New School Standards May Boost Odds of ADHD Diagnosis
Increased emphasis on performance means kids under more
scrutiny, study suggests
By Serena Gordon
HealthDay Reporter
(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.
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