Validation of the FSA as screening tool for children with ADHD

• This study investigated the validity of the FSA as a screening tool to discriminate children with ADHD from normal children.
• The modified FEATS scale was applied to rating the FSA in order to verify the FSA's validity.
• The reliability and validity of the FSA as a screening tool were examined.
• The FSA was confirmed to secure reliability and validity as a tool to discriminate children with ADHD from normal children.

The validity of the Face Stimulus Assessment (FSA) (Betts, 2003) as a tool for screening children with attention-deficit/hyperactivity disorder (ADHD) was investigated. The study subjects were 193 children from first to sixth graders in an elementary school located in Busan city, South Korea. Study analysis using the FSA drawings and Korean-ADHD rating scale (K-ARS) revealed the following results. First, in order to examine the reliability of the FSA assessment items, reliability was verified based on internal consistency while inter- and intra-rater consistencies were calculated. The reliability coefficient of assessment items for each FSA drawing was Cronbach's α = .778, .835 and .831 for the FSA drawing #1, #2 and #3, respectively. Inter-rater consistency of three persons was r = .801–1.00 while intra-rater consistency was r = .830–1.00. Second, in order to investigate the validity of the FSA as a screening tool for children with ADHD, cross tabulation and discriminant analyses were conducted to examine differences in the characteristics of the responses to the FSA drawings between normal children and children with ADHD. According to the analysis results, the common items that showed differences in the FSA drawing #1, #2 and #3 included color fit, logic, realism, developmental level, details of objects and environment, line quality, perseveration, form, and emotional tone. In other words, compared to normal children, Children with ADHD showed a higher tendency to be unable to use colors properly, were illogical and drew a simple face in the lower level of development. In many cases, the subjects drew a face with insufficient detail in the object and the environment and used shaky or wavering lines with repetitive coloring. In regard to the drawing theme, children with ADHD were more inclined to draw something other than a portrait and something that expressed negative emotions such as sorrow, fright, grotesqueness, fear, and anxiety. Among the aforementioned items of FSA assessment, line quality had the highest explanatory power. Discriminant power, which is the ability to predict normal children and children with ADHD based on the assessment items of the FSA drawings, was in the range of 79–81.3%. The drawing #3 showed the highest value of 81.3%.