Download What is ADHD?

Making an Educational
Diagnosis within the scope of an
MFE
 Current
practices
 Overview of DSM practices
 Presentation of field interviews
 Results from staff survey
 Discussion
Current Practices
 US
Department of Education states that to
identify ADHD there are three types of
evaluations:

Behavioral
• Questionnaires and rating scales

Educational
• Demonstration that this affects education

Medical
• Often in the form of a doctor’s note based on other
information
Current Practices


US Department of Education notes that IDEA tells us
that we must identify students with a disability that is
affecting their education
DOE goes on to state:
 “The results of a medical doctor’s, psychologists, or
other qualified professional’s assessment of ADHD
MAY be important…”
 Not mandatory in language, just suggestive
Diagnosing: Behavioral
Evaluations

The American Academy of Pediatrics (AAP)
suggest using the following rating scales for
accurate diagnosis of ADHD in children:
•
•
•
Connors Parent/Teacher Rating Scales
(CPRS/CTRS)
Barkley’s School Situations Questionnaire –Original
Version, Number of Problem Settings Scale (SSQ-01)
Barkley’s School Situations Questionnaire –Mean
Severity Scale (SSQ-0-2)
Diagnosing: Educational
Evaluation

Should be a team decision.
•
•
Should include classroom observations (2-3 different
observations across different days, 20-30 minutes in
length) noting the frequency of various ADHD
symptoms exhibited compared to the behaviors of the
other children in the classroom.
Should also include an assessment of the child’s
productivity in completing classwork and other
academic assignments. Its important to collect
information about both the percentage of work
completed as well as the accuracy of the work. The
productivity of the child can be compared to the
productivity of other children in the class.
Diagnosing: Medical Evaluation
 Part
B of IDEA does not necessarily
require a school district to conduct a
medical evaluation for the purpose of
determining whether a child has ADHD. It
is the schools discretion as to whether or
not to require a medical evaluation by an
MD as part of the MFE.
Distinction between a Medical
Diagnosis and an Educational
Assessment

Medical Diagnosis are made in order to (a)
determine the best treatment strategy, (b) advise
what to expect in the future (prognosis), (c) allow
data collection and statistical analysis, and (d)
support billing of third-party payers.
 Educational Assessments are designed to
determine eligibility for special educational
assistance.
Is ADHD Medical?
It
is not a disorder of attention as
previously thought, it is a function of
developmental failure in the brain circuitry
that monitors inhibition and self-control
Children
with ADHD display a range of
symptoms and varying levels of severity
Most
children with ADHD are of at least
average intelligence
ADHD (cont.)
 Almost
one-third of children with ADHD
will have some type of learning disability
 3-5 % of the student population has ADHD
with boys 4-9 times more likely to be
diagnosed than girls.
Three subtypes of ADHD according
to DSM-IV

Predominately Inattentive


Predominately Hyperactive-Impulsive


Fidgety, has difficulty staying seated or playing quietly
and acts as if driven by a motor
Difficulty participating in tasks that require taking
turns, blurting out answers to questions instead of
waiting to be called on. Flitting from one task to
another without finishing the previous task.
Combined Types
DSM-IV Criteria

Child must display several characteristics to be
clinically diagnosed with ADHD





Severity. The behavior in question must occur more
frequently in the child than in other children at the
same developmental age.
Early Onset. At least some of the symptoms must
have been present prior to age 7.
Duration. The symptoms must also have been
present for at least 6 months prior to the evaluation.
Impact. The symptoms must have a negative impact
on the child’s academic or social life.
Settings. The symptoms must be present in multiple
settings.
Interviews
 Practitioners
and educators selected to
answer the following questions:



What is the best way to diagnose ADHD?
What are the barriers to in-school diagnosis?
Why don’t more school psychologists do this?
Interview Results: Joe
Kovaleski, D.Ed.
 Best
way to diagnose
inattention/spectrum?


Liaison between school, medical community,
and family
School psychologists are essential as they do
the “footwork” of diagnosis such as the
Conners’ and observations. Doctors just
eyeball these data and make the diagnosis
Interview Results: Joe
Kovaleski, D.Ed.
 Why
don’t more school psychologists
diagnose?



School psychologists do not have strong
enough sense of self-esteem.
We seem more comfortable referring this out
even though we have the training
Many school psychologists don’t want to
diagnose a disorder treated with medication.
Yet we diagnose ED and CD.
Interview Results: Joe
Kovaleski, D.Ed.

Who is resisting school psychologists becoming
diagnosticians?


We are. We don’t come across as assured. When a
parent comes to us and asks us for a diagnosis we
say we can’t do this and it erodes our profession. The
student then goes to a clinical psychologist who may
have less training in educational diagnoses
We haven’t pushed this issue and we don’t come
across as confident and assured
Interview Results: Antoinette
Miranda, Ph.D.
 What’s
the best way to diagnose
inattentive/spectrum disorders?




Note from the doctor
Behavior rating scale
Observation
Documentation that the disorder is affecting
the student’s academics
Interview Results: Antoinette
Miranda, Ph.D.
 Who
is restricting school psychologists
from diagnosing in schools?


School districts
Why should a pediatrician or physician with
no specialized training/field data be able to
diagnose a student when we work with them
everyday?
Interview Results: Antoinette
Miranda, Ph.D.
 Are
school psychologists presently
prepared to diagnose when they leave
graduate training?


No, not yet.
Not enough specialized training in these
areas. Still focused more on academic
interventions than mental health
Interview Results: Jane Welch,
Ph.D.
 What’s
the best way to diagnose
inattentive/spectrum disorders?


In school
Do a clinical interview with family and student,
an observation, rating scale, and diagnose
(with consent)
Interview Results: Jane Welch,
Ph.D.

Why aren’t school psychologists doing this?


We still don’t receive enough training in these areas
Clinical psychologists will diagnose these disorders
even without specialized training or observations in
the classroom. Or they will have an MA level assistant
do it and they will sign off
Interview Results: Jane Welch,
Ph.D.
 Who



is resisting in school diagnosing?
We are
Far too concerned with special education
issues and not with clinical side
There may be a bit of ignorance on our part
about what we can do in the schools
Interview Results: Jane Welch,
Ph.D.
 Are
we not diagnosing because we are not
Ph.Ds?


No, look at MA level Professional Counselors.
They will diagnose inattentive and spectrum
disorders
Eds. Level psychologists could be doing this
as well
Interview with Dr. Jim Broyles
(GCPS)
 Diagnosis
of ADHD: different ways to
diagnose for different issues (educational
problems compared to home issues)
• Clinical interviews regarding child/family history
along with observations and interviews
• Classroom observations difficult for MD’s to
diagnose
• Best way to diagnose ADHD is a collaboration
between School Psychologists, MD’s, well trained
social workers/Psychologists
Dr. Broyles (cont.)

Autism is a little more challenging: best done
from collecting data from variety of domains
• As far as a medical diagnosis: so many domains are involved
and autism is such a powerful label its best to be very
thorough in gathering information, best practice is to have an
expert in social function to pool information. He also believes
that it is more important to determine where in each domain a
child is as far as severity of symptoms not just the diagnosis
• Having a school make a determination of an educational
diagnosis of ADHD/Autism makes sense to him as long as
the student meets criteria for each disorder
Dr. Broyles
From a physicians point of view they just want to make sure a true
evaluation is being done. They are not sure of the qualifications of
the person doing the evaluation or the quality of the work done in the
school. Dr’s do not understand psychology as a science, they are
not current on who is truly qualified and what is competent work.
They just want to make sure that a child is not being mislabeled or
misidentified.
Doctors also want the schools to provide more services (as far as
identifying) but are not sure how to get it done. Dr. Broyles states
that it is a doctors perception that it is difficult for parents to have
access to school psychologists. Parents come in to doctors offices
saying that the schools will not do the evaluations and reinforce this
perception.
Dr. Broyles thinks that overall most MD’s would be glad to have the
schools to provide information/reports educationally identifying
students with possible disorders.
Dr. Broyles (cont.)
Dr. Broyles says that it is his experience thus far that some
school psychologists are qualified and some are not. He
has received reports from school districts in which
educational identifications have been made in the report.
He feels that a school psychologist with a Masters level
education is qualified in gathering information and
assess from all of the domains but that PhD's have the
additional training and can give a better
insight/understanding into what is going on with the child.
They can better understand the more subtle issues that
are going on with a student better than a M.A..
Dr. Broyles (cont)
Dr. Broyles believes that the real solution for PDD/ADHD
kids is not just getting the right diagnosis but to link the
family to services available to them, not just school
services but family services. The one benefit to having a
MD make the identification is that they are more in touch
with ALL services available to a family not just school
services.
Dr. Broyles also believes that it would be nice to have one
dedicated person in a district to test/assess/measure
PDD disorders. This would ensure a uniformity in
identifications as well as competency.
What about SWCS?
 District



policy:
The school psychologist collects the data
(observations, parent report, teacher
consultation, and rating scale)
The parent is asked to have a doctor
diagnose the disorder
The diagnosis is then used for determination
of a presence of a disability
What Do You Think?
 We
purposely didn’t interview specialist
level psychologists because we wanted to
hear what you have to say now
 Results from survey
0%
27%
73%
Are you comfortable diagnosing inattentive/spectrum disorders in school?
Blue: Yes
Percentages same for both questions: inattention and spectrum disorders
0%
50%
50%
Do you think school psychologists are properly trained to make in school diagnoses?
Blue: Yes
0%
50%
50%
Do you think school psychologists should be able to make these diagnoses?
Blue: Yes
0%
33%
67%
Do you think by not making these diagnoses in school we have weakened or compromised
our profession?
Blue: Yes
Questions and
Discussion
What do you think?