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    A Scoping Review of Attention-Deficit/Hyperactivity Disorder Assessment and Diagnosis: Tools, Practices, and Sex Bias
    (Springer Nature, 2025-08-07) Crocker SL; Roemer A; Strohmaier S; Wang GY; Medvedev ON
    Objectives: Accurately diagnosing attention-deficit/hyperactivity disorder (ADHD) is challenging due to the overlap of symptoms with other mental health conditions. This scoping review evaluated the dependability and accuracy of prevalent diagnostic scales and investigates potential obstacles to ADHD assessment diagnosis including potential sex bias. Method: Following the PRISMA-ScR guidelines, 11 widely used diagnostic scales were identified and included. All scales were evaluated based on their psychometric quality and alignment with DSM-5 diagnostic criteria for ADHD. Results: The Attention Deficit Disorders Evaluation Scale emerged as the most reliable among the 11 scales, with the Symptom Checklist-4 ranking as the least reliable. No single assessment tool was adequate for ADHD diagnosis; additional testing was required for accurate conclusions. The literature revealed sex and age biases in some of the assessments. It was discovered that girls were diagnosed with ADHD less often than boys, yet their likelihood of misdiagnosis was notably lower. Conclusions: This review emphasizes the necessity of comprehensive, multi-method assessment approaches for accurate ADHD diagnosis, as no single tool demonstrated sufficient diagnostic precision. Effective clinical assessment design must incorporate strong psychometric measures, address sex-based diagnostic disparities, and emphasize the importance of evaluating behavioural changes over time and their functional impact across settings.
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    Wearable multi-sensory design for adults with SPD : a thesis presented in partial fulfilment of the requirements for the degree of Master of Design at Massey University, Wellington, New Zealand
    (Massey University, 2022) Guieb, Tracey
    Our senses are extremely important in helping us understand and respond to environmental changes. Someone with Sensory Processing Disorder (SPD) may struggle to create appropriate responses to input through these sensory systems - leading to sensory overload or anxiety. There is limited support for adults living with SPD due to the misconception that only children experience it or that it is a condition that can be ‘grown out of' as you get older. Most sensory products in the market are targeted at children and are not suitable for individuals who may want to self-regulate discreetly. My thesis explores how wearable multi-sensory design in apparel can help adults with SPD cope in situations and environments that may cause them discomfort, stress, or anxiety in a way that is appealing and specific to their unique sensory challenges. Universal design strategies were implemented within an empathic and iterative design process. Secondary contextual research combined with expert consultancy, questionnaires, surveys, and wearer testing, identified specific user needs. Multiple design explorations responding to identified criteria and adult sensory profiles created a range of visually appealing, discreet, customisable sensory wear. This modular apparel range aids adults who experience SPD, as well as a much wider group of individuals who identify with associated sensory challenges.
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    Confirmatory bias in the diagnosis of ADHD : an exploratory study and survey of New Zealand clinicians' protocols & practices in the diagnosis of attention-deficit hyperactivity disorder : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 1999) Mickleson, Julie F
    Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous syndrome of childhood, with primary symptoms of inattention, hyperactivity, and impulsivity. In recent years, numbers of children diagnosed with ADHD have increased. While many factors may be associated with this increase, one possibility is increased false positive diagnoses due to confirmatory bias (CB) in the diagnostician. CB occurs when a clinician pays attention to positive symptoms with disregard of disconfirmatory symptoms. The present study used a quasi-experimental approach to investigate whether CB was present in the diagnosis of ADHD. Diagnostic decision making was examined in three hypothetical case studies where the ratio of positive to negative ADHD symptoms varied. Results demonstrated CB in the diagnosis of ADHD for many participants. Forty-three percent of clinicians gave no indication of considering disconfirmatory symptoms. Additionally, for all symptoms but one, more attention was paid when they were positive rather than negative. Gaining knowledge from psychological literature and completing an internship increased the likelihood of considering disconfirmatory data. CB was related to clinicians' realworld belief of ADHD prevalence, although this was limited to a statistical trend. The majority of clinicians gave a tentative ADHD diagnosis for all case studies. For clear (i.e. not tentative) diagnoses, clinicians who demonstrated CB were significantly more likely to give a positive diagnosis than a negative diagnosis, whether or not this diagnosis was correct. Results suggest possible misdiagnosis of ADHD in some cases, with concerns of this study being support for the potential of overdiagnosis as a function of CB. Some additional hints of underdiagnosis by a few clinicians merit further research, with the phenomenon of a possible disconfirmatory bias raised and discussed. ln addition, clinicians were surveyed regarding ADHD assessment and treatment in actual practice. Clinicians indicated using an average of 7 assessment steps, with school information, parent or family interview, and rating scales being the most popular tools. Clinicians who took disconfirmatory data into account used more assessment steps in actual practice than the CB group. There was a mean of 4 treatment options listed, with the most utilised being medication and behavioural treatment. Findings are limited by the survey-based, correlational nature of the study. The ability to generalise findings to actual practice is considered and discussed.
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    New Zealand primary school teachers' knowledge and perceptions of attention-deficit/hyperactivity disorder (ADHD) : a thesis presented in partial fulfilment of the requirements for the degree of Master in Educational Psychology at Massey University, Albany, New Zealand
    (Massey University, 2013) Dilaimi, Alia
    Attention-deficit/hyperactivity disorder (ADHD) is one of the most common, unremitting, and controversial childhood disorders, which affects between 1% and 7% of New Zealand children. It leads to impairments in the individual’s key life activities, including social relations, academic, family, and vocational functioning, self sufficiency, as well as adherence to social regulations, norms, and laws. Teachers play a central role in the referral, diagnosis, treatment, and monitoring of students with ADHD. Research examining teachers’ knowledge of ADHD however, has led to some uncertainty as to whether teachers have the level of knowledge about the disorder needed to support ADHD learners. The present study had two main objectives. It examined the knowledge and perceptions of attention-deficit/hyperactivity disorder held by primary school teachers in New Zealand and sought to determine whether teacher characteristics, such as demographic variables and experiences of students with ADHD, are associated with teachers’ knowledge of ADHD. Eighty-four primary school teachers completed a postal survey containing demographic information and the Knowledge Of Attention Deficit Disorders Scale (KADDS). Results indicated that teachers answered an average of 35% of questions correctly on the KADDS. Teachers’ scored significantly higher on the Symptoms/Diagnosis subscale compared to the Associated Features and Treatment subscales. All teachers in the present study reported that they believed ADHD impacts on the educational experiences of students diagnosed with the disorder. Most teachers had received no pre-service or in-service training about ADHD, and 90% of teachers wanted more training on ADHD. The majority of teacher characteristics examined were unrelated or only weakly related to teachers' knowledge of ADHD. However, the number of students with ADHD teachers’ had taught, participation in an individual behaviour plan (IBP), and participation in an individual education plan (IEP), were significantly and moderately related to higher KADDS total and Symptoms/Diagnosis scores. The results of this study suggest that New Zealand primary school teachers do not in fact have the level of knowledge about the disorder required to effectively participate in the referral, diagnosis, treatment, or monitoring of students with ADHD. Implications for educational psychology practice and directions for future research are discussed. Strengths and limitations of the study are also considered.
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    Instructional and improvisational models of music therapy with adolescents who have attention deficit hyperactivity disorder (ADHD) : a comparison of the effects on motor impulsivity : a thesis presented to fulfil the requirements for the degree of Master of Music Therapy at Massey University, Wellington, New Zealand
    (Massey University. Conservatorium of Music, 2004) Rickson, Daphne Joan
    This study compared the impact of instructional and improvisational music therapy approaches on the level of motor impulsivity displayed by adolescent boys who have Attention Deficit Hyperactivity Disorder (ADHD). Measures included numbers of errors made on a Synchronised Tapping Task (STT); and Conners' Rating Scales (Conners, 1997). Participants (n=13), aged 11 - 16 years, were enrolled in a special residential school. A combination of a multiple contrasting treatment and an experimental control group design was used. Students were randomised to three groups; control (Group A) and two treatment groups. Students in Group B received eight sessions of improvisational music therapy followed by eight sessions of instructional music therapy, while the order was reversed for Group C.There was no statistical difference between the impacts of the contrasting music therapy approaches on the level of motor impulsivity displayed by the students as measured by the STT and the Restless-Impulsive and Hyperactive-Impulsive Conners' subscales. However all students significantly improved on the STT across each phase of treatment and improvement was slightly greater during the instructional treatment periods for both groups. During these same periods teachers reported a small decrease in restless and impulsive behaviours. The results therefore cautiously imply that the instructional approach might contribute to a reduction in motor impulsivity in the classroom.Significant improvement on STT without the corresponding improvement in motor impulsivity suggested that increased accuracy on the STT might be attributable to progress in other developmental domains. Teacher report of significant improvement for treatment groups on the DSM-IV Total Subscale adds weight to this suggestion, and implies that combined music therapy approaches might have contributed to a reduction in DSM-IV symptomology in the classroom.Rickson's (2001) tentative suggestion that creative music-making might over-arouse students with ADHD was not confirmed. Students did make more errors when tested on the STT a second time on the same day but this was regardless of whether they had been involved in instructional, improvisational or no music therapy programme. It is possible that students who have ADHD are easily aroused by the general school milieu and classroom or music room interactions with peers.