ADHD Assessment (page 3)

The assessment of students with disabilities occurs across several settings. In some cases, a disorder is suspected early in a child's life, and appropriate evaluations are conducted before the elementary school years in order for the child to qualify for early intervention services. In other cases, classroom teachers suspect the existence of a disorder and use a variety of pre-referral strategies and assessments to determine whether a full evaluation and referral to special education are necessary. If a full evaluation is warranted, a variety of assessment instruments are used to evaluate the child's abilities. Although many experts in ADHD advocate for comprehensive psychological and even medical evaluations, IDEA '04 does not require such costly medical or psychiatric diagnoses for these individuals (Weyandt, 2001; U.S. Department of Education, 2005). Finally, unless otherwise noted in an IEP, all students must participate in state- and district-wide standardized testing; in these cases, assessment accommodations may be warranted for a child with a disability. All of these situations, and applications for students with ADHD, are discussed next.

Early Identification

The symptoms of ADHD do arise during early childhood, but the acknowledgement of their presence is often retrospective. In other words, few preschoolers are identified as having ADHD because of (1) the fear of misidentifying children as having disabilities when their problems may be due to developmental lags or immaturity and (2) the fact that the characteristics of ADHD (e.g., short attention span, being in constant motion) are typical of many young children without ADHD. Thus, unless doctors and education professionals can document some incident that caused brain damage, identification during the early childhood years is not likely (NIMH, 2005). Nevertheless, the federal government requires that for students to receive special education services for ADHD, the symptoms must have been present before the age of seven (OSEP, 2003).

Pre-Referral

The primary purpose of pre-referral is to avoid unnecessary referrals to special education by implementing research-validated practices in the general education classroom. If the implemented practices work—that is, if the behaviors of concern decrease significantly or disappear—then a referral is not needed. For students who may have ADHD, the pre-referral process should contain multiple steps, and the efficacy of each attempt should be documented.

In the pre-referral phase for students with ADHD, a teacher's actions should focus on preventing problem behaviors. For children with a predisposition toward inattention or hyperactivity, the physical and instructional structure of the classroom must be considered. Students with self-regulation difficulties do better in structured settings, so teachers need to have a well-planned behavior management system in place, complete with rules, procedures, and consistently delivered consequences. Maintenance of a regular classroom routine is very important, as are clearly articulated instructions and expectations for academic and social tasks. Well-planned transition times can decrease the opportunities for "problem" behaviors.

Other colleagues, such as teachers or a school nurse, can be helpful resources. At an initial level, a school nurse can be consulted to rule out other conditions (e.g., hearing loss) through general screening procedures. If other conditions might be the source of behavioral problems, then the evaluation process involves professionals with expertise in those areas of concern (e.g., an audiologist). When the school nurse suspects the presence of ADHD characteristics, the direction of the evaluation efforts is adjusted accordingly. Other teachers can conduct classroom observations to help the general educator find additional ways to improve the classroom structure and educational environment. Parents and family members are a critical resource at this stage, both for feedback regarding interventions that have been successful in the past and to maintain consistency between the home and school environments. If a variety of methods have been employed to increase attention or reduce hyperactivity, with little or no success, then a formal referral to special education is warranted.

Evaluation: Testing Accommodations

Just as for students with other disabilities, many types of accommodations are available to students with ADHD; however, one accommodation seems to be the most commonly offered. Whether the students' special needs are addressed through IDEA '04 or through Section 504, the most common accommodation to testing situations for students with ADHD is extended time (Elliott & Marquart, 2004). When offered this accommodation, students with disabilities typically take only 8 or 12 minutes longer to answer test items. But does having longer to complete a test make a difference in results? Surprisingly, whether for students with disabilities or without disabilities, extended time does not significantly improve students' scores. What . interesting, however, is that students who are offered extended time feel better about the testing situation, claim they were more motivated to complete the [est, felt less frustrated, and thought they performed better. Outcome measures—measures of how well the students actually did on the test—did not support students' feelings about their performance (Elliott & Marquart, 2004).