Many elementary-aged children with clinically elevated attention problems in one grade no longer demonstrate these problems the following year in their new classroom, according to a study led by researchers at Duke University.
The findings underscore the importance of annually reevaluating children diagnosed with attention disorders such as Attention Deficit Hyperactivity Disorder (ADHD) to avoid treating them for problems at school that may no longer be evident, said David Rabiner, lead author of the study and a faculty member in Duke's Department of Psychology and Neuroscience and Center for Child and Family Policy.
The research, published online March 17 in the Journal of Developmental and Behavioral Pediatrics (http://journals.lww.com/jrnldbp/Abstract/publishahead/Instability_in_Teacher_Ratings_of_Children_s.99910.aspx), looked at three independent samples of elementary school children. Two samples -- 27 first-graders and 24 fourth-graders, respectively -- consisted of children rated as highly inattentive by their teacher but who did not have a formal ADHD diagnosis. The third sample consisted of 28 children in grades first through fourth who had been diagnosed with ADHD.
In each sample, teacher ratings of inattentive symptoms were completed in successive years -- roughly 12 to 14 months apart -- so that the stability of clinically elevated ratings from one grade to the next could be examined.
In all three samples, clinically elevated ratings persisted for less than 50 percent of children, while between 25 percent and 50 percent had ratings that declined to within the normal range. Especially striking was that roughly 30 percent of children reported as showing at least six teacher-rated inattentive symptoms during one year were rated with no symptoms the following year. These declines could not be attributed to children beginning medication treatment, according to the report.
The authors said the study was not designed to determine why teacher reports of attention problems decline substantially for many children, but rather to examine the stability of clinically elevated inattentive symptoms at school from one year to the next.
One possibility they suggested was that attention problems at school may result from classroom factors such as poor organization and a high concentration of disruptive classmates, rather than reflecting an enduring attribute of the child. If children enter a better-organized classroom the following year, they are able to stay more focused and attentive, researchers said.
"ADHD is generally regarded as a chronic condition and it certainly persists over the long term for many children," Rabiner said. "However, our findings highlight that many children with significant attention difficulties during one grade do not show these problems at school the following year, even children who have been carefully diagnosed with ADHD."
Authors of the study stressed that their findings in no way imply that significant attention problems in children are simply "in the eye of the beholder" or that ADHD is not a real disorder. However, they emphasized that if children diagnosed with ADHD are not re-evaluated each year, some may continue to be diagnosed with a condition that no longer applies and receive medication treatment for problems at school that are no longer evident.
Other researchers involved in this study were professors Desiree W. Murray and Kristina Hardy from the Department of Psychiatry at Duke University Medical Center; Ann Skinner, also from Duke's Center for Child and Family Policy; Lisa Rosen and Marion Underwood from the School of Behavioral and Brain Sciences at the University of Texas at Dallas.
The study, which is scheduled for print publication in April, was funded by grants from the U.S. Department of Education and the National Institutes of Health.