Conversely, children with ADHD, Predominantly Hyperactive/Impulsive Type show the reverse pattern. Thus, should your child have one of these subtypes of ADHD, you would look specifically at the appropriate symptom group to determine how well the difficulties are being managed.
BEHAVIORAL, SOCIAL AND EMOTIONAL FUNCTIONING
Items 13-15 provide a basic screening for behavioral, social, or emotional difficulties. In addition to seeing mostly low scores for items 1-12, you want to see high scores (i.e. 3’s or 4’s) for these items. If your child receives low scores (i.e. 0’s or 1’s) on any or all of these items, you will want to contact the teacher to obtain more detailed information about the difficulties that were observed.
NOTE: It is important to emphasize that these items provide only a simple screen for behavioral, social, and emotional difficulties and is not intended to be a comprehensive assessment. Although teacher’s are generally in an excellent position to comment on how a child is following classroom rules, they can be less aware of how a child is doing socially or how a child is feeling. The absence of any teacher reported difficulties in these latter two areas thus does not necessarily mean that your child is not experiencing any such difficulties. Learning about this in a more comprehensive way requires feedback from the child as well.
ACADEMIC PERFORMANCE
The second page of the rating form provides important information on your child’s academic performance during the school week. Information is provided on the amount of assigned work completed, the general quality of the work completed and whether this varies by subject, and also alerts you to homework assignments that may not have been turned in. Obviously, the ideal is for your child to be completing all assigned work, for it to be of good to very good quality, and for no homework assignments to have been missing.
SUGGESTED GUIDELINES FOR USING THE INFORMATION
The information contained in the weekly monitoring form is designed to provide you and your child’s physician with the data you need to make informed decisions about the effectiveness of your child’s treatment and when any additions or modifications appear necessary.
It is important to stress, however, that any child can have an occasional bad week. If your child has been doing well, and then one week the monitoring form indicates difficulties in one or more areas, this should not necessarily cause alarm or indicate the need for changes in treatment. In general, this would not be suggested unless the problems persist for several weeks in succession, or if troublesome weeks start to occur with increased frequency (i.e. instead of one bad week every couple of months you start to see several bad weeks each month).
IMPORTANT - If your child‘s teacher is making monthly ratings rather than weekly ratings, a single bad month would be cause for concern. Thus, I would recommend the
information be shared right away with your child‘s physician so that he or she can determine whether modifications to your child’s treatment(s) need to be made.
With these guidelines in mind, a simple and reasonable framework for evaluating the information contained in the weekly monitoring form is to consider the ADHD symptom ratings (i.e. items 1-12) and the other information separately. When done in this way, several different combinations are possible. These are discussed below.
EVERYTHING GOING WELL
This is what we hope to see each week. In this scenario, ratings of ADHD symptoms in items 1-12 are primarily or exclusively 0’s and 1’s,ratings for items 12-15 indicate that your child is following rules, getting along with peers, and appearing happy, and your child is completing all or almost all assigned work and the work is of good quality.
When this is the case, it is clear that your child is doing a great job at school, and that whatever treatments and/or support are in place are working well. No changes or adjustments are indicated.
EVERYTHING GOING POORLY
At the other extreme is a situation where nothing is going well. Ratings of ADHD symptoms are high, problems with behavior, peer relations, and/or mood are also evident, and both the quantity and quality of assigned work being completed is problematic.
In almost all cases, this indicates a situation where changes and adjustments (i.e. to medication, behavioral plan, etc.) need to be implemented. The only exception would be if, as noted above, your child has been doing consistently well and then has a single bad week. If this is the case, it is still important to speak with your child and his or her teacher to try and learn what may have accounted for the difficult week. Should things get back to normal the following week, there is probably no need to change anything. If the difficulties persist, however, it will be important for the appropriate modifications to be made. Consult with your child’s physician about the most appropriate steps to pursue.
As noted above, if ratings are being provided monthly, this situation would definitely warrant a discussion with your child’s healthcare provider.
ADHD SYMPTOMS UNDER CONTROL, BUT PROBLEMS WITH BEHAVIOR, PEER RELATIONS, MOOD, OR ACADEMICS
This would be indicated when ratings of ADHD symptoms on items 1-12 are fine (i.e. mostly 0’s and 1’s) but problems are indicated in one or more of these other areas. When ADHD symptom ratings are low, these other problems are unlikely to be direct results of ADHD, but may reflect additional difficulties. Such difficulties can occur for a variety of reasons and it is very important to try and learn what factors may be contributing to the difficulties occurring for your child. Once again, consulting with your child’s physician is recommended.
NOTE: When children are in middle school or high school and have multiple teachers, teachers often do not spend enough time with the child each day to observe problems with regards to
ADHD symptoms. At these ages, it is more common for these symptom ratings to look okay, but for the difficulties to show up in a child’s academic performance or behavior. It is important to be aware of this because from the teacher’s ratings it may look like primary ADHD symptoms are being effectively managed when they may not be, and adjustments in medication may be necessary.
OTHER AREAS LOOK GOOD BUT RATING OF ADHD SYMPTOMS ARE HIGH
This would be indicated when ratings on items 1-12 include lots of 2’s and 3’s but no other real problems are reported. This is probably the most unusual combination because generally when a child’s ADHD symptoms are not being managed well significant problems in behavioral, emotional, social, and/or academic functioning are also evident.
Should this pattern persist for more than one week, some adjustment in treatments used to manage primary ADHD symptoms is likely to be necessary (i.e. medication adjustment, revising behavior plan). Of course, if a child continues to do well academically, socially, and behaviorally at school despite high levels of ADHD symptoms it may not be necessary to change anything. Generally, however, one would expect problems in these areas to emerge if ADHD symptoms are not being managed well for any sustained period. Again consulting with your child’s physician is strongly recommended.
NOTE: The first question on side 2 asks for the teacher’s rating of how morning and afternoon periods compared. If your child is taking medication, and is receiving a longer acting stimulant or is taking a second dose during the day at school, morning and afternoon behavior would not be expected to differ.
If your child is receiving only a single dose of a stimulant that is not intended to provide coverage across the entire school day, however, and the teacher’s ratings indicate that mornings are consistently better than the afternoons, it may indicate that the medication is wearing off during the day and that a single dose is not sufficient. If this pattern emerges in the teacher’s ratings, you should discuss this issue with your child’s physician. It is possible that a second dose or the use of a longer acting medication would be helpful.
Note: You‘ll find the weekly and monthly versions of the monitoring forms on the next pages. I hope this is helpful to you.
READING AND PRINTING THESE INSTRUCTIONS AND THE MONITORING SYSTEM CHARTS BELOW
You must have Adobe® Acrobat® Reader® installed to view and print the documents linked below. You can download the Adobe Reader for free at http://www.adobe.com/products/acrobat/readstep2.html. If you have any problems or have any questions contact FamilyIQ at 888.249.9596
Read and/or Print this article
Chart I: Weekly Monitoring Report.pdf
Chart II: Monthly Monitoring Report.pdf
For further information, see FamilyIQ courses, “Behavioral Approaches to ADHD” and “Mental Health Options.” A pertinent FamilyIQ article is, “Attention Deficit Hyperactivity Disorder."
Notes from the author:
Thanks again to Landmark College for supporting my efforts to distribute this tool to the widest possible audience.
In my own experience, I have found that this program works best with elementary school children who have only a single teacher. This program can also be quite helpful for children who are in middle school or high school, although sometimes teachers in these grades do not spend enough time with a student to provide ratings that are as reliable. You will have to see how this works in your own situation.
I have used this program in my own practice for a number of years and have found that it is an extremely helpful tool for parents to have available. I sincerely hope that you begin to use it regularly and find it to be as helpful to you as it has been to many of the parents that I work with.
I want to recognize the support provided by Aspen Education Group to assist me in distributing this tool.
Sincerely,
David Rabiner, Ph.D., Senior Research Scientist, Duke University
Dr. Dave Rabiner received his Ph.D in clinical psychology from Duke University in 1987 where he also completed a one-year internship in child psychology at Duke University Medical Center. From 1987-1998, he was a professor in the psychology department at the University of North Carolina at Greensboro. During this time, he maintained a part-time private practice where he worked primarily with children diagnosed with ADHD (Attention Deficit Hyperactivity Disorder). In addition to this direct clinical work, he has consulted with numerous pediatricians and family physicians in North Carolina to assist them in evaluating and treating children with ADHD.
Dr. Rabiner has also published a number of papers on children‘s social development in peer-reviewed journals and presented his work at professional conferences. He‘s also served as a consultant on two federally funded grants to study ADHD.
