ADHD Assessment & Identification

Screening

The first step in identifying a student with ADHD is screening (DuPaul, 2004). In a school, a teacher will typically be the first to observe that a student exhibits inattentiveness, hyperactivity, and/or impulsiveness at levels that are greater than peers' and that these behaviors interfere with the student's academic progress and/or social adjustment in the classroom. The Attention Deficit Hyperactivity Disorder Test (Gilliam, 1995) is a screening instrument that may be used by a teacher to evaluate students for possible ADHD (Venn, 2007). Once a teacher determines that a student may have ADHD, the teacher should seek the assistance of a psychologist to determine if further evaluation is needed. The psychologist will interview the teacher to screen for the severity and frequency of symptoms that might indicate ADHD.

It is important to note that a teacher should not recommend to a parent that a student be referred to a physician for evaluation for ADHD or that a student might be a good candidate for medication. The multidisciplinary team should be involved in any decision regarding whether a referral to a physician will be recommended to the parent. Moreover, the physician, in consultation with the psychologist, teachers, other relevant school professionals, and the child's parents, will make any decision regarding whether the student should be identified with ADHD and the use of any medical intervention that may be needed.

As we've noted despite efforts to standardize the criteria for ADHD in DSM-IV-TR, these criteria "remain subjective and may be interpreted differently by different observers" (AAP, 2000, p. 1163). Because of this subjectivity in the identification process, multiple measures and multiple methods should be used to collect data regarding the student's behavior across a range of settings and sources (Salend & Rohena, 2003). These methods should include interviews with parents and teachers, behavior ratings scales completed by parents and/or teachers, observation of the child's behavior in multiple school settings (e.g., classroom, lunchroom, playground), and assessment of academic functioning (DuPaul, 2004). It is also useful to review the student's school records and medical history (OSEP, 2003).

The American Academy of Pediatrics (2000) has recommended the use of several behavior rating scales, questionnaires, and checklists that have been developed to quantify the behavioral characteristics of students with ADHD. These rating scales are used to differentiate students who do and do not have ADHD.

While a physician ultimately makes the decision regarding whether a student has ADHD, the multidisciplinary team has the responsibility for conducting an educational evaluation to determine the extent to which the behaviors associated with ADHD might have influenced the child's academic achievement and social adjustment. Both standardized norm-referenced tests and criterion-referenced measures of academic achievement may be used as well as curriculum-based measures that address progress that the child is making in the general education curriculum. In addition, observations of the student in the general education classroom, examination of test scores and report-card grades, and interviews with teachers and parents should be conducted to collect this information.

When the multidisciplinary team suspects that the student could have a coexisting disability, additional information should be collected. As we have noted, a substantial proportion of students with ADHD also have learning disabilities and emotional/behavioral disorders.

Determining Eligibility for Services

Once the student has been identified as having ADHD and information has been collected from multiple sources regarding the student's academic progress and social adjustment, the multidisciplinary team examines and discusses these data to determine if the student is eligible for special education services. To be eligible for special education services, the student must be identified with ADHD, and the ADHD must adversely affect educational performance. It is important to note that the multidisciplinary team may decide the child has ADHD but is not eligible for special education services because the disability does not adversely affect educational performance.

A student who has ADHD but is not eligible for special education services may be appropriate for evaluation under Section 504. The same type of data is collected for making this determination. If the data collected demonstrate that the child's ADHD adversely affects his or her learning (which is a major life activity), the student may qualify under Section 504 for services (OSEP, 2003). Students who are eligible under Section 504 do not have an IEP but "must be provided regular or special education and related aids or services that are designed to meet their individual needs as adequately as the needs of non-disabled students are met" (p. 5).