Attention-Deficit/ Hyperactivity Disorder (page 2)
Definitions, Prevalence, and Characteristics
Robert has an attention-deficit/hyperactivity disorder and both his family and teacher could benefit from suggestions as to how to best work with him. Robert’s disruptive behaviors and his inability to sustain attention could put Robert at risk for failing in school (Maag & Reid, 1994). Attention-deficit/hyperactivity disorder (ADHD) refers to a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development” (American Psychiatric Association, 2000, p. 85). Observations made in the classroom will identify these students as those who often say “Huh, what?” immediately following directions; often appear to be daydreaming; act before they think; blurt out answers; interrupt; and constantly fidget, wiggle, and move around. compares the sharp contrast between commonly noted behaviors on elementary school report cards with students with ADHD.
From 1.35 to 2.25 million children—3% to 5% or more of all school-age children—may have attention-deficit/hyperactivity disorder [American Psychiatric Association (APA), 2000;.Barkley, 1998; Council for Exceptional Children (CEC), 1992]. Most students with ADHD are served full time in general education classrooms, with only about half of them qualifying for special education services under IDEA (CEC, 1992).
The Diagnostic and Statistical Manual-IV–Text Revision (DSM-IV-TR) of the American Psychiatric Association (APA, 2000) describes criteria for classification as ADHD. The symptomatic behaviors must be maladaptive and must be present for a minimum of six months to warrant a classification as either inattentive ADHD or hyperactivity-impulsivity ADHD. Some symptoms should have been present before 7 years of age. Furthermore, a child must display a minimum number of identifying characteristics before ADHD is diagnosed. For example, students must meet six of nine characteristics under Inattention, or six of nine characteristics under Hyperactivity/Impulsivity. There also must be evidence of impairment in social, occupational, or academic functioning, and some impairment from the symptoms must be present in at least two settings.
Any inattentiveness, impulsivity, and hyperactivity must be observed across settings (APA, 2000). Or, as in the case of Robert, the teacher and parents must observe similar behavior patterns at school and at home. Although some symptoms change over time, ADHD is now considered potentially a lifelong disorder (APA, 2000). Males outnumber females about 3 to 1 in the disorder (Barkley, 1998; Bender, 1997).
Students with ADHD are thought to be more likely to have a learning disability than other children. In a sample of students with ADHD, Barkley (1990) identified 21% with disabilities in reading, 26% in spelling, and 28% in math (see also Barkley, 1998).
Causes of ADHD
Precise causes of ADHD are unknown; however, it is thought that many factors contribute to it (Riccio, Hynd, & Cohen, 1997). These factors include genetic, nongenetic, psychosocial, and neurobiological bases. Genetic evidence is based on research with families who have ADHD. Some researchers estimate that as many as 32% of children with ADHD have parents or siblings with ADHD (Biederman et al., 1992), and concordance of ADHD has been seen to be much higher in identical (monozygotic) twins than in fraternal (dizygotic) twins, suggesting a genetic component (Barkley, 1998). Nongenetic factors include prenatal and perinatal factors, allergies, and thyroid disorders (Riccio, Hynd, & Cohen, 1997). Although both food additives (Feingold, 1975) and sugar (Smith, 1975) have been proposed as causes of ADHD, research has not substantiated these as plausible causes of ADHD (Barkley, 2000; Wolraich, Milich, Stumbo, & Schultz, 1985). Other research has investigated the psychosocial and neurological correlates associated with ADHD, with evidence growing in support of neurological indicators (Riccio, Hynd, & Cohen, 1997). To date, however, as with many disorders, no definitive single etiological factor has been uncovered. At present, it seems that ADHD appears to be more influenced by neurological and genetic factors than by social or environmental factors (Barkley, 1998).
Issues in Identification and Assessment of ADHD
Many experts recommend a two-step approach to the assessment of ADHD. The first step is to determine whether ADHD exists, and the second step is to determine whether the student’s educational progress is adversely affected by it (CEC, 1992). During the first step, information is collected on observations of the individual’s behavior throughout the day, medical history, family information, school information, social-emotional functioning, and cognitive-academic functioning (CEC, 1992; Schwanz & Kamphaus, 1997). Rating scales of the individual’s behavior are usually completed by the child’s parents and teachers as part of this evaluation process.
To qualify for special education services in the “other health impairment” category of IDEA, it must be documented that the ADHD has an adverse effect on educational performance. To qualify for special services under Section 504 of the Vocational Rehabilitation Act, it must be documented that the ADHD substantially limits learning. If either of these requirements is met, an intervention plan is designed and implemented as either part of the IEP in compliance with IDEA or the accommodation plan for compliance with Section 504. In the event that students with ADHD do not meet criteria for either IDEA or Section 504, no special accommodations are designed as part of any legally mandated system. However, these students with ADHD also frequently benefit from some of the general classroom adaptations described in this article and listed below.
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