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Attention Deficit Hyperactivity Disorder Archive 2006

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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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Click a topic below to expand the full question and answer.

  • Dealing with an uncooperative school study team.

Question:

I have a 16 year old son with a diagnosis of ADHD who attends high school. I have been very frustrated in attempts to get the school study team to work with me. Despite the fact that I had made it very clear that I was planning to attend and arrived on time, the team had already discussed my child and apologized that they had to start early because they had "another meeting".

Prior to the meeting I had provided the team with a copy of an evaluation done by an educational psychologist that showed his academic abilities between the 92nd and 99th percentile while his scores on a test of executive function -organizing and setting priorities--was in the 2nd to 10th percentile.

The only request that I made was that my child's teachers provide a copy of his assignments to me--by email, fax or my coming to the school to pick them up--whatever was easiest for the teachers. In return, I received a lecture about how my son was going to go to college in 2 years, that he needed to be responsible because no one was going to collect the assignments for him at college.

I know that in theory my son should have a right to some accommodations but it seems like the position of the study team is that he has to reach the point where he is doing poorly in school again before they will even consider any requests. Also, their response about the problem being his lack of responsiblity made me feel that they didn't really understand ADHD. In truth, I left the meeting in tears.

I do not want to be so pushy that I alienate the members of the Study Team but I also want to be proactive and effective in helping my son have a more successful year. Thanks for any suggestions you can give me. -DW


Answer:

Dear DW,

Your concerns are common for many parents of high school students. You didn’t mention if your son has a history of receiving accommodations. Because symptoms of AD/HD in adolescence are not as obvious as before puberty, families often experience frustration in getting others to recognize impairment in their teen. Hyperactivity tends to diminish even as demands for organizational ability increase.

You didn’t mention the type of meeting to which you were invited. I assume that this was a Student Study Team (SST) meeting which is a general education, as opposed to “special” education, process. The purpose of the SST meeting is to provide school personnel with the opportunity to discuss concerns about a student. Legally, parents should be notified that an SST meeting will occur, but their attendance is not required for the meeting to take place. You may have felt slighted when school personnel conducted the meeting without you but this was not illegal.

You commented that you believe that “in theory” your son has a right to some accommodations. The key words here are “in theory.” Unfortunately, sometimes there is a difference between moral and legal obligations. Your son’s academic abilities are in the high achieving to “gifted” range. Legally, this places him in a delicate situation.

Services for students with AD/HD can be provided in one of three ways: in general education, under Section 504 of the Rehabilitation Act of 1973 or under IDEA 2004, an educational law. Section 504 is a civil rights law that protects disabled students from discrimination by ensuring that all students have equal access to educational programs, activities, and services. IDEA is a federally funded educational law that provides a free, appropriate, education to students with one or more of thirteen identified disabilities. Students who qualify under one of the designated categories are eligible for individually-designed instruction at no cost to the parents. Students who qualify under IDEA are automatically protected by Section 504.

To qualify for protection under Section 504, the law states that a student must:

  • have a physical or mental impairment that substantially limits one or more life activities
  • have a record of such an impairment or
  • be regarded as having such an impairment.

The words “substantially limits” considerably affect s who receives these services. The law requires school districts to determine their own definition of “substantially limits.” Districts often reference the American with Disabilities Act (ADA) for guidance in formulating their definition. The ADA describes the individual who is “substantially limited” as one who is ”unable to perform a major life activity that the average person in the general population can perform.” [29 CFR 1630.3 (j)(1)(i) ] or is “significantly restricted as to the condition, manner or duration under which the average person in the general population can perform the same major life activity.”

Your son’s school district’s policy determines if his disability “substantially limits” his life activities. Some districts interpret this to mean that if a student is able to perform in school at the level of the “average person in the general population” then he is not “substantially limited.” The district then has provided access to the curriculum. Thus, if a child has high potential, depending on district policy, a school may not be required to provide accommodations that will ensure that he perform s to his potential. Accommodations might only be required to allow him to learn at the level of the “average” student. The law is to guarantee access, not results.

Of course, this reasoning may not be consistent with the moral obligation that many educators feel to educate a child to his or her potential to learn. Also, the policy varies from district to district and some districts may consider that a difference between potential and actual achievement is a “substantial” limitation. However, from your description of your personal experience, I would venture that your district probably takes the first view. You can verify the district policy by contacting the Section 504 plan coordinator for your school district.

The second way for your son to qualify for accommodations would be if he were to qualify for individually designed instruction under IDEA. This means he would be eligible for federally funded special education services. Students with AD/HD often qualify for services under the categories of learning disabled or other health impaired. You can request that you son be evaluated for special education services if you feel he needs them.

To maintain your positive relationship with the school, your best first recourse is probably to attempt to make some informal accommodations on a teacher by teacher basis. Many teachers are willing to work out arrangements if approached personally that they might be reluctant to implement if legal strings are attached. You might also consider privately hiring an ADHD coach who could assist your son in developing some organizational strategies. Your local Children and Adults with Attention Deficit Disorder (CHADD) organization may have some recommendations.

If you do not agree with the outcome of the SST meeting, your first recourse should be to contact the school principal. If you wish to further investigate your son’s rights, the organization Parents Helping Parents can direct you to the appropriate resources.

Good luck. This can be a painful situation!

Resources:

Diagnostic Center, Northern California. Understanding Section 504. Online training available at: http://www.dcn-cde.ca.gov/online.htm

Parents Helping Parents. www.php.com


  • When are "fidget toys" appropriate?

Question:

I’ve heard a lot about fidget toys and am interested in using them with students. When are they appropriate? Which ones should I use? Where can I find them?

Laura


Answer:

Dear Laura,

Fidget toys can be calming, but they don’t work for everyone. Because AD/HD is a neurological condition, children with AD/HD often have sensory differences. Most experts consider AD/HD to be related to under-stimulated, under-active, areas of the brain. Many research studies (Barkley, 2006) have shown that children with AD/HD have greater variability in sensory arousal patterns and tend to be underactive to stimulation. Children with AD/HD often seek stimuli in order to alert them to their environment and help them organize incoming information.

The principle behind fidget toys is to stimulate the arousal level so the child becomes more attentive. Some children, however, are not able to cope with stimulation that might compete with the expected item of focus. Instead, they over-focus on the toy and become disruptive. Douglas (1972) and others have suggested that the person with AD/HD has difficulty regulating arousal to meet situational demands. This means that many children with AD/HD are overreactive to high stimulation and under-react to low levels of stimulation. Only experimentation can predict whether a particular child will benefit from holding a fidget toy.

Toys are often introduced during times when the child is expected to sit quietly without much physical activity and during transitions. Children with AD/HD have most difficulty transitioning from unstructured to structured settings, such as returning to the classroom from recess. A short transitional activity involving fidget toys, coupled with quiet music can often assist the student to refocus after returning from recess. Before providing the toys, be sure to discuss guidelines for their use. To optimize success, rehearse the activity before expecting children to use it in the appropriate situation.

Fidget toys can also be used during lecture periods, read-alouds, and while waiting for an activity to start. While reading aloud “The Indian in the Cupboard,” one teacher provided students with plastic miniature figures like that in the story. Fidget toys are also useful when students are expected to wait for an activity such as the arrival of a specialist teacher or while waiting to line up. Whenever possible, during lectures, link the toy to the theme being discussed. For example, try passing out metal shavings and a magnet during a lecture about magnets. Crafts, such as knitting and braiding can also be productive fidgets as many adults will attest.

Fidget toys are available in many toy stores and online at a variety of sites. Materials catalogues for occupational therapists are often good sources because occupational therapists often intervene on arousal and sensory issues. Below are some of my favorites:

Sensory Comfort Toys. http://www.sensorycomfort.com/toys.htm

The Therapy Shoppe. http://therapyshoppe.com/

Therapro. www.theraproducts.com

TFH Special Needs Toys. www.specialneedstoys.com

Star Magic. www.starmagic.com

Sources:

Barkley, Russell. (2006) Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York: The Guilford Press.

Zentall, Sydney S. (2006). ADHD and Education: Foundations, Characteristics, Methods, and Collaboration. Upper Saddle River, New Jersey: Pearson Education, Inc.


  • I keep getting calls at work about his behavior. Does this sound like AD/HD?

Question:

I have a 5-year-old son who is extremely bright however has some behavior issues at home as well as at school. He is a fast learner but has a short memory. For example, if I ask him to go wash his hands he will go into the bathroom and then immediately come out and say "What did you tell me to do?" At school, he just won't settle down when it is time to sit and follow the teachers instructions. He's very figity. However, I know he's learning because he is already reading and has a photgraphic memory. For example, the first time he saw the word “family” he spelled it once and then when I covered it up he spelled it correctly.

I keep getting calls at work about his behavior. What can I do? Does this sound like AD/HD?

Laura


Answer:

Dear Laura,

The symptoms you describe very well could represent AD/HD yet they could also be characteristics of many other conditions. If I were your son’s parent, I would request a full evaluation to look at any number of conditions that could be causing his difficulties, including, but not limited to learning disability, giftedness, depression, anxiety, and AD/HD.

This assessment can be completed by your school district. In California, parents may request an assessment and the district has an obligation to create an assessment plan within fifteen days of the request. I stress the words in writing. A simple verbal request will not do the trick.

The conditions mentioned above can be diagnosed by a school psychologist. After the assessment is completed, parents also have the right to request an independent assessment if they disagree with the assessment results. Neurologists, pediatricians, psychiatrists, and clinical psychologists are able to provide differential diagnosis for AD/HD. Of these, child psychiatrists have the most in depth background in other mental health conditions that sometimes mimic AD/HD.

Because your son is so young, a specific diagnosis may not be apparent at this time. Cognitive test scores do not stabilize until about age eight and children mature at different rates socially and emotionally. You may have to wait but you should document incidents that occur in case additional assessment needs to take place in the future.

If your son is found to have exceptional needs, even if these are not severe enough to qualify him for special education, he may be eligible for a behavior support plan that would specify interventions to take place for behavior problems. Having the school intervene to support appropriate behavior would provide relief from the potentially stressful experience of receiving calls about your son at work.

With the advent of IDEA 2004, California schools are in the process of transition. IDEA 2004 gave school districts to right to implement a new service delivery model designed to prevent serious academic and behavioral problems. As part of your assessment process, you should check to see if your son’s school is implementing the Response to Intervention (RTI) model. Steps for support will differ under this model than under the conventional approach. Your son may or may not be eligible for “Tier 2” interventions. These are interventions such as “social skills group” that take place in small groups rather than with an entire class. Eligibility is driven by documentation of past history including multiple office referrals, teacher request for assistance, and parent referral.

Additional information about assessment for AD/HD is available at:

Additional information about behavioral support is available at:


  • Test results may vary greatly with students with ADHD.

Question:

A psychologist concluded that ADHD was strongly supported due in part by scores on the following academic assessments:

WJR-III 5/5/04
 
Broad Reading SS: 70
Broad Math SS: 86
Broad Writing SS: 70
   
WIAT-II 12/1/04
 
Reading Composite SS: 61
Math Composite SS: 79
Written Language Composite SS: 71

I am concerned that the psychologist is drawing conclusions between two different tests, while similar, may be assessing different things, in addition to norms not being the same.

Do the statistical correlations between these two assessments demonstrate a sound comparison of skill level?

I understand that test results may vary greatly with students with ADHD. Were the above scores a demonstration of this characteristic?

Maureen


Answer:

Dear Maureen,

I am concerned that your letter may not include all of the information that the psychologist used to make the diagnosis. However, academic test scores alone definitely are not adequate to diagnose a student with ADHD.

Both the formal tests that you cited are “norm referenced” academic assessments. They are designed to measure academic achievement - defined as those skills and information that a student acquires in an academic setting in relationship to a student’s peers nationwide. Neither of these assessments purport to measure ability, aptitude, or cognitive processing. The manual for the WJ-III Tests of Achievement (WJ-III ACH) indicates that “An examiner can use the WJ-III ACH to determine and describe the present status of an individual’s academic strengths and weaknesses. Additionally, test results help determine how certain factors are affecting related aspects of development. For example, a weakness in phoneme/grapheme knowledge may interfere with overall development in reading and spelling.” Diagnosing mental disorders is not listed as a use for the WJ-III ACH.

The Wechsler Individual Achievement Test, Second Edition (WIAT-II) has a similar purpose. The manual for the WIAT-II states, “The WIAT-II is a comprehensive, individually administered test for assessing the achievement of children, adolescents, and college students… The WIAT-II measures aspects of the learning process that take place in the traditional academic setting in the areas of reading, writing, mathematics and oral language.”

In contrast, ADHD is classified as a “disruptive behavior disorder” in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). ADHD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.” All of the criteria described are observable behaviors. Nothing in the criteria for ADHD indicates that the level of academic achievement, advanced, delayed or normal, is involved in the disorder.

Children who have ADHD often demonstrate characteristics that may be evident in their academic work. For example, one of the criteria in the DSM-IV suggests that child with ADHD, Inattentive type “often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities.” These careless errors may be evident in a student’s responses on either the WJ-III or the WIAT-II, but neither of these assessments provides a means to measure any degree of carelessness in order to diagnose ADHD.

The WIAT-II Examiner’s Manual reports that the assessment was administered to a sample of individuals diagnosed with ADHD and the results were compared with a control group. All means were in the expected range for individuals with ADHD. Although the means were within the average range, lower scores were reported on the Written Expression and Spelling subtests than in other areas.

The WJ-III has a cognitive component called the Tests of Cognitive Abilities (WJ-III COG). Some of the subtests in this battery may be useful for diagnosing ADHD but none is sufficient unto itself. The WJ-III Technical Manual cites research done to indicate that certain WJ-III COG subtests may correlate from slightly to moderately to other measures of attention. However, your question does not mention any WJ-III COG subtests. Whether WIAT-II scores correlate with WJ-III ACH scores is not relevant to the potential diagnosis of ADHD.

In summary, please refer to the link to “Previous Questions” at the Ask a Specialist website, for a complete description of what to look for in an assessment for ADHD. The response describes the guidelines for ADHD assessment published by American Academy of Pediatrics. These guidelines are a good place to start to evaluate if the assessment your child is receiving is thorough and appropriate.

 

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000) Washington, DC: American Psychiatric Association.

Mather, N. and Woodcock, R. (2001) Examiner’s Manual. Woodcock-Johnson III Tests of Achievement. Itasca, IL: Riverside Publishing

McGrew, K and Woodcock, R. (2001) Technical Manual. Woodcock-Johnson III. Itasca, IL: Riverside Publishing

WIAT-II Examiner’s Manual . San Antonia, TX: The Psychological Corporation (2002)

 


  • Is ADHD more prevalent among African-Americans?

Question:

I teach children who come from families with a primarily African-American background. They seem to demonstrate many more ADHD like behaviors than children of other ethnic groups with which I have experience. Is ADHD more prevalent among African-Americans?

A teacher at a recent ADHD workshop


Answer:

Thank you for your excellent question. Few research studies have been conducted comparing the incidence of ADHD in various US ethnic groups. Those that have been done indicate a similar incidence of ADHD among African-Americans, Hispanic-Americans and European-Americans in the United States (Office of the U.S. Surgeon General). One exception that I found was Dr. Russell Barkley who cites research indicating that prevalence may be higher among Puerto Ricans and children of military personnel. This research does not indicate that the incidence is higher among African-Americans than among the rest of the population.

Most sources I checked agreed that African American youth are two and a half times less likely than European-American children to receive a diagnosis of ADHD. According to the CHADD Educators’ Manual, one study also found lower use of medication in non-white youth. Just five percent of African-Americans and two percent of Hispanics in contrast with eight percent of Caucasians used medication to treat ADHD.

In contrast to their under-representation in ADHD diagnoses, African-American males are diagnosed with emotional and behavioral disorders at a higher rate than white males. One interpretation of these statistics is that students who might actually have ADHD are being placed in the category of “emotionally disturbed”. African-American children are also over-represented in arrests, detentions, and incarcerations. (Office of the U.S. Surgeon General). In general, children who do not receive treatment for ADHD are at high risk for developing criminal behavior. (Barkley) The general concern is that African-American children are not receiving optimal care for the conditions that they may have, not that ADHD occurs more frequently in that population.

There are several reasons why it might seem that there is a high rate of ADHD in your students. As discussed above, some of your students who have ADHD may not have been diagnosed with the condition. Secondly, although you do not mention your own ethnicity, it is possible that your communication style differs from that of your students.

Whenever professionals work with an ethnic group different from their own, we must be culturally sensitive. This requires education and effort on our part. Enid Lee, a leader in equity education addresses this question: “How do you tap into students’ cultures if you don’t know about these cultures and if they differ from yours? You might think that my first suggestion would be to learn as much as you can about the students’ cultures. This is important, but even more crucial is knowledge and assessment about your own culture.”

Various sources list specific communication styles of specific groups. A source for this type of information, Multicultural Students with Special Language Needs is listed in the Resources. However, I would like to share some of the tips given by Ms. Lee:

  • If we ourselves are members of the dominant culture we need to be aware of our tendency to think in “deficit” terms in relation to our own culture. As a first step, we need to check ourselves and ask “Is it really deficit? Or is it just different from what we consider normal?”
  • Ask ourselves, “Where can I look for that culture?” in order to learn more.
  • Most of us experience other cultures through the food and multicultural festivals. If we start there, we must look beneath these expressions of culture to ask “What is the meaning of these activities in the lives of the students and their families? What can they tell me about the prior experiences of this ethnic group? What does it indicate about my students’ interests and their goals?”
  • We can learn about our students’ culture through respectful interactions with their families and communities through getting to know these families and attending events in the community open to the general public.
  • We can continue to learn about the cultures through the literature and art of our students.
  • As we educate ourselves about our students’ cultures, Ms. Lee suggests the following guidelines:
  • Guard against the “deficit” lense. We risk perpetuating racism and limiting learning if we are not mindful of the ways in which the cultures of people of color are racialized and minimized.
  • Watch out for categorizing whole groups of people in a single word. Cultures change over time and vary over location. Ms. Lee suggests that we will be more accurate if we qualify our observations using terms such as “with this group of Native Americans, Latinos, etc. I have noticed this cultural pattern.”
  • Be open to learning from our students. They are a goldmine.
  • Honor our students’ families and communities as their first teacher.
  • Periodically renew our commitment to learn about the values and victories of our students and ways to incorporate these into our teaching.
  • Allow the joy of learning about our students’ and our own culture to shine on.

References:

Barkley, Russell.(2006) Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York, New York: The Guilford Press

Delpit, Lisa. (1995) Other People’s Children: Cultural Conflict in the Classroom. New York, New York: The New Press.

Lee, Enid. Enid Lee Reader. Online at www.enidlee.com see “Questions to Enid Lee” and “Educating Children of African Ancestry in The United States of America, Canada, and The United Kingdom- A Select Bibliography”

Roseberry-McKibbin, C. (2002) Multicultural Students with Special Language Needs, Second Edition. Oceanside, CA: Academic Communication Associates.

Zeigler Dendy, C., Durheim, M., and Ellsion, A. (2006) CHADD Educator’s Manual on Attention-Deficit/Hyperactivity Disorder (AD/HD). Landover, MD: CHADD

Research regarding prevalence of ADHD cited here from the CHADD Educator’s Manual:

Office of the U.S. Surgeon General. (2001) Mental Health: Culture, Race. And Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General.Washington, DC (author)

Rowland, A.S., Umbach, D.M, Stallone, l, Naftel, A.J. Bohlig, E.M. & Sandler, D.P. (2002) “Prevalence of Medication Treatment for Attention Deficit-Hyperactivity Disorder Among Elementary School in Children in Johnston County, North Carolina.” American Journal of Public Health, 92, 231-234.


  • ADHDs affect on "executive function."

Question:

My son has ADHD and is taking Ritalin. He is having problems with remembering his spelling words. He also has problems with writing the b,d & p he writes it the opposite way. He is 7 years old and attends a normal school. I had to make him repeat grade 1 because he was not coping with the work. He also has problems with math. In 2006 he progressed to grade 2.

Please help.

MALANIE


Answer:

Dear Malanie,

I am sorry to hear that your son is struggling in school. Although ADHD is not recognized as a learning disability in the California Education Code, it is a neurological condition that frequently affects learning, particularly in the area of “executive function.”

Depending on the level of severity of ADHD, medication may or may not “normalize” the child’s functioning. The Multi-Modal Treatment study, a well-known research study by the National Institute of Mental Health (NIMH) found that given the best clinically supervised medical and behavioral intervention, about 68% of students with ADHD were normalized. Most children with ADHD do not receive state-of-the-art treatment. This means that we can expect that at least 32% of our students with ADHD require additional support to function in the general education classroom.

To explain the concept of executive function, Dr. Thomas Brown of Yale University compares the brain to a symphony orchestra, where the musicians in the orchestra represent innate talents and abilities. The “musicians” or talents are present in the brain of the person with ADHD as in the typical brain. However, the typical brain has a conductor to coordinate the musicians so that the music is played clearly and on time. The conductor respresents executive function. The brain of the person with ADHD is lacking the critical direction to function in a coordinated manner.

There are many models of executive function. Dr. Brown has identified six components of executive function. Here is a brief explanation of each of these and how they affect school performance:

Executive Function

Definition

Implications for school performance

Activation

Organizing, prioritizing, and initiating tasks and activities

Trouble starting schoolwork. Procrastination on school tasks and homework.

Focus

Directing, sustaining and shifting attention

Easily distracted by noises or sights in the environment. Also distracted from completing tasks by internal thoughts.

Effort

Regulating alertness, sustaining effort, processing speed

Often have difficulty with sleep. May complete assignments more slowly than other students. Have difficulty sticking with work after starting.

Emotion

Managing frustration, anxiety and other emotions.

Easily frustrated when encounter difficulties in schoolwork.

Memory

Primarily short-term and working memory

Have difficulty holding things in mind while doing something else. In school, this particularly affects the areas of mathematics and written language.

Action

Monitoring and regulating actions once these have been initiated.

Difficulty monitoring their progress on long-term projects. Socially, often fail to notice their effect on others.

As you can see, children with ADHD often have significant difficulty with memory, which is a big factor in learning arithmetic facts and spelling words. The most prevalent learning disabilities for children with ADHD are written language and mathematics.

Since ADHD is not recognized as being a disability by the Education Code, many teachers do not realize the extent to which it can impede learning. Your child may be eligible for either special education, under the category of Other Health Impaired, or for accommodations in the general classroom under Section 504 of the Civil Rights Act. You might consider requesting an assessment to determine whether your son is eligible for either of these.

As a preliminary to requesting an assessment by the school district, consider sharing information with school personnel about how ADHD can affect learning. Two articles that I have found to be informative and accessible are:

Chris Zeigler-Dendy. “Five Components of Executive Function and How They Impact School Performance”, Attention! Magazine, February 2002, pps. 26-30.

Rosmary Tannock and Rhonda Martinussen. “Reconceptualizing ADHD”, Educational Leadership, Vo. 59. #3. November, 2001.

The websites listed below will also be helpful for informing teachers:

Dr. Thomas Brown
http://www.drthomasebrown.com/brown_model/index.html

Chris Ziegler-Dendy
http://www.chrisdendy.com/executive.htm

Children and Adults with Attention Deficit Disorder (CHADD)
www.chadd.org


  • Why is ADHD seen so much more frequently in the United States than in other countries?

Question:

Why is Attention Deficit Disorder seen so much more frequently in the United States than in other countries? Is the incidence increasing or is it just being diagnosed more?

Fifth grade teacher


Answer:

Many educators and parents have wondered if the incidence of AD/HD is increasing. Our perception often suggests that this is the case. However, research about the incidence of AD/HD among children has been inconclusive, with studies suggesting a range of incidence from 1% to 18%. This is because there is not a standardized research protocol for reporting the incidence of AD/HD. Thus, determining whether the incidence is increasing is difficult.

Well-known researcher, Dr. Russell Barkley, has detailed the differences that can occur in reporting due to the type of criteria used in any given report. Variations in the prevalence of AD/HD can occur due to differences in the ways in which samples are chosen, the criteria used to define AD/HD, and the age range and gender composition of the sample. For example, lower rates of AD/HD are reported when the full DSM-IV criteria and parent reports are used and higher rates are reported when teacher only reports are used. The DSM-IV or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, is the book used by mental health professionals to diagnose mental health disorders.

One of the more reliable studies was conducted in 2005 by the U.S. Center for Disease Control (CDC). This survey looked at the number of children reported by their parents in 2003 to have or ever have been diagnosed with AD/HD. The CDC found that the prevalence of AD/HD was about 7.8% nationally but varied quite a bit across socio-economic groups and geographic location. The lowest incidence of 5% was reported in Colorado and the highest, of 11% was reported in Alabama. California, at 5.34 % had one of the lowest reported incidence. This same report indicates that only about half of those children ages 4-17 years diagnosed with AD/HD actually took medication for AD/HD. The highest prevalence for medication treatment was in children aged 9 to 12 years.

In contrast, the incidence of adults taking medication for AD/HD has been increasing. A 2005 study by Medco Health Solutions found that the number of adults taking prescription drugs for AD/HD more than doubled from the years 2000 to 2004. One of the reasons for this increase may be than many people who began taking medication for AD/HD as children are now young adults. Even with the increase, only about 1% of the adult population takes medication to treat AD/HD.

Prevalence of reported AD/HD symptoms increased with age and was highest for males aged 16 years and females aged 11 years and lowest for preschool children. The highest rates were noted among English-speaking, non-Hispanic, and insured children. In addition, the rates were most prevalent in families in which the most highly educated adult had a high school diploma and lower in those families in which the most educated adult had more or less education than a high school diploma. Families with incomes below the poverty line were also more likely to report a child with AD/HD.

Studies of the incidence of AD/HD worldwide present a similar conundrum. The design of the studies are not the same, therefore, the results are not reliably comparable. However, the most reliable authorities describe a similar incidence world-wide. For example:

  • 3.8% among Dutch children, by parent report
  • 5.3% among Chinese children ages 6-11 years, using teacher ratings
  • 14.9% among primary school children in the United Arab Emirates, using teacher ratings
  • 19.8% among Ukranian children based on parent ratings of DSM-IV symptoms

Hope this helps to provide some perspective for you on the mystery of AD/HD.

Resources:

Centers for Disease Control and Prevention (2005) Prevalence of Diagnosis and Midication Treatment for Attention-Deficit/ Hyperactivity Disorder – United States, 2003. Morbidity and Mortality Weekly Report. September 2, 2005; vol.54, No. 34: pp. 842-847.

Barkley, Russell (2004) Attention-Deficit. Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity. American Psychological Association

Barkley, Russell (2006) Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York, New York: Guilford Press

Hitti, M and Smith, M. ADHD Drups: Adult Use Doubled in 4 Years. MedicineNet.com. http://www.medicinenet.com/script/main/hp.asp

National Resource Center on AD/HD. http://www.help4adhd.org/en/about/statistics

St. Sauver,J. Mayo Clinic Proceedings, September 2004; vol 79: pp 1124-1131


  • Accommodations for the SAT.

Question:

My son wants to take the SAT this year. He is a senior at a small school for students with learning disabilities. His disabilities are Attention Deficit Disorder and Dysgraphia. The school does not offer any SAT prep classes and I am concerned he would just not be able to handle the test or the time required to  focus while taking the test. I understand the accommodations that are available. We need for him to be familiar with the test and the time involved. The school is also unable to suggest anyone who can tutor him. It is a Non- Public School funded through our District, who also does not have any suggestions for test prep for their NPS students.

Where can we go for assistance to help him prepare for this test which he will take in a few months? We live in the Claremont, CA. area. He is an excellent reader and speller, limited math skills and very limited ability to use a pen (dysgraphia), great difficulty studying, doing homework is a nightmare F on report cards for work,  he takes the classroom tests and earns A's.  F in homework  A's on test equals C and D on report cards.

Any information you can share with us would be much appreciated.

Thank you,

Chris


Answer:

Dear Chris,

You mention that you are familiar with the possible accommodations for the SAT’s. For readers who may not be so up to date, SAT accommodations are grouped in four areas. Examples include:

Presentation

  • Large print (14 pt; 20 pt)
  • Fewer items on each page
  • Reader
  • Colored paper
  • Use of a highlighter
  • Sign/orally present instructions
  • Visual magnification (magnifier or magnifying machine)
  • Auditory amplification
  • Audiocassette
  • Colored overlays
  • Braille
  • Braille graphs
  • Braille device for written responses
  • Plastic covered pages of the test booklet

Responding

  • Verbal; dictated to scribe
  • Tape recorder
  • Computer without spell check/grammar/cut & paste features
  • Record answers in test booklet
  • Large block answer sheet

Timing/Scheduling

  • Frequent breaks
  • Extended time
  • Multiple day (may/may not include extra time)
  • Specified time of day

Setting

  • Small group setting
  • Private room
  • Screens to block out distractions
  • Special lighting
  • Special acoustics
  • Adaptive/special furniture/tools
  • Alternative test site (with proctor present)
  • Preferential seating

Extensive information about eligibility for accommodations and the procedure to apply is available at the College Board website. In order for your student to qualify, he will need to show that he has received accommodations for testing in school. Since your student has dysgraphia, you may also be considering computer accommodations for the essay on the SAT Reasoning Test. Dysgraphia is one of the three impairments that are eligible for computer accommodations. The others are physical disabilities and severe learning disabilities. Poor handwriting does not automatically qualify a student for computer accommodations. Dysgraphia will only be considered when due to a documented fine motor impairment, so be sure that your son’s dysgraphia is well-documented. Refer to:http://www.collegeboard.com/ssd/student/index.html

The College Board website also contains resources for preparing for the test including a SAT calendar with daily sample questions, a study guide with sample questions, and an online course that students can take at their own pace.

Schools are not required to provide instruction on SAT test-taking strategies. Most parents, including those of typical students, hire professionals privately for instruction in taking the SAT. A popular resource is Kaplan Test Prep and Admissions. Kaplan offers both small group and one-to-one tutoring to teach test-taking strategies for the SAT. With individual attention, you and your son would be able to tailor instruction to his needs. Information about Kaplan Test Prep, including private tutoring and locations is available at: www.kaptest.com

If you decide to hire privately, consider a professional ADHD coach with experience in preparing high school students for the SAT. Just as the physician manages the biological aspects of ADHD, and the psychotherapist can help with social and emotional difficulties, the ADHD coach provides support with practical daily life problems.

The ADHD coach helps students with organizational and time management issues that may impact their performance on the SAT. College students who are away from home for the first time, often encounter difficulty in managing everyday life activities such as completing chores like laundry and keeping track of appointments and events. Most ADHD students rely on parents to structure these activities during high school. When that support is removed, some students experience difficulties. One advantage of using a coach now to help with SAT test-taking strategies is that your son may establish a relationship that could continue into college. The International Coach Federation (ICF) has a Coach Referral Service as well as information on finding the right coach and is found online at:www.coachfederation.org

The Educational Consultant is another type of professional often hired by families to help with college decisions. The Independent Educational Consultant Association (IECA) is a professional organization that provides consultants nationally. The Educational Consultant works with the family to teach the student self-advocacy skills that the student must use independently in college and is knowledgeable about schools and admissions processes. Educational Consultants can be contacted at: http://iecaonline.com/parents_learn.html

Additional Resources:

Bozak, S. Choosing an Educational Consultant. Attention! Magazine, October, 2001. 23-24.

Goldberg, R.L. The Transition to College for Students with LD and AD/HD: The Educational Consultant’s Role. IECA Insights, June-July 2004, 6-8.

Novash, P. Obtaining Extended Time on College Entrance Exams. Attention! Magazine. August, 2006, 36-39.

Quinn, P., Ratey, N. & Maitland, T. (2000) Coaching College Students with AD/HD. Silver Spring, MD: Advantage Books.

Young, J., & Giwerc, D. Just What is Coaching?. Attention! Magazine, December, 2003, 36-45.

For your son:

Mooney, J. (2000) Learning Outside the Lines: Two Ivy League Students with Learning Disabilities and ADHD Give You the Tools. New York: Simon and Schuster.