To the Editor:
The article, "The Attention Deficit Disorder, Evaluation and Treatment," in the May 1 985 issue of Pediatric Annals was quite comprehensive and, in general, very excellent as a review of this somewhat complicated problem.
I enjoyed particularly your comments regarding the fact that a school visit in the diagnosis of ADD would be extremely useful in clarifying the issues in that environment. We have operated under the assumption that the diagnosis of ADD can only be made with comfort after a school visit has been obtained, we have engaged, for the past ten years, a former teacher to act as our liaison and serve as a diagnostic tool through a 2 to 3 hour observation of the child in the classroom, at lunch and on the playground. This particular act reduced our use of psychostimulant medication in half, and allowed us a clear definition of what the teacher and parent were calling "hyperactive."
Your comments in the article give the first useful, in print, comment relative to that particular mode as a diagnostic tool.
John H. Richards, MD
Kaiser Permanente Center for School Problems
San Diego, California
Dr. Dulcan, author of the article, responds to Dr. Richards' comments.
The system of school observation described by Dr. Richards sounds ideal, particularly if the observer uses a standardized format for observation and recording. He does not mention if the observer returns to assess the effect of medication, but that would be very helpful also. Using a former teacher provides a great deal of data while economizing on physician time.
Mina K. Dulcan, MD
University of Pittsburgh