Are We Assessing ADHD Appropriately?
Last semester, in my Developmental Psychopathology (PSYC 412) class, we discussed Attention Deficit Hyperactivity Disorder (ADHD). With any mental disorder, the proper diagnosis and assessment must be given, so treatment strategies can be evaluated. When assessing the severity of ADHD, both parent and teacher reports are taken into consideration using the SNAP-IV Rating Scale. Both reports make the test more reliable, but the teacher’s report is critical for the diagnosis of ADHD as they are knowledgeable of a normative framework for placing children’s behaviour. Teachers are experienced with children and can identify certain behaviours that may not be present in a home environment.
The SNAP-IV includes two subsets assessing inattention and hyperactivity/impulsivity based on a 4-point scale where:
0 = Not at All, 1 = Just a Little, 2 = Quite a Bit, and 3 = Very Much
The ratings in the subset are added together and then divided by the number of items in the subset. If the scores in each subset are <13/27, then the symptoms are not clinically significant, 13–17 = mild symptoms, 18–22 = moderate symptoms, and 23–27 = severe symptoms.
When using this assessment, one problem arises: how will one combine the reports from multiple informants to categorize children? The way one combines the reports can impact the type of ADHD diagnosis a child may be given.
There are three different diagnostic subtypes of ADHD according to the DSM-5 criteria:
- Combined (C): at least 6 inattentive AND 6 hyperactive symptoms must be present
- Primarily Inattentive (PI): at least 6 inattentive symptoms, but fewer than 6 hyperactive symptoms
- Primarily Hyperactive (PH): at least 6 hyperactive symptoms, but fewer than 6 inattentive symptoms
When one observes a parent or teacher report alone, you see more diagnoses of either PI or PH. However, if one were to combine the two reports using the “OR” rule for symptoms, where symptoms can be present if identified by either informant, most cases of ADHD become combined (C).
For example, given a case where a 7-year-old child is being assessed for ADHD, using these reports, and just accounting for the parent’s observation, the child does not have enough symptoms for either diagnosis of PI, PH, or C. Using solely the parent’s report, the child meets diagnostic criteria for PI. Finally, combining both reports using the “OR” rule for symptoms indicates that the child can be diagnosed with ADHD Combined.
It is clear from this example that there is a possibility of misdiagnosing or perhaps not diagnosing ADHD at all. Methods of assessment are the basis of an individual’s trajectory as they cope with their mental disorder and affect what treatments they explore. With this idea in mind, it is important for both teachers and parents to accurately assess children to the best of their ability by staying true to the 4-point scale. As well as taking into account the “OR” rule for symptoms. With these strategies in mind, we still must always ask, will this be enough to accurately assess ADHD in children?
References:
“ADHD.” Collaborative Mental Health Care. Collaborative Mental Health Care in Canada, n.d. Web. 29 Jan. 2016.
“Attention-Deficit / Hyperactivity Disorder (ADHD): Symptoms and Diagnosis.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 08 Jan. 2016. Web. 29 Jan. 2016.
Belliveau, Jeannette. “ADHD Rating Scale: What It Is and How to Understand It.” Healthline. N.p., 22 Jan. 2014. Web. 29 Jan. 2016.
Dirks, Melanie. Lecture at McGill University, September 2015
