Journal of Abnormal Child Psychology, Vol. 26, No. 4, 1998, pp 269-277 A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD Benjamin L. Handen,1,2,6 Sarah McAuliffe,2 Janine Janosky,3 Heidi Feldman,1,4 and Anna Marie Breaux5 There have been numerous efforts during the past 20 years to develop and validate clinic-based as- sessment tools to assist in the diagnosis of attention deficit hyperactivity disorder, or ADHD. Such evalu- ations have included observation of mother-child in- teractions, independent play assessments, and obser- vation of children engaged in academic tasks. Routh 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsyl- vania 15213. 2Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213. 3Clinical Epidemiology and Preventive Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213. 4Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213. 5Private practice, Wexford, Pennsylvania 15090. 6Address all correspondence, including reprint requests, to Dr. Benjamin Handen, Merck Outpatient Program, Western Psychi- atric Institute and Clinic, 3811 O'Hara St., Pittsburgh, Pennsyl- vania 15213. and Schroeder were among the first to report the use of a playroom observation system to distinguish be- tween children with and without hyperactivity (Routh & Schroeder, 1976). Subsequent to this, Campbell and her colleagues developed a number of clinic- based observations of mother-child interactions as well as independent play assessments to examine dif- ferences between toddlers and preschoolers with ADHD and a group of control children (e.g., Camp- bell, Ewing, Breaux, & Szumowski, 1986). Similar clinic-based playroom protocols have been found to discriminate among children with ADHD, ADHD and aggression, and psychiatric controls (Milich, Loney, & Landau, 1982). Clinic-based observations of children engaged in academic tasks have also dis- criminated between ADHD and control children (Breen, 1989) and have been found to be sensitive to stimulant drug effects in children with ADHD (Barkley, DuPaul, & McMurray, 1991; Barkley, Fis- cher, Newby, & Breen, 1988). 269 0091-0627/98/0800-0269$15.00/0 © 1998 Plenum Publishing Corporation KEY WORDS: ADHD; mental retardation. Received April 7, 1995; revision received January 6, 1997; accepted March 24, 1997 Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD- combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indi- cated that the ADHD-combined group was significantly more vocal and engaged in a sig- nificantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD- combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.