Attention+Deficit+Hyperactivity+Disorder

Rebecca Lambert

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder or ADHD affects a significant percentage of school-age children. IDEA includes ADHD not as its own disability category but as a subcategory of the “other health impairments” section (Turnbull, Turnbull, & Wehmeyer 182). A student with other health impairments is defined as having limited strength, vitality, or alertness which adversely affects a child’s educational performance (182). ADHD is one of the most common childhood disorders and can affect an individual well into adolescence and even adulthood (ADHD 1). The accepted definition is that which the American Psychiatric Association provides: “The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and severe than is typically observed in individuals at a comparable level of development” (Turnbull, Turnbull, & Wehmeyer 182). The characteristics of ADHD are wide and many. Symptoms include difficulty staying focused and concentrating and over-activity (ADHD 1). ADHD has three subtypes: predominately inattentive type, predominately hyperactive-impulsive type, and the combined type. A student must exhibit a certain amount of characteristics defined in each type in order to be classified as having that type. The characteristics are defined by Turnbull, Turnbull, & Wehmeyer (183-184) and are as follows: // (a) //// Often fails to give close attention to details or makes mistakes in schoolwork, work, or other activities // // (b) //// Often has difficulty sustaining attention in tasks or play activities // // (c) //// Often does not seem to listen when spoken to directly // // (d) //// Often does not follow through on instructions and fails to finish schoolwork, chores, or duties, in the workplace (not due to oppositional behavior or failure to understand instructions) // // (e) //// Often has difficulty organizing tasks and activities // // (f) //// Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) // // (g) //// Often loses things necessary for tasks or activities // // (h) //// Is often easily distracted by extraneous stimuli // // (i) //// Is often forgetful in daily activities // // Hyperactivity // // (a) //// Often fidgets with hands or feet or squirms in seat // // (b) //// Often leaves seat in classroom or in other situations in which remaining seated is expected // // (c) //// Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) // // (d) //// Often has difficulty playing or engaging in leisure activities quietly // // (e) //// Is often “on the go” or often acts as if “driven by a motor” // // (f) //// Often talks excessively // // Impulsivity // // (g) //// Often blurts out answers before questions have been completed // // (h) //// Often has difficulty awaiting turn // // (i) //// Often interrupts or intrudes on others // // Student possesses qualities of both the inattentive type and the hyperactivity-impulsivity type. // The causes of ADHD are still somewhat unknown but several factors can come into play, the biggest one being genes. Heredity and genetic factors have shown to cause ADHD in about 80 percent of those who experience it (Turnbull, Turnbull, & Wehmeyer 187). Children with a parent with ADHD are 50% more likely to have it and siblings of children with it are five to seven times more likely to have ADHD (187). According to the National Institute of Mental Health (NIMH), researchers’ knowledge of genetic factors affecting ADHD could lead to prevention of the disorder in the future or better treatments. Another factor that comes into play is structural differences in the brain. The frontal lobe, cerebellum and basal ganglia all appear to have a critical affect on the areas of motivation, behavioral inhibition, and movement (Turnbull, Turnbull, & Wehmeyer 187). Researchers are studying these areas of the brain in individuals with ADHD and they have found that these areas of the brain are less well developed and less active in people with ADHD compared to people who do have the disorder (188). Researchers have also found that stimulants which are the primary medication prescribed to treat ADHD are very effective because they increase the levels of dopamine in the brain which improves certain functions such as attention, working memory, impulsiveness, and motor control (188). Other factors which may cause this disorder are environmental factors, brain injuries, sugar intake, and food additives. There may be a link between cigarette smoking, lead exposure, and alcohol consumption during pregnancy with ADHD in children. Research is currently underway to determine links between food additives and sugar intake and ADHD in children. As of now, more research discounts these theories than supports them (ADHD 4). Treatments for ADHD revolve around reducing the symptoms while increasing functioning. Currently, treatments include medications, various forms of psychotherapy, education or training, or a combination (ADHD 7). Most commonly, the medication prescribed for ADHD falls in the stimulant category. Unusually, stimulants have a calming effect on children with ADHD and may actually improve their symptoms. These medications help children to reduce impulsivity and hyperactivity while improving their ability to focus, concentrate, work, and learn. Obviously different medications produce different effects in different kids so many times, multiple medications have to be experimented with in order to find the right fit. The side effects of stimulant medications vary but include many of the following: decreased appetite, sleep problems, anxiety, and irritability (7). Less commonly, children may develop tics or sudden repetitive movements or sounds. Some children may also experience a change in their personality such as having no emotion. It is when these side effects persist that a doctor needs to either lower dosages or change medications (8). Although these medications do not cure ADHD, they do control the symptoms as long as they are taken and can improve students’ ability to succeed in school. Psychotherapy, another form of treatment, can also help children with ADHD. Behavior therapy, for example, can help children change his or her behavior. This type of therapy teaches a child how to monitor their own behavior and gives them practical help, such as organization or completing schoolwork. These therapists also help children in their social skills such as how to wait their turn, respond to teasing or learning to read facial expressions and tones of voices (10). The diagnosis of ADHD comes either before the student enrolls in school or after because their teachers or school psychologists suspect the presence of the disorder and request an evaluation (Turnbull, Turnbull, & Wehmeyer 188). The school then conducts a nondiscriminatory evaluation of the student to determine if he/she will qualify to receive special education (ADHD 13). The evaluation includes the following steps: Observation, Screening, Pre-referral, Referral, Nondiscriminatory evaluation procedures and standards, and Determination. They start with observing the child and taking note of whether the student appears to be predominantly inattentive or predominantly hyperactive-impulsive or a combination of the two. The screening step involves looking at the students classroom work, giving a group intelligence test, group achievement tests, a medical screening, and vision and hearing screenings. These various tests are simply to rule out any other possibilities before diagnosing. The pre-referral is when the teacher implements the suggestions made by the previous tests. The process continues if the student still experiences frustration and trouble in school despite various forms of intervention. The student is then referred fully to a multidisciplinary team for a complete evaluation which includes several tests. The student is then given a psychological evaluation by a psychiatrist or psychologist who determines if the child exhibits the criteria for ADHD. They are then given an individualized intelligence test and an individualized achievement test. The next step is a behavior rating scale, teacher observation, curriculum-based assessment, and direct observation. Based on the results of all of these tests, the team determines whether or not the student has ADHD and whether or not they need to receive special education services. This same team then develops an appropriate education plan for the student (Turnbull, Turnbull, & Wehmeyer 189). Accommodations for students with ADHD vary greatly from student to student. They are very specific to the symptoms that the student experiences. For instance, to help students in planning, teaching students to use day planners, time schedules, or organizers will increase planning skills. This will help them to develop these skills which they will use for the rest of their lives. To increase organization, teachers can allow time for these students to organize their materials, lockers, and backpacks. Limiting the amount of folders and binders they use will also help to consolidate and organize their papers rather than stuffing them somewhere. ADHD students often need help in improving follow-through and self-control. Creating work completion routines, accepting late work, and giving partial credit for partially completed work will help with follow-through. For self-control improvement, students need to be prepared for transitional times during the school day and they need to have clear rules and consequences set. For students who need assistance with working memory, focus on one subject at a time and write all the work down. Providing these students with summaries, study guides, notes, outlines, and lists will help them along with teaching them note taking skills. For students with memory retrieval problems, teach them memory strategies such as mnemonic devices and practice distinguishing between main ideas and details. For difficulty in beginning tasks, repetition of directions as well as summarizing key information will help. Students who need help staying on task and finishing tasks, divide large assignments into small sections and make it interesting (Pierangelo 168). Finally, for all students with ADHD, providing as much one on one instruction as possible will be beneficial as well as incorporating an active learning style. These students need variety in their school day (167). While there are a large amount of students diagnosed with ADHD, accommodating for them in schools is simple as long as teachers are willing to help. These students experience many different symptoms and side effects from their disorder and their treatment and they are often told that they will never succeed. On the contrary, these students are fully capable of everything that “normal” children are; they simply learn differently. Children with ADHD can be very successful if allowed.
 * // Predominately inattentive type //**
 * // Predominately hyperactive-impulsive type //**
 * // Combined type //**

Works Cited Turnbull, A., Turnbull, R., Wehmeyer, M. L., (2007). Exceptional Lives: Special Education in Today’s Schools. Columbus, OH: Pearson Merrill Prentice Hall.

Pierangelo, Roger. (2004). The Special Educator’s Survival Guide: second edition. San Francisco, CA: Jossey-Bass: A Wiley Imprint.

Attention Deficit Hyperactivity Disorder (ADHD). (2008). National Institute of Mental Health. Retrieved on September 29, 2009 from: []

Rebecca Lambert ADHD Interviews Interviews with individuals affected by Attention Deficit Hyperactivity Disorder proved to be fairly insightful into how this disorder affects the individual as well as various people surrounding the individual such as parents, siblings, and teachers. There is no doubt that this sort of diagnosis can be very challenging emotionally, physically, spiritually, and financially. The individual’s basic characteristics alone can lead to hair-pulling, stress-inducing, emotional breakdown kind of reactions. Considering the vast amount of aspects that go into having a child or student with this diagnosis, you can imagine how demanding that can be. Attention Deficit Hyperactivity Disorder has very wide spectrum of characteristics and symptoms and this was made evident in the interviews. Teachers’ describe their students as needing constant reminders to stay on task or stay seated or stop talking (3U). These students have a very hard time focusing (4N). These being the most common, stereotypical symptoms of ADHD still do remain. This can definitely lead to frustration of the teachers’ end if they do not know how to accommodate appropriately. However, “after school, a family with an ADHD student is going to look a lot different than a family without an ADHD student because their symptoms don’t end after the school day” (1A). Parents must be equipped and prepared to handle their children at home because their symptoms will continue past the school day and may even get worse because their medication begins to wear off. Children with ADHD also tend to be very impulsive. One of the participants stated that her daughter “is very impulsive. When she goes to the store or a friend’s house, we have to pat her down to make sure she hasn’t taken anything” (4BE). Because of these kids’ impulsivity, they also tend to be generous with other peoples’ things which can be good or bad. “My sister has a shirt like that, let me give it to you, I’m sure it will be fine” (4BZ). Kids with ADHD also seem to be somewhat quirky and exhibit peculiar tendencies. Examples from interviews are below: Diagnosing a child with ADHD takes a long process of steps. The parents must be proactive in getting them into the right doctors and getting a diagnosis. One of the participants described her experience with the doctor: “they gave out pieces of paper to the parents, teachers, and anyone who regularly comes in contact with her and you fill out a scale based on her behavior and characteristics (4V). Depending on how it’s ranked and the history of the child, the doctor can diagnose the child” (4W). Many doctors choose to use method of diagnosing but there are several different ways a doctor can evaluate the child. The most common treatment for ADHD is prescribing medication. There are different methods of doing this: there are oral medications, patches, time released medicines. “It’s just a matter of figuring out what is right for the child” (4X). These medications are not an end-all treatment, however. They do not cure ADHD and there are side effects, depending on the child’s body reacts to the medication. “[My daughter’s] main side effect is decreased appetite. She does not eat when she is on the medications” (4Y). These medications do not last forever either. They tend to wear off in the late afternoon and behavior can get worse. “The students [behavior] could even get worse [after the school day] because their medications begin to wear off. So, the mom has to know how to deal with that” (1B). As discussed previously, a child’s symptoms do not end with the school day so the parents also have to implement accommodations and extra help at home. This type of treatment can also cause a very tough financial situation. These medications are very expensive and some families seek alternative methods: “we could not afford [the medication] so we searched for a generic brand. In the US, there is no generic brand of Abilify, but in Canada there is. So we purchased Aripriprozole, from Canada which costs $50-60 for three months” (4AJ). Another option parents may seek is taking their child off of medication by their own choice. “Many parents take their kids off medication by their choice by the time they get to high school and then they just go crazy because it’s no longer controlled” (3O). This can result in a negative or positive experience. One of the participants has actually had a very positive experience since taking her child off medication: “ever since we took her off the patch, she has been doing really well. She is on the basketball, volleyball, and softball teams (she is 5’9”) and her grades have been A’s and B’s” (2F). In addition to the financial burden that medication entails, many families experience other financial ties related to their child’s diagnosis: “because of her combined Learning Disability and Attention Deficit Hyperactivity Disorder, we employed someone when she was younger as a tutor and nanny to give her the one on one attention and help she needed to advance in her schoolwork. And of course all of the medical expenses such as doctor’s visits and medications have tied us financially” (2H). The IEP process with these students and families can be a very pleasant experience or a tough, frustrating experience. As professionals, “we try to keep [the IEP process] a positive experience, especially if the parents are really exasperated” (1G). Teachers and professionals involved in this process must be aware of the frustration that can occur to families and try to lessen that for parents. “We try to remind them that we are here to work together and to partner with them to continue to help their child be successful” (3H). Another one of the participants (a teacher), has a similar idea: “We talk about how we can bridge the gaps between the differences between them and their classmates by setting goals (1H). We try to make it so that parents walk away with a positive attitude and a set of goals on how they can help their child” (1I). Professionals should attempt to make this somewhat frustrating and emotionally-draining experience as pain-free and smooth as possible for the sake of the parents and families as well as the student. “I allow [parents] to rely more on me as a professional rather than the actual IEP document. I make myself available and let them know that they can come to me with any concerns or call and ask questions if ever necessary” (1J). From the parent viewpoint, this availability of the professionals proves to be very helpful. “That is what really helps the child. When a teacher tells me a time to contact them, that is what is helpful…that is the only way anything will get done” (4CO). The families’ experiences with the IEP process depend greatly on the attitude and proficiency of the professionals involved. Families can have very positive experiences or negative experiences. Participants’ experiences are noted below: Because of the wide range of characteristics and symptoms of Attention Deficit Hyperactivity Disorder, there is also wide range of accommodations used to help with these. There is no magic formula for what works because of course, the accommodations have to be specific to the symptoms and to the child. Just like a doctor has to experiment with what medication works best, accommodations have to be experimented to find what works best for the child. It is a bit of a trial and error game; if a certain accommodation does not work, that one is thrown out and a new one has to put into place. Participants in the interviews did give specific examples of the accommodations that they have to work best. Participants who are teachers commented on what works for their students: The parent participants also commented on the various accommodations that they have found to work for their child specifically. Because of the characteristics of ADHD, one of the parent participants stated that they send her to get ready for bed (or when doing anything really), at least 30 minutes early because they know that so many things distract her (2E). The other parent participant stated that her daughter, now in second grade, sits directly next to the teacher because that is the only way she will focus (4Q). Because of this child’s characteristics, however, and the amount of time her medications last, homework cannot be done; homework is just not possible in the state it is in right now (4BG). These parents also help their daughters by working with them with their school work at home. This seems to be vital to any child’s success, especially one with ADHD. The parents must be involved and provide assistance and help to their child when working on homework or when improving specific skills. For example, one parent participant does math problems with her daughter at home in an attempt to improve her math skills (4BP). This parent has also found that her daughter, along with other children diagnosed with ADHD are ultimately really good kids and they just need good, positive feedback (4DB). These kids already get teased and ridiculed enough so they just need good self-esteem and positive feedback. Being diagnosed with Attention Deficit Hyperactivity Disorder obviously involves so many different aspects that it is very easily seen as overwhelming and certainly has a great emotion impact not only on the families but also on the student themselves. It also affects their relationships greatly which can be very draining. “It has been a struggle for her to make friends but she doesn’t really know why she has a hard time because she doesn’t recognize that she is being less mature then her peers. It’s hard for her to understand social cues (2P). The teacher participants also had insight on how the student feels about his or her own diagnosis. “Sometimes [the students] are kind of self-conscious about it but most of the time not. Most of the time, they seem to not even care what other students think” (3P). Another teacher participant had a bit of a different viewpoint: “freshmen in high school come to me and they really don’t know that they have a disability or they don’t really know what their disability is (1N). So by the end of their freshmen year, I like to have sat down with them and really get them to understand their disability and their medications and how they are different from their peers (1O). There are two reactions. They either have a sense of relief knowing what they have and that there are other kids with the same thing or they have absolutely no idea that they are any different from anyone else and they completely refuse to believe that they have a disability. They just have a lack of self-awareness” (1P). More often, though, they experience a sense of relief when they finally come to the realization of their disability. Disabilities also impact the parents of these students significantly as well. It affects not only their marriage but also their outside relationships and their emotional well-being. This impact can even be seen by teachers in situations such as parent-teacher conferences or IEP meetings. “Disabilities wear on parents a whole lot; they are completely exasperated because they don’t know what to do (1E). I see parents being very very tired and they are out of ideas or they are very on top of things and they have found a system they’ve found that works…the student is then more likely to succeed because they know that mom will follow through at home” (1F). Parents are either entirely frustrated or they are completely on top of things and proactive. There is a lot of stress put on parents when their child is diagnosed with a disability. A lot of parents of these kids are divorced but it is unknown whether this is because of the stress from their child’s disability or because that seems to be the trend in general. Parents obviously have to make significant changes and adjustments when their child is put in this situation. They have to learn things quickly which can impact their marriage or even bring them closer together. “We definitely had to learn a lot of patience…” (2R). Some couples actually draw closer and learn to work as team because handling these kids can definitely not be a one person job. “We pray a lot, a whole lot” (4CZ). The interviews conducted with individuals affected by ADHD turned out to be incredibly insightful into the world that these families experience. A child’s diagnosis goes far beyond a simple title but affects every aspect of that child’s life as well as anyone surrounding the child at all. It greatly affects the child’s teachers, siblings, and especially parents. It can be an extremely frustrating and emotionally-draining situation. Therefore, we, as professionals, have the responsibility to do everything we can to make this situation more pleasant for the families and especially for the student.
 *  //When she was 3, at nighttime, she would get up in the middle of the night and get into things (4F.) One night, she got into camouflage paint and made a big green stain on the couch and carpet; she grounded make up all over the carpet and bathroom walls (4G). Then she went into the freezer and took everything out and left it out on the floor. We found her in the morning, fallen asleep in her room with paint, make-up, and food all over her. This kind of thing happened at least once a week (4H).//
 *  //Locked items don’t mean anything to her, she will get into them; we had to lock her in her room every night and take the crank off the window so she couldn’t get out and get into anything(4J).////We actually had to switch her doorknob around so we could lock it from the outside and lock her in, otherwise she would sometimes lock us out of her room. In the morning, she would just knock on the door and we would let her out (4K).//
 *  //She does weird things like taking the macaroni box, dumping it on the floor, licking the cheese mix and dumping it on the carpet (4BF).//
 *  //She was always taking things apart much more so than a ‘normal’ child (4D).//
 *  //She is very in-your-face and has a hard time making friends because she comes off to other kids as weird and immature (2O).//
 *  //I have found [the IEP process] to be pleasant; the people I work with are very good (4CD).//
 *  //But I have found that as a parent, I have to jump through hoops over and over again to get help for my child (4CE).//
 *  //The IEP process has helped with setting goals but they need to have more frequent communication (4CM).//
 *  //I believe though, that the problem is that the classroom teacher doesn’t keep those goals in mind, because they have a class of 25 kids (4CJ).//
 *  //I have doubts on whether they even read the IEP or not (4CK).//
 *  //It’s also hard for when we only meet once a year because I had a meeting with the first grade teacher, but the second grade teacher has her now. This just doesn’t seem to work as efficiently as it could (4CL).//
 *  //We just moved districts a year and a half ago so it has been a new experience (2I). The professionals in this new district seem to be helpful but there are a lot of things that we have to remind them of (2K).//
 *  //They have a teacher follow the student around rather than pulling them out of class so that is new (2L). They seem to always change [my daughter’s] schedule because of their own convenience rather than her well being which we do not like (2M).//
 *  //I put an estimated time on the top of their homework because it helps them to know how long it will take because they don’t want to sit there forever. So, if I put say 20 minutes on the top of their paper, than they are more likely to actually sit down and tackle it because they can handle 20 minutes (1D).//
 *  //[I tell parents that] the student may need to run around for a while before doing homework so they get their energy out or they may just do little spurts of homework rather than doing it all at once (1C).//
 *  //The most common accommodation is [to have them use a planner] but sometimes we use preferential seating. We put them at the front of the room by the teacher so they can focus more (3R).//
 * <span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> //Sometimes we use a behavior contract. They just sign a paper saying that they will try to behave as best they can. Sometimes it will say that if they stay on task the whole period then they will get the last five minutes to talk or something, some kind of privilege (3T).//