Assessment and intervention for attention-deficit/hyperactivity disorder in the schools. Lessons from the MTA study.

The MTA experience provides several lessons that may have clinical relevance. First, the MTA study identified six key instruments (see Table 1) that clinicians may want to use, but even on these instruments discrepancies in parent and teacher sources should be expected. We believe that unnoticed or unresolved discrepancies may be important factors contributing to the "disconnect" identified by the Consensus Conference Panel. Based on the MTA experience, we recommend a telephone call to the child's teacher, specifically to inquire about any discrepancy in the "source by domain" summary, as an efficient way to make a meaningful connection "... between developmental or educational (school-based) assessments and health-related (medical practice-based) services" for children with ADHD. Second, evaluation of pharmacologic intervention in the MTA study confirmed that teachers' reports are crucial for documenting efficacy, whereas parent reports are crucial for documenting side effects. Based on the MTA experience, we recommend frequent telephone contact with the teacher specifically to inquire about the peak effects and dissipation of effects of medication that are expected to occur during the school hours as a way to improve "... communication between diagnosticians and those who implement and monitor treatment in the schools."