National Edition

Are standardized tests leading to more ADHD diagnoses?

Published: Tuesday, Oct. 8 2013 10:30 p.m. MDT

Second grade student Kaign Groce, 7, reads a book Wednesday, Feb. 1, 2006, during a literacy class at the John Fenwick Elementary School in Salem, N.J.

Jose F. Moreno, Associated Press

As a young mother, Robin Richeson was overwhelmed by her son Aaron’s boundless energy. Richeson chalked up his behavior, which included climbing tall trees, running away and an inability to focus in school to boys being boys.

But the teachers at Aaron's school in Ownesboro, Ky., thought something else was going on. “They just said that he was all over the place — he couldn't handle the structure. 'We think he has ADD or ADHD,'” Richeson remembers being told at a parent-teacher meeting.

An evaluation by the family doctor confirmed those suspicions. Aaron has ADHD, a condition marked by inability to focus and impulsive behavior. Today, 7-year-old Aaron takes Ritalin, which helps him focus in school.

Aaron is one of about six million children with ADHD in America. One in nine children between the ages of 4 and 17, or about 11 percent, have an ADHD diagnosis, according to a 2012 study by the Centers for Disease Control. CDC data also show that the rates of ADHD diagnoses have gone up rapidly in the last decade, increasing by 40 percent between 2003 and 2012.

But national averages don’t tell the whole story when it comes to ADHD. CDC data also shows that the likelihood a child will be diagnosed with ADHD depends on which state they live in. In Western states, including Nevada, California, Utah, Colorado and Hawaii, rates of ADHD diagnosis fall between 5.5 and 7 percent of all school-aged children. Compare that to Southern states, including North and South Carolina, Florida and Kentucky, where ADHD diagnosis rates are more than double that — from 12 to 16 percent of all school-aged children.

In their forthcoming book “The ADHD Explosion and Today’s Push for Performance,” Dr. Stephen Hinshaw, professor of Psychology at UC Berkeley and his colleague UC Berkeley economics professor Richard Scheffler, examine what is behind the diverging rates of ADHD in states across the country. Their conclusion: a driving factor behind these trends is state education systems.

ADHD and exit exams

As Hinshaw and Scheffler looked at the numbers they noticed an interesting pattern: states with high school exit exams (tests students must take as a condition for graduation), also tended to have above-average rates of ADHD. “In these states, you don’t get a diploma unless you can show you’ve mastered certain material,” Hinshaw said. The stakes are high for students: “fail the test and you won’t make it to college,” Hinshaw said.

But the tests aren’t just for the students. Many states use exit exam outcomes to measure school and teacher performance. “District funding, not to mention jobs, are contingent on student performance on these exams,” Hinshaw said.

With stakes this high, educators must find ways to get their students’ performance to mandated levels, and an ADHD diagnosis, according to Hinshaw, might be helpful. A child with an ADHD diagnosis will be prescribed medication, which, if taken, tends to improve their ability to function in a structured classroom and, many experts contend, actually can improve a child’s academic performance.

Additionally, in many states children with ADHD diagnoses are offered educational accommodations. For example, because of his ADHD Aaron Richeson has extra time to complete homework assignments and exams, preferential classroom seating, and prompting and cueing from teachers, said his mother, Robin. Some states put kids with ADHD in special education programs, according to Hinshaw, which means they are not required to participate in the exit exams. “It’s a way of not penalizing teachers for kids who can’t focus,” Hinshaw said.

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