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Instability in Teacher Ratings of Children's Inattentive Symptoms: Implications for the Assessment of ADHD

Rabiner, David L. PhD*; Murray, Desiree W. PhD; Rosen, Lisa PhD; Hardy, Kristina PhD; Skinner, Ann MEd§; Underwood, Marion PhD

Journal of Developmental & Behavioral Pediatrics: April 2010 - Volume 31 - Issue 3 - p 175-180
doi: 10.1097/DBP.0b013e3181d5a2d8
Original Article

Objective: To examine the cross-grade stability of clinically elevated teacher ratings of inattentive symptoms in 3 samples of elementary schoolchildren.

Participants and Methods: Samples 1 and 2 included 27 first graders and 24 fourth graders, respectively, identified based on clinically elevated teacher ratings of inattentive symptoms. The third sample included 28 children in grades 1 to 4 from the Multimodal Treatment Study of attention-deficit hyperactivity disorder (Multimodal Treatment Study of Children with attention-deficit hyperactivity disorder Study) with a confirmed attention-deficit hyperactivity disorder diagnosis. Teacher ratings of inattentive symptoms were completed an average of 12 to 14 months apart so that cross-grade stability of elevated ratings could be computed for each sample.

Results: In all 3 samples, clinically elevated ratings persisted for less than 50% of children and between 25% and 50% had ratings that declined to within the normative range. The decline in attention difficulties was not related to hyperactivity, oppositional behavior, or anxiety at baseline, nor was it explained by children beginning medication treatment.

Conclusions: Many elementary-aged children rated by their teachers as highly inattentive are not considered to demonstrate these problems the following year, even children with a confirmed attention-deficit hyperactivity disorder diagnosis. The instability in clinically elevated teacher ratings found across 3 independent samples highlights the importance of annual reevaluations to avoid treating children for problems that may no longer be present.

From the *Department of Psychology and Neuroscience, Center for Child and Family Policy, Duke University; †Department of Psychiatry, Duke University Medical Center, Durham, NC; ‡School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX; §Center for Child and Family Policy, Duke University, Durham, NC.

Received May 22, 2009; accepted December 16, 2009.

This manuscript reflects the views of the authors and may not reflect the opinions or views of the MTA 96 Study Investigators or the MTA.

Dr. Rabiner is a consultant for Cogmed, a company that provides a computerized working memory training program to address working memory and attention difficulties. Dr. Murray receives grant funding from Lilly Pharmaceuticals and Ortho-McNeil Janssen Scientific Affairs. These companies had no role in this manuscript.

This investigation was supported by grant R305H050036 from the US Department of Education and by grants R01MH63076 and K02MH73616 from the National Institutes of Health.

Address for reprints: David Rabiner, PhD, Box 90545 Duke University, Durham, NC 27708; e-mail: drabiner@duke.edu.

© 2010 Lippincott Williams & Wilkins, Inc.