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Searching for the best approach to assess teachers’ perception of inattention and hyperactivity problems at school

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Abstract

Although major guidelines in the field and current diagnostic criteria clearly demand an assessment of children’s attention deficit/hyperactivity disorder (ADHD) symptoms at school, few studies address the fundamental question of which is the best approach for clinicians to get this information from teachers. Three screening strategies for ADHD were applied to teachers of 247 third grade students. They were asked (1) an overt question about potential cases of ADHD in their classroom; (2) to complete a broad-band questionnaire assessing common child mental health problems; (3) to rate ADHD-specific symptoms in a narrow-band questionnaire. Based on the overt question, teachers identified one in five students (21.1 %) as having ADHD; 28 cases (11.3 %) were identified using standard cut-offs for the narrow-band, and 13 (5.3 %) using a standard threshold for the sub-scale of hyperactivity from the broad-band questionnaire. Agreement among strategies was low (k = 0.28). A subsample of students, clinically assessed to confirm screenings, showed modest agreement with final diagnosis. The narrow-band questionnaire had the best diagnostic performance. Multivariate analysis indicated that the presence of a comorbid externalizing disorder was the only variable associated with teachers’ ascertainment of ADHD caseness or non-caseness. Choice of screening strategy significantly affects how teachers report on ADHD symptoms at school. The halo effect of externalizing behaviors impacts the correct identification of true cases of ADHD in the school setting. Clinicians can rely on narrow-band instruments like the SNAP-IV to get information on ADHD symptoms at school from teachers.

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Acknowledgments

This work was supported by a grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil), 575239/2008-5.

Conflict of interest

Dr Rohde was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. He also received travel awards (air tickets + hotel) for taking part of two child psychiatric meetings from Novartis and Janssen-Cilag in 2010. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Abbott, Eli-Lilly, Janssen-Cilag, Novartis, and Shire. Dr. C. Kieling received two partial travel stipends to participate in ADHD-related meetings from Novartis. Dr. R. Kieling, Dr. Aguiar, Dr. Dorneles and Dr. Costa have no conflict of interest to disclosure.

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Authors and Affiliations

  1. ADHD Outpatient Program (ProDAH) at the Child and Adolescent Psychiatric Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcellos, 2350 - 2201A, Porto Alegre, RS, 90035-003, Brazil

    Renata R. Kieling, Christian Kieling, Ana Paula Aguiar, Adriana C. Costa, Beatriz V. Dorneles & Luis A. Rohde

  2. National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil

    Luis A. Rohde

  3. Postgraduate Program in Education, School of Education, Porto Alegre, Brazil

    Beatriz V. Dorneles

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  1. Renata R. Kieling
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  6. Luis A. Rohde
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Correspondence to Luis A. Rohde.

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Kieling, R.R., Kieling, C., Aguiar, A.P. et al. Searching for the best approach to assess teachers’ perception of inattention and hyperactivity problems at school. Eur Child Adolesc Psychiatry 23, 451–459 (2014). https://doi.org/10.1007/s00787-013-0466-y

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  • DOI: https://doi.org/10.1007/s00787-013-0466-y

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