Page 1 of 5 DSM-5 criteria for the diagnosis of ADHD emphasize the importance of gathering behavioral information from multiple settings and multiple informants. To accomplish this, standardized ADHD rating scales are recommended as Best Practice by the American Psychiatric Association and the American Academy of Pediatrics. In addition to ADHD rating scales, DefiniPoint provides a variety of standardized instruments to gather additional behavioral information. This information regarding the individual's functioning and degree of impairment can be helpful to quantify the progress of therapy/treatment and document outcomes. DefiniPoint facilitates Best Practice ADHD assessments consistent with DSM-5 diagnostic criteria which include the evaluation of other emotional/behavioral, developmental, and physical conditions. As such, the information provided by DefiniPoint is not intended to be the sole source of information but rather is part of a comprehensive evaluation. WEISS FUNCTIONAL IMPAIRMENT RATING SCALES (WFIRS) The Weiss Functional Impairment Rating Scales assesses symptoms and to what degree an individual's behavior or emotional problems impact various clinically-relevant domains of functioning. Although ADHD symptoms and actual impairment are distinct concepts, it is informative to measure both since some patients are highly symptomatic but not impaired or vice versa. The WFIRS contains items that are most likely to represent the patient's target of treatment and therefore has utility when used to assess treatment efficacy. The WFIRS is designed to determine not only if the ADHD has improved, but if the patient's functional difficulties are also better. The instrument has been translated into 18 languages, used in many studies, and psychometrically validated. The clinical utility of the WFIRS has been demonstrated in multiple clinical studies and described in journal articles since its introduction. SELF REPORT RATING SCALE The Weiss self-report version is appropriate for adolescent and adult report of functional impairment associated with ADHD. It contains 68 items spanning six functional domains: Home Self-Concept Learning & Work Activities of Daily Living Social Activities Risky Activities Validation The scale has been psychometrically validated with an internal consistency >0.8 for each domain and for the scale as a whole. It has moderate convergent validity (0.6) with other measures of functioning (i.e. Columbia Impairment Scale and the Global Assessment of Functioning (GAF). It has moderate discriminating validity (0.4) from symptoms pre-treatment (i.e. ADHD-Rating Scale) and quality of life (CHIP). The domains have been confirmed by factor analysis, although the domain of school functioning separates into learning and behavior. The scale is highly sensitive to change with treatment and, in particular, significantly correlated to change in ADHD symptoms (40% change) and overall psychopathology. Use in Determining Treatment Outcomes This functional impairment rating scale effectively quantifies the level of functioning in relevant domains and can be used to systematically monitor improvements and inform treatment decisions. The WFIRS can be completed in less than 15 minutes, making it ideal to easily gather information on a routine basis.
Page 2 of 5 NOTE: The WFIRS does not provide a normalized score or a single probability score and therefore cannot be integrated with other assessment results in DefiniPoint. Scoring and Interpretation Results Any item rating 2 or 3 is considered clinically impaired. Interpretation of results can be accomplished by by utilizing the total score or the mean score for each domain, omitting those rated not applicable. For clinical purposes, when defining impairment for DSM-IV, clinicians can consider that any domain with at least two items scored 2, one item scored 3 or a mean score >1.5 is impaired. Each anchor point on the Likert scale represents approximately one standard deviation (SD). A total score change of 13 would be considered a significant improvement or about half a SD. The change obtained in treatment is typically one full SD. The mean score for risky behavior in children is 0.5 but increases with age. For adolescents the mean score is 1. Tabular results for Bill Smith are shown below and organized by domain. Domain Number Average Total scored 2 or 3 A. Family 4 1.71 12 B. Work 5 1.60 16 C. School 5 1.88 15 D. Life Skills 5 1.45 16 E. Self Concept 4 2.50 10 F. Social 4 1.63 13 G. Risk 7 1.62 21 Total Sum: 103 Average Score: 1.7
Page 3 of 5 Question Response Score A. Family 1 Having problems with family Never or not at all 0 2 Having problems with spouse/partner Sometimes or somewhat 1 3 Relying on others to do things for you Often or much 2 4 Causing fighting in the family Very often or very much 3 5 Makes it hard for the family to have fun together Not applicable NA 6 Problems taking care of your family Very often or very much 3 7 Problems balancing your needs against those of your family Often or much 2 8 Problems losing control with family Sometimes or somewhat 1 B. Work 9 Problems performing required duties Never or not at all 0 10 Problems with getting your work done efficiently Sometimes or somewhat 1 11 Problems with your supervisor Often or much 2 12 Problems keeping a job Very often or very much 3 13 Getting fired from work Not applicable NA 14 Problems working in a team Very often or very much 3 15 Problems with your attendance Sometimes or somewhat 1 16 Problems with being late Never or not at all 0 17 Problems taking on new tasks Sometimes or somewhat 1 18 Problems working to your potential Often or much 2 19 Poor performance evaluations Very often or very much 3 C. School 20 Problems taking notes Not applicable NA 21 Problems completing assignments Very often or very much 3 22 Problems getting your work done efficiently Often or much 2 23 Problems with teachers Sometimes or somewhat 1 24 Problems with school administrators Never or not at all 0 25 Problems meeting minimum requirements to stay in school Sometimes or somewhat 1 26 Problems with attendance Often or much 2 27 Problems with being late Very often or very much 3 28 Problems with working to your potential Not applicable NA 29 Problems with inconsistent grades Very often or very much 3 D. Life Skills 30 Excessive or inappropriate use of internet, video games or TV Often or much 2 31 Problems keeping an acceptable appearance Sometimes or somewhat 1 32 Problems getting ready to leave the house Never or not at all 0 33 Problems getting to bed Sometimes or somewhat 1 34 Problems with nutrition Often or much 2 35 Problems with sex Very often or very much 3 36 Problems with sleeping Not applicable NA 37 Getting hurt or injured Very often or very much 3 38 Avoiding exercise Often or much 2 39 Problems keeping regular appointments with doctor/dentist Sometimes or somewhat 1 40 Problems keeping up with household chores Never or not at all 0 41 Problems managing money Sometimes or somewhat 1 E. Self Concept 42 Feeling bad about yourself Often or much 2 43 Feeling frustrated with yourself Very often or very much 3 44 Feeling discouraged Not applicable NA 45 Not feeling happy with your life Very often or very much 3
Page 4 of 5 Question Response Score 46 Feeling incompetent Often or much 2 F. Social 47 Getting into arguments Sometimes or somewhat 1 48 Trouble cooperating Never or not at all 0 49 Trouble getting along with people Sometimes or somewhat 1 50 Problems having fun with other people Often or much 2 51 Problems participating in hobbies Very often or very much 3 52 Problems making friends Not applicable NA 53 Problems keeping friends Very often or very much 3 54 Saying inappropriate things Often or much 2 55 Complaints from neighbours Sometimes or somewhat 1 G. Risk 56 Aggressive driving Never or not at all 0 57 Doing other things while driving Sometimes or somewhat 1 58 Road rage Often or much 2 59 Breaking or damaging things Very often or very much 3 60 Doing things that are illegal Not applicable NA 61 Being involved with the police Very often or very much 3 62 Smoking cigarettes Often or much 2 63 Smoking marijuana Sometimes or somewhat 1 64 Drinking alcohol Never or not at all 0 65 Taking "street" drugs Sometimes or somewhat 1 66 Sex without protection (birth control, condom) Often or much 2 67 Sexually inappropriate behaviour Very often or very much 3 68 Being physically aggressive Not applicable NA 69 Being verbally aggressive Very often or very much 3 70 Additional comments none
Powered by TCPDF (www.tcpdf.org) Bill Smith Page 5 of 5 REFERENCES The instrument has been translated into 18 languages, used in many studies, and psychometrically validated. The clinical utility of the WFIRS has been demonstrated in multiple clinical studies and described in journal articles since its introduction. References for the WFIRS: Maziade M, Rouleau N, Lee B, Rogers A, Davis L, Dickson R. Atomoxetine and neuropsychological function in children with attention-deficit/hyperactivity disorder: results of a pilot study. J Child Adolesc Psychopharmacol. 2009 Dec;19(6):709-18. doi: 10.1089/cap.2008.0166. Weiss M, The Unique Aspects of Assessment of ADHD. Primary Psychiatry. 2010;17(5):21-25. Hantson J, Wang PP, Grizenko-Vida M, Ter-Stepanian M, Harvey W, Joober R, Grizenko N. Effectiveness of a therapeutic summer camp for children with ADHD: Phase I Clinical Intervention Trial. J Atten Disord. 2012 Oct;16(7):610-7. doi: 10.1177/1087054711416800. Epub 2011 Aug 19. Downloaded: 04/16/2014 10:22:40