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ADHD Evaluations Driven Mainly by Parents, Not Educators, Says CDC Report

The stereotype that overwhelmed teachers are the ones primarily pushing parents to have their children assessed for attention deficit hyperactivity disorder is not borne out by a new report from the Centers for Disease Control and Prevention. 

ADHD is a common childhood behavioral disorder that often lasts into adulthood. Children with ADHD may be overly active, have trouble paying attention, or be prone to impulsive behaviors.

About 65 percent of the time, a family member is the one who first has concerns about a child's behavior, according to a survey of households with children ages 0 to 17. Thirty percent of the time, the concern comes from someone at the child's school or daycare. About 5 percent of the time, the concern came from another individual, like a doctor. The report, Diagnostic Experiences of Children With Attention-Deficit/Hyperactivity Disorder, was released Sept. 3.  

Those percentages varied depending on the child's age at the time he or she was diagnosed. For children 5 or younger—generally younger than school-age—family members were the first ones to spot concerning behavior about three-quarters of the time. For children ages 6 to 15, family members spotted problems first 60 percent of the time, while 30 percent of the first mentions of behavior issues came from teachers. This chart from the report offers more detail on the individuals that family members say were first concerned about their child's behavior. 

adhd_cdc_chart.JPG

"I have heard that same concern, that the increasing rate of ADHD is driven by teachers who are intolerant of behavioral problems in class," said Dr. Susanna Visser, the lead author of the report and lead epidemiologist at the CDC's National Center on Birth Defects and Developmental Disabilities. "I think we have to be very careful and supportive of the relationship between family members and other adults who know the child well."

The CDC survey is intended to find out how closely parent-reported experiences aligned with what the American Academy of Pediatrics says are best practices for diagnosing ADHD. Those best practices include assessing the child's behavior in multiple settings and gathering reports on the child's behavior from parents, teachers, and others involved in the child's care.

Primary Providers Largely Following Guidelines for Diagnosing ADHD

Among the other findings from the survey:

  • The median age for a ADHD diagnosis was 7, and about a third of children was diagnosed before age 6. Most of the children in the survey, about 76 percent, were diagnosed before age 9.
  • Behavior rating scales, which the AAP recommends, were used for about 90 percent of children assessed for ADHD. The survey also found that more than three-quarters of children diagnosed before age 6 and nearly two-thirds of older children diagnosed with ADHD had undergone neuropsychological testing.
  • Neurological imaging or lab tests were used somewhat less for diagnosis—about 30 percent of the time. 
  • About 80 percent of the time, the professional who makes the ADHD diagnosis included the assessments of other adults in the child's life (generally teachers for older children, or childcare providers for younger children). 

Visser said that the overall findings suggest that primary care providers are adhering to the AAP diagnosis guidelines. "We take this as good news," she said. 

Diagnosing ADHD can be a challenge, but Visser said that two strategies work well regardless of the cause of the child's behavioral problems. One is being consistent with discipline, and the second is praising positive behaviors. "They are just magical. They can really change the way the child behaves," she said. 

The CDC's "My Child Has Been Diagnosed with ADHD-Now What?" page goes into more detail on these and other helpful behavior strategies.


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