Enhancing Quality in
School Mental Health

Screening

School-based evaluations

Multimethod Assessment

Interpretation

Treatment Design

Treatment Evaluation

To effectively treat students with attention and hyperactivity problems, it is necessary for clinicians to first make a thorough assessment. A detailed assessment process is outlined in the following five stages.
Stage 1: Screening
Once a teacher expresses concern about a student’s inattention, impulsivity, and/or hyperactivity, clinicians interview the teacher(s) and ask them and the parent to complete a measure such as the Vanderbilt Assessment Scale (. A screening measure such as this, when scored, helps determine whether the student’s behavior might be outside the range of “typical” development.
Stage 2: Multimethod Assessment
If the scores from the initial screening indicate the possibility of ADHD, clinicians gather information about causes and consequences of student problem behavior.
Parents and teachers fill out questionnaires that touch on the student’s academic and social history and screen for other problems that may relate to the student’s difficulties. A classroom observation is also conducted during this stage to determine frequency, intensity and duration of problem behavior.
Stage 3: Interpretation
Clinicians now look at the information obtained from stage 2 in a social and developmental context. The clinician compares the student to other classmates in relation to age of onset and persistence of problem behaviors.
Interpretation should be informed by a thorough understanding of the students’ current situation at home and at school. Prior learning difficulties or domestic abuse may explain or exacerbate symptoms of ADHD. Inconsistency in assessment data across sources or settings should signal clinicians to look more closely at variables beyond the student’s control.
Stage 4: Treatment Design
By using the data gathered in the first three stages, clinicians can formulate a treatment plan based on the severity and function of the student’s problem behavior.
The clinician must consider the impact of comorbidity, as well as the student’s response to previous interventions. Clinicians must also consider the teacher’s and family’s ability to implement interventions. Finally, consideration should be given to the availability and accessibility of treatment resources in the community.

School-based evaluations for ADHD (cont’d)

Stage 5: Treatment evaluation
The clinician refers to initial assessment data as a baseline for the student’s future behavior. Reliable behavior change can be determined by collecting and scoring teacher ratings before, during and after treatment.
Students, parents, and teachers measure treatment success in terms of observable change (e.g. Is the student staying on-task more often?, Is student turning in more homework?). Clinicians then should evaluate outcomes in terms of socially meaningful and functionally relevant improvements. Remember, the goal for treatment is the normalization of behavior (for ratings to be in the normal range, rather than the clinical range).
Dupaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.

Coaching teens to achieve their goals

Adolescents with ADHD face a variety of obstacles as they prepare for the transition to adulthood. In addition to coping with symptoms of ADHD, these adolescents must quickly adapt to the competing demands of a personal and professional life.
School mental health clinicians can support adolescents with ADHD by using the coaching model. Dawson and Guare (1998) developed a resource workbook that provides instructions and materials for how to “coach” an adolescent with ADHD.
Once the student selects a coach, the clinician trains the coach in how to empower the student to achieve their self-selected goals. Through regular weekly meetings, the coach helps the adolescent with ADHD set goals, develop plans for attaining them, and identify obstacles to attainment.
Clinicians can use the coach to match the adolescent’s intentions with their own goal-directed behavior.
Dupaul, G.J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford Press.