This chapter focuses on Attention Deficit Hyperactive Disorder (ADHD). The medical definition of ADHD is provided. While not one of the disabilities recognized under IDEA, students with ADHD can receive services under the Other Health Impaired category or through Section 504 of the Rehabilitation Act.  Neurological, hereditary, and environmental factors influencing the development of ADHD are explored.  Characteristics of ADHD include behavioral, social, emotional reactions and occur comorbidly with other conditions. In terms of the assessment of ADHD, medical, behavioral, and educational evaluations are discussed. While most students with ADHD are served in the general education classrooms, functional behavioral assessments, self-regulation and self-monitoring, and instructional modifications along with home-school collaboration have proven to help students succeed. There is recognition that ADHD is a disability that influences individuals throughout the lifespan and impacts social and personal relationships as well as postsecondary education, employment, and career options. ADHD appears in all racial/ethnic groups but is based on subjective judgments. ADHD is more frequently diagnosed in boys. Technology can be used in content area instruction as well as to help students maintain their attention during class and for self-monitoring.

Learning Objectives:

• Define attention deficit hyperactivity disorder (ADHD).
• Describe the historical evolution of the concept of ADHD.
• List possible etiological factors associated with ADHD.
• Identify learning characteristics and social-emotional issues typical of persons with ADHD.
• Explain how ADHD is diagnosed.
• Define multimodal intervention.
• Outline instructional and environmental modifications typically used with pupils who have ADHD.
• Describe the role of stimulant medication in treating individuals with ADHD.
• Summarize the impact of ADHD on adolescents and adults.

Lecture Outline:

1. Defining ADHD
   
   1. Students with Attention Deficit Hyperactivity Disorder (ADHD) may struggle with school routines and expectations due to their tendency to appear inattentive or distractible. Students with ADHD may find that they have a hard time concentrating and complying with requests that their classmates do not.
   2. Described by the American Psychiatric Association (2000) as “a persistent pattern of inattention and/or hyperactive impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.”
      
      1. The behaviors must have persisted for at least 6 months and to a marked degree across two or more settings.
   3. IDEA does not have a definition of ADHD
      
      1. ADHD is not a separate disability category (it is in the Other Health Impaired category)
   4. ADHD does not constitute its own category but impacts the lives of a large number of students. ADHD may occur with other disabilities.
   5. Students with ADHD may be eligible for special education and an IEP or Section 504 of the Rehabilitation Act services
   6. Three subtypes: ADHD predominately inattentive type, ADHD predominantly hyperactive-impulsive type, and ADHD combined type
      
      1. Students may exhibit either type or a combination of both which is the most common.
2. Brief History of the Field
   
   1. 1902- “defective moral conduct”
      
      1. A London doctor described children with ADHD-like characteristics in a way that reflected the social beliefs of the era
   2. 1930s- discovery of stimulant medications
      
      1. Administration of stimulant medication to individuals who displayed ADHD-like characteristics produced a calming effect in their behavior
   3. 1940s and 1950s- research regarding distractibility issues
      
      1. Scientists studied children with intellectual disability with and without suspected brain injury in addition to children with cerebral palsy to research distractibility issues. The findings were turned into recommendations for teaching children who display ADHD-like characteristics.
   4. 1950s and 1960s- “minimal brain injury”
      
      1. The term “minimal brain injury” grew and waned in popularity during this time
   5. 1960s- “hyperactive child syndrome”
      
      1. The term “hyperactive child syndrome” came into use because it lacked the element of brain injury
   6. 1980s- shift of focus to observable behaviors rather than speculating about brain injury
      
      1. Development of ADHD label and criteria
3. Prevalence and Etiology of ADHD
   
   1. Prevalence
      
      1. Estimate that 3-9% of the school-age population have ADHD
      2. The diagnosis of ADHD is becoming more prevalent and the numbers of students served under the Other Health Impaired category, which contains the label of ADHD, have increased tremendously.
      3. The label of ADHD may reflect cultural gender differences that account for the greater number of male students who are identified as having ADHD.
   2. Etiology
      
      1. Neurological dysfunction: Anatomical differences and imbalances in brain chemistry may be contributing factors for ADHD. These regions control behaviors such as self-regulation and working memory.
      2. Hereditary factors: Family and twin studies seem to indicate that ADHD runs in families
      3. Environmental factors: Environmental factors can include: maternal drug or alcohol abuse, lead poisoning, low birth weight, premature birth
4. Characteristics of Students with ADHD
   
   1. Inattention
   2. Hyperactivity
   3. Behavioral inhibition difficulties
   4. Executive function problems
   5. Social and behavioral issues
   6. Comorbidity of other academic and behavioral difficulties
5. Assessment of Students with ADHD
   
   1. Multidimensional evaluation process: Involves parents, teachers, physicians, and school professionals
   2. Medical evaluation: Evaluate children aged 6-12, must meet DSM-V criteria, requires input from various settings, must consider coexisting disabilities
   3. Behavioral/educational evaluation: Rating scales are used to evaluate a students’ behavior. Potential for bias exists due to the varying perceptions of multiple assessors.
   4. Common assessment tools:
      
      1. DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)
         1. Contains the criteria for diagnosing disorders
      2. Rating scales: Tool used to evaluate behaviors by multiple assessors.
         1. ADHD Rating Scale-IV
         2. Conners’ Teachers Rating Scale-3
6. Educational Considerations
   
   1. Students with ADHD are likely to spend all or most of their school day in the regular education classroom although it is impossible to determine exact figures due to its placement in the Other Health Impaired category.
   2. Most students with ADHD are eligible for accommodations that will help them to achieve academic and behavioral success.
   3. Classroom accommodations to assist students with ADHD
      
      1. Inattention
      2. Impulsiveness
      3. Motor activity
      4. Academic skills
      5. Organization
      6. Compliance
      7. Mood
      8. Socialization
   4. Functional Behavioral Assessment (FBA): An FBA is conducted to determine the causes and consequences of a student’s actions/behaviors in order to create effective behavior intervention strategies.
   5. Self-regulation/monitoring.: A behavioral self-control strategy that assists students in monitoring their own behavior
   6. Home-school collaboration: The parents’ role in the special education process is mandated by law. Effective collaboration benefits the school, the child, and the family.
   7. Instructional modifications: Modifications are often crucial if a child with ADHD is to achieve academic and behavioral success.
   8. Multimodal interventions: combination of approaches
   9. Medication: Medication is often used as part of a program to assist students in maintaining their behavior and should not be used as the sole means of changing behavior. There are many controversies surrounding the use of psychostimulant medications in children.
      
      1. Ritalin
      2. Dexedrine
      3. Focalin
      4. Adderall
      5. Concerta
      6. Strattera
   10. Counseling services
   11. Making Inclusion Work
       
       1. Instructional strategies
       2. Collaboration with parents and professionals
7. Adolescents and Adults with ADHD
   
   1. Characteristics of Adolescents and Adults with ADHD
      
      1. Many professionals wrongly consider ADHD to be a childhood condition and only recently has adult ADHD become an area of research. ADHD is a life-long condition and adults with ADHD often require support and self-management throughout life in order to achieve successful education, employment, and relationships.
      2. Observable characteristics and their consequences
   2. Important considerations:
      
      1. Educational/vocational outcomes
      2. Marriage and relationships
      3. Family relationships
8. Diversity
   
   1. ADHD occurs in all cultures, social classes, races, genders, and across ages.
   2. It is difficult for assessors to rate the behaviors of individuals from cultures they are not familiar with and may lead to an overrepresentation of minority children who receive a diagnosis of ADHD.
9. Technology and Individuals with ADHD
   
   1. Devices that allow for stimulation but do not disrupt instruction
   2. Self-monitoring technologies