to assess for the presence of a wide array of
problems, including internalizing problems, as comorbid-
ity in clinical child and adolescent populations is the rule
rather than the exception (Frick, Barry, & Kamphaus,
2010). Indeed, the co-occurrence between symptoms of
ADHD, ODD, and CD can be observed as early as the pre-
school years (Bendiksen et al., 2017). Moreover, the pre-
sence of additional problems has direct intervention
implications. Research on the developmental psycho-
pathology of ADHD and disruptive behaviors points to
additional constructs that should be evaluated for
a comprehensive picture of impairment. For example,
ADHD has been associated with broad, pervasive execu-
tive functioning deficits that are connected with specific
impairments at home and at school (Barkley, 2013). In the
case of conduct problems, the presence of callous-
unemotional (CU) traits, which are analogous to the char-
acteristics of the Limited Prosocial Emotions Specifier in
the DSM-5 criteria for CD (American Psychiatric
Association, 2013), emerged as predicting the most severe
and persistent behavioral problems in youth (see Frick
et al., 2014).
Particularly from a cost-effectiveness standpoint, clini-
cians should strive to design assessment batteries wherein
each component has incremental validity. That is, there
should be limited redundancy in the assessment of symp-
toms and each assessment tool (e.g., interviews, beha-
vioral observations, rating scales, neuropsychological
testing) should provide unique information toward the
answer of diagnostic or referral questions and for generat-
ing treatment recommendations. The concept of incre-
mental validity as an additional consideration beyond
traditional psychometric attributes of assessment mea-
sures is discussed further in the “General Issues in
Selecting Measures” section.
If the result of a multimethod, multi-informant, evi-
dence-based assessment suggests that a child or adoles-
cent has significant problems with inattention,
impulsivity/hyperactivity, oppositionality, and/or con-
duct problems, a diagnosis of ADHD, ODD, or CD may
still not be appropriate. The clinician must first deter-
mine if the symptoms are atypical in their frequency or
severity for the child’s developmental level, as well as
consider whether there are better, alternative explana-
tions for the symptoms. At that point, the connection
between apparent difficulties and functional impair-
ment (e.g., academics, relationships) is needed to
make a diagnosis. Perhaps more importantly, the evi-
dent impairments would highlight areas in which
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309
intervention is needed as well as potential specific inter-
ventions (e.g., effective command delivery if the child is
persistently noncompliant with parent or teacher
instructions). It should also be noted that a child or
adolescent does not necessarily need diagnosis of
ADHD or DBDs to benefit from available interventions,
supports, or accommodations. As such, impairments in
a child’s daily life are still important to evaluate even if
the child does not meet a diagnostic threshold for the
number, frequency, or persistence of symptoms.
Lastly, an important element of evidence-based assess-
ment is that, as more information regarding the depth and
breadth of a client’s symptomatology is gathered, the clin-
ician should engage in a process of hypothesis testing,
whereby all data from all sources are treated as informa-
tion that helps to confirm or disconfirm hypotheses that
address the referral question, including but not limited to
diagnostic decisions (Barry, Frick, & Kamphaus, 2013). In
this way, evidence-based assessment has been likened to
the process of completing a scientific study in that hypoth-
eses are developed based on background information, data
are collected and interpreted, and conclusions are reached
with an emphasis on the next steps to further address the
problem (i.e., informing intervention; Frick et al., 2010).
A central aspect of evidence-based assessment, though, is
a careful consideration of the methods and informants
used to gain a comprehensive view of the child’s externa-
lizing symptoms.
ASSESSMENT METHODS
General Issues in Selecting Measures
There is no evidence supporting a single measure or set of
measures as the definitive approach to assessing ADHD or
conduct problems. As noted, it is incumbent on a clinician
to conduct an evaluation that will assess for a wide variety
of behavioral issues associated with these constructs as
well as potential comorbidities. To that end, clinical inter-
views, behavioral observations, and behavior rating scales
may represent a parsimonious battery. Importantly, each
of these methods provides incremental validity toward
answering a referral question while still leaving an oppor-
tunity to use more specific tools if necessary.
Aside from selecting measures/methods that assess het-
erogeneous presentations of ADHD or conduct problems,
it is also important for measures to appropriately reflect
developmental context. For example, evaluations of pre-
school-age children should place more emphasis on asses-
sing behavioral dysregulation (e.g., temper tantrums),
whereas, for adolescents, conduct problems that reflect
covert conduct problems (i.e., acts of opportunity) should
be more central (Maughan et al., 2004; Ramtekkar et al.,
2010). In the case of rating scales, there must be appro-
priate norms on which to base conclusions about the typi-
cality/atypicality of a child’s behavioral problems (Frick
et al., 2010).
 310 CHRISTOPHER T. BARRY, REBECCA A. LINDSEY, AND ALYSSA A. NEUMANN
Psychometric features (e.g., reliability, validity, norm
sample) are also important in selecting measures.
However, because of the strengths of tools that are not
norm-referenced (e.g., unstructured interviews, beha-
vioral observations), there is no ground rule in the area
of evidence-based assessment that states that a measure
must pass a specific standard for inclusion in an assess-
ment battery (Barry et al., 2013; Mash & Hunsley, 2005).
Importantly, tests are not inherently reliable or valid. That
is, one must consider the appropriateness of the conclu-
sions drawn from a measure given its psychometric prop-
erties, content, and scope (Barry et al., 2013). For example,
a rating scale that does not provide adequate coverage of
symptoms of ADHD or DBDs (i.e., construct underrepre-
sentation) should not be used as a basis for arriving at
diagnostic decisions on these disorders.
In addition to reliability and validity, Mash and Hunsley
(2005) emphasize clinical utility as another important
consideration in evidence-based assessment (see also
Hunsley & Allen, Chapter 2, this volume). Measures or
methods with clinical utility “make a meaningful differ-
ence in relation to diagnostic accuracy, case formulation
considerations, and treatment outcomes” (Mash &
Hunsley, 2005, p. 365). Furthermore, as noted, incremen-
tal validity speaks to an assessment method’s clinical uti-
lity in that it indicates the unique information provided by
the measure (Johnston & Murray, 2003), thus aiding in
decision-making and the design of interventions. In
a practical sense, the assessment of ADHD and DBDs
should include methods that provide adequate content
coverage of the primary symptoms of these disorders,
account for the symptoms across different settings, and
recognize developmental differences in how the symp-
toms may manifest and link to impairment. To date,
there remains limited data-driven consensus on the clin-
ical utility of particular measures/methods. Therefore,
clinicians must be aware of the relative strengths and
limitations of methods such as interviews, behavioral
observations, and rating scales and they should be pre-
pared to design batteries that provide the most compre-
hensive and least redundant evaluation of a child’s
attention problems, behavioral issues, and co-occurring
difficulties.
Clinical Interviews
Clinical interviews, particularly unstructured interviews
that are tailored to the client, are indispensable in clinical
assessment but are also inherently unreliable (Barry et al.,
2013; Mash & Hunsley, 2005), as they are idiosyncratic to
the case, interviewer, informant, and setting. Interviews
provide important contextual information about the spe-
cific symptoms of ADHD and the disruptive behaviors
exhibited by the child, their onset, the degree to which
they are setting-specific, and numerous other risk and
protective factors that may inform diagnostic decisions
and treatment recommendations. Importantly,
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unstructured clinical interviews allow the clinician to
gain information about the connection between the
child/adolescent’s symptomatology and functional impair-
ments in important domains. A number of the tools
described herein do not provide the flexibility needed to
determine the extent to which problems with concentra-
tion, sustained attention or argumentativeness, for exam-
ple, are related to academic or relational difficulties.
However, unstructured clinical interviews do not pro-
vide direct information about the extent to which the
child’s presentation is atypical for their age and the infor-
mation is filtered through an informant who may have
their own biases as to the significance of the child’s symp-
toms. Importantly, there is no mechanism for unstruc-
tured clinical interviews to provide information about
noncredible reporting, a limitation that is at least indir-
ectly addressed by some rating scales, as discussed in
“Behavior Rating Scales.” In addition, because of their
client-specificity, unstructured clinical interviews are
inherently unreliable; thus, clinicians may also opt for
structured diagnostic interviews to gain important infor-
mation about symptom presentation in a consistent, reli-
able manner.
Structured interviews by nature are consistent and reli-
able, as the clinician is provided with the sequence and
wording of questions that are presumably based directly
on diagnostic criteria or core features of behavioral pro-
blems. In addition, there are clear procedures for scoring
such interviews (Barry et al., 2013). Not surprisingly,
structured interviews have far superior reliability to
unstructured interviews, and structured interviews, if
selected properly, have clear content validity in that they
typically assess the diagnostic symptoms of interest
directly (Frick et al., 2010). However, for the purposes of
assessing ADHD and DBDs, structured interviews have
limitations, including the amount of time required to con-
duct the interview, the potential for informants to present
an inaccurately favorable or unfavorable view of the child/
adolescent’s behavior, and the lack of client-specific infor-
mation that would lend itself to interventions (Frick et al.,
2010). Therefore, structured diagnostic interviews may be
most useful when clinicians are unable to make
a diagnostic decision from information gleaned from the
other tools discussed here. In that case, the specific,
detailed assessment of diagnostic criteria offered by struc-
tured interviews would have clear incremental validity in
assisting the clinician in answering a referral question
related to ADHD or DBDs.
Behavioral Observations
Behavioral observations are unique in that they allow for
direct data gathering of important behaviors of interest,
often in a child’s natural setting such as the classroom
(Barry et al., 2013). Approaches to behavioral observations
can vary in their structure and targets (see Frick et al.,
2010). A unique strength of behavioral observations is
 ASSESSMENT OF CHILDHOOD DISRUPTIVE BEHAVIOR DISORDERS AND ADHD
the opportunity to observe and record consistent antece-
dents (e.g., extended periods of independent work) and
consequences (e.g., teacher redirection) of a target beha-
vior (e.g., becoming off-task, leaving one’s seat). Indeed,
objective behavioral observations of activity appear to out-
perform laboratory tasks designed to assess processes
underlying ADHD in predictive validity (Hall et al., 2016).
However, there is the potential for reactivity on the part of
the child being observed, and there are important charac-
teristics or behaviors that may not be directly observable
in the selected situation (e.g., trouble concentrating, cov-
ert conduct problems). Despite these limitations, beha-
vioral observations are necessary, though not sufficient,
for drawing conclusions concerning the presence of
ADHD and DBDs, as well as potential avenues for
intervention.
Behavior Rating Scales
Behavior rating scales and symptom checklists have
become a central part of assessment for a variety of child/
adolescent problems as well as adaptive domains. Such
measures stand out in terms of their efficiency and the
availability of norm-referenced scores based on large, gen-
erally representative standardization samples. There are
legitimate concerns about the lack of client-specific con-
textual information (e.g., antecedents, consequences of
problem behaviors), as well as about potential noncredible
reporting. The former points to the indispensability of
clinical interviews to gain more information about the
manifestation and developmental trajectory of a child’s
behavioral problems. The latter is addressed, in part, by
the inclusion of validity scales in some behavior rating
scale systems, such as the Behavior Assessment System
for Children – Third Edition (BASC-3; Reynolds &
Kamphaus, 2015) and Conners – Third Edition (Conners-
3; Conners, 2008). Validity scales are geared toward noting
a pattern of overly positive, overly negative, or inconsistent
response patterns (Frick et al., 2010). However, noncred-
ible reports could also be an artifact of reluctance to share
information about negative behaviors, limited observation
of a child by a particular informant, or alternatively
a generally negative attitude regarding the child/adoles-
cent’s functioning that lends itself to negative reporting
across psychological domains (Barry et al., 2013). Thus,
knowledge of the relative strengths and weaknesses of
different informants for child assessment and specific
awareness of an informant’s overall view of the child in
question are essential for interpreting rating scale data.
The state-of-the-art rating scales in clinical child and
adolescent assessments are broad-band (i.e., omnibus).
These scales are efficient in that they assess a variety of
domains (e.g., inattention, aggression, depression, social
skills) in a relatively short format, include versions for
different informants, and generally have strong, represen-
tative samples that are the basis of norm-referenced
scores. A detailed review of these scales is not possible
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311
here but widely used rating scale systems, including the
Achenbach System of Empirically Based Assessment
(ASEBA; Achenbach & Rescorla, 2001), the BASC-3
(Reynolds & Kamphaus, 2015), and the Conners-3
(Conners, 2008), are summarized in Table 22.1.
Overall, omnibus rating scales, particularly those that
cover theoretically relevant domains and have good psy-
chometric properties, generally have the advantage of
providing norm-referenced information in a reliable and
cost-effective manner (Frick et al., 2010). However, infor-
mation from rating scales is filtered through the
perspective of an informant and they lack the depth of
client-specific information necessary to ultimately arrive
at an individualized case conceptualization. Knowledge of
some of the potential pitfalls of using rating scales should
greatly assist the clinician in selecting rating scales and in
appropriately integrating their results with other available
findings. Single-domain rating scales, often utilized in
research, are also available for the assessment of attention
or conduct problems, as well as related difficulties (e.g.,
executive dysfunction), and may be used to provide more
in-depth coverage of the constructs of interest and the
heterogeneity of symptom presentation but still present
the potential issue of noncredible or biased reporting.
However, to date, commonly used rating scales of these
constructs do not include validity scales to aid in interpre-
tation of potentially noncredible reporting.
In summary, it is important for a clinician to be familiar
with the uses, strengths, and weaknesses of a variety of
assessment methods to provide the most comprehensive
evaluation of a child’s problems. To do so, particularly in
the assessment of children and adolescents, multiple
sources or informants are routinely used. This multi-
method, multi-informant approach has the unique advan-
tage of gaining information about an individual’s
functioning in a variety of settings on a number of con-
structs without relying on a single informant or method
that may be unreliable. However, that also means that
a clinician must engage in the difficult process of carefully
considering the use of different informants and deciding
how to integrate data across different sources based on the
available research (Achenbach, Ivanova, & Rescorla,
Chapter 11, this volume).
INFORMANTS
Parent Informants
For multiple reasons, parents/caregivers are considered
indispensable informants for assessments of children
and adolescents. For children prior to adolescence, par-
ents are thought to be the most useful informant (Frick
et al., 2010). Parents are well-positioned to provide
detailed developmental history and descriptions of beha-
viors for their children. Once the child reaches adoles-
cence, a parent still can provide useful information
regarding changes in functioning and, when combined
 Table 22.1 Common rating scales used to assess ADHD, ODD, and CD

Number of Relevant Subscales/ Validity

Measure Name Type of Measure Age Range Informants Items Symptom Count Scales Overall Conclusions

Behavior Assessment
System for Children – Third
Edition Parent Rating Scale
(BASC-PRS; Reynolds &
Kamphaus, 2015)
Behavior Assessment
System for Children – Third
Edition Teacher Rating
Scale (BASC-TRS; Reynolds
& Kamphaus, 2015)
Omnibus Rating 2–5 (Preschool) Parent 132 (Preschool) Attention Problems, Yes Normed based on current US
Scale 6–11 (Child) 175 (Child) Hyperactivity, Census population
12–21 (Adolescent) 173 Aggression, Conduct characteristics; adequate
(Adolescent) Problems* reliability and construct
validity; assesses for comorbid
disorders/ concerns
Omnibus Rating 2–5 (Preschool) Teacher 105 (Preschool) Attention Problems, Yes Normed based on current US
Scale 6–11 (Child) 156 (Child) Hyperactivity, Census population
12–21 (Adolescent) 165 Aggression, Conduct characteristics; adequate
(Adolescent) Problems* reliability and construct
validity; assesses for comorbid
disorders/ concerns

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Behavior Assessment Omnibus Rating 8–11 (Child) Child 137 (Child) Attention Problems, Yes Normed based on current US
System for Children – Third Scale 12–21 (Adolescent) 189 Hyperactivity Census population
Edition Self Report of (Adolescent) characteristics; adequate
Personality (BASC; reliability and construct
Reynolds & Kamphaus, validity; assesses for comorbid
2015) disorders/ concerns
Child Behavior Checklist Omnibus Rating 1½ –5 (Preschool) Parent 100 (Preschool) Attention Problems, No Includes multicultural norms,
Parent Rating Scale (CBCL; Scale 6–18 (Child) 113 (Child) Aggressive Behavior, adequate reliability and
Achebach & Rescorla, 2001) construct validity; assesses for
comorbid disorders/ concerns
Child Behavior Checklist Omnibus Rating 6–18 Teacher 113 Attention Problems, No Includes multicultural norms,
Teacher Rating Form (CBCL- Scale Aggressive Behavior, adequate reliability and
TRF; Achenbach & Rescorla, Rule-Breaking construct validity; assesses for
2001) Behavior comorbid disorders/ concerns
Child Behavior Checklist Omnibus Rating 11–18 Child 112 Attention Problems, No Includes multicultural norms,
Youth Self Report (YSR; Scale Aggressive Behavior, adequate reliability and
Achenbach & Rescorla, Rule-Breaking construct validity; assesses for
2001) Behavior comorbid disorders/ concerns
Conners Rating Scales – 3 ADHD, ODD, CD 6–18 (Parent, Parent, 45 (Parent) Inattention, Yes Normed based on current US

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(Conners, 2008) Teacher) Teacher, 41 (Teacher) Hyperactivity/ Census population
8–18 (Child) Child Impulsivity, Defiance/ characteristics; adequate
41 (Child)
Aggression, ADHD, reliability and construct
ODD, CD Symptomsa validity; assesses for comorbid
disorders/ concerns
Note.
*
Conduct Problems subscale is not on the Preschool Version of the BASC-3.
 ASSESSMENT OF CHILDHOOD DISRUPTIVE BEHAVIOR DISORDERS AND ADHD
with adolescent self-reports, parent informants may shed
light on the extent to which the adolescent engages in
behavioral problems outside of the parent’s awareness.
Some general principles regarding influences on parent
reports should be kept in mind, particularly as they relate
to assessment of ADHD and DBDs. For instance, parental
psychopathology is associated with more negative views of
the child’s adjustment (see Frick et al., 2010), that is, par-
ents experiencing their own distress may overreport their
child’s difficulties. De Los Reyes and Kazdin (2005) also
noted that parents who view the child’s problems as dis-
positional rather than situational are more likely to rate
the child negatively. Such factors should be considered for
case conceptualization but should not lead a clinician to
eschew parental reports based on the central role parents
play in a child’s development/adjustment and in potential
interventions.
Teacher Informants
By virtue of the amount of time that children spend in
school, the opportunities available for socialization in
that setting, and the potential for ADHD and conduct
problems to translate to academic impairments, teacher
informants play a valuable role in clinical assessments of
children. As with parent informants, there are limitations
in teacher reports that a clinician must consider. Teachers
are thought to be particularly good at providing informa-
tion on ADHD symptoms but they may not observe the full
array of a child’s problem behaviors (Barry et al., 2013).
Furthermore, as the child gets older, teachers may be less
useful, as an individual teacher likely spends less time with
individual students and may also see more students in
a number of classes throughout the day. Thus, their famil-
iarity with a student receiving assessment should be
expected to be lower than for teachers of young children.
A unique strength of teacher informants is that they have
professional knowledge of typical child development, can
base their ratings of a given child on their understanding
of behavioral expectations at a particular developmental
level, and are also able to observe the child’s classroom
social functioning (Frick et al., 2010).
Child Informants
Although prior to approximately age eight or nine children
are not considered reliable informants of their own atten-
tional or behavioral difficulties, older children may be
quite useful for gaining information on factors such as
difficulty concentrating, feeling restless, and covert beha-
vioral problems (Frick et al., 2010). It is reasonable to
suggest that children or adolescents may underreport
their own symptoms but there is no clear evidence that
indicates a systematic tendency for youth informants to
over- or underreport relative to parents (De Los Reyes &
Kazdin, 2005). Thus, the clinician should be prepared to
utilize youth self-report but make a determination as to
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313
whether the particular child or adolescent was sufficiently
motivated to participate, was able to comprehend the
assessment questions, and provided truthful information.
Peer Informants
Peer-referenced assessment is rarely used in routine
assessments of ADHD and DBDs; yet, for some con-
structs (e.g., aggression, hostility toward others, class-
room disruptions), peers may provide unique insights.
In research contexts, classrooms have been one of the
more commonly used contexts in which to conduct
peer-referenced assessments and a common approach
is to have children nominate a number of classmates on
characteristics of interest (e.g., “fights most,” “liked
most,” “is shy”) and to determine the rate at which
the child being assessed is nominated. Despite the
unique information afforded by peer-referenced assess-
ment, logistical and ethical concerns limit their use. If
peer informants are desired, a professional must take
steps to ensure confidentiality of the child who is the
focus of the assessment and to limit the time required
for children to complete the process so as to not disrupt
their typical routine (Barry et al., 2013).
School/Institutional Records
Another source of relevant information for assessments of
ADHD and DBDs include records from schools or other
institutions (e.g., treatment facilities). Specifically, impor-
tant information from these records may include aca-
demic grades, disciplinary citations or infractions, or
positive achievements/awards. These records have the
advantage of providing a more objective and ecologically
valid account of the child’s functioning. For example,
instead of a parent simply reporting that a child is doing
poorly in school, obtaining grades would aid the clinician
in determining the degree of academic problems (if any)
the child is experiencing and whether such problems are
global or confined to certain subject areas. Unfortunately,
there is no clear empirical evidence as to the validity or
utility of such records or how these records should be
integrated with data obtained through other means. The
difficulty in arriving at clear guidelines for handling insti-
tutional records is based, at least in part, on the vast set-
ting-specific ways in which child behavior and functioning
are documented (Barry et al., 2013). At the very least, these
records could provide indications of a child’s impairments
in important settings and thus might contribute unique
information to case conceptualization and intervention
planning.
Integration across Informants
Perhaps one of the most challenging aspects of conducting
assessments with children and adolescents is the integra-
tion of information from multiple informants. Informant
 314 CHRISTOPHER T. BARRY, REBECCA A. LINDSEY, AND ALYSSA A. NEUMANN
discrepancies should be expected based on factors such as
situational specificity (Konold, Walthall, & Pianta, 2004)
but also factors related to the informant and the measures
used. These factors include the demographics (e.g., age,
gender) of the child and attributions (e.g., purposeful,
beyond their control) that the informant makes about the
child’s symptoms or behaviors (De Los Reyes & Kazdin,
2005). The clinician should be aware of these potential
reasons for informant discrepancies, as well as factors
that may be at play for a specific child.
To integrate and interpret findings, a process has been
recommended in which all issues considered problematic
by any informant are initially considered (see Barry et al.,
2013; Frick et al., 2010). Areas of convergence (e.g.,
between parents and teachers) signal important concerns
given their apparent pervasiveness across settings,
whereas informant discrepancies may point to important
considerations for intervention or issues in the assessment
methods that warrant closer examination (see Kazak et al.,
2010). From there, the clinician can conceptualize the
primary and secondary concerns that need to be consid-
ered diagnostically and for treatment planning.
Pelham and colleagues (2005) discuss the concepts of
positive predictive power and negative predictive power
that may also prove useful in efficiently highlighting infor-
mation that is diagnostically relevant. In brief, symptoms
with negative predictive power are generally the core
symptoms of a disorder (e.g., difficulty with sustained
attention), the absence of which would help rule out the
presence of a disorder (e.g., ADHD). Positive predictive
power involves the unique symptoms of a disorder (e.g.,
fire setting for conduct disorder) that, if developmentally
atypical, would increase the likelihood that the disorder is
present. In the case of ADHD, Rosales and colleagues
(2015) noted that each of the eighteen symptoms contri-
butes unique information to the classification of ADHD
but that symptoms involving losing or forgetting things,
perhaps signifying positive predictive power, were indica-
tive of the most severe presentations. Thus, if a clinician is
preparing to conduct a comprehensive, multi-informant,
multimethod assessment of ADHD and DBDs, an effective
approach may be to first screen for core symptoms of the
disorders of focus. From there, the lack of core symptoms
would allow the clinician to focus on other issues, whereas
their presence would signal to the clinician to then more
carefully assess for other unique symptoms and the sever-
ity level of a disorder. More work is needed to further
refine models of negative and positive predictive power
across a number of clinical problems and across develop-
mental levels.
The discussion herein has focused largely on interview
and rating information obtained from informants such as
parents, teachers, and children/adolescents. However, the
field of clinical assessment has attempted for several dec-
ades to also develop presumably more objective, standar-
dized tools that might provide important data on the
child’s functional impairments. Further advances in
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assessment may present useful models or algorithms for
prioritizing and conceptualizing information in
a clinically meaningful way.
TECHNOLOGICAL ADVANCES
Laboratory tasks represent an approach to assessment of
externalizing problems that may have some intuitive
appeal but they have mixed support in terms of validity
and clinical utility. More specifically, laboratory tasks
(e.g., Stroop, Continuous Performance Tests [CPTs],
Lexical Decision Tests, Implicit Attitudes Tests) are pre-
sumed to tap into important processes that underlie the
associated impairments of ADHD and conduct problems;
yet the extent to which they do so in a reliable manner and
with incremental validity is uncertain. Advances in the
area of evidence-based assessment may eventually support
the idea that a child’s performance on an analogue task
mimics their behavior in difficult, real-world situations.
Such tasks would enjoy the advantage of not depending on
the perspective of informant responses and may also have
treatment implications (e.g., clear, consistent contingency
management for children who demonstrate low respon-
siveness to punishment cues on a performance-based
task).
Many of the well-known laboratory tasks have been in
existence for a relatively long time. Generally, however,
agreement between measures such as CPTs and informant
reports has been only moderate to low. Recent research on
preschoolers indicates that aspects of performance (e.g.,
omission and commission errors) correlate differently at
different points in the test with teacher-reported ADHD
symptoms, suggesting that performance on these tests is
complex and multiply determined (Allan & Lonigan,
2015). It should be noted that laboratory tasks may have
clinical utility for youth with behavioral problems insofar
as task performance might highlight processes (e.g.,
reward dominance) connected to potential responsiveness
to behavioral interventions (Frick & Loney, 2000; O’Brien
& Frick, 1996). Nevertheless, there remains limited evi-
dence that such tools are necessary or sufficient to make
diagnostic and intervention decisions for youth with
ADHD or DBDs.
An additional use of technology in assessment has
been the online administration of rating scales and
other measures, whereby the informant (and clinician)
can access assessment materials outside of the typical
clinical appointment. Such an approach has the poten-
tial advantage of increasing efficiency in the use of face-
to-face time between the clinician, parents, and child/
adolescent, as well as allow the clinician quicker access
to ratings for scoring and interpretation purposes.
Although there is limited evidence regarding the psy-
chometric equivalence of online responses to standard
assessment tools, initial findings indicate no differences
in reliability in caregiver pencil-and-paper versus online
ratings (Pritchard et al., 2017). Therefore, as the
 ASSESSMENT OF CHILDHOOD DISRUPTIVE BEHAVIOR DISORDERS AND ADHD
availability of online assessment tools (and, presum-
ably, confidence in their security) increase, more clin-
icians may wish to utilize this resource.
DIVERSITY ISSUES
There is no evidence that cultural factors should result in
qualitatively different approaches to assessment of ADHD
and DBDs. However, aspects of evidence-based assess-
ment described above should take into account a client/
family’s cultural background. For example, a systematic
literature review found that white children were more
likely to be diagnosed with ADHD compared to nonwhite
children and that nonwhite children were more likely to be
diagnosed with a DBD, suggesting that children’s emo-
tional and behavioral problems may be interpreted differ-
ently based on their racial/ethnic background and perhaps
leading to an overrepresentation of minority children in
diagnoses of DBDs (Liang, Matheson, & Douglas, 2016).
A clinician may also choose to investigate a measure’s
psychometric properties relative to specific populations,
as some measures have demonstrated acceptable reliabil-
ity and validity in minority samples (Schmidt et al., 2017).
This research, however, is still in relative infancy.
Emerging psychometric research generally supports that
the factor structures of ADHD- and DBD-related con-
structs (e.g., sluggish cognitive tempo, both ADHD sub-
types, ODD) hold up in samples from Nepal (Khadka,
Burns, & Becker, 2016), Spain (Servera et al., 2016), and
Germany (Rodenacker et al., 2017). Other cultural issues,
including the selection of measures, interpretation of find-
ings, factors in how child behavior problems are viewed,
and acceptability of treatment options, are also important
and warrant more study.
FUTURE DIRECTIONS AND PRACTICAL
IMPLICATIONS
In addition to being guided by the prevailing empirical
evidence on the developmental trajectories of ADHD
and conduct problems – and by sound assessment
methods that adequately cover all relevant aspects of
the constructs in question – it is also important that the
assessments of these problems be conducted in a cost-
effective manner. To be comprehensive means to
account for heterogeneous presentations of ADHD and
conduct problems, assess for co-occurring difficulties,
address relevant aspects of the child’s context for
understanding symptom manifestation and potential
approaches to intervention, and account for intraperso-
nal and contextual factors that might serve a risk or
a protective role for the child’s ongoing development.
To be cost-effective includes efforts to address the cen-
tral concern or referral question in a sound manner
while using a parsimonious battery (Barry et al., 2013).
Further research is needed to delineate factors involved
in increasing efficiency and cost-effectiveness of
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315
assessment of ADHD and conduct problems and in alter-
native modalities of service delivery. For example, preli-
minary evidence has suggested that assessments via
videoconferencing may be comparable to face-to-face ser-
vices (see Diamond & Bloch, 2010), and it is likely that
clinicians have used variations of this approach for some
aspects of assessment (e.g., teacher telephone interviews)
for years. Nevertheless, such alternatives, particularly
insofar as they increase efficiency and increase availability
of services in rural areas, are in need of systematic empiri-
cal examination.
This discussion has attempted to briefly highlight
research-supported principles of evidence-based assess-
ment of ADHD and DBDs in children and adolescents.
Foremost among these is a recognition of the heteroge-
neous ways in which youth may present with attention or
conduct problems and the need to systematically consider
evidence gathered through developmentally sensitive and
incrementally valid tools that also document an individual
child’s specific impairments and contextual influences on
their strengths and behavioral concerns. In this way, clin-
ical assessment inherently uses population-based knowl-
edge on developmental psychopathology to provide the
best child-specific explanations for any difficulties and
guidance as to the next steps for ameliorating those
difficulties.
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