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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD): A NATIONAL SURVEY
OF TRAINING AND CURRENT ASSESSMENT PRACTICES IN THE SCHOOLS
MICHELLE KILPATRICK DEMARAY
Northern Illinois University
KATHERINE SCHAEFER
Virginia Commonwealth University
LAUREN K. DELONG
Northern Illinois University
The primary purpose of this research was to survey school psychologists to investigate their
training and current assessment practices for attention-deficit/hyperactivity disorder (ADHD) in
the schools. The survey consisted of 38 questions regarding participant characteristics and three
main areas relevant to ADHD: (a) training, (b) caseloads/referral patterns, and (c) assessment.
The respondents reported receiving adequate training in the assessment of ADHD, with doctorate-
level psychologists self-reporting being better trained than nondoctorate psychologists. Results
confirmed a substantial caseload of ADHD referrals. In the assessment of ADHD, the results
indicated school psychologists are using multiple informants, methods, and settings for the assess-
ment of ADHD with rating scales, observations, and interviews the most common methods
identified. Limitations of current practices will be discussed. © 2003 Wiley Periodicals, Inc.
Approximately 3–5% of the childhood population is estimated to have attention-deficit/
hyperactivity disorder (ADHD) (Barkley, 1998). This statistic makes ADHD one of the most
frequent referrals to school psychologists and mental health clinics (DuPaul & Stoner, 1994).
Although many researchers have identified best practices or practice parameters for the assess-
ment of ADHD (American Academy of Child and Adolescent Psychiatry, 1997; American Acad-
emy of Pediatrics, 2000; Atkins & Pelham, 1991; Barkley, 1998; National Institutes of Health,
1998), published research investigating the actual assessment practices of school psychologists
for ADHD is lacking. Surprisingly, “only a handful of studies have examined the realities of
ADHD in the schools” (Reid, Reason, Maag, Prosser, & Xu, 1998, p. 56). Furthermore, survey
research investigating the actual measures and methods used by psychologists is unavailable
(Barkley, 1998).
Because of the high incidence of referrals to psychologists for the assessment and treatment
of ADHD (e.g., one child per every classroom), and the academic and social difficulties children
with ADHD often experience in schools, school psychologists are in an ideal position to be actively
involved in the assessment and treatment of ADHD (Power, Atkins, Osborne, & Blum, 1994).
Because school psychologists will be expected to assess and treat children with ADHD (Reid
et al., 1998), it is important to understand their current training and assessment practices.
Despite the existence of empirical evidence regarding the assessment of ADHD by clinical
psychologists and physicians, there are no studies based solely on school psychologists’ assess-
ment practices of ADHD assessment. The few studies that do include school psychologists as part
of the sample usually group them together with clinical psychologists, and are outdated (Rosen-
berg & Beck, 1986; Ullman & Doherty, 1984).
Many researchers and practitioners have identified best practices or practice parameters for
the assessment of ADHD across a variety of professions (American Academy of Child and
Adolescent Psychiatry, 1997; American Academy of Pediatrics, 2000; Atkins & Pelham, 1991;
Correspondence to: Michelle Kilpatrick Demaray, Department of Psychology, Northern Illinois University, DeKalb,
IL 60115. E-mail: mkdemaray@niu.edu
Psychology in the Schools, Vol. 40(6), 2003 © 2003 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.10129
583
Barkley & Edwards, 1998; Brock, 1997; DuPaul & Stoner, 1994; Landau & Burcham, 1996;
National Institute of Health, 1998; Shelton & Barkley, 1994). A thorough discussion of the best
practices associated with the assessment of ADHD is outside the scope of this article. Interested
readers are referred to the more thorough above-cited sources. However, a very brief description
of the methods that may be used in the assessment of ADHD will be described below.
It is often cited as best practice for school psychologists to employ the consultative problem-
solving model (Landau & Burcham, 1996) and functional analysis of behavior (Boyajiam, DuPaul,
Handler, Eckert, & McGoey, 2001; Northup & Gulley, 2001) when working with parents and
teachers to assess and develop interventions for a child ADHD. The goals of assessment ofADHD
behaviors in schools should be clearly linked to interventions. In addition, assessments should
include multiple raters, multiple methods, and cross-multiple settings (Landau & Burcham, 1996).
The most commonly cited specific methods of assessment for ADHD include rating scales,
interviews, and direct observations (Gordon & Barkley, 1998, Shelton & Barkley, 1994). Psycho-
logical tests (e.g., cognitive tests, achievement tests) may be used in detecting comorbid dysfunc-
tion (e.g., learning disabilities), but are not deemed valid solely for the assessment of ADHD
(Brock, 1997; Gordon & Barkley, 1998). Neuropsychological tests are sometimes used to assess
for the core symptoms of ADHD. Although a wide range of neuropsychological measures may be
used, one of the most common is the continuous performance test (e.g., Connor’s Continuous
Performance Test; Connors, 1995). These tests typically measure vigilance and sustained attention
as well as impulsivity. Although research has demonstrated the ability of these measures to dis-
criminate children with ADHD from children without ADHD and to be sensitive to medication
effects (Barkley, 1998), there are concerns about their ecologically validity (Landau & Burcham,
1996) and possible false negatives (DuPaul, Anastopoulos, Shelton, Guevremont, & Metevia,
1992). Also, it is recommended that children suspected of having ADHD obtain a medical exam-
ination in the assessment process to provide a differential diagnosis of ADHD from other medical
conditions (American Academy of Pediatrics, 2000; Barkley, 1998; Brock, 1997).
Purpose of Current Study
Because ADHD is currently one of the most frequent referrals to school psychologists (DuPaul
& Stoner, 1994), it is apparent that the need for assessments of ADHD in the school setting will
continue to increase in the future. Although there are a variety assessment techniques and best
practice recommendations for ADHD, the actual assessment practices and training of school psy-
chologists remains unknown. Therefore, the current study sought to collect information on (a)
school psychologists’ training in the assessment of ADHD, (b) school psychologists’ caseloads
and referral patterns for children with ADHD, and (c) the specific methods/measures school psy-
chologists are currently using in the assessment of ADHD.
Method
Participants
Four hundred seven school psychologists (40.7%) returned the survey. The respondents con-
sisted of 302 females (74.2%) and 100 males (24.6%) (with one participant’s gender missing .3%).
Participants’ ages ranged from 25 to 74 years, with a mean of 43.6 years. Of the 407 respondents,
39 (9.6%) reported they were not currently practicing school psychology and were not included in
further analysis. In addition, 52 respondents (12.8%) who reported they do not provide assess-
ments for ADHD in their current positions were removed from further data analysis. Therefore, a
total of 316 participants (31.6% of total sample surveyed) were included in the sample to ensure
that the respondents were practicing school psychologists that actually assess for ADHD in their
584 Demaray, Schaefer, and DeLong
work settings. See Table 1 for more information on the participants’ gender, ethnicity, years of
experience, and degree.
Materials
The survey was a four-page questionnaire (37 questions) developed by the authors to obtain
information regarding participant characteristics (seven questions) and three main areas relevant
to ADHD: (a) training (six questions), (b) case loads/referral patterns (five questions), and (c)
assessment (17 questions). Two questions were also asked on treatment; however, they were not
included in the current article. It was estimated to take approximately 20 minutes to complete the
survey.
The items for the questionnaire were chosen based on a review of the current assessment of
ADHD. For example, when asked what rating scales the participants used to assess for ADHD,
lists of ratings scales often discussed in the literature for this purpose were included as response
options. In addition, participants were given the option of writing in another response if none of
the specific response options were applicable to them. Several different formats (e.g., Likert-scale
ratings, open-ended questions, and checklists) were used to obtain the desired information.
Table 1
Participant Characteristics and 1999 NASP Membership Data
Current Study NASP 1999
N%%
Gender
Female 228 72.2 72.3
Male 87 7.5 27.7
Missing 1 .3 Not Reported
Ethnicity
African-American 2 .6 2.1
Asian-American 6 1.9 .9
Hispanic-American 4 1.3 3.1
Native American 1 .3 .4
White 301 95.2 92.0
Missing or other 2 .6 1.4
Yrs of Experience
1–5 87 27.5 30.6
6–10 55 17.4 16.2
11–15 56 17.7 15.1
16–20 63 20.0 17.7
21–25 30 9.5 9.0
More than 25 20 6.3 11.4
Missing 5 1.6 Not Reported
Degree
BA, BS 0 0 4.4
Masters or Masters ⫹98 31.0 51.5
EdS (Specialist) 136 43.0 15.1
EdD, PhD, PsyD 72 22.8 25.5
Other 10 3.2 3.5
ADHD: A National Survey 585
The survey was given to two practicing school psychologists to review the survey for ease of
completion and clarity of questions before mailing. Their feedback was incorporated into the
measure to increase the reliability and validity of the responses. In addition, based on completed
surveys, it appeared that the majority of participants understood and completed the questionnaire
correctly.
Procedure
The survey was sent in April 1999 to 1,000 school psychologists selected at random from
membership in the National Association of School Psychologists (NASP). A letter explaining the
purpose of the study and requesting voluntary participation was sent with the survey along with a
postage-paid return envelope. No additional prompts or reminders were sent to the participants.
The only method used to encourage completion of the survey was an explanation to participants in
the cover letter that one respondent would be chosen at random to receive a free book on the
assessment of ADHD. When all surveys were returned, one respondent was chosen at random and
did receive a free book on ADHD. In addition, upon completion of the survey, only those partici-
pants who responded were sent a postcard listing a Web site for them to obtain results of the
survey.Answers to questions on the survey were coded and entered into the database for analyses.
For the open-ended questions, respondents’ responses were coded into broad categories and entered
into the database.
There were three open-ended questions on the survey that were identified as being suscepti-
ble to extreme scores or outliers. These questions were regarding the number of yearly referrals for
the assessment of ADHD, the number of workshops and courses attended during formal education,
and the number of workshops and courses attended during the last 5 years. Responses for each of
these three items that were four or more standard deviations above the mean were removed from
subsequent analyses. A total of 11 responses across these three questions were identified and
deleted.
Results
Training
Information was gathered on participants’ formal training (e.g., workshops, courses) during
and after graduate training. Furthermore, participants were asked to self-report how well trained
they felt in the assessment of ADHD. During their formal education 113 participants (35.8%)
reported attending workshops on the assessment of ADHD (number of workshops ranged from 0
to 10, M⫽.97). Eighty-nine participants (28.2%) reported taking courses on ADHD during their
formal education (number of courses ranged from 0 to 4, M⫽.46). Participants were also given an
opportunity to self-report any other modes of training during their formal education. The three
most common modes of training that were self-reported via participants in the “other category”
were (a) training as part of a course (n⫽42, 13.3%), training during their internship (n⫽12,
3.8%), and (c) independent research or reading (n⫽7, 2.2%).
During the last 5 years (or since graduation) the majority of participants, 277 (87.7%), reported
attending workshops on the assessment of ADHD (number of workshops ranged from 0 to 20, M⫽
4.69). A few participants (n⫽25, 7.9%) reported taking courses on ADHD since graduation
(number of courses ranged from 0 to 3, M⫽.12). Participants were again given the opportunity to
list any “other category” of training they have received in the last 5 years. The only other signif-
icant mode of training self-reported by participants was independent reading and/or research by
56 participants (17.7%).
586 Demaray, Schaefer, and DeLong
Participants were asked four questions using a five-point Likert-scale asking them to self-
report how well trained they felt in the assessment of ADHD (1 ⫽low or not well trained and 5⫽
high or well trained). These questions were: (a) How beneficial their overall training in the assess-
ment of ADHD has been for their practice, (b) How well trained they feel in providing a thorough
assessment of ADHD, (c) How well trained they feel in providing a diagnosis of ADHD, (d) How
well trained they feel in the assessment of ADHD for educational interventions or special educa-
tion verification (e.g., Other Health Impaired), and (e) How well trained they feel in providing
treatment (e.g., educational interventions, consultation, etc.) for children with ADHD. See Table 2
for the results of these questions.
Participants were grouped into two categories according to their highest degree obtained,
nondoctorate (n⫽244) and doctorate (n⫽72), to compare their training experiences (workshops
and courses on ADHD) and perceptions of how well trained they are on the five previously men-
tioned questions by degree (nondoctorate vs. doctorate). The nondoctorate group consisted of
school psychologists with a Masters degree or a Masters degree plus additional graduate credits
(n⫽98), a Specialist degree (n⫽136), and other (n⫽10). The doctorate group consisted of
individuals with a doctoral degree (i.e., EdD, PhD) (n⫽71) and a PsyD degree (n⫽1). The means
and standard deviations for each of the five training questions are listed for both of the groups in
Table 2. Interestingly, doctorate-level school psychologists did not report any more attendance at
Table 2
School Psychologists’ Self-Assessment of Training, Caseloads, and Assessment of ADHD
for Total Participants and by Degree (Doctorate and Non-Doctorate)
Question Mean RatingaSD
Training Total D ND Total D ND
1. How beneficial has your overall training in the assessment of ADHD
been for your practice? 3.9 4.0 3.8 .9 1.0 .9
2. How well trained do you feel in providing a thorough assessment
of ADHD? 3.6 4.0b3.5b1.0 .8 1.0
3. How well trained do you feel in providing a diagnosis of ADHD? 3.4 3.9b3.3b1.3 1.1 1.3
4. How well trained do you feel in the assessment of ADHD for
educational interventions or special education verification? 4.0 4.3b3.9b1.0 .8 1.0
5. How well trained do you feel in providing treatment for children
with ADHD? 3.6 4.0b3.6b1.0 .9 1.0
Caseload and Referral Patterns
1. How much is the assessment of ADHD an essential part of your
practice? 3.5 3.5 3.5 1.0 1.0 1.0
2. How much of your work time is devoted to the assessment of ADHD? 2.6 2.6 2.6 .9 1.0 .9
3. How much of your work time is devoted to providing treatment for
children with ADHD? 2.8 2.8 2.8 1.0 1.0 1.1
Assessment
1. How active are you in monitoring ADHD children’s progress with
their medication? 2.5 2.9b2.4b1.1 1.2 1.1
2. How often do you use consultation (with parents and teachers) as a
method to assess and treat ADHD? 3.8 4.3b3.7b1.1 1.0 1.2
Note.aThe Likert-based ratings are on a scale of 1 (low) to 5 ( high).
bItems were rated significantly higher by doctorate-level school psychologists.
D⫽Doctoral and ND ⫽Nondoctoral school psychologists.
ADHD: A National Survey 587
workshops [t(289) ⫽⫺.34, p⫽.74] or courses [t(290) ⫽⫺.27, p⫽.79] during their formal
graduate training, or workshops [t(288) ⫽⫺.16, p⫽.87] or courses [t(308) ⫽1.81, p⫽.07 ] in the
last 5 years since their graduation.
However, doctorate-level participants did self-assess being better trained on all but one of the
Likert ratings. Although the doctorate and nondoctorate groups did not significantly differ on their
ratings for the first question about how beneficial their training was for their practice [t(309) ⫽
⫺1.65, p⫽.10], the doctorate students rated the remaining self-reported training questions higher.
They reported being better trained to provide an assessment of ADHD [t(311) ⫽⫺3.96, p⬍
.001], better trained to provide a diagnosis of ADHD [t(308) ⫽⫺3.96, p⬍.001], better trained in
the assessment of ADHD for educational interventions [t(312) ⫽⫺3.06, p⬍.01], and better
trained to provide treatment [t(311) ⫽⫺3.04, p⬍.01].
Referrals
On average, school psychologists estimated receiving 17.19 (range ⫽1 to 100) referrals per
year for the assessment of ADHD. One hundred ninety respondents (60.1%) reported that in
addition to conducting their own assessments of ADHD they may refer students to another pro-
fessional for an assessment of ADHD. Respondents were asked to circle all professionals in which
they referred to; therefore, respondents may have identified more that one specialist. Respondents
reported sending referrals to pediatricians (n⫽187, 59.2%), family doctors (n⫽141, 44.6%),
psychiatrists (n⫽111, 35.1%), clinical psychologists (n⫽51, 16.1%), and neurologists (n⫽38,
12.0%). Respondents were also asked what percent of the cases they might additionally refer to
other professionals (assuming they might not refer all of their cases). They reported referring an
average of 56.4% of their cases to other professionals.
In addition to referral patterns, participants were asked a series of Likert-type questions
regarding their case load, such as, how much is the assessment of ADHD an essential part of their
practice, how much work time is devoted to the assessment of ADHD, and how much is work time
is devoted to the treatment of ADHD. Table 2 contains the results of these questions. Analyses
were also conducted on these questions to determine if doctorate and nondoctorate psychologists
reported more or less time assessing and treating ADHD. No differences were found on any of the
questions. Specifically, no differences were found between doctorate and nondoctorate school
psychologists for how much ADHD is an essential part of their practice [t(310) ⫽.71, p⫽.48], or
how much work time they devote to the assessment [t(312) ⫽⫺.35, p⫽.72], and treatment of
ADHD [t(312) ⫽.03, p⫽.98].
Because of the emphasis of using a problem-solving, consultative model to intervene in the
schools with students with ADHD, and the possible role of school psychologists in monitoring
medication, we asked two additional Likert-scale questions: (a) how often consultation is used to
assess and treat ADHD, and (b) how active they are in monitoring ADHD children’s progress with
medication. The results of these questions are presented in Table 2. Differences between nondoc-
torate and doctorate-level psychologists’ answers on these two Likert-rating questions were also
investigated. Doctorate-level psychologists reported being more likely to use consultation [t(311) ⫽
⫺3.6, p⬍.001], and more involved in monitoring medication [t(311) ⫽⫺3.26, p⫽.001].
Assessment Process
A major portion of data was gathered on specifics regarding the assessment of ADHD. Spe-
cifically, information on screening practices, who is involved in the assessment process (e.g.,
parents, teachers), the specific measures and methods used to assess for ADHD, and several ques-
tions about diagnosis of ADHD.
588 Demaray, Schaefer, and DeLong
Screening. Two hundred twenty-five participants (71.2%) reported they perform a screen-
ing before assessing for ADHD. If participants reported screening for ADHD before conducting a
formal evaluation, they were asked to list what measures or methods they used in the screening
process. If participants listed a specific measure, for example, a specific rating scale, this was
categorized as a “rating scale.” The five most common methods/measures cited were rating scales
(n⫽159, 50.3%), observations (n⫽109, 34.5%), interviews (n⫽103, 32.6%), file review (n⫽
22, 7.0%), and traditional psychoeducational testing (e.g., intelligence testing, achievement test-
ing, etc.) (n⫽13, 4.1%).
Role of Parents and Teachers. Participants were asked to rate in what percent of their cases,
for an evaluation of ADHD, they involve the child’s parents and teachers. They were given a scale
starting at 0% that increased by 10% until it reached 100% and asked to circle the number that
reflected the percent of cases that they involved the child’s parents/teachers. For parents, the
results ranged from 10% to 100%, with a mean of 96.2%. A substantial number of participants
(n⫽260, 82.3%) reported that in 100% of their cases they involve the child’s parents. Regarding
the involvement of teachers in the assessment, the results ranged from 60% to 100%, with a mean
of 99.3%. The majority of the participants (n⫽302, 95.6%) reported that they involve teachers in
100% of their assessments for ADHD.
To determine involvement of parents and teachers in completion of rating scales, participants
were asked who typically completes the rating scales. For this question 178 (56.3%) of the par-
ticipants reported both parents and teachers complete rating scales, 127 (40.2%) reported that
parent, teachers, and students complete the rating scales, 8 (2.5%) reported that teachers only
completed the rating scales, and 2 (.6%) reported that teachers and students completed the rating
scales.
Assessment Methods. With regards to methods of assessment used to collect data, 283 respon-
dents (89.6%) reported using rating scales to collect data from parents and 287 respondents (90.8%)
reported using ratings scales to collect data from teachers. Two hundred sixty-two respondents
(82.9%) and 253 respondents (80.1%) reported using interviews to collect data form parents and
teachers, respectively. Also, 297 respondents (94.0%) reported conducting observations in the
classroom. Participants were also asked if there is one method that plays the largest role in their
assessment and diagnosis of ADHD. Participants’ answers to this open-ended question were coded,
and 93 respondents (29.4%) reported that rating scales play the largest role, 48 respondents (15.2%)
indicated observations play the largest role, and 20 participants (6.3%) reported that interviews
play the largest role in their assessment and diagnosis of ADHD.
To gather more specific information on which rating scales were used in school psycholo-
gists’ assessment of ADHD, the survey included a list of commonly used broad-band and narrow-
band rating scales. Participants were instructed to indicate if they used each measure and then rate
how often they typically used the measure based on a four-point scale (0 ⫽never use, 1 ⫽some-
times use, 2 ⫽often use and 3 ⫽always use). Results of this checklist are presented in Table 3.
Participants were also asked to indicate whether they administered measures from the fol-
lowing categories during an evaluation for ADHD: (a) intelligence tests [including a question
about the Freedom from Distractibility Score (FDS) on the WISC-III], (b) achievement tests, (c)
neuropsychological tests, (d) continuous performance tests, (e) projective measures, and (f ) per-
sonality measures. The frequencies and percentages of the reported use of measures from these
categories are presented in Table 4. In addition, the most commonly cited measures used in each
of the categories are presented in Table 4.
Assessment of Comborbid Disorders. Approximately half of the school psychologists (n⫽
147, 46.5%) reported that there are certain assessment tools that they routinely use to assess for
ADHD: A National Survey 589
comorbid disorders during an assessment of ADHD. When asked to list what specific comorbid
disorders they assessed for they most commonly cited the following: Depression (n⫽71, 22.5%),
Anxiety (n⫽43, 13.6%), Learning Disabilities (n⫽31, 9.8%), Oppositional Defiant Disorder
(n⫽19, 6.0%), Conduct Disorder (n⫽20, 6.3%), and Emotional Disturbance (n⫽13, 4.1%). In
addition, five (1.6%) participants responded more broadly that they assess for externalizing behav-
ior problems and three (.9%) reported they assess for internalizing behavior problems. Partici-
pants most commonly reported the use of narrow-band rating scales assess for comorbid disorders
(n⫽94, 29.7%). In addition, they reported using broad-band rating scales (n⫽53, 16.8%),
intelligence tests (n⫽18, 5.7%), achievement tests (n⫽18, 5.7%), projective measures (n⫽17,
5.4%), and interviews (n⫽11, 3.5%).
Diagnosis. With regard to the diagnosis ofADHD, 192 school psychologists (60.8%) reported
that they believe it is appropriate for school psychologists to make a diagnosis of ADHD. How-
ever, only 100 school psychologists (31.6%) reported that they diagnose clients with ADHD.
When asked whether the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition
(DSM-IV; American Psychiatric Association, 1994) guidelines were beneficial for diagnosing
ADHD, 265 respondents (83.9%) reported that the DSM-IV was a beneficial tool for diagnosing
ADHD.
Discussion
Despite the fact that ADHD is one of the most common referrals to school psychologists,
research investigating school psychologists’ actual assessment practices in the areas of ADHD is
lacking. In an effort to identify the current practices and training of school psychologists in the
Table 3
Rating Scales for Assessment of ADHD: Reported Use of Each Scale (n) and Mean Rating of Usage
Usage Ratinga
Rating Scale n%MSD
Broad-Band Measures
Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1994) 211 66.8 1.98 .75
Child Behavior Checklist (CBCL; Achenbach & Edlebrock, 1983) 189 59.8 1.78 .76
The Personality Inventory for Children (PIC; Lachar, 1982) 48 15.2 1.24 .49
Narrow-Band Measures
Connors’ Rating Scales-Revised (CRS-R; Connors, 1997) 256 81.0 2.19 .75
Disruptive Behavior Rating Scale (Barkley & Murphy, 1998) 23 7.3 1.67 .80
ADHD-IV Rating Scale (DuPaul, Power, Anastopoulos, & Reid, 1998) 73 23.1 1.55 .76
Child Attention Profile (CAP; Barkley, 1990) 39 12.3 1.52 .68
Home Situation Questionnaire (HSQ; Barkley, 1990) 91 28.9 1.65 .82
School Situation Questionnaire (SSQ; Barkley, 1990) 89 28.2 1.66 .83
Academic Performance Rating Scale (APRS; DuPaul, Rapport, & Perriello, 1991) 15 4.7 1.67 .72
Attention Deficit Disorders Evaluation Scales (ADDES; McCarney & Bauer, 1995) 168 53.2 1.88 .79
ADD-H: Comprehensive Teacher’s Rating Scale (ACTeRS; Ullmann, Sleator, &
Sprague, 1997) 75 23.7 1.51 .67
Attention Deficit/Hyperactivity Disorder Test (ADHDT; Gilliam, 1995) 18 5.7 1.31 .60
Note.aIf participants reported using a specific measure, they were asked to rate how often he /she used it on a
three-point scale (1 ⫽Sometimes Use, 2 ⫽Often Use, 3 ⫽Always Use).
590 Demaray, Schaefer, and DeLong
Table 4
Reported Use of Additional Measures in the Assessment of ADHD
a
Measure N%
Intelligence tests 231 73.1
Wechsler Scales
(WISC-III; Wechsler, 1991; WPPSI-R; Wechsler, 1989; WAIS; Wechsler, 1997) 191 60.4
Stanford-Binet Intelligence Scale (4th ed.)
(Thorndike, Hagen, & Sattler, 1986) 37 11.7
Kaufman Brief Intelligence Test
(KBIT; Kaufman & Kaufman, 1990) 18 5.7
Freedom from Distractibility Score on the WISC-III 189 59.8
Achievement tests 213 67.4
Woodcock-Johnson Psychoeducational Battery-R
(Woodcock & Johnson, 1989) 94 29.7
Wechsler Individual Achievement Test
(WIAT; Psychological Corporation, 1992) 83 26.3
Kaufman Test of Educational Achievement
(KTEA; Kaufman & Kaufman, 1985) 32 10.1
Neuropsychological tests 71 22.5
Paper and Pencil Cancellation Tests 29 9.2
Bender Visual Motor Gestalt Test
(Bender, 1938) 17 5.4
Developmental Test of Visual-Motor Integration
(VMI; Beery, 1982) 8 2.5
Continuous performance tests 42 13.3
Conner’s Continuous Performance Test
(CPT; Conners, 1995) 17 5.4
Test of Variables of Attention
(TOVA; Greenberg & Kindschi, 1996) 9 2.8
Gordon Diagnostic System
(GDS; Gordon, 1983) 4 1.3
Projective measuresb94 29.7
Personality measuresb91 28.8
Drawing (House-Tree-Person, Buck, 1948;
Draw-A-Person, Machover, 1949, etc.) 47 14.9
Sentence Completion 34 10.8
Children’s Apperception Test
(CAT; Bellak & Bellak, 1949) 12 3.8
Thematic Apperception Test
(TAT; Murray, 1943) 12 3.8
Robert’s Apperception Test for Children
(RATC; McArthur & Roberts, 1982) 9 2.8
Rorshach
(Exner, 1993) 6 1.9
Note.aRespondents were asked if they administered measures from each of the bolded categories listed
above. Then, they self-identified the specific measures they used from each category. The top three mea-
sures from each category are listed above.
bThe specific measures listed under the projective and personality categories were combined, because
many respondents listed the same measure under both categories. The top six measures identified from both
of these categories are listed above.
ADHD: A National Survey 591
assessment of ADHD, a survey was sent to 1,000 school psychologists nationwide. A total of 407
school psychologists responded and 316 of the participants were included in the analyses. The
main goal of the current study was to investigate current assessment practices of school psychol-
ogists to compare to “best practice” assessment of ADHD. Specifically, the goals were to collect
information on (a) school psychologists’ training in the assessment ofADHD, (b) school psychol-
ogists’ caseloads and referral patterns for children with ADHD, and (c) the specific methods /
measures school psychologists are currently using in the assessment of ADHD. The data collected
are compared to recommended best practice assessment of ADHD.
The majority of participants reported obtaining formal instruction on ADHD during both
their formal schooling and within the last 5 years. For example, almost all participants (88%)
attended a workshop on ADHD in the last 5 years. Overall, the participating school psychologists
reported being well trained in the assessment and treatment of ADHD. On average, doctoral-level
school psychologists self-reported being better trained than the nondoctoral school psychologists.
However, they did not report obtaining any more formal training (i.e., via workshops, courses,
etc.) than nondoctoral school psychologists. It is important to note that these were self-reports
regarding training and competence and does not reflect actual differences in skill level. On the
contrary, the nondoctoral and doctoral psychologists did not differ on the more objective question
about actual training experiences. Because they did not differ on training experiences, it may be
beneficial to investigate what aspects of their formal or informal experiences influenced doctoral
school psychologists to believe they were better trained. The results of the study support the
notion that school psychologists are receiving the necessary training according to their self-report.
The results confirmed that school psychologists obtain many ADHD referrals per year (approx-
imately 17). Although all of the school psychologists included in the study reported that they do
assess for ADHD, it appears a little over half of them also reported referring outside the school to
other professionals for assessment. They also reported that assessment of ADHD is an essential
part of their practice, with a substantial amount of time devoted to both the assessment and treat-
ment of ADHD. No differences were noted between the nondoctoral and doctoral-level school
psychologists on their self-reports of time devoted to the assessment and treatment of ADHD.
When comparing results of the survey to recommended best practices in the assessment of
ADHD, there are some areas where school psychologists are following these guidelines and some
areas where school psychologists are lacking. School psychologists are using multiple sources,
settings, and methods in their assessments. For example, school psychologists reported involving
parents and teachers in the majority of their cases demonstrating the use of multiple informants
and multiple settings in their assessments. Approximately 82% and 96% of participants reported
including parents and teachers in all of their assessments, respectively. In addition, they reported
using multiple methods to gather data for their assessments. The most common methods employed
to assess for ADHD were rating scales, interviews, and observations. This data matches the pre-
viously reported most common methods used in screening (rating scales, observation, and inter-
views). Thus, it appears that by far the most common and influential methods used to assess and
diagnose ADHD appear to be rating scales, interviews, and observations.
Respondents reported using rating scales at a much more significant level than previous
researchers have demonstrated (Rosenberg & Beck, 1986). This is noteworthy because of the
importance of normative data gathered via rating scales that is unavailable from the other modes
of assessment (e.g., interviews, observations). Furthermore, three-fourths of the school psychol-
ogists reported performing a screening before they assess for ADHD.
However, a few areas of concern were also noted from the results. First, a large number of
school psychologists reported using data or measures that have limited validity for assessment of
ADHD. For example, approximately half of the respondents reported using the Freedom from
592 Demaray, Schaefer, and DeLong
Distractibility Score on the WISC-III in their assessment. This practice is not recommended for
establishing evidence for or against ADHD (Barkley, 1998). Research on whether scores on this
factor can discriminate children with ADHD from children withoutADHD is conflicting (Barkley,
1998). The use of this measure may seriously limit the validity of school psychologists’ assess-
ment results.
In addition, when asked to endorse additional measures they typically administer in an eval-
uation of ADHD, a large number of school psychologists reported conducting traditional assess-
ments of intelligence (73%) and achievement (67%). According to Barkley (1998), these tests are
central to differential diagnosis. Although these measures may be good to rule in or out comorbid
disorders, they are not useful in providing a diagnosis of ADHD (Barkley, 1998; Landau & Bur-
cham, 1996). Although these measures cannot reliably identify children as ADHD, they may be
useful in an assessment of ADHD because many of these children may have cooccurring learning
problems (Burcham & DeMers, 1995).
The use of neuropsychological tests and continuous performance tests were moderately
endorsed by the respondents, although to a lesser extent. Because there is a lack of data on the use
of neuropsychological tests for use in an assessment of ADHD, use of them is not recommended
(Barkley, 1998). Although data from continuous performance measures may contribute to the
school psychologist’s confidence that the child does have ADHD, it cannot be used to disconfirm
that the child has ADHD (Burcham & DeMers, 1995). Commonly cited problems with these
measures are their reliability and validity, their lack of ecological validity, (Burcham & DeMers,
1995; Landau & Burcham, 1996), and the high rate of false positive and negatives (Brock, 1997).
Burcham and DeMers (1995) suggested that the use of continuous performance tests, if they are
even used at all, should be limited to a small role in the assessment of ADHD.
Also, about 30% of the respondents reported typically using personality and projective mea-
sures in their assessment of ADHD. Projective and personality measures include drawings, ink-
blots, and story-telling techniques. Although some of these measures have been found to reliably
discriminate ADHD children from children without any psychopathology with regard to impul-
sivity symptoms (Gordon & Barkley, 1998), little predictive validity has been found for the iden-
tification of children with ADHD with these measures (Barkley, 1998). However, these measures
may also indicate serious thought or emotional disorders in children that may account for their
ADHD symptomotology and be useful in differential diagnosis.
A large concern was that approximately half of the school psychologists did not identify
particular measures they use to assess for comorbid disorders, which is an important aspect in the
assessment of ADHD (Barkley, 1998). A comprehensive evaluation of ADHD should include
assessment of other disorders to aid in differential diagnosis. Furthermore, if ADHD is diagnosed,
assessment of comorbid disorders is an important component to the comprehensive assessment of
ADHD.
A final area of concern was that more doctoral-level school psychologists reported monitor-
ing medication effects and using consultation than nondoctoral school psychologists. Overall,
school psychologists indicated that they are less than moderately active in monitoring the medi-
cation of students with ADHD, an area in which school psychologist involvement is recommended
(Landau & Burcham, 1996).
A final noteworthy finding was the fairly significant number of school psychologists reported
they do not believe it is appropriate for school psychologists to diagnose a child with ADHD. In
addition, only about 30% of the psychologists reported diagnosing ADHD. Given the large num-
ber of referrals for ADHD, and the overwhelming opportunities school psychologists have to be
actively involved in the assessment and treatment of ADHD, compared to other nonschool pro-
fessionals, it was surprising to the authors that half of the respondents reported they do not think
ADHD: A National Survey 593
it is appropriate for school psychologists to diagnose ADHD. However, these results may be
influenced by state or district practices and, therefore, reflect policy instead of opinion. The meth-
odology of the current study does not allow the authors to determine why so many school psy-
chologists reported that they do not think it is appropriate for school psychologists to diagnose
ADHD.
The results of the present study are valuable, in that current published research examining
how school psychologists assess for ADHD is lacking. Because ADHD is an extremely prevalent
disorder in school-aged children, and many negative effects may result if the child does not receive
services, it is extremely important that these children are being thoroughly and accurately assessed.
Also, in framing the study around a comparison of current practice to best practice guidelines, this
study provides a valuable connection between research and actual practice that may be helpful in
future training in the assessment of ADHD.
There are a few limitations that deserve mentioning. First, the participants of the study were
all NASP members. Thus, only those school psychologists who joined this professional organiza-
tion were included, and results may not be reflective of all school psychologists’ practices.Although
the overall return rate in the current study of 40.7% was similar to some other survey studies of
NASP members that have obtained return rates of 40% (Christenson, Sheridan, Hurley, & Fenster-
macher, 1997) and 42% (Pelco, Jacobson, Ries, & Melka, 2000), it was far less that some studies
that have obtained rates as high as 80% (Wilson & Reschly, 1995). In addition, because some of
the returned surveys were excluded from the analyses, only 31.6% of the surveyed sample was
used in the data analyses. Thus, the lower return rates may in turn lower the generalizablity of the
results of the survey.
In addition, 52 participants reported that they do not assess for ADHD in children and ado-
lescents. Therefore, they were not included in analyses because the majority of the remaining
questions were blank or not relevant. It would have been beneficial to know why they are not
assessing for ADHD (e.g., their setting does not require it because they work with birth to three,
etc.). Because that data was unavailable, the number of school psychologists that assess for ADHD
could have been underestimated in the study results.
Another limitation of the study was that use of a survey relies solely on self-report from the
school psychologists about their current practices in the assessment of ADHD. Furthermore, the
questionnaire used in the current study was limited in scope in that it did not contain questions on
every single method that may be included in assessment (e.g., functional analysis, curriculum-
based assessment, and structured interviews). Although several open-ended questions were present
on the survey to attempt to capture assessment methods not captured in specific questions, analysis
of these questions was problematic because there may not have been uniformity in what respon-
dents mentioned. For example, what one respondent listed in the “other” category another respon-
dent may not have thought of at that moment but may have endorsed if given the opportunity.
It is also worth mentioning that although the current study may help us understand what
methods and tools are being used to assess for ADHD, it does not tell us how school psychologists
use the information gained through the assessment. For example, it may not be poor practice to
include a projective measure or a continuous performance task as part of a thorough battery
including rating scales, interviews, and observations, unless the majority of the diagnostic deci-
sion is placed on data gained via these methods. Additionally, although all of the school psychol-
ogists reported that they do assess for ADHD, a large portion reported that they also refer to other
professionals for an assessment of ADHD. A limitation of the current study is that one is unable to
determine from the survey how much of the assessment the psychologist completes, or how they
utilize the data gathered by other professionals, or what cases they decide to refer. More informa-
tion on referral patterns of school psychologists would be helpful.
594 Demaray, Schaefer, and DeLong
Future research should be targeted to gain a better understanding of how school psychologists
are interpreting and using the information gained in assessment. It would be useful to examine
whether they are utilizing their data to correctly diagnose children with ADHD and provide them
with appropriate interventions based on their unique symptoms, situational influences, and strengths.
Although a medical examination has been identified as a major component of best assessment
practices (Barkley, 1998), the current study did not obtain information specifically regarding a
medical examination. It can be inferred that because over half of the participants reported they
also refer their cases to pediatricians and family doctors, a medical examination is being per-
formed in those cases. Additional information regarding the types of medical assessments and
tests that are currently being used and how that information is interpreted would be beneficial.
Because of the differences among states with regard to the practice of assessing ADHD, it
may be helpful for future researchers to investigate the different practices among states or regions.
The method of data collection for the current study did not allow for those types of analyses.
Although participants represented a wide variety of states, some states were represented by a
small number of participants. It is important to note, however, that differences in state require-
ments for the assessment of ADHD may have been influencing how the participants in the current
study responded to the survey. For example, responses to the question about the appropriateness of
school psychologists in diagnosing ADHD could have been influenced by state guidelines on that
topic. Future research may be better able to separate out state or regional differences in the prac-
tice of ADHD assessment by focusing on that issue.
In conclusion, the results of the survey indicated that school psychologists believed they were
competent in their skills to provide comprehensive assessments of ADHD. They are using multiple
informants, methods, and settings in their assessments. The major methods or tools used in their
assessments include rating scales, observations, and interviews. However, there were some large
areas of concern, such as the use of nonvalid measures in their assessments and not assessing for
comorbid disorders. Further research should focus on how school psychologists use the specific
information gained via different assessment methods and tools to provide an accurate diagnosis
and assessment.
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