Letter: A response to Port's column about ADHD diagnosis

As a school psychologist with 31 years of experience working in North Dakota schools, I feel both compelled and qualified to comment on Rob Port’s Dec. 2nd column where he addressed concerns about the diagnosis of ADHD.

When quoting research results from Harvard University, Port states “. . . teachers and other school personnel are more likely than physicians or parents to first suggest that a child may have A.D.H.D.” It appears that Port is implying that teachers and school personnel are overstepping their bounds when they suggest that a child may have difficulties with attention. I believe that placing the observations of school personnel in context will clarify their intent, based on my experiences.

First, teachers have the opportunity to observe children for a number of hours per day during the school week in a controlled, structured setting. They are able to use their training in typical child development to compare a particular child’s behavior both in the context of what is expected at that age level and in the context of the classroom with a number of the child’s peers present to be used for comparison. Concerns about attention cannot be made in isolation, but must be considered in the context of typical child development and in the development of peers.

Second, the cognitive demands of the school day are much different than the cognitive demands of a child’s time at home. During school, the child is expected to display sustained attention, planning, organization skills, the ability to transition between tasks, and the ability to delay gratification at levels and at a sustained duration that are not required in their home environment. As I told parents a number of times, sustained attention for math, reading or any other academic pursuit is much more challenging than brief homework sessions, watching television or playing that parents observe at home. When a child’s cognitive and attention skills are “put to the test” in a school setting, then possible deficits are more readily apparent when comparing them to their classmates. Therefore, school personnel have many more opportunities to observe a child's difficulties than do their child's parents.

Third, in the school districts in which I worked, school personnel never attempted to obtain or advocated with parents for a final diagnosis of ADHD. We fully recognized that deficits in attention can be caused by a variety of factors, ADHD being only one of those factors. Yes, we would suggest to parents that they may want to consider a consultation about their child’s needs with their primary care providers, but we never said that a child had ADHD. To make such a medical diagnosis was far outside the realm of our training.

Finally, it was oftentimes standard practice for physicians to request information from schools when a child was seen for possible attention concerns. Those requests took the form of either anecdotal information or the completion of standardized behavior assessments that were provided by the physician. In making these requests, the physicians recognized the unique perspective that school personnel could provide that could not be obtained in a one-to-one office visit in a clinic. Based on my career experiences, suggestions of possible attention difficulties were never taken lightly.