New guidelines for the diagnosis of attention deficit hyperactivity disorder from the nation’s pediatricians will help foster more collaboration between schools and physicians, educators say.
The American Academy of Pediatrics last week issued the first guidelines on the diagnosis and evaluation of ADHD in children ages 6 to 12. The academy is expected to release a second document next spring describing how to treat children with ADHD.
| |
| The guidelines are available online at www.aap.org/policy/ac0002.html |
“The guidelines provide school systems with a more serious approach to diagnosis than in the past,” said Kevin P. Dwyer, the president of the National Association of School Psychologists.
ADHD is the most commonly diagnosed behavioral disorder in American children, affecting an estimated 2 million school-age youngsters, according to the National Institutes of Health. Characterized by inattention, hyperactivity, and impulsivity, the condition can often be an obstacle to children’s education.
As the debate over the diagnostic process and treatment strategies has grown in recent years, so have concerns among policymakers, parents, educators, and others. A panel of medical experts convened by the NIH in 1998 to discuss the best way to diagnose and treat the disorder concluded that the lack of consensus was “a major health problem.” (“Experts Call Lack of Consensus on ADHD a Major Health Problem,” Nov. 25, 1998.)
Currently, no diagnostic test for the disorder is available, a fact that has led to the misdiagnosis and unnecessary medication of many children, some experts say. A recent study, in fact, showed a sharp increase from the early to mid-1990s in the prescription of psychiatric drugs, such as Ritalin, to treat the disorder in very young children.
In response to those findings, the Clinton administration in March announced an initiative to curb the rise in such prescriptions and plans to host a White House conference in the fall to examine the diagnosis and treatment of children with behavioral and mental disorders.
Teacher Input
The pediatricians’ new document, three years in the making, offers four major recommendations, which incorporate criteria from the American Psychiatric Association’s diagnostic manual of mental disorders. Under the pediatricians’ guidelines for diagnosis, ADHD symptoms must be present in two or more of a child’s settings, such as at home and in school, and the symptoms must adversely affect the child’s academic or social functioning for at least six months.
The academy also recommends that evaluations be initiated by the primary-care doctor and that the assessment of the disorder include information obtained from parents, as well as a teacher or other school professional.
Diane Smallwood, a school psychologist in South Brunswick, N.J., sees the new guidelines as the right approach. “Most teachers are frequently asked to provide information on student behaviors,” she said. “Partnership between school personnel and medical personnel is the most effective approach to managing the needs of students with ADHD. It underscores that this kind of collaboration is a good practice.”
Evaluation of a child with ADHD should also include assessment for learning and language problems, aggression, disruptive behavior, and depression or anxiety. According to the academy, as many as one-third of children diagnosed with ADHD have a coexisting condition.
‘Good Communication’
“The recommendations can lead to real teamwork between parents, teachers, and physicians,” said Dr. James M. Perrin, an author of the guidelines and an associate professor of pediatrics at the Harvard Medical School.
“We recognize that the environment of a child at home is very different from his or her classroom environment,” added Dr. Martin T. Stein, the co-author and a professor of pediatrics at the University of California, San Diego.
“The quality of diagnosis and evaluation of ADHD is enormously improved when there is good communication between doctors and schools. It is critically important,” he said.
Matthew Cohen, the president of Children and Adults With Attention Deficit Hyperactivity Disorder, a nonprofit advocacy and support group based in Landover, Md., called the guidelines an important step in the treatment of ADHD. “To maximize treatment outcomes,” he said, “doctors need to stay involved, and stay in close contact with the school and parents to make sure that treatment is effective.”
