A Novel Approach to Equating English Teachers’ and Chinese Teachers’ Ratings of Behaviours Characterised by Attention Deficit Hyperactivity Disorder

The diagnosis and treatment of ADHD rely on accurately identifying and interpreting symptoms. However, different raters may have different perceptions of ADHD symptoms, which can significantly impact ADHD diagnosis and prevalence rates. This study presented a novel way to compare ADHD symptom ratings between children from China and England while considering raters' differences. The study developed a series of cartoon animations to measure the raters' leniency toward Children’s ADHD symptoms. The Many-facet Rasch Model was then applied to adjust the children's ADHD symptom ratings according to their raters' leniency. The study was conducted in Year 2 classrooms in schools in China and England, and participating teachers were asked to rate cartoon characters' ADHD behaviours according to their tolerance. They were also asked to rate 10 children selected randomly from their class about ADHD symptoms. The study found that Chinese teachers were more lenient with children's ADHD behaviours than their English colleagues. Moreover, after adjusting for raters' leniency, Chinese children's ratings increased significantly, while English children's ratings decreased significantly. The study also found that Chinese children's ratings of ADHD behaviours were significantly higher than those of English children. Additionally, the Inter-rater Agreement was low among Chinese teachers. The findings highlight the significant impact of raters' differences on ADHD symptom ratings and the importance of equating teachers' ratings of children's ADHD symptoms to produce a relatively fair comparison between countries. The study's use of cartoon animations offers many advantages over text and videotape vignettes for cross-cultural studies. Moreover, the findings suggest that multi-informants are necessary for a single setting for diagnosing ADHD in children. In conclusion, this study provides valuable insights into the impact of rater differences on ADHD symptom ratings and the importance of considering these differences when comparing prevalence rates between countries. Future research should explore ways to improve inter-rater agreement among raters and investigate other factors that may affect ADHD diagnosis and treatment.