Special Education Opinion

Diagnosing ADHD Is Hard. Here’s What Teachers Need to Know

Certain groups of students are vulnerable to being over- or underdiagnosed with ADHD
By Evelyn Polk Green — July 13, 2022 5 min read
Conceptual illustration of silhouetted children distorted by bias
  • Save to favorites
  • Print

The chances are high that at some point in your teaching career, you’ll be asked to fill out an assessment (or many) for students suspected of having attention-deficit/hyperactivity disorder, or ADHD.

Most diagnoses require observational data of a student’s behaviors in different settings, such as at school and at home. But these observations are subjective and vulnerable to biases. An increasing number of studies show that certain groups of students are either over- or underdiagnosed with ADHD due to misconceptions about the disorder and differences by gender and race.

An estimated 6.1 million children in the United States have been diagnosed with ADHD. Millions more children with the disorder are surely left undiagnosed. Early intervention is so crucial for success down the road, at home and at school.

See Also

Special Education Opinion We're Getting ADHD Wrong (Especially in Boys)
Elizabeth Heubeck, February 13, 2018
4 min read

It is important that teachers—who play a key observational role in ADHD assessments in a school setting—understand that many factors can play into a diagnosis and how racial, gender, and age biases can affect those factors. It is equally important that school systems provide educators additional support through more objective testing measures, many of which already exist.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ADHD as a neurodevelopmental disorder characterized by persistent patterns of inattention or hyperactivity to the point where they interfere with development and daily functioning. Common symptoms are a lack of impulse control, restlessness, daydreaming, disorganization, forgetfulness, and poor attention to detail. While many of these behaviors can be attributed to typical child development, a key difference in a child with ADHD is they struggle with the same problems repeatedly, regardless of consequence or incentive.

Of course, many of these same symptoms are common with other disabilities, including anxiety disorders, obsessive-compulsive disorder, and autism. External factors like a lack of sleep, an unstable home life, stress, and trauma can also produce these symptoms.

Put all those factors together, and it can be difficult to distinguish ADHD from other issues initially.

When people think of a child with ADHD, they probably envision a child with boundless energy, constantly moving and talking, disruptively jumping from task to task. While these are classic signs, they do not paint a complete picture of ADHD and lead to the underdiagnosis of female students and the overdiagnosis of younger students.

According to the Centers for Disease Control and Prevention, male students are more than twice as likely to receive an ADHD diagnosis than female students. This is because ADHD symptoms often present differently between genders. ADHD is typically defined by three categories of behavior—hyperactivity-impulsivity, inattention, and combined. These behaviors are a common display of hyperactivity-impulsive type and are more often, but not exclusively, seen in male students.

Across genders, all three behavior types show up very differently. For example, hyperactivity-impulsivity in females often deals with difficulties in regulating emotion and can lead to difficulties forming social relationships with their peers. Females are also more likely to display inattentive-type behaviors such as distractibility, forgetfulness, inattention to detail, and disorganization. Because inattentive behaviors are often less overtly disruptive than hyperactive-impulsive behaviors, they are often overlooked.

Where girls are less likely to be diagnosed than boys, younger students are far more likely to be diagnosed than their older classmates. A recent meta-analysis of 19 studies in 13 countries covering more than 15.4 million children concluded that children whose birth date puts them on the younger side of their age-based cohort in school are considerably more likely to be diagnosed with or medicated for ADHD than their older peers. The pace of child development is very rapid, especially in the early years, so students who are months younger than their grade-level peers will display marked differences in behavior, especially when it comes to impulse control and activity levels.

Implicit bias can also hinder a diagnosis for students of color.

In both instances, children who go undiagnosed develop coping skills that then mask their symptoms. Critics of ADHD use these studies to argue that the diagnosis of ADHD is a sham, but this disparity is actually the result of emotional immaturity in younger children.

Implicit bias can also hinder a diagnosis for students of color. It’s an uncomfortable fact that everyone brings certain biases to their worldview. Our personal experiences, cultural messaging, and exposure to different people and ideas shape our judgments, for better or worse, and we may not know we have these implicit biases.
While these types of judgments are not maliciously intended, they can have a disproportionate effect on students of color. A 2013 study found that nonwhite students were 46 percent to 69 percent less likely to receive an ADHD diagnosis than their white peers. Follow-up studies as recently as this year have continued to confirm these disparities. In fact, students of color are more likely to be labeled with conduct disorder or oppositional defiant disorder (ODD) for behaviors that are labeled as ADHD in white students. Additional hurdles like higher rates of poverty, less access to health care, and cultural stigmas towards mental health within communities of color compound the problem.

The reality is that diagnosing ADHD is hard. With so many age-related and developmental questions at play in competition with our own biases, nothing is more important to the future of ADHD diagnosis than the widespread adoption of objective testing measures.

To get to an accurate (and unbiased) diagnosis, educators should use computer-based tests. These objective tools are already used by many clinicians who offer ADHD testing and diagnostic services, and the data generated serves as a valuable supplement to observational assessments, aiding behavioral health professionals in determining the best course of action. Tests that are cleared by the Federal Food and Drug Administration and can measure all three core symptoms stand to provide the largest benefit to clinicians and schools.

As our children face yet another year impacted by the pandemic, isolation, and remote learning, they are staring down the barrel of serious developmental challenges uniquely associated with growing up in this uncertain time. This is why now is a critical time for improvements in the assessment and diagnosis of ADHD and other developmental disorders so that we can get students the services they need to navigate this unprecedented era.

Related Tags:

A version of this article appeared in the September 07, 2022 edition of Education Week as What Teachers Need To Know About Diagnosing ADHD


Jobs Virtual Career Fair for Teachers and K-12 Staff
Find teaching jobs and other jobs in K-12 education at the EdWeek Top School Jobs virtual career fair.
English-Language Learners Webinar English Learners and the Science of Reading: What Works in the Classroom
ELs & emergent bilinguals deserve the best reading instruction! The Reading League & NCEL join forces on best practices. Learn more in our webinar with both organizations.
This content is provided by our sponsor. It is not written by and does not necessarily reflect the views of Education Week's editorial staff.
Teaching Webinar
Challenging the Stigma: Emotions and STEM
STEM isn't just equations and logic. Join this webinar and discover how emotions fuel innovation, creativity, & problem-solving in STEM!
Content provided by Project Lead The Way

EdWeek Top School Jobs

Teacher Jobs
Search over ten thousand teaching jobs nationwide — elementary, middle, high school and more.
View Jobs
Principal Jobs
Find hundreds of jobs for principals, assistant principals, and other school leadership roles.
View Jobs
Administrator Jobs
Over a thousand district-level jobs: superintendents, directors, more.
View Jobs
Support Staff Jobs
Search thousands of jobs, from paraprofessionals to counselors and more.
View Jobs

Read Next

Special Education Q&A Schools Should Boost Inclusion of Students With Disabilities, Special Olympics Leader Says
Schools have work to do to ensure students with intellectual and developmental disabilities feel a sense of belonging, Tim Shriver said.
6 min read
Special Olympics Chairman Timothy Shriver greets a child at one of the organization’s events.
Special Olympics Chairman Timothy Shriver greets a child at one of the organization’s events.
Courtesy of Special Olympics
Special Education Spotlight Spotlight on the Science of Reading for Students with Disabilities
This Spotlight will empower you with strategies to apply the science of reading to support students with learning differences and more.
Special Education Video A Student Wrote a Book About Her Learning Disability. Now, She Has Advice for Teachers
Zoe Kozina, 17, is the author of Your Beautiful Mind, a children’s book published this year.
Special Education Disability or 'Superpower'? The Push to Change Mindsets About Students With Learning Differences
Advocates are calling for a paradigm shift in how adults perceive, and educate, students with learning differences.
5 min read
Conceptual artwork, imagination dream and hope concept, Superhero boy
Jorm Sangsorn/iStock/Getty