Attention-Deficit/ Hyperactivity Disorder M F C · FS14, 3rd Edition, April 2002 Resources updated...

FS14, 3rd Edition, April 2002Resources updated 2004

A publication of the National Dissemination Center for Children with Disabilities

Attention-Deficit/Hyperactivity Disorder

NICHCY

BRIEFING PAPER

Table of Contents

I. Understanding &Diagnosing AD/HD ....... 2

II. TreatmentRecommendations ........ 10

III. School Issues &Interventions ................ 15

IV. Meeting theChallenge ...................... 20

V. References ..................... 21

VI. Resources ...................... 21

VII. Publishers ..................... 23

by Mby Mby Mby Mby Mararararary Fy Fy Fy Fy Fowowowowowlelelelelerrrrr

Although many people refer toattention-deficit/hyperactivity disorderas ADD, throughout this paper thedisorder is called by its medically correctname of AD/HD.

Every yearthe National

DisseminationCenter for Children

with Disabilities(NICHCY) receives

thousands of requests forinformation about the educa-

tion and special needs of childrenand youth with attention-deficit/hyperactivity disorder (AD/HD). If yourchild or teen has AD/HD, or if yoususpect that to be the case, you might beoverwhelmed by the amount of avail-able information. A lot of that informa-tion is based on good scientific research.However, some of it is not scientificallyaccurate.

This NICHCY Briefing Paper iswritten to help parents, teachers, andothers interested in AD/HD know whatto look for, what to do, and how to gethelp.

NICHCY: 800.695.0285 2 AD/HD Briefing Paper (3rd Ed.)

What is AD/HD?AD/HD is one of the most

commonly diagnosed behavioraldisorders of childhood. Thedisorder is estimated to affectbetween 3 to 7 out of every 100school-aged children [AmericanPsychiatric Association (APA),2000]. This makes AD/HD a majorhealth concern. The disorder doesnot affect only children. In manycases, problems continue throughadolescence and adulthood.

The core symptoms of AD/HDare developmentally inappropriatelevels of inattention, hyperactivity,and impulsivity. These problemsare persistent and usually causedifficulties in one or more majorlife areas: home, school, work, orsocial relationships. Clinicians basetheir diagnosis on the presence ofthe core characteristics and theproblems they cause.

Not all children and youth havethe same type of AD/HD. Becausethe disorder varies among individu-als, children with AD/HD won’t allhave the same problems. Somemay be hyperactive. Others may beunder-active. Some may have greatproblems with attention. Othersmay be mildly inattentive butoverly impulsive. Still others mayhave significant problems in allthree areas (attention, hyperactivity,and impulsivity).

I. Understanding & Diagnosing AD/HD

Thus, there are three subtypes ofAD/HD:

A. Predominantly InattentiveType

B. Predominantly Hyperactive-Impulsive Type

C. Combined Type (inattention,hyperactivity-impulsivity)

Of course, from time to time,practically every person can be a bitabsent-minded, restless, fidgety, orimpulsive. So why are these samepatterns of behavior considerednormal for some people andsymptoms of a disorder in others?It’s partly a matter of degree. WithAD/HD, these behaviors occur farmore than occasionally. They arethe rule and not the exception.

What Causes AD/HD?AD/HD is a very complex,

neurobiochemical disorder.Researchers do not know AD/HD’sexact causes, as is the case withmany mental and physical healthconditions. Where AD/HD isconcerned, there are a few individu-als who do not believe AD/HDreally exists. As researchers con-tinue to learn more about AD/HD,this controversy will be put to rest.Meanwhile, scientists are makinggreat strides in unlocking themysteries of the brain. Recenttechnological advances in brainstudy are providing strong clues asto both the presence of AD/HD andits causes. In people with thedisorder, these studies show thatcertain brain areas have less activityand blood flow and that certainbrain structures are slightly smaller.These differences in brain activityand structure are mainly evident inthe prefrontal cortex, the basalganglia, and the cerebellum(Castellanos & Swanson, 2002).

These areas are known to help usinhibit behavior, sustain attention,and control mood.

There is also strong evidence tosuggest that certain chemicals in thebrain—called neurotransmitters—play a large role in AD/HD-typebehaviors. Neurotransmitters helpbrain cells communicate with eachother. The neurotransmitter thatseems to be most involved withAD/HD is called dopamine.Dopamine is widely used through-out the brain. Scientists havediscovered a genetic basis for partof the dopamine problem thatexists in some individuals with AD/HD. Scientists also think that theneurotransmitter callednorepinephrine is involved tosome extent. Other neurotransmit-ters are being studied as well(Castellanos & Swanson, 2002).

When neurotransmitters don’twork the way they are supposed to,brain systems function inefficiently.Problems result. With AD/HD,these are manifested to the world asinattention, hyperactivity, impul-sivity, and related behaviors.

Children with AD/HD are oftenblamed for their behavior. How-ever, it’s not a matter of theirchoosing not to behave. It’s a matterof “can’t behave without the righthelp.” AD/HD interferes with aperson’s ability to behave appropri-ately.

And speaking of blame—parents and teachers do not causeAD/HD. Still, there are many thingsthat both parents and teachers cando to help a child or teen managehis or her AD/HD-related difficul-ties. Before we look at what needsto be done, however, let us look atwhat AD/HD is and how it isdiagnosed.

AD/HD Briefing Paper (3rd Ed.) 3 NICHCY: 800.695.0285

• we sustain (pay attention for aslong as needed);

• we inhibit (avoid focusing onsomething that removes ourattention from where it needs tobe); and finally

• we shift (move our attention toother things as needed).

Children with AD/HD can payattention. Their problems have todo with what they are payingattention to, for how long, andunder what circumstances. It’s notenough to say that a child has aproblem paying attention. We needto know where the process is

breaking down for the child so thatappropriate individualized rem-edies can be created.

With AD/HD, we see threecommon areas of inattentionproblems:

• sustaining attention longenough, especially to boring,tedious, or repetitious tasks;

• resisting distractions, especiallyto things that are more interest-ing or that fill in the gaps whensustained attention quits; and

• not paying sufficient attention,especially to details and organi-zation.

These attention difficulties resultin incomplete assignments, carelesserrors, and messy work. Childrenwith AD/HD often tune outactivities that are dull, uninterest-ing, or unstimulating. Their perfor-mance is inconsistent both at home

and in school. Social situations areaffected by frequent shifts or losingtrack of conversations, not listeningto others, and not followingdirections to games or rules (APA,2000).

Symptoms of inattention, aslisted in the DSM-IV-TR*, are:

(a) often fails to give closeattention to details or makescareless mistakes in schoolwork,work, or other activities;

(b) often has difficulty sustain-ing attention in tasks or playactivities;

(c) often does not seem tolisten when spoken to directly;

(d) often does not followthrough on instructions andfails to finish schoolwork,chores, or duties in the work-place (not due to oppositionalbehavior or failure to under-stand instructions);

(e) often has difficultyorganizing tasks and activities;

(f) often avoids, dislikes, or isreluctant to engage in tasks thatrequire sustained mental effort(such as schoolwork or home-work);

(g) often loses things necessaryfor tasks or activities (e.g., toys,school assignments, pencils, books,or tools);

(h) is often easily distracted byextraneous stimuli;

(i) is often forgetful in dailyactivities. (APA, 2000, p. 92*)

Hyperactivity

Excessive activity is the mostvisible sign of AD/HD. Studiesshow that these children are moreactive than those without thedisorder, even during sleep. Thegreatest differences are usually seenin school settings (Barkley, 2000).

*Reprinted with permission fromthe Diagnostic and Statistical Manualof Mental Disorders, Fourth Edition,Text Revision. Copyright 2000American Psychiatric Association.

...the main featuresof the disability [are]:

inattention, hyperactivity,and impulsivity.

How is AD/HD Diagnosed?AD/HD is considered a mental

health disorder. Only a licensedprofessional, such as a pediatrician,psychologist, neurologist, psychia-trist, or clinical social worker, canmake the diagnosis that a child,teen, or adult has AD/HD. Theseprofessionals use the Diagnosticand Statistical Manual of MentalDisorders, Fourth Edition, TextRevised (DSM-IV-TR) as a guide(APA, 2000).

Over the last 10 years, publicawareness about AD/HD has led tomore children and adults beingdiagnosed with the disorder. Somepeople have expressed concernthat the condition is beingoverdiagnosed. The AmericanMedical Association (AMA)took a serious look into theseclaims. According to AMA’sSpecial Council Report, how-ever, there is little evidence ofwidespread overdiagnosis ofAD/HD or over-prescription ofmedication for the disorder(Goldman et al., 1998).

In order to be diagnosed withAD/HD, children and youth mustmeet the specific diagnostic criteriaset forth in the DSM-IV-TR. Thesecriteria are primarily associatedwith the main features of thedisability: inattention, hyperactivity,and impulsivity. Let’s take a closerlook at the specific types of behav-ior that must be evident in order fora diagnosis of AD/HD to be made.

Inattention

Attention is a process. When wepay attention:

• we initiate (direct our attentionto where it is needed or desiredat the moment);


Many parents find their toddlersand preschoolers quite active. Caremust be given before labeling ayoung one as hyperactive. At thisdevelopmental stage, a comparisonshould be made between the childand his or her same-age peerswithout AD/HD. In young chil-dren, usually the hyperactivity ofAD/HD will come across as “alwayson the go” or “motor driven.” Youmay see behaviors such as dartingout of the house or into the street,excessive climbing, and less timespent with any one toy. In elemen-tary years, children with AD/HDwill be more fidgety and squirmythan their same-age peers who donot have the disorder. They also areup and out of their seats more.Adolescents and adults feel morerestless and bothered by quietactivities. At all ages, excessive andloud talking may be apparent.(APA, 2000)

Symptoms of hyperactivity, aslisted in the DSM-IV-TR*, are:

(a) often fidgets with hands orfeet or squirms in seat;

(b) often leaves seat in class-room or in other situations inwhich remaining seated is expected;

(c) often runs about or climbsexcessively in situations in which itis inappropriate (in adolescents oradults, may be limited to subjectivefeelings of restlessness);

(d) often has difficulty playingor engaging in leisure activitiesquietly;

(e) is often “on the go” or oftenacts as if “driven by a motor;”

(f) often talks excessively. (APA,2000, p. 92*)

Impulsivity

Children and youth with AD/HD often act without fully consid-ering the circumstances or theconsequences. Actually, thinking

about the potentialoutcomes of theiractions before the factoften does not evencross their minds. Theirneurobiologicallycaused problem withimpulsivity makes ithard to delay gratification. Waitingeven a little while is too much fortheir biological drive to have it now.

The impulsivity leads thesechildren to speak out of turn,interrupt others, and engage inwhat looks like risk-taking behav-ior. The child may run across thestreet without looking or climb tothe top of very tall trees. Althoughsuch behavior is risky, the child isnot so much a risk-taker as a childwho has great difficulty controllingimpulse and anticipating conse-quences. Often, the child is sur-prised to discover that he or she hasgotten into a dangerous situationand has no idea of how to get outof it. Some studies show that thesechildren are more accident prone,particularly those youth who aresomewhat stubborn or defiant(Barkley, 2000).

Symptoms of impulsivity, aslisted in the DSM-IV-TR (APA, 2000,p. 92*), are:

(g) often blurts out answersbefore questions have been com-pleted;

(h) often has difficulty awaitingturn;

(i) often interrupts or intrudeson others (e.g., butts into conversa-tions or games).

For a diagnosis of predominantlyinattentive type of AD/HD, six ormore of the inattention symptomsmust be present (see list on page3). For a diagnosis of hyperactive/impulsive type, six or more of thehyperactivity or impulsivity symp-toms must be present (see lists onthis page). For a diagnosis of

combined type, six ormore symptoms ofinattention, plus six ormore symptoms of

hyperactivity or impulsiv-ity, must be present.

The word often appearsbefore each symptom of inatten-tion, hyperactivity, and impulsivityin the DSM-IV-TR. In order to beconsidered a symptom of AD/HD,a behavior can’t be “a once in awhile” problem. Nor can it be aproblem that pops up all of asudden. According to the DSM-IV-TR, the following must be true:

• There must be clear evidence ofsignificant difficulty in two ormore settings (e.g., at home, inschool, with peers, or at work).

• Symptoms of inattention,hyperactivity, or impulsivitymust be present at least sixmonths.

• Some of these symptoms haveto cause problems before age 7.

• The symptoms have to bedevelopmentally inappropriate.

“Developmentally inappropri-ate” is an important point. If youlook again at the symptom list forthe three main features of AD/HD,you will notice that some of thesebehaviors may be fairly normal atcertain ages. For instance, no oneexpects a two year old to keep trackof toys or to stay seated for verylong. So, losing things or not beingable to stay in a chair for longwould not be considered symp-toms of AD/HD at that age. Thesesame behaviors in a ten year old,however, would be developmentallyinappropriate. We don’t expect a tenyear old to constantly lose things.We do expect a ten year old to beable to stay seated during a half-hour of class or a family dinner.

AD/HD is determined by thenumber of symptoms present andthe extent of the difficulty these


cause. Also, the number of symp-toms and the problems they causemay change across the life span. Ina small number of cases, AD/HDdoes go away in adolescence oradult years. However, in most cases,the problems shift. A hyperactive-impulsive fourteen year old may beable to stay seated longer than he orshe could at age nine. Whileproblems caused by hyperactivity-impulsivity seem to lessen with age,other AD/HD-related symptomsusually become more problematic.For instance, demands for longerperiods of sustained attentionincrease with age. So, for example,even though a fourteen year oldmay sit still during a lengthyreading assignment, he or she maybe bothered by an inability toconcentrate.

What Are OtherSigns of AD/HD?

Research is showing us that AD/HD impairs the brain’s executivefunction ability. It’s as if the brainhas too many workers but no bossto direct or guide them. When thebrain’s executive function abilitiesoperate appropriately, we think,plan, organize, direct, and monitorour thoughts and activities. Inessence, our brain has a capableexecutive or boss.

Of course, none of us is bornbeing our own executive. Weacquire these skills as our brainsdevelop and mature. Until we areable to monitor and regulate ourown activities and lives, we rely onpeople and things outside ofourselves to guide and direct us.Puberty marks the time when webecome increasingly “brain-able”to be our own boss.

Our executive abilities also helpus to concentrate longer and tokeep track of our thoughts, espe-cially those we need later. We areless distracted by our own thoughtsand find it much easier to return towork after we’ve been distracted.

The brain’s executive abilitiesalso help us inhibit, or control,behavior. Inhibition is the ability todelay or pause before acting ordoing. It allows us to regulate ourthoughts, actions, and feelings. Thisself-regulation or self-control helpsus manage or limit behavior. Welearn to say “not now” or “not agood idea” to impulse. We learn tocontrol our activity levels to meetsituational demands. For example,to yell at a ball game is fine (unlesswe are shouting in someone’s ear).Yelling in a classroom is usually notokay.

Thanks to our brain’sexecutive abilities, webecome driven more byintention than impulse.That means we pauseand reflect before weact. For instance, we areable to consider thedemands of a situationalong with the rules. Wecan delay an immediatereward in order to holdout for a later rewardthat’s more meaningful.

With AD/HD, the very brainareas responsible for executivefunction and inhibition are im-paired. Children with AD/HD canbe considered hyperresponsive,because they behave too much.They are more likely to respond toevents that others usually overlook(Barkley, 2000). Their characteristicdisinhibition often causes others tofind them annoying, irritating, orexasperating.

Obviously, executive functiondifficulties can create distress andproblems with daily functioning,including emotional control. Inaddition to symptoms of inatten-tion, impulsivity, and hyperactivity,you may also see these types ofexecutive function problems:

• weak problem solving,

• poor sense of time and timing,

• inconsistency,

• difficulty resisting distraction,

• difficulty delaying gratification,

• problems working toward long-term goals,

• low “boiling point” for frustra-tion,

• emotional over-reactivity,

• changeable mood, and

• poor judgment.

It’s important to remember thatthe self-control and self-regulationproblems seen in people with AD/HD are not a matter of deliberatechoice. These problems are causedby neurological events or condi-tions. People with AD/HD knowhow to behave. They generallyknow what is expected in a givensituation. But they run into troubleat the point of performance—thatmoment in time when they mustinhibit behavior to meet situationaldemands. Their troubles may showup in how they act in the outsideworld, or in their internal selves.They characteristically have incon-sistent performance. This inconsis-tency is often mistaken for a lack ofregard or respect, or as a lack ofeffort.

Because of inhibition problems,the disorder also makes it hard forthe young person to follow therules, especially if the rules are not

Research is showing usthat AD/HD impairs the brain’s

executive function ability...[which allows us to] think, plan,organize, direct, and monitor our

thoughts and activities.


crystal clear. Children with AD/HDusually need a lot of incentive tofollow the rules, too. That doesn’tmean that they are intentionallybratty or demanding. When achild’s executive and inhibitionmechanisms are not functioningfully or normally, then we need toprovide external incentives topump up the child’s ability toinhibit thoughts, feelings, andactions.

Performance usually improveswhen external guides, rewards, andincentives are provided. Thesemight include step-by-step ap-proaches, extra praise and encour-agement, and the chance to earnspecial privileges for better perfor-mance. More will be said aboutthese approaches in Section II ofthis Briefing Paper.

How Do I Know For SureThat My Son or Daughter

Has AD/HD?At present, no laboratory test

exists to determine if your child hasthis disorder. You can’t diagnoseAD/HD with a urinalysis, bloodtest, CAT scan, MRI, EEG, PET orSPECT scan, although some ofthese technologies are used forresearch purposes.

Diagnosing AD/HD is compli-cated and much like puttingtogether a puzzle. You, as a parent,may think your child has AD/HD,but an accurate diagnosis requiresan assessment conducted by a well-trained licensed professional

(usually a developmentalpediatrician, childpsychologist, childpsychiatrist, pediat-ric neurologist, orclinical socialworker). Thisperson must knowa lot about AD/HDand all otherdisorders that canhave symptoms

similar to those found in AD/HD.Until the practitioner has collectedand evaluated all the necessaryinformation, he or she—like you,the parent—can only assume thatthe child might have AD/HD.

The AD/HD diagnosis is madeon the basis of the observablebehavioral symptoms listed onpages 3 and 4. The symptoms ofAD/HD must occur in more thanone setting. The person doing theevaluation must use multiple sourcesof information. Since symptoms ofAD/HD can also be associated withmany other conditions, be wary ofany practitioner who makes a snapdiagnosis either because you’vesaid you think your child has AD/HD or because he or she hasobserved the child once. Childrenwith AD/HD commonly behavewell on the first meeting. Further-more, personal observation is onlyone source of information.

What is the RecommendedDiagnostic Procedure?The American Academy of

Pediatrics (2000) recommends thatclinicians collect the followinginformation when evaluating achild for AD/HD:

1. A thorough medical andfamily history.

2. A medical examination forgeneral health and neurologicstatus.

3. A comprehensive interviewwith the parents, teachers, andchild.

4. Standardized behavior ratingscales, including AD/HD-specificones completed by parents,teacher(s), and the child whenappropriate. (Know that peoplewith AD/HD typically are not greatat accurately reporting symptoms ofthe disorder, because it causes themto have poor insight into their ownbehavior.)

5. Observation of the child.

6. A variety ofpsychological teststo measure IQ andsocial and emotionaladjustment. Thesetests also help todetermine the presenceof specific learning disabilities,which can co-occur with AD/HD.

Once the practitioner completesthe evaluation, he or she makes oneof three determinations:

1. The child does or does nothave AD/HD.

2. The child does not have AD/HD, but either has anotherdisorder(s) or other factors thathave created the difficulties.

3. The child has AD/HD andanother disorder (called a co-existing condition).

To make the first determina-tion—that the child has or does nothave AD/HD—the clinician consid-ers his or her findings in relation tothe criteria of the DSM-IV-TRmentioned earlier.

To make the second determina-tion—that the child’s difficulties arecaused by another disorder or otherfactors—the professional firstconsiders the disorders that havesymptoms similar to AD/HD. Youshould be aware that some mentalhealth disorders have their onsetafter puberty, but early warningsigns, which are very similar to AD/HD symptoms, may be present.Thus, it is possible for a diagnosisto change as the child develops andother disorders become moreapparent. It is also possible for achild or youth to have more thanone disorder, or co-occuringdisorders.


Disorders That Commonly Co-Occur With AD/HD

For more information about the following disorders that frequentlyoccur with AD/HD, see the resource list on page 22.

Oppositional Defiant Disorder (ODD)—A pattern of negative, hostile,and defiant behavior. Symptoms include frequent loss of temper,arguing (especially with adults), refusal to obey rules, intentionallyannoying others, blaming others. The person is angry, resentful,possibly spiteful, and touchy. (Many of these symptoms disappearwith AD/HD treatments.)

Conduct Disorder (CD)—A pattern of behavior that persistentlyviolates the basic rights of others or society’s rules. Behaviors mayinclude aggression toward people and animals, destruction of prop-erty, deceitfulness or theft, or serious rule violations.

Anxiety—Excessive worry that occurs frequently and is difficult tocontrol. Symptoms include feeling restless or on edge, easily fa-tigued, difficulty concentrating, irritability, muscle tension, and sleepdisturbances.

Depression—A condition marked by trouble concentrating, sleeping,and feelings of dejection and guilt. There are many types of depres-sion. With AD/HD you might commonly see dysthymia, whichconsists of a depressed mood for many days, over or under eating,sleeping too much or too little, low energy, low self-esteem, poorconcentration, and feeling hopeless. Other forms of depression mayalso be present.

Learning Disabilities—Problems with reading, writing, or mathemat-ics. When given standardized tests, the student’s ability or intelli-gence is substantially higher than his or her achievement. Under-achievement is generally considered age-inappropriate. [Note:Children with AD/HD frequently have problems with readingfluency and mathematical calculations. AD/HD learning problemshave to do with attention, memory and executive function difficul-ties rather than dyslexia, dysgraphia, or dyscalculia, which arelearning disabilities. The point here is not to overlook either. De-pending on how learning disabilities are defined, between 10-90% ofyouth with AD/HD also have a learning disability (Robin, 1998).]

Generally, the DSM-IV-TRrequires clinicians to rule out AD/HD if they see Pervasive Develop-mental Disorder (PDD), schizo-phrenia, other psychotic disorders,or if the symptoms are betterexplained by another disorder. Forinstance, although not very com-mon, Bipolar Disorder (BPD) canbe mistaken for AD/HD in earlyyears.

It is also true that major stressfullife events can result in temporarysymptoms that look like AD/HD.Such events could include parentaldivorce, child abuse, death of aloved one, a move, or a suddentraumatic experience. Under thesecircumstances, AD/HD-like symp-toms may arise suddenly and,therefore, would have no long-termhistory. Remember, AD/HD symp-toms must exist for at least sixmonths and cause some difficultybefore the age of seven. Of course, achild can have AD/HD and astressful event, so such events donot automatically rule out theexistence of AD/HD.

To make the third determina-tion—that the child has AD/HDand a co-existing condition—theassessor must first be aware thatAD/HD can and often does co-occur with other difficulties,particularly learning disabilities,oppositional defiant disorder, andanxiety. A list of disorders thatcommonly co-occur with AD/HD isprovided in the box below.

The fact is: Other mental healthconditions such as those listed inthe box to the right can be the resultof AD/HD, in addition to AD/HD,or mistaken for AD/HD. That is whyevaluations need to be conductedby a professional who is trained ina wide variety of child and adoles-cent disorders. Thorough andcorrect diagnosis is an essential firststep to better treatments.

How Do I Have My ChildEvaluated for AD/HD?When your child is experiencing

difficulties that suggest that he orshe may have AD/HD, you as aparent can take one of two basicpaths to evaluation. You can seekthe services of an outside profes-sional or clinic, or you can requestthat your local school districtconduct an evaluation.

In pursuing a private evaluationor in selecting a professional toperform an assessment for AD/HD,you should consider the clinician’straining and experience with thedisorder, as well as his or heravailability to coordinate thevarious treatment approaches.Most AD/HD parent supportgroups know clinicians trained toevaluate and treat children withAD/HD. You may also ask your


child’s pediatrician, a communitymental health center, a universitymental health clinic, or a hospitalchild evaluation unit.

It is important for you to realize,however, that the schools have anaffirmative obligation to evaluate achild (aged 3 through 21) if schoolpersonnel suspect that the childmight have AD/HD or any otherdisability that is adversely affectingeducational performance. (Thatmeans the child must be havingdifficulties in school. Those diffi-culties include social, emotional,and behavioral problems, not justacademic troubles.) (See the boxbelow if your child is under threeyears old.) This evaluation isprovided free of charge to familiesand must, by law, involve morethan one standardized test orprocedure.

Thus, if you suspect that yourchild has an attentional or hyperac-tivity problem, or know for certainthat your child has AD/HD, and hisor her educational performance

appears to be adversely affected,you should first request that theschool system evaluate your child.Be sure to put your request in writing.Your letter should include the date,your name, your child’s name, andthe reason(s) you are requesting anevaluation. The letter should statethe type of educational difficultiesyour child is experiencing. Keep acopy of the letter in your file.

Preschoolers (children aged 3through 5) may be eligible forservices under Part B of the Indi-viduals with Disabilities EducationAct (IDEA). If your child is apreschooler, you may wish tocontact the State Department ofEducation or local school district,

ask your pediatrician, or talk withlocal day care providers about howto have your child assessed throughyour school district’s specialeducation department.

Also, under Head Start regula-tions, AD/HD is considered achronic or acute health impairmententitling the child to specialeducation services when the child’sinattention, hyperactivity, andimpulsivity are developmentallyinappropriate, chronic, and dis-played in multiple settings, andwhen the AD/HD severely affectsperformance in normal develop-mental tasks (for example, inplanning and completing activitiesor following simple directions).

If your child is school-aged(six or older), and you suspectthat AD/HD may be ad-versely affecting his or hereducational performance,you can ask your localschool district to conductan evaluation. With theexception of the physicalexamination, the assess-

ment can be conducted byschool personnel as long asa member of the evaluation

group is knowledgeable aboutassessing AD/HD. If not, thedistrict may need to use an outsideprofessional consultant trained inAD/HD assessment. This personmust know what to look for duringchild observation, be competent toconduct structured interviews withparents, teacher(s), and child, andknow how to administer andinterpret behavior rating scales.

But My Child is a Toddler...

If your child is under three years old, and you suspect that AD/HDmay be affecting his or her development, you may want to investi-gate what early intervention services are available in your state throughthe Part C program of the Individuals with Disabilities Education Act(IDEA).

Since AD/HD is a developmental disorder, diagnosing young childrenrequires some special consideration. For instance, toddlers don’t payattention for long periods of time, so a clinician wouldn’t necessarilyfind inattention in a toddler a symptom of AD/HD. Also, toddlers aremore easily frustrated and do shift activities a lot. It’s important thatthe person doing the diagnosis be very familiar with normal childdevelopment in order to determine what behaviors would be inappro-priate for that age.

You can find out about the availability of early intervention servicesin your state by contacting the state agency responsible for adminis-tering early intervention services (which is listed on NICHCY’s StateResource Sheet), by asking your pediatrician, or by contacting thenursery or child care department in your local hospital.


IDEA’s Definition of “Other Health Impairment”

In order to be eligible for special education, a student must meet thedefinition criteria for at least 1 of 13 disability categories listed in thefederal regulations. Some students may meet more than one definition.Many students with AD/HD now may qualify for special educationservices under the “Other Health Impairment” category within theIndividuals with Disabilities Education Act (IDEA). IDEA defines “otherhealth impairment” as...

“...having limited strength, vitality or alertness, including a height-ened alertness to environmental stimuli, that results in limitedalertness with respect to the educational environment, that is dueto chronic or acute health problems such as asthma, attentiondeficit disorder or attention deficit hyperactivity disorder, diabetes,epilepsy, a heart condition, hemophilia, lead poisoning, leukemia,nephritis, rheumatic fever, and sickle cell anemia; and adverselyaffects a child's educational performance.”

34 Code of Federal Regulations §300.7(c)(9)

Identifying where to go andwhom to contact in order torequest an evaluation is just thefirst step. Unfortunately, manyparents experience difficulty in thenext step—getting the schoolsystem to agree to evaluate theirchild. In the past, some schoolshave not understood their obliga-tions to serve children who,because of their AD/HD, are inneed of special education andrelated services. In 1999, AD/HDwas specifically listed in the federalregulations of IDEA under thedisability category of “other healthimpairment” (see definition in thebox above). The inclusion of AD/HD in this disability categoryshould help to clarify the school’sobligation to evaluate children whoare suspected of having AD/HDthat is adversely affecting educa-tional performance.

However, if the school districtdoes not believe that your child’seducational performance is beingadversely affected, it may refuse toevaluate your child. In this case,there are a number of actions youcan take, including pursuing aprivate evaluation. It is also impor-tant to persist with the school,enlisting the assistance of anadvocate, if necessary. You cangenerally find this type of assistanceby contacting the Parent Training

and Information (PTI) center foryour state, the Protection andAdvocacy (P&A) agency, or a localparent group. (Contact NICHCY toget a State Resource Sheet, whichlists your state’s PTI and P&A.) Aschool district’s refusal to evaluatea child suspected of having AD/HDinvolves issues that must beaddressed on an individual basis.Your state’s PTI, P&A, or a localparent group will typically be ableto provide information on a

parent’s legal rights, give specificsuggestions on how to proceed, and inmany cases offer direct assistance. Youmay also use a special educationattorney.

For children who are evaluated bythe school system, eligibility forspecial education and related serviceswill be based upon evaluation resultsand the specific policies of the state.Many parents have found this to be aproblematic area as well. Therefore,eligibility for special educationservices—and the services them-selves—will be discussed in greaterdetail in Section III of this BriefingPaper (see page 15).

For the moment, however, let uslook at what we know about manag-ing AD/HD and the specific difficultiesassociated with the disorder.


II. Treatment Recommendations

How is AD/HD Treated?Like many medical conditions,

AD/HD is managed, not cured.There’s no “quick fix” that resolvesthe symptoms of the disorder. Yet alot can be done to help. Througheffective management, some of thesecondary problems that often ariseout of untreated AD/HD may beavoided. In the majority of cases,AD/HD management will be a life-long endeavor. It may be helpful tothink of AD/HD as a challenge thatcan be met.

Recently, the National Instituteof Mental Health (NIMH), incombination with the U.S. Depart-ment of Education’s Office ofSpecial Education Programs(OSEP), completed a long-term,multi-site study to determine whichtreatments had the greatest positiveeffect on reducing AD/HD symp-toms. This study is known as theMTA study (The MTA CooperativeGroup, 1999). MTA stands for multi-modal treatment study of childrenwith AD/HD.

The recommended multi-modaltreatment approach consists of fourcore interventions:

1. patient, parent, and teachereducation about the disorder;

2. medication (usually from theclass of drugs called stimulants);

3. behavioral therapy; and

4. other environmental supports,including an appropriate schoolprogram.

Each of these core interventionsis described in more detail below.These approaches are your toolchest.

1—Parent, Child, and TeacherEducation about the Disorder

Often, the first treatment stepbegins with learning what AD/HDis and what to do about it. Thisknowledge will help you under-stand that the way your childthinks, acts, and feelshas a lot to do withcircumstancesoutside his or hercontrol. When weunderstand thenature of thechallenge, we arebetter equipped tomeet the challenge.

UnderstandingAD/HD also changesthe way in which achild’s behavior is viewed. Whenwe know more about AD/HD, wecome to understand that the childhas troubles and is not the cause ofthose troubles.

There are accommodations thatcan help your son or daughteradapt reasonably well. It is criticalto learn what these accommoda-tions are and to work to see thatthey are put in place across differentenvironments—school, home,community. Children with AD/HDneed strong advocates. They alsoneed to be taught self-advocacyskills if they are to successfullymanage their symptoms throughoutlife. Self-advocacy should beginearly in life. Help your childunderstand and identify his or herdifficulties. Teach him or her how toask for help and accommodations.

2—Medication

The MTA study found medica-tion to be very effective in themanagement of AD/HD symptoms.Since AD/HD is a neuro-biochemi-cally-based problem, it stands toreason that medication that gets tothe core of the problem would be

effective. The medication mostoften used is stimulant medica-tion, especially methylpheni-date. Most people know thismedication as the drug Ritalin.There are other stimulant medi-cations—Concerta, Metadate,

Dexedrine, Cylert, and Adderall,an amphetamine compound.

These medications are believedto work by stimulating the action ofthe brain’s neurotransmitters,especially dopamine. With thebrain’s systems working moreefficiently, attention, memory, andexecutive functions, includinginhibition, are improved. The resultis better concentration, increasedworking memory capacity, greaterrecall, less hyperactivity, and moreimpulse control. Stimulant medica-tions do not tend to help withsymptoms of anxiety or depression(Barkley, DuPaul, & O’Connor,1999).

The decision to place a child onmedication may not be an easy one,especially given the controversy thatsurrounds the stimulants, specifi-cally Ritalin. There have been manyreports that medication is overpre-scribed for treatment of AD/HD.However, according to the Ameri-can Medical Association’s Council


on Scientific Affairs(Goldman et al., 1998),“There is no widespread over-prescription of methylpheni-date by physicians” (p. 1100).By following good diagnosticprocedures, the chances ofoverprescribing this medica-tion are significantly reduced.Some children cannot takestimulant medications. Inthese cases, the physicianknows what other medica-tions can be helpful inrelieving AD/HD symptoms.Medication may not be the rightapproach for every child.

Always discuss any medicationtreatment thoroughly with yourchild’s physician. He or she shouldexplain the benefits and the draw-backs of medication to you and alsoto your child, if appropriate. Whenmedication is first prescribed, thephysician should start with a lowdose and then gradually raise ituntil the symptoms improve. Youwill need to dispense the medica-tion as prescribed and closelymonitor its effects, including anyside effects. With stimulants, mostside effects are quite mild and goaway over time. Since your childspends a large portion of his or herday at school, you will also need tobe in contact with your child’steachers to determine positiveeffects and side effects. Communi-cate with the physician often,especially when medication isstarted. Call immediately with anyproblems or questions.

Also be aware that duringadolescence many teens activelyresist taking medication. If thishappens, it’s wise to discuss thesituation with your child’s doctor.While medication cannot be forcedon an unwilling patient, the doctormay have some ideas of how towork with your son or daughterabout any resistance to taking themedication.

Some parents are reluctant toplace their child on medication forfear that doing so may lead to latersubstance abuse. Researchers havelooked into this concern quiteseriously. A recent study supportsprevious findings that stimulantmedication treatment may actuallyprevent later substance abuse(Zametkin & Ernst, 1999). As withany medication, though, parentsmust carefully monitor its use to besure that the medication is taken asprescribed.

3—Behavioral Therapy

As parents and teachers know,AD/HD can cause significantinappropriate behavior. Frequentcomplaints include failure to followrules, listen to commands, com-plete tasks, delay gratification, orcontrol impulse. In addition, someyouth may be aggressive or anxious.These symptoms lead to their ownset of problems, such as fighting oravoiding tasks. It is very easy foreveryone involved—the child, theparents, and the teacher(s)—to beworn down into a pattern ofnegative, and sometimes hostile,interactions. This cycle, however,can be broken, and different, morepositive interactions and behaviorpatterns can be developed. Know-ing more about behavior and howto support behavior that is positiveand appropriate is extremely usefulinformation for any parent orteacher of a child with AD/HD.

Often, the first treatment stepbegins with learning whatAD/HD is and what to do

about it. When we understandthe nature of the challenge,

we are better equippedto meet the challenge.

Researchers have identifiedeffective strategies that parentscan use. The following briefexplanation gives you an ideaof the types of help your sonor daughter needs, along withsome examples. You can find alot more help through read-ing, talking to other parents,and working with a clinician.

You must consider the ageof your child and his or her

ability before using any strategy.A good rule of thumb is to provideinterventions until your son ordaughter demonstrates that theseare no longer needed. If youwithdraw interventions and prob-lems re-occur, put the interventionsback in place.

Think of the executive as theboss who creates a work environ-ment in which all the workers knowwhat they have to do to do theirjobs appropriately. The boss alsoprovides the necessary structure forthem to do so. Performance expec-tations and company rules are clear.The executive supervises and directsbut does not overmanage or micro-manage. Children who havedifficulty with planning, thinking,organizing, concentrating, and self-monitoring need to have systems inplace to guide and direct them.Parents and teachers need to be theexecutives in the child’s life.

—Behavior Intervention A—

✦ ✦ ✦ ✦ ✦ Be an executive ✦✦✦✦✦Provide structure, routines,assistive devices, externalsupports, and guides.


Examples:

• Make your expectations clear.Say, “I expect you to...”

• Try to do things at the same timeevery day—homework, playtime,recreation, bedtime. Post theschedule on the fridge.

• When making schedule changes,give advance warning as much aspossible.

• Have simple systems for organi-zation—where to keep posses-sions and needed items such asbackpacks, gym clothes, pens,and so on.

• Use homework organizers,notebook organizers, dayplanners, weekly planners,computers, or even laptops—when called for.

• Do backpack cleaning andnotebook organization once aweek.

Understand that you and yourchild’s teachers will need to providemuch more direct supervision thanseems necessary for the chronologicalage. Remember, AD/HD is a devel-opmental disability, so these youthusually fall short of age expecta-tions.

The main goal of all behaviormanagement strategies is to increasethe child’s appropriate behaviorand decrease inappropriate behav-ior. The best way to influence anybehavior is to pay attention to it.Thus, the best way to increase adesirable behavior is to catch thechild being good.

Children with AD/HD receive atremendous amount of negativefeedback. Parents and teachers needto learn to give much more positiveattention and feedback. That meansyou have to pick your battlescarefully and let a lot of nonessen-tial stuff slide. Otherwise, increasedconflict and arguments betweenyou and your child can result.

How do you make the bulk ofyour interactions positive and yetstill provide discipline? Withthought and planning. Effectiveparents (and teachers) know aheadof time what behavior is acceptableand not acceptable. They knowwhat issues they are willing to

negotiate and which ones, likesafety, are non-negotiable. In anutshell: Don’t sweat thesmall stuff, and don’t ignorethe good stuff no matter howsmall.

Much of behavior manage-ment is about changing whatyou do. Your house rules (or

the classroom rules) need to becarefully designed. First, you wantto structure them so that your childor teen will be able to meet theexpectations. In other words, you

don’t wait for a behavior to happenor not happen. You change whathappens before the behavior—headit off at the pass, so to speak. Forinstance, if your child constantlyforgets things for school, design asystem for where to put things sothey get picked up on the way outthe door.

Your son or daughter needs toknow ahead of time what behavioris expected. He or she also needs toknow what the consequences willbe for behaving (following therules) or misbehaving (breaking therules). Consequences are given assoon as possible. Give far morepositive consequences and rewardsthan punishment. Children whohear too much negative feedbackoften become oppositional ordepressed. Managing behaviorthoughtfully, without a lot ofreaction, especially undue punish-ment or criticism, helps to preventunwanted side effects of poorlymanaged AD/HD.

Some families need to useformal behavior managementsystems. These include charts orcontracts. The difference betweenthe two is simple.

Generally, contracts are usedduring early to mid-adolescence. Ina contract, the involved parties(usually the parents and child, orteacher and student) talk aboutcertain chores or obligations thatthe youth will fulfill. They draw upan agreement. The youth receivescertain agreed-upon privileges orrewards for meeting the terms of thecontract.

Charts are usually used forchildren ages 11 or younger. A chartlists behaviors that the child mustdisplay. Points are given or takenaway depending on the child’sbehavior. Accumulated points maybe traded for rewards.

—Behavior Intervention B—

✦ ✦ ✦ ✦ ✦ Develop behavior management strategies ✦✦✦✦✦Use positive attention, rules

and consequences, andformal systems such ascontracts and charts.


If you decide to make a behaviormodification chart, you may wish tofollow these three simple steps.

• Make a list of problematicbehaviors or ones that needimproving.

• Select three to fivebehaviors from thelist. Review the listand, with inputfrom your child,select the behaviorsto work on. Pickbehaviors that occur ona daily or frequent basis, such asdoing homework, going to bedon time, being respectful to allfamily members, or doingchores.

• Create a reward system. Assign apoint value to each listedbehavior. Throughout the day,give points for appropriatebehavior. At the end of the dayor week, your child can “cash in”points for rewards or privilegesthat have been agreed upon inadvance.

In order for rewards to work,they must have value to the child.Since children with AD/HD tend tobecome disinterested in the samething over time, the rewards usuallyneed to be changed frequently tohave value. (For more detailedinformation on how to design anduse charts and contracts, see thesuggested reading list starting onpage 21.)

About punishment: Children andteens with AD/HD respond best tomotivation and positive reinforce-ment. It is best to avoid punish-ment. When punishment is neces-sary, use it sparingly and withsensitivity. It is important that youand your child’s teachers respondto the inappropriate behaviorwithout anger and in a matter-of-fact way. Your child needs to betaught to replace inappropriate withappropriate behavior.

to mind. Evaluate them. Pick theone that seems most likely to work.Go back to the drawing board if itdoesn’t. This approach helps tostop conflict from escalating.

For example: Suppose yourchild argues when you ask him orher to do a chore. While it appearsas if arguing is the problem, actuallythat behavior might be the result ofsome problem with the request todo chores. Instead of focusing onthe arguing, direct your attention tothe chore and what that problem is.For instance, do you have a regularchore schedule? Are expectationsclear? Does the child understand allthe task expectations? Is there adefinite time line? To some chil-dren, picking up the room meansmoving a couple of things out ofthe way.

Once you clearly define theproblem, then you can brainstormfor a workable solution. Let’s sayyour child understands all aspectsof the chore, but it still doesn’t getdone without your nagging orthreatening. Come up with a planwhere the child knows exactly whatto do by when. Decide if reminderswill be given. Give a reward for on-time chore completion. Give abonus if the chore is done ahead oftime. Penalize the child if the choreis not done on time, but don’t nag.Take action. Don’t react. Make notdoing the chore the child’s problemand not yours.

About time-out: When your childis misbehaving or out of control,time-out can be an effective way tomanage the problem. Time-outmeans that your child is sent for ashort period of time to a previouslyagreed-upon place—usually out ofthe main hub, like a special chair orarea of a room. In general, he or shestays in time-out and must be quietfor three to five minutes. The time-out place should not be a traumaticplace, such as a closet or darkbasement. The purpose of time-outis to provide a cooling off placewhere your child can regain control.

Time-out works best with pre-adolescent kids. You can also usetime-out with teens. Usually thatmeans asking your teen to go to hisor her room until he or she calmsdown.

Problem solving helps take thereaction out of parenting. It isresults-oriented. If your child ismature enough, involve him or herin this process. Good problemsolving has three parts:

• accurately defining the problem,

• coming up with workablesolutions, and

• evaluating results and tryingsomething else, if necessary.

Very often, people spend a lot oftime solving the wrong problem.It’s important to analyze problemareas. Pay attention to the facts andnot the emotions of the situation.Brainstorm to find possible solu-tions. Put down all ideas that come

—Behavior Intervention C—

✦ ✦ ✦ ✦ ✦ Use problem solving ✦✦✦✦✦Develop skills in the art of

negotiation, give and take, andconflict resolution through

peaceful means.


Screaming, yelling, speakingthrough clenched teeth, stampingfeet, throwing things, finger point-ing, and making threats are violentforms of communication. Theseescalate problems, as do put-downs, sarcasm, lecturing, preach-ing, and name calling. When we areusing good communication skills,we:

• let the speaker finish,

• concentrate on what is beingsaid,

• show interest,

• avoid judgment,

• eliminate putdowns,

• express our agreement, and

• use praise.

Problem solving and goodcommunication help to eliminatesome of the oppositional andhostile encounters that oftenaccompany the disorder of AD/HD.

4—Educational Interventions

One of the most critical areas inwhich to offer support is in theschool arena. This is where mostchildren with AD/HD experiencethe greatest difficulty. Thatis because schoolsrequire great skill inthe areas wherestudents with AD/HDare the weakest:attention, executive function, andmemory. Although AD/HD doesnot interfere with the ability tolearn, it does wreak havoc onperformance. Behavior problems,which usually get the most atten-tion, may actually be by-products ofthe school environment and AD/HD. These usually occur when tasks

are too long, too hard, or lackinterest. Many behavior problemscan be avoided or lessened byadapting the school setting to fit theneeds of the student.

In the school arena, AD/HD isan educational performance problem.When little or nothing is done tohelp children with AD/HD improvetheir performance, over time theywill show academic achievementproblems. This underachievementis not the result of an inability tolearn. It is caused by the cumulativeeffects of missing important blocksof information and skill develop-ment that build from lesson tolesson and from one school year tothe next. (It should be noted that anumber of students with AD/HD

Ways to Improve Life in General

Become Proactive. Knowledge is power. Gain knowledge about AD/HD so you understandwhy and how this disability affects your son or daughter at home, in school, in socialsituations, and how it affects your entire family.

Change Your Belief System. Before your son or daughter can change his or her self-concept,the adults in the child’s life have to change the way they view him or her. Separate the childfrom the behavior, and then separate the child from the disability. We don’t have “AD/HDchildren.” We have children who have AD/HD.

De-stress. Find positive ways to soothe yourself. For example, exercise, meditate, take longwalks. Less stress means better self-control. Look for the humor in things, and enjoy a goodlaugh.

Act, Don’t React. Emotional responses such as blame and anger lessen when you stop, look,listen, and then respond. Thoughtful parenting is needed here.

Catch the Child Being Good. The home atmosphere and the child’s sense of self-worthchange when the air fills with words of praise and encouragement. Pay plenty of positiveattention to your son or daughter. Reward and show appreciation when he or she does whatis expected.

—Behavior Intervention D—

✦ ✦ ✦ ✦ ✦ Use good communication skills ✦✦✦✦✦Say what you mean in a firm,loving way. Practice listeningwithout judgment and dis-cussion without attack.

Recognize that your child withAD/HD has trouble listening.Be brief and to the point.


In the elementary years, AD/HDusually causes these problems:

• off-task behavior,

• incomplete or lost assignments,

• disorganization,

• sloppy work or messyhandwriting,

• not following directions,

• errors in accuracy,

• inconsistent performance,

• disruptive behavior or spacey,daydreaming behavior, and/or

• social interaction difficulties.

Around middle school and intohigh school and beyond, most ofthese problems continue. However,additional ones arise. That isbecause adolescents are expected tobe much more independent and

self-directed. They receive lesssupervision. Demands for concen-tration and more sophisticatedthinking and problem solvingincrease. AD/HD makes it hard tomeet those demands.

Given the additional problemsthat seem to arise in middle schooland beyond, it’s not unusual to seea student who’s gotten by in earliergrades dive bomb academicallyaround puberty.

The thinking difficulties associ-ated with AD/HD do not have to dowith intellectual ability. Instead,they arise out of problems withconcentration, memory, andcognitive organization. Typically,AD/HD-related memory problemsarise in two areas:

• working memory—which helpsthe student keep one thing inmind while working onanother, and

• retrieval—being able to locate ondemand information that hasbeen learned and stored inmemory.

Many students also showproblems in:

• time management,

• prioritizing work,

• reading comprehension,

• note taking,

• study skills, and

• completing multi-step tasks.

Clearly, a student with AD/HDcan have difficulty in any number ofacademic areas and with criticalacademic skills. Thus, it is extremelyimportant that the school andparents work together to design anappropriate educational programfor the student. This program needs

III. School Issues & Interventions

also have learning disabilities, andthese do interfere with the ability tolearn.)

Generally, AD/HD will affect thestudent in one or more of thefollowing performance areas:

• starting tasks,

• staying on task,

• completing tasks,

• making transitions,

• interacting with others,

• following through on directions,

• producing work at consistentlynormal levels, and/or

• organizing multi-step tasks.

Those teaching or designingprograms for students with AD/HDneed to pinpoint where eachstudent’s difficulties occur. Other-wise, valuable intervention re-sources may be spent in areaswhere they are not critical.

For example, one child with AD/HD may have difficulty starting atask because the directions are notclear. Another student may fullyunderstand the directions but forgetto follow all of them. Another mayhave difficulty making transitionsand, as a result, get stuck in thespace where one task ends andanother begins. With the first child,intervention needs to focus uponmaking directions clear and inhelping the child to understandthose directions. The second child

would need guidance to follow allthe directions. The third childwould need help in making transi-tions from one activity to another.

The sooner educational interven-tions begin, the better. They shouldbe started when educationalperformance problems becomeevident and should not be delayedbecause the child is still holding hisor her own on achievement tests.Specific suggestions for educationalinterventions are presented inSection III of this Briefing Paper.Other school issues,including specialeducation, arediscussed thereas well.


to include the accommodations,modifications, and other servicesnecessary to support the studentacademically and promote success-ful learning and appropriatebehavior.

Will Special EducationHelp My Child?

Special education is instructionthat is specially designed (at no costto parents) to meet the uniqueneeds of a child with a disability.“Specially designed” means adapt-ing the content, methodology, ordelivery of instruction (as appropri-ate) to the needs of the child, inorder to:

• address the unique needs of thechild that result from his or herdisability, and

• ensure the child’s access to thegeneral curriculum (the samecurriculum as for studentswithout disabilities) so that heor she can meet the educationalstandards that apply to allchildren within the schooldistrict or jurisdiction.

Because special education isspecially designed instruction, itmay be very helpful to your child.However, not all children with AD/HD need, or are eligible for, specialeducation services. Conversely,many would not be able to receivean appropriate education withoutspecial education services.

How Is My ChildFound Eligible forSpecial Education?

The process by which a child isfound eligible for special educationservices is described within thefederal law known as the Individu-als with Disabilities Education Act,or IDEA. The IDEA is the federal lawunder which schools:

• evaluate children for the pres-ence of a disability and theirneed for special services, and

• provide special education andrelated services to students whomeet eligibility requirements.

Eligibility decisions about achild’s need for special educationand related services are made on acase-by-case basis. School districtsmay not arbitrarily refuse to eitherevaluate or offer services to studentswith AD/HD.

In order for your child to beeligible, he or she must have adisability according to the criteriaset forth in the IDEA or under statelaw (state law is based on theIDEA). The disability must ad-versely affect his or her educationalperformance. Thus, a medicaldiagnosis of AD/HD alone is notenough to make your child eligiblefor services. Educational perfor-mance, which consists of social,emotional, behavioral, or academicperformance, must be adverselyaffected.

Presently, the IDEA lists 13categories of disability under whicha child may be found eligible forspecial education. AD/HD isspecifically mentioned in the IDEAas part of its definition of “OtherHealth Impairment.” The definitionof this disability is provided onpage 9.

Certain steps typically need to betaken in order for the child withAD/HD to be found eligible forspecial education services. Thesesteps are:

1. The child must be experienc-ing educational performanceproblems.

2. When such problems becomeevident, the parent, teacher, or otherschool staff person must requestthat the child be evaluated for thepresence of a disability.

3. The child is evaluated todetermine if he or she does indeedhave a disability and to determinethe nature and extent of the child’sneed for special education andrelated services.

4. A group of individuals,including the parents, meets toreview the evaluation results anddetermine if the child meetseligibility criteria set forth in stateand federal law. If so, the child isfound eligible for special educationand related services.

If your child is found eligible forspecial education, you will thencollaborate with school personnelto develop what is known as anIndividualized Education Program(IEP). Your child’s IEP is a writtendocument that spells out, amongother things, how your child’sspecific problems and uniquelearning needs will be addressed.The IEP considers strengths as well.


If a child’s behavior impedeslearning (including the learning ofothers), the parents and schoolmust consider, if appropriate,strategies to address that behavior.This includes positive behavioralinterventions, strategies, andsupports. This proactive approachto addressing behavior problems isintended to help individual stu-dents minimize discipline prob-lems that may arise as a result of thedisability. If your child has behaviorproblems, you will want to makesure that these are addressed in hisor her IEP.

After specifying the nature ofyour child’s special needs, the IEPteam (which includes you) deter-mines what types of services areappropriate for addressing thoseneeds. The IEP team also decideswhere your child will receive theseservices—for example, the regulareducation classroom, a resourceroom, or a separate classroom.

The IEP is a very importantdocument in the lives of studentswith disabilities. There is a lot toknow about how it is developed,what type of information it con-tains, and what part you, as aparent, play in writing it. Moredetailed information about the IEPprocess is available from NICHCY,either by contacting us directly(at 1-800-695-0285) or by visitingour Web site (www.nichcy.org).

What Do I Do If MyChild Is Not Eligible

for Services?Under IDEA, the school system

must tell you in writing why yourchild was found “not eligible.” Itmust also give you informationabout what you can do if youdisagree with this decision. Thereare legal actions and remediesavailable. Each state has specific

procedures requiredby the IDEA that mustbe followed.

Read the informa-tion the school systemgives you. Make sure itincludes informationabout how to chal-lenge the eligibilitydecision. If thatinformation is not inthe materials theschool gives you, askthe school for it.

Also get in touch with yourState’s Parent Training and Informa-tion (PTI) center. The PTI can tellyou what steps to take next. YourPTI is listed on NICHCY’s StateResource Sheet for your state.

It is also helpful to know thatstudents with AD/HD may beeligible for services under a differ-ent law—Section 504 of the Reha-bilitation Act of 1973. Section 504 isa civil rights law prohibitingdiscrimination on the basis of adisability. Any school district thatreceives federal funds must followthis law. Under Section 504, aperson with a disability means anyperson with an impairment that“substantially limits one or moremajor life activities.” Since learningis considered a major life activity,many students with AD/HD qualifyas a “person with a disability”under Section 504. Schools are thenrequired to provide them with a“free appropriate public educa-tion,” which can include regular orspecial education services, depend-ing upon each student’s specificneeds.

Therefore, if your child is foundineligible for services under IDEA,ask to have your child evaluatedunder the criteria of Section 504.Many children are not eligible forservices under IDEA but are eligibleunder Section 504.

What Can Teachers Do ToHelp a Child with AD/HD?

Whether your child receivesservices under IDEA, Section 504, oranother program designed to helpstudents with special needs, it isimportant that the intervention betailored to meet your child’sindividual needs. One size does notfit all. Work with the school toidentify the nature of your child’sspecial needs and to design aneducational program suited tothose needs.

In addition to the core interven-tions described in the previoussection, there are a number of othereducational interventions that canpotentially help students with AD/HD. This section looks at some ofthe more common interventions,modifications, and adaptations.

Select a Supportive Teacher

✓ Try to place the student withteachers who are positive,upbeat, flexible, and highlyorganized problem-solvers.Teachers who praise liberallyand who are willing to “go theextra mile” to help studentssucceed can be enormouslybeneficial to students withAD/HD.

Whether your child receivesservices under IDEA, Section

504, or another programdesigned to help students withspecial needs, it is important

that the intervention betailored to meet your child’s

individual needs.


Adapt Curriculum andInstruction

✓ Provide more direct instructionand as much one-on-oneinstruction as possible.

✓ Use guided instruction.

✓ Teach and practice organizationand study skills in every subjectarea.

✓ Lecture less.

✓ Design lessons so that studentshave to actively respond—get up,move around, go to the board,move in their seats.

✓ Design highly motivating andenriching curriculum with ampleopportunity for hands-onactivities and movement.

✓ Eliminate repetition from tasksor use more novel ways topractice.

✓ Design tasks of low to moderatefrustration levels.

✓ Use computers in instruction.

✓ Challenge but don’t overwhelm.

✓ Change evaluation methods tosuit the child’s learning stylesand strengths.

Provide Supports to PromoteOn-Task Behavior

✓ Pair the student with a studybuddy or learning partner whois an exemplary student.

✓ Provide frequent feedback.

✓ Structure tasks.

✓ Monitor independent work.

✓ Schedule difficult subjects at thestudent’s most productive time.

✓ Use mentoring and peer tutor-ing.

✓ Provide frequent and regularlyscheduled breaks.

✓ Set timers for specific tasks.

✓ Call attention to schedulechanges.

✓ Maintain frequent communica-tion between home and school.

✓ Do daily/weekly progressreports.

✓ Teach conflict resolution andpeer mediation skills.

Provide Supports to PromoteExecutive Function

❑ To support planning:

✓ Teach the student to useassignment pads, day plan-ners or time schedules, taskorganizers and outlines.

✓ Teach study skills and practicethem frequently and in allsubjects.

❑ To increase organization:

✓ Allow time during school dayfor locker and backpackorganization.

✓ Allow time for student toorganize materials andassignments for homework.

✓ Have the student create amaster notebook—a 3-ringbinder where the studentorganizes (rather than stuffs)papers.

✓ Limit number of folders used;have the student use hole-punched paper and clearlylabel all binders on spines;monitor notebooks.

✓ Have daily and weeklyorganization and clean uproutines.

✓ Provide frequent checks ofwork and systems for organi-zation.

❑ To improve follow through:

✓ Create work completionroutines.

✓ Provide opportunities forself-correction.

✓ Accept late work.

✓ Give partial credit for workpartially completed.

❑ To improve self-control:

✓ Prepare the student fortransitions.

✓ Display rules.

✓ Give behavior prompts.

✓ Have clear consequences.

✓ Provide the student with timeto de-stress.

✓ Allow doodling orother appropriate,mindless motormovement.

✓ Use activity asa reward.

✓ Provide moresupervision.


Memory Boosters

❑ To assist with working memory:

✓ Focus on one concept at atime.

✓ List all steps.

✓ Write all work down.

✓ Use reading guides and plotsummaries.

✓ Teach note-taking skills—letthe student use a study buddyor teacher-prepared notes tofill in gaps.

✓ List all key points on board.

✓ Provide summaries, studyguides, outlines, and lists.

✓ Let the student use thecomputer.

❑ To assist with memory retrieval:

✓ Teach the student memorystrategies (grouping,chunking, mnemonic de-vices).

✓ Practice sorting main ideasand details.

✓ Teach information andorganization skills.

✓ Make necessary test accom-modations (allow open booktests; use word banks; useother memory cues; test inpreferred modality—e.g.,orally, fill in blank; givefrequent quizzes instead oflengthy tests).

Attention Getters and Keepers

❑ For problems beginning tasks:

✓ Repeat directions.

✓ Increase task structure.

✓ Highlight or color codedirections and other impor-tant parts.

About the Author...

Mary Fowler is an author, advocate, educator, and AD/HD coach, as well as an internation-ally recognized expert on AD/HD. Her best-selling book, Maybe You Know My Kid: A Parent’sGuide to Attention Deficit Hyperactivity Disorder, is published in several languages. Her newestbook, Maybe You Know My Teen: A Parent’s Guide for Adolescents with ADHD (2001), is pub-lished by Broadway Books. Mary also serves as a consultant to NICHCY on several writingprojects, including this Briefing Paper.

Mary has testified before Congress on educational issues and presented numerous workshopsfor parents and educators both in the United States and abroad. Mary’s workshops offer themost current information on brain-based learning, AD/HD, and behavior, as well as thepractical applications of this information. Visit her Web site at: www.maryfowler.com.

✓ Teach the student keywordunderlining skills.

✓ Summarize key information.

✓ Give visual cues.

✓ Have the class start together.

❑ For problems sticking with andfinishing tasks:

✓ Add interest and activity to tasks.

✓ Divide larger tasks into easilycompleted segments.

✓ Shorten overall tasks.

✓ Allow the student choice intasks.

✓ Limit lecture time.

✓ Call on the student often.


IV. Meeting the Challenge

There is no question that AD/HD creates plenty of opportunity toovercome adversity. Why are somechildren and families better able tomeet the challenges AD/HDpresents? The answer can beglimpsed in the research that’s beendone on resilience.

Resilience does not meanavoiding adversity or sailing off intothe sunset. To be resilient is toadapt despite challenges andthreatening circumstances.

AD/HD places children andyouth at risk for a number of lifeproblems. Research shows thatcertain protective factors help at-riskchildren and youth to minimize thepossibility of negative affects.Among these helpful protectivefactors are:

• ordinary parents,

• connection to competent andcaring adults,

• self-efficacy (the power or abilityto produce a desired outcome),

• intellectual ability,

• pleasing personality,

• talents valued by society, and

• being able to control one’s self—one’s attention, emotion,arousal, and behavior. (Masten,1999)

When researchers Weiss andHechtman (1993) did follow-upstudies on adults with AD/HD whomanaged to successfully meet theirchallenges, the adults overwhelm-ingly identified one main reason fortheir success: Someone believed inthem.

Most often that someone was aparent. Still, other caring adultssuch as coaches, teachers, andspouses, also filled them with hopeand a belief in self.

To help your son or daughterdevelop a sense of well-being, thinkabout the above list of protectivefactors. Which ones can you helpyour child develop?

Remember, AD/HD is not amatter of can’t or won’t. It’s a matterof can and will—with the rightrecognition and help.

Where can I find support?For parents, teachers, and

children challenged by this disor-der, AD/HD can be a truly uniqueexperience. While some days thestruggles seem insurmountable, it’simportant to realize that when AD/HD is properly managed children

with AD/HD can turn some of theirliabilities into assets, and they canminimize the others.

Meanwhile, there is help andhope available. Parent supportgroups exist in every state. Some,like CHADD and ADDA, are AD/HD-specific. Others like the Learn-ing Disabilities Association andParent’s Anonymous may also beuseful, depending on your indi-vidual circumstances. Visit the Websites of these groups (see “Organi-zations” on page 22), where you’llfind information on activities andcontact numbers of similar groupsin your area.

10 Ways to Teach Your Children Well

10. Help your child identify his or her areas of strength.

9. Help him or her to identify areas of weakness and ways to workaround them.

8. Teach self-advocacy skills.

7. Be your child’s strongest advocate.

6. Create opportunities for success—no matter how large or small,like special chores.

5. Play or do activities with him or her.

4. Encourage your child’s special interests.

3. Enroll him or her in extra-curricular activities.

2. Help your child find a niche.

1. Be your child’s biggest fan.


V. References

American Academy of Pediatrics. (2000,May). Clinical practice guideline: Diagnosis andevaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105(5),1158-1170.

American Psychiatric Association. (2000).Diagnostic and statistical manual of mentaldisorders (4th ed., text revision). Washington, DC:Author.

Barkley, R.A. (2000). Taking charge of ADHD:The complete, authoritative guide for parents (Rev.ed.). New York: Guilford.

Barkley, R.A., DuPaul, G., & O’Connor, D.(1999). Stimulants. In J.S. Werry & M.G. Aman(Eds.), Practitioner’s guide to psychoactive drugs forchildren and adolescents (2nd ed.). New York:Plenum.

Castellanos, F.X., & Swanson, I.M. (2002).Biological underpinnings of ADHD. In S.Sandberg (Ed.), Hyperactivity and attentiondisorders of childhood (2nd ed.). Cambridge,England: Cambridge University Press.

Code of Federal Regulations (CFR): Title 34,Part 300 (2001). (These are the federalregulations for the IDEA.)

Goldman, L.S., Genel, M., Bezman, R., &Slanetz, P.J. (1998). Diagnosis and treatment ofattention-deficit/hyperactivity disorder in

children and adolescents. JAMA (Journal of theAmerican Medical Association), 279(14), 1100-1107.[Abstract of this article is available on-line at:http://jama.ama-assn.org/issues/v279n14/toc.html]

Masten, A.S. (1999). Resilience in children atrisk: Implications for interventions. In theAmerican Association of Children’s ResidentialCenters (AACRC), Contributions to residentialtreatments 2000 conference. Washington, DC:AACRC.

MTA Cooperative Group. (1999, December).A 14-month randomized clinical trial of treatmentstrategies for attention-deficit/hyperactivitydisorder. Archives of General Psychiatry, 56(12),1073-1086. [Abstract of this article is available on-line at: http://archpsyc.ama-assn.org/issues/v56n12/toc.html]

Robin, A. (1998). ADHD in adolescents:Diagnosis and treatment. New York: Guilford.

Weiss, G., & Hechtman, L.T. (1993).Hyperactive children grown up: ADHD in children,adolescents, and adults (2nd ed.). New York:Guilford.

Zametkin, A.J., & Ernst, M. (1999). Currentconcepts: Problems in the management ofattention-deficit/hyperactivity disorder. NewEngland Journal of Medicine, 340(1), 40-46.

VI. Resources

Books and Videos on AD/HD

Barkley, R. (1997). ADHD and the nature ofself-control. New York: Guilford.

Barkley, R. (2000). A new look at ADHD:Inhibition, time, and self-control [Video]. NewYork: Guilford.

Barkley, R. (2000). Taking charge of AD/HD:The complete, authoritative guide for parents (Rev.ed.). New York: Guilford.

Barkley, R., & Benton, C. (1998). Your defiantchild: Eight steps to better behavior. New York:Guilford.

Brooks, R., & Goldstein, S. (2001). Raisingresilient children. New York: NTC/Contemporary.

Dendy, C.A.Z. (1995). Teenagers with ADD: Aparents’ guide. Bethesda, MD: Woodbine House.

Obtaining Resources of InterestThe names and addresses of the publishers(e.g., Guilford) of these materials areprovided on page 23.

Dendy, C.A.Z. (1999). Teaching teens with ADDand ADHD: A quick reference guide for teachers andparents. Bethesda, MD: Woodbine House.

Dendy, C.A.Z., & Zeigler, A. (2003). A bird’s-eyeview of life with ADD and ADHD: Advice fromyoung survivors. A reference book for children andteens. Cedar Bluff, AL: Cherish the Children.

Fowler, M. (1999). Maybe you know my kid: Aparent’s guide to helping your child with attentiondeficit hyperactivity disorder (3rd ed.). Kensington,NY: Citadel.


Fowler, M. (2001). Maybe you know my teen: Aparent’s guide to helping your adolescent withattention deficit hyperactivity disorder. New York:Broadway Books.

Hallowell, E.M., & Ratey, J.J. (1995). Driven todistraction: Recognizing and coping with attentiondeficit disorder from childhood through adulthood.New York: Simon & Schuster.

National Institute of Mental Health. (2000).NIMH research on treatment for attention deficithyperactivity disorder: The Multimodal TreatmentStudy—Questions and answers [On-line]. Available:www.nimh.nih.gov/childhp/mtaqa.cfm

National Institutes of Health. (1998).Diagnosis and treatment of attention deficithyperactivity disorder. NIH Consensus Statement,16(2), 1-37 [On-line]. Available: odp.od.nih.gov/consensus/cons/110/110_statement.htm

Power, T.J., Karustis, J.L., & Habboushe, D.F.(2001). Homework success for children withADHD: A family-school intervention program. NewYork: Guilford.

Rief, S. (2003). ADHD & LD: Powerfulteaching strategies & accommodations [Video].Available: www.sandrarief.com

Reiff, M.I., & Tippins, S. (Eds.). (2004).ADHD: A complete and authoritative guide. ElkGrove Village, IL: American Academy ofPediatrics.

U.S. Department of Education. (2003).Identifying and treating attention deficit hyperactiv-ity disorder: A resource for school and home [On-line]. Available: www.ed.gov/teachers/needs/speced/adhd/adhd-resource-pt1.doc

Weingartner, P.L. (1999). ADHD handbook forfamilies: A guide to communicating withprofessionals. Washington, DC: Child WelfareLeague of America.

Wilens, T. (2004). Straight talk aboutpsychiatric medications for kids. (Rev. ed.). NewYork: Guilford.

Wodrich, D.L. (2000). Attention deficithyperactivity disorder: What every parent wants toknow (2nd ed.). Baltimore, MD: Paul H. Brookes.

Zentall, S., & Goldstein, S. (1999). Seven stepsto homework success. Plantation, FL: SpecialityPress.

Resources on Conditions That Can Co-Occurwith AD/HD

Barkley, R.A. (1997). Managing the defiantchild: A guide to parent training [Video, withcompanion manual]. New York: Guilford.

Dacey, J.S. & Fiore, L.B. (2002). Your anxiouschild: How parents and teachers can relieve anxietyin children. San Francisco: Jossey-Bass.

Green, R. (1999). The explosive child: A newapproach for understanding and parenting easilyfrustrated, chronically inflexible children. New York:HarperCollins.

Koplewicz, H.S. (1997). It’s nobody’s fault:New hope and help for difficult children and theirparents. New York: Times Books.

Manassis, K. (1996). Keys to parenting youranxious child. Hauppauge, NY: BarronsEducational Series.

Papolos, D.F., & Papolos, J. (2000). The bipolarchild: The definitive and reassuring guide tochildhood’s most misunderstood disorder. New York:Broadway Books.

Rapee, R.M., Spence, S., Cobham, V., &Wignall, A. (2000). Helping your anxious child: Astep-by-step guide for parents. Oakland, CA: NewHarbinger.

Riley, D.A. (1997). The defiant child: A parent’sguide to oppositional defiant disorder. Dallas, TX:Taylor.

Riley, D.A. (2001). The depressed child: Aparent’s guide for rescuing kids. Dallas, TX: Taylor.

Organizations

CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), 8181 ProfessionalPlace, Suite 150, Landover, MD 20785.Phone: 800.233.4050; 301.306.7070.Web: www.chadd.org

Learning Disabilities Association (LDA), 4156Library Road, Pittsburgh, PA 15234-1349.Phone: 412.341.1515. Web: www.ldaamerica.org

Attention Deficit Disorder Association (ADDA),P.O. Box 543, Pottstown, PA 19464.Phone: 484.945.2101 (to leave a message).Web: www.add.org

Parents Anonymous, Inc., 675 W. FoothillBoulevard., Suite 220, Claremont, CA 91711.Phone: 909.621.6184.Web: www.parentsanonymous.org


VII. Publishers

American Association of Children’s ResidentialCenters (AACRC), 51 Monroe Place, Suite 1603,Rockville, MD 20850. Phone: 301.738.6460.Web: www.aacrc-dc.org

American Psychiatric Publishing, 1400 K Street, N.W.,Washington, DC 20005. Phone: 800.368.5777;202.682.6262. Web: www.appi.org

Barrons Educational Series, Inc., 250 WirelessBoulevard, Hauppauge, NY 11788.Phone: 800.645.3476. Web: barronseduc.com/

Broadway Books: The resources that list “Broadway” aspublisher are available through your local booksellersor booksellers on-line such as amazon.com. To helpreaders identify either a local or on-line bookseller,Broadway Books (through Random House) providesthis address: www.randomhouse.com/backyard/order.html

Cambridge University Press, The Edinburgh Building,Shaftesbury Road, Cambridge, England CB2 2RU.Web: www.uk.cambridge.org

Child Welfare League of America, 440 First Street NW,Third Floor, Washington, DC 20001-2085.Phone: 202.638.2952. Web: www.cwla.org/pubs/

Citadel Books, contact Kensington PublishingCorporation, Dept. CO, 850 Third Avenue,New York, NY 10022. Phone: 877.422.3665.Web: www.kensingtonbooks.com

Guilford Press, 72 Spring Street, New York, NY 10012.Phone: 800.365.7006. Web: www.guilford.com

HarperCollins, 10 East 53rd Street, New York, NY 10022.Phone: 800.331.3761; 212.207.7000.Web: www.harpercollins.com

Free Information!

For free information about a variety of disorders, including AD/HD, anxiety, conduct disorders, bipolar disorder,oppositional defiant disorder, and depression visit these Web sites or contact the organizations directly:

Center for the Advancement of Children's Mental Health,Division of Child and Adolescent Psychiatry, ColumbiaUniversity, 1051 Riverside Drive, New York, NY 10032.Phone: 212.543.5334. Web: www.kidsmentalhealth.org

National Alliance for the Mentally Ill (NAMI), ColonialPlace Three, 2107 Wilson Blvd., Suite 300,Arlington, VA 22201. Phone: 800.950.6264;703.516.7227 (TTY). Web: www.nami.org

National Institute on Mental Health (NIMH), Office ofCommunications, 6001 Executive Boulevard, Room 8184,MSC 9663, Bethesda, MD 20892-9663.Phone: 866.615.6464; 301.443.4513; 301.443.8431 (TTY).Web: www.nimh.nih.gov/publicat/index.cfm

National Mental Health Association Resource Center,2001 N. Beauregard Street, 12th Floor,Alexandria, VA 22311. Phone: 800.969.6642;800.433.5959 (TTY). Web: www.nmha.org

National Mental Health Information Center,P.O. Box 42557, Washington, DC 20015.Phone: 800.789.2647; 866.889.2647 (TTY) or301.443.9006 (TTY). Web: www.mentalhealth.org

Jossey-Bass, Customer Care Center, 10475 CrosspointBoulevard, Indianapolis, IN 46256.Phone: 877.762.2974. Web: www.josseybass.com/

New Harbinger Publications, 5674 Shattuck Avenue,Oakland, CA 94609-1662. Phone: 800.748.6273;510.652.0215. Web: www.newharbinger.com/

NTC/Contemporary Books, contact ResiliencePartners, 230 South 500 East, Suite 100,Salt Lake City, UT 84102. Phone: 801.532.1484.Web: www.raisingresilientkids.com/index.html

Paul H. Brookes Publishing Company, P.O. Box 10624,Baltimore, MD 21285-0624. Phone: 800.638.3775.Web: www.brookespublishing.com

Plenum Publishing, contact Kluwer AcademicPublishers, Order Department, P.O. Box 358,Accord Station, Hingham, MA 02018-0358.Phone: 781.871.6600.Web: www.wkap.nl/kaphtml.htm/HOMEPAGE

Simon & Schuster, 100 Front Street, Riverside, NJ 08075.Phone: 800.223.2336. Web: www.simonsays.com

Speciality Press (now ADD WareHouse),300 N.W. 70th Avenue, Suite 102, Plantation, FL 33317.Phone: 800.233.9273. Web: www.addwarehouse.com

Taylor Publishing Company: The resources that list“Taylor” as publisher are available through your localbooksellers or booksellers on-line such as amazon.com.

Times Books, see Broadway Books.

Woodbine House, 6510 Bells Mill Road,Bethesda, MD 20817. Phone: 800.843.7323;301.897.3570. Web: www.woodbinehouse.com

Publication of this document is made possible through Cooperative Agreement #H326N030003between the Academy for Educational Development and the Office of Special Education Programs of

the U.S. Department of Education. The contents of this document do not necessarily reflect the views or policies of theDepartment of Education, nor does mention of trade names, commercial products, or organizations imply endorsement bythe U.S. Government.

The Academy for Educational Development, founded in 1961, is an independent, nonprofit serviceorganization committed to addressing human development needs in the United States and throughoutthe world. In partnership with its clients, the Academy seeks to meet today’s social, economic, andenvironmental challenges through education and human resource development; to apply state-of-the-art education,training, research, technology, management, behavioral analysis, and social marketing techniques to solve problems; andto improve knowledge and skills throughout the world as the most effective means for stimulating growth, reducingpoverty, and promoting democratic and humanitarian ideals.

P.O. Box 1492Washington, DC 20013800.695.0285 (V/TTY)202.884.8200 (V/TTY)E-mail: [email protected]: www.nichcy.org

National Dissemination Centerfor Children with Disabilities

NICHCY Briefing Papers are published in response to questions from individuals and organizations that contactus. NICHCY also disseminates other materials and can respond to individual requests for information. Forfurther information or assistance, or to receive a NICHCY Publications Catalog, contact NICHCY, P.O. Box 1492,Washington, DC 20013. Telephone: 800.695.0285 (V/TTY) and 202.884.8200 (V/TTY). You may also e-mail us([email protected]) or visit our Web site (www.nichcy.org), where you will find all of our publications.

NICHCY thanks our Project Officer, Dr. Peggy Cvach, at the Office of Special Education Programs, U.S. Depart-ment of Education. We would also like to thank Dr. Peter Jensen, Director of the Center for Advance of Children’sMental Health, New York, New York, for his thoughtful and timely review of this publication. And, finally, weextend our deep appreciation to Mary Fowler for her longstanding commitment to the well-being of children withAD/HD, their parents, and their teachers, and for generously sharing her expertise with all of us.

Director .................................................................................................. Suzanne RipleyAssistant Director ................................................................................... Donna WaghornDirector of Publications/Editor ............................................................. Lisa KüpperAuthor .................................................................................................... Mary Fowler

This information is copyright free. Readers are encouraged to copy and share it, but please credit the Na-tional Dissemination Center for Children with Disabilities (NICHCY). Please share your ideas and feed-back with our staff by writing to the Director of Publications.

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