Procedures relating to data collection

Data collection involved four procedural stages.

In stage one, when parents of boys with ADHD contacted the researcher by telephone, their questions about the study would be answered, and they would be invited to participate. Parents would be informed that data collection was to take between three and four hours, which could be conducted over one or two sessions, and a first session was scheduled if the parent was still agreeable.

In stage two, informed consent was to be sought from the parent of the ADHD child at the outset of the initial clinical interview. The semi-structured interview was then to be conducted with the parent and child jointly, asking questions about the demographic, developmental, familial, mental status and mental health history of the child. This was to be followed by the administration of the short-form version of the WISC-III with the child, while the parent completed the behaviour-rating scales, the ADHD Rating Scale-IV and BASC, in the waiting room.

In stage three, the child participant was to be involved in a second session on his own. Time was to be spent first between the interviewer and child engaging in play, such as a card game or drawings, in order to strengthen rapport and prepare the child for administration of the RIM. Once the boy was comfortable, the RIM was to be administered in accordance with the procedures outlined in the CS (Exner, 2003).

In stage four, upon the completion of the assessment all data collected from psychological testing and behaviour rating scales was to be scored. A brief psychological report summarising the findings of the assessment was then to be prepared by the researcher and sent to the parent and treating practitioner of the boy with ADHD. All parents were to be offered the invitation to discuss the assessment report with the researcher, via telephone or in person.

5.3.2.1 Determination of diagnostic status

Given that boys were referred to the present study only if their paediatrician or psychologist had assigned them an ADHD diagnosis using the DSM-IV (APA, 1998) or DSM-IV-TR (APA, 2000) criteria, it was judged that unnecessary stress would be created for the boys and their parents if their diagnoses were questioned at the completion of stage one of the assessment process (after scoring the relevant behaviour rating scales). Therefore full data would be collected from all boys referred to the study, and each would receive a full assessment.

The accuracy of their diagnosis would be determined at the completion of the assessment using the method outlined below.

Data from numerous sources, namely that gathered by the clinical interview, the ADHD Rating Scale-IV, and the BASC Hyperactivity and Inattention clinical subscales, completed by parents regarding their child’s behaviour, would be used to exclude from the study the data pertaining to children for whom the ADHD diagnosis appeared potentially inaccurate. A child’s ADHD Inattentive Type diagnosis would

be deemed inaccurate when his Inattention percentile score on the ADHD Rating Scale-IV was less than 85, and his Inattention T-score on the BASC was less than 60, the clinical cut-off points on both scales, and such findings were consistent with data derived at clinical interview. Similarly, a child’s ADHD Combined Type diagnosis would be deemed inaccurate when his Inattention percentile score on the ADHD Rating Scale-IV was less than 85 and both of his Hyperactivity and Inattention T- scores fell below 60 on the BASC, and such findings were consistent with data derived at clinical interview.

The data of boys with ADHD with co-morbid ODD were, of course, to be accepted into the study, with the exception of children with co-morbid diagnoses of autism or intellectual disability. With respect to the assignment of ADHD boys into the ODD subgroup, this was to be determined by 1) a pre-existing ODD diagnosis made by the referring clinician, 2) Aggression or Conduct Problems T-scores on the BASC of at least 60, or 3) a history, reported at interview by the parent of an ADHD child, evidencing clinically significant oppositional and defiant behaviour or conduct disturbance.

5.4 Summary of the Comprehensive System Rorschach Inkblot Method and Mutuality of Autonomy Scale variables to be employed

The dependent variables under investigation, including their measurement and criterion for clinical significance, are listed in Tables 3 and 4. Table 3 on page 106 below pertains to the variables contained in Hypotheses 1 to 4 concerning the entire sample of ADHD subjects. Table 4 on page 107 below pertains to the variables

contained in Hypotheses 5 and 6 concerning comparison of the two subgroups of ADHD boys with and without a co-morbid diagnosis of ODD.

Table 3

Summary of Dependent Variables and Rorschach Inkblot Method and Mutuality of Autonomy Scale Measures Represented in Hypotheses One to Four Concerning the Entire ADHD Sample

Dependent Variables Measurement: MOA Scale and CS RIM Variables

Criteria for Clinical Significance

Ego Functioning

Coping & Social Competence

Coping Deficit Index (CDI)

CDI > 3

Reality Testing Distorted Form Quality

(X-%)

X-% > .20

Object Relations

Representations of Object Relations

MOA Scale: Severely Maladaptive

Representations of Object Relations

MOA Scores > 5

Sense Of Self

Table 4

Summary of Dependent Variables and Rorschach Inkblot Method Measures Represented in Hypotheses Five and Six Concerning Comparison of ADHD Boys With and Without ODD

Dependent Variables Measurement: RIM Variables

Criteria for Clinical Significance

Ego Functioning

Quality of Thinking Weighted Sum of six Critical Special Scores (WSum6)

WSum6 > age appropriate clinical cut-off point:

Age 7, WSum6 > 16

Age 8 - 10, WSum6 > 15

Age 11 – 13, WSum6 > 13

Object Relations

Capacity for Empathy Distorted Form Human Movement Responses (M-)

M- > 0