Term Paper: Attention Deficit Hyperactivity Disorder

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[. . .] Because teachers are often the first ones to recognize the symptoms of ADHD, it is essential for them to draw upon a current and accurate knowledge base as they interact with parents, physicians, and other professionals (Busch, 2003)."

"Teachers play their most crucial role before any diagnosis is actually made by the family physician, psychiatrist, or pediatrician (Busch, 2003). According to Weber et al. (1992), children who are suspected of having ADHD are initially identified because of their behavioral and academic performance in the classroom. Studies conducted in schools repeatedly report the same sequence of events for many children referred for suspected ADHD. Teachers become aware of the students' difficulty in meeting the behavioral, attentional, and academic norms for the class and suggest the possibility of ADHD to parents (Pearcy, Clopton, & Pope, 1993; Runnheim et al., 1996; Weber, et al., 1992). Parents are concerned about their child's academic performance and behavior in the classroom and follow through with a referral to a physician (Busch, 2003). Referred students are frequently diagnosed as having ADHD by the physician based on reports from the teachers and parents. Kwasman et al. (1995) reported that 39% of physicians telephoned the schools of children who had been referred for ADHD and 77% attempted to obtain a written report from the school (Busch, 2003). In the absence of independently valid tests for ADHD (NIH Consensus Statement, 1998), teacher referrals have become a significant factor in determining whether a child will be diagnosed with the disorder. If a teacher informs parents that the child should be evaluated for ADHD, that teacher is also likely to rate the child high on characteristics associated with the disorder. As a result of this circular procedure, children diagnosed with ADHD are viewed as having a medical disorder that must be treated by a physician (Busch, 2003). "

School nurse assessment tools can assist in the reduction of any circular diagnosis that may be caused by the teacher's feelings about the student by the time he or she is asked to complete an assessment form.

'Because teachers play such a pivotal role in the identification and treatment of ADHD, they need to be knowledgeable. However, past studies have revealed that special education teachers received little or no training on ADHD or issues related to stimulant drug therapy (Kasten, Coury, & Heron, 1992; Reid et al., 1994), and more recent studies suggest that this is still the case (Busch, 2003)."

This study strengthens the need for the development of a tool for assessing possible ADHD in students that can be used by school nurses .

One study examined teacher ability to recognize potential ADHD in the classroom. The study used a four part survey that was developed to explore not only the teacher knowledge about ADHD but also their opinion about the disorder.

"However, it was uniquely designed around the specific research questions to reflect current knowledge about the nature of ADHD and treatment with stimulant medications (Busch, 2003). The survey began with eight demographic questions. The remaining three parts of the survey consisted of statements to which teachers were asked to respond using the 5-point Likert-type scale. Part A of the survey consisted of 13 items to assess factual knowledge about ADHD and the use of stimulant medication (Busch, 2003). Although Part A assessed factual information, a Likert-type scale was used rather than a true / false format for two reasons: (a) to provide consistency in format throughout the survey and (b) to increase the probability that responses reflected knowledge (or lack of knowledge) rather than guessing. Part B consisted of 23 items that asked participants to indicate their views about the effects of stimulant medication on classroom behavior (Busch, 2003)."

Four hundred surveys were sent with a return rate that was 36%.

"The teachers had a mean of 16.5 years of experience (SD = 9.46) and a range of 1 to 36 years as a teacher. Fifty-two respondents had more than 20 years of classroom experience (Busch, 2003). There were no significant correlations between years of experience and answers to items. All respondents indicated that they had experience with students who had been diagnosed with ADHD (Busch, 2003)."

" Responses were determined to be correct on the basis of the NIH Consensus Statement (1998). Only 5 out of 13 items were answered correctly by more than half of the responding teachers. To determine whether the mean differences were significant between general and special educators, an analysis of variance (ANOVA) comparing means was completed (Busch, 2003). There were no statistically significant differences between general and special educators (Busch, 2003). "

The results of this study indicate that teachers have less knowledge about ADHD then was previously thought. In addition this study flies in the face of another study concluding teachers had a solid knowledge of the topic. It is important to provide an standard and universally applicable tool for the assessment of ADHD students.

The hallmark symptoms of ADHD are different for each subtype. What can further complicate the matter is that the symptoms are also common to appropriate stages of childhood development.

The above chart underscores the problem with identifying potential ADHD students when one factors in the subjective ness of the symptom list.

The importance of designing an assessment tool for school nurses in the search for ADHD students is strengthened by the known negative impact that the disorder can have on the student's self-esteem and consequent behavior patterns (Reason, 1999).

"Children's happiness and success depend on their constructive response to the expectations of family, friends, and school. These expectations, to a greater or lesser extent, derive from the goals held in common by a community. In setting these goals, a community imposes significant demands on children's psychological resources (Reason, 1999). Given their cultural origin, it is no surprise that many of these demands, and the expectations from which they derive, vary from community to community. Children growing up in a postindustrial society are faced with a host of demands, some of which are shared by other communities, while others are specific to that society (Reason, 1999). For instance, formalized education imposes a whole range of requirements, including compliance, focused concentration, and the willingness to listen and reflect. The hurdles set by the education system are partially a function of modern society's emphasis on competition and achievement (Reason, 1999)."

Difficulties meeting the demands can have a range of negative impacts on the child's educational path.

There are a large number of children currently diagnosed with ADHD. It does not discriminate against age, race or economic standing as it impacts schools nationwide.


Statistically children from poverty stricken families and intercity areas are more likely to be diagnosed than children of affluence and upper middle America. This knowledge should also serve as a prompt to assess as early as possible and to be especially aware of children displaying possible symptoms who also fit the demographic profile of the disorder.

"The results of a study on Attention Deficit Hyperactivity Disorder (ADHD) suggest it is not practical to administer a wide range of neuropsychological tests in order to evaluate ADHD (Rosselli, 1999). Tests assessing attention, memory, visuoconstructional abilities and executive function may be included. It is also suggested that tests assessing primary cognitive functions and other complementary tests may also be added (Rosselli, 1999)."

Certain portions of IQ testing have proven to be lower in the ADHD population than in the control groups. "Some results deserve further investigation. Despite a normal score on the WISC-R Vocabulary subtest, and higher scores on the Similarities and Comprehension subtests, children with ADHD significantly under-performed on the Token Test, another language comprehension test. The Token Test, however, assesses more than language understanding alone. Attention may be important, as well as verbal span memory and the ability to follow verbal commands. Therefore, we propose that the low scores of children with ADHD observed in this test may have not been due to a deficit in language understanding, but rather to an attentional deficit and an inability to follow verbal commands. It is well-known that the inability to follow verbal commands represents a significant defect in ADHD (American Psychiatric Association, 1994)."

The memory test results have intrigued experts in the field in particular. Tests show that they can store and retrieve information as well as no ADHD students, however more attempts to retain the information, both verbal and non-verbal.


The importance of a nursing assessment tool can be easily defined. A nursing assessment tool for the assessment of ADHD will provide a standard of assessment that can be followed nationwide. Teachers interact with the students on a daily basis. They have the potential to develop preconceived ideas about the children in their classrooms. If the child is ADHD and disruptive the teacher may develop a dislike for that student. In addition the teacher may view all disruptive kids as… [END OF PREVIEW]

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