Correct detection of attention-deficit hyperactivity disorder (ADHD) is imperative because early detection helps direct individualized management.  DSM-IV criteria for diagnosing ADHD depend on the observation of individuals who interact most with the child.  In the past, the diagnosis was made mostly from the history provided by parents.  Now, a diagnosis of ADHD requires that symptoms must be present in more than one setting.  Teachers’ input has become critical.  This study investigates the frequency and extent to which teachers and parents agree on a child’s symptoms, and whether disagreements about symptoms have reduced the apparent prevalence of ADHD. 

Of 6171 elementary school students screened, teachers identified 1573 with high risk for ADHD.  Follow-up parent interviews and standardized questionnaire information from teachers were collected on 213 of these children. 

When comparing parent and teacher agreement on the criteria of ADHD (having six or more symptoms of inattention or hyperactivity/impulsivity and performance impairment), there was poor agreement.  The presence of disagreement was compared to whether the child had a diagnosis of ADHD (measured by whether the child was prescribed stimulant medication).  When the two-setting criterion was strictly enforced (symptoms at home and school), the diagnosis of ADHD decreased.  The diagnostic rate of inattentive type of ADHD decreased from 15% to 5%; the rate of  hyperactive/impulsive type decreased from 11% to 3% and the combined type of ADHD decreased from 23% to 7%.  Lack of agreement between parents and teachers was not associated with the child’s race. 

(Wolraich ML, et al.  J Develop Behav Pediatr 2004; 25(1):41-47.)

Comment:  Let’s hope that having to have two settings with symptoms is the correct way to diagnose ADHD. Otherwise, we will be under-diagnosing this in the future.   – H.T.