Current diagnostic criteria for adhd involves documentation of impairment in more than one setting. since most kids receive an adhd diagnosis during their school years, we greatly depend on teachers to provide us with information on behavior and symptoms. however, there is no standard way for teachers to measure adhd and many have little to no training on adhd or behavioral prob- lems.
A group of researchers in Brazil recently conducted a cross-sectional study to determine what might be the best way to accurately glean information on adhd from classroom teachers. The teachers of 247 third graders were asked about adhd in students using three methods. These included:
an overt question about potential cases of adhd in their students: “Which of the following students do you think has ADHD?”
The 25-item strengths and difficulties Questionnaire (sdQ), a structured broad-band question- naire on common child mental health problems, including adhd.
The swanson, Nolan, and pelham iV scale (sNap-iV), a narrow-band instrument using a subscale of hyperactivity and symptoms of oppositional defiant disorder.
Teachers identified an average of one
In five students (21.1%) as having adhd using the overt question. The broad questionnaire (sdQ) identified 5.3% of students, and the narrow questionnaire (sNap-iV) identified 11.3%.
All of the students that were identi- fied as having adhd by teachers, com- bined with a random sample of students who were not identified as having adhd, were assessed by a team led by a child psychiatrist for true adhd based on diag- nostic standards. Fifty-two students were positively identified as having adhd using any of the instruments by teachers. The clinical team confirmed diagnosis in 18 students; 17 of these were among those identified by teachers.
Both the sNap-iV and the sdQ showed moderate agreement with the final diagnosis. Upon detailed analysis, the sNap-iV was the most accurate tool used by teachers, with the sdQ perform- ing at close to “chance” level.
Half of each teacher’s students were evaluated prior to the teacher complet- ing a short, one-day course designed to increase their awareness of adhd and the other half were evaluated after. The teachers’ completion of the course on adhd did not significantly affect their ability to accurately identify the disorder in students. in addition, the presence of comorbid externalizing disorders, which may seem like adhd to an untrained observer, affected the correct identifica- tion of true cases (Kieling r et al, Eur Child Adolesc Psychiatry 2013;online ahead of print).
CCPR’s Take: Most of us have had the experience of getting back a subjec- tive report by a teacher or parent that describes a different child than the one we appear to have in our office. This study suggests that adhd-specific ques- tionnaires may help us get better infor- mation, but that untrained eyes are just that—untrained.
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