Attention Deficit Hyperactive Disorder
The National Institute of Mental Health or NIMH (2008) states, “Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and
adulthood” (p. 1). Hardman, Drew, and Egan (2011) state, “Prevalence estimates for ADHD most
often suggest that 3-7% of all school-aged children may have the disorder although some researchers believe this is too low” (p. 183). With such a high prevalence of ADHD among school-aged children, teachers need to
understand what ADHD is. Just as important for teachers to know is how students with ADHD can be helped
under Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act (IDEA).
A summary of the history of ADHD which Krans (2010, July 29) gives follows. Sir Alexander Crichton started studying what he called “mental restlessness” in 1798. In 1902 Sir George Frederick Still of Britain wrote of behavior and inattentive problems in 43 children that he studied. He saw this as a “morbid defect in moral control”. In 1937 Dr. Charles Bradley started treating hyperactivity with stimulants. In 1968 the American Psychiatric Association (APA) recognized it in the second publication of the Diagnostic Statistical Manual of Mental Disorders as “hyperkinetic reaction of childhood”. Its current name of Attention deficit hyperactivity disorder was giving to it in 1987. Attention deficit hyperactivity disorder (ADHD) is currently the correct terminology for this disorder. It is commonly called ADD or ADHD (Ashley, 2005, p. 2). At times it is written Attention deficit/hyperactivity disorder or AD/HD. There are three types of attention deficit hyperactivity disorder (ADHD): attention deficit hyperactivity disorder (ADHD), primarily inattentive
type commonly called ADD; attention deficit hyperactivity disorder (ADHD), primarily hyperactive-impulsive type often called ADHD; and attention deficit hyperactivity disorder (ADHD), combined type also referred to as
ADHD (Ashley 2005, p. 2). The primarily inattentive type refers to those with a significant number of the characteristics or symptoms of inattention but not as many of the hyperactive-impulsive characteristics (Rief, 2005, p. 4). Characteristic that the APA has given as diagnostic criteria include inattention, include failing to
give close attention to details, difficulty sustaining attention, seeming to not listen, not following directions or instructions, difficulty organizing tasks, and easily being distracted by outside stimuli (Hardman et al., 2011 p. 184). The predominantly impulsive type is the opposite of the inattentive type in that it is predominately hyperactive-impulsive characteristics with relatively few inattention characteristics. The characteristics for hyperactivity and impulsive behavior given by the APA include: fidgeting with hands or feet or squirms in seat, leaves seat in classroom when expected to stay seated, runs or climbs excessively, often is “on the go”, blurts out answers before question is completed, and has difficulty awaiting turn (Hardman et al., 2011 p. 184). People who are diagnosed with the combined type exhibit both inattentive and hyperactive-impulsive characteristics. There are different levels of severity in ADHD. Rabiner (2004) states:
There are definitely different levels of severity of ADHD. For some children, even though they meet the
criteria for the diagnosis, their symptoms are relatively mild. Other children, in contrast, display symptoms of much greater intensity and are significantly more difficult to manage.
It is also important to recognize that the severity of a child's symptoms can vary significantly over time,
and even at the same point in time across different settings. Thus, some children experience a diminishing of their symptoms as they grow older - many times to the point where the symptoms no longer cause significant
impairment and the child - who may now be a teen or young adult - no longer
would be diagnosed with ADHD. (para. 1-2)
criteria for the diagnosis, their symptoms are relatively mild. Other children, in contrast, display symptoms of much greater intensity and are significantly more difficult to manage.
It is also important to recognize that the severity of a child's symptoms can vary significantly over time,
and even at the same point in time across different settings. Thus, some children experience a diminishing of their symptoms as they grow older - many times to the point where the symptoms no longer cause significant
impairment and the child - who may now be a teen or young adult - no longer
would be diagnosed with ADHD. (para. 1-2)
According to Rief (2003), “Heredity accounts for about 80% of children with ADHD,” (p. 25). Rief (2003) also gives as causes: prenatal, during birth, or postnatal trauma/injury, illnesses and brain injury, diminished activity and lower metabolism in certain brain regions, chemical imbalances or deficiency in neurotransmitters,
slight structural brain differences, and environmental factors (p. 25-27). Studies have been done to determine if these are indeed the causes. Barkley (2000) writes,
Some scientist suggest that neurotransmitters (chemicals in the brain that permit nerve cells to transmit information to other nerve cells) are deficient in those with ADHD. . .Two genes that regulate dopamine have
already been identified as being associated with ADHD ( p. 66).
already been identified as being associated with ADHD ( p. 66).
Studies on the brain have been done on electrical activity with electroencephalograph (EEG), brain activity by
positron emission tomography (PET) scans, and also blood flow. These studies show lower brain electrical activity, less brain activity particularly in the frontal lobe, and less blood flow. Smoking cigarettes and
drinking alcohol during pregnancy also increase the chances of a child having ADHD. According to Rief (2005), “Researchers say that no more than 5% of those with ADHD are believed to acquire this disorder
through illness or postnatal brain damage” (p. 17).
According to Hardman et al. (2011), “The average male/female ratio ranges from 2.5:1 to 3.5:1” (p. 183).
Rief (2005) states, “The vast majority of research on ADHD has been conducted with samples of white boys between the ages of six and eleven years with middle-class backgrounds” (p. 19). This indicates that very little is known about ADHD in minority populations. Evidence shows that African Americans may be mistrusting of medical research and Latinos are more likely to involve extended family in decisions about diagnosis and
opinions (Rief, 2005, p. 19).
Children with ADHD may qualify for educational services under Section 504 of the Rehabilitation Act of 1973 as well as under IDEA. Section 504 makes it so that public schools cannot discriminate against children with disabilities. Schools are expected to make reasonable accommodations and modifications for a child’s disability (Ashley, 2005, p. 75). IDEA entitles children with disabilities to a free and appropriate public education (FAPE) in the least restrictive environment, the provision of nondiscriminatory and multidisciplinary
assessments, parents’ right to involvement, and an individualized education program (IEP) for each student (Hardman et al., 2011, p. 28). Students must have a qualifying disability and need specialized services to receive services under IDEA.
Not all students with ADHD will qualify for special education services under IDEA. However, those who do qualify can qualify for special education services under the category of “other health impairments” (National Dissemination Center for Children with Disabilities [NICHCY], 2009). According to NICHCY, IDEA (2004) states that,
Other health impairmentmeans having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational
environment, that--
(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and
(ii) Adversely affects a child’s educational performance. [§300.8(c)(9)]
IDEA clearly states that children do not need to show evidence of a learning disability on standardized tests to qualify for services; rather they are entitled to functional assessments (Monastra, 2005, p. 103). According to Ashley (2005) the following is a list of specific criteria necessary to be eligible under “other health impairments”.
· The child must have a diagnosis of AD/HD and the disorder must have led to limited alertness in academic
tasks.
· The effects of AD/HD must be chronic or acute.
· The effects of AD/HD must have an adverse effect on educational performance, including grads, achievement test scores, behavior problems, impaired or inappropriate social relations, or impaired work
skills.
· The student requires special education services to address the AD/HD and its effects. (p. 81)
Once it has been determined that a student qualifies for services under IDEA or Section 504, an intervention
plan and necessary services must be set up and implemented.
Intervention plans may include reasonable accommodations which are required to be made under section 504. Students who qualify under IDEA automatically qualify for services under section 504 but the reverse isn’t the
same. Section 504 can cover students in need of accommodations who do not qualify for services under IDEA. These accommodations may include seating a student at the front of the class, allowing extra time to complete tasks, ignoring impulsive calling out, providing immediate praise and rewards, providing short breaks between
activities, allowing the student to stand while working, and allowing the student to have a set of books both at home and at school (Ashley, 2005, p. 77).
Intervention under IDEA can implement the same accommodations that were implemented under Section 504 but it can also include related special services directed towards intervening and helping the student. According to Rief (2005)
Related services, as listed under IDEA, include (but are not limited to): Speech-language pathology services, transportation, occupational therapy, orientation and mobility services, parent counseling and training, physical therapy, audiology services, counseling services, early identification and assessment of disabilities in children, medical services, psychological services, recreation, rehabilitation counseling services, school nurse services that enable a child with a disability to receive a FAPE as described in his or her IEP, social work services, interpreting services. (p. 398)
A number of effective learning strategies can be implemented by teachers. According to Rief (2005), “Some involve use of a mnemonic device that assists a student in understanding and completing a task, usually by specifying a series of steps to be completed in sequential order” (p. 227). Rief (2005) also believes teachers can also implement other things to help students in academic areas such as providing a manipulative for math, substituting non-written projects such as oral reports for written assignments, practicing writing words with special pens to encourage spelling practice, and brainstorming in class. To enhance social skills Rief (2005) suggests that teachers could have children greet each other, give group assignments, allow students time to practice listening and responding, and do other activities that teach social skills in small groups.
Behavior intervention is often implemented with students with ADHD. Behavior intervention rewards good behavior in order to replace unwanted behavior. Ashley (2005) states, “Despite appearances, most AD/HD children really do want to do what is right. They are very responsive to praise and, if they know it is readily available, they will work to earn it”(p. 127). Praise is easy for anyone to give. Rewards and positive reinforcements for good behavior can include verbal praise, positive phone calls home, class applause, recognition at awards assemblies, and playing a game with friends (Rief, 2003, p. 102).
Another intervention that can help with ADHD is medical intervention. Hardman et al. (2011) state, “Controlling hyperactivity and impulsive behavior appears to be most effectively accomplished with medication (often methylphenidate or Ritalin)” (p. 188). Medical intervention such as prescription medication must be done by medical professionals. This will usually require multiple follow ups. Doctors like to hear educators’ opinion on the effect of the medication on classroom behavior.
Family is an important part of intervention. Parents often struggle at home when dealing with a child who has ADHD. Ashley (2005) states:
Behavior intervention is often implemented with students with ADHD. Behavior intervention rewards good behavior in order to replace unwanted behavior. Ashley (2005) states, “Despite appearances, most AD/HD children really do want to do what is right. They are very responsive to praise and, if they know it is readily available, they will work to earn it”(p. 127). Praise is easy for anyone to give. Rewards and positive reinforcements for good behavior can include verbal praise, positive phone calls home, class applause, recognition at awards assemblies, and playing a game with friends (Rief, 2003, p. 102).
Another intervention that can help with ADHD is medical intervention. Hardman et al. (2011) state, “Controlling hyperactivity and impulsive behavior appears to be most effectively accomplished with medication (often methylphenidate or Ritalin)” (p. 188). Medical intervention such as prescription medication must be done by medical professionals. This will usually require multiple follow ups. Doctors like to hear educators’ opinion on the effect of the medication on classroom behavior.
Family is an important part of intervention. Parents often struggle at home when dealing with a child who has ADHD. Ashley (2005) states:
AD/HD children are not your average children and they do not readily respond to the usual parenting methods. Parents raising AD/HD children need to go above and beyond the usual parenting techniques. Be sure your parenting skills include:
· Creating a rulebook
· Structuring your child’s life
· Working as a parenting team
· Designing and using a point system
· Giving immediate consequences
· Using time-out (p.144)
· Creating a rulebook
· Structuring your child’s life
· Working as a parenting team
· Designing and using a point system
· Giving immediate consequences
· Using time-out (p.144)
These techniques help a child with ADHD know what their parents expected of them. Having immediate consequences for the child’s choices, whether good or bad, helps the child distinguish between desirable and undesirable behavior. Teaching children with ADHD good habits at home can reinforce what a teacher is trying to teach them at school.
Parents have the right to request that their child be evaluated for special services if they believe he needs help at school. When an IEP or Section 504 meeting is necessary, parents can help develop educational expectations for their child. Ideally everyone involved in intervention with the child would meet together at the same time to discuss the child. This is not always possible. Parents are often an important bridge between medical and educational professionals. They can provide valuable information that they have obtained from professionals who are unable to attend an IEP meeting such as a physician or psychologist. If the child is on medication or sees a psychologist, parents can also bring up information about a child’s behavior at school with the professionals who are working with their child outside of the school setting.
Attention deficit hyperactivity disorder or ADHD affects my son. We went through a period of time wondering if he had ADHD or if it was his age. Within two weeks of starting kindergarten, he was suspended because of inappropriate behavior. By the time two months had passed, he had in-school suspensions three times and out-of-school suspensions twice. We knew this was not normal for a child in kindergarten and took him to see a doctor. It was a very long process to find the right medication and the right level for him. At the same time we were battling his inappropriate behavior. We talked to his teachers to make sure we were all using the same terminology with things so there was consistency between home and school. He was seated at the front of his class at our request. This minimized the number of things that could distract him. He has made significant progress. Now he still has a lot of energy, but he understands what behavior is appropriate for different places. It is important that teachers know the signs and symptoms of ADHD. The first teacher my son had was not very understanding of this issue. At one point, I brought up that he could tell me everything that was going on in that class and she said, “He needs to be able to just do his work and ignore what is going on around him.” She was unwilling to move him and often blamed him for things that he wasn’t even involved in. This really showed me how important it is for teachers to understand ADHD.
ADHD affects many school children. ADHD is covered by IDEA under the “other health impairments” category and services can also be serviced under Section 504 of the Rehabilitation Act of 1973. Children with this disorder are not always going to qualify for special services under these laws. If teachers understand what ADHD is and intervention techniques for it, they can still implement techniques in their classroom that would help these children have a better chance at success even when the child doesn’t qualify for special services.
Parents have the right to request that their child be evaluated for special services if they believe he needs help at school. When an IEP or Section 504 meeting is necessary, parents can help develop educational expectations for their child. Ideally everyone involved in intervention with the child would meet together at the same time to discuss the child. This is not always possible. Parents are often an important bridge between medical and educational professionals. They can provide valuable information that they have obtained from professionals who are unable to attend an IEP meeting such as a physician or psychologist. If the child is on medication or sees a psychologist, parents can also bring up information about a child’s behavior at school with the professionals who are working with their child outside of the school setting.
Attention deficit hyperactivity disorder or ADHD affects my son. We went through a period of time wondering if he had ADHD or if it was his age. Within two weeks of starting kindergarten, he was suspended because of inappropriate behavior. By the time two months had passed, he had in-school suspensions three times and out-of-school suspensions twice. We knew this was not normal for a child in kindergarten and took him to see a doctor. It was a very long process to find the right medication and the right level for him. At the same time we were battling his inappropriate behavior. We talked to his teachers to make sure we were all using the same terminology with things so there was consistency between home and school. He was seated at the front of his class at our request. This minimized the number of things that could distract him. He has made significant progress. Now he still has a lot of energy, but he understands what behavior is appropriate for different places. It is important that teachers know the signs and symptoms of ADHD. The first teacher my son had was not very understanding of this issue. At one point, I brought up that he could tell me everything that was going on in that class and she said, “He needs to be able to just do his work and ignore what is going on around him.” She was unwilling to move him and often blamed him for things that he wasn’t even involved in. This really showed me how important it is for teachers to understand ADHD.
ADHD affects many school children. ADHD is covered by IDEA under the “other health impairments” category and services can also be serviced under Section 504 of the Rehabilitation Act of 1973. Children with this disorder are not always going to qualify for special services under these laws. If teachers understand what ADHD is and intervention techniques for it, they can still implement techniques in their classroom that would help these children have a better chance at success even when the child doesn’t qualify for special services.
References
Ashley, S. A. (2005). ADD & ADHD answer book: The top 25 questions parents ask. Naperville, IL: Sourcebooks,
Inc.
Barkley, R. A. (2000). Taking charge of ADHD: The complete authoritative guide for parents (revised ed.). New York, NY: Guilford Press.
Hardman, M. L., Drew, C. J., Egan, M. W. (2011). Human Exceptionality. Belmont, CA: Wadsworth.
Krans, B. (2010, July 29). History of ADHD. Retrieved from: http://www.healthline.com/health/add-adhd-attention-deficit-history-of-adhd
Monastra, V. J. (2005). Parenting Children with ADHD: 10 lessons that medicine cannot teach.
Washington, D.C.: APA LifeTools.
National Institute of Mental Health (2008). Attention deficit hyperactivity disorder (ADHD) (NIH Publication No. 08-3572). Bethesda, MD: National Institute of Mental Health.
National Dissemination Center for Children with Disabilities (2009, August). Other Health Impairments (NICHCY Disability Fact Sheet 15 (FS15)). Retrieved from: http://nichcy.org/disability/specific/ohi
Rabiner, D. (2004). Are there different levels of ADHD. Retrieved from: http://www.adhdlibrary.org/library/are-there-different-levels-of-adhd/
Rief, S. F. (2003). The ADHD book of lists: A practical guide for helping children with teens with attention deficit disorders. San Francisco, CA: Jossey-Bass.
Rief, S. F. (2005). How to reach and teach children with ADD/ADHD: Practical techniques, strategies, and interventions (2nd ed.). San Francisco, CA: Jossey-Bass.
Barkley, R. A. (2000). Taking charge of ADHD: The complete authoritative guide for parents (revised ed.). New York, NY: Guilford Press.
Hardman, M. L., Drew, C. J., Egan, M. W. (2011). Human Exceptionality. Belmont, CA: Wadsworth.
Krans, B. (2010, July 29). History of ADHD. Retrieved from: http://www.healthline.com/health/add-adhd-attention-deficit-history-of-adhd
Monastra, V. J. (2005). Parenting Children with ADHD: 10 lessons that medicine cannot teach.
Washington, D.C.: APA LifeTools.
National Institute of Mental Health (2008). Attention deficit hyperactivity disorder (ADHD) (NIH Publication No. 08-3572). Bethesda, MD: National Institute of Mental Health.
National Dissemination Center for Children with Disabilities (2009, August). Other Health Impairments (NICHCY Disability Fact Sheet 15 (FS15)). Retrieved from: http://nichcy.org/disability/specific/ohi
Rabiner, D. (2004). Are there different levels of ADHD. Retrieved from: http://www.adhdlibrary.org/library/are-there-different-levels-of-adhd/
Rief, S. F. (2003). The ADHD book of lists: A practical guide for helping children with teens with attention deficit disorders. San Francisco, CA: Jossey-Bass.
Rief, S. F. (2005). How to reach and teach children with ADD/ADHD: Practical techniques, strategies, and interventions (2nd ed.). San Francisco, CA: Jossey-Bass.