Vanderbilt Assessment Scale (VAS)

AIM:

To assess the level of clinical symptoms and performance impairment of the child using the Vanderbilt Assessment Scale.

INTRODUCTION:

Attention Deficit Disorder (Hyperkinetic Disorder) is a syndrome first described by Heinrich Hoff in 1854. Since then, it has been known by a variety of names such as minimal brain dysfunction (MBD), hyperkinetic syndrome, Strauss syndrome, organicdrivenness, and minimal brain damage. It is a neuropsychiatric condition affecting Pre-schoolers, children, adolescents, and adults around the world, characterized by a pattern of diminished sustained attention, and increased impulsivity or hyperactivity. A relatively common disorder, it occurs in about 3% of school-age children. Males are 6-8 times more often affected. The onset occurs before the age of 7 years and a large majority of patients exhibit symptoms by the 4th year of age.

Core Characteristics

  • DSM-5 uses two lists of symptoms to define ADHD. The first list includes symptoms of inattention, poor concentration, and disorganization. The second list includes symptoms of hyperactivity–impulsivity.
  • Children who are inattentive find it difficult to sustain mental effort during work or play and find it difficult to resist salient distractions while doing so.
  • Children with ADHD are extremely active, but unlike other children with a high energy level, they accomplish very little.
  • Children with ADHD are impulsive, which means they seem unable to bridle their immediate reactions or they may fail to think before they act.
  • DSM specifies three presentation types of ADHD based on primary symptoms: predominantly inattentive, predominantly hyperactive–impulsive, or both.
  • A diagnosis of ADHD requires the appearance of symptoms before age 12, a greater frequency and severity of symptoms than in other children of the same age and gender, persistence of symptoms, occurrence of symptoms in several settings, and impairments in functioning.
  • Although useful, the DSM criteria have several limitations; an important one is developmental insensitivity.

Associated Characteristics

  • Besides their primary difficulties, children with ADHD display other problems, such as cognitive and learning deficits, speech and language impairments, motor incoordination, medical and physical concerns, and social problems.
  • Children with ADHD display deficits in executive functions (EFs), the higher-order mental processes that underlie the child’s capacity for planning and self-regulation.
  • Children with ADHD score slightly lower on IQ tests, but most are of normal intelligence. Their difficulty is in applying their intelligence to everyday life situations.
  • Children with ADHD experience school performance difficulties, including lower grades, a failure to advance in grade, and more frequent placements in special education classes.
  • Many children with ADHD have a specific learning disorder, typically in reading, spelling, or math.
  • Some children with ADHD report a higher self-esteem than is warranted by their behavior, referred to as a “positive bias.”
  • They often have speech and language impairments and have difficulty using language in everyday situations.
  • They may experience many health-related problems, including enuresis and encopresis, asthma, obesity, eating problems, and sleep disturbances and tend to be accident prone. The costs of and medical service use in those with ADHD are high.
  • They experience numerous social problems with family members, teachers, and peers.

Prevalence and Course

The best estimate is that ADHD affects about 5% to 9% of all school-age children. The diagnosis of ADHD is about two to three times more common in boys than in girls. Girls with ADHD have a significant disorder; clinic-referred girls with ADHD display many of the same features and outcomes as boys with ADHD. ADHD occurs across all socioeconomic levels and has been identified in every country where it has been studied. Symptoms of ADHD change with development. A difficult temperament as an infant may be followed by hyperactive-impulsive symptoms at 3 to 4 years of age, which are followed, in turn, by the increasing visibility of symptoms of inattention around the time that the child begins school. Although some symptoms of ADHD may decline in prevalence and intensity as children grow older, for many individuals ADHD is a lifelong and painful disorder.

Theories and Causes

Theories about possible mechanisms and causes for ADHD have emphasized deficits in cognitive functioning, reward/motivation, arousal level, and self-regulation. There is strong evidence that ADHD is a neurodevelopmental disorder; however, biological and environmental risk factors together shape its expression.  Findings from family, adoption, twin, and specific gene studies suggest that ADHD is inherited, although the precise mechanisms are not yet known.

Many factors that compromise the development of the nervous system before and after birth may be related to ADHD symptoms, such as pregnancy and birth complications, maternal smoking during pregnancy, low birth weight, malnutrition, maternal alcohol or drug use, early neurological insult or trauma, and diseases of infancy. ADHD appears to be related to abnormalities and developmental delays in the frontostriatal circuitry of the brain and the pathways connecting this region with the limbic system, the cerebellum, and the thalamus. Neuroimaging studies tell us that in children with ADHD there is a structural difference or less activity in certain regions of the brain, but they don’t tell us why. The known action of effective medications for ADHD suggests that several neurotransmitters are involved, with

most evidence suggesting a selective deficiency in the availability of both dopamine and norepinephrine.

Psychosocial factors in the family do not typically cause ADHD, although they are important in understanding the disorder. Family problems may lead to greater severity of symptoms and relate to the emergence of co-occurring conduct problems.

ADHD is likely the result of a complex pattern of interacting influences, perhaps giving rise to the disorder through several nervous system pathways.

Accompanying Psychological Disorders and Symptoms

A factor that makes ADHD so challenging is that children with the disorder have much higher than expected rates of other psychiatric disorders, particularly conduct problems,

anxiety, and mood disorders. As many as 50% of children with ADHD also meet criteria

for oppositional defiant disorder or conduct disorder. About 25% or more of children with ADHD experience excessive anxiety. The presence of co-occurring anxiety is associated with more social and academic difficulties, and greater long-term impairment and mental health

problems. As many as 20% to 30% children with ADHD experience depression or another mood disorder. Although depression may be partly related to demoralization as a result of their symptoms, it also can result from an elevated risk for depression in families of children with ADHD. The relation between ADHD and bipolar disorder is controversial. A diagnosis of childhood bipolar disorder appears to sharply increase the child’s risk for previous or co-occurring ADHD, but a diagnosis of ADHD does not appear to elevate the child’s risk for bipolar disorder. Children with ADHD may display motor coordination difficulties and tic disorders.

Treatment

There is no cure for ADHD, but a variety of treatments can be used to help children cope with their symptoms and any secondary problems that may arise over the years. The primary approach to treatment combines stimulant medication, parent management training, and educational intervention.

Stimulants are the most effective treatment for managing symptoms of ADHD; however, their limited long-term benefit raises important issues about their clinical use that

are yet to be resolved.

Parent management training (PMT) provides parents with a variety of skills to help them manage their child’s oppositional and defiant behaviors and cope with the difficulties of raising a child with ADHD.

Educational interventions focus on managing inattentive and hyperactive–impulsive behaviors that interfere with learning and on providing a classroom environment that capitalizes on the child’s strengths. Findings from the MTA Study, a landmark controlled comparison of intensive treatments for ADHD, suggest that for children with uncomplicated ADHD, medication may be the best treatment option; however, for those with ADHD and oppositional symptoms, poor social functioning and ineffective parenting, combining medication and behavioural treatment may be the best option.

Additional interventions for ADHD include family counselling and support groups, and individual counseling for the child.

Description of the test

The Vanderbilt Assessment Scale consists of a symptom and impairment in performance evaluation that is used in the diagnostic of attention deficit hyperactivity disorder (ADHD) in children of 6 to 12 years, based on parent and teacher input. The two assessments (parent and teacher) consist of three subtypes and 3 screens for other co-morbidities:

  • Predominantly Inattentive subtype;
  • Predominantly Hyperactive/Impulsive subtype;
  • ADHD Combined Inattention/Hyperactivity;
  • Oppositional-Defiant Disorder Screen;
  • Conduct Disorder Screen;
  • Anxiety/Depression Screen.

The scales are not meant to be used in isolation for ADHD diagnosis and should be accompanied by interviews and other information.

According to Wolraich et al. the scale has good internal reliability with Cronbach’s alpha coefficient of > .90 (parent) and >.89 (teacher). The scale also has adequate test-retest reliabilities (r=.27 – .34). Convergent validity is evidenced by the moderate to high correlations with the Diagnostic Interview Schedule for Children-IV Parent Version.

METHODOLOGY:

MATERIAL REQUIRED :

Pencil/pen and Vanderbilt Assessment Scale.

PROCEDURE TO FIND THE PARTICIPANT-

The participant was chosen as random basis as per convenient, since it was highly difficult to find a person suffering from or diagnosed with ADHD.

INFORMED CONSENT-

The participant was first given a brief description of the test. He was also informed that this test would be conducted entirely at his own discretion which implies that he could decline his participation in this experiment if it was not convenient.

He was then given a consent form and all the relevant details related to the form were explained before soliciting the signature.

___________________________________________________________________________

INFORMED CONSENT FORM

This form seeks to take your consent to participate in a study. The following will provide you with information about the study that will help you in deciding whether or not you wish to participate. If you agree to participate, please be aware that you are free to withdraw at any point throughout the duration of the experiment.

All information you provide will remain confidential and will not be associated with your name. If for any reason during this study you do not feel comfortable, you may leave the laboratory and your information will be discarded.

When this study is complete you will be provided with the results of the experiment if you request them, and you will be free to ask any questions. Please indicate with your signature on the space below that you understand your rights and agree to participate in the experiment.

Your participation is solicited, yet strictly voluntary. All information will be kept confidential and your name will not be associated with any research findings.

ANI

SIGNATURE OF THE APPLICANT (PARENT)

___________________________________________________________________________

RAPPORT FORMATION-

A rapport was established before giving the instructions by giving him a brief detail of the study. It was also ensured that the details were explained to the participant in the language which was most agreeable with him.

All the arrangements regarding the experiment were arranged in an appropriate manner. The participant’s concerns if any were also managed for the smooth conduction of the experiment.

DEMOGRAPHIC DETAILS-

  • NAME: Man
  • AGE: 7
  • GENDER: FEMALE

INSTRUCTIONS:

The parent is told the following – “I will be asking a few questions about certain developmental milestones of your child for particular ages. Depending on whether or not your child accomplished these tasks at that particular age, answer ‘yes’ or ‘no’. In case you do not understand something, please clarify before answering”.

PROCEDURE :

The experiment started with rapport formation wherein the subject was made comfortable. The subject being a child was accompanied by his mother. The subject’s mother was explained about the scale, its purpose, and was seated around to make the subject feel at comfort. For certain items on the scale, direct questions were asked to check if the specific characteristic was present. For many others, judgment was made by observing the subject.

For each characteristic that was present, the subject was given a score of 1, and if not present then 0.

RESULTS :

PARENT ASSESSMENT SCALECOMMENTS/REMARKS
Predominantly Inattentive subtypeNIL
Predominantly Hyperactive/Impulsive subtypeNIL
ADHD Combined Inattention/HyperactivityNIL
Oppositional-Defiant Disorder ScreenNIL
Conduct Disorder ScreenNIL
Anxiety/Depression ScreenNIL
Total number of questions scored 2 or 3 in questions 1–9: 0
Total number of questions scored 2 or 3 in questions 10–18: 0
Total Symptom Score for questions 1–18: 6
Total number of questions scored 2 or 3 in questions 19–26: 0
Total number of questions scored 2 or 3 in questions 27–40: 0
Total number of questions scored 2 or 3 in questions 41–47: 0
Total number of questions scored 4 or 5 in questions 48–55: 0
Average Performance Score: 19

INTERPRETATION AND DISCUSSION :

The subject scored 0 on all the domains/areas been measured under symptoms categories, and scored an overall 6, which means he has no clinical symptoms. In the Performance area, he scored a total of 19 score, which again showed no delay in the performance development of the child. Hence, it can be concluded that the child is growing normally and shows no clinical abnormality or performance delay.

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