Can the Physician Diagnose Hyperactivity in the Office?

Abstract

Office diagnosis of hyperactivity can present a problem to the pediatrician because only about 20% of the potential patients show hyperactive behavior during office examination. Exclusion of the children who appear normal in the physician's office can eliminate from medical treatment a large number of patients for whom treatment is appropriate. Eighty percent of the children ultimately accepted into the project on the basis of home and school reports showed exemplary behavior and no sign of hyperactivity in the office. Nonetheless, at a three-year follow-up, these children were rated the same as those who were obviously hyperactive in the presence of the pediatrician. The groups appeared no different on school grade, teachers' ratings of classroom behavior, amount of stimulant medication prescribed, or duration of drug treatment. The reported outcome data indicate that the physician can have confidence in historical information from the parents combined with current teacher reports as reliable aids in the diagnostic process with hyperactive children.

An evaluation of the validity of the diagnostic category of attention deficit disorder.

“…In that case the ADD and ADDH samples in this study would be an ar tifact of the circumstance that hyperac tive children often do not display inap propriate behavior during a one-to-one interview with a clinician. 51 Accounting in this manner fo r this study's failure to find diffe rences between groups labeled ADD and ADDH in essence argues that there exist two groups of troubled chil dren , those who have ADD and those who have ADDH, but that frequently only the behavior of the ADDH children is inappropriate enough to cause them to be referred fo r clinical treatment. Hence, separating those re f erred chil dren into groups labeled ADD and ADDH is misleading.…”

Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms.

“…Yet measurement issues cloud the viability of these findings, in that initial aggression was indexed by behavior ratings from the psychologists who performed the cognitive testing. Such individualized appraisals of externalizing behavior in the laboratory, doctor's office, or testing room are not sensitive indicators (see, for example, Sleator & Ullmann, 1981). Because more valid indexes might have altered the paths, the unidirectional link of Schonfeld et al from verbal deficits to conduct disorder should be viewed cautiously.…”

Incremental Validity in the Psychological Assessment of Children and Adolescents.

“…Lobitz and Johnson (1975) found that parent reports of young children's behavior problems were able to correctly classify 90% of clinic-referred children and 90% of nonreferred children, and neither lab-based nor home observations of child behavior added much to this prediction. Similarly, in a classic study of ADHD, Sleator and Ullman (1981) demonstrated that observations of behavior in a physician's office often failed to agree with parent and teacher reports and did not aid in the prediction of future problems. In fact, Sleator and Ullman cautioned that overreliance on observational data may actually interfere with the accuracy of the diagnostic process.…”