PERSISTENT SCHOOL DYSFUNCTION - UNRECOGNIZED COMORBIDITY AND SUBOPTIMAL THERAPY

To determine reasons for continued school dysfunction in children prev iously diagnosed as having attention deficit hyperactivity disorder (A DHD) or enrolled in a special education program (spec. ed.), a retrosp ective chart review of patients referred for interdisciplinary evaluat ions at a tertiary center for hyperactivity and learning problems was completed. Interdisciplinary clinical recommendations were used to def ine reasons for treatment failure in 116 children with a prior diagnos is of ADHD or spec. ed. placement, Results showed 45% of children enro lled in spec. ed. had previously undiagnosed ADHD. Thirty-one percent of those with ADHD, 55% of those in spec. ed., and 55% of those diagno sed with ADHD and in spec. ed. (Both) received a new educationally han dicapping diagnosis. Psychiatric comorbidity was present in 28% of tho se with ADHD, 18% of those in spec. ed., and 23% of Both subjects. Thi rteen percent of those in spec, ed, had significant coexisting medical conditions. Special education services were insufficient in 55% of ch ildren in spec. ed. and 55% of Both subjects. A significant difference (P < 0.01) in medication use was noted between the groups with 56% of the ADHD group, 55% of the Both group, and none of the spec. ed. grou p treated with medication. Of all subjects with ADHD, 76% were receivi ng insufficient or no medication, This review suggests the following: (1) Comorbidity in children with school dysfunction is frequently not recognized. (2) Educational therapy alone may not be sufficient treatm ent for school dysfunction, and in cases where the treatment program i s failing, the appropriateness of the program should be reviewed. (3) ADHD is commonly seen in conjunction with other educationally handicap ping conditions, Therefore, in cases of continuing school dysfunction, children previously diagnosed as having ADHD should be assessed for o ther educationally handicapping conditions; those previously diagnosed as educationally handicapped should be assessed for ADHD. (4) Subopti mal medication use may be associated with treatment failure.