Teachers Diagnosing ADD in 50% of Cases: study

March 9, 2005

http://www.healthyplace.com/Communities/add/Site/story_diagnosis.htm

Doctors act as 'rubber stamp'

(Aug. 31, 2003) - A study of schoolchildren with attention deficit disorder found more than half were first diagnosed by their teachers, with some physicians pressured to "rubber stamp" the finding and put the student on medication.

Dr. Leonard Sax, a family doctor and psychologist in the United States, interviewed 400 child psychiatrists, pediatricians and family doctors in Washington, D.C., Northern Virginia and suburban Maryland for his study.

"In the great majority of cases, teachers were the first to suggest the diagnosis. Doctors are busy; they've got a room full of patients. And very seldom do they do their own investigation. They just take a paper from the school saying, 'We think Justin has ADD would you please prescribe Ritalin' and doctors do it. The doctors are acting as a rubber stamp for teachers," Dr. Sax said.

After he interviewed the doctors for his study, many sent comments expanding on their experience.

"One said he did do an evaluation and concluded the child did not have attention deficit disorder but the principal of the school then called his superior, angry, and said how dare the doctor question the school's diagnosis, and said the doctor should be disciplined," Dr. Sax said. "He was actually called into his medical director's office to defend his action."

Dr. Sax said half a dozen physicians described similar incidents.

His study is expected to be published in a major U.S. medical journal next month.

Dr. Sax, who is also the founder of the National Association for Single Sex Public Education, spoke about his findings following a conference on the merits of single-sex schooling in Toronto yesterday.

He found the initial diagnosis of ADD came from teachers in more than half of cases, from parents in 25% of cases and from the primary physician in 10%. The rest of the time ADD was identified by a psychologist, neighbor or friend.

Dr. Sax said in four U.S. states, teachers have been prohibited from recommending a diagnosis of ADD following concerns children are being over-medicated to control their ADHD behavior.

Speaking at the conference at Upper Canada College, a private all-boys school, he told more than 400 educators he believes children are often wrongly diagnosed with ADD when it is simply a case of them not hearing a soft-spoken teacher.

Dr. Sax presented research yesterday showing boys' brains are wired differently. "Women and girls hear better than boys and men. A boy's failure to pay attention may be misinterpreted as attention deficit disorder when it is merely a result of the teacher not speaking loud enough," he said.

Educators used to worry about girls' performances in math and science, but concern has recently shifted to boys.

Dr. Sax argued that boys and girls learn differently -- in math, for example, boys are fascinated by numbers on their own, while girls prefer things to be put in the context of real life; in literature, boys enjoy action and are less likely to talk about how they feel about a character, he said.

Single-sex schooling has largely been limited to private schools in Canada but is being tested in some public schools. A Hamilton school will offer the first single-sex classrooms in a public school starting this fall. In Calgary, two all-girl schools are opening this year -- one a regular public school, the other a charter school.

Studies have found boys who attend single-sex schools are more likely to pursue interests in art, music, dance, drama and food, and are more likely to major in humanities than those who attend mixed-sex schools, said Dr. Sax, who argued that single-sex schooling makes boys comfortable going into non-traditional roles.

However, Dr. Sandra Witelson, a professor of behavioral neurosciences at McMaster University who is best known for having studied Albert Einstein's brain, told yesterday's conference it was not as simple as differences in boys' and girls' brains. Educators must be aware that even among boys and girls, there were differences in their characteristics, she said.

Some students are a "mosaic" and may have female and male characteristics, she said, concluding more research needs to be done to prove a link between the differences in male and female brains and levels of performance.

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