Evaluation of Patient- and Parent-Rated Emotional Expression Using theExpression and Emotion Scale for Children (EESC) in an ObservationalStudy of ADHD in Children and Adolescents

Background: The assessment of emotional expression in patients with ADHD can differ between parent/caregiver and child. Therefore, a new patient-rated version of the Expression and Emotion Scale for Children (EESC) was created and psychometrically analysed. Methods: This is a 6-month follow-up data analysis of a multicenter, prospective, 12-month observational study in children and adolescents with ADHD. Agreement between the two EESC versions (patient- and parent-rated), internal consistency, sensitivity for changes, floor and ceiling effects as well as test-retest variability were evaluated. The relationship between both EESC scores and the physician-rated ADHD-rating scale (ADHD-RS), Clinical Global Impression of Severity (CGI-S), and General Impression of Percieved Difficulties (GIPD) were also calculated. Results: 504 patients (mean age 9.6 years) were included and treated with non-stimulant medication (n=252) or stimulant medication (n=247); 5 patients received both medications. The EESC scores decreased similarly for patients and parents and in parallel over time by about 15 points, with the patient EESC scores being always about 3-4 points less than the parent-rated score. Both satisfaction scores increased in parallel by 2-3 points. The agreement and the correlation between the two EESC versions were in a modest range of approximately 0.5 to 0.6 and stable over time. The item-total correlations and analysis of Cronbach's Alpha showed mostly good support of the different items for the total scores, except items 19 and 24 (r 0.48). Correlations between the EESC score and other ADHD scales (ADHD-RS, CGI-S) were small to moderate for both ratings. The correlation between the GIPD and the EESC within raters was constant over time (r� 0.5). Conclusion: This analysis showed that both EESC versions have sound psychometrical properties and can be used in routine settings.