Abstract
Objective: To establish the validity and reliability of a provisional 30-item impulsive aggression (IA) diary in children (ages 6–12 years, inclusive) with attention-deficit/hyperactivity disorder (ADHD).Methods: The provisional 30-item IA diary was administered for 14 days to parents of children with ADHD and IA symptoms (n = 103). Key inclusion criteria: confirmed ADHD diagnosis; signs of IA as measured by a Retrospective-Modified Overt Aggression Scale (R-MOAS) score ≥20 and an Aggression Questionnaire score of −2 to −5. Analyses included inter-item correlations, exploratory factor analysis (EFA), item response theory (IRT) modeling, internal consistency, test–retest reliability (TRT), concurrent validity (estimated by correlation between the IA diary and the R-MOAS/Nisonger Child Behavior Rating Form), and known-groups methods.Results: The prevalence rates of 15 (50.0%) items were found to be too low (<1%) for analysis; three items with prevalence rates ≤1% were retained, as content validity was deemed high by clinical experts. The remaining 12 behavior items had prevalence rates of 2.7%–73.6%. EFA and IRT models confirmed two subdomains in the IA diary included within a general domain of IA behavior frequency, yielding a single total behavioral frequency score (TBFS). Internal consistency was high for this TBFS (marginal reliability = 0.86 and α = 0.73). TRT for the TBFS, based on the intraclass correlation coefficient, was 0.8. Concurrent validity of TBFS with R-MOAS ranged from r = 0.49 to r = 0.62.Conclusion: The final 15-item IA diary is a reliable, psychometrically validated IA measurement tool that will allow clinicians and researchers to assess the frequency of IA behavior.
Highlights
Maladaptive aggression in children is challenging to diagnose and treat (Connor 2016)
Diary items can be grouped into three hypothesized domains: verbal aggression, physical aggression directed at things or objects, and physical aggression directed at people
While some items included in the diary are components of the RMOAS, the impulsive aggression (IA) diary uniquely consists of two parts, which parents/caregivers completed during the 14-day study
Summary
Maladaptive aggression in children is challenging to diagnose and treat (Connor 2016). Impulsive aggression (IA) is the most common clinically aggressive behavior in children, with an occurrence rate of *80% within aggressive children (Barratt et al 1999; Blader et al 2009; American Psychiatric Association 2013). Associated with various neuropsychiatric disorders, IA can be characterized as a reactive, overt, and maladaptive form of aggression occurring outside the acceptable social context. S.T.B. was an employee of Supernus at the time this work was conducted. C.J.E. and S.H. were paid consultants to Supernus at the time this work was conducted
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