Diagnosis of Attention-Deficit/Hyperactivity Disorder (AD/HD) in Childhood: A Review of the Literature
Brock, Stephen E., Clinton, Amanda, The California School Psychologist
This article examines recent literature related to the diagnosis of Attention-deficit/Hyperactivity Disorder (AD/HD) in childhood. First, the article discusses diagnostic criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). Next, it explores the diagnostic procedures for AD/HD recommended in current publications. Results of this comprehensive literature review indicate that rating scales, interviews, laboratory/psychological testing, and observations are the most frequently recommended AD/HD diagnostic techniques. The implications of these findings for school psychologists are discussed.
KEYWORDS: ADHD, Attention Deficit, Diagnosis
Although medical science recognized inattention, impulsivity, and hyperactivity as problematic among children as long as 200 years ago (Anastopoulos & Shelton, 2001), no single method for reliably diagnosing Attention-deficit/Hyperactivity Disorder (AD/HD) has yet to be identified. This lack of a specific diagnostic procedure makes AD/HD identification complicated (Brock, 1999; Detweiler, Hicks, & Hicks, 1999). Furthermore, differential diagnosis can be confounded by a variety of other disorders that can co-exist with AD/HD or cause symptoms similar to those observed in AD/HD (Levy, Hay, Bennett, & McStephen, 2004; Power, Costigan, Eiraldi, & Leff, 2004). To address these issues, an accurate diagnosis requires multiple diagnostic procedures, such as obtaining information from different sources (Barkley, 1998; Hoff, Doepke, & Landau, 2002), behavioral observations (Miranda, Presentacion, & Soriano, 2002), and psychological assessment (Detwiler et al., 1999).
Before proceeding further, it is important to acknowledge that the role of the school psychologist in the diagnosis of AD/HD is somewhat controversial as this disorder is not a special education eligibility category in either state or federal regulations. Consequently, from the first author's experiences, it has been observed that some districts do not allow their school psychologists to make AD/HD diagnoses. Such limitations are problematic given that (a) both state and federal regulations clearly specify that students with AD/HD may be eligible for special education services or section 504 protections (CEC §56339; Davila, Williams, & MacDonald, 1991), and (b) school districts are required to identify special needs and must conduct assessments in all areas of suspected disability (34 C.F.R. §§ 104.32, 104.35, 300.304). Thus, there appear to be important legal reasons for school psychologists at least being well informed about the important elements of the AD/HD diagnosis. Further emphasizing the need for such knowledge is the California Education Code section specifying that all school personnel be trained to develop greater awareness of AD/HD [CEC §56339(d)].
Consistent with the need for school psychologists to be better informed regarding AD/HD, the purpose of this article is to review relevant diagnostic issues and information, beginning with a discussion of the American Psychiatric Association's (APA) diagnostic criteria and, subsequently, presenting the results of a comprehensive literature review that identified the frequently recommended techniques for diagnosing AD/HD. This latter part of the paper is intended to provide school psychologists with a resource that documents the agreed upon elements of a comprehensive AD/HD diagnostic assessment. While it is clear there is no specific method or set of methods for diagnosing AD/HD, this literature review reveals significant agreement regarding recommended diagnostic practices. In addition to guiding the school psychologist's practice, from the first author's applied experiences, this knowledge will be helpful in those instances wherein a school assessment team is presented with an "AD/HD" diagnosis that is judged to be questionable because it fails to meet standard diagnostic practices. …