Harvey C. Parker, Ph.D.
Clinical Psychologist
Co-Founder of Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)
Author of The ADHD Workbook for Parents and The ADHD Handbook for Schools
The primary characteristics of Attention Deficit Hyperactivity Disorder (ADHD/ADD) are
not difficult to spot in a classroom. However, not all children who are inattentive,
impulsive, or overactive have ADD. These same symptoms can be a result of other factors
such as: frustration with difficult schoolwork, lack of motivation, emotional concerns, or
other medical conditions. A comprehensive assessment by a team of professionals working in
conjunction with the parents and the child can usually determine whether problems are the
result of ADD or other factors. Members of this assessment team usually include
physicians, psychologists, social workers, and school personnel such as teachers, guidance
counselors, or learning specialists.
The Physicians Role
Routine Physical examinations of children with ADD are often normal, but they are
needed to rule out the unlikely possibility of there being a medical condition which could
cause ADD-like symptoms. Tests such as chromosome studies, electroencephalograms (EEGs),
magnetic resonance imaging (MRI), or computerized axial tomograms (CT scans) are not used
routinely for evaluation of ADD. Child and adolescent psychiatrists and pediatric
neurologists may play an important part in identifying this condition as well as other
possible related conditions such as learning disabilities, Tourette syndrome, pervasive
development disorder, obsessive compulsive disorder, anxiety disorder, depression or
bipolar disorder.
The Psychologist's Role
Clinical or school psychologists administer and interpret psychological and educational
tests of cognition, perception, and language development (such as intelligence, attention
span, visual-motor skills, memory, impulsivity) as well as tests of achievement and
social/emotional adjustment. Psychologists and other mental health professionals often
interpret data collected from parents and teachers who complete behavior rating scales
about the child in question. Results of such tests can provide important clues as to
whether a child's difficulties are related to having ADD and/or other problems with
learning, behavior, or emotional adjustment. Such scales offer quantifiable, descriptive
information about the child, thus providing a means by which to compare the child's
behavior to that of others of the same sex and age. Some of the more popular rating scales
used in the assessment of ADD are: Conners Teacher Rating Scale (CTRS) and Conners Parent
Rating Scale (CPRS), ADD-H: Comprehensive Teacher Rating Scale (ACTeRS), ADHD Rating
Scale, Child Attention Profile, Child Behavior Checklist (CBCL), Home Situations
Questionnaire, School Situations Questionnaire, and Academic Performance Rating Scale
(APRS).
The School's Role
Assessments for ADD should always include information about the student's current and
past classroom performance, academic skills strengths and weaknesses, attention span, and
other social, emotional, or behavioral characteristics. Such information can be gathered
through teacher interviews, review of cumulative records, analysis of test scores, and
direct observation of the student in class. The student's adjustment in class should
relate to aspects of the instructional environment, namely: the curriculum in which the
student is working; teacher expectations for the class and for the individual student;
methods of instruction employed by the teacher; incentives for work completion; methods of
teacher feedback to students; and comparative performance of other students in the class.
The Parent's Role
Having witnessed the child in a variety of situations over a number of years, parents
have the unique perspective on their child's previous development and current adjustment.
Information from parents is usually acquired by interview or through questionnaires
completed by parents. The focus is usually on obtaining overall family history, current
family structure and functioning, and to document important events from the child's
medical, developmental, social, and academic history relevant to the assessment of ADD.
The Child's Role
An interview with the child offers the clinician the opportunity to observe the child's
behavior and can yield valuable information as to the child's social and emotional
adjustment, feelings about themselves and others, attitudes about school and other aspects
of their life. However, even children with ADD often behave well during such interviews.
Therefore, observations of a child's behavior, level of activity, attentiveness, or other
compliance made during the interview sessions should not be taken as true of the child in
other settings. Normal behavior in a one-on-one setting does not diminish the likelihood
of the child having ADD.
The Team's Role after the Assessment
Ideally, after all the data has been collected, members of the assessment team should
collaborate to discuss their findings. This should lead to a thorough understanding of the
child's strengths and areas of need physically, academically, behaviorally, and
emotionally. If a diagnosis of attention deficit disorder (and/or other conditions) is
established, treatment planning should be done in all areas where interventions are
recommended. The physician may discuss appropriate medical interventions with the child
and parents. The psychologist or other mental health professional may discuss counseling,
behavior modification, or social and organizational skills training options. The school
may set up classroom interventions to accommodate the child's areas of need in school or
may provide special education or related services. Once the initial assessment is
completed and appropriate treatment is instituted, there should be routine follow-up by
members of the assessment and treatment team to determine how the child is progressing.
ADD, being a chronic condition, will often require long-term care and monitoring on a
regular basis. Obviously, parents play a key role in encouraging members of the assessment
and treatment team to maintain close collaboration and to work together consistently for
the best interests of the child. Coordination of all this, whether it be by a parent or a
professional, is no easy task, but the outcome is usually well worth the effort.
