ADHD Assessment

Early Identification

The symptoms of ADHD do arise during early childhood, but the acknowledgement of their presence is often retrospective. In other words, few preschoolers are identified as having ADHD because of (1) the fear of misidentifying children as having disabilities when their problems may be due to developmental lags or immaturity and (2) the fact that the characteristics of ADHD (e.g., short attention span, being in constant motion) are typical of many young children without ADHD. Thus, unless doctors and education professionals can document some incident that caused brain damage, identification during the early childhood years is not likely (NIMH, 2005). Nevertheless, the federal government requires that for students to receive special education services for ADHD, the symptoms must have been present before the age of seven (OSEP, 2003).

Pre-Referral

The primary purpose of pre-referral is to avoid unnecessary referrals to special education by implementing research-validated practices in the general education classroom. If the implemented practices work—that is, if the behaviors of concern decrease significantly or disappear—then a referral is not needed. For students who may have ADHD, the pre-referral process should contain multiple steps, and the efficacy of each attempt should be documented.

In the pre-referral phase for students with ADHD, a teacher's actions should focus on preventing problem behaviors. For children with a predisposition toward inattention or hyperactivity, the physical and instructional structure of the classroom must be considered. Students with self-regulation difficulties do better in structured settings, so teachers need to have a well-planned behavior management system in place, complete with rules, procedures, and consistently delivered consequences. Maintenance of a regular classroom routine is very important, as are clearly articulated instructions and expectations for academic and social tasks. Well-planned transition times can decrease the opportunities for "problem" behaviors.

Other colleagues, such as teachers or a school nurse, can be helpful resources. At an initial level, a school nurse can be consulted to rule out other conditions (e.g., hearing loss) through general screening procedures. If other conditions might be the source of behavioral problems, then the evaluation process involves professionals with expertise in those areas of concern (e.g., an audiologist). When the school nurse suspects the presence of ADHD characteristics, the direction of the evaluation efforts is adjusted accordingly. Other teachers can conduct classroom observations to help the general educator find additional ways to improve the classroom structure and educational environment. Parents and family members are a critical resource at this stage, both for feedback regarding interventions that have been successful in the past and to maintain consistency between the home and school environments. If a variety of methods have been employed to increase attention or reduce hyperactivity, with little or no success, then a formal referral to special education is warranted.

Identification

Experts strongly suggest that the identification process for ADHD include multidimensional evaluations (Barkley & Edwards, 1998; Gordon & Barkley, 1998; Weyandt, 2001). Such comprehensive assessments would include many different . -pes of procedures such as

• Diagnostic interviews
• Medical examinations
• Behavior rating scales
• Standardized tests
• Observations

Because prescription medicines are widely used to assist in the management of hyperactivity, many parents of children with ADHD seek help from their doctors first. Thus the medical profession often is involved in these students' diagnosis, even though only three states require diagnosis by either a physician or a mental health professional as part of the eligibility determination for ADHD (Muller & Markowitz, 2004), (Only five states call out special guidelines for qualifying these students for special education services.)

Even if the student's pediatrician or family doctor makes a diagnosis of ADHD, school personnel must also make a determination about whether the student qualifies for accommodations though Section 504 or for special education services. They use a multilevel approach to gather all the information they need to understand the nature of the individual's problems and the types of supports and services needed (Merrell & Boelter, 2001; Salend & Rohena, 2003). These education professionals collect data about the student's academic performance, behavioral patterns, social interactions, and medical history. They compare this information with the DSM-IV-TR definition of ADHD to determine both needs and eligibility. The subjectivity of some of the assessment procedures (e.g., a parent's perception of hyperactivity compared to a teacher's) requires that caution be exercised. Cooperation among the many people involved in this process is vital. Remember that for a student to receive special education services, the characteristics of ADHD must be significant, must be observed across several settings, must be documented (even if retrospectively) as having existed before the age of seven, and must seriously affect educational performance.

Once a child is identified as having ADHD, the school's multidisciplinary team goes into high gear to develop the student's IEP and determine what accommodations and services are required. A broad array of professionals from a wide variety of disciplines, including a school nurse and a physician, should work with that student's parents throughout the IEP development and implementation process (Austin, 2003). Each professional uses a variety of assessment tools and techniques to monitor the student's academic and behavioral progress. For those students who are receiving medication, it is important that teachers work closely with the family and health professionals to monitor the effectiveness of the medications and ensure that the student doesn't experience negative side effects (American Academy of Pediatrics, 2005; OSEP, 2003).

Evaluation: Testing Accommodations

Just as for students with other disabilities, many types of accommodations are available to students with ADHD; however, one accommodation seems to be the most commonly offered. Whether the students' special needs are addressed through IDEA '04 or through Section 504, the most common accommodation to testing situations for students with ADHD is extended time (Elliott & Marquart, 2004). When offered this accommodation, students with disabilities typically take only 8 or 12 minutes longer to answer test items. But does having longer to complete a test make a difference in results? Surprisingly, whether for students with disabilities or without disabilities, extended time does not significantly improve students' scores. What . interesting, however, is that students who are offered extended time feel better about the testing situation, claim they were more motivated to complete the [est, felt less frustrated, and thought they performed better. Outcome measures—measures of how well the students actually did on the test—did not support students' feelings about their performance (Elliott & Marquart, 2004).