The Back-to-School Diagnosis

When parents, teachers, and professionals team up for an accurate diagnosis and successful treatment, the child wins.

Teachers cannot diagnose ADHD.

As children get ready to return to the classroom, doctors are preparing to see more referrals for ADHD. How can the school help to ensure an accurate diagnosis and successful treatment for the child?

It may take a village to raise a child, but, if that child happens to have ADHD, it takes a multidisciplinary team to get him through school. That team should include the child, the parents, the doctor, a school psychologist, the classroom teacher, special education teachers and others. Each member of the team offers his expertise, and works together to develop the best plan for the student's education. This team approach provides a comprehensive picture of the child, making diagnosis more accurate and increases the probability of successful treatment, instead of relying solely on one perspective from a parent or a teacher.

A model provided by the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder demonstrates the importance of a collaborative approach in detection, diagnosis, and treatment. Teachers of the almost 600 children involved in the study were given specific training in ADHD, including instructions about what to watch for and expect from children on medication.

Participating teachers were asked to provide daily ratings of behavior and academic performance for the first month of the study. "Based on the MTA experience," wrote a team who studied the research, "we recommend frequent telephone contact with the teacher specifically to inquire about the peak effects and dissipation of effects of medication that are expected to occur during the school hours as a way to improve... communication between diagnosticians and those who implement and monitor treatment in the schools."

As the person in the best position to evaluate the effectiveness of treatment, the teacher is the eyes and ears for the doctor. A teacher sees the child five days a week in a realistic environment. A prescribing physician, on the other hand, only sees his patient for about ten minutes once every six months in the confines of the office.

Teachers cannot diagnose ADHD. However, teachers are able to evaluate classroom performance and to compare the child with same-age peers. During treatment, the teacher is in a unique position to see the child while the medication is in effect. But the benefits of these observations are wasted unless the information is passed on to the parents and physician.

The AAFP, the same group that recommended the team approach mentioned above recognizes the importance of the school psychologist in this process. An editorial published by the organization — ADHD: How School Psychologists Can Help — recommends the development of a collaborative relationship between physicians and school psychologists. According to the article, "The training and experience that school psychologists have in behavioral assessment and intervention, as well as their direct access to the child's teacher and classroom, contribute to the overall assessment and treatment process, which would be a challenge for physicians to manage alone."

But, again, the benefit of the school psychologist is wasted unless there is adequate communication between the school, the physician and the parents. In the words of one psychologist who has worked with ADHD students for 25 years, "A doctor is a resource, but a presumptuous and negligent resource if he or she makes an ADHD determination without consulting the school team."

The multidisciplinary team is a great idea. Unfortunately, it is not utilized often enough.

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