Chapter Eight Individuals With Attention Deficit Hyperactivity Disorder

Defining Attention Deficit Hyperactivity Disorder (ADHD) ADHD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” (American Psychiatric Association, 2013) ADHD is not a separate disability IDEA category; it is in the Other Health Impaired (OHI) category ‒ Students with ADHD may be eligible for special education or Section 504 services 3

Defining ADHD – Students with Attention Deficit Hyperactivity Disorder (ADHD) may struggle with school routines and expectations due to their tendency to appear inattentive or distractible. Students with ADHD may find that they have a hard time concentrating and complying with requests that their classmates do not. – Described by the American Psychiatric Association (2000) as “a persistent pattern of inattention and/or hyperactive impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.”

The behaviors must have persisted for at least 6 months and to a marked degree across two or more settings. – IDEA does not have a definition of ADHD ADHD is not a separate disability category (it is in the Other Health Impaired category) – ADHD does not constitute its own category but impacts the lives of a large number of students. ADHD may occur with other disabilities. – Students with ADHD may be eligible for special education and an IEP or Section 504 of the Rehabilitation Act services

– Three subtypes: ADHD predominately inattentive type, ADHD predominantly hyperactive-impulsive type, and ADHD combined type Students may exhibit either type or a combination of both which is the most common.

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Brief History of the Field – “defective moral conduct” A London doctor described children with ADHD-like characteristics in a way that reflected the social beliefs of the era – 1930s- discovery of stimulant medications Administration of stimulant medication to individuals who displayed ADHD-like characteristics produced a calming effect in their behavior – 1940s and 1950s- research regarding distractibility issues Scientists studied children with intellectual disability with and without suspected brain injury in addition to children with cerebral palsy to research distractibility issues. The findings were turned into recommendations for teaching children who display ADHD- like characteristics. – 1950s and 1960s- “minimal brain injury” The term “minimal brain injury” grew and waned in popularity during this time 9

– 1960s- “hyperactive child syndrome” The term “hyperactive child syndrome” came into use because it lacked the element of brain injury – 1980s- shift of focus to observable behaviors rather than speculating about brain injury

Prevalence of ADHD  Affects 3% to 9% of school-aged children (estimated 5.4 million children)  ADHD is one of the most chronic childhood conditions  There has been an increase in recent years in the number of students identified in the Other Health Impaired category  Boys are more likely than girls to receive a diagnosis of ADHD 11

Suspected Etiologies of ADHD – Etiology Neurological dysfunction: Anatomical differences and imbalances in brain chemistry may be contributing factors for ADHD. These regions control behaviors such as self-regulation and working memory. Hereditary factors: Family and twin studies seem to indicate that ADHD runs in families Environmental factors: Environmental factors can include: maternal drug or alcohol abuse, lead poisoning, low birth weight, premature birth 12

Characteristics of Individuals with ADHD Characteristics of Students with ADHD – Inattention – Hyperactivity – Behavioral inhibition difficulties – Executive function problems – Social and behavioral issues – Comorbidity of other academic and behavioral difficulties 13

Assessment of Students with ADHD – Multidimensional evaluation process: Involves parents, teachers, physicians, and school professionals – Medical evaluation: Evaluate children aged 6-12, must meet DSM-V criteria, requires input from various settings, must consider coexisting disabilities – Behavioral/educational evaluation: Rating scales are used to evaluate a students’ behavior. Potential for bias exists due to the varying perceptions of multiple assessors. – Common assessment tools: DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) – Contains the criteria for diagnosing disorders Rating scales: Tool used to evaluate behaviors by multiple assessors. – ADHD Rating Scale-IV – Conners’ Teachers Rating Scale-3 14

Educational Considerations It is not possible to determine accurate statistics regarding the educational placement of students with ADHD due to their inclusion in the Other Health Impaired category. It seems a safe assumption that most students with ADHD receive some or all of their education in the regular education classroom. Students with ADHD may receive a special education or accommodations under Section

– Classroom accommodations to assist students with ADHD Inattention Impulsiveness Motor activity Academic skills Organization Compliance Mood Socialization

Educational Considerations  Functional Behavioral Assessment (FBA)  Self-regulation/monitoring  Home-school collaboration  Instructional modifications  Stimulant medication 17

– Functional Behavioral Assessment (FBA): An FBA is conducted to determine the causes and consequences of a student’s actions/behaviors in order to create effective behavior intervention strategies. – Self-regulation/monitoring.: A behavioral self-control strategy that assists students in monitoring their own behavior – Home-school collaboration: The parents’ role in the special education process is mandated by law. Effective collaboration benefits the school, the child, and the family. – Instructional modifications: Modifications are often crucial if a child with ADHD is to achieve academic and behavioral success. – Multimodal interventions: combination of approaches – Medication: Medication is often used as part of a program to assist students in maintaining their behavior and should not be used as the sole means of changing behavior. There are many controversies surrounding the use of psychostimulant medications in children. Ritalin Dexedrine Focalin Adderall Concerta Strattera – Counseling services – Making Inclusion Work: Instructional strategies AND Collaboration with parents and professionals

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Diversity – ADHD occurs in all cultures, social classes, races, genders, and across ages. It is difficult for assessors to rate the behaviors of individuals from cultures they are not familiar with and may lead to an overrepresentation of minority children who receive a diagnosis of ADHD

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Issues of Diversity ADHD diagnosis may reflect cultural biases of the evaluators Difficulty in identification of ADHD in individuals from culturally or linguistically diverse backgrounds 24

Technology and Individuals with ADHD – Devices that allow for stimulation but do not disrupt instruction – Self-monitoring technologies Seat cushions for extra stimulation “Fidget toys” Self-monitoring technologies 25