New School Standards May Boost Odds of ADHD Diagnosis

Increased emphasis on performance means kids under more scrutiny, study suggests

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By Serena Gordon
HealthDay Reporter

FRIDAY, April 7, 2006 (HealthDay News) -- Certain factors in a child's social and school environment may play a large role in whether or not attention-deficit hyperactivity disorder (ADHD) is diagnosed.

One such factor may be whether your school has strict accountability standards designed to improve students' academic performance, reports a new study in the April issue of Pediatrics.

"School standards may have unintended consequences, but it's difficult to say whether there's a positive or negative relationship between accountability laws and ADHD diagnosis," said study author Helen Schneider, a visiting professor in the department of economics at the University of Texas at Austin.

"For example, it may be that teachers are more motivated to report problems when there is accountability. But, it also might encourage parents or teachers to treat children with drugs rather than to address other aspects of behavioral problems," she explained.

The National Institute of Mental Health estimates that between 3 percent and 5 percent of school-age children in the United States have been diagnosed with attention-deficit hyperactivity disorder. That means in the average classroom, there will likely be at least one child with the disorder, according to the institute. ADHD is characterized by an inability to pay attention or to focus on a task for any length of time.

Dr. F. Xavier Castellanos, director of the Institute for Pediatric Neuroscience at the New York University Child Study Center, said he believes that most estimates of ADHD's prevalence are probably too low, and that the disorder often goes undiagnosed.

One reason that may happen, he said, is that it's usually a teacher who first notices ADHD, and some teachers "are very apprehensive about having a conversation with parents to explain that their child is struggling and that it may be ADHD. There's a lot of reluctance to have that conversation," he explained.

That may be why school accountability standards are having an affect on the incidence of ADHD diagnosis.

Schneider designed her study to look at the different factors, such as school accountability, that are independently associated with children being diagnosed with ADHD.

The researchers estimated the "relative risk" of being diagnosed with ADHD by using information from the Early Childhood Longitudinal Survey - Kindergarten Cohort. They included data from 9,278 children from the time they began kindergarten through the third grade.

During that time, just under 6 percent of the children were diagnosed with ADHD. As has been reported in previous studies, some of the biggest risk factors for ADHD are being male, being white, having U.S.-born parents, and having been born in the summer months.

The researchers also found that having an older teacher made the diagnosis of ADHD more likely, as did having a nonwhite teacher.

"The contribution that we made to the literature was in concentrating on school policies and accountability laws," said Schneider. "We found the stricter the accountability laws, the higher the odds were of being diagnosed."

Castellanos said school accountability laws may start to mitigate some of the startling differences in the rates at which ADHD is diagnosed in different racial groups. He said it's not that only white children have the disorder, but that they're the ones currently being diagnosed.

"This isn't only happening in ADHD. Minorities are less likely to have heart disease detected. It's not that they're not having heart attacks," he said, but that it's not being diagnosed early enough. Why that's happening in heart disease, ADHD and other disorders isn't always clear, he said.

But school accountability may start to increase the diagnosis of ADHD in other groups. "The schools under the greatest pressure from these laws tend to be those with minority populations," Castellanos noted.

More information

To learn more about diagnosing ADHD, read this information from the American Academy of Pediatrics.

SOURCES: Helen Schneider, Ph.D., visiting professor, department of economics, University of Texas at Austin; F. Xavier Castellanos, M.D., director, Institute for Pediatric Neuroscience, director, research, New York Univeristy Child Study Center, Brooke and Daniel Neidich professor of child and adolescent psychiatry, and professor, radiology, New York University School of Medicine, New York City; April 2006 Pediatrics

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