پديد آورندگان :
مؤمنيان، وحيده دانشگاه سمنان، سمنان، ايران , نظيفي، مرتضي دانشگاه بجنورد، بجنورد، ايران , طالع پسند، سياوش دانشگاه سمنان، سمنان، ايران
چكيده فارسي :
هدف: اختلال نارسايي توجه/فزون‌كنشي به‌دليل ماهيت پيچيده جزو تشخيص‌هاي روان‌پزشكي مجادله‌انگيز باقي مي‌ماند. هدف پژوهش حاضر بررسي توان تشخيصي مقياس‌هاي درجه‌بندي معلم در تفكيك كودكان مبتلا به اختلال نارسايي توجه/فزون‌كنشي از كودكان فاقد اين اختلال بود.
روش‌بررسي: پژوهش حاضر از نوع توصيفي و روش شناختي بود. جامعهٔ آماري را دانش‌آموزان پسر ابتدايي شهر مشهد در سال تحصيلي 94-1393 تشكيل دادند. نمونهٔ پژوهش چهل نفر از دانش‌آموزان پسر (بيست نفر بهنجار و بيست نفر داراي اختلال نارسايي توجه/فزون‌كنشي) بودند كه با روش نمونه‌گيري دردسترس انتخاب شدند. براي جمع‌آوري داده‌ها از نسخهٔ معلم پرسشنامهٔ كانرز و مقياس اسنپ-4 در دو مرحله با فاصلهٔ چهار هفته استفاده شد. داده‌ها ازطريق ميانگين و انحراف معيار، آلفاي كرونباخ و همبستگي پيرسون (براي اعتبار بازآزمايي)، آزمون تحليل واريانس چندمتغيري و تحليل راك در سطح معناداري 0٫05 با استفاده از نسخهٔ 25 نرم‌افزار SPSS تحليل شدند.
يافته‌ها: نتايج پژوهش نشان داد، نسخهٔ معلم دو پرسشنامهٔ اسنپ و كانرز مي‌تواند به‌طور معناداري كودكان نارساتوجه/فزون‌كنش را از كودكان فاقد اين اختلال متمايز كند (0٫001≥p). براي تمام خرده‌مقياس‌ها اندازه‌هاي حساسيت با مقادير بيشتر از0٫80 و ويژگي بيشتر از 0٫75 بوده است.
نتيجه‌گيري: براساس يافته‌هاي اين پژوهش دو مقياس اسنپ و كانرز داراي خصوصيات روان‌سنجي عالي تا پذيرفتني بودند؛ لذا از اين دو مقياس مي‌توان به‌طور سودمند در تشخيص اختلال نارسايي توجه/فزون‌كنشي استفاده كرد.
چكيده لاتين :
Background & Objectives: The accurate and timely diagnosis of Attention–Deficit Hyperactivity/Disorder (ADHD) has been evidenced to be especially complex and challenging. This study aimed to investigate the diagnostic power of behavioral rating scales responded by teachers in
diagnosing ADHD as well as their other methodological properties. Pursuing this goal is especially important in Iran due to the lack of proper diagnostic tools for ADHD assessment.
Methods: This was a descriptive and methodological study. The statistical population included all male students in Mashhad City, Iran, in the
2014–2015 academic year. Besides, our study sample consisted of 40 male students selected through the direct observation of children in their
classroom, interviews with their teachers and their parents, and examining children’s educational records. Parents and teachers signed informed
consent forms and they were informed about the confidentiality of the obtained data. Of the study samples, 20 were healthy and 20 had received
ADHD diagnosis by a physician before participating in our study. We administered a short three–subscale form of the Wechsler’s Intelligence
Scale for Children–Revised (WISC–R) on all study participants to ensure they have no Intellectual Disability (ID) and that the two groups were
matched by Intelligence Quotient (IQ). Then, we trained blind interviewers to administer semi–structured interviews on the children’s teachers
to verify their initial ADHD diagnoses. Moreover, the teachers were requested to rate the children’s classroom behavior using Conner’s Teacher
Rating Scale (CTRS) (1969) and Swanson, Nolan and Pelham’s Fourth Revision Scale (SNAP–IV) (1980) two times with one–month interval.
We used Receiver Operating Characteristic (ROC) analysis to calculate sensitivity and specificity as well as False Positive Rate (FPR) and False
Negatives Rate (FNR) for these scales. Additionally, we used Cronbach’s alpha coefficient and Pearson correlation coefficient methods to
investigate the internal consistency and test–retest reliability of these inventories.
Results: Multivariate Analysis of Variance (MANOVA) followed by separate Analysis of Variance (ANOVA) as post–hoc test indicated that
all the subscales of CTRS and SNAP–IV could significantly distinguish ADHD and non–ADHD children. Cronbach’s alpha coefficient for the
total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive subscale (second 9 items)
of SNAP–IV were measured as 0.99, 0.98, and 0.89, respectively; these data indicated excellent internal consistencies of the subscales. Test–
retest reliabilities for the total scale (all 18 items), predominantly inattentive subscale (first 9 items), and predominantly hyperactive/impulsive
subscale (second 9 items) of SNAP–IV were computed as 0.95, 0.96, and, 0.93 respectively, indicating excellent test–retest reliabilities. For
CTRS rating scale, Cronbach’s alpha coefficients were calculated as 0.96, 0.87, and 0.52 for classroom behavior, group participation, and attitude
toward authority subscales, respectively. Test–retest reliabilities for classroom behavior, group participation, and attitude toward authority
subscales were 0.92, 0.85, and 0.69, respectively. The ROC analyses data also revealed an excellent to acceptable sensitivity and specificity for
all the subscales of CTRS and SNAP–IV. All achieved sensitivities ranged between 0.80 and 0.95, all specificities between 0.75 and 0.95, and
all Areas under Curve (AUC) between 0.85 and 0.99; these findings indicated an excellent diagnostic power with low FPR and FNR rates.
Conclusion: The present research results suggested excellent to acceptable diagnostic accuracy and proper methodological properties for the
Persian versions of CTRS and SNAP–IV. These scales could successfully reduce FPR and FNR rates; therefore, they could be considered as
beneficial and complementary diagnostic tools in the multi–method assessment of ADHD. Although CTRS and SNAP–IV presented excellent diagnostic accuracy in this study, using them in isolation is recommended.
