Teaching Children with ADHD
Inattention, hyperactivity and impulsivity are the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD). A child's academic success is often dependent on his or her ability to attend to tasks and teacher and classroom expectations with minimal distraction. Such skill enables a student to acquire necessary information, complete assignments and participate in classroom activities and discussions (Forness & Kavale, 2001). When a child exhibits behaviors associated with ADHD, consequences may include difficulties with academics and with forming relationships with his or her peers if appropriate instructional methodologies and interventions are not implemented.
There are an estimated 1.46 to 2.46 million children with ADHD in the United States; together these children constitute 3-5 percent of the student population (Stevens, 1997; American Psychiatric Association, 1994). More boys than girls are diagnosed with ADHD; most research suggests that the condition is diagnosed four to nine times more often in boys than in girls (Bender, 1997; Hallowell, 1994; Rief, 1997). Although for years it was assumed to be a childhood disorder that became visible as early as age 3 and then disappeared with the advent of adolescence, the condition is not limited to children. It is now known that while the symptoms of the disorders may change as a child ages, many children with ADHD do not grow out of it (Mannuzza, Klein, Bessler, Malloy, & LaPadula, 1998).
The behaviors associated with ADHD change as children grow older. For example, a preschool child may show gross motor overactivity-always running or climbing and frequently shifting from one activity to another. Older children may be restless and fidget in their seats or play with their chairs and desks. They frequently fail to finish their schoolwork, or they work carelessly. Adolescents with ADHD tend to be more withdrawn and less communicative. They are often impulsive, reacting spontaneously without regard to previous plans or necessary tasks and homework.
According to the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association (APA) (1994), ADHD can be defined by behaviors exhibited. Individuals with ADHD exhibit combinations of the following behaviors:
- Fidgeting with hands or feet or squirming in their seat (adolescents with ADHD may appear restless);
- Difficulty remaining seated when required to do so;
- Difficulty sustaining attention and waiting for a turn in tasks, games, or group situations;
- Blurting out answers to questions before the questions have been completed;
- Difficulty following through on instructions and in organizing tasks;
- Shifting from one unfinished activity to another;
- Failing to give close attention to details and avoiding careless mistakes;
- Losing things necessary for tasks or activities;
- Difficulty in listening to others without being distracted or interrupting;
- Wide ranges in mood swings; and
- Great difficulty in delaying gratification.
Children with ADHD show different combinations of these behaviors and typically exhibit behavior that is classified into two main categories: poor sustained attention and hyperactivity-impulsiveness. Three subtypes of the disorder have been described in the DSM-IV: predominantly inattentive, predominantly hyperactive-impulsive, and combined types (American Psychiatric Association [APA] as cited in Barkley, 1997). For instance, children with ADHD, without hyperactivity and impulsivity, do not show excessive activity or fidgeting but instead may daydream, act lethargic or restless, and frequently do not finish their academic work. Not all of these behaviors appear in all situations. A child with ADHD may be able to focus when he or she is receiving frequent reinforcement or is under very strict control. The ability to focus is also common in new settings or while interacting one-on-one. While other children may occasionally show some signs of these behaviors, in children with ADHD the symptoms are more frequent and more severe than in other children of the same age.
Although many children have only ADHD, others have additional academic or behavioral diagnoses. For instance, it has been documented that approximately a quarter to one-third of all children with ADHD also have learning disabilities (Forness & Kavale, 2001; Robelia, 1997; Schiller, 1996), with studies finding populations where the comorbidity ranges from 7 to 92 percent (DuPaul & Stoner, 1994; Osman, 2000). Likewise, children with ADHD have coexisting psychiatric disorders at a much higher rate. Across studies, the rate of conduct or oppositional defiant disorders varied from 43 to 93 percent and anxiety or mood disorders from 13 to 51 percent (Burt, Krueger, McGue, & Iacono, 2001; Forness, Kavale, & San Miguel, 1998; Jensen, Martin, & Cantwell, 1997; Jensen, Shertvette, Zenakis, & Ritchters, 1993). National data on children who receive special education confirm this co-morbidity with other identified disabilities. Among parents of children age 6-13 years who have an emotional disturbance, 65 percent report their children also have ADHD. Parents of 28 percent of children with learning disabilities report their children also have ADHD (Wagner & Blackorby, 2002).
When selecting and implementing successful instructional strategies and practices, it is imperative to understand the characteristics of the child, including those pertaining to disabilities or diagnoses. This knowledge will be useful in the evaluation and implementation of successful practices, which are often the same practices that benefit students without ADHD.
Reprinted with the permission of the U.S. Department of Education.