School Based Assessment Of Attention-Deficit / Hyperactivity Disorder

Attention Deficit/Hyperactivity Disorder (AD/HD) is a neurobehavioral syndrome marked by inattention, hyperactivity, and impulsivity (American Psychiatric Association, 2000). The essential features of the disorder include a persistent pattern of inattention and/or hyperactivity that is more frequent than typically observed in individuals at a comparable development level. In addition, diagnostic criteria require that some symptoms are evident prior to age 7, the symptoms are present in two or more settings, and the symptoms clearly interfere with social, academic, or occupational functioning. There are three subtypes of ADHDincluding Predominantly Inattentive Type (AD/HD-I), Predominantly Hyperactive – Impulsive Type (AD/HDHI), and Combined Type (AD/HD-C).


______________________ Introduction
While ADHDis not specifically named as a qualifying condition under IDEA, students with ADHDmay qualify for services under the categories Other Health Impairment (OHI), Specific Learning Disability (SLD), or Emotional Disturbance (ED) depending upon the educational impact of their disability.
Furthermore, the Office of Special Education Programs (OSEP) has clarified that a medical diagnosis is not required for student with ADHDto meet eligibility criteria under the category OHI, only that the evaluation be conducted by a professional competent in ADHDassessment and knowledgeable about the impact ADHDon educational performance (Martin & Zirkel, 2011).However, rating scales are not without their own limitations such as possible negative halo effects (Alloway, et. al., 2009) 46 BYLUND, J.: School Based Assessment Of Attention-Deficit/Hyperactivity Disorder.
Nevertheless, additional assessments beyond rating scales are needed in order to make a differential diagnosis and develop appropriate interventions.

Classroom Observations And Ad/Hd
In addition to the limitations of rating scales listed above, they also do not account for improvements over time as a result of maturation (Vaughn, et. al., 2011).Differences in CPT performance between ADHDand non-ADHDsubjects have been found in terms of response time variability, omission errors, and commission errors (Vaughn et. al., 2011).
While CPTs have been demonstrated to differentiate individuals with ADHDfrom "normal" controls, these tests may not be sensitive enough to distinguish those with ADHDfrom those with non-clinical levels of attention problems as both groups have been shown to perform below the normative mean on such tests (Preston, Fennell, & Bussing, 2005).Given that a referral for evaluation suggests that some level of difficulty with attention, or other learning process, is evident (at least to the referral source) our as that of behavior rating scales (Toplak et al., 2009).This may not be surprising however, given

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School psychologists are clearly positioned to fill this role.However, the level of training in school based assessment of ADHDvaries amongst professionals in the field and in many cases additional training may be needed.For example Handler and DuPaul (2005) found that only 23% of school psychologists surveyed reported to conduct comprehensive ADHDassessments consistent with best practice.The problem, of course, being that a failure to utilize a multi-method assessment approach greatly increases the likelihood of misdiagnosis Clinical interviews are the cornerstone of diagnosis and when assessing ADHD parent and teacher interviews should address symptoms outlined in the Diagnostic and Statistical Manual, 4 th Edition, Text Revision (DSM-IV-TR), including the pervasiveness of symptoms over the past 6 months, the presence of symptoms across two or more settings, and the age at which symptoms emerged (Valo & Tannock, 2010).Additionally, parent interviews can provide information regarding prenatal and postnatal history, family history of AD/HD, social functioning, parenting techniques, and psychosocial factors.
-Johnson, and Schacher (2009) found that students who received low T-Scores (i.e.below 60) on the Conners' Teacher Rating Scale (CTRS) DSM-IV subscale were unlikely to meet diagnostic criteria for ADHDbased on a clinical interview.However, a student receiving mid to high range T-Scores did not necessarily confirm that the child will reach the diagnostic criteria as outlined in the DSM-IV-TR.In other words, the CTRS-R produced a low number of false negatives but at the same time resulted in a high number of false positives.Part of the reason for this is that while children and adolescents with ADHDreceive significantly higher scores of on the Conners' and BRIEF than do non-clinical peers, so do young people with other clinical diagnoses(Sullivan & Riccio, 2007).The Conners' 3 may have corrected for this shortcoming by including a DSM-IV-TR symptoms count in addition to the normative scales(Conners & Multihealth Systems Staff, 2008).
environmental conditions that either contribute to or curb inattentiveness and hyperactivity(Kofler et al. 2008).Direct observations, on the other hand, provide critical information regarding the antecedents and consequences of behaviors, as well as their frequency, intensity, and duration(Sattler & Hoge, 2006).School psychologists have greater opportunities to observe student in natural environments (e.g. the classroom) than do psychologists working in other settings(Handler,   & DuPaul, 2005), and perhaps for this reason observations are the assessment procedure most frequently used by school psychologists(Kofler et al., 2008).Attention or "on-task behavior" is often operationalized as visual orientation towards the expected stimulus such as the teacher, smart board, or text book, and children and adolescents with ADHDare observed to be off task more frequently and for longer periods of time than their typical peers(Kofler et al., 2008).Time sampling, or interval time sampling, is an ideal method for assessing a student's ADHDcharacteristics in the classroom setting.With time sampling, the observation period is divided into equal intervals, anywhere from 5 to 30 seconds, and the school psychologist records whether or not a target behavior (e.g."off task") occurs(Sattler & Hoge, 2006).Behaviors can be tallied if they occur at any point during the interval (i.e.partial interval time sampling), if the behavior occurs for the entire interval (i.e.whole interval sampling), or if the behavior is occurring at a specific time within the interval such as at the end (i.e.momentary time interval sampling).Direct observation of children withADHDreveals significant discrepancies between their time on task and that of their typical classmates(Kofler et al., 2008;McConaughy et al., 2009).In a meta-analysis of studies examining off task behavior of children and youth with AD/HD,Kofler et al. (2008) found that children withADHDwere off task 25.66% of the time compared to 12.09% of the time for their typical peers.These differences are noted even when children are observed for short periods of time (e.g.10-15 minutes).Cognitive Assessment AndAd/Hd While the current diagnostic criteria for ADHDare based on observed behaviors, a growing body of evidence suggests that individuals with ADHDalso perform poorly on cognitive tests of attention and executive functioning.For example, Holmes et.al. (2010) found that children with ADHDwere distinguishable from their typical peers based on measures of response inhibition, set shifting, planning, card sorting, and working memory.Consistent with these findings, Hale and Fiorello (2004) cite research suggesting that children with AD/HD-I and AD/HD-C subtypes perform poorly on measures of executive functioning, working memory, and processing efficiency while those with AD/HD-HI are distinguishable by their poor performance on meassures of response inhibition.Despite their utility as part of a comprehensive ADHD assessment, however, psychologists use cognitive tests far less frequently than other methods such as reviewing school records, interviewing parents, observing in natural setting, and administering behavior rating scales (Handler & DuPaul, 2005).Numerous psychological tests may be used to assess various aspects of attention including continuous performance tests (CPT) and performance based measures of executive functioning.CPTs typically provide measure of vigilance (e.g.sustained attention) and impulse regulation based on measures of response times and error patterns (e.g.omissions and commissions).CPT performance of individuals with ADHDhas been shown to lag significantly behind their non-ADHDpeers despite relative challenge is often times to distinguish clinically significant from sub-clinical levels of attention problems.Consequently, while a CPT is a valuable tool in the assessment of AD/HD, it should only be used as part of a multifaceted assessment battery.Performance based measures of executive functioning have also been found to distinguish children and adolescents with ADHDfrom their non-clinical peers.For example, Wodka et.al. (2008) found that children with ADHDperformed significantly lower than non-clinical controls in terms of their performance on all 4 measures from the Delis Kaplan Executive Function System (DKEFS) used in the study including Trail the diagnosis is typically made, at least in part, based on rating scale data.Nevertheless, of school age children have AD/HD, and the associated characteristics may significantly impair learning and school performance (APA, 2000).While ADHDis not specifically identified under IDEA, it is nevertheless essential for school psychologists to have a solid foundation in terms of assessing and treating the disorder.Furthermore, the fact that ADHDis not listed under IDEA does not restrict school psychologists from assessing in this area so long as it is within the scope of their professional competence.In fact, requiring that a parent obtain a medical or clinical diagnosis prior to receiving appropriate educational services would likely amount to a denial of their child's right to a ideally suited for assessing children and adolescents suspected of having AD/HD.Unlike those in clinical settings, school psychologists have regular access to children in natural settings (e.g.classroom, playground, etc.) as well as a wealth of records pertaining to the child's health, development, and educational functioning.Further, school psychologists are well positioned to interview multiple informants (e.g.child, parent, and teacher), are experts in a variety of quantitative observation techniques (e.g.time sampling), and are knowledgeable in the administration and interpretation of behavior rating scales (e.g.Conners' 3 and BRIEF) and cognitive assessment tools (e.g.CPT II and DKEFS).Moreover, school psychologists who conduct comprehensive evaluations of students with suspected AD/HD, and are grounded in a solid understanding of the disorder and its manifestation in individual children, can knowledgeable assist multidisciplinary problem solving teams in developing effective psychological and educational interventions.

Behavior Rating Scales And Ad/Hd
Specifically, parent reports on the Inhibit scale were significantly associated with hyperactive and impulsive characteristics while the Shift, Working Memory, and Plan/Organize scales were associated with inattentive characteristics.