How To Reach And Teach Children with ADD / ADHD: Practical Techniques, Strategies, and Interventions

Contents

Introduction

Part 1: Key Information for Understanding and Managing ADHD

Section 1.1: Understanding Attention-Deficit/Hyperactivity Disorder

Definitions and Descriptions of ADHD

Behavioral Characteristics of ADHD

The Predominantly Inattentive Type of ADHD

The Predominantly Hyperactive-Impulsive Type of ADHD

Positive Traits and Characteristics Common in Many Children, Teens, and Adults with ADHD

Girls with Attention-Deficit Disorders

ADHD and the Executive Functions

ADHD Look Alikes

ADHD and Co-Existing (or Associated) Disorders

Statistics and Risk Factors

What Is Currently Known About ADHD

What May Be the Causes of ADHD

What Is Not Known About ADHD

ADHD and the Impact on the Family

Section 1.2: Making the Diagnosis

The Components of a Comprehensive Evaluation for ADHD

Who Is Qualified to Evaluate a Child for ADHD?

Section 1.3: Multimodal Treatments for ADHD

Management Strategies

AAP Guidelines and Additional Points

A Word About Alternative and Unproven Treatments

Section 1.4: Medication Treatment and Management

Psychostimulant (Stimulant) Medications

Antidepressants

Atomoxetine (Strattera™)

Other Medical Treatments

What Teachers and Parents Need to Know If a Child/Teen Is on Medication

Advice for Parents

Interview with Mike

Section 1.5: Do’s and Don’ts for Teachers and Parents

Advice for Teachers

Advice for Parents

Interview with Spencer’s Mother

Interview with Steve

Section 1.6: Critical Factors in the Success of Students with ADHD

Interview with Joe

Section 1.7: ADHD and Social Skills Interventions

Skill Deficits Versus Performance Deficits

Interventions for Social Skills Problems

School Interventions

Child Social Skills Interventions

Parent Interventions

Summer Treatment Programs

Section 1.8: ADHD in Preschool and Kindergarten

Parent Concerns and Recommendations

Preschool and Kindergarten Classroom Strategies for Success

Creating the Climate for Success

Management Techniques in Kindergarten

What Else Is Important?

What to Do About . . .

Section 1.9: ADHD in Middle School and High School

What All Adolescents Need

The Value of Mentorship

Dan’s Story

The Core Symptoms of ADHD During Adolescence

How Parents Can Help

Why Can’t They Act Their Age?

School Supports

Exemplary Model Program for Students with ADHD (The ADHD Zero Point Program)

Looping in Middle School

Student Support Teams

Warning Signs of Trouble in Middle School and High School

Warning Signs of Learning Disabilities in Secondary School Children

Interview with Joe

Part 1: Recommended Resources

Part 2: Managing the Challenge of ADHD Behaviors

Section 2.1: Classroom Management and Positive Discipline Practices

Common Triggers or Antecedents to Misbehavior

Classroom Management Tips

Addressing Student Misbehavior

Possible Corrective Consequences

Interview with Brad

Section 2.2: Preventing or Minimizing Behavior Problems During Transitions and Less Structured Times

Some Ways to Help

Section 2.3: Individualized Behavior Management, Interventions, and Supports

Understanding the ABCs of Behavior

Target Behaviors

Goal Sheets

Home Notes and Daily Report Cards

Chart Moves

Contracts

Token Economy or Token Programs

Response Costs

Self-Monitoring

Rewards

Strategies to Aid Calming and Avoid Escalation of Problems

Tips for Dealing with Challenging or Difficult Kids

What Is an FBA?

What Is a BIP?

Guiding Questions for Behavioral Issues

Section 2.4: Strategies to Increase Listening, Following Directions, and Compliance

Tips for Teachers and Parents

Compliance Training

Section 2.5: Attention!! Strategies for Engaging, Maintaining, and Regulating Students’ Attention

Getting and Focusing Students’ Attention

Maintaining Students’ Attention Through Active Participation

Questioning Techniques to Increase Student Response Opportunities

Keeping Students On-Task During Seatwork

Tips for Helping Inattentive, Distractible Students

Self-Monitoring Attention and Listening Levels (Self-Regulatory Techniques)

Part 2: Recommended Resources

Part 3: Instructional and Academic Strategies and Supports

Section 3.1: Reaching Students Through Differentiated Instruction

What Differentiation Means

What Can Be Differentiated?

Flexible Grouping

Multiple Intelligences

Layered Curriculum

Interview with Bob

Section 3.2: Multisensory Instruction

Multisensory Strategies for Learning Multiplication Tables

Multisensory Spelling Strategies and Activities

Instructional Suggestions for Teachers

Accommodations and Modifications

Interview with Brita

Section 3.3: Reaching Students Through Their Learning Styles and Multiple Intelligences

Learning Styles

Environmental Adaptations and Accommodations

Multiple Intelligences

Student Learning Style/Interest Interview

Interview with Amy

Section 3.4: The Advantages of Cooperative Learning for Students with ADHD

The Five Elements of Cooperative Learning

Getting Started with Group Work

Structuring to Achieve Positive Interdependence

Teaching Social Skills Through Cooperative Learning

Section 3.5: Organization, Time Management, and Study Skills

What Teachers and Parents Can Do to Help Build Organization Skills

What Teachers and Parents Can Do to Help with Time Management

Section 3.6: Learning Strategies and Study Skills

Learning Strategies

Study Skills

Interview with Susan

Section 3.7: Writing and Reading Challenges for Students with ADHD

Why Writing Is Such a Struggle for Students with ADHD

Common Reading Difficulties in Children and Teens with Attention-Deficit Disorders

Reading Disabilities/Dyslexia

What Research Tells Us About Learning to Read and Reading Difficulties

What Is Known About Effective Intervention for Struggling Readers

Section 3.8: Written Language Strategies, Accommodations, and Interventions

Strategies to Help with Planning/Organizing (Pre-Writing)

Strategies for Improving Fine Motor, Handwriting, Written Organization, and Legibility

Strategies for Bypassing and Accommodating Writing Difficulties

Section 3.9: Strategies for Building Written Expression and Editing Skills

Written Expression—Strategies and Support

More Instructional Recommendations

Help with Editing Strategies and Other Tips

Section 3.10: Reading Strategies and Interventions

The Reading Process: What Good Readers Do

Strategies for Building Word Recognition, Reading Vocabulary, and Fluency

Independent Reading

Oral Reading Strategies

Vocabulary Enhancement

Reading Tips and Strategies for Parents

Research-Based Reading Intervention Programs

Interview with Malinda

Section 3.11: Reading Comprehension Strategies and Interventions

Pre-Reading Strategies

During-the Reading Strategies

After-Reading Strategies

Graphic Organizers (Graphic Outlines or Graphic Aids)

Other Reading Comprehension/Meaning-Making Strategies

Other Active Reading/Discussion Formats

Book Projects/Activities

Interview with John

Section 3.12: Mathematics: Challenges and Strategies

Math Difficulties Associated with ADHD

Math Strategies and Interventions

National Council of Teachers of Mathematics (NCTM) Standards

Part 3: Recommended Resources

Part 4: Personal Stories and Case Studies

Section 4.1: A Parent’s Story: What Every Teacher and Clinician Needs to Hear

A Parent’s Story

Section 4.2: Case Studies and Interventions (Adam and Vincent)

Adam (Twelve Years Old, Seventh-Grade Student)

Vincent (Seventeen Years Old, High School Senior)

Part 5: Collaborative Efforts and School Responsibilities in Helping Children with ADHD

Section 5.1: Teaming for Success: Communication, Collaboration, and Mutual Support

The Necessity of a Team Approach

The Parents’ Role in the Collaborative Team Process

The Educators’ Role in the Collaborative Team Process

The Clinicians’ Role in the Collaborative Team Process

Cultural Sensitivity and Its Impact on Effective Communication and Collaboration

Final Thoughts on Home/School Collaboration

Section 5.2: The Role of the School’s Multidisciplinary Team

The Student Support Team (SST) Process

If You Suspect a Student Has ADHD

The School’s Role and Responsibilities in the Diagnosis of ADHD

School-Based Assessment for ADHD

Section 5.3: School Documentation and Communication with Medical Providers and Others

Communication with Physicians

Communication Between Schools

Communication with Community Health Providers/Organizations

Teacher Documentation

Section 5.4: Educational Laws and Rights of Students with ADHD

Individuals with Disabilities Act (IDEA)

Section 504

Which One May Be Better for a Student with ADHD—A 504 Plan or an IEP?

Disciplining Students with Disabilities Under Special Education Law

The Reauthorization of IDEA

IDEA 2004

No Child Left Behind (NCLB)

Section 5.5: Innovative Collaborative Programs for Helping Children with ADHD

The Utah Model—Intermountain Health Care’s (IHC’s) Care Management System for ADHD

Project for Attention Related Disorder (PARD) of San Diego, California

OU Pediatrics/Kendall Whittier Elementary—Collaborative Model of Care in Tulsa, Oklahoma

Insights from Dr. Donald Hamilton, OU Pediatrics

More Innovative Programs and Projects for Improving the Lives of Those with ADHD

Part 6: Additional Supports and Strategies

Section 6.1: Stress Reduction, Relaxation Strategies, Leisure Activities, and Exercise

Fun and Laughter

Breathing Techniques

Yoga and Slow Movement Exercises

Visualization and Guided Imagery

Music

Leisure Activities, Recreation, and Hobbies

Exercise and Sports

Section 6.2: Music for Relaxation, Transitions, Energizing, and Visualization

Music for a Calming Effect

Music for Moving from Here to There

Music for Transitional Times

Effect of Music on Mood

Interview with Bruce

It is both a pleasure and a privilege to provide this strong and unequivocal endorsement of so informative and consumer-friendly a book as this one. Grounded in the latest science of ADHD, filled with exceptionally detailed advice . . . parents and educators will find this book to be exceptionally useful in raising a successful ADHD child.

—Russell A. Barkley, Ph.D., professor of psychiatry, Medical University of South Carolina, and author of Taking Charge of ADHD

"For over a decade, Sandra Rief’s How to Reach and Teach Children with ADD/ADHD has been the most definitive and user-friendly ‘go-to’ guide for teachers and parents eager to help children with ADHD succeed in school, home, and life overall. Now updated with the latest research findings from the last ten years, this book outstrips even the original. Unlike so many other volumes, this book is hands-on, well-organized, extremely readable, and full of the kind of wise, practical advice that only comes from someone who has been there (and continues to be there!) helping teachers, parents, children, and youth struggling with ADHD. I especially like the focus on different ages, school settings, and subjects. My highest recommendation for this book, and my greatest praise for Sandra making this invaluable resource available!"

—Peter S. Jensen, M.D., director, Center for the Advancement of Children’s Mental Health and Ruane Professor of Child Psychiatry at Columbia University

Sandra Rief is one of the most astute as well as compassionate voices in the world about ADHD. She really gets it, and this book will give you what she gets. A wonderful contribution and valuable, practical resource for all teachers, parents, and clinicians.

—Edward Hallowell, M.D., author of When You Worry About the Child You Love and coauthor of Driven by Distraction

This valuable resource should be at every teacher’s fingertips! Sandra Rief offers current research-based strategies and information on ADHD that are a must read for every educator.

—Ellen Stantus, special education director, Davis School District, Farmington, Utah

This book not only addresses the latest research on this neuro-biological difference, but goes further by offering creative strategies for home and school in order to help these students reach their full potential. As always, Sandra Rief fills her book with what to do about it.

—Jill Murphy, special educator, ADHD life skills and academic coach, ADD Resources Parent Support, and mother of two children with ADD/ADHD, Bonney Lake, Washington

Jossey-Bass Teacher

Jossey-Bass Teacher provides K–12 teachers with essential knowledge and tools to create a positive and lifelong impact on student learning. Trusted and experienced educational mentors offer practical classroom-tested and theory-based teaching resources for improving teaching practice in a broad range of grade levels and subject areas. From one educator to another, we want to be your first source to make every day your best day in teaching. Jossey-Bass Teacher resources serve two types of informational needs—essential knowledge and essential tools.

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Copyright © 2005 by Sandra F. Rief. All rights reserved.

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About the Author

Sandra F. Rief, M.A., is a leading educational consultant, author, and speaker on effective strategies and interventions for helping students with learning, attention, and behavioral challenges. Sandra presents seminars, workshops, and keynotes nationally and internationally on this topic. She received her B.A. and M.A. degrees from the University of Illinois. Sandra was formerly an award-winning teacher (1995 California Resource Specialist of the Year) with over twenty-three years’ experience teaching in public schools.

Sandra is the author of several books and publications, including the following published by John Wiley & Sons: The ADHD Book of Lists; How to Reach and Teach All Students in the Inclusive Classroom (co-authored with Julie Heimburge); The ADD/ADHD Checklist: An Easy Reference for Parents & Teachers; and Alphabet Learning Center Activities Kit (co-authored with Nancy Fetzer).

Sandra also developed and presented the acclaimed educational videos ADHD & LD: Powerful Teaching Strategies and Accommodations; How to Help Your Child Succeed in School: Strategies and Guidance for Parents of Children with ADHD and/or Learning Disabilities; ADHD: Inclusive Instruction & Collaborative Practices, and together with Linda Fisher and Nancy Fetzer, the videos Successful Classrooms: Effective Teaching Strategies for Raising Achievement in Reading and Writing and Successful Schools: How to Raise Achievement & Support At-Risk Students.

Sandra is a past member of the CHADD National Professional Advisory Board and was on the faculty of NICHQ (National Initiative for Children’s Healthcare Quality—Collaborative on ADHD). For more information, visit her website at www.sandrarief.com.

About This Book

This book offers comprehensive guidance to everyone engaged in the positive education of children who have been diagnosed with ADD/ADHD. Whether you are a classroom teacher or a parent; a special education teacher, counselor, or psychologist; or a school or district administrator, this book will be a valuable resource. You’ll find information, techniques, and strategies to help these students succeed. While the book addresses the specific needs of students with ADD/ADHD, the strategies are also appropriate and recommended for all students who appear to have attention problems, learning disabilities, or are underachieving for any reason, including gifted children.

This second edition includes enhanced content in the following areas: medications, case studies, documentation, placement, model programs, and references, among others. For easy use, the information is organized into thirty-five sections that provide comprehensive, practical guidance on such topics as:

Preventing behavioral problems in a classroom

Learning styles: elements and interventions

Cooperative learning techniques

Q&A with a school nurse regarding medication and its management

Techniques for relaxation and visualization

Challenges and specific interventions for students of all ages

Tips on communicating effectively with parents, physicians, and agencies

Dedication

This book is dedicated to the memory of my beloved son, Benjamin, and to all of the children who face obstacles in their young lives each day with loving, trusting hearts, determination, and extraordinary courage. I also wish to dedicate this book in loving memory of Levana Estline—dear friend, exceptional teacher, and a blessing to all who knew her.

Acknowledgments

My deepest thanks and appreciation to

Itzik, Ariel, Jackie, Gil, Sharon, Jason, Mom, and Ben—for the joy you bring me, and your constant, loving support, encouragement, and good humor

My girls (Jackie and Sharon), the new generation of teachers in the family—I am so proud of you and the enthusiasm, talent, and fresh ideas you bring to the profession

All of the children who have touched my heart and inspired me throughout the years. It is because of you that I love what I do

The special families who have shared with me their struggles and triumphs and allowed me to be part of their lives

Mrs. Linda Haughey and the wonderful Haughey family, for courageously sharing their personal, powerful story in Section 4.1

My dear friends, Lynda and Diana, for so generously sharing their precious sons’ case studies, school histories, and intervention plans (last names omitted at their request to protect their privacy)

All of the wonderful, dedicated educators I have had the great fortune to work with and meet over the years, thank you for sharing with me your creative strategies, ideas, and insights

The extraordinary parents (especially the wonderful volunteers in CHADD and other organizations worldwide) whose tireless efforts have raised awareness about ADHD, and as a result, improved the care and education of our children

All of the researchers and practitioners in the different fields dedicated to helping children and families with ADHD, LD, and other disabilities, from whom I have learned so much

Steve Thompson, Ph.D., my editor at Jossey-Bass in San Francisco, for all of your help and guidance, and for making it such a pleasure to write this book

Sandra Wright and Susie Horn, exceptional school nurses in the San Diego City Schools—my friends and role models—for all you have done to help children with ADHD and their families

Karen Easter, one of the wonderful mothers I have been privileged to meet and befriend at one of my workshops, for sharing your original poems in this book

My illustrators—Decker Forrest, an incredibly talented former student of mine, who was in the eighth grade at the time he drew these illustrations (first published in the 1993 edition), and Ariel Rief, my darling son, who provided some of the other illustrations in this book (as well as those in The ADHD Book of Lists)

Joe, Spencer, Steve, Susan, Mike, Bruce, Amy, Joseph, John, Brita, Malinda, Bob, and Brad (teens and adults with ADHD), and the group of early childhood educators, who allowed me to interview them and share their insights in excerpts throughout this book

Introduction

When I first wrote How to Reach and Teach ADD/ADHD Children back in 1993, awareness of attention-deficit/hyperactivity disorder and information/resources available were minimal at best. Since that time, a tremendous amount of scientific research and education efforts have taken place. It would be rare to find anyone who has not heard of ADD or ADHD.

Reliable information is now easily accessible, and far more resources than ever before are available to parents/caregivers, educators, and those who work with and treat children with attention deficit disorders. However, there is still a great deal of misinformation, controversy, and myths surrounding this disorder. There are still countless children and teens who have ADHD and who have been suffering and experiencing school failure due to their lack of identification or treatment and misinterpretation of their behaviors by teachers and others, who don’t understand or accept the reality of their disorder and its impact on school performance.

According to a Surgeon General’s report, attention-deficit/hyperactivity disorder is the most common neurobehavioral disorder of childhood, affecting approximately 3 to 7 percent of school-aged children. Every teacher has at least one student with ADHD in his or her classroom. Educators need to be aware and knowledgeable about the nature of the disorder, as well as the strategies effective in reaching and teaching these students. Parents of children with ADHD also need to be well-informed and equipped with the skills and strategies that help in managing and coping with inattentive, hyperactive, and impulsive behaviors. It is often not easy to live with a child who has ADHD (either at home or at school). Knowledge about the disorder is very important, because when we understand what ADHD is and how it affects the child’s behavior and performance, it helps us become more tolerant and empathetic.

Attention deficit/hyperactivity disorder is not something that we can cure; nor does a child with ADHD outgrow it in most cases (although behaviors are manifested differently as the child matures and symptoms may be less or more impairing at different times in their lives). We, the significant adults in their lives, play a major role in how well these children and teens succeed and how they feel about themselves. We are the ones who can help them manage with the challenges they face, cope with frustrations, and compensate for weaknesses. We are also the ones who can help them see and utilize their many strengths and value their uniqueness.

Many children with ADHD have grown up to be very successful adults. They have drawn on their strengths, creativity, and survival skills to their advantage. On the other hand, there are many who have not fared well. There is a high correlation between ADHD and a number of negative outcomes. A significant percentage of individuals who drop out of school, are unable to keep a job, are stuck in work positions to which they have defaulted rather than aspired, fail in their interpersonal relationships, pack our prison system, have self-medicated with drugs and alcohol, and so on, had this disorder without the benefit of identification, intervention, and treatment. Many adolescents and adults with ADHD have painful memories of their childhoods, particularly of their experiences and frustrations in school. Many experienced years of failure and serious depression.

It is our responsibility in the schools to pull together as a team, doing everything we can to meet these students’ needs effectively. This includes providing each child with the environment, engaging instruction, skills, tools, and confidence to learn and achieve. We need to be patient, positive, and understanding—and try to see past the behaviors to the whole child—as we provide support and remove the obstacles in their paths.

Much can be done to help those with ADHD. Most of this book focuses on specific strategies, supports, and interventions that have been found to be effective in minimizing the typical problems associated with ADHD and on helping these children/teens achieve success. I am very fortunate to have spent most of my twenty-three-year teaching career working at a school that was a model in inclusive education. Our staff was firmly committed to reaching and teaching all students; and we were very successful in doing so. A number of strategies or recommendations in this book come from what I have learned from my many students with ADHD and/or learning disabilities, their families, and my colleagues.

In addition, I have had the privilege these past few years of observing hundreds of classrooms and working with scores of educators across the United States and internationally. I am grateful for the openness of these wonderful teachers (and parents), who so willingly shared their ideas, strategies, struggles, and successes. Their stories and insights have inspired and taught me so much.

For easy use, this resource is organized into six parts that provide comprehensive, practical guidance divided into sections. In essence, the content in much of this book comes from (1) a lot of hands-on experience working with students who have ADHD and (2) from many experts I have learned from—particularly in the fields of education and psychology. Although the book is designed and written to address the specific needs of students with ADHD, the suggested strategies are generally good teaching practices for all students (or positive parenting practices for any child). The techniques and suggestions are, however, of particular benefit for those who are experiencing behavior, attention, or learning difficulties. Be aware that many gifted, intelligent children fall within this category.

I urge all readers to read Section 4.1, A Parent’s Story, the poignant account by the mother of six children, four of whom have been diagnosed with ADD/ADHD. The original story from the first edition is included, along with a follow-up about the family a decade later. In addition, be sure to read Section 4.2, the highly informative and insightful case studies of Adam and Vincent. One of the rewards I have gained in writing this book comes from the wonderful opportunity I had to interview teenagers and adults from across the country who have grown up with ADHD. Excerpts of these interviews are included throughout this book. By their openly sharing their experiences and insights, the parents’ stories, the case studies, and the personal interviews reveal an important message about what makes a difference and the power we have as teachers.

It is always preferable to be able to identify children with ADHD or any special needs early and then initiate interventions and supports at a young age in order to avoid some of the frustration, failure, and subsequent loss of self-esteem. However, it is never too late to help a child. In many cases, the kind of help that makes a difference does not take a huge effort on our part. Sometimes even small changes (such as in the way we respond to our child or teen) can lead to significant improvements. If I am able to convey any single message with this book, I wish for it to be one of hope and optimism. When we work together—providing the necessary structure, guidance, encouragement, and support—each and every one of our children can succeed!

Sandra F. Rief

A Note from the Author

The most official term for the disorder at this time is Attention-Deficit/Hyperactivity Disorder (AD/HD). You may see it in print with or without the slash. In the past, the term ADD was commonly used. Many people still prefer to use ADD if the individual does not have the hyperactive characteristics. However, ADHD (with or without the slash) is the most current term or abbreviation, and it is inclusive of all types of the disorder:

The predominantly inattentive type (those without hyperactivity)

The predominantly hyperactive/impulsive type

The combined type

I want to make clear to readers that, although I am maintaining the use of ADD/ADHD in the title (as in the first edition of 1993), I have chosen throughout this new book to refer to this disorder as ADHD. Please be aware that all references to ADHD also include those individuals who do not have the hyperactive behaviors.

Part 1

Key Information for Understanding and Managing ADHD

Section 1.1: Understanding Attention-Deficit/Hyperactivity Disorder

Section 1.2: Making the Diagnosis: A Comprehensive Evaluation for ADHD

Section 1.3: Multimodal Treatments for ADHD

Section 1.4: Medication Treatment and Management

Section 1.5: Do’s and Don’ts for Teachers and Parents

Section 1.6: Critical Factors in the Success of Students with ADHD

Section 1.7: ADHD and Social Skills Interventions

Section 1.8: ADHD in Preschool and Kindergarten

Section 1.9: ADHD in Middle School and High School

Section 1.1

Understanding Attention-Deficit/Hyperactivity Disorder

As mentioned in this book’s introduction as well, many people continue to use the two distinct terms of ADD (Attention-Deficit Disorder) and ADHD (Attention-Deficit/Hyperactivity Disorder). Some use the two terms interchangeably, and others specifically use ADD when referring to those who do not have the symptoms of hyperactivity. However, the most current and official term or acronym is ADHD (with or without the slash). This is the umbrella term or acronym under which all three types of the disorder are included:

The predominantly inattentive type of ADHD (those without hyperactivity)

The predominantly hyperactive/impulsive type of ADHD (those without a significant number of the inattentive symptoms)

The combined type (the most common type of ADHD—those with a significant amount of symptoms in all three core areas—inattention, impulsivity, and hyperactivity)

In the first edition of this book (1993) I had used ADD/ADHD, and it remains as such in the title of this new edition. However, throughout the remainder of this text I choose to use the most current terminology of ADHD; and this will include all three types of attention-deficit disorders.

Definitions and Descriptions of ADHD

There are several descriptions or definitions of ADHD based on the most widely held belief of the scientific community at this time. The following are some of those provided by leading researchers and specialists in the field:

ADHD is a neurobiological behavioral disorder characterized by chronic and developmentally inappropriate degrees of inattention, impulsivity, and, in some cases, hyperactivity (CHADD, 2001c).

ADHD is a brain-based disorder that arises out of differences in the central nervous system (CNS)—both in structural and neurochemical areas.

ADHD is a dimensional disorder of human behaviors that all people exhibit at times to certain degrees. Those with ADHD display the symptoms to a significant degree that is maladaptive and developmentally inappropriate compared to others that age.

ADHD is a developmental disorder of self-control, consisting of problems with attention span, impulse control, and activity level (Barkley, 2000b).

ADHD is a chronic physiological disorder that interferes with a person’s capacity to regulate and inhibit behavior and sustain attention to tasks in developmentally appropriate ways.

ADHD is a neurobiological behavioral disorder causing a high degree of variability and inconsistency in performance, output, and production.

ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual’s capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways (National Institute of Mental Health, 2000; National Resource Center on AD/HD, 2003a).

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. ADHD is also among the most prevalent chronic health conditions affecting school-aged children (American Academy of Pediatrics, 2000).

ADHD is a neurobehavioral disorder characterized by differences in brain structure and function that affect behavior, thoughts, and emotions (CHADD, 2001c).

ADHD is characterized by a constellation of problems with inattention, hyperactivity, and impulsivity. These problems are developmentally inappropriate and cause difficulty in daily life (Goldstein, 1999).

Behavioral Characteristics of ADHD

The fourth edition of the Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association [APA] in 1994, is the source of the official criteria for diagnosing attention-deficit/hyperactivity disorder. The DSM-IV and more recently the DSM-IV-TR (text revised) lists nine specific symptoms under the category of inattention and nine specific symptoms under the hyperactive/impulsive category. Part of the diagnostic criteria is that the child or teen often displays at least six of the nine symptoms of either the inattentive or the hyperactive/impulsive categories. The lists below contain those symptoms or behaviors found in the DSM-IV (1994) and DSM-IV-TR (2000). Below are the symptoms specifically listed in the DSM (which are indicated in italics), as well as additional common and related behaviors (Rief, 2003).

The Predominantly Inattentive Type of ADHD

This type of ADHD (what many still call ADD), refers to those with a significant number of inattentive symptoms that occur frequently. They may have some, but not a significant number of the hyperactive/impulsive symptoms. Since they do not exhibit the disruptive behaviors that get our attention, it is easy to overlook these students and misinterpret their behaviors and symptoms (for example, as not trying or being lazy).

It is common to display any of the following behaviors at times, in different situations, to a certain degree. Those who truly have an attention-deficit disorder have a history of showing many of these characteristics—far above the normal range developmentally—causing impairment in their functioning (at school, home, social situations, work). The nature of these inattentive symptoms tends to heavily impact academic performance and achievement. Those written in italics are the behaviors that are listed in the DSM-IV and DSM-IV-TR.

Characteristics and Symptoms of Inattention (That Occur Often)

Easily distracted by extraneous stimuli (sights, sounds, movement in the environment)

Does not seem to listen when spoken to directly

Difficulty remembering and following directions

Difficulty sustaining attention in tasks and play activities

Difficulty sustaining level of alertness to tasks that are tedious, perceived as boring, or not of one’s choosing

Forgetful in daily activities

Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

Tunes out—may appear spacey

Daydreams (thoughts are elsewhere)

Appears confused

Easily overwhelmed

Difficulty initiating or getting started on tasks

Does not complete work, resulting in many incomplete assignments

Avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (such as schoolwork or homework)

Difficulty working independently—needs high degree of refocusing attention to task

Gets bored easily

Sluggish or lethargic (may fall asleep easily in class)

Fails to pay attention to details and makes many careless mistakes (with math computation, spelling, written mechanics—capitalization, punctuation)

Poor study skills

Inconsistent performance—one day is able to perform a task, the next day cannot; the student is consistently inconsistent

Loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools)

Disorganized—misplaces or loses belongings; desks, backpacks, lockers, and rooms may be total disaster areas

Difficulty organizing tasks and activities (planning, scheduling, preparing)

Little or no awareness of time—often underestimates length of time a task will require to complete

Procrastinates

Displays weak executive functions as described below in this section

Academic Difficulties Related to Inattention

Reading:

Loses his or her place when reading

Cannot stay focused on what he or she is reading (especially if text is difficult, lengthy, boring, not choice reading material), resulting in missing words, details, and spotty comprehension

Forgets what he or she is reading (limited recall) and needs to reread frequently

Writing:

Difficulty planning and organizing for the writing assignment

Off topic as result of losing train of thought

Minimal written output and production

Slow speed of output/production—taking two or three times longer to execute on paper what is typical for the average child/teen that age or grade

Poor spelling, use of capitalization/punctuation, and other mechanics, ability to edit written work (as a result of inattention to these boring details)

Math:

Numerous computational errors because of inattention to operational signs (+,–,×,÷), decimal points, and so forth

Poor problem solving due to inability to sustain the focus to complete all steps of the problem with accuracy

The Predominantly Hyperactive-Impulsive Type of ADHD

Those individuals with this type of ADHD have a significant number of hyperactive/impulsive symptoms; they may have some, but not a significant number of inattentive symptoms. Children and teens with ADHD may exhibit many of the following characteristics (not all of them). Even though each of these behaviors is normal in children at different ages to a certain degree, in those with ADHD, the behaviors far exceed that which is normal developmentally (in frequency, level, and intensity). Again, those written in italics are the behaviors that are listed in the DSM-IV and DSM-IV-TR.

Characteristics and Symptoms of Hyperactivity (That Occur Often)

On the go or acts as if driven by a motor

Leaves seat in classroom or in other situations in which remaining seated is expected

Cannot sit still (jumping up and out of chair, falling out of chair, sitting on knees or standing by desk)

Highly energetic—almost nonstop motion

Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

A high degree of unnecessary movement (pacing, tapping feet, drumming fingers)

Restlessness

Seems to need something in hands. Finds/reaches for nearby objects to play with and/or put in mouth

Fidgets with hands or feet or squirms in seat

Roams around the classroom—is not where he or she is supposed to be

Difficulty playing or engaging in leisure activities quietly

Intrudes in other people’s space; difficulty staying within own boundaries

Difficulty settling down or calming self

Characteristics and Symptoms of Impulsivity (That Occur Often)

Much difficulty in situations requiring having to wait patiently

Talks excessively

Difficulty with raising hand and waiting to be called on

Interrupts or intrudes on others (butts into conversations or games)

Blurts out answers before questions have been completed

Has difficulty waiting for his or her turn in games and activities

Cannot keep hands/feet to self

Cannot wait or delay gratification—wants things NOW

Knows the rules and consequences, but repeatedly makes the same errors/infractions of rules

Gets in trouble because he or she cannot stop and think before acting (responds first/thinks later)

Difficulty standing in lines

Makes inappropriate or odd noises

Does not think or worry about consequences, so tends to be fearless or gravitate to high risk behavior

Engages in physically dangerous activities without considering the consequences (jumping from heights, riding bike into street without looking); hence, a high frequency of injuries

Accident prone—breaks things

Difficulty inhibiting what he or she says, making tactless comments—says whatever pops into head and talks back to authority figures

Begins tasks without waiting for directions (before listening to the full direction or taking the time to read written directions)

Hurries through tasks (particularly boring ones) to get finished—making numerous careless errors

Gets easily bored and impatient

Does not take time to correct/edit work

Disrupts, bothers others

Constantly drawn to something more interesting or stimulating in the environment

Hits when upset or grabs things away from others (not inhibiting responses or thinking of consequences)

Other Common Characteristics in Children and Teens with ADHD

A high degree of emotionality (temper outbursts, quick to anger, get upset, irritable, moody)

Easily frustrated

Overly reactive

Difficulty with transitions and changes in routine/activity

Displays aggressive behavior

Difficult to discipline

Cannot work for long-term goals or payoffs

Low self-esteem

Poor handwriting, fine motor skills, written expression, and output

Overly sensitive to sounds, textures, or touch (tactile defensive)

Motivational difficulties

Receives a lot of negative attention/interaction from peers and adults

Learning, school performance difficulties—not achieving or performing to level that is expected (given his or her apparent ability)

Language and communication problems (sticking to topic, verbal fluency)

Criteria for a Diagnosis of ADHD

It is not just the existence of symptoms that indicate ADHD. It must be proven that there is a history of those symptoms having been evident since before age seven and lasting for a while (at least the past six months). In addition, those symptoms must be (a) more severe than in other children that same age; (b) evident in at least two settings (for example, school and home); and (c) causing impairment in the child’s functioning (academically, socially).

Remember that each individual with ADHD is unique in the combination, amount, and degree of symptoms he or she exhibits, as well as that person’s own set of strengths, talents, interests, personality traits, and so forth.

Positive Traits and Characteristics Common in Many Children, Teens, and Adults with ADHD

Parents and teachers must recognize, appreciate, and nurture the many talents and positive qualities our children possess. To develop their self-esteem and enable them to become resilient, successful adults, we must help our children to value their areas of competency and strengths. The following are some common positive characteristics and traits that many of those with ADHD possess (Rief, 2003):

Highly energetic

Verbal

Spontaneous

Creative and inventive

Artistic

Persistent/tenacious

Innovative

Imaginative

Warmhearted

Compassionate/caring

Accepting and forgiving

Inquisitive

Resilient

Makes and creates fun

Knows how to enjoy the present

Empathetic

Sensitive to needs of others

Resourceful

Gregarious

Not boring

Enthusiastic

Intelligent/bright

Humorous

Outgoing

Ready for action

Willing to take a risk and try new things

Good at improvising

Enterprising

Sees different aspects of a situation

Able to find novel solutions

Charismatic

Observant

Negotiator

Full of ideas and spunk

Can think on their feet

Intuitive

Good in crisis situations

Passionate

Girls with Attention-Deficit Disorders

Many girls with ADHD have gone undiagnosed (or misdiagnosed) for years because they frequently do not have the typical hyperactive symptoms seen in boys that signal a problem and draw attention. In the past few years, much more attention has been given to girls with the disorder. Girls who do have the combined symptoms of ADHD are very recognizable because their behavior is so significantly out of norm for other girls. But on the whole, most girls have the predominantly inattentive type of the disorder and are often labeled or written off as being space cadets, ditzy, or scattered (Rief, 2003).

Much of what we are now aware of and beginning to understand about females with ADHD comes from the work of Dr. Kathleen Nadeau, Dr. Patricia Quinn, Dr. Ellen Littman, Sari Solden, and others who have strongly advocated on the behalf of this population. The scientific community has now been looking at gender issues in ADHD. Studies have recently begun to reveal the significance of gender differences and issues and will undoubtedly result in changes and improvements in the diagnosis and treatment for girls and women with this disorder.

According to Dr. Nadeau, Dr. Quinn, and Dr. Littman (1999), girls with ADHD:

Have more internal and often less external (observable) symptoms

Have greater likelihood of anxiety and depression

Experience a lot of academic difficulties, peer rejection, and self-esteem issues

Are more likely to be hyperverbal than hyperactive

In addition:

Symptoms in girls tend to increase rather than decrease at puberty, with hormones having a great impact.

PMS worsens ADHD symptoms by adding to disorganization and emotionality.

Another reason girls are likely underdiagnosed is because the current diagnostic criteria require evidence of symptom onset before seven years of age; but in girls symptoms are likely to emerge later.

Girls tend to try very hard to please teachers and parents. They often work exceptionally hard (compulsively so) to achieve academic success.

Impulsivity in girls can lead to binge eating, engaging in high-risk/high-stimulation activities (smoking, drinking, drugs, sexual promiscuity, unprotected sex) (Nadeau, Littman, & Quinn, 1999).

Dr. Janet Giler (2001) also points out that female social rules place a greater value on cooperation, listening, caretaking, and relationship-maintaining activities, compromising girls with ADHD whose symptoms interfere with these social norms.

ADHD and the Executive Functions

When discussing difficulties associated with ADHD, many of them center on the ability to employ the executive functions of the brain. The following are some definitions/descriptions of what is referred to as executive functioning.

Executive Functions Are

The management functions (overseers) of the brain

The covert, self-directed actions individuals use to help maintain control of themselves and accomplish goal-directed behavior

The range of central control processes in the brain that activate, organize, focus, integrate, and manage other brain functions—enabling us to perform both routine and creative work (Brown, 2000; National Resource Center on AD/HD, 2003b)

Brain functions that have to do with self-regulation of behavior

Many specialists and researchers believe Dr. Russell Barkley’s theory (2000a, May) that the deficit in inhibition (the core of ADHD) impairs the development of these executive functions. Apparently, in children with ADHD, the executive functions (at least some of them) are developmentally delayed compared to other children of the same age. The individual with ADHD, therefore, does not fully utilize his or her executive functions for self-management.

Executive Function Components

It has not as yet been determined exactly what constitutes the executive functions of the brain. However, some of those functions are believed to involve:

Working memory (holding information in your head long enough to act on it)

Organization of thoughts, time, and space

Planning and prioritizing

Arousal and activation

Sustaining alertness and effort

Self-regulation

Emotional self-control

Internalization of speech/language (using your inner speech to guide your behavior)

Inhibiting verbal and nonverbal responding

Quick retrieval and analysis of information

Developing and following through on a plan of action

Strategy monitoring and revising, which involves making decisions based on task analyses, planning, reflection, and goal-directed problem solving (Brown, 2000; Dendy & Ziegler, 2002)

It is important to realize that executive function weaknesses cause academic challenges (mild to severe) for most students with ADHD, irrespective of how intelligent, gifted, and capable they may be. Consequently, most children and teens with attention-deficit disorders will need some supportive strategies and/or accommodations to compensate for their deficit in executive functioning (whether they are part of a written plan or not).

ADHD Look Alikes

Not everyone who displays symptoms of ADHD has an attention-deficit disorder. There are a number of other conditions and factors (medical, psychological, learning, psychiatric, emotional, social, environmental) that can cause inattentive, hyperactive, and impulsive behaviors. The following can cause some of the symptoms that may look like or mimic ADHD:

Learning disabilities

Sensory impairments (hearing, vision, motor problems)

Mood disorders (depression, dysthymia)

Substance use and abuse (of alcohol and drugs)

Oppositional defiant disorder (ODD)

Conduct disorder (CD)

Allergies

Post-traumatic stress disorder (PTSD)

Anxiety disorder

Obsessive-compulsive disorder (OCD)

Sleep disorders

Bipolar disorder (manic/depressive)

Thyroid problems

Rare genetic disorders (for example, Fragile X syndrome)

Seizure disorders

Lead poisoning

Hypoglycemia

Anemia

Fetal alcohol syndrome/fetal alcohol effects

Chronic illness

Language disorders

Tourette’s syndrome (Tourette’s disorder)

Pervasive developmental disorder

Autism

Asperger’s syndrome

Developmental delays

Sensory integration dysfunction

Low intellectual ability

Very high intellectual ability

Severe emotional disturbance

Side effects of medications being taken (for example, anti-seizure medication, asthma medication)

Emotional and environmental factors that have nothing to do with ADHD can also cause a child or teen to be distracted, unable to concentrate, and have acting-out or aggressive behaviors. For example, if the child/teen is experiencing or witnessing physical/sexual abuse/violence or family stresses such as divorce and custody battles; a victim of bullying/peer pressure and other peer/social issues; or has a chaotic, unpredictable, unstable, and/or neglectful home life with inappropriate expectations placed on the child.

Inattention and disruptive classroom behaviors can be school-related (again without having anything to do with ADHD). Students may display those behaviors if they are in a school environment that has a pervasive negative climate, poor instruction and low academic expectations, nonstimulating and unmotivating curriculum, ineffective classroom management, and so forth.

ADHD and Co-Existing (or Associated) Disorders

Besides a condition that looks like ADHD, it is very possible that in addition to ADHD the child has some other co-existing conditions or disorders. ADHD may be only part of the diagnostic picture. It is important to be aware that there is a high rate of co-morbidity with ADHD, which means there are at least two co-occurring conditions. Studies show that approximately two-thirds of children with ADHD have (or will develop) at least one other co-existing condition (MTA Cooperative Group, 1999; Pierce, 2003). This, of course, makes treatment, intervention, and management more complicated.

Making an accurate and complete differential diagnosis requires a skilled, knowledgeable professional who is aware of conditions that produce symptoms similar to ADHD and who can identify and address other conditions or disorders that may co-exist.

The prevalence reported of individuals with ADHD who have additional co-existing disorders varies among sources. The following range is agreed on by most researchers (American Academy of Pediatrics, 2000; CHADD, 2001a):

Co-Existing Disorders in Those Diagnosed with ADHD

Oppositional defiant disorder (ODD)—from 30 to 65 percent

Anxiety disorder—from 20 to 35 percent of children and 25 to 40 percent of adults

Conduct disorder (CD)—from 10 to 25 percent of children, 25 to 50 percent of adolescents, and 20 to 25 percent of adults

Bipolar (manic/depressive illness)—from 1 to 20 percent

Depression—from 10 to 30 percent in children and 10 to 47 percent in adolescents and adults

Tics/Tourette’s syndrome—about 7 percent of those with ADHD have tics or Tourette’s syndrome, but 60 percent of Tourette’s syndrome patients also have ADHD

Learning disabilities—from 12 to 60 percent, with most estimating between one-third and one-half of children with ADHD having a co-existing learning disability

Sleep problems—more than 50 percent of ADHD children need more time to fall asleep; nearly 40 percent may have problems with frequent night waking; and more than half have trouble waking in the morning

Secondary behavioral complications—up to 65 percent of children with ADHD may display secondary behavioral complications such as noncompliance, argumentativeness, temper outbursts, lying, blaming others, being easily angered, and so forth

Keep the following points in mind:

Most children with ADHD have some kind of school-related problems (achievement, performance, social).

A high percentage of children with ADHD have co-existing learning disabilities. The multidisciplinary school team should always evaluate students when there are signs of any learning problems.

It is believed that having ADHD predisposes that person to these above-mentioned disorders. Therefore, the diagnostic process should include screening for possible co-morbidities through interview, questionnaires, and rating scales that may indicate or alert the diagnostician to symptoms of other co-existing disorders.

ADHD falls under the category of disruptive behavior disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (APA, 1994) and most current version, DSM-IV-TR (APA, 2000). Also in this category are the commonly co-occurring disorders of oppositional defiant disorder (ODD) and conduct disorder (CD). Children with ADHD are at a much higher risk than the average child of developing a more serious disruptive behavior disorder. It is important that we recognize the risk and implement early interventions.

The diagnosis of oppositional defiant disorder (ODD) requires a pattern of negative, hostile, and defiant behavior that has been evident for a while; occurs more frequently than is typical in individuals of comparable age and developmental level; and causes significant impairment. The child/teen with ODD often loses his or her temper, argues and actively defies adult requests or rules, deliberately annoys people, and blames others for his or her own mistakes or misbehavior. These children and teens also tend to be touchy or easily annoyed by others, angry and resentful, and spiteful or vindictive.

Conduct disorder (CD) is the most serious form of disruptive behavior disorders in children and teens, and involves a pattern of delinquent behavior. Some of the characteristics include aggression to people and animals, deliberate destruction of property, deceitfulness or theft, and serious violations of rules.

Parents, educators, and medical/mental-healthcare providers should be alert to signs of other disorders and issues that may exist or emerge (often in the adolescent years), especially when current strategies and treatments being used with the ADHD child/teen are no longer working effectively. This warrants further diagnostic assessment.

Formula ONE for Disaster

take ONE impulsive child

add ONE forbidden object

multiply by ONE minute

to equal

ONE predictable trip to the emergency room. . . .

Karen Easter ©1995

Statistics and Risk Factors

ADHD is associated with a number of risk factors. Compared to their peers of the same age, youth with ADHD (those untreated for their disorder) experience:

More serious accidents, hospitalizations, and significantly higher medical costs than those children without ADHD (Centers for Disease Control and Prevention, 2003)

More school failure and dropout

More delinquency and altercations with the law

More engagement in antisocial activities

More teen pregnancy and sexually transmitted diseases

Earlier experimentation and higher use of alcohol, tobacco, and illicit drugs

More trouble socially and emotionally

More rejection, ridicule, and punishment

More underachievement, and underperformance at school/work (Barkley, Cook, Dulcan, et al., 2002; Barkley, 2000b)

Without early identification and appropriate treatment, ADHD can have serious consequences that include school failure and drop out, depression, conduct disorder, failed relationships, underachievement in the workplace, and substance abuse (CHADD, 2003b). Yet despite the serious consequences, studies indicate that less than half of those with the disorder are receiving treatment (Barkley, Cook, Dulcan, et al., 2002)

Prevalence of ADHD

Approximately 3 to 5 percent of school-aged children have ADHD, according to much of the literature over the past several years, including the Surgeon General’s Mental Health Report (1999, 2001).

Current estimates, according to the American Academy of Pediatrics, indicate that as high as 4 to 12 percent of all school-aged children may be affected (American Academy of Pediatrics and National Initiative for Children’s Healthcare Quality, 2002).

Nearly 7 percent of elementary-aged children in the United States have been diagnosed with ADHD, according to the first nationwide survey conducted by the Centers for Disease Control and Prevention reported in May 2002. And ADHD is estimated to affect between 3 and 7 percent of school-aged children, according to the American Psychiatric Association (2000).

ADHD affects approximately 2 to 4 percent of the adult population (Murphy & Barkley, 1996).

ADHD is a lifelong disorder. Most children with ADHD (up to 80 percent) continue to have substantial symptoms into adolescence, and as many as 67 percent continue to exhibit symptoms into adulthood (CHADD, 2003a).

More risks associated with ADHD:

Almost 35 percent of children with ADHD quit school before completion (Barkley, 2000b).

Up to 58 percent have failed at least one grade in school, and at least three times as many teens with ADHD as those without ADHD have failed a grade, been suspended, or been expelled from school (Barkley, 2000b).

For at least half of children with ADHD, social relationships are seriously impaired (Barkley, 2000b).

Within their first two years of independent driving, adolescents with a diagnosis of ADHD have nearly four times as many auto accidents and three times as many citations for speeding as young drivers without ADHD (Barkley, Murphy, & Kwasni, 1996).

ADHD is diagnosed at least three times more frequently in boys than girls; although it is believed (and research is showing) that many more girls actually have ADHD. In fact, the actual number may be nearly equal (CHADD, 2003b).

What Is Currently Known About ADHD

There are degrees of ADHD ranging from mild to severe; types of ADHD with a variety of characteristics; and no one has all of the symptoms or displays the disorder in the exact same way. Symptoms vary in every child, and even within each child with ADHD the symptoms may look different from day to day.

ADHD is not new. It has been around, recognized by clinical science, and documented in the literature since 1902 (having been renamed several times). Some of the previous names for the disorder were minimal brain damage, minimal brain dysfunction, hyperactive child syndrome, and ADD with or without hyperactivity.

We know that ADHD is not a myth. It is not a result of poor parenting or lack of caring, effort, and discipline. ADHD is not laziness, willful behavior, or a character flaw. There is no quick fix or cure for ADHD.

Many children/teens with ADHD slip through the cracks without being identified and without receiving the intervention and treatment they need. This is particularly true of ethnic minorities and girls.

ADHD exists across all populations, regardless of race or ethnicity. There are racial and ethnic disparities in access to healthcare services. As such, ethnic minorities with ADHD are often underserved and do not receive adequate help and treatment (Satcher, 2001).

Children and teens with ADHD do much better when they are provided with activities that are interesting, novel, and motivating. Generally, the majority of students with ADHD can learn well in general education classrooms when teachers employ proper management, effective instructional strategies, and assistive supports/interventions.

Fortunately, we know a great deal about:

Which behavior management techniques and strategies are effective in the home and school for children with ADHD

The classroom interventions, accommodations, and teaching strategies that are most helpful for students with ADHD

Specific parenting strategies that are most effective with children who have ADHD

Treatments that have been proven effective in reducing the symptoms and improving functioning of children/teens with ADHD

Many additional strategies that are helpful for individuals with ADHD, such as organization and time management, stress reduction/relaxation

We also know:

ADHD can be managed best by a multimodal treatment and a team approach.

It takes a team effort of parents, school personnel, and health/mental healthcare professionals to be most effective in helping children with ADHD.

No single intervention will be effective for treating/managing ADHD. It takes vigilance and ongoing treatment/intervention plans, as well as revision of plans and going back to the drawing board frequently.

The teaching techniques and strategies that are necessary for the success of children with ADHD are good teaching practices and helpful to all students in the classroom.

There is a lot of help out there, and resources are available for children, teens, and adults with ADHD, as well as those living with and working with individuals with ADHD.

We are learning more and more each day due to the efforts of the many researchers and practitioners (educators, mental health professionals, physicians) committed to improving the lives of individuals with ADHD.

The extensive research into ADHD during the past several years has revealed a lot about the disorder. The following is a summary of the current evidence about ADHD, based on the research from metabolic, brain-imaging, and molecular genetic studies.

Differences in the Brain

Differences between those with ADHD and control groups have been identified using brain activity and imaging tests/scans (MRIs, SPECT, EEG, BEAMS, PET, and functional MRIs). Those brain differences include decreased activity level and lower metabolism levels in certain regions of the brain (mainly the frontal region and the basal ganglia); lower metabolism of glucose (the brain’s energy source) in the frontal region; decreased blood flow to certain brain regions; and specific brain structures are smaller than in those unaffected by ADHD.

Note: Imaging and other brain tests are NOT used in the diagnosis of ADHD. To date, a comprehensive history of the problem remains the best way to identify the disorder.

There is very strong scientific evidence which supports that ADHD may be due to imbalances in various neurotransmitters or brain chemicals and/or reduced metabolic rates in certain regions of the brain. These chemicals are believed to travel across the synapses of the brain, affecting the braking mechanism or inhibitory circuits of the brain. Dopamine pathways in the brain, which link the basal ganglia and frontal cortex, for example, appear to play a major role in