Teachers: A Pivotal Piece of the ADHD Diagnosis Puzzle
by Pardis Khosravi, PsyD, Clinical Director, Catherine T. Harvey Center for Clinical Services, CHC
Next to their parents, who spends the most time with kids? Teachers. Educator, mentor, nurturer, inspiration…teachers play many roles in their students’ lives. They are also pivotal players in the ADHD diagnostic process, serving as frontline observers of a child’s behavior in a structured school setting on a daily basis.
“Teachers are in a unique position where they can speak to a child’s ability to interact with peers, sustain attention, self-monitor, regulate emotions, and control behaviors, all of which are diagnostically important when considering ADHD,” says Whitney Geller, PHD, a clinical psychologist at CHC. “Teachers also tend to have a good measuring stick for what is typical (or not typical), as they interact with so many children on a daily basis.”
Teachers: The Ultimate Observers
Teachers are ideally positioned to provide insights into a child’s academic performance and work habits, and can note patterns of inattention, hyperactivity, and impulsivity. If a child is having difficulties with focus, organization, and task completion, it could indicate ADHD-related challenges. Teachers can also observe a child’s interactions with peers and adults, and pick up on social challenges, impulsivity, or difficulties in maintaining relationships—all factors that can also be related to ADHD.
A teacher’s input can also come into play during the diagnosis process. While a formal diagnosis of ADHD is typically made by healthcare professionals, such as psychologists, psychiatrists, or pediatricians, the process includes a comprehensive assessment that uses information from multiple sources, including teachers. Because a diagnosis of ADHD requires symptoms to be present in at least two settings—home and school, for example—a teacher’s observations are critical. A teacher’s report of the child’s work habits, behavior, and social skills in the classroom environment can give a more complete picture of the child’s behavior and functioning.
Common Classroom Behaviors That Might Actually Indicate ADHD
ADHD can manifest in subtle ways. Here are some concerns your child’s teacher might point out as minor problems; but which could actually be indicators of ADHD and could warrant further assessment and support.
Kids with ADHD often experience social challenges due to issues with impulse control, maintaining attention during interactions, and difficulty picking up on social cues. This can impact their ability to form meaningful peer relationships, potentially leading to feelings of loneliness, rejection, or frustration in social settings.
Geller explains, “Children with ADHD tend to be less mature than their same-age peers and are at increased risk for adverse social outcomes like bullying or social exclusion. They often become anxious and worried about what they might do next in a social situation as they have difficulty controlling themselves (interrupting, talkativeness, being overly loud, hyperactivity that can be off-putting to peers). After social transgressions, they feel guilt and sadness despite having little control over themselves and/or poor understanding of what went wrong. This cycle can lead to long-term problems with anxiety, depression, and low self-esteem if not properly managed.”
Ask your child’s teacher questions about your child’s social functioning at school. For example, “Have you observed any challenges my child faces in social situations?”, “Do you notice my child struggling with social inattentiveness, such as not listening during conversations or not picking up on social cues?”, and “Are there times when my child exhibits impulsive behavior, especially in social situations? Can you provide examples of how they navigate peer interactions?”
Executive Functioning Difficulties
Sure, lots of kids have messy backpacks. And lots of students need to be reminded more than once to open their math book and turn to the correct page. But sometimes difficulty following instructions, keeping track of school supplies, and initiating tasks can be indicators of ADHD. Parents can ask their child’s teacher questions such as, “How does my child manage her time and organize her work at school?”, “Does my child have trouble following multi-step instructions?” or “Have you noticed my child having difficulty starting or finishing tasks?”
Difficulty with Transitions
Difficulty with transitions is a common challenge that may not initially raise a concern for ADHD. However, children with ADHD who have challenges with cognitive flexibility, an executive function, often show difficulties with shifting from one activity to the next, particularly if they’re going from a preferred activity (like soccer practice) to a non-preferred activity (like homework). Parents can ask teachers questions like, “Are there specific times during the school day when my child struggles with transitions between activities or tasks? How is this behavior managed in the classroom?”, to learn more about how their child manages transitions at school.
Lastly, problems with emotion regulation can be a symptom of ADHD but are frequently overlooked. Children with ADHD often have difficulty controlling their emotions as frontal areas of the brain (areas responsible for emotion regulation and executive functions) are affected in individuals with ADHD. It is important to gather information about how your child is able to regulate their emotions in both highly structured environments (e.g., school) as well as less structured settings (e.g., home).
Classroom Behaviors That Might Not Indicate ADHD
It’s important to be aware that problems flagged by teachers may not always turn out to be ADHD. A formal assessment should always be done to reach a diagnosis. Here are some types of feedback you might receive that bear further assessment, but could also be explained by something other than ADHD:
“Your child often seems distracted in class and has difficulty staying focused on tasks. It might be ADHD.”
While difficulties with attention and focus can certainly be characteristic of ADHD, vision or hearing problems, anxiety, or specific learning disabilities could also contribute to distractibility. A comprehensive assessment can help rule out these factors.
“Your child struggles to sit still and is constantly fidgeting. It may be ADHD.”
Hyperactivity is a hallmark symptom of ADHD, but sensory processing issues or anxiety can also lead to fidgeting. It’s essential to explore various possibilities through a comprehensive evaluation.
“Your child has difficulty following instructions consistently. It could be ADHD.”
Auditory processing issues, language difficulties, or even specific learning disabilities might contribute to challenges in following instructions. A thorough assessment can help differentiate these factors.
Teachers are valuable allies when it comes to educating and nurturing your child. Partnering with an educator who has a window to your child’s daily classroom experience can give you important insights, helping you understand when your child might benefit from a professional assessment and support. Together we’re working toward the best possible outcomes for our kids.
Dr. Pardis Khosravi specializes in conducting comprehensive psychological evaluations and providing evidence-based psychotherapy to children, adolescents and transitional aged youth. She is passionate about psychological assessment as a tool to best understand each child’s strengths and weaknesses to empower the child and their family to utilize their strengths to increase resiliency and optimize academic, social and emotional functioning.