No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Assessment of ADHD: Differences Across Psychology Specialty Areas
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) x 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.
... 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 , ...
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).
... Different methodologies can be used: rating scales, structured or nonstructured teacher interviews, and/or structured or nonstructured observations. Evidence suggests that up to 85% the clinicians reported using teacher rating scales to assess ADHD symptoms at school (Handler & DuPaul, 2005). Furthermore, 64% of the clinicians reported using teacher interviews (structured and nonstructured), whereas only 38% reported to use classroom observations (structured and nonstructured) (Handler & DuPaul, 2005). ...
... Evidence suggests that up to 85% the clinicians reported using teacher rating scales to assess ADHD symptoms at school (Handler & DuPaul, 2005). Furthermore, 64% of the clinicians reported using teacher interviews (structured and nonstructured), whereas only 38% reported to use classroom observations (structured and nonstructured) (Handler & DuPaul, 2005). ...
... Systematic observations are viewed as one of the most objective and direct measurements of a child's behavior including ADHD (Volpe et al., 2005). They are frequently used to assess ADHD symptoms at school, particularly among school psychologists (Handler & DuPaul, 2005;Shapiro & Heick, 2004;Wilson & Reschly, 1996). The most commonly used observational coding schemes assessing ADHD symptoms focus on inattention by measuring offtask behavior and hyperactivity by measuring motor movement and noisiness. ...
Objective: To assess attention-deficit/hyperactivity disorder (ADHD) symptoms in the classroom, most often teacher rating scales are used. However, clinical interviews and observations are recommended as gold standard assessment. This systematic review and meta-analysis evaluates the validity of teacher rating scales. Method: Twenty-two studies ( N = 3,947 children) assessing ADHD symptoms using teacher rating scale and either semi-structured clinical interview or structured classroom observation were meta-analyzed. Results: Results showed convergent validity for rating scale scores, with the strongest correlations ( r = .55–.64) for validation against interviews, and for hyperactive–impulsive behavior. Divergent validity was confirmed for teacher ratings validated against interviews, whereas validated against observations this was confirmed for inattention only. Conclusion: Teacher rating scales appear a valid and time-efficient measure to assess classroom ADHD; although validated against semi-structured clinical interviews, there were only a few studies available. Low correlations between ratings and structured observations of inattention suggest that observations could add information above rating scales.
... Direct observations have long been recommended as an important component of ADHD assessment (Handler & DuPaul, 2005). Such observations may involve observing a student's behavior in the classroom. ...
... However, direct observations can be burdensome and costly assessments to conduct. Indeed, the majority of diagnostic practices for ADHD do not include classroom observations (Austerman, 2015;Handler & DuPaul, 2005;Parker & Corkum, 2016), despite the fact that best practice guidelines recommend using multi-method approaches that include direct observation in naturalistic settings (DuPaul & Stoner, 2014;Handler & DuPaul, 2005). ...
... However, direct observations can be burdensome and costly assessments to conduct. Indeed, the majority of diagnostic practices for ADHD do not include classroom observations (Austerman, 2015;Handler & DuPaul, 2005;Parker & Corkum, 2016), despite the fact that best practice guidelines recommend using multi-method approaches that include direct observation in naturalistic settings (DuPaul & Stoner, 2014;Handler & DuPaul, 2005). ...
Classroom observations have long been considered a necessary component of Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations. Yet, research evaluating the utility of observational ratings in ADHD assessment is limited. This study examined the contributions of the Behavioral Observation of Students in Schools (BOSS) to ADHD assessment by investigating associations between BOSS scores with ADHD symptom clusters and symptoms of frequently co-occurring externalizing and internalizing disorders. The utility of BOSS scores in predicting future ADHD-related impairment beyond standard parent and teacher ratings was also examined. One hundred and thirty-five children in grades 2–5 across 23 public schools participated in a randomized controlled trial examining a psychosocial treatment for ADHD. BOSS ratings were collected at baseline. Parent and teacher ratings of child symptoms and impairment were collected at baseline, post-treatment (3–4 months later), and follow-up (8–12 months later). Multiple regressions investigated the associations between the BOSS subscale of Task Engagement (TE) and parent and teacher ratings of ADHD symptoms and related disorders. Multi-level modeling accounted for school cluster effects. Results showed that lower BOSS TE was related to higher teacher-rated inattention but not hyperactivity/impulsivity symptoms. Lower BOSS TE was also associated with higher teacher-rated Oppositional Defiant Disorder (ODD) and depression symptoms, but not anxiety symptoms. Further, BOSS TE predicted higher future impairment beyond baseline teacher and parent ratings of ADHD symptoms and impairment, controlling for treatment. The BOSS appears sensitive to symptoms of child inattention, ODD, and depression, and may have utility in informing future impairment beyond standard informant ratings of ADHD.
... The chronic nature of the disorder and its long-term impact on the social and academic life of affected individuals substantiate the need for early identification and treatment. Behavioral rating scales and interviews with parents and teachers are the most frequently used diagnostic tools in the assessment of ADHD [2][3][4], as the diagnostic criteria are of a behavioral nature [2,5]. Informant ratings offer an efficient summary of natural observations over extended time spans [6]. ...
... A survey of school psychologists in the U.S. revealed that direct observations are among the most commonly used methodologies in diagnostic processes [13]. Handler and DuPaul [4] consider the use of observations in combination with other assessment methods to be consistent with standards of best practice. For treatment evaluation, blinded observations were claimed to be the gold standard of assessment [14]. ...
... (3) Findings on convergent validity of observational measures are evaluated, i.e., correlations between observational data and other measures of ADHD (mostly parent and teacher ratings). (4) The evidence that behavioral observations detect treatment effects is reviewed. ...
This review evaluates the clinical utility of tools for systematic behavioral observation in different settings for children and adolescents with ADHD. A comprehensive search yielded 135 relevant results since 1990. Observations from naturalistic settings were grouped into observations of classroom behavior (n = 58) and of social interactions (n = 25). Laboratory observations were subdivided into four contexts: independent play (n = 9), test session (n = 27), parent interaction (n = 11), and peer interaction (n = 5). Clinically relevant aspects of reliability and validity of employed instruments are reviewed. The results confirm the usefulness of systematic observations. However, no procedure can be recommended as a stand-alone diagnostic method. Psychometric properties are often unsatisfactory, which reduces the validity of observational methods, particularly for measuring treatment outcome. Further efforts are needed to improve the specificity of observational methods with regard to the discrimination of comorbidities and other disorders.
... Obtaining an accurate diagnosis is important and may be necessary to gain access to specific treatment/placement options (e.g., medication, special Downloaded by [University of South Florida] at 16:55 20 January 2014 education services). Several researchers have reviewed best practice guidelines for the diagnosis of ADHD (Brock & Clinton, 2007;Handler & DuPaul, 2005). A majority of the guidelines recommend basing diagnosis on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV ); using interviews with the parent, teacher, and child; parent and teacher standardized behavior rating scales; assessment of cognitive functioning and academic achievement; and behavioral observations during unstructured (e.g., playground) and structured times (e.g., classroom). ...
... Behavioral observations were recommended in 68% of the studies. Handler and DuPaul (2005) compared current practices of school, clinical, and counseling psychologists (n = 230) to best practice guidelines (specifically, the use of parent and child interviews, information from school regarding the child's behavior, cognitive performance, achievement, parent and teacher ratings scales, and observations of the child in the classroom and in less structured situations). Only 15% of participants across the three groups reported using methods aligned with best practice guidelines. ...
... They found that doctoral-level practitioners reported higher levels of confidence in their training in the overall assessment of ADHD, diagnosis, assessment to develop educational interventions, and providing treatment than their non-doctorate-level counterparts. Handler and DuPaul (2005) found that psychologists who earned higher degrees were more likely to complete comprehensive diagnostic assessments including interviews with multiple informants. However, it is unclear how training experiences relate to the other purposes of assessment. ...
Youth exhibiting symptoms of attention deficit hyperactivity disorder are frequently referred to school psychologists because of academic, social, and behavioral difficulties that they face. To address these difficulties, evidence-based assessment methods have been outlined for multiple purposes of assessment. The goals of this study were to delineate school psychologists’ (a) primary purpose of their assessment of attention deficit hyperactivity disorder (i.e., screening, diagnosis, placement, intervention planning, progress monitoring), (b) use of recommended assessment tools/strategies and the perceived importance of each recommended tool/strategy for decision making, and (c) their perceived adequacy of training regarding attention deficit hyperactivity disorder assessment. Surveys from 217 school psychologists identified intervention planning as the primary purpose of assessment. Participants reported following recommended guidelines most frequently for diagnosis, impairment, and intervention development; they were least likely to follow guidelines for progress monitoring, evaluating outcomes, and assessing integrity. Participants reported being best trained for screening and placement, and least well trained in evaluating outcomes and developing interventions. Implications for practice and future research are discussed.
... Minimal empirical research has examined psychologists' adherence to established diagnostic criteria for ADHD such as criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its revisions. Handler and DuPaul (2005) surveyed psychologists and found that approximately 90% reported using DSM criteria as a guide for diagnosing ADHD but nearly 40% reported not strictly adhering to these criteria when diagnosing ADHD. The authors noted that these findings obtained through self-report may not have been reflective of actual practice. ...
... Although, as Murphy and Gordon (2006) noted, there is "no one right way" (p. 434) to assess for ADHD, there is generally agreement among experts that a multi-method, multiinformant assessment approach is a recommended practice (Handler & DuPaul, 2005). Empirical investigation has yet to be conducted to determine the frequency in which this recommended approach is utilized by psychologists who assess postsecondary students for ADHD. ...
... Empirical investigation has yet to be conducted to determine the frequency in which this recommended approach is utilized by psychologists who assess postsecondary students for ADHD. Several survey studies (Demaray, Schaefer, & Delong, 2003;Handler & DuPaul, 2005;Koonce, 2007) have been conducted on the ADHD assessment practices of psychologists working with children in K-12 settings. Generally, these studies have found that psychologists tend to endorse using a multi-method, multiinformant approach; however, several important methods were not endorsed (e.g., behavioral observations in natural settings) and other less validated methods for assessing ADHD (e.g., projective measures) were endorsed at a higher rate than expected. ...
To examine how ADHD evaluations are documented for postsecondary students requesting disability eligibility.
A total of 100 psychological reports submitted for eligibility determination were coded for documentation of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, methods and instruments used in the evaluations, and recommended academic accommodations.
Results showed that a minimal number of reports (≤1%) documented that students met all DSM criteria for ADHD. Psychologists rarely documented childhood impairment, symptoms across settings, or the use of rule-outs. Symptom severity was emphasized over current impairment. The majority of psychologists utilized a multi-informant, multi-method evaluation approach, but certain methods (e.g., symptom validity tests, record reviews) were limited in use. Most reports included recommendations for academic accommodations, with extended time being the most common (72%).
This study raises awareness to the aspects of adequate ADHD evaluation and subsequent documentation that can be improved by psychologists. Recommendations are made regarding valid documentation of ADHD for disability determination purposes.
© 2014 SAGE Publications.
... Ainsi une revue systématique de plus de 150 études de prévalence fait état de variations importantes allant de 0,4% à 16,6% des enfants d'âge scolaire [5,6], avec des enquêtes pointant des taux supérieurs à 20% voire 25% d'enfants TDAH, augurant une véritable épidémie d'hyperactivité [7]. Les analyses rigoureuses menées par Polanczyk et collègues en 2007 et 2014 montrent qu'au-delà des différences démographiques ou culturelles des pays ou des régions enquêtées -Europe, Amérique (dont USA), Asie -les taux de prévalence de l'hyperactivité sont déterminés par la méthode de recherche utilisée : étude clinique, enquête téléphonique, questionnaire remis aux parents et/ou aux enseignants [6]… Malheureusement, ces différents types d'enquêtes présentent de nombreux biais tels qu'ils en interrogent voire en invalident la portée : variations en fonction des critères diagnostics, des échelles et des grilles d'analyse utilisées, de l'échantillonnage, du niveau de formation des enquêteurs et du niveau d'information des répondants, de la prise en compte des risques de comorbidité, d'erreurs diagnostiques ou de facteurs sociaux susceptibles d'influencer le diagnostic [8][9][10][11][12][13][14][15][16][17][18][19] En France, la seule étude disponible repose sur une enquête téléphonique menée en 2008 sur un échantillon de 7012 foyers sélectionnés de manière aléatoire. En interrogeant les parents selon des critères méthodologiques précis, les chercheurs ont estimé que 3,5% des enfants âgés de 6 à 12 ans souffraient d'hyperactivité/TDAH, tandis que par ailleurs, 2,2% étaient traités par psychostimulant sans pouvoir être formellement diagnostiqués [20, p.517]. ...
... Ainsi plusieurs études sérieuses ont montré que le diagnostic d'hyperactivité initialement posé dans les centres spécialisés était réfuté dans 62% à 78% des cas après ré-évaluation [9,12]. Plusieurs études ultérieures ont suggéré que les médecins ou les psychologues ne suivaient pas correctement les procédures d'évaluation des enfants ni les approches compréhensives et cliniques susceptibles d'orienter, confirmer ou infirmer le diagnostic [13,14]. De plus, les changements récurrents et l'élargissement constant des critère diagnostics, ainsi que l'apparition de sous-types, contribuent à l'augmentation exponentielle des taux de prévalence -et par voie de conséquence, à l'augmentation de faux-positifs et des risques de sur-diagnostic [8,17,18,19]. ...
Résumé
Contexte
La prévalence de l’hyperactivité/TDAH fait l’objet d’intenses débats au niveau international. En France, la seule étude disponible pointe un taux de prévalence du TDAH de 3,5 à 5,6 % des enfants âgés de 6 à 12 ans. Les auteurs estiment également que 3,48 % des 6–12 ans sont traités par psychostimulant. Notre article s’appuie sur les données de l’Assurance Maladie pour discuter ces résultats.
Méthode
Il est possible de procéder à une étude rigoureuse du taux diagnostic et du niveau de prescription du méthylphénidate en France en analysant les données de l’Assurance Maladie. Dans cette perspective, nous avons utilisé les informations extraites de la base du Système National d’Information Inter-Régime de l’Assurance Maladie (SNIIRAM) présentées en 2017 dans un rapport de l’Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM).
Résultats
Les données de l’Assurance maladie permettent d’établir une estimation de la prévalence du TDAH de 0,3 % en France.
Discussion
Ce résultat appelle des investigations plus approfondies dans la base du SNIIRAM. Il questionne les raisons du faible taux de médication du TDAH en France en comparaison d’autres pays occidentaux. Il interroge les biais méthodologiques et les conflits d’intérêts susceptibles d’orienter les études de prévalence du TDAH en France et au niveau international.
... Most problematic for LD, there is no universally accepted diagnostic methodology (Harrison & Holmes, 2012), and agreement across methods is poor (Sparks & Lovett, 2009). Although ADHD has more universally accepted diagnostic criteria than LD, there is little consistency in assessment approaches (Handler & DuPaul, 2005). In addition, studies have found that LD and ADHD documentation submitted in support of accommodation requests is frequently poor and lacking critical information (e.g., Nelson, Whipple, Lindstrom, & Foels, 2014;Sparks & Lovett, 2014). ...
... It was uncommon for guidelines to request formal testing for ADHD verification. This was not surprising given that recommended diagnostic procedures for ADHD are more focused on symptom rating scales, clinical interview, and history than formal testing results (Handler & DuPaul, 2005). In contrast, it was unexpected that only one set of ADHD guidelines requested standardized normreferenced symptom rating scales, with six failing to reference them at all. ...
Testing agencies request documentation to verify a test-taker’s disability status under the Americans With Disabilities Act of 2008 and Section 504 of the Rehabilitation Act of 1973. A number of recent legal developments, culminating in technical assistance from the U.S. Department of Justice, suggest changes in enforcement of relevant laws are imminent. This article reviews the legal developments and presents results of a survey of the learning disability and Attention-Deficit/Hyperactivity Disorder documentation guidelines of 10 standardized tests commonly used to aid admissions decisions for undergraduate and graduate programs. Consistent with the recent guidance, virtually all guidelines requested documentation from a qualified evaluator, a diagnosis, and accommodation recommendations and rationale. In contrast, agencies were less likely to request the information necessary to grant accommodations based on history of accommodation use. Few agencies had policies allowing submission of reduced amounts of documentation for students with lengthy histories of disabling conditions. Finally, guidelines frequently neglected to provide the guidance that evaluators need to generate useful documentation. Benefits and limitations of the recent legal guidance are discussed, and recommendations for testing and enforcement agencies, as well as secondary schools, are provided.
... 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). ...
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.
... Unfortunately, some psychologists adopt flexible criteria when assessing ADHD and recommend accommodations without evidence of impairment (Harrison, 2017). For example, Handler and DuPaul (2005) found that nearly 40% of psychologists admitted that they did not adhere strictly to DSM criteria when assessing ADHD. More recently, Harrison, Lovett, et al. (2013) found that 45% of psychologists who conduct disability evaluations believe that the purpose of those evaluations was to help students gain access to accommodations. ...
Neuropsychologists are often asked to evaluate students for attention-deficit/hyperactivity disorder (ADHD) and to provide documentation to support their requests for academic accommodations in college. Research points to the importance of multi-method, multi-informant data when evaluating ADHD and determining the need for accommodations. However, the Association on Higher Education and Disability (AHEAD) directs disability service providers to give primacy to students' self-reports and their own impressions of students' narratives over objective, third-party data when rendering accommodation decisions. The organization asserts that in many cases information from parents, teachers, and psychologists is not needed to confirm the existence of a disability or students' need for accommodations. In this article, we describe the way disability service providers are directed to evaluate accommodation requests, the limitations of these procedures, and the dangers of well-intentioned, but indiscriminate accommodation-granting. We then provide recommendations for neuropsychologists who conduct ADHD evaluations for college students in light of these professional guidelines.
... Decades ago, a few papers had already shown that prevalence studies could be subject to numerous biases, which alter or invalidate their results. The variations can be due to the heterogeneous diagnostic criteria, assessment scales, and analysis processes; studies' sampling methods; the different profiles of those who led the inquiries; the heterogeneous levels of information in respondents; or even the taking into account of comorbidity risks, diagnostic errors, or social factors influencing diagnoses (Barkley, 2005;Cotugno, 1993;Cuffe et al., 2005;Desgranges et al., 1995;Handler & DuPaul, 2005;Kube et al., 2002;LeFever et al., 2002;Milberger et al., 1995;Sciutto & Eisenberg, 2007;Wasserman et al., 1999;Wolraich et al., 1996Wolraich et al., , 1998. ...
Objective: Prevalence estimates for ADHD have been debated for decades. In France, the only available study states the prevalence rate in France ranges from 3.5% to 5.6% of children aged 6 to 12. It also evaluates that 3.48% of children aged 6 to 12 are treated with psychostimulants. The article uses a different method to determine whether these estimates hold true. Method: Estimating ADHD diagnosis and methylphenidate prescription rates can be done by analyzing national health care insurance system’s data. We used data from the French Healthcare Insurance as reported by the National Agency for Medicines and Health Products Safety. Results: We claim that an adequate estimate of the ADHD prevalence rate in France fluctuates around 0.3% of children aged 6 to 11. Discussion: Methodological biases in ADHD prevalence studies and factors contributing to the low level of prescription in France need to be assessed. Conclusion: We call for supplementary investigations in health care insurance databases to conduct contradictory studies.
... Postavljanje dijagnoze je subjektivno, te iz toga razloga dijagnoza ADHD sindroma mora biti postavljena na jedinstvenoj i individualnoj osnovi (Barkley i Edwards, 2006). Sa ciljem smanjivanja mogućnosti grešaka u postavljanju finalne dijagnoze, preporučeni model u procjeni ovog sindroma je multidimenzionalni pristup, gdje je potrebno sakupiti što više podataka (Handler i DuPaul, 2005). ...
... Our findings are also important for informing diagnostic assessment, treatment planning, and intervention monitoring practices. Currently, full psychoeducational evaluations for ADHD are used with diminished frequency within clinical settings because (in part) of insurance reimbursement challenges, ever-increasing patient quotas, and long waitlists for services (Handler & DuPaul, 2005;Nelson, Whipple, Lindstrom, & Foels, 2014). However, the present results suggest that psychoeducational testing for SLD may be a valuable component of ADHD assessment and treatment planning given high comorbidity rates and varying responses to treatment. ...
Attention deficit/hyperactivity disorder–predominantly inattentive presentation (ADHD-I) and specific learning disorder (SLD) are commonly co-occurring conditions. Despite the considerable diagnostic overlap, the effect of SLD comorbidity on outcomes of behavioral interventions for ADHD-I remains critically understudied. The current study examines the effect of reading or math SLD comorbidity in 35 children with comorbid ADHD-I+SLD and 39 children with ADHD-I only following a behavioral treatment integrated across home and school (Child Life and Attention Skills [CLAS]). Pre- and posttreatment outcome measures included teacher-rated inattention, organizational deficits, and study skills and parent-rated inattention, organizational deficits, and homework problems. A similar pattern emerged across all teacher-rated measures: Children with ADHD-I and comorbid ADHD-I+SLD did not differ significantly at baseline, but between-group differences were evident following the CLAS intervention. Specifically, children with ADHD-I and comorbid ADHD-I+SLD improved on teacher-rated measures following the CLAS intervention, but children with ADHD-I only experienced greater improvement relative to those with a comorbid SLD. No significant interactions were observed on parent-rated measures—all children improved following the CLAS intervention on parent-rated measures, regardless of SLD status. The current results reveal that children with ADHD-I+SLD comorbidity benefit significantly from multimodal behavioral interventions, although improvements in the school setting are attenuated significantly. A treatment-resistant fraction of inattention was identified only in the SLD group, implying that this fraction is related to SLD and becomes apparent only when behavioral intervention for ADHD is administered.
... Al respecto, en un estudio se señala que el 85% de los psicólogos informó que para la evaluación del TDAH emplea escalas que son contestadas por profesores (Handler y DuPaul, 2005). Considerando el argumento sobre el mayor conocimiento del niño que tienen los profesores, este dato no deja de ser importante ya que se vuelve un actor relevante en el proceso no solo del diagnóstico sino también del tratamiento contingente destinado a disminuir el impacto negativo en el niño; lo anterior también puede hacerse extensivo a los padres y a la familia en general (Berger, 2011). ...
Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent disorder during childhood. The present study aimed to evaluate if the Conners Continous Performance Test was able to discriminate among ADHD and normal children completed the Conners computarized test. Significant differences between normal and clinical sample were found. All children selected as normal did not fit the clinical profile. Only 50% of the children considered as having ADHD fit the clinical profile. Implications for the issue of overdiagnosis of the disorder are discussed.
... For example, those children who have experienced childhood neglect or emotional abuse can often display similar sets of behaviours and cognitive deficits that are also associated with ADHD. This makes it very possible for a child to be misdiagnosed as both conditions have the potential to mimic one another in their presentations ( Haber, 2003;Handler and DuPaul, 2005:). ...
ADHD, trauma and neglect: How do we prevent children who are in the child protection system from being misdiagnosed with ADHD? As we start to discover more about the presenting behaviours and after effects of
childhood adversity and experienced traumas, a plethora of evidence is beginning to emerge which supports the view that both ADHD and certain experienced traumas will present an overlap in symptomatology.
... Surveys suggest that many clinicians employ flexible thresholds for making the diagnoses of SLD and/or ADHD. For example, Handler and DuPaul (2005) compared the ADHD assessment practices of 230 psychologists and found that less than 16% of respondents used best practice assessment methods. While approximately 90% reported using DSM criteria as a guide for diagnosing ADHD, nearly 40% of the psychologists admitted they did not adhere strictly to these criteria when making this diagnosis. ...
Specific learning disabilities (SLD) and attention deficit hyperactivity disorder (ADHD) are lifelong neurolog-ically based disorders diagnosed using objective and specific criteria. Evaluation of current practices indicates that many clinicians employ flexible thresholds for making these diagnoses , at least when evaluating young adults. Given that academic accommodations can provide significant competitive advantages and that students with these diagnoses may qualify for substantial government-funded subsidies and benefits, issues of fairness arise if the objective and research-informed criteria for making these diagnoses are not upheld. This paper investigates the extent to which flexible thresholds are being employed in these diagnoses and the clinical, ethical, and forensic implications that result if clinical standards are not upheld. Recommendations for improved training of professional are provided.
... First, all data were collected via self-report and thus may be subject to inaccuracies inherent to this methodology (i.e., self-reported diagnostic status may not match clinical diagnosis). Furthermore, even if students accurately report being diagnosed with either ADHD or LD, previous research has demonstrated both a wide range in the quality of information used for diagnosis by professionals, and legitimate concerns regarding students feigning a disorder (Handler & DuPaul, 2005;Sansone & Sansone, 2011;Sollman, Ranseen, & Berry, 2010;Sparks & Lovett, 2009. Nevertheless, group differences in self-report data are noteworthy even if not completely accurate because these provide important insights into how students with self-reported ADHD and/or LD view themselves and their academic experiences and may best represent the population of students who present themselves to offices of disability services. ...
Students with attention-deficit/hyperactivity disorder (ADHD) and/or learning disabilities (LD) experience significant challenges in making the transition from high school to college. This study examined the ways first-year college students with ADHD, LD, ADHD+LD, and comparison peers differ in engagement, core self-evaluation, high school preparation behaviors, and goals/expectations. Participants were from the 2010 Cooperative Institutional Research Program Freshman Survey, including students with ADHD (n = 5,511), LD (n = 2,626), ADHD+LD (n = 1,399), or neither disability (n = 5,737). Controlling for SAT/ACT scores, family income, and parent education, students with ADHD, LD, or ADHD+LD differed from peers on self-ratings of academic and creative abilities and psychosocial functioning; school disengagement, substance use, and emotional difficulties during their last year of high school; reasons for attending college; and expectations for college activities. Several differences were found between disability groups. Implications for college support services and future research are discussed.
... Studies were separated based on the diagnostic method used to form ADHD and TD groups. That is, diagnostic information might be gathered from self-report measures, parent rating scales, teacher rating scales, clinical interviews, behavioral observations, school/classroom observations, and/or a combination of these measures ( Demaray, Elting, & Schaefer, 2003;Handler & DuPaul, 2005). Grouping procedures that rely exclusively on single-source rating scale cutoff scores appear to be the least face valid method of grouping, considering the nonpathognomonic nature of ADHD symptoms and corresponding high number of DSM-5 childhood disorders that feature attention and behavioral problems as core or secondary features (APA, 2013). ...
Impulsive behavior is a core DSM-5 diagnostic feature of attention-deficit/hyperactivity disorder (ADHD) that is associated with several pejorative outcomes. Impulsivity is multidimensional, consisting of two sub-constructs: rapid-response impulsivity and reward-delay impulsivity (i.e., choice-impulsivity). While previous research has extensively examined the presence and implications of rapid-response impulsivity in children with ADHD, reviews of choice-impulsive behavior have been both sparse and relatively circumscribed. This review used meta-analytic methods to comprehensively examine between-group differences in choice-impulsivity among children and adolescents with and without ADHD. Twenty-eight tasks (from 26 studies), consisting of 4320 total children (ADHD=2360, TD=1,960), provided sufficient information to compute an overall between-group effect size for choice-impulsivity performance. Results revealed a medium-magnitude between-group effect size (g=.47), suggesting that children and adolescents with ADHD exhibited moderately increased impulsive decision-making compared to TD children and adolescents. Further, relative to the TD group, children and adolescents with ADHD exhibited similar patterns of impulsive decision-making across delay discounting and delay of gratification tasks. However, the use of single-informant diagnostic procedures relative to multiple informants yielded larger between-group effects, and a similar pattern was observed across samples that excluded females relative to samples that included females.
... Finally, because of variations in diagnostic decision making and assessment instruments, ADHD may be diagnosed more often than it would be if the DSM criteria were properly utilized and/or if reliable and valid assessment instruments were utilized (Posserud et al., 2014). Studies of assessment and diagnostic decision making show that psychologists and physicians often make a diagnosis of ADHD without a comprehensive assessment (Handler & DuPaul, 2005;Wasserman et al., 1999). The potential for misdiagnosis, then, is definitely plausible. ...
Many gifted characteristics overlap the symptoms of attention deficity–hyperactivity disorder (ADHD). The potential for the misdiagnosis of giftedness as ADHD exists, but so does the potential for a dual diagnosis of giftedness and ADHD. A decade after the misdiagnosis of giftedness as ADHD was first investigated we examine lessons learned regarding misdiagnosis, dual diagnosis, and the identification of giftedness and ADHD. The current study reviewed empirical studies of the misdiagnosis, identification, and dual diagnosis of giftedness and ADHD published in peer-reviewed domestic and international academic journals between 2000 and 2014. We explored the literature for diagnostic trends and challenges, theories of misdiagnosis, and empirical findings on dual diagnosis. We discuss differences between misdiagnosis and dual diagnosis and conclude with a description of limitations found within reviewed studies and suggestions for future research.
... al 1999). Even many psychologists do not regularly follow assessment procedures that are consistent with the best practice guidelines, which can result in a false positive diagnosis and the inception of pharmacological therapy (Handler & DuPaul, 2005). ...
The aim of this paper is to build a case for the utility of conceptualizing ADHD, not as a unitary disorder that contains several subtypes, but rather as a marker of impairment in attention and/or impulsivity that can be used to identify one of several disorders belonging to a spectrum. The literature will be reviewed to provide an overview of what is known about ADHD in terms of heterogeneity in symptomatology, neuropsychology, neurobiology, as well as comorbidity with other diseases and treatment options. The data from these areas of research will be critically analyzed to support the construct of a spectrum of disorders that can capture the great variability that exists between individuals with ADHD and can discriminate between separate disorders that manifest similar symptoms. The symptoms associated with ADHD can be viewed as dimensional markers that point to a spectrum of related disorders that have as part of their characteristics impairments of attention and impulsivity. The spectrum can accommodate symmetrically and asymmetrically comorbid psychiatric disorders associated with ADHD as well as the wide heterogeneity known to be a part of the ADHD disorder. Individuals presenting with impairments associated with ADHD should be treated as having a positive marker for a spectrum disorder that has as part of its characteristics impairments of attention and/or impulsivity. The identification of impairment in attention and/or impulsivity should be a starting point for further testing rather than being an endpoint of diagnosis that results in pharmacological treatment that may or may not be the optimal therapy. Rather than continuing to attribute a large amount of heterogeneity in symptom presentation as well as a high degree of symmetric and asymmetric comorbidity to a single disorder, clinical evaluation should turn to the diagnosis of the type of attentional deficit and/or impulsivity an individual has in order to colocate the individual's disorder on a spectrum that captures the heterogeneity in symptomatology, the symmetrical and asymmetrical comorbidity, as well as subthreshold presentation and other variants often worked into the disorder of ADHD. The spectrum model can accommodate not only the psychophysiological profiles of patients, but is also consistent with what is known about the functional heterogeneity of the prefrontal cortex as well as the construct that cognitive processes are supported by overlapping and collaborative networks.
... In contrast, the guidance encourages the use of significantly limited assessment approaches (e.g., self-report, observations) by professionals who vary in their level of assessment training (Madaus et al., 2010) while also discouraging requests for documentation from experts. Admittedly, external documentation is far from perfect; many external evaluators fail to understand the legal standards of disability (e.g., Gordon, Lewandowski, Murphy, & Dempsey, 2002), and hidden disabilities are often diagnosed using procedures other than researchbased best practices (e.g., Handler & DuPaul, 2005). However, these issues should lead DSPs to review external documentation carefully and critically, not to reject it entirely. ...
Once students with disabilities leave high school, they must take proactive steps to document their disabilities to educational institutions or employers when requesting accommodations. The Association on Higher Education and Disability (AHEAD) has been the principal organization offering suggestions on documentation requirements, and AHEAD’s recently revised guidance involves radical changes to the suggested requirements. AHEAD now recommends that students’ self-reports and disability services professionals’ impressions take precedence over external, objective records. This article reviews the relevant research to evaluate the evidence base for the revised guidance, finding it lacking in important ways as it applies to hidden disabilities (learning, cognitive, and psychiatric disabilities). The evidence supporting various sources of disability documentation is reviewed, and implications for policy and practice are discussed.
... School psychologists, clinical psychologists, psychiatrists, and pediatricians, among others, can all diagnose ADHD, and each specialty uses somewhat different assessment tools and criteria to make a judgment about the disorder's presence (Handler & DuPaul, 2005). Even within a single specialty, school psychologists have been found to vary greatly in their assessment methods; Koonce (2007) found that 23% of 246 school psychologists surveyed said that an intelligence test was the only standardized test needed to make an ADHD diagnosis, whereas 19% said that they would never or only occasionally include an intelligence test when assessing for the presence of ADHD. ...
Extended time is one of the most common testing accommodations provided to students with disabilities. It is also controversial; critics of extended time accommodations argue that extended time is used too readily, without concern for how it changes the skills measured by tests, leading to scores that cannot be compared fairly with those of other students. Advocates argue, instead, that many students with disabilities are only able to demonstrate their skills with extended time. This article reviews a wide variety of empirical evidence to draw conclusions about the appropriateness of extended time accommodations. The evidence reviewed raises concerns with the way that extended time accommodations are currently provided, although the same literature also points to potential solutions and best practices.
... However, diagnosis of ADHD relies heavily on subjective interpretations of the diagnostic criteria [3]. Primary care physicians vary greatly in their assessment methods and do not always follow "best practice" guidelines when diagnosing ADHD [4]. Such variations in diagnostic procedures would likely increase misdiagnosis of the disorder [5]. ...
The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) often results in chronic treatment with psychostimulants such as methylphenidate (MPH, Ritalin®). With increases in misdiagnosis of ADHD, children may be inappropriately exposed to chronic psychostimulant treatment during development. The aim of this study was to assess the effect of chronic Ritalin treatment on cognitive and neural development in misdiagnosed “normal” (Wistar Kyoto, WKY) rats and in Spontaneously Hypertensive Rats (SHR), a model of ADHD. Adolescent male animals were treated for four weeks with oral Ritalin® (2 × 2 mg/kg/day) or distilled water (dH2O). The effect of chronic treatment on delayed reinforcement tasks (DRT) and tyrosine hydroxylase immunoreactivity (TH-ir) in the prefrontal cortex was assessed. Two weeks following chronic treatment, WKY rats previously exposed to MPH chose the delayed reinforcer significantly less than the dH2O treated controls in both the DRT and extinction task. MPH treatment did not significantly alter cognitive performance in the SHR. TH-ir in the infralimbic cortex was significantly altered by age and behavioural experience in WKY and SHR, however this effect was not evident in WKY rats treated with MPH. These results suggest that chronic treatment with MPH throughout adolescence in “normal” WKY rats increased impulsive choice and altered catecholamine development when compared to vehicle controls.
... It is also possible that some of our participants did not actually suffer from ADHD at all, even if they had received that diagnosis in the past. Diagnosis of ADHD depends enormously on the type of practitioner performing the assessment, the setting in which the assessment is conducted, the informants used (Handler & DuPaul, 2005), and whether multimodal assessment (especially neuropsychological testing) is utilized. A number of our participants scored above Ϫ1.8 on the summary ADHD score on the TOVA, suggesting that they may not have been fully symptomatic. ...
The Test of Variables of Attention (TOVA) is a continuous performance test that assesses attention, impulsivity, and processing speed. Continuous performance tests are used in the assessment of attention-deficit/hyperactivity disorder (ADHD) in children and adults. TOVA norms are based on a morning administration, and any TOVA administered after 1:00 p.m. is flagged as potentially invalid. Whereas the testing time recommendations make sense for pediatric samples, it is unclear whether they are appropriate for young adults, who typically show significant phase delay in their diurnal rhythms. The current study explores the impact of time of day on TOVA performance in young adults with ADHD. Participants were randomly assigned to either morning or afternoon administration. We found no significant diurnal variation in TOVA performance. We also found no interaction between diurnal preference and time of day of administration. Night owls endorsed more inattention symptoms on a self-report measure than more intermediate individuals but actually made significantly fewer omission (inattention) errors on the TOVA. Self-reported symptoms of inattention showed moderate, significant correlations with various TOVA performance indices. Self-reported symptoms of hyperactivity and impulsivity, however, showed no relationship to TOVA performance. These results suggest that the TOVA can be administered to adults with ADHD outside of the hours recommended in the manual without significantly compromising the interpretative validity of test score interpretation. Thus, a TOVA report that is consistent with ADHD should not be dismissed simply because it was administered in the late afternoon.
... Surveys comparing therapists' practices to " best practice " assessment guidelines have also found very low percentages of clinicians adhering to those guidelines. For example, fewer than 1/3 of psychologists follow ADHD assessment recommendations (Handler & DuPaul, 2005) and only 3.5% of couples therapists follow guidelines for domestic violence assessment (Schacht, Dimidjian, George, & Berns, 2009). Finally, surveys suggest that formal treatment outcome monitoring is also infrequently used by psychologists (Hatfield & Ogles, 2004) and psychiatrists (Gilbody, et al., 2002), despite evidence that clinicians are poor judges of client progress when they evaluate it informally (Hannan, et al., 2005; Love, Koob, & Hill, 2007). ...
In an era of evidence-based practice, why are clinicians not typically engaged in evidence-based assessment? To begin to understand this issue, a national multidisciplinary survey was conducted to examine clinician attitudes toward standardized assessment tools. There were 1,442 child clinicians who provided opinions about the psychometric qualities of these tools, their benefit over clinical judgment alone, and their practicality. Doctoral-level clinicians and psychologists expressed more positive ratings in all three domains than master's-level clinicians and nonpsychologists, respectively, although only the disciplinary differences remained significant when predictors were examined simultaneously. All three attitude scales were predictive of standardized assessment tool use, although practical concerns were the strongest and only independent predictor of use.
... Are they the more severely symptomatic and impaired? It is likely that a more rigid and stringent application of DSM criteria is applied to children participating in peer-reviewed and published research studies (Handler & DuPaul, 2005). Children in these studies may also be more symptomatic and impaired than children in the community. ...
... Studies of assessment practices among psychologists and physicians suggest that a diagnosis of ADHD is often made without a comprehensive assessment. Handler and DuPaul (2005) found that a large majority of practicing psychologists did not regularly follow assessment procedures that are consistent with the best practice guidelines. Similarly, Wasserman and colleagues (1999) found that primary care physicians varied considerably in their assessment and diagnosis of childhood disorders. ...
According to the DSM-IV TR, approximately 3 to 7% of school-age children meet the criteria for ADHD. However, there is a common conception that ADHD is overdiagnosed. The purpose of this article is to evaluate the evidence for and against overdiagnosis.
Recent prevalence studies and research on factors affecting diagnostic accuracy were reviewed. For ADHD to be overdiagnosed, the rate of false positives (i.e., children inappropriately diagnosed with ADHD) must substantially exceed the number of false negatives (children with ADHD who are not identified or diagnosed).
Based on the review of prevalence studies and research on the diagnostic process, there does not appear to be sufficient justification for the conclusion that ADHD is systematically overdiagnosed. Yet, this conclusion is generally not reflected in public perceptions or media coverage of ADHD. Potential explanations for the persistence of the belief in the overdiagnosis of ADHD are offered.
This chapter is organized into several sections as we, the authors, aim to demonstrate how clinicians, trained in third-wave behavior therapy, approach attention deficit/hyperactivity disorder (ADHD). First, we provide definitions of major third-wave therapies (e.g., Acceptance and Commitment Therapy [ACT], Dialectical Behavior Therapy [DBT] and Mindfulness Based Interventions [MBIs]). A description of the reality of where most individuals receive treatment for ADHD (i.e., primary care) and treatment implications of this setting is then discussed. Next, we briefly review the core aspects of ADHD, accompany etiology, research outcomes, and implications this may have for clinicians who practice from a third-wave perspective. Additionally, case conceptualization will be discussed, and case illustrations will be offered within the clinical context of primary care. We hope readers will have their assumptions challenged regarding the presentation of ADHD, and this chapter will offer an additional lens from which to view patients presenting with typical ADHD symptomology. Further, we hope a context is created that propels clinicians to be curious (or more curious) about the contexts their patients live. Finally, we hope clinicians take the additional steps with their patients to create a clinical context that inspires love, compassion, and grace within their patients. Even with ADHD, “Love isn’t everything, it is the only thing” (TEDx Talks, Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityofNeveda [Video file]. Retrived from https://www.youtube.com/watch?v=o79_gmO5ppg, 2016, 19:26).
Resumen El Trastorno por Déficit de Atención e Hiperactividad (TDAH) tiene una gran prevalencia tanto en la infancia como en la adolescencia. Últimamente, se ha podido observar un creciente interés por este trastorno tanto desde una perspectiva social como profesional y edu-cativa. Los errores diagnósticos en el TDAH pueden ser debidos a posibles casos de Trastorno por Estrés Postraumático (TEPT) no identificados. El principal objetivo es investigar la relación entre el TDAH y TEPT en población infantil y analizar si esta relación puede llevar a diagnósticos erróneos. Para ello se efectuó una revisión de la literatura científica a través de bases de datos especializadas em-pleando los términos "TDAH", "trauma", "TEPT", "abuso infantil", "déficit atención" y con especial interés en los artículos que relacionaban TDAH y TEPT. Los 48 documentos y estudios analizados muestran una estrecha relación entre algunos síntomas del TDAH que pueden solaparse con los síntomas del TEPT infantil y viceversa. Los niños que han padecido un trauma, con frecuencia muestran síntomas simi-lares al TDAH y éstos, a su vez, se superponen con el TEPT. Distinguir un diagnóstico de TEPT y TDAH puede ser un proceso complejo si además tenemos en cuenta que un trastorno puede influir en la expresión de otro y, al contrario. Un correcto diagnóstico diferencial y una precisa evaluación de cada caso posible de TDAH es fundamental para evitar falsos positivos. La principal contribución de este trabajo es señalar la necesidad de tener en cuenta la exploración de posibles traumas previos en la historia clínica dentro del proceso de evaluación y diagnóstico de posible TDAH.
Attention deficit hyperactivity disorder (ADHD) is believed to be the most frequently diagnosed childhood mental health disorder in the world (Furman, 2005). A recent meta-analysis investigating worldwide ADHD prevalence in children age 18 and under found an overall pooled estimate of 7.2% (Thomas, Sanders, Doust, Beller, & Glasziou, 2015). The prevalence rate in the USA is even higher. Pastor, Reuben, Duran, and Hawkins (2015) found that 9.5% of children in the USA aged 4–17 years had been diagnosed with ADHD. That means that approximately two million children in the USA exhibit symptoms of ADHD, ADHD ranks first in terms of referrals to primary care physicians (Barkley, 2006), and ADHD presents a significant challenge to educational systems (Forness & Kavale, 2002).
The evidence-based assessment of attention-deficit/hyperactivity disorder (ADHD) depends on adherence to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) diagnostic criteria and reliance on multi-method/multi-informant data. Although nearly all psychologists endorse these practices, college students with ADHD may lack documentation supporting their diagnoses. We reviewed the documentation submitted by 214 undergraduates diagnosed with ADHD and receiving academic accommodations for this condition. Their clinicians also completed a checklist that described their assessment procedures. Relatively few psychologists assessed all DSM-5 criteria, based on either the psychologist’s self-reported assessment procedures (23.4%), written documentation (14.0%), or multi-method/multi-informant data (10.3%) such as educational/medical records, results of rating scales, or interviews with other informants. Psychologists were least likely to assess students’ areas of impairment or to rule out alternative causes for students’ self-reported symptoms. This lack of adherence to DSM-5 criteria and overreliance on students’ self-reports can threaten the reliability of diagnosis and the appropriateness of medication and accommodations that follow.
Prevalence rates in ADHD differ depending on the classification system used. Other reasons for variability include difficulties resulting from the subjective character of the rating scales and lack of a single theory of ADHD. Genetic, anatomical, functional and neuropsychological studies do not provide a causal model of ADHD. Therefore, it has been proposed by leading researchers in ADHD to identify endophenotypes as theoretical constructs that connect genotype with phenotype. Endophenotypes should not only allow the development of objective tests but also guide the selection of adequate treatment. Finally, neurofeedback is introduced as a treatment that is based on the observation of neurophysiological deficiencies in ADHD. If these deficiencies turn out to be a neuromarker or endophenotype they will be used as an objective, specific and sensitive test for diagnosis and also guide specifics of treatment.
Despite the rise of medical interventions to address behavioral issues in childhood, the social determinants of their use remain poorly understood. By analyzing a dataset that includes the majority of prescriptions written for stimulants in the United States, we find a substantial effect of schooling on stimulant use. In middle and high school, adolescents are roughly 30 percent more likely to have a stimulant prescription filled during the school year than during the summer. Socioeconomically advantaged children are more likely than their less advantaged peers to selectively use stimulants only during the academic year. These differences persist when we compare higher and lower socioeconomic status children seeing the same doctors. We link these responses to academic pressure by exploiting variation between states in educational accountability system stringency. We find the largest differences in school year versus summer stimulant use in states with more accountability pressure. School-based selective stimulant use is most common among economically advantaged children living in states with strict accountability policies. Our study uncovers a new pathway through which medical interventions may act as a resource for higher socioeconomic status families to transmit educational advantages to their children, either intentionally or unwittingly.
The 2008 amendments to the Americans With Disabilities Act have now been followed by implementation guidelines from the Department of Justice. These guidelines take strong positions on how testing entities should review requests for testing accommodations from examinees with disabilities. In this article, themes from the guidelines are evaluated against the findings of recent empirical research, highlighting major discrepancies. In general, the Department of Justice places more trust in the accommodations expertise of K-12 schools, clinical professionals, and testing entities than is warranted by empirical research. This trust is likely to lead to excessive recommendation of testing accommodations, even when they threaten a test's validity. Several implications of these findings for practice and policy are discussed.
Evidence-based assessment (EBA) is an essential component of evidence-based practice. Information obtained from EBA can be used to make decisions about what to target in treatment, to generate a case conceptualization, and to objectively monitor treatment progress. Numerous studies indicate that incorporating EBA into treatment can improve client outcomes. Unfortunately, relative to the amount of information available to clinicians about evidence-based treatments, little information exists to guide clinicians who are interested in incorporating EBA into their treatment practices. This special section seeks to address that gap by providing practical clinical guides and case examples for a variety of EBA strategies across a variety of settings.
Objective:
To evaluate the information postsecondary institutions require when determining disability service eligibility for students with reported ADHD.
Method:
ADHD documentation requirements of 200 U.S. institutions were surveyed by reviewing guidelines posted on disability services websites.
Results:
Whereas virtually all institutions required documentation, findings revealed significant variability in requirements across institutions. Required variables most often included a qualified evaluator (80%), diagnostic statement (75%), and identification of substantial limitations (73%), but only 5 of 46 evaluated variables were required by at least 50% of institutions. Supportive data such as diagnostic criteria, standardized assessment results, and rationale for accommodations were rarely required.
Conclusion:
The majority of institutions required little to verify ADHD as a disability. Furthermore, there was little agreement on what components are essential for verification. When integrated with research, a large portion of guidelines failed to address identified weaknesses in ADHD diagnosis and disability determination.
Objective:
The present study investigated the validity of using the Conners' Teacher and Parent Rating Scales (CTRS/CPRS) or semistructured diagnostic interviews (Parent Interview for Child Symptoms and Teacher Telephone Interview) to predict a best-practices clinical diagnosis of ADHD.
Method:
A total of 279 children received a clinical diagnosis based on a best-practices comprehensive assessment (including diagnostic parent and teacher interviews, collection of historical information, rating scales, classroom observations, and a psychoeducational assessment) at a specialty ADHD Clinic in Truro, Nova Scotia, Canada. Sensitivity and specificity with clinical diagnosis were determined for the ratings scales and diagnostic interviews.
Results:
Sensitivity and specificity values were high for the diagnostic interviews (91.8% and 70.7%, respectively). However, while sensitivity of the CTRS/CPRS was relatively high (83.5%), specificity was poor (35.7%).
Conclusion:
The low specificity of the CPRS/CTRS is not sufficient to be used alone to diagnose ADHD. (J. of Att. Dis. 2016; 20(6) 478-486).
[Clin Psychol Sci Prac 18: 173–177, 2011]
Given the excellent work being conducted in the area of evidence-based treatments (EBTs), it is important to consider whether other forms of evidence-based practice are receiving concomitant attention. While significant progress has been made in the last five years to generate reviews of evidence-based assessment (EBA) practices, this work lags behind efforts to identify EBTs. This commentary describes available data on assessment practices in clinical care settings, discusses the importance of and current status of EBA, and considers how the next generation of EBA reviews might move beyond consideration of psychometric properties to the inclusion of “effectiveness” parameters.
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.
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.
To assess the evaluation and treatment practices of family physicians in regard to attention-deficit hyperactivity disorder (ADHD).
A 20-item survey was developed and mailed to all 940 family and general physicians in Kansas.
Physician practices regarding ADHD.
The 471 respondents (50.1%) included 386 physicians in private clinical practice, who constituted the study group. Ninety-eight percent of these physicians regularly saw children and over half suspected four or more cases of ADHD in the past year. When suspecting ADHD, 43% of the physicians referred for diagnosis and treatment; 30% evaluated and treated by themselves; and 27% referred for evaluation but did follow-up treatment themselves. There was no significant difference in these ratios between rural and urban physicians. Family physicians referred to a pediatric psychiatrist most often, with no apparent difference in referral pattern by community size; 75% indicated they were comfortable with their current referral support. Of the physicians who diagnosed and treated ADHD themselves, only 30.6% routinely ordered laboratory work or other tests, only 28.7% used teacher questionnaires, and only 20.4% used parent questionnaires.
An important amount of patient care for ADHD is managed by family physicians, without significant differences between rural and urban practices. Most family physicians are satisfied with their current level of referral support. Physicians who treat ADHD themselves usually rely on clinical evaluation rather than special tests or standardized questionnaires.
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.
Although there has been extensive research in the area of Attention-deficit Hyperactivity Disorder (ADHD), the estimated prevalence of this disorder ranges from 1% to 20%. 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% of the special education sample (teacher rating only). In contrast, the prevalence of pure ADHD in the specialty clinic sample ranged from 35.6% (teacher rating only) to 11.9% (parent rating only). Only 5.9% 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.
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.
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.
The DSM-IV Child Psychiatry Work Group surveyed 460 child psychiatrists about their use of DSM-III-R and their reactions to specific proposed nosological revisions for DSM-IV. This paper presents the responses of the sample as a whole and of respondent subgroups with different theoretical, practice, and training characteristics. The survey indicates that DSM-III and DSM-III-R are widely used and generally accepted by child psychiatrists. Ninety-eight percent of respondents believe a criterion-based diagnostic system is useful, and 65% consider DSM-III-R to be an improvement over DSM-III. Depending on the diagnosis 47% to 66% of the respondents reported that they generally assess all applicable criteria and 28% to 49% often refer to the manual before assigning a diagnosis. A majority of respondents supported proposals for several new diagnostic subtypes. Ninety-three percent of respondents indicated that "adequacy of family support" was very valuable for treatment planning or estimating prognosis. Fifty-five percent of respondents admitted to diagnosing adjustment disorders in order to avoid the stigma associated with other disorders. Child psychiatrists who are psychodynamically oriented or practicing in an office-based setting or out of training for more than 10 years tend to use the DSM-III-R less rigorously.
This study examined, in a national survey, the assessment and treatment practices of pediatricians who care for children with attention deficit disorders (ADD). A questionnaire was sent to randomly selected members of the American Academy of Pediatrics (AAP), stratified by state. Of 417 (52%) responses returned, there were 290 (38%) completed questionnaires. It was found that most pediatricians did not utilize specific DSM-III criteria for ADD; however, they do rely on symptoms of distractibility, overactivity, and impulsivity, which are the behaviors central to the DSM-III diagnosis. In addition, learning difficulties were felt to be contributory. Parents were the most frequently reported sources of information about a child's behavior, but the histories provided by teachers, and psychoeducational reports, also were sought frequently. Many pediatricians still use diagnostic procedures that have recently come under question, such as soft neurologic signs, activity level in the office, and response to stimulant medication. Methylphenidate and behavior modification were the most frequent therapies employed. Over half of the respondents use periodic reevaluation with rating scales to determine medication efficacy, but very few use placebo trials. More recently trained pediatricians tended to rely more on behavioral treatments than did earlier trained physicians.
To summarize knowledge about attention deficit disorder in the areas of epidemiology, etiology, clinical predictors, assessments, natural history and outcome, and management.
A literature review of articles, books, and chapters primarily published in the past 10 years was completed. Articles presenting new information, most relevant to clinical practice, were reviewed.
Key findings in the areas listed above are presented.
Major advances have been made in all areas. The clinical picture has been refined and developmental manifestations have been delineated. Patterns of comorbidity have been detailed. Various etiological factors, particularly in the biological area, have been investigated. Multimodal management has been promulgated as the treatment of choice.
This summary of the practice parameters describes the assessment, differential diagnosis, and treatment of children, adolescents, and adults who present with symptoms of attention-deficit/hyperactivity disorder. The rationales for specific recommendations are based on a review of the scientific literature and clinical consensus which is contained in the complete document. Assessment includes clinical interviews with the child and parents and standardized rating scales from parent and teachers. Testing of intelligence and academic achievement is usually required. Comorbidity is common. The cornerstones of treatment are support and education of parents, appropriate school placement, and psychopharmacology. The primary medications are psychostimulants, but antidepressants and alpha-adrenergic agonists are used in special circumstances. Other treatments such as behavior modification, school consultation, family therapy, and group therapy address remaining symptoms.