Teacher Agreement on Symptom of Inattention and ADHD

There has been almost as much excitement in the ADHD community regarding a new study by Duke University researchers that has found that elementary school age students with ADHD may not have symptoms of ADHD when evaluated a year later as their has been in the general community to the Duke University basketball championship. The study can be found here.

The researchers asked the teachers of some ADHD students in first grade and some ADHD students in 4th grade to rate these students level of inattention. Twelve to fourteen months later, their current teachers again evaluated the students for inattention. The two teachers disagreed about the severity of the inattentive ADHD symptoms about 25%-50% of the time.

One of the authors of the study, which is entitled Teacher Ratings of Children's Inattentive Symptoms: Implications for the Assessment of ADHD, reported that, “ADHD is generally regarded as a chronic condition and it certainly persists over the long term for many children. However, our findings highlight that many children with significant attention difficulties during one grade do not show these problems at school the following year, even children who have been carefully diagnosed with ADHD.

The authors of the study reported that children diagnosed in school with ADHD might improve in a more organized classroom or in class with fewer disruptive classmates. They concluded that children should be evaluated yearly lest their ADHD symptoms have unknowingly improved and they be given medication or other remediation that is no longer necessary.

I should be ecstatic about this findings but I am not. The reason is this. We know from age-old studies that it is unlikely that any two teachers will agree on the severity of a child's ADHD symptoms. Parent and teacher agreement is even worse. In 30% to 50% of cases parent and teacher will not agree upon the ADHD symptoms of a child. A study done in 1987 reported that, ”The degree of agreement between parents and teacher for any dimension of child behavior is modest, often ranging between .30 and .50 (Achenbach, McConaughy, & Howell, 1987).

The authors of the study found clinically elevated ratings persisted for less than 50% of children and between 25% and 50% had ratings that declined to within the normative range when evaluated one year later by their new teachers.

My contention is that the Duke researchers would have seen these improved findings after 5 days or any minimal amount of time because the teacher disagreement is a constant and has nothing to do with a child's improvement and more to do with they teacher's idea of what is clinically significant ADHD inattention.

The philosophical implications of these finding are interesting in their own right. Currently if teacher and parent agree that the child has ADHD symptoms that are so severe that they are impairing learning, the child is started on medication or on some other ADHD treatment. If, as documented, two teachers disagree so consistently, we may want to consider a less arbitrary method of diagnosis than what we are currently using. It may make much more sense to rely more on less subjective ADHD tests such as Quotient™ ADHD System. There is information on that test here.

Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.