Skip to main content

Advertisement

SpringerLink
Log in

Attention Deficit Hyperactivity Disorder: A Rasch Analysis of the SWAN Rating Scale

  • Original Article
  • Published:
Child Psychiatry and Human Development Aims and scope Submit manuscript

Abstract

The prevalence of attention-deficit/hyperactivity disorder (ADHD) has been estimated at 3–7% in the population. Children with this disorder are often characterized by symptoms of inattention and/or impulsivity and hyperactivity, which can significantly impact on many aspects of their behaviour and performance. This study investigated the characteristics of the SWAN Rating Scale and its discrimination of ADHD subtypes. This instrument was developed by Swanson and his colleagues and measures attentiveness and hyperactivity on a continuum, from attention problems to positive attention skills, using a seven-point scale of behaviour: “far below average” to “far above average”. The Australian Twin Attention-Deficit/Hyperactivity Disorder Study consists of questionnaire data collected from families in 1990/2007. The Rasch model was used to measure the characteristics of items from the SWAN Rating Scale; how well these items discriminated between those with and without ADHD. The prevalence of each subtype was found to be 5.3% for inattentive ADHD, 4.3% for hyperactive ADHD and 4.6% for combined ADHD. A total of 14.2% of the cohort appeared to have ADHD. While the inattentive items appeared to be consistent with each other in their measurement behaviour and response patterns, the hyperactive items were less consistent. Further, the combined subtype appeared to be an entirely different type, with unique features unlike the other two subtypes. Further work is needed to distinguish the diagnostic features of each subtype of ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Psychiatric Association (2008) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn. American Psychiatric Association, Washington, DC, pp 85–93 Text Revision ed

    Google Scholar 

  2. Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2(2):104–113

    PubMed  Google Scholar 

  3. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948. doi:10.1176/appi.ajp.164.6.942

    Article  PubMed  Google Scholar 

  4. Wilens TE (2007) ADHD: prevalence, diagnosis, and issues of comorbidity. CNS Spectr 12(4, Suppl 6):1–5

    PubMed  Google Scholar 

  5. Neuman RJ, Sitdhiraksa N, Reich W, Ji TH, Joyner CA, Sun LW, Todd RD (2005) Estimation of prevalence of DSM-IV and latent class-defined ADHD subtypes in a population-based sample of child and adolescent twins. Twin Res Hum Genet 8(4):392–401. doi:10.1375/twin.8.4.392

    Article  PubMed  Google Scholar 

  6. Merrell C, Tymms PB (2001) Inattention, hyperactivity and impulsiveness: their impact on academic achievement and progress. Br J Educ Psychol 71(Pt 1):43–56. doi:10.1348/000709901158389

    Article  PubMed  Google Scholar 

  7. Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J (1996) Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry 35(3):319–324. doi:10.1097/00004583-199603000-00013

    Article  PubMed  Google Scholar 

  8. Baumgaertel A, Wolraich ML, Dietrich M (1995) Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample. J Am Acad Child Adolesc Psychiatry 34(5):629–638. doi:10.1097/00004583-199505000-00015

    Article  PubMed  Google Scholar 

  9. Marshall RM, Hynd GW, Handwerk MJ, Hall J (1997) Academic underachievement in ADHD subtypes. J Learn Disabil 30(6):635–642. doi:10.1177/002221949703000607

    Article  PubMed  Google Scholar 

  10. Barry TD, Lyman RD, Klinger LG (2002) Academic underachievement and attention-deficit/hyperactivity disorder: the negative impact of symptom severity on school performance. J Sch Psychol 40(3):259–283. doi:10.1016/S0022-4405(02)00100-0

    Article  Google Scholar 

  11. Biederman J, Faraone SV, Taylor A, Sienna M, Williamson S, Fine C (1998) Diagnostic continuity between child and adolescent ADHD: findings from a longitudinal clinical sample. J Am Acad Child Adolesc Psychiatry 37(3):305–313. doi:10.1097/00004583-199803000-00016

    Article  PubMed  Google Scholar 

  12. Barkley RA (1997) Advancing age, declining ADHD. Am J Psychiatry 154(9):1323–1325

    PubMed  Google Scholar 

  13. Barkley RA, Fischer M, Smallish L, Fletcher K (2004) Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 45(2):195–211. doi:10.1111/j.1469-7610.2004.00214.x

    Article  PubMed  Google Scholar 

  14. Biederman J, Wilens T, Mick E, Faraone SV, Weber W, Curtis S, Thornell A, Pfister K, Jetton JG, Soriano J (1997) Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 36(1):21–29. doi:10.1097/00004583-199701000-00013

    Article  PubMed  Google Scholar 

  15. Currie J, Stabile M (2006) Child mental health and human capital accumulation: the case of ADHD. J Health Econ 25(6):1094–1118. doi:10.1016/j.jhealeco.2006.03.001

    Article  PubMed  Google Scholar 

  16. Biederman J, Newcorn JH, Sprich S (1997) Comorbidity of attention-deficit/hyperactivity disorder. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First M, Davis W (eds) DSM-IV sourcebook, vol 3. American Psychiatric Press, Washington, DC

    Google Scholar 

  17. Lahey BB, Carlson CL, Frick PJ (1997) Attention-deficit disorder without hyperactivity. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First M, Davis W (eds) DSM-IV sourcebook, vol 3. American Psychiatric Press, Washington, DC

    Google Scholar 

  18. McBurnett K (1997) Attention-deficit disorder: review of diagnostic issues. In: Widiger TA, Frances AJ, Pincus HA, Ross R, First M, Davis W (eds) DSM-IV sourcebook, vol 3. American Psychiatric Press, Washington, DC

    Google Scholar 

  19. Frick PJ, Lahey BB, Applegate B, Kerdyck L, Ollendick T, Hynd GW, Garfinkel B, Greenhill L, Biederman J, Barkley RA et al (1994) DSM-IV field trials for the disruptive behavior disorders: symptom utility estimates. J Am Acad Child Adolesc Psychiatry 33(4):529–539. doi:10.1097/00004583-199405000-00011

    Article  PubMed  Google Scholar 

  20. Lahey BB, Applegate B, McBurnett K, Biederman J, Greenhill L, Hynd GW, Barkley RA, Newcorn J, Jensen P, Richters J et al (1994) DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. Am J Psychiatry 151(11):1673–1685

    PubMed  Google Scholar 

  21. Schneider K (1959) Clinical psychopathology. Grune and Stratton, New York

    Google Scholar 

  22. First MB (2008) Externalizing disorders research planning conference. DSM-V prelude project: research and outreach

  23. Barkley RA (2007) What may be in store for DSM-V. The ADHD Report 15(4):1–7. doi:10.1521/adhd.2007.15.4.1

    Article  Google Scholar 

  24. Rasch G (1980) Probabilistic models for some intelligence and attainment tests. The University of Chicago Press, Chicago Original work published in 1960

    Google Scholar 

  25. Andrich D (1978) A rating formulation for ordered response categories. Psychometrika 43:561–573. doi:10.1007/BF02293814

    Article  Google Scholar 

  26. Thurstone LL (1927) A law of comparative judgement. Psychol Rev 34:278–286

    Google Scholar 

  27. Andrich D (2004) Controversy and the Rasch model: a characteristic of incompatible paradigms? Med Care 42(1, Suppl):16–17

    Google Scholar 

  28. Merrell C, Tymms P (2005) Rasch analysis of inattentive, hyperactive and impulsive behaviour in young children and the link with academic achievement. J Appl Meas 6(1):1–18

    PubMed  Google Scholar 

  29. van Alphen A, Halfens R, Hasman A, Imbos T (1994) Likert or Rasch? Nothing is more applicable than good theory. J Adv Nurs 20(1):196–201. doi:10.1046/j.1365-2648.1994.20010196.x

    Article  PubMed  Google Scholar 

  30. Levy F, Hay DA, McStephen M, Wood C, Waldman I (1997) Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. J Am Acad Child Adolesc Psychiatry 36(6):737–744. doi:10.1097/00004583-199706000-00009

    Article  PubMed  Google Scholar 

  31. DeFries JC, Fulker DW (1985) Multiple regression analysis of twin data. Behav Genet 15(5):467–473. doi:10.1007/BF01066239

    Article  PubMed  Google Scholar 

  32. DeFries JC, Fulker DW (1988) Multiple regression analysis of twin data: etiology of deviant scores versus individual differences. Acta Geneticae Medicae et Gemellologiae (Roma) 37(3–4):205–216

    Google Scholar 

  33. Masters GN (1982) A Rasch model for partial credit scoring. Psychometrika 47:149–174. doi:10.1007/BF02296272

    Article  Google Scholar 

  34. Likert R (1932) A technique for the measurement of attitudes. Archives of Psychology, New York

    Google Scholar 

  35. Swanson JM, Flodman P, Kennedy J, Spence MA, Moyzis R, Schuck S, Murias M, Moriarity J, Barr C, Smith M, Posner M (2000) Dopamine genes and ADHD. Neurosci Biobehav Rev 24(1):21–25. doi:10.1016/S0149-7634(99)00062-7

    Article  PubMed  Google Scholar 

  36. Lahey BB, Applegate B (2001) Validity of DSM-IV ADHD. J Am Acad Child Adolesc Psychiatry 40(5):502–504. doi:10.1097/00004583-200105000-00003

    Article  PubMed  Google Scholar 

  37. Lahey BB, Pelham WE, Stein MA, Loney J, Trapani C, Nugent K, Kipp H, Schmidt E, Lee S, Cale M, Gold E, Hartung CM, Willcutt E, Baumann B (1998) Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. J Am Acad Child Adolesc Psychiatry 37(7):695–702. doi:10.1097/00004583-199807000-00008

    Article  PubMed  Google Scholar 

  38. Swanson J, Schuck S, Mann M, Carlson C, Hartman K, Sergeant J, Clevenger W, Wasdell M, McCleary R (2006) Categorical and dimensional definitions and evaluations of symptoms of ADHD: the SNAP and SWAN rating scales. University of California, Irvine

    Google Scholar 

  39. Hay DA, Bennett KS, Levy F, Sergeant J, Swanson J (2007) A twin study of attention-deficit/hyperactivity disorder dimensions rated by the strengths and weaknesses of ADHD-symptoms and normal-behavior (SWAN) scale. Biol Psychiatry 61(5):700–705. doi:10.1016/j.biopsych.2006.04.040

    Article  PubMed  Google Scholar 

  40. Bennett KS, Hay DA, Piek J, Pearsall-Jones J, Levy F, Martin N (2006) The Australian twin ADHD project: current status and future directions. Twin Res Hum Genet 9(6):718–726. doi:10.1375/twin.9.6.718

    Article  PubMed  Google Scholar 

  41. Hay DA, McStephen M, Levy F, Pearsall-Jones J (2002) Recruitment and attrition in twin register studies of childhood behavior: the example of the Australian twin ADHD project. Twin Res 5(5):324–328. doi:10.1375/136905202320906039

    Article  PubMed  Google Scholar 

  42. Martin NG, Gibson JB, Mathews JD (1981) Australian NHMRC twin registry. Med J Aust 2(10):518

    PubMed  Google Scholar 

  43. Hopper JL (1993) The Australian NHMRC twin registry: a resource for paediatric research. Arch Dis Child 69(4):472. doi:10.1136/adc.69.4.472-a

    Article  PubMed  Google Scholar 

  44. Croft ML, Read AW, de Klerk N, Hansen J, Kurinczuk JJ (2002) Population based ascertainment of twins and their siblings, born in Western Australia 1980 to 1992, through the construction and validation of a maternally linked database of siblings. Twin Res 5:317–323. doi:10.1375/136905202320906020

    Article  PubMed  Google Scholar 

  45. Levy F, Hay D, McLaughlin M, Wood C, Waldman I (1996) Twin sibling differences in parental reports of ADHD, speech, reading and behaviour problems. J Child Psychol Psychiatry 37(5):569–578. doi:10.1111/j.1469-7610.1996.tb01443.x

    Article  PubMed  Google Scholar 

  46. Hay DA, O’Brien PJ (1987) Early influences on the school social adjustment of twins. Acta Geneticae Medicae et Gemellologiae (Roma) 36(2):239–248

    Google Scholar 

  47. Gau JS, Silberg JL, Erickson MT, Hewitt JK (1992) Childhood behavior problems: a comparison of twin and non-twin samples. Acta Geneticae Medicae et Gemellologiae (Roma) 41(1):53–63

    Google Scholar 

  48. Polderman TJ, Derks EM, Hudziak JJ, Verhulst FC, Posthuma D, Boomsma DI (2007) Across the continuum of attention skills: a twin study of the SWAN ADHD rating scale. J Child Psychol Psychiatry 48(11):1080–1087. doi:10.1111/j.1469-7610.2007.01783.x

    Article  PubMed  Google Scholar 

  49. Wright BD, Masters GN (1982) Rating scale analysis: rasch measurement. MESA Press, Chicago

    Google Scholar 

  50. Wu ML, Adams RJ, Wilson MR, Haldane SA (2007) ACER ConQuest Version 2.0: generalised item response modelling software. Australian Council for Educational Research Ltd., Melbourne

    Google Scholar 

  51. Hay DA, McStephen M, Levy F (2001) Introduction to the genetic analysis of attentional disorders. In: Levy F, Hay DA (eds) Attention, genes and ADHD. Brunner-Routledge, Philadelphia, pp 7–34

    Google Scholar 

  52. McBurnett K (2008) The diagnosis and how we got there. In: McBurnett K, Pfiffner L (eds) Attention deficit hyperactivity disorder: concepts, controversies, new directions. Informa Healthcare USA, Inc., New York, pp 1–8

    Google Scholar 

  53. Sawyer MG, Kosky RJ, Graetz BW, Arney F, Zubrick SR, Baghurst P (2000) The national survey of mental health and wellbeing: the child and adolescent component. Aust N Z J Psychiatry 34(2):214–220. doi:10.1046/j.1440-1614.2000.00729.x

    Article  PubMed  Google Scholar 

  54. Pary R, Lewis S, Matuschka PR, Rudzinskiy P, Safi M, Lippmann S (2002) Attention deficit disorder in adults. Ann Clin Psychiatry 14(2):105–111

    PubMed  Google Scholar 

  55. Wilens TE, Biederman J, Spencer TJ (2002) Attention deficit/hyperactivity disorder across the lifespan. Annu Rev Med 53:113–131. doi:10.1146/annurev.med.53.082901.103945

    Article  PubMed  Google Scholar 

  56. Wilens TE, Faraone SV, Biederman J (2004) Attention-deficit/hyperactivity disorder in adults. JAMA 292(5):619–623. doi:10.1001/jama.292.5.619

    Article  PubMed  Google Scholar 

  57. RACP (2008) The draft guidelines on attention deficit hyperactivity disorder (ADHD). The Royal Australiasian College of Physicians, Sydney

    Google Scholar 

  58. APA (2008) Diagnostic and statistical manual of mental disorders (DSM) V. American Psychiatric Association, Arlington

    Google Scholar 

  59. Rohde LA (2008) Is there a need to reformulate attention deficit hyperactivity disorder criteria in future nosologic classifications? Child Adolesc Psychiatr Clin N Am 17(2):405–420. doi:10.1016/j.chc.2007.11.007

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr Margaret Wu, Research Fellow, Assessment Research Centre, Melbourne Graduate School of Education, and The University of Melbourne. Her input both in terms of her twin daughters and her expertise as a psychometrician was invaluable for this research study. At the Australian Council for Educational Research, Margaret developed the software program ConQuest® for the analysis of item response data. This research was funded by the National Health and Medical Research Council Project Grant, ADHD Grown-up: Genetic and environmental determinants of the adult outcomes of childhood ADHD and comorbid conditions [NHMRC Grant Number 479217]. We would like to acknowledge the support of the Australian Twin Registry [NHMRC Enabling Grant; 2004-2009] and the Western Australian Twin Registry. We would like to thank the families of the twins and their siblings without whom this study could not have taken place.

Author information

Authors and Affiliations

  1. School of Psychology, Curtin University of Technology, GPO Box U1987, Perth, 6845, WA, Australia

    Deidra J. Young, Neilson C. Martin & David A. Hay

  2. School of Psychiatry, Prince of Wales Hospital and University of New South Wales, Sydney, NSW, Australia

    Florence Levy

Authors
  1. Deidra J. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florence Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neilson C. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David A. Hay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deidra J. Young.

Additional information

This paper is dedicated to Dr Kenneth Rowe, Principal Research Fellow, Australian Council for Educational Research, who encouraged me in my quest to understand the Rasch model. Ken was a selfless researcher who gave much time to teach me about multilevel modelling in 1988 and onwards. Without Ken I would not be the researcher I am today. Sadly, Ken was defending his holiday home in Marysville in Victoria, Australia on Saturday, 7th February 2009 when he was overcome by the fires which claimed the lives of so many from the area. Ken, you were my hero and example. Thank you.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Young, D.J., Levy, F., Martin, N.C. et al. Attention Deficit Hyperactivity Disorder: A Rasch Analysis of the SWAN Rating Scale. Child Psychiatry Hum Dev 40, 543–559 (2009). https://doi.org/10.1007/s10578-009-0143-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-009-0143-z

Keywords

Search

Navigation