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Assessment of ADHD: Differences Across Psychology Specialty Areas

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Journal of Attention Disorders
Authors:
Marcie W Handler at May Institute, Massachusetts
Marcie W Handler
  • May Institute, Massachusetts
George J DuPaul at Lehigh University
George J DuPaul
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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.
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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). ...
... . All ages combined, this increase reached 56.7% over the period (10,065 incident patients in 2011,15,776 in 2019). This increase was mainlyThis was based on the distribution of psychotropic drugs ATC N , ...
ADHD diagnosis and methylphenidate consumption in children and adolescents: A systematic analysis of health databases in France over the period 2010–2019
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  • Oct 2022
Context ADHD is the most common mental disorder in school-aged children. In France, methylphenidate is the only drug authorized for ADHD. Here, we describe the pattern of ADHD diagnosis and methylphenidate prescription to children and adolescents from 2010 to 2019. Methods We conducted a retrospective cohort study of all beneficiaries of the French general health insurance scheme (87% of the population, 58 million people). We extracted information for all children and adolescents aged 0–17 years who received: (1) A diagnosis of ADHD (34,153 patients). (2) At least one methylphenidate prescription (144,509 patients). We analyzed the clinical, demographic, institutional, and social parameters associated with ADHD diagnosis and methylphenidate consumption in France. Results The ADHD diagnosis among children and adolescents increased by 96% between 2010 and 2019. ADHD diagnosis affects more boys than girls. About 50.6% of children hospitalized with a diagnosis of ADHD in 2017 also had another psychiatric diagnosis. The rate of children hospitalized with an ADHD diagnosis and treated with MPH varied between 56.4 and 60.1%. The median duration of MPH treatment for a 6-year-old ADHD child initiated in 2011 is 7.1 years. In 2018, 62% of ADHD children were receiving at least one psychotropic medication. Between 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription reached between 0.61 and 0.75% in 2019. Boys are predominantly medicated. The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. Diagnoses associated with methylphenidate prescription did not always correspond to the marketing authorization. Among children receiving the first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. A quarter of initiations and half of renewals were made outside governmental recommendations. Educational and psychotherapeutic follow-up decreased from 4.1% in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class were more likely to be diagnosed (55%) and prescribed methylphenidate (54%). Children from disadvantaged families had an increased risk of ADHD diagnosis (41.4% in 2019) and methylphenidate medication (25.7% in 2019).
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... Primary care providers are shown to rarely follow DSM diagnostic criteria (Chan et al., 2005;Epstein et al., 2014), instead using low value practices (e.g., reliance on screeners to diagnose, informal discussion of symptoms, failing to obtain teacher ratings or consider alternative diagnoses). Research in specialty psychology practices and schools demonstrates similar findings (Handler & DuPaul, 2005). Consequently, routine care diagnostic agreement is low when compared: (1) to research team clinicians (Cotuono, 1993;Longridge et al., 2019), (2) to the same routine care clinician at a different time point (Longridge et al., 2019), and (3) between routine care professionals (de la Viuda Suárez et al., 2021). ...
Racial and Gender Disparities in Community Mental Health Center Diagnoses of Adolescent ADHD and Comorbidities: A Mixed Methods Investigation
Article
Full-text available
Though ADHD is the most common pediatric diagnosis in community mental health clinics (CMHCs), little is known about its diagnostic accuracy in these settings. We characterize CMHC diagnostic patterns for ADHD and common comorbidities with attention to gender and racial/ethnic disparities and the impact of misdiagnosis on evidence-based treatment implementation. Culturally diverse adolescents with a primary diagnosis of ADHD (N=278) completed comprehensive research team diagnostic assessments. Concurrently, they were assessed at one of four CMHCs in a large United States city. CMHC psychiatric diagnoses were obtained from electronic health records and compared to best practices research diagnoses. Mixed methods analyses characterized diagnostic agreement, racial/ethnic and gender disparities, and the effect of missed ADHD diagnoses on treatment implementation, as well as agency staff perceptions of barriers and facilitators to accurate diagnosis. Diagnostic agreement was unacceptable for all diagnoses (k=.02 to .19). CMHCs provided an ADHD diagnosis to 65.4% of best practices diagnosed participants. Female gender and White race were associated with missed ADHD diagnoses (often in favor of depressive or adjustment disorders) and CMHCs demonstrated overdiagnosis of conduct disorder (CD) in African American youth. Missed ADHD diagnoses predicted clinician deviation from evidence-based treatment for ADHD. Agency stakeholders noted systemic barriers and clinician beliefs and biases that may contribute to diagnostic inaccuracy and made suggestions for future practice. CMHCs might review their ADHD diagnostic practices to identify contributors to misdiagnosis, such as racial and gender biases, clinician inexperience, and systemic disincentives for careful diagnosis. Adopting systematic diagnostic practices such as pursuing parent and teacher ratings, consulting the DSM when diagnosing, and integrating supervisors into diagnostic process may be helpful.
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... Take, for example, the consideration of formal school supports through a Section 504 accommodation plan or through an IEP based on special education eligibility within the OHI category. In both cases, the precipitating reason for identification of the student to receive these supports is a diagnosis of ADHD, something that is not universally assigned by a school psychologist using current evidence-based diagnostic procedures (e.g., Handler & DuPaul, 2005). Although an ADHD diagnosis is not required to receive special education supports or accommodations through a Section 504 accommodation plan (U.S. ...
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... Although the gold standard for ADHD evaluation consists of clinical interviews, symptom checklists, records review, and collateral reports (Handler & DuPaul, 2005), neuropsychological testing is often employed and can have utility (Shura et al., 2017b). An advantage of objective cognitive testing in ADHD evaluations is the inclusion of performance validity tests and symptom validity tests (PVTs and SVTs), which are the best methods available for identifying response bias. ...
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... With regard to the assessment of ADHD, there is a general consensus that evaluations should be multi-method and multi-source in nature and that practitioners should gather information about which symptoms are present, how pervasive and chronic they are, and the degree to which the symptoms impair student functioning (Handler & DuPaul, 2005). Recommendations for multi-method, multi-source ADHD assessment typically include record review, multi-informant interviews (i.e., parents, teachers, student), multi-informant behavior rating scales (i.e., parents, teachers), and behavioral observations (DuPaul & Stoner, 2015). ...
State Variation Regarding Other Health Impairment Eligibility Criteria for Attention Deficit Hyperactivity Disorder
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Full-text available
  • Mar 2023
The special education eligibility category that has come to be most commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD) in recent years is Other Health Impairment (OHI). However, the eligibility criteria for the OHI disability category have been criticized for being especially vague, given that the disability category incorporates a wide range of health impairments without providing any additional specificity. Because states have the latitude to utilize more specific eligibility criteria than what is provided at the federal level, the purpose of the current study was to review state-level special education eligibility criteria for OHI, with particular interest in identifying the degree to which eligibility guidance exists specific to students with ADHD and the extent to which this guidance varies across states. Results suggested that wide state variation exists regarding eligibility guidance, with 22% of states utilizing the federal definition and only 14% of states providing elaboration regarding all three components of the federal definition. Whereas it was most common for states to provide additional guidance surrounding what is needed to establish that a student has a health impairment, less than half of states provided specific guidance surrounding the other two components of the federal definition. Implications for policy and practice are discussed.
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A Contextual, Multidimensional, Interdisciplinary Approach to Assessment of ADHD
Article
  • Jul 2008
Studies indicate that many mental health clinicians do not follow evidence-based guidelines for assessment of ADHD. This article combines a literature review of diagnostic and evaluation issues in ADHD with original case study illustrations that delineate a step-by-step evidence-based best practice model for clinical assessment of ADHD according to three criteria: contextual, multidimensional, and specificity.
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Determining cutoff scores on the Conners' adult ADHD rating scales that can definitively rule out the presence of ADHD in a clinical sample
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Convergent validity of the Behavior Observation of Students in Schools for elementary school students with disruptive behaviors
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  • Jun 2023
Systematic direct observations (SDOs) and behavior rating scales are integral to multimethod behavioral assessment approaches. The present study investigated the convergent validity of the Behavior Observation of Students in Schools (BOSS) form, a widely utilized SDO system, with the most frequently used teacher rating scales in schools, the Behavioral Assessment System for Children, Third Edition (BASC‐3) and the Behavioral and Emotional Screening System, third edition (BESS‐3). Specifically, the present study compared independent observer data collection of student on‐task and disruptive behaviors on the BOSS with teachers' ratings of behavioral problems on the BASC‐3 and BESS‐3. Data come from a sample of 136 teachers and 349 students with or at risk of disruptive behavior disorders (DBDs). Pearson correlations were computed between BOSS and teacher ratings on the BASC‐3 and BESS‐3. Findings demonstrated significant, small to moderate correlations. Results indicate evidence of convergent validity for the BOSS and BASC3 assessments and highlight multimethod behavioral assessment's utility in supporting students with or at risk of DBDs.
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Revisiting the intake policy at the mental child and adolescent clinics
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Multimethod Assessment of Attention-Deficit Hyperactivity Disorder: The Diagnostic Utility of Clinic-Based Tests
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Full-text available
  • Dec 1992
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Investigated the utility of two clinic-based tests, the Matching Familiar Figures Test (MFFT; Kagan, 1966) and a version of the Continuous Performance Test (CPT; Gordon, 1983), in the assessment of children with attention-deficit hyperactivity disorder (ADHD). At a group level of analysis, scores on the CPT and MFFT were found to share little variance with parent and teacher report on several behavior rating scales used to evaluate ADHD. Further, clinic test scores, either alone or in combination, resulted in classification decisions that frequently disagreed with a diagnosis of ADHD based on parent interview and behavior-rating-scale data. The limited utility of currently available tests in the evaluation of ADHD suggests the need to develop clinic-based measures of sufficient ecological validity, which can be used in conjunction with parent and teacher report.
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Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Article
Full-text available
  • Apr 1998
Objective.-To deal with public and professional concern regarding possible overprescription of attention-deficit/hyperactivity disorder (ADHD) medications, particularly methylphenidate, by reviewing issues related to the diagnosis, optimal treatment, and actual care of ADHD patients and of evidence of patient misuse of ADHD medications. Data Sources.-Literature review using a National Library of Medicine database search far 1975 through March 1997 on the terms attention deficit disorder with hyperactivity methylphenidate, stimulants, and stimulant abuse and dependence, Relevant documents from the Drug Enforcement Administration were also reviewed. Study Selection.-All English-language studies dealing with children of elementary school through high school age were included. Data Extraction.-All searched articles were selected and were made available to coauthors for review, Additional articles known to coauthors were added to the initial list, and a consensus was developed among the coauthors regarding the articles most pertinent to the issues requested in the resolution calling for this report, Relevant information from these articles was included in the report. Data Synthesis.-Diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness, The criteria of what constitutes ADHD in children have broadened, and there is a growing appreciation of the persistence of ADHD into adolescence and adulthood, As a result, more children (especially girls), adolescents, and adults are being diagnosed and treated with stimulant medication, and children are being treated for longer periods of time, Epidemiologic studies using standardized diagnostic criteria suggest that 3% to 6% of the school-aged population (elementary through high school) may suffer from ADHD, although the percentage of US youth being treated for ADHD is al most at the lower end of this prevalence range, Pharmacotherapy, particularly use of stimulants, has been extensively studied and generally provides significant short-term symptomatic and academic improvement, There is little evidence that stimulant abuse or diversion is currently a major problem, particularly among those with ADHD, although recent trends suggest that this could increase with the expanding production and use of stimulants. Conclusions.-Although some children are being diagnosed as having ADHD with insufficient evaluation and in some cases stimulant medication is prescribed when treatment alternatives exist, there is little evidence of widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate by physicians.
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The diagnosis of attention deficit hyperactivity disorder (ADHD) in community mental health centers: Where and when
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The high degree of coexistence of attentional disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), with a number of other disorders continues to pose diagnostic problems and to highlight a continuing need to differentiate better between overlapping diagnoses. The purpose of this study was to assess the extent to which this type of diagnostic confusion continues to exist in referrals for assessment of ADHD to community mental health centers. Using referrals to a specialized ADHD Clinic of our center, 92 children with a previous diagnosis of ADHD were provided comprehensive evaluations, addressing cognitive, intellectual, personality, academic, social, behavioral, developmental, and medical concerns. After comprehensive evaluation and careful review of the results, only 22% of our sample were given a primary diagnosis of ADHD and only 37% a secondary diagnosis of ADHD. Substantial numbers of children were diagnosed instead with primary anxiety and mood disorders. Reasons for this discrepancy are discussed.
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‘A method for judging all contrasts in the analysis of variance’
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  • Mar 1969
p. 89, l.8 from bottom. μ^1should readμ^i⁠. p. 90, l.7. Insert comma after ηj. p. 93. Delete footnote. Tukey's method does not apply to the interactions, since the aij are not all equal for i ≠ j. p. 100, l. below (28): ψ > A¯Should read ψ $ A. p. 100, 2nd and 7th lines below (28): ψ ⩾ A. p. 102, l.16. ζ^1should readζ^i⁠. p. 102, l. 15 from bottom. Insert this sentence: It is assumed that γ < ½ π in the following developments; the value of P2 at γ = ½ π, stated in § 4, is easily derived separately. p. 102, l. 14 from bottom. ζk-1should readζ^k-1⁠. p. 103, 2nd line above (38). Insert w before p1.
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Attention Deficit Hyperactivity Disorder: A Handbook of Diagnosis and Treatment
Book
  • Jan 2006
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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Methodological Differences In The Diagnosis Of Attention-Deficit Hyperactivity DisorderImpact On Prevalence
Article
  • Jan 1994
Although there has been extensive research in the area of Attention-deficit Hyperactivity Disorder (ADHD), the estimated prevalence of this disorder ranges from 1&percnt; to 20&percnt;. This variability is due in part to variations in how one defines ADHD and the difficulty of precisely measuring the features of the syndrome. Additionally, problems of differential diagnosis and comorbidity of ADHD with other disorders may impact resultant prevalence rates. The present study was conducted in order to examine the impact of various qualitative and quantitative differences in the diagnostic process on the prevalence of ADHD in samples of children in special education and children referred to a tertiary-care specialty clinic for learning disabilities (LD) and ADHD. Of particular interest was the prevalence of ADHD with no other psychopathology (“pure” ADHD) in the two samples. Children with pure ADHD made up only 15.8&percnt; of the special education sample (teacher rating only). In contrast, the prevalence of pure ADHD in the specialty clinic sample ranged from 35.6&percnt; (teacher rating only) to 11.9&percnt; (parent rating only). Only 5.9&percnt; were rated by both teacher and parent as pure ADHD. The clinical and methodological implications of these findings are discussed in terms of the criteria for diagnosis of ADHD and implications for future research.
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Preferred Assessment Methods and Treatment Modalities for Hyperactive Children Among Clinical Child and School Psychologists
Article
  • Jun 1986
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This study was a survey that solicited clinical child psychologists and school psychologists' preferred assessment and treatment for hyperactive children. Three hundred eight practitioners responded to the survey. Results indicated that most practitioners use traditional assessment batteries consisting of interviews, behavioral observations, and a standardized intelligence test to assess suspected hyperactive children. Empirically derived rating scales were used less frequently and specific tests of vigilance-attention were infrequently employed. Treatment preferences indicated an acceptance of medication with a combination of behavioral and/or cognitive strategies. Although school psychologists differ from clinical psychologists on the use of neuropsychological tests and methods that directly assess vigilance-attention, there were no striking differences in the treatment preferences between these two groups. The need for more standardized and objective measures for assessing hyperactive children, and the importance of developing treatment strategies that are related to assessment findings are discussed in this article.
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A Comparison of Evaluation Methods and Treatment Modalities for Attention Deficit Disorder by School Psychologists and Other Practitioners
Article
  • Jan 1994
A survey was conducted of 56 clinical child psychologists, 93 school psychologists, 24 family physicians, and 24 pediatricians concerning assessment methods and interventions for use with children with attention deficit disorders (ADD). Survey results are compared with results of a 1986 survey by R. Rosenberg and S. Beck to assess changes over 6 years. Data on use of the following assessment methods, by each group, are cited: interviews with the child, teachers, and parents; specific behavioral assessments; standardized tests; drawing tests; rating scales; apperception tests; and neuropsychological tests. Six groups of interventions were also examined: medication, behavior therapy, modification of school environment, cognitive behavior intervention, systems intervention, and psychotherapy. Results indicated that the diagnostic methods most commonly reported by all four groups were interviews and behavioral observations. School psychologists tended to modify the school environment and employ cognitive behavior therapy more frequently than did other groups. The survey also examined each group's work settings, level of education, workshops or classes on ADD attended, and extent of ADD children in their workload. (JDD)
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The diagnosis of attention deficit hyperactivity disorder (ADHD) in community mental health centers: Where and when
Article
  • Oct 1993
  • PSYCHOL SCHOOLS
The high degree of coexistence of attentional disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), with a number of other disorders continues to pose diagnostic problems and to highlight a continuing need to differentiate better between overlapping diagnoses. The purpose of this study was to assess the extent to which this type of diagnostic confusion continues to exist in referrals for assessment of ADHD to community mental health centers. Using referrals to a specialized ADHD Clinic of our center, 92 children with a previous diagnosis of ADHD were provided comprehensive evaluations, addressing cognitive, intellectual, personality, academic, social, behavioral, developmental, and medical concerns. After comprehensive evaluation and careful review of the results, only 22% of our sample were given a primary diagnosis of ADHD and only 37% a secondary diagnosis of ADHD. Substantial numbers of children were diagnosed instead with primary anxiety and mood disorders. Reasons for this discrepancy are discussed.
View