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Attention Deficit Hyperactivity Disorder Archive 2003

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Shari Gent, M.S.,
Educational Specialist

Shari Gent, M.S. is an education specialist with eighteen years of teaching experience. She has taught a diversity of students including those with learning handicaps, mental retardation, and autism spectrum disorders in both urban and rural environments. Her special interest is working with children with attention deficit disorder and associated mental health conditions. Shari has appeared on National Public Radio with leading experts in the field of attention deficit disorder. In addition to her professional work, she is a chapter coordinator for Children and Adults with Attention Deficit Disorder (CHADD) and parents a teenager with AD/HD.

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  • Can my daughter have ADHD even though shes not hyperactive?

Question:

I have an 8 year old daughter in the third grade. Her teacher has suggested that she might have ADD and the school psychologist thinks she should be evaluated. She's definitely not hyperactive - in fact, according to them she just sits in class and stares out the window. Every year she's been in school since kindergarten this has come up. I don't get it. How can such a quiet kid have ADD?

. . . A concerned father


Answer:

Dear dad, Believe it or not, it is possible that your daughter might have attention deficit disorder or "AD/HD" as it is currently abbreviated. ADHD is often written with a slash, as in AD/HD because the term refers to several types of disorders: Attention Deficit Disorder, Predominantly Hyperactive-Impulsive; Attention Deficit Disorder, Predominantly Inattentive; and Attention Deficit Disorder, Combined Type. In other words, attention deficits can occur with or without the "H" - or "hyperactivity." 

Inattentive ADHD is the type most commonly diagnosed in girls before puberty. Girls with this disorder tend to be daydreamers, shy, and easily overwhelmed. Research studies about ADHD children's self perceptions have shown that boys with ADHD are often not even aware that their behaviors annoy others. In contrast, girls with ADHD tend to withdraw and are often painfully aware of their differences. Rather than being overactive, girls with inattentive type ADHD can be lethargic. They are easily discouraged and often have difficulty expressing themselves verbally.

If you decide to have your daughter assessed, be sure to have her tested to rule out a learning disability, as learning disabilities are often confused with ADHD, Inattentive type. Children with learning disabilities can withdraw in class because they do not know how to complete assigned schoolwork and may not understand concepts discussed in class. ADHD has historically been under-diagnosed in girls. Some authorities speculate that this is because these children aren't disruptive like many ADHD boys. The few girls whose behavior meets the criteria for ADHD, Hyperactive Impulsive and Combined types are often identified at a younger age and are sometimes seen as "difficult" by age 3 to 4 years. These girls often demonstrate temper tantrums, willfulness and emotional intensity. According to Dr. Patricia Quinn, MD, there is a higher incidence of learning problems in girls with this type. They are also at a high risk for low self-esteem as their high activity level and tendency to take risks is considered undesirable in girls. 

The Combined Type is most commonly diagnosed after puberty. Many of these girls are overly talkative and "hyper-social." They can be restless and fidgety. Though many are charismatic because of their social activity level, they can be bossy. When they have difficulty managing the demands of daily life, they often blame others. 

If your daughter is diagnosed with ADHD, you should be aware of the fact that many of these girls develop symptoms of depression and anxiety in adolescence. Although you probably won't need to manage her behavior as intensely as you would a boy's, you will need to be careful of her fragile self-esteem. Girls often develop shame and guilt about their awkward behaviors. Mothers of these girls need to guard against a tendency to be critical. As she enters adolescence, issues with peer relationships can become extremely intense. Your daughter may need to spend more time than others on learning social skills. Be sure to catch her being good. Recognize her talents and help her to develop islands of competence that will foster self-esteem. And don't forget to celebrate the gifts of ADHD. A few of these: 

Inventive
Energetic
Imaginative 
Innovative 
Creative
Independent 
Persuasive 
Spontaneous 
Curious 
Enthusiastic 
Often Artistic or Musical
Gregarious and Never Boring!

Resources: 

Nadeau, Katherine, Patricia Quinn and Ellen Littman. Understanding Girls with AD/HD. (1996)Advantage Books 

Solden, Sari. "Girls and ADD: An Equal Opportunity Disorder" in Women with AD/HD. (1995) 

Advance: A Resource for Women and Girls with Attention Deficit Disorder www.addvance.com
  • Teaching functional academics and skills within the educational environment.

Question:

Hi, I voluntarily support a 14-year old boy who has ADHD and I need some help. I need to find a way to teach him some functional academics and skills within the educational environment. My aim is for him to be more autonomous, to be able to make his own decisions to empower him as a student thus enhancing his self-esteem, and enabling him to control his impulsivity so he can stay out of trouble. I also need some strategies to help him maintain relationships. 

As far as I know ADHD is the boy's only diagnosis. He is in a mainstream class. Cognitively and academically he functions as his peers. His academic results are on the lower range of the class. He is not on medical treatment. His main problems are that he is very impulsive. He has an impaired sense of time and difficulty in establishing relationships. That is why I have been asked to support him. I appreciate your help.

Clara 


Answer:

Dear Clara:

"Functional skills" for a teen with ADHD who has average intelligence and academic skills should focus on those critical skills that enable the student to participate more efficiently in the general class environment and in the community. For a teen with ADHD, this usually means time management and study skills. Your student will probably have a case coordinator for his 504 plan or IEP. If he is eligible, he can receive direct instruction in study skills and organizational strategies from a qualified professional, such as a resource specialist or in a class designed to teach study skills. To improve his relationships, he may also benefit from participation in a social skills group conducted by a trained mental health professional. 

As a volunteer support, you can encourage or coach your student to learn strategies to participate in making decisions about his educational program. He should be included in all meetings about his school progress. His participation begins at the awareness level: How well does your teen understand and accept his strengths and weaknesses, including those associated with ADHD? Priscilla Harvell, Transition Specialist, has expertise in teaching this essential first step. She will address methods for developing awareness and for advocacy skills in the community in a coming Transition ASK A SPECIALIST Q & A. The books and video below may be useful resources in helping your student understand ADHD: 

Gordon, Michael (1993) I Would If I Could: A Teenager's Guide to ADHD/Hyperactivity. GSI Publications: DeWitt, New York. Phone: 315-446-4849 Dr. Gordon feels that having ADHD is not a disaster, but rather a challenge to be mastered. He describes the impact of ADHD on family life, school functioning, and self-esteem in both words and pictures. His account of a teenager's reaction to the diagnostic process, family therapy, and stimulant medication is informative, insightful, and poignant. He offers realistic coping suggestions. 

Nadaeu, Kathleen. Help 4 ADD @ High School.Com. Written for teenagers with ADHD, this book is designed like a web site that you can "surf." It has short, easy-to-read, information-packed sections which tell you what you need to know about how to get your life together for yourself, not for your parents or teachers. You don't have to read the whole book to find the information you want. Just check out the "home page" and turn to the topics you're interested in. The book includes tips on studying, ways your high school can help you succeed; tips on getting along better at home, on dating, exercise, and more. 

Both books are available at: http://www.addwarehouse.com/shopsite_sc/store/html/kids.html 

Teen to Teen: the ADD Experience by Chris Dendy. Available at: www.chrisdendy.com. Chris Dendy is a parent, professional and speaker who raised a son with ADHD who is featured on the video. 

When your student has developed an awareness of his learning style and needs, he can begin to learn self-advocacy skills. Since he is placed in a general classroom, accommodations for his learning weaknesses may enable him to participate more fully. Your student should be at the hub of the educational team that determines appropriate accommodations. He may need education as to possible options. Filling out a self-report form [this will be linked to a document] to determine a starting point for accommodations may be useful. Additional information on self-advocacy written for teens is available at: 
http://www.ldinfo.com/self-advocacy_chapter_5.htm#top

Intervention must take place in high school for students with disabilities to successfully advocate for themselves in the post-secondary environment. The educational team can help your student learn self-advocacy skills by role-play of specific strategies. The student should be prepared for a variety of reactions from teachers ranging from negative to indifferent to positive. Specific strategies for negotiating with teachers who may have these different attitudes are available in an article Requesting Academic Accommodations by Sheila Graham and Ronald L. English from the October 2001 issue ofAttention! Magazine. This article is also available by search at http://www.ldonline.org. Use the search words "requesting accommodations."

Begin by teaching your student a specific procedure for approaching teachers. To prepare for self-advocacy, your student should: 

  • Learn to talk comfortably about ADHD
  • Advocate for yourself before problems begin
  • Show your teacher that you are motivated. Offer to do extra work to make up for failures
  • Meet your counselor and form a relationship early in the year before problems occur
Some tips for meeting with teachers include: 
  • Practice beforehand. Make notes and bring them along
  • Use "I" statements and choose your words carefully
  • Come prepared with ideas for solving the problem and offer suggestions
  • Focus on what you need, not what you think the teacher is doing wrong
  • Listen
  • Bring your sense of humor. Be willing to laugh at yourself
  • If the meeting does not get results, talk to your school counselor or other adult
A resource specialist could provide direct support or guide you to support your student to learn to use his accommodations and to use critical study skills such as the use of a planner, test-taking strategies, and breaking long-term projects into short, attainable chunks. You can be supportive by checking to be sure that he has completed his assignments and has them packed to hand in. You might also be able to help him organize his backpack and binder and keep in touch with his teachers. 

Most students with ADHD do best with a consistent organizational system. In high school, many teachers like to create a personalized system. Some teachers may require spiral notebooks, others require an entire binder for one class. This can lead to frustration for the ADHD student. Consider advising your student to make use of a consistent binder system as one of his accommodations. In many cases, spirals can be clamped into binders. Some students, particularly those who are too impulsive to file papers at school do best with clipboards. With these, they just carry a clipboard for each class and clip papers onto the board. You can coach your student to create a color-coded file system at home. Use colored hangers and file folders, one color for each class. When he returns home from school each day, he should file his papers in the corresponding colored folder. Another system that students have used with success is the "one binder" system. The student's planner, a heavy duty pocket with all needed materials, and all spirals and papers are kept in one binder. The pocket should hold more than the usual pencils and pens. Items such as a small stapler, hole reinforcers, a small scissors, tape, paper clips, glue, a small ruler, a calculator and colored pencils or markers should also be included. Consider placing a pocket for completed homework that is ready to be turned in the front. Be sure to include extra paper. 

Many planners are available to help your student organize his day. He should include afterschool and school activities on one schedule. Your student may prefer to use an official school planner, if one is available. One easy to read planner is The Homework Organizer by Gail Epstein Mengel, available at:www.homework-organizer.com. If your student enjoys computers, he may prefer a Palm Pilot. These are expensive, however, and easily lost by many students with ADHD. 

You can support positive self-esteem by praising effort over achievement. Avoid criticism. Remember that "five to one gets the job done." If you criticize at all, remember to give five instances of praise for every critical comment. 

Good luck! Remember to keep the goal of eventual independence in mind. Teens often have difficulty accepting help from adults. Your student may have to learn some things by experiencing natural consequences.
  • Resources discussing the benifits of taking/not taking medication for ADD.

Question:

My 12-year-old son has just been told he has ADD. Could you please provide me with a Website(s) with info on the benefits of taking a drug or not taking a drug to help with his learning? I'm trying to gather all and any info regarding this matter. Thank-you in advance for any information you may be able to send my way. 
Debra, parent


Answer:

Dear Debra: 

To medicate or not medicate a child is one of the most difficult questions parents of children with AD/HD have to face. The issue brings up ethical and medical questions for most parents: If my child is medicated, will she or he still have the opportunity to learn appropriate behaviors? Will he or she experience side effects? In what tasks will medication help my child? Will he or she be more or less prone to addiction as a result of taking medication? Will my child have brain damage as a result of the medication? Although I can't answer all of these questions for your son, some of the resources I'll describe may lead you to your own conclusions. 

To gain an understanding of the possible side effects that your son may experience, first talk directly with his physician about the medication she or he recommends. The following websites are helpful in listing medications commonly used to treat AD/HD and their possible side effects: 

http://www.chadd.org/webpage.cfm?cat_id=24 

Children and Adults with Attention Deficit Disorder (CHADD) is a national organization that provides information, support and advocacy for families of children with AD/HD. This site contains a fact sheet on medical management of AD/HD.

http://www.additudemag.com/medical.asp?DEPT_NO=504&SUB_NO=3

This link, provided by ADDitude magazine, contains questions and answers about specific AD/HD medication. There is a link to another website where specific medications including recently developed non-stimulant medications are detailed. There is also a link to a description of alternative treatments. 

http://www.nimh.nih.gov/sciadvances/16.cfm 

The National Institute for Mental Health (NIMH) has researched the best interventions for AD/HD. The Multimodal Treatment Study (MTA) compared the effectiveness of behavior management, strategies, psychological counseling and medication and concluded that medication, only when strictly monitored on an ongoing basis, provides the most effective treatment for AD/HD. An explanation of the MTA results is available at this site. 

http://www.nimh.nih.gov/publicat/adhdqa.cfm 

This link provides answers to questions commonly posed about the MTA study. 

http://www.nimh.nih.gov/events/pradhdmri.cfm 

Regarding potential long-term effects of medication on the developing brain, a previous Ask A Specialist answer addressed the question of possible addiction. Recently, concerns about possible brain shrinkage have been studied. Results demonstrated that children with AD/HD do have smaller brain size than normal peers, but this is not a result of medication. This link provides study results for your review. 

Yes, your son will probably continue to learn appropriate behavior even when on medication. However, because his behavior will not be as extreme when he takes medication, others will not react in extreme ways. Because medication generally decreases impulsivity, your son may have more opportunity to think before he acts. Although medication will not usually increase standardized test scores, your son's grades may improve because he is more productive. Only a lucky few children are completely "normalized" by medication, however. Your son may need continued support for organizational skills at school and home. For more information on what medication can and cannot do, refer to the book, Beyond Ritalin by Stephen Garber, Marianne Daniels Garber and Robyn Spizman. Another book that may help you make your decision is Should I Medicate My Child? by Lawrence Diller, MD. Dr. Diller has a middle-of -the-road attitude toward medication that some parents find sane and refreshing. 

http://www.schwablearning.org/articles.asp?g=2&r=532 
Whether or not you decide on medication for your son, you will want to talk with him about the diagnosis and consideration of medication. Some suggestions for this discussion by Dr. Shashank Joshi, a child psychiatrist at Stanford University School of Medicine, can be found at the above link. 

http://www.chadd.org 
You may want to contact the organization Children and Adults with Attention Deficit Disorder (CHADD) and attend a meeting in your area to talk with other parents facing the same decision. A directory of local CHADD groups can be found at this link. 

Good luck!


  • Homework, after medication has worn off.

Question:

My sixth grade son, who is also gifted/dyslexic, takes Concerta. It gets him through the school day, but wears off by homework time (after 6 p.m.). After that, he can be very oppositional and agitated. He will be going into junior high next year where the workload will increase enormously. I want him to be able to stay in college prep. level classes because he needs the challenging material, but I fear he will never get his homework done. I can think of obvious stategies, like doing homework right after school, but what else might work to either increase his output or give him accommodations to allow for his non-medicated state? Anita


Answer:

Dear Anita,

Thank you for your question. Homework completion is a common problem with children who have Attention Deficit Disorder. Since I do not know your son or his circumstances, I cannot make specific recommendations for his situation. However, when planning for school success, two areas you should consider are special education and/or classroom accommodations and medication adjustment. 

If you believe your son has a disability, you should speak with his teacher or principal. She or he may contact the school's Student Study Team. Your child may be eligible for special education under IDEA or accommodations under section 504. Students are referred to the Student Study Team because teachers or parents have expressed concerns that the student has limited school success as demonstrated by:

  • Failing grades
  • Poor test performance
  • Retention or consideration of retention
  • Student has multiple discipline problems, including suspension and/or expulsion
  • Student has difficulties with peers and adults
  • Student was formerly enrolled in Special Education
  • Student was previously determined ineligible for Special Education
  • Student returns to school following a serious or lengthy illness or injury
  • Student has a known chronic health problem
If the team finds your son eligible, the team will develop a "504 Plan" for services provided under Section 504 of the Rehabilitation Act of 1973. This statute is a federal civil rights law that prohibits discrimination against individuals with disabilities. The intent of the law is to provide qualified disabled students equal access to educational programs, services and activities. 

Your son may or may not qualify. Students who meet the definition of a person with a disability are those who: 

  • Have a physical or mental disability that substantially limits one or more life activities
  • Have a record of such an impairment; or
  • Are regarded as having such and impairment
The key word is "substantially limited." Districts are mandated to set their own criteria for this descriptor. Many districts refer to the Americans with Disabilities Act for guidelines. This act considers "substantially limited" to be when "an individual is unable to perform a major life activity that the average person in the general population can perform." Keep in mind that some children who have been determined to be "gifted" may have difficulties that prevent them from achieving to their potential. However, if they are able to learn at the level of the "average" person, a school district may not consider their access to education to be "substantially limited." 

Should your son be considered eligible, he could receive accommodations such as: 

  • Shortened assignments that focus on essential content to be covered. Since your son is bright, he may not need to complete as much homework as others in order to understand the underlying concepts.
  • Extended time to complete assignments.
  • Use of a homework log or organizer to be signed by both parent and teacher to insure that your son receives the assignment.
  • Communication with a "study buddy" for questions about the assignments.
  • Loan of an additional set of textbooks to be kept at home to be sure your son has access to appropriate educational materials.
  • Notetaking support which can include use of a notetaker, to guarantee access to classwork.
Even if your son does not qualify for Section 504 accommodations, as a parent you can communicate with his teacher(s) about ways to support homework completion. Many middle schools routinely use a "Binder Reminder" and other organizational strategies routinely with all students. Also, you can support successful homework completion at home. Be sure to provide your son with a regular place to work and any equipment he needs. Some children with ADHD do best at a desk or table outside of their bedroom since bedrooms are associated with relaxation. One homework plan that is often effective is the "15-10-15" plan. Your son chooses an activity that he enjoys such as playing basketball or watching a video. He works on his homework for 15 minutes, then takes a break for ten. Setting a kitchen timer for the intervals minimizes conflict. 

You may want to ask your son's physician about the possibility of an additional low dose of Ritalin to be taken in the late afternoon to help him focus on homework. Any decisions or recommendations about medication should be made by a physician. Concerta is generally considered to be effective for about 12 hours. However, depending on the time he takes his morning dose, the effects may wear off before evening. If his doctor does prescribe an additional dose of Ritalin, be sure to have your son take it on schedule since the medication can cause sleep problems if taken too late in the day. 

Support from other families who experience similar challenges can be invaluable. Consider contacting CHADD for information and support. An informative online training about Section 504 law is available on our website. 

RESOURCES 

Family Support 
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) http://www.chadd.org/ 

Section 504 
Nielsen, Mary Anne. Understanding Section 504: An Online Training. Available at: http://www.dcn-cde.ca.gov/504/504_index.htm 

Homework Issues 
Canter, Lee and Lee Hausner. Homework without Tears. Harper Perennial, New York:1987. A classic primer on dealing with homework issues. 

Zentall, Sydney and Sam Goldstein. Seven Steps to Homework Success. Specialty Press, Plantation, FL: 1999. Describes eleven common homework problems and how to solve them. Also includes forms for home and school communication. 

For your son 
Mengel, Gail Epstein. The Homework Organizer: Assignment Notebook and GuideGet Organized! South Hadley, MA. An assignment notebook that includes icons for students with reading difficulties or a visual learning style. Available at: http://www.homework-organizer.com/ 

Schumm, Jeanne Shay and Marguerite Radenicich. School Power: Strategies for Succeeding in School. Free Spirit Publishing, Available at:http://www.freespirit.com/ A cool book with kid appeal that uses photos of real junior high kids to demonstrate effective study skills.
  • What role should the classroom teacher play in assessing a child with ADHD? 

Question:

I am a third grade teacher who has had many hyperactive kids in my class. I used to be able to just tell parents to think about placing their child on medication, but now I've been told I could be sued if I do. How can I get help for kids who can't sit still or pay attention? What role should the classroom teacher play in assessing a child with ADHD? 

Befuddled


Answer:

Dear Befuddled,

Most schools have a student study team that should be your first stop to explore diagnosis and support for any child in your class who has difficulty attending. If not, share your concerns about your student with the school psychologist. At all costs, avoid mentioning the word "medication" to the family. Whoever told you that you could be "sued" for suggesting medication is close to the truth. Your school district might be liable for any medical bill incurred if school personnel recommends a medical evaluation. You can, however, tell the family that the child in question has "attention problems." Should the family then ask if you are implying that they should seek medication, you should be certain to make clear that you understand that the question of medication is a concern for medical personnel not an educational professional. Under no circumstances should a teacher tell parents that their child needs "drugs". 

As a teacher, however, you are an important part of the assessment team. Other than the parents, you spend more time with the child than anyone else. Your input is crucial for an appropriate diagnosis. So, 

• DO promptly fill out any surveys or assessment tools given to you by your school psychologist, the child's individual psychologist or the child's pediatrician.

 DO keep anecdotal records of the child's behavior to support your observations. 

• DO be open to accepting phone calls by mental health and medical professionals. 

 DO be willing to fill out forms or communicate with parents and/or physician to track the effects of medications and dosages attempted. 

When children get to middle and high school age, some teachers feel less inhibited about discussing medication issues with the child. 

BEWARE - Under no circumstances should you discuss these issues with the child, even if that "child" is 16 or 17 years old. Never tell a child he or she needs more medication. Instead, contact the family and express your concerns about persistent attending problems. The child is not legally or medically responsible until she or he is legally an adult. 

The American Academy of Pediatrics has published AD/HD assessment guidelines for pediatricians. These guidelines will provide you with some idea of what to expect when you become involved in an assessment. They are available online at: http://www.aap.org/policy/ac0002.html