Assessment

It is important for school professionals, school psychologists, and teachers, to be knowledgeable of the assessment techniques used to determine ADHD. There are several reasons for this (DuPaul & Stoner, 1994).

  1. Attention and motor problems are two of the most frequent reasons for referring children to child specialists, typically school or clinical psychologists; the teacher's observations are invaluable in these circumstances.
  2. School professionals have access to information that can be crucial to a diagnosis of ADHD. Such information includes direct observations of the child's behavior, both in the class and on the playground, and academic records.
  3. The epidemiology of ADHD indicates that certain populations are at greater risk for developing ADHD; among these are children with learning disabilities who are in frequent interaction with school professionals.
  4. 4. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) permits services to be delivered to those who meet the criteria for special education services under health/other health impairments (see Chapter 4) (Heward, 2022). Additionally, many students with ADHD are served under the learning disabilities and behavioral disorders categories (Heward, 2022).

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An Overview of Assessment Methods Used in Diagnosing ADHD

The assessment will involve multiple sources and methods of data collection. The emphasis during assessment is on acquiring reliable data from parents, teachers and others who have direct contact with the referred child (Atkins & Pelham, 1991; Barkley, 1990b; Guevremont et al., 1990; Kritikos et al., 2018; Schaughency & Rothlind, 1991). These informants will provide information about the child through interviews and questionnaires. If the referred child is an adolescent, the person will also complete a questionnaire regarding his or her behavior, such as the Child Behavior Checklist (Achenbach, 2001). Regarding the latter practice, there are two factors that limit the use of self-report questionnaires for the child with ADHD.

First, children who display disruptive behaviors do not report their behavior accurately (Barkley, 1997b). The second problem has to do with the structure of these self-report forms (Landau, Milich, & Widiger, 1991). Too often, many of these questionnaires do not have separate subscales that directly assess ADHD. Thus, the diagnostic function of self-report questionnaires by the child is limited.

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Assessment Methods

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Assessing Inattention and Impulsivity

Children diagnosed with ADHD perform less well on repetitive tasks than do matched controls. Another difficulty that children with ADHD face is that they are easily distracted by highly salient or appealing stimuli (Martella et al., 2002; Milich & Lorch, 1994). For example, if a child with ADHD is reading a passage and there is a large orange triangle in the corner of the page, the child is likely to become distracted by the triangle.

A second class of stimuli that children with ADHD find distracting is irrelevant stimuli that are embedded in a task. For example, if the child is doing a puzzle, the child may become distracted by a slight misprint in a piece and ignore the rest of the puzzle even though it can be completed irrespective of the misprint. Not all studies find a deficit performance on sustained attention tasks by children with ADHD; furthermore, some investigators find that these children's attention does not diminish over time. These investigators argue that what is unique in ADHD is not a problem with sustaining attention, but one with regulating motor responses (Taylor, 1995; van der Meere, van Baal, & Sergeant, 1989). All these events occur even if the child desires to continue performing a repetitive task; it is not entirely clear why such inhibition is very difficult for the child with ADHD (see Barkley, 1997b).

One way of assessing sustained attention is with the Conner's Continuous Performance Test 4 (CPT 4) (Conners, 2014) and the Matching Familiar Figures Test (MFFT) (Kagan, 1966). The CPT presents the child with a series of stimuli, such as letters on a computer screen, and the child is told to press a button when a particular sequence of letters appears. If the child fails to press the button when this sequence appears, it is referred to as an error of omission and reflects inattention. Alternatively, if the child presses the button before the sequence appears, it is referred to as an error of commission and reflects impulsivity. On the CPT, children with ADHD make more errors of both omission and commission than other children.

A couple of factors limited the usefulness of the second edition version of the CPT and MFFT in individual administration, even though group comparisons indicate that these tests can discriminate between children with ADHD and their normal counterparts (DuPaul & Stoner, 1994; Guevremont et al., 1990). A number of studies failed to find a significant correlation between the criteria measures (i.e., parent and teacher ratings) and scores on the CPT II; that is, the CPT II or MFFT says the child is suffering from inattention, but the parent or teacher reports do not support this conclusion. The ecological validity of the CPT and MFFT is suspect (Barkley, 1991b). When classification decisions have been based on the CPT, the MFFT, or a combination of the two, the resulting diagnosis is inconsistent with parent interview information and behavior rating scales diagnoses (DuPaul, Anastopoulos, Shelton, Guevremont, & Metevia, 1992).

Cognitive Assessment

One of the most frequently used assessment tools in the school setting is the intelligence test. The most frequently used intelligence test for children is the Wechsler Intelligence Scale for Children, currently in its fifth edition (WISC-5). When the performance of children with ADHD is compared to normative data, these children score lower on the full-scale IQ and subtests although their average level of intellectual functioning is within the normal distribution.

These findings, however, do not hold for those diagnosed with the hyperactivity subtype of ADHD. This finding suggests that the overall intellectual profile may be a correlate of inattention rather than an inherent intellectual deficit (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Further problems are delineated when the intellectual profiles of the siblings of children with ADHD are examined. There is a similar pattern of intellectual functioning between children with ADHD and their male siblings.

However, such a profile is not unique to ADHD. For example, children with learning disabilities and other conduct disorders provide similar profiles (Newby, Recht, Caldwell & Schaefer, 1993). Thus, the WISC-5 does not reliably discriminate between children with ADHD and those with a learning disability, or between children with ADHD and their normal peers. These results hold true even when children with ADHD are administered the subtests that comprise the freedom from distractibility factor (the ability to stay focused without getting sidetracked by irrelevant stimuli) (Cohen, Becker, & Campbell, 1990; Wielkiewicz, 1990).

Another factor that places in question the utility of cognitive tests in discerning ADHD is that children with ADHD are capable of displaying appropriate levels of attention and motor controls in structured situations and one-to-one interactions even if the adult is unfamiliar to the child (Barkley, 1990b). In sum, the assessment test most frequently used by school psychologists is incapable of diagnosing ADHD.

Academic Achievement

Although IQ tests can provide an overall view of cognitive functioning, they cannot provide the detailed profile of the strengths and weaknesses of a particular learning disability. In contrast, academic achievement tests are specifically designed to tap into the skills that contribute to academic competence.

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