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Original Article

Cross-Informant Disagreement on Behavioral Symptoms in Adolescent Attention-Deficit/Hyperactivity Disorder and Its Impact on Treatment Effects

Published Online:November 29, 2017https://doi.org/10.1027/1015-5759/a000446

Abstract

Abstract. In assessing adolescent behavior difficulties, parents, teachers, and the adolescents themselves are key informants. However, substantial disagreement has been found between informants. Specifically, children with attention-deficit/hyperactivity disorder (ADHD) tend to overestimate their competencies, also known as “positive (illusionary) bias.” This study compared parent, teacher, and adolescent ratings of ADHD and other behavioral symptoms in a sample of 114 adolescents with ADHD. Further, the effect of cross-informant disagreement (CID) on treatment outcomes was investigated in a subsample of 54 adolescents who had undergone a training and coaching intervention. Overall, there was moderate agreement among informants. Parent and adolescent ratings were more strongly correlated with each other than with teacher ratings. The strongest discrepancy was found between teacher and adolescent ratings on prosocial behavior. This discrepancy explained 12% of the variance in parent-rated ADHD symptom severity after the intervention. The treatment was less effective in participants with high teacher-adolescent disagreement on prosocial behavior (d = 0.41) than with low disagreement (d = 0.98). These findings suggest that professionals working with adolescents with ADHD should consider multiple sources of information before initiating treatment and pay attention to cross-informant disagreements because these may indicate a risk of diminished treatment effects.

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