Differential validity of the TAT in distinguishing attention deficit hyperactivity disorder from externalizing disorders
Abstract
Statement of the problem. Evaluation and diagnosis of ADHD is a complex multimethod procedure for the psychologist. In the search for a better differential diagnostic process which can assess Attention Deficit/Hyperactivity Disorder (ADHD), several investigators including Leopold Bellak (1986) have suggested that an analysis of the formal story characteristics of Thematic Apperception Test (TAT) responses can identifying patients with ADHD. He proposed 15 story characteristics which would indicate the presence of ADHD. In order to examine this hypothesis, the study evaluated the effects of diagnostic category of 61 male subjects (ADHD, normal and Externalizing Disorders) and selected TAT cards on the presence or absence of Bellak's 15 scoring characteristics. Methods of the study. Boys ages 5-11 being treated in an outpatient setting were classified into either ADHD (N = 20) or Externalizing Disorder (N = 21) groups based on the results normed behavior checklists. They were then scored by 2 independent raters on their responses to 5 TAT cards, as were 20 Control subjects who were boys recruited from an elementary school. Demographic and clinical data completed the data set. Statistical analyses compared the three groups on demographics and on scores for the 15 criteria. The rating scale was analyzed for test and item reliability as well as inter-rater and rater reliability. Results of the study. No main effects of either diagnostic groups or specific cards could be substantiated, thus there was no support for the hypothesis that Bellak's criteria for TAT stories could differentiate ADHD boys from normal boys or those with Externalizing Disorders. There was an interaction effect between the Externalizing Disorder group and Card 2, a family scene. The items were found to consist of 47% good discriminators. The rates had good inter-rater and individual reliability, and the card scores overall had moderate reliability. Conclusions. The poor discrimination ability of many rating scale items and the comorbidity of ADHD and Externalizing Disorders appeared to have contributed to the failure to find a significant difference between the clinical groups. The interaction between the Externalizing Disorders group and Card 2 may have been related to a significant difference in family composition.
This paper has been withdrawn.