Some Words of Caution From a School Psychologist

1. Are diagnoses of "ADHD" carefully done? Short answer: No, almost never. Why? Let's start with the much encouraged private practice assessment.
a. Classroom observation: These are almost never done by private practitioners because the cost is prohibitive. Parents must demand classroom observationS. The "average" unsophisticated private practitioner completing an "ADHD" assessment does not know what to look for. Instead, they rely on checklists completed by teachers, and parents. They often consider just the teacher checklist. Why is a checklist not the equivalent of a classroom observation? For one thing, most checklists are symptom focused. Problems with attention and activity are frequently caused by ecology (teaching practices, class environment - temperature, acoustics, size, sound-proofing, etc.). Checklists do not evaluate problems not related to symptoms. Teacher personality and teaching style can only be evaluated by observation. The presence of an observer changes behavior during a single observation because something (someone) new is in the room. Hence, multiple observations are necessary to get a true picture. The observer must note how many times the teacher calls on the child that is being evaluated because children that are never called on tend to loose interest (not "pay attention"). The observer, after several observations, needs to request that the teacher call on the child being evaluated in order to determine whether the child is paying attention. This needs to be done several times to get a true picture of whether the child can pay attention. One response to a teacher question is never enough.
b. Performance tests. Many private practitioners administer performance tests. One of these is the CPT, or Continuous Performance Test. School psychologists (even recent graduates) question the validity of such tests for a number of reasons. One is that they are boring as H-E double hockey sticks. A second reason is that they do not come close to duplicating real educational tasks. A third is that they are administered in an office, not a classroom. The clever private practitioner will claim that these tests are valid and reliable because they have been standardized. There needs to be a question concerning validity if they are not ecologically sound.
c. Interviews. Interviews are one of the most important aspects of assessment. They are discouraged as an information source in the assessment of "ADHD" because research has shown that 50% of children do not agree with the symptom description provided by teachers and parents. This is a significant problem because it implies that only teachers and parents tell the truth. It also implies that the patient lies about symptoms. Finally, it also suggests that the only purpose of interview questions is to determine symptoms. There are many ecological factors that only a child can reveal in an interview. One important line of inquiry involves sleep. Sleep problems have been misdiagnosed as "ADHD" in as many as 50% of the cases. Sleep problems (sleepiness) causes hyperactivity and inattention in children. It seems odd, but many practitioners will counter this by saying just the opposite: "'ADHD' causes sleep problems." There are ways to treat and investigate sleep problems before making an "ADHD" diagnosis. Parents cannot respond to many questions about sleep simply because they are sleeping when a child experiences the problem. Teachers cannot respond to these questions for obvious reasons. There are more concerns that only a child can address during an interview. Private practitioners must interview the child, AND report responses in an evaluation.
d. Brain Scans. Brain scans are actually brain scams. That is the short of it. Very few practitioners do these. Dr. Jay Gied, of the Child Psychiatry Branch of the National Institutes of Mental Health (NIMH) said this in a very erudite (educated and thoughtful) way when writing in a recent issue of Archives of General Psychiatry. The latest nonsense in this regard concern SPECT Scans, positively presented in a recent issue of Newsweak magazine, and structural size, presented as a variation in the size of the cerebral vermis by Dr. Teicher of the Harvard Medical School. Dr. Gied described that variations in the size of brain structures are caused by any number of factors including gender, development, quantity of support cells (glia, astrocytes, etc.), arborization (numbers of dendrites - cell structures), etc. He also revealed that SPECT Scans lack specificity. That is - investigations have revealed that they do not adequately differentiate "ADHD" brains from normal brains because normal brains have never been adequately evaluated. It would be unethical to do so because SPECT Scans use radioactive isotopes. By the way, would you risk the use of radioactive material to test your child? I also think that it is important for parents to know how to respond to the frequently made statement about their child's brain, when the practitioner says that s/he has "ADHD."
Practitioner: "Your child has a chemical imbalance in her/his brain."
This is how a parent that I worked with responded:
Parent: "Do a medical test to show me that."
Practitioner: "It is very expensive."
Parent: "I have lots of money. I'll pay for it."
Practitioner: "Your son will have to have a painful spinal tap."
Parent: "My son has a high tolerance for pain. Go ahead with the test."
Practitioner: "Oh, all right. Those tests are just experimental."
That was a real dialogue.
2. School evaluations of "ADHD." These are even worse than the private practice evaluations. When you think about things that I and others present, you will realize that "ADHD" is not a disease or disorder - it is fraud perpetrated on the public. If you, the reader, wants me to spend time writing a little about this, e-mail me.

Please note that I am not trying to drum up business for myself. I have more than I can handle. I just want the public to be extremely cautious about this stuff.

About me (briefly):

Steve Edelman, Licensed Psychological Associate, Licensed School Psychologist (North Carolina)
Member: National Association of School Psychologists (NASP)
Psi Chi (The National Honor Society for Psychology)
Fulbright Memorial Fund, Teacher Grant Recipient, 1997 Studied schools in Matsuyama and Imabari, Japan.
Employed by: Cumberland County Schools (Fayetteville, North Carolina)
Carolina Psychological Associates, LLP (Fayetteville, North Carolina)
Psychologist since: 1977.