This is a chapter excerpt from Guilford Publications.

ADHD Rating Scale–5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation.
By George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid.
Copyright © 2016. Purchase this book now: www.guilford.com/p/dupaul2

Chapter 1
Introduction to
the ADHD Rating Scales

s
es
Pr
rd
lfo
ui
G
e
Th

A ttention-­deficit/hyperactivity disorder (ADHD) is a diagnostic category used

16

to describe individuals who display developmentally inappropriate levels of

inattention, impulsivity, and/or motor activity (American Psychiatric Association,
20

2013). Epidemiological studies have found that ADHD affects approximately 5.9–
7.1% of children and adolescents (Willcutt, 2012). In the United States, parents
©

report that around 11% of children have received an ADHD diagnosis from com-
munity practitioners (Visser et al., 2014). Given the prevalence, chronicity, and
ht

myriad difficulties associated with this disorder, it is important for clinicians to

use psychometrically sound instruments when evaluating children and adolescents
ig

suspected of having ADHD.

yr
op

Purpose of the Manual
C

The purpose of this manual is to describe the ADHD Rating Scale–5, Home Ver-
sion, and the ADHD Rating Scale–5, School Version. With the permission of the
American Psychiatric Association, both rating scales are based on the diagnostic
criteria for ADHD as described in the fifth edition of the Diagnostic and Statisti-
cal Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013).
Information is presented about the development and standardization of these
scales, collection of normative data, factor structure, psychometric properties (i.e.,
reliability and validity), as well as the interpretive uses of these scales in clinical
and school settings.
1
2 ADHD R ating Scale–5 for Children and Adolescents

Background and Description of the ADHD Rating Scale–5

Over the past three decades, the diagnostic criteria for ADHD have under-
gone several changes that have significantly altered the clinical assessment of
this disorder. Research over the last 30 years has consistently demonstrated that
ADHD symptoms can be divided into two separate factors of inattention and
hyperactivity–­impulsivity (e.g., Bauermeister et al., 1995; DuPaul, Power, Anasto-
poulos, & Reid, 1998). Based, in part, on these findings, DSM-5 provides diag-
nostic criteria organized into two dimensions of inattention and hyperactivity–­
impulsivity, each of which consists of nine symptoms. Recent research has also

s
demonstrated that there was a need for slightly different symptom descriptors

es
for children and adolescents. In particular, symptom descriptions that are devel-
opmentally relevant for adolescents and adults were added to the DSM-5 crite-

Pr
ria for ADHD. Thus the ADHD Rating Scale–5 has incorporated the DSM-5
changes by creating separate forms for children and adolescents, with the ado-

rd
lescent form providing developmentally relevant examples of problem behavior
based on DSM-5 descriptions. Finally, recent research stressed that it is crucial

lfo
that symptoms result in functional impairment in common home and/or school

ui
situations. In fact, the DSM-5 requires symptoms to be associated with impair-
ment in at least one functional area (e.g., academic performance, social rela-
G
tionships) for an ADHD diagnosis to be warranted. For this reason, the ADHD
Rating Scale–5 has incorporated two impairment scales keyed to the inattention
e
and hyperactivity–­impulsivity dimensions. This allows users to assess the extent
Th

to which ADHD-related problems adversely affect the home and/or school func-
tioning of children and adolescents.
16

An evaluation of ADHD typically involves multiple components that may

include diagnostic interviews with the child and his or her parents and teachers,
20

behavior rating scales completed by parents and teachers, direct observations of

school behavior, and clinic-­based testing (Barkley, 2015; DuPaul & Stoner, 2014).
©

Although many behavior questionnaires are available for use in such evaluations,
very few of the currently available instruments specifically include items directly
ht

adapted from the DSM-5 criteria for ADHD. Thus our purpose in creating the
ADHD Rating Scale–5 was to provide clinicians with a method to obtain parent
ig

and teacher ratings regarding the frequency of each of the symptoms of ADHD
yr

based on DSM-5 criteria.

op

Eighteen scale items were written to reflect DSM-5 criteria as closely as pos-
sible while maintaining brevity. The primary change made to each symptom was
C

to omit the word “often” from the symptomatic description because respondents
are asked to indicate the frequency of each symptom on a 4-point Likert scale
(“never or rarely,” “sometimes,” “often,” or “very often”). Adapted descriptions
of ADHD symptoms, based on wording used in DSM-5, are included for the ado-
lescent version. Parents are asked to determine symptomatic frequency that best
describes the child’s or adolescent’s home behavior over the previous 6 months
(in accordance with DSM-5 guidelines), and teachers rate the frequency that best
describes the student’s school behavior over the previous 6 months or since the
beginning of the school year. English and Spanish versions of the ADHD Rating
Scale–5, Home Version: Child and Home Version: Adolescent are presented in the
 Introduction to the ADHD Rating Scales 3

Appendix, as is the School Version of the ADHD Rating Scale–5 for children and
adolescents (English only).

Administration and Scoring

All versions of the ADHD Rating Scale–5 are designed to be completed indepen-
dently by a child’s parent or teacher. The respondent is instructed to provide demo-
graphic information (i.e., name of child, age, grade, and name of respondent) and
to circle the number for each item that best describes the child’s or adolescent’s

s
home (or school) behavior over the previous 6 months (or since the beginning of

es
the school year if the teacher has known the student for less than 6 months). If the
respondent skips any item, he or she should be asked to provide a rating for this

Pr
item. If the respondent indicates a lack of opportunity to observe the behavior and
skips an item, then this item is not included in the scoring of the scale. If three or

rd
more items are omitted, the clinician should use extreme caution in interpreting
the scale for screening, diagnostic, or treatment evaluation purposes.

lfo
The home and school versions of the ADHD Rating Scale–5 consist of two

ui
symptom subscales: Inattention (nine items) and Hyperactivity–­Impulsivity (nine
items). These subscales are empirically derived (see Chapter 2) and conform to the
G
two symptomatic dimensions described in the DSM-5. Thus three symptom scores
(Inattention, Hyperactivity–­Impulsivity, and total) are derived from each version.
e
The Inattention subscale raw score is computed by summing the item scores for
Th

Items 1–9. The Hyperactivity–­Impulsivity subscale raw score is computed by sum-

ming the item scores for Items 10–18. The Total Scale raw score is obtained by
16

adding the Inattention and Hyperactivity–­Impulsivity subscale raw scores.

The ADHD Rating Scale–5 was designed to include items reflecting six
20

domains of impairment that are common among children with ADHD. One
domain assessed by the ADHD Rating Scale–5 is relationships with significant
©

others (family members for the home version and teachers for the school version).
A second domain is peer relationships, which are frequently impaired among chil-
ht

dren with ADHD (Barkley, 2015). A third domain is academic functioning, which
is perhaps the most common impairment among children with ADHD (DuPaul
ig

& Stoner, 2014). A fourth domain is behavioral functioning; impairment due to

yr

disruptive behavior has been universally recognized and is extremely common

op

among children with the hyperactive–­impulsive and combined presentations of

ADHD. A fifth domain is homework functioning, which is commonly impaired
C

among children with ADHD and is associated with academic problems, emotional
difficulties, and disruptive behavior (Power, Werba, Watkins, Angelucci, & Eiraldi,
2006). A sixth domain is self-­esteem, which is often impaired among children with
ADHD due to the disproportionate amount of punitive feedback these children
receive from adults and peers (Barkley, 2015).
When using the ADHD Rating Scale–5, respondents complete each set of six
impairment items twice, first after rating the inattention symptom items and again
after rating the hyperactivity–­impulsivity items. They are asked, “How much do
the above behaviors cause problems for your child (this student)?” Items are rated
on a 4-point scale (no, minor, moderate, severe problem).
4 ADHD R ating Scale–5 for Children and Adolescents

Raw scores are converted to percentile scores by using the appropriate scoring
profile (presented in the Appendix) based on the child’s gender and age. The raw
score for a particular gender, age, and scale is circled in the body of the profile.
The corresponding percentile score is displayed in the extreme right- and left-
hand columns of the profile. Figure 1.1 displays a sample profile for symptom
scoring the ADHD Rating Scale–5, Home Version, for a 7-year-old boy. This boy’s
mother provided ratings resulting in the following raw scores and percentiles:
Hyperactivity–­Impulsivity = 17 (93rd percentile), Inattention = 15 (91st percen-
tile), and Total = 32 (94th percentile). Note that when a raw score is associated
with more than one percentile score, the clinician should report the lowest of the

s
possible percentile scores. Figure 1.2 displays a sample profile for scoring impair-

es
ments using the ADHD Rating Scale–5, Home Version, for a 7-year-old boy. Note
that a child’s score on each impairment dimension reflects the higher of the two

Pr
ratings on items pertaining to symptom-­related impairment for that dimension.
For example, if the child received a rating of 1 for homework impairment related

rd
to inattention and a rating of 2 for homework impairment related to hyperactivity–­
impulsivity, the child’s score on the homework impairment dimension would be

lfo
a 2. In this case, the child received the following ratings from his mother: Family

ui
Relations = 0 (65th percentile), Peer Relations = 2 (98th percentile), Homework =
1 (90th percentile), Academics = 1 (90th percentile), Behavior = 3 (99.5th+ percen-
tile), and Self-­Esteem = 1 (95th percentile).
G
In Chapter 2, we describe the factor analyses used to derive the subscales of
e
the ADHD Rating Scale–5. Descriptions of the normative samples, as well as gen-
Th

der, age, and ethnic differences in scale scores, are given in Chapter 3. The reli-
ability and validity of various versions of the ADHD Rating Scale–5 are detailed in
16

Chapter 4. Chapters 5 and 6 provide clinicians with guidelines for the interpreta-
tion and use of the scales for diagnostic and treatment evaluation purposes.
20
©
ht
ig
yr
op
C
 Introduction to the ADHD Rating Scales 5

Child’s name:  Glenn Brown June 9, 2015  Age: 

 Date:   7

HI HI HI HI IA IA IA IA Total Total Total Total

%ile 5–7 8–10 11–13 14–17 5–7 8–10 11–13 14–17 5–7 8–10 11–13 14–17 %ile
99+ 27 27 26 21 27 27 27 27 50 53 52 47 99+

99 24 26 22 16 25 27 27 26 45 49 47 39 99

98 19 20 19 15 23 25 27 25 41 44 43 37 98

97 18 20 18 13 22 21 25 21 38 38 38 34 97

96 17 19 17 12 21 20 22 20 38 36 36 30 96

s
95 17 18 15 10 18 17 21 19 35 35 34 27 95

es
94 17 17 14  9 17 16 21 18 32 33 31 26 94

Pr
93 17 16 13  9 17 16 19 18 31 31 30 25 93

rd
92 16 16 12  9 16 16 18 17 29 30 28 25 92

91 15 15 11  8 15 15 18 16 27 29 26 22 91

lfo
90 15 14 10  8 14 14 17 16 27 28 25 21 90

ui
89 13 13 10  7 14 12 16 15 26 25 24 20 89

88 13 11  9  7 12 12 15
G 14 25 24 23 19 88
e
87 12 10  9  6 11 12 15 13 24 22 22 18 87
Th

86 12 10  9  5 11 11 15 12 22 21 22 18 86

85 10  9  9  5 10 11 14 11 20 19 21 17 85
16

84 10  9  9  5 10 11 13 11 20 19 21 16 84
20

80  9  8  7  4  9  9 12 10 18 17 19 14 80

75  8  7  6  3  9  9 10  9 16 14 17 11 75
©

50  5  3  2  1  5  4  6  4 10  8  8  5 50
ht

25  2  1  0  0  2  2  1  1  4  3  2  2 25
ig

10  0  0  0  0  0  0  0  0  0  1  0  0 10
yr

1  0  0  0  0  0  0  0  0  0  0  0  0 1
op

FIGURE 1.1.  Sample symptom scoring profile on the ADHD Rating Scale–5, Home Version,
C

for a 7-year-old boy. HI, Hyperactivity–­Impulsivity; IA, Inattention.

 Child’s name:  Glenn Brown  Date: 
June 6, 2015  Age: 
 7
C
Family Relations Peer Relations Homework Academics Behavior Self-Esteem
op
%ile 5–7 8–10 11–13 14–17 5–7 8–10 11–13 14–17 5–7
yr 8–10 11–13 14–17 5–7 8–10 11–13 14–17 5–7 8–10 11–13 14–17 5–7 8–10 11–13 14–17 %ile

99.5+ 3 3 3 3 3 3 ig3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2-3 3 99.5+

99 2 2 ht 2 2 2 2 2 99

98 2 2 2 2 2 © 2 2 2 2 2 98

written permission of The Guilford Press.

95 1 1 2 20 2 2 2 2 2 1 1 1 95

93 1 1 1 1 1 1 1 1 93

Purchase this book now: www.guilford.com/p/dupaul2

90 1 1 1 1 1 1 90
16
85 1 1 1 1 1 85
Th
80 0 e 80

75 0 G 0 0 0 0 0 75

or introduced into any information storage or retrieval system, in any form or by any
Copyright © 2016 The Guilford Press. All rights reserved under International Copyright
70 0 0 0 0 0 0 0 0 0 70

means, whether electronic or mechanical, now known or hereinafter invented, without the
Convention. No part of this text may be reproduced, transmitted, downloaded, or stored in
ui
65 0 0 0 65
lfo
60 0 0 0 60
rd
55 0 0 Pr 55

50 es 50

www.guilford.com
212-431-9800
370 Seventh Avenue
Guilford Publications

New York, NY 10001

800-365-7006
s
FIGURE 1.2.  Sample impairment scoring profile on the ADHD Rating Scale–5, Home Version, for a 7-year-old boy.