Dr. Svec's Latest Physician Research Report
Don't bet on teachers helping you diagnose ADHD correctly
The released guidelines by the American Academy of Pediatrics on the assessment and treatment of ADHD recommends that children as young as four years of age be evaluated and diagnosed with ADHD and that teachers be involved in the diagnostic process. The question arises as to who is pointing the finger to begin the diagnostic process for pre-school and school-aged children. Best practices often point to asking teachers or early child care educators to complete checklistsor standard measures to help with the assessment. However, research suggests that teachers are poorly trained (if at all) to help diagnose ADHD and often report a significant number of false positives when considering boys. (Kypriotaki andManolitsis, 2010)
Other research points to the fact that once a teacher notes that there is a “problem” that “looks like ADHD,” they willcomplete forms erroneously as if other types of ADHD behaviour are present even if they are not (referred to as the ‘Halo Effect,’ Simsa and Christopher, 2012).
It is clear from the literature that once a teacher points the finger that something is wrong with the child, there is no need to have them complete a standardized instrument as we know the result. Yet teachers are powerful. In one study, Fabiano et al., 2013, noted that 73.3 per cent of students identified with ADHD in elementary school were receiving stimulant medication based on a teacher’s report. This despite the fact that teachers’ knowledge of ADHD comes primarily from media or friends or relatives, and not from scientific resources or training (Ghanizadeh, Bahredar, and Moeini 2006; Stormont and Stebbins 2005).
So what do we do? Here are my recommendations based on the literature and clinical practice:
- Parents need to complete the “Not ADHD Checklist” and provide this to the attending physician on the first visit. With pre-school-aged children, what is known as a “Wait, Watch and Enrich” strategy is suggested;
- Rather than complete a one-time checklist on a child that the teacher already believes to have ADHD, brief ratings over time with descriptive qualitative information be collected. We have created a free tool www.trackadhd.com that allows the parent or child to enter the teacher’s e-mail address so that the teacher is prompted on a regular basis to chart the child. During a four-week period, a more valid report would be provided and the parents can then print out the chartings and take those to the follow-up appointment with the physician;
- The parent charting of symptoms during this time –as well as the child’s –should be given more weight and credence than those provided by educators with respect to a one-time rating scale or checklist.
I have provided a graphic representation –“Who points the finger” –over the life span with regard to this very important issue, and I will continue to examine this factor in upcoming issues of this letter. Your comments and thoughts are appreciated and can be sent to me directly at firstname.lastname@example.org or by calling my direct line at 519-437-1956.
Our recent web poll question indicates the following individuals who are likely to point the finger and start the diagnostic process for ADHD.
Who was the first person to suggest that you or your child might have ADHD? (who first “pointed the finger?”)
Who is pointing the finger?
Listening to ADHD: The Physician Report, is provided free of charge, six times per year and delivered electronically or via regular mail to selected physicians across North America. Although sponsored by outside corporations, this publication is solely the opinion and uninfluenced conclusions of Dr. Henry J. Svec.