Here is what I have found.
- The United States Dept. of Education is firmly against school personnel giving the "medical" diagnosis of ADHD. The rationale is focused solely on school staff not intruding on the medical doctor/family dynamic. School staff should not be giving opinions that could impact the administration of medication.
(Of course, one of the DOE's primary source was the American Association of Pediatrics (AAP), who, surprisingly, takes an extremely M.D.-centric view of the universe.) The AAP stance is that the DSM-IV criteria should be followed.
- The above fact does not interfere with the assessment of ADHD for educational purposes or legal requirements under IDEA or 504. They are treated as two separate issues. However, the DSM-IV is the prevailing criteria for eligibility.
So apparently, they are two completely separate diagnostic criteria that use the exact same diagnostic criteria!? (Although one requires specific educational impact.)
Therefore, school personnel don't HAVE to accept someone else's diagnosis for ADHD at face-value, but they do have to perform their own assessment and due diligence.
Likewise, we cannot require that someone gets a medical diagnosis before we would, say, consider a 504.
(I hope my mental health practitioner who asked this question is reading.)
We are responsible for pursuing the matter ourselves.
DISCLAIMER - The diagnostic conversation seems overly simplified and watered-down to me.
Under IDEA, each public agency—that is, each school district—shall ensure that a full and individual
evaluation is conducted for each child being considered for special education and related services. The
child’s individualized education program (IEP) team uses the results of the evaluation to determine the
educational needs of the child. The results of a medical doctor’s, psychologist’s, or other qualified professional’s
assessment indicating a diagnosis of ADHD may be an important evaluation result, but the
diagnosis does not automatically mean that a child is eligible for special education and related services.
A group of qualified professionals and the parent of the child determine whether the child is an eligible
child with a disability according to IDEA. Children with ADHD also may be eligible for services under
the “Specific Learning Disability,” “Emotional Disturbance,” or other relevant disability categories of
IDEA if they have those disabilities in addition to ADHD.
Section 504 was established to ensure a free appropriate education for all children who have an impairment—****
physical or mental—that substantially limits one or more major life activities. If it can be demonstrated
that a child’s ADHD adversely affects his or her learning—a major life activity in the life of
a child—the student may qualify for services under Section 504. To be considered eligible for Section
504, a student must be evaluated to ensure that the disability requires special education or related services
or supplementary aids and services. Therefore, a child whose ADHD does not interfere with his or her
learning process may not be eligible for special education and related services under IDEA or supplementary
aids and services under Section 504.
Here is my take:
1 - School Psychologists have (or at least should be expected to have) the training and expertise necessary to formally diagnose any DSM-IV Disorder.
In fact, for many diagnoses, the battery used by school psychologists is better than many used in practice by many others in practice. This is supported by the fact that, in California, Licensed Educational Psychologists (LEP's) in practice are allowed to diagnose and bill for diagnosis in private practice with no additional training in this realm. Of course, individual results and competency will vary.
2 - Having the training and ability does not mean that they should be going down that road very often. Any time school psychologists working for an educational agency stray from education code and education-based decision-making things get precarious.
The decision if/when to focus on clinical diagnosis should be deferred to the chain-of-command at any given agency.
I expect all of my staff to be fully competent in diagnosing ADHD or any DSM-IV Disorder.
This is best done sparingly when we need to undo a previous diagnosis or to update a better differential diagnosis, and only when there are true treatment implications at stake. Too often, I see it done to quibble with other practitioners over "who is right" and not to forward a discussion on how to best serve a student.
For example, my last assessment was to refute consideration of an Asperger's Syndrome diagnosis from a quickie assessment performed by Dr. Buy-a-diagnosis and maintain the team's focus on the student's Emotional Disturbance/Mental Health and ADHD needs.
In this regard, I started with Ed Code but added DSM-4 for added emphasis.
Even then, I don't formally diagnose, I stick with the "walks like a duck, acts like a duck, quacks like a duck" type of language.
For example, I use language that perfectly matches DSM-4 criteria without announcing that I am doing that.
For ADHD, I may say, "There is no evidence of signs, symptoms, or impairment prior to the age of 7. Furthermore, the following cannot be effectively ruled out as alternative explanations. In fact, the evidence suggests that these are more likely causes of the presenting...."