3.28 At-Home Functional Impairment in Youth With Attention-Deficit/Hyperactivity Disorder (ADHD): Factor Structure and Norm-Referenced Cut-Off Points for the Before School Functioning Questionnaire and Parent Rating of Evening and Morning Behavior Scale, Revised

Abstract

Objective. Children with attention deficit hyperactivity disorder (ADHD) frequently manifest behavioral difficulties in the morning prior to school and in the afternoons and evenings. We sought to establish norms for two time-specific measures of functioning: The Before School Functioning Questionnaire (BSFQ) and the Parent Rating of Evening and Morning Behavior scale, revised (PREMB-R). Study Design. The normative survey was an online survey of a representative U.S sample of 1200 primary caregivers of children and adolescents aged between 6 and 17 years. A quota system was used whereby parents of 50 male and 50 female children/adolescents were recruited in each age group, i.e., 100 parents for each of the 12 age groups. Results. Our findings were consistent with other studies in showing well replicated features of ADHD as regards to prevalence, male predominance and the lessening of symptoms with age. We also provide further evidence that early morning and late afternoon/evening impairments are associated with childhood ADHD independent of other psychiatric disorders. The use of a large population sample allowed us to compute age-stratified norms for three thresholds of risk: screening risk (80th percentile); mild functional impairment (90th percentile); moderate functional impairment (93rd percentile); and severe functional impairment (98th percentile). Conclusions. The norms generated by this study can guide clinicians in the use of the BSFQ and PREMBR for identifying those ADHD youth who may be experiencing difficulties in the early morning and late afternoon. Such tools are needed given the availability of treatments that can target ADHD symptoms and impairments at these extremes of the daily routine.