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Assessment of ADHD: Differences Across Psychology Specialty Areas

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Journal of Attention Disorders
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Abstract

Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited information regarding the extent to which psychologists adhere to recommended assessment practices and whether differences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) × 3 (employment setting) between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psychologists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria, use of clinical interviews, and type of behavior observation. Only 15% of psychologists report using multiple methods consistent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is conducted.
10.1177/1087054705278762Journal of Attention Disorders / November 2005Handler, DuPaul / Assessment of ADHD
Assessment of ADHD: Differences Across
Psychology Specialty Areas
Marcie W. Handler
The May Institute
George J. DuPaul
Lehigh University
Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited
information regarding the extent to which psychologists adhere to recommended assessment practices and whether differ-
ences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/
or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) ×3 (employment setting)
between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psycholo-
gists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria,
use of clinical interviews, and type of behavior observation.Only 15% of psychologists report using multiple methods consis-
tent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of
ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is
conducted. (J. of Att. Dis. 2005;9(2), 402-412)
Keywords: assessment of ADHD; diagnosis of ADHD; psychology specialty area
ADHD entails persistent problems with inattention,
impulsivity, and hyperactivity that are inconsistent
with one’s developmental level and result in clinically
significant impairment across at least two settings (Amer-
ican Psychiatric Association, 2000). Given that ADHD is
a relatively common behavior disorder, children may be
referred to many different types of psychologists (e.g.,
clinical, counseling, or school psychologists) and physi-
cians (e.g., pediatricians, family practitioners, or psychia-
trists). To diagnose a child with ADHD, Diagnostic and
Statistical Manual of Mental Disorders (4th ed., text revi-
sion; DSM-IV-TR; American Psychiatric Association,
2000) criteria requires that a clinician determine not only
the presence of symptoms but also their severity relative
to same-aged peers, chronicity, pervasiveness, age of
onset, and the degree of impairment that results from the
symptoms.
Psychologists, psychiatrists, and pediatricians agree
that “best practice” when assessing ADHD symptoms in
children occurs when a clinician uses a multimethod
approach across multiple sources and settings to obtain
information about symptom presence, pervasiveness,
chronicity, and impairment as outlined by standardized
diagnostic criteria (i.e., DSM-IV-TR; American Academy
of Pediatrics, 2000; Dulcan & Benson, 1997; Goldman,
Genel, Bezman, & Slanetz, 1998; Hoff, Doepke, & Lan-
dau, 2002). Typically, recommended assessment methods
include clinical interviews with the parent, teacher, and
child; standardized behavior rating scales completed by
the parent and teacher; review of school information; and
clinical observations of the child’s behavior (when possi-
ble, in the classroom and in less structured situations;
Barkley, 1998; Dulcan & Benson, 1997; DuPaul &
Stoner, 2003; Hoff et al., 2002; Zentall & Javorsky, 1996).
Despite ongoing discussions about best practice, the
National Institutes of Health (NIH) Consensus Develop-
ment Panel concluded that “there is a wide variation
among types of practitioners with respect to frequency of
diagnosis of AD/HD” (NIH, 1998, p. 9). Thus, given the
growing number of children being diagnosed with
ADHD, researchers have become interested in examining
402
Journal of Attention Disorders
Volume 9 Number 2
November 2005 402-412
© 2005 Sage Publications
10.1177/1087054705278762
http://jad.sagepub.com
hosted at
http://online.sagepub.com
Address correspondence to George J. DuPaul, Lehigh University, 111
Research Drive, Bethlehem, PA 18015; gjd3@lehigh.edu
... Beyond the demographic or cultural differences of the countries or regions surveyed (Europe, the Americasincluding the United States-and Asia), the analyses show that the prevalence rates of hyperactivity are determined by the research method used, including clinical studies, telephone surveys, and questionnaires given to parents and/or teachers (10). Unfortunately, these different types of methods present numerous biases that question or even invalidate their significance: variations related to diagnostic criteria, scales and analysis grids, sampling, level of training of the interviewers, and level of information of the respondents, to the taking into account of the risks of co-morbidity and to diagnostic errors or social factors likely to influence the diagnosis (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). ...
... Previous international studies already reported such critical stance about ADHD prevalence estimations: serious studies have shown that the diagnosis of hyperactivity initially made in specialized centers was refuted in 62 to 78% of cases after re-evaluation (12, 14). Several subsequent studies have suggested that doctors or psychologists do not properly follow assessment procedures or comprehensive and clinical approaches meant to guide, confirm, or refute the diagnosis (15,20). Furthermore, recurrent changes and the constant expansion of diagnostic criteria, as well as the emergence of subtypes, contribute to an exponential increase in prevalence rates and consequently to the increase in false-positives (11, 13, 21, 22). ...
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Recent years have seen tremendous advances in understanding and treating Attention-Deficit/Hyperactivity Disorder (ADHD). Now in a revised and expanded third edition, this authoritative handbook brings the field up to date with current, practical information on nearly every aspect of the disorder. Drawing on his own and others' ongoing, influential research - and the wisdom gleaned from decades of front-line clinical experience - Russell A. Barkley provides insights and tools for professionals working with children, adolescents, or adults. Part I presents foundational knowledge about the nature and developmental course of ADHD and its neurological, genetic, and environmental underpinnings. The symptoms and subtypes of the disorder are discussed, as are associated cognitive and developmental challenges and psychiatric comorbidities. In Parts II and III, Barkley is joined by other leading experts who offer state-of-the-art guidelines for clinical management. Assessment instruments and procedures are described in detail, with expanded coverage of adult assessment. Treatment chapters then review the full array of available approaches - parent training programs, family-focused intervention for teens, school- and classroom-based approaches, psychological counseling, and pharmacotherapy - integrating findings from hundreds of new studies. The volume also addresses such developments as once-daily sustained delivery systems for stimulant medications and a new medication, atomoxetine. Of special note, a new chapter has been added on combined therapies. Chapters in the third edition now conclude with user-friendly Key Clinical Points. This comprehensive volume is intended for a broad range of professionals, including child and adult clinical psychologists and psychiatrists, school psychologists, and pediatricians. It serves as a scholarly yet accessible text for graduate-level courses. Note: Practitioners wishing to implement the assessment and treatment recommendations in the Handbook are advised to purchase the companion Workbook, which contains a complete set of forms, questionnaires, and handouts, in a large-size format with permission to photocopy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(jacket)
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