A survey study of the assessment practices used to diagnose Attention-Deficit/Hyperactivity Disorder.

摘要

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder and one of the most prevalent childhood psychiatric disorders. The most common treatment for ADHD is stimulant medication. In the 1990's, there was a threefold increase in the use of stimulant medications for preschool aged children alone to treat this disorder. Is this trend of increased prescription of stimulant medications due to a heightened awareness of this chronic condition, especially among previously under diagnosed groups (including females and adults), or are more stimulants being prescribed due to ineffective and incomplete diagnostic procedures? As ADHD is frequently treated in the primary care setting, a survey study was administered to pediatricians to inquire about their diagnostic process in regard to this disorder. Pediatricians' self-reported diagnostic methods were then compared with standards put forth in the Empirically Based Assessment (EBA) literature. Ninety six percent of physicians surveyed report that they conduct a clinical interview and 90% of physicians endorse using broad band behavior rating scales when considering an ADHD diagnosis. However, only 6% report conducting an FBA, which the research indicates is a critical component of diagnosis, as it ensures the presenting problem is operationalized, and environmental contingencies are evaluated to determine what may precipitate, maintain, or exacerbate undesirable behaviors. Given the practical constraints of pediatricians' time and workplace setting, recommendations are made for increased collaboration with school psychologists. School psychologists are in a unique position, having been trained in: social-emotional, behavioral, and academic assessment, the design and implementation of evidence-based interventions, and consultation. If school psychologists are able to step in where pediatricians cannot by conducting an FBA and then sharing that information, functional impairment can be examined, and treatment can be provided to children whose functional impairments justify it. Collaboration between diagnosticians and school psychologists could elevate the quality of ADHD assessment by informing it with information that quite simply could not be independently gathered from one professional alone.