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      Interrater agreement on behavioral executive function measures in adolescents with Attention Deficit Hyperactivity Disorder Translated title: Funciones ejecutivas conductuales en adolescentes con trastorno por déficit de atención con hiperactividad: acuerdo entre informantes

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          Background/Objective

          Though most children with Attention Deficit Hyperactivity Disorder (ADHD) show difficulties in behavioral measures of executive functions (EF), few studies have examined interrater agreement in these measures.Objective: To analyze the agreement between parents, teachers and self-reports of behavioral EF in adolescents with ADHD and controls. Method: A sample of 118 adolescents (75 with ADHD and 43 controls) was rated by parents, teachers and the adolescents themselves using the Comprehensive Executive Function Inventory. The intraclass correlation coefficient (ICC) and Bland and Altman methods were used to evaluate agreement. Results: The ICC between parents, teachers and self-report was poor or moderate in the group with ADHD; in the control group the agreement was fair to good. The Bland and Altman graphs show that, in the control group, most of the scores are below to the clinical cut-off point, while in the group with ADHD they are above. Conclusions: Agreement between all raters was low. Parents, teachers and adolescents agreed on the absence of deficits in behavioral EF in the control group, and on the presence of deficits in the group with ADHD, although they did not agree on the frequency of these deficits.

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          Antecedentes/Objetivo

          Aunque muchos adolescentes con Trastorno por Déficit de Atención con Hiperactividad (TDAH) muestran dificultades en las funciones ejecutivas (FE) conductuales, pocos estudios han analizado el acuerdo entre informantes en estas medidas. Objetivo: Analizar el acuerdo entre informantes en la valoración de FE conductuales en adolescentes con TDAH y controles. Método: Ciento dieciocho adolescentes (75 con TDAH y 43 controles) fueron evaluados con el Comprehensive Executive Function Inventory por padres, maestros y autoinforme. Se utilizó el coeficiente de correlación intraclase (ICC), y el método de Bland y Altman para evaluar el acuerdo entre informantes. Resultados: El ICC varía entre bajo y moderado en el grupo con TDAH, y entre moderado y bueno en el grupo control. Los gráficos de Bland y Altman muestran que, en el grupo control, la mayoría de las puntuaciones se sitúan por debajo del punto de corte clínico, mientras que en el grupo con TDAH están por encima del punto de corte. Conclusiones: El acuerdo entre informantes es bajo. Padres, maestros y adolescentes coinciden en la ausencia de déficits en las FE conductuales en el grupo control y en la presencia de déficits en el grupo con TDAH, aunque no coinciden en la frecuencia de estos déficits.

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          Comparing methods of measurement: why plotting difference against standard method is misleading.

          When comparing a new method of measurement with a standard method, one of the things we want to know is whether the difference between the measurements by the two methods is related to the magnitude of the measurement. A plot of the difference against the standard measurement is sometimes suggested, but this will always appear to show a relation between difference and magnitude when there is none. A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way. We show this theoretically and by a practical example.
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            The childhood executive functioning inventory (CHEXI): a new rating instrument for parents and teachers.

            Poor executive functioning has been shown to be of central importance in disruptive behavior disorders such as attention deficit hyperactivity disorder (ADHD), and a large number of laboratory measures of executive functioning have been developed. There are, however, few available questionnaires tapping executive functioning and those that exist also include items focused directly on the symptom criteria for ADHD, which makes it difficult to draw conclusions regarding executive functioning per se. In the present study, a new rating instrument, the Childhood Executive Functioning Inventory (CHEXI) was therefore introduced. This instrument was shown to have good test-retest reliability. Using factor analysis, two factors tapping working memory and inhibition emerged using parent ratings and these two factors were replicated using teacher ratings. Modest, yet mostly significant, relations to laboratory measures of working memory and inhibition were found. Ratings on the CHEXI were also found to be significantly related to ADHD symptoms as well as early academic achievement. Interestingly, ratings on the CHEXI and laboratory measures of working memory and inhibition were shown to explain independent variance in ADHD symptoms and academic achievement, which point to the importance of using a multi-assessment strategy when studying executive functioning.
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              Diagnosing ADHD in adolescence.

              This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and retrospective reporting of childhood symptoms were addressed.
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                Author and article information

                Contributors
                Journal
                Int J Clin Health Psychol
                Int J Clin Health Psychol
                International Journal of Clinical and Health Psychology : IJCHP
                Asociacion Espanola de Psicologia Conductual
                1697-2600
                2174-0852
                30 April 2019
                May 2019
                30 April 2019
                : 19
                : 2
                : 141-149
                Affiliations
                [a ]Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
                [b ]Institute of Neuroscience, University of Barcelona (UBneuro), Spain
                [c ]Departament of Social Psychology and Quantitative Psychology, University of Barcelona, Spain
                Author notes
                [* ]Corresponding author. Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain jamador@ 123456ub.edu
                Article
                S1697-2600(19)30093-6
                10.1016/j.ijchp.2019.02.007
                6517650
                4642a5fc-fe87-464b-9cc4-721ef2f70523
                © 2019 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 November 2018
                : 15 February 2019
                Categories
                Originals article

                adhd,behavioral executive functions,interrater agreement,bland and altman approach,correlational cross-sectional study,tdah,funciones ejecutivas comportamentales,acuerdo entre evaluadores,enfoque de bland y altman,estudio transversal correlacional

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