Attention Deficit Hyperactivity Disorder Archive 2008
Shari Gent, M.S.,
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 you offer any advice or insight into children who are gifted and ADHD?
My little boy is 7 years old. He was diagnosed with ADHD during kindergarten and takes stimulant medication that has tremendously improved his attention and behavior. We decided to homeschool him for his first grade year. The PhD who tested him suggested that if we place him in public school next year, we should speak with the principal about grade acceleration.
Can you offer any advice or insight into children who are gifted and ADHD? I am concerned about bringing this up to the principal, but I know my son, and he would really benefit from grade acceleration. Socially speaking, his friends are all older and he is well-accepted by them.
How fortunate you are to be parenting such a special child! As you are just starting on the school journey, each year will reveal more.
Characteristics of giftedness can be variously identified. IQ is often used as the determining factor, but most experts agree that it should not be the only consideration. Other traits considered important in determining giftedness include creative problem-solving, inventiveness, high abstract reasoning ability, social and artistic talent. Your son’s psychologist may have mentioned to you that IQ does not tend to be reliable until about age eight years. So, you may expect some some changes in his tested ability in the future.
Each child is an individual, so I urge you to be cautious about applying generalizations to your son. However, it may be helpful to aware of some characteristics of gifted and ADHD children identified by experts.
Most children who are gifted demonstrate the ability to learn quickly and sustain attention for long periods of time. Studies of gifted children (Gottfried, 1994) have indicated that children who show giftedness at age eight have superior intrinsic motivation. They tend to have advanced attention, persistence, curiosity, enjoyment of learning, and the tendency to pursue challenge and mastery.
They are able to produce prodigiously and are often perfectionistic about performance. In contrast, many children with ADHD are slow processors, have difficulty with motivation and have problems producing enough schoolwork to keep up. Children who are gifted often have excellent fine and gross motor coordination. Many children with ADHD have problems with handwriting and fine motor skills. Gifted children are often emotionally sensitive and excitable. This excitability can be confused with the impulsivity of ADHD. Children who are gifted often need less sleep than the typical child. Children with ADHD have difficulty sleeping and, as a result, are often drowsy and have problems with alertness.
Giftedness and ADHD have many characteristics in common including:
- Uneven development and abilities
- Sleep anomalies
- Openness to new ideas
- Misses details
- Tendency to question authority
ADHD and giftedness share many common characteristics, but these are often expressed differently.
Can concentrate intensely for long periods of time without completing a task or being rewarded
ADHD and gifted children have some educational needs in common. Both benefit from intense, fast-paced instruction that revolves around personal interests. Acceleration is often appropriate for the gifted child, may not be appropriate for the child of average ability with ADHD, and can be problematic for the gifted child with ADHD. Your son seems not to have the three to four year social and emotional delay typical for most children with ADHD, but he is still young. This is something to watch for as he matures. In addition, he may require an adjustment period as he transitions from home schooling to public schooling where his instruction may not be as individualized. Whatever program he enters, I urge you to look for “differentiated” instruction. This general education approach take individual needs, interests, and learning styles into consideration.
Thank you for sharing information about your son and posing this interesting question. Please keep me posted about his progress in school.
Besnoy, K.(2006) Successful Strategies for Twice Exceptional Children. Waco TX: Prufrock Press
Johnsen, S & Kendrick, J. (2005) Teaching Gifted Students with Disabilities. Waco, TX: Prufrock Press.
Kiesa, K. (2000) Uniquely Gifted: Identifying and Meeting the Needs of the Twice Exceptional Student. Gilsom, NH: Avocus Publishing
Lovecky, D. (2004) Different Minds: Gifted Children with AD/HD, Asperger Syndrome and Other Learning Deficits. Great Britain: Jessica Kingsley.
SENG: Supporting Emotional Needs of the Gifted. www.sengifted.org
How do we teach students to become independent learners?
Recently, I attended one of your trainings. I went over the strategies with our director. His question was, “How do we teach students to become independent learners?”
From what you said in the training, AD/HD students lag behind other students by 3-4 years in maturity. Do you have any suggestions as to how I can support my students with AD/HD to develop independent study skills?
Becoming an independent learner is challenging for all our students, particularly for students with AD/HD.
Students with AD/HD have the same talents and abilities as other students. However, they lack the ability, or “executive function” (EF), to marshall these resources for goal-directed behavior. This means that they will have trouble identifying a goal, setting priorities for task completion, breaking tasks into steps, monitoring their progress toward the goal over time and completing their work in a timely manner. These problems can particularly interfere with independent study skills and the completion of long term projects.
Dr. Thomas Brown of Yale University likens EF to the conductor of an orchestra. In this analogy, brain function is likened to the orchestra. In the student with AD/HD, all the “musicians” are present and as talented as in the typical student, however, the conductor is absent. The resulting production is chaotic and uncoordinated.
Many models for EF skills have been proposed. Dr. Brown suggests five primary executive functions:
Each of these is linked to specific academic and life skills.
When adapting curriculum for students with AD/HD, teachers must scaffold to support missing executive function skills. The student with AD/HD is initially dependent on this scaffold but can be taught the strategies, although she or he will acquire them more slowly that the typical student. Basic principles to incorporate into instruction are:
When teaching independent learning skills to children with AD/HD, procedures that typical students learn incidently will need to be explicitly taught. For example, in order to ensure that the student with AD/HD participates in a small group inquiry project, each member of the group may need to be assigned a role. Inquiry can be effectively structured through the use of a visual organizer. The K-W-L chart is an organizer frequently used for this purpose. Many variations of this chart are available. Below is an example of the most basic:
To use this chart students identify questions they want to have answered through their inquiry and link these to conclusions following the activity.
When students are required to complete long-term projects independently, the student with AD/HD may need to have specific steps for project completion explicitly outlined. Each step should have a corresponding due date and opportunity for adult recognition of completion of that step. Eventually, the student with AD/HD can move to self-monitoring of steps. The final goal for the mature student should be the creation of his/her own outline for project completion. In contrast, many typical peers, will have the executive function skills to plan a long-term project without instruction in these skills.
Here are some basic steps to use to create a checklist for younger children:
- Collect Resources
- Other _____________
Identify three main ideas and write them down.
- Big Sentence
Write one sentence that tells the big idea for the report.
- Fact Sheets
Write each main idea on a sheet or index card. List at least three facts or details for each idea.
- First Draft
Put your fact sheets in order. Write them in full sentences so each sheet is a paragraph.
Ask a buddy to edit your draft.
- Clean copy
Write or keyboard a corrected copy. Add bibliography, illustrations, and a cover sheet. Turn in your report!
These examples can help you start planning accommodations for students with AD/HD to become independent learners. A plethora of resources are available to help you expand your repertoire of strategies.
Brown, T.(2005) Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Cambridge, MA: Yale University Press
Brown, T. website: www.drthomasebrown.com
Davis, L. Sirotowitz, S, and Parker, H. (2003) Study Skills for Early School Success, grades 3-6 Plantation, Florida: Specialty Press, Inc.
Rief, S. (2005) How to Reach and Teach Children with ADD/ADHD: Practical Techniques,Strategies, and Interventions, Second Edition. San Francisco, CA: Jossey-Bass Teacher
Zeigler Dendy, C. (2000) Teaching Teens with ADD and ADHD. Bethesda, MD: Woodbine House
Zeigler Dendy, C., Durheim, M., Ellison, A.T. (2006) CHADD Educator’s Manual. Landover, MD: CHADD
Zentall, S. (2006) ADHD and Education. Upper Saddle River, New Jersey: Pearson Education
Difficulty with a teacher not being understanding.
I just started the process of having my son evaluated. He is having a hard time in his pre-school class. He is defiant, impulsive, somewhat aggressive toward teachers, he refuses to join the group at times just to name a few. His teacher has started a system in class and we have a communication notebook. I am doing my best until he can be tested. How do I make her understand that he may not be in control? I need her to be more understanding and compassionate. He may be able to control himself. Please, I need help!
It is sometimes difficult for teachers to understand that AD/HD is a neurobiological disorder and that behavior is sometimes beyond the conscious control of the child. Often parents are called on to educate the educators. Although teachers spend a great deal of time with children during the day and are able to compare their performance and behavior with that of typical peers, only parents see their kids develop and grow over time.
When parents try to share with teachers, they may find that teachers are extremely busy and have little time to read and study in addition to their teaching duties. However, to help your son’s teacher understand his behavior and avoid conflict with her, consider sharing with her some simple information written for professionals about AD/HD. A number of organizations provide information online that is easy to access and print out. I strongly suggest that you stick with sites that feature research-based materials. There are many groups that exist to promote their own products and do not necessarily provide scientifically-based information. The sites below are reliable:
National Institute of Mental Health (NIMH)http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
The NIMH website provides an excellent introduction to AD/HD including an explanation of the neurobiological causes for the disorder. A video of recent research about AD/HD and brain development is easily accessed at the site. This new research indicates that the brain of the child with AD/HD develops in the same way as the brain of the typical child, but is delayed in development by about three years. Sharing this fact with your son’s teacher may help her to understand that your son may simply be less mature than his classmates.
National Resource Center on AD/HD
The National Resource Center is a joint project of Children and Adults with Attention Deficit Disorder (CHADD) and the U.S. Centers for Disease Control and Prevention. This invaluable resource includes comprehensive and reliable information about all aspects of AD/HD. The website also includes a series of printable pamphlets entitled “What We Know” (WWK) about all aspects of AD/HD. Links to the latest news about AD/HD are available.
U.S. Centers for Disease Control and Prevention
The address above is a link to a one page document discussing the definition and prevalence of AD/HD.
This website specifically designed for teachers includes information based on the NIMH website. In addition, teachers can find links to specific topics such as AD/HD and the gifted child, as well as links to articles about specific strategies on intervention strategies.
Hopefully, your child’s teacher will have the time and interest to look further. If so, the following are excellent introductions to information about identification of and interventions for children with AD/HD:
CHADD Educators Manual, Chris Zeigler-Dendy, editor
Available at www.chadd.org This excellent reference includes information about all aspects of AD/HD including characteristics and interventions for preschool.
Office of Special Education, U.S. Department of Education (OSEP)
OSEP publishes two excellent and free resources for teachers: Identifying and Treating Children with Attention Deficit Hyperactivity Disorder; and Teaching Children with Attention Deficit Hyperactivity Disorder. These can be downloaded and printed from their website or ordered in bound form.
Mother does not want her son to take medication.
I live in Kansas City, Mo . I am the grandmother. My son and his 10 year old son live with us. He has been diagnosed with adhd and was taking 27 mg Concerta. His mother has gone off the deep end and doesn’t want him to take medicine anymore. Her idea to solve this is "beat his ass". My son and I went to the parent-teacher conference this past Thursday and we took his medical records and he is not doing very well at all in school. Since he has been diagnosed with ADHD they are trying everything they can in class to help him. At the rate he is going he probably will not pass the 5th grade. I am deeply concerned about him because when he was taking the medicine he was doing very well.
Do you have any suggestions on what we can do?
I’m sorry to hear that your grandson is having difficulties in the fifth grade. It must be hard to watch this happen.
Your question seems to have two parts: one about withdrawal of medication and the second about discipline methods at home. I will address the second part, but first I would like to introduce the newest member of our Ask A Specialist staff. Dr. John L. Digges, MD, PhD, MPH, and FAAP (Fellow of the American Academy of Pediatrics) will be answering questions about school-related medical issues beginning in January, 2009. Dr. Digges served as a Forensic (Child Abuse) Pediatrician and has had a private practice focused ADHD consultations for the past ten years. He currently serves as the President of the Kern County Medical Society. I would like to defer your question about discontinuing medications to Dr. Digges who has promised to respond when he starts in January. Welcome, Dr. Digges!
That leaves your concern about discipline at home. I gather that your grandson’s parents feel that consequating his behavior by punishment will produce positive change. Many people feel this way. In fact, spanking is the discipline method of choice in many cultures.
Unfortunately, research has shown that punishment, particularly corporal punishment, may seem to improve behavior in the short run but has some serious long term
- Punishment may be effective the first time, but in order to continue being effective, punishment must be metered out in ever-increasing doses. You can see where this could lead. What starts out as a tap, can end up being a wallop.
- Children with ADHD are particularly resistant to punishment. Because of their ADHD, they seek stimulation of any kind. A child with ADHD may actually have the tendency to seek out the excitement of the parent’s anger and physical attention, even negative attention.
- The child receiving the punishment tends to associate the punisher with unpleasant or even painful experiences. This can undermine the relationship between the parent and child.
- Because the child associates the adult with a painful experience, he or she may tend to avoid directives in the future.
- The adult who punishes is modeling behavior that is not appropriate for the child to do. Children who are punished tend to become punishers. If a child is spanked, he or she is more likely to hit someone himself.
- When a child is punished, the opportunity to teach desirable behavior is lost. The child does not learn the appropriate way to communicate.
- All behavior is an attempt at communication. When the behavior is simply suppressed, the underlying reason for the behavior is never explored.
When a parent engages in punishment, he or she may feel that something is being accomplished simply because they are providing a consistent response to an undesirable behavior. This response can be achieved in ways that do not have the negative side effects associated with spanking and other punishments. The key is to see the glass half full rather than half empty – to change criticism to recognition.
Although parents do not cause their child to have ADHD, their parenting style can have a strong influence on their child’s progress. To get you started, here are some of my favorite strategies, from a variety of sources:
Because many ADHD children engage in activities which elicit a negative reaction, many parents of these children attempt to interact less often with these children. When interactions occur, they may be corrective or coercive in nature. For this reason, many ADHD children experience fewer rewards when relating to adults and therefore are less motivated to comply.
One technique often recommended to counteract this tendency is the introduction of "special time". Parents choose a 15 to 20 minute time period each day to spend with their child. During this time, the child is allowed to decide on the activity. Parents are to remain as nondirective and noncorrective as possible. S\he needs to avoid asking questions or suggest other activities. During the play period, the parent descibes the play activity in positive terms, ignoring any mildly disruptive behavior
Children, especially those with ADHD, are often most disruptive when parents are involved in their own activities, such as talking on the telephone, cooking a meal, or mopping a floor. Parents are often easily annoyed by these intrusions and can provide children with a great deal of attention for them. When children are playing quietly, many parents tend to be grateful for the quiet time and make use of it, ignoring the children until they become disruptive and demand attention. One way to decrease this cycle is for parents to make an effort to recognize appropriate independent play, even when this means interrupting their own activity to do so. When independent play is rewarded by a compliment, it is more likely to reoccur in the future.
Commands are often phrased in such a way as to be directed toward disruptive behavior. The child is asked to refrain from a given behavior rather than invited to participate in an appropriate one. For example, the child may be told, "Take your feet off the table." A more effective command might be, "Keep your feet on the floor." Rather than threatening a child with punishment, a more effective mode is to remind the child of positive consequences. For example, "When you are done with your homework, you still have 15 minutes of TV time", will be more effective than "If you don't finish your homework by 9pm, you have to go right to bed!"
Always end interactions with the ADHD child in a way that allows him/her to experience success. For example, a child is sent to his room for refusing to clean up after spilling milk on the floor. Give the child a chance to comply with the request, in this case wiping up the milk, after he returns from his room. Praising him for his now appropriate behavior will increase the likelihood of compliance in the future.
Remember to offer praise more frequently than criticism. A good ratio to keep in mind is five praises to every criticism given. Catch your child doing something right, even if it is seemingly insignificant.
Break time, also known as “time out” or “time away” is an effective strategy for dealing with disruptive behaviors, particularly with children from ages 4 through 12. The purpose of time away is not punishment, but to make expectations for compliance clear, or, in some cases to provide an opportunity for the child to calm down. Break Time is most effective, in the first situation, when it takes place for a short period of time in the room where the noncompliance took place. One effective form this can take is a chair in the corner of the room. During Break Time, the child may talk quietly to himself, but may not play or talk to others. Break Time should last a minute or two. When the child leaves time out, he/she needs to have the opportunity to return to the problem situation and attempt compliance.
Barkley, R.(2000) Taking Charge of ADHD (Revised Edition) New York, NY: Guilford Press
Illes, T. From Defiance to Compliance: What Parents Need to Know to Transform Resistance into Obedience. Attention Magazine. June, 2008. 14-17
Love and Logic. Information available at www.loveandlogic.com
Love and Logic is a parenting approach that offers adults an alternative way to communicate with their child.
How can I talk with parents who refuse medication?
I’ve heard that treatment with medication is the single biggest factor contributing to longterm success for students with AD/HD. Unfortunately, throughout the years, many parents of my students with AD/HD refuse to medicate their child either because of fears of possible addiction or because they disagree with the principle of relying on medication to control behavior. How can I talk with parents who refuse medication?
Phil, Special Day Class Teacher
This is one of the most common questions asked when I give AD/HD workshops to teachers. I’m often also asked another question, “So many parents are eager to have their child diagnosed with AD/HD so they can give them medication that they have heard will improve their performance. What can I tell them?” Both questions can be addressed with a similar approach.
The primary principle you should consider when the question of medication arises is: teachers are not qualified to give any medical opinion. Many states have legislation restricting what school personnel are permitted to discuss with parents. Check with your school about the protocol in your district. One statement that is sometimes permitted to use with a parent is:
“The decision about whether or not to use medication is between the family and physician. Your child’s physician is qualified to answer your questions.”
If you suspect a child has AD/HD, your school district will generally have specific guidelines you should follow. Some general steps to consider are:
- Arrange for a parent conference to examine the possible reasons for the student’s difficulties. Many experienced teachers may already feel certain that the child has AD/HD. However, under no circumstances should you express this opinion. Instead, stick to a factual description of your concerns. For example, if a child is not completing written work in class, show the parent a record of missing assignments and a sample of the student’s work. Inquire about any information the parent might have that could explain or be contributing to the student’s difficulty. Often health conditions such as allergies or family circumstances such as a divorce, death in the family, or newly adopted child might lead to changes in a student’s performance at school.
- Implement a trial of simple pre-referral interventions and document the results. Examples of these general interventions include changing the seating arrangement, playing quiet music during independent work periods, and providing a specific place and time for the student to turn in homework. Documentation can take the form of formal data, for example the number of assignments completed during a period of time, anecdotal reports, and/or a portfolio of the student’s work during the time the intervention was implemented. This is also a good time to communicate with previous teachers and speak informally with support staff for advice.
- If the student continues to demonstrate difficulties, consult a multidisciplinary or student study team. This meeting is often the time when discussion will take place about whether the student’s difficulties may or may not be the result of a disability. Suspicions that a disability exists trigger legal obligations.
- The parents are informed by the multidisciplinary team about what the diagnostic process for disability will entail and offered this option if they are interested.
- Diagnosis of AD/HD can be made by a psychiatrist, physician, neurologist, clinical psychologist, or, in some school districts, school psychologist. Although a child may be diagnosed by a psychologist, only a physician can provide treatment with medication.
Following diagnosis and during treatment, if a parent initiates discussion, remember to repeat that the child’s physician is best qualified to answer questions about medication. Additionally, you might also consider referring the parent to the Children and Adults with Attention Deficit Disorder (CHADD), a group that provides support for parents. The CHADD website contains a series of useful handouts entitled “What We Know.” Several of these discuss the use of medication and alternative and controversial treatments.
National Resource Center on AD/HD. A program of Children and Adults with Attention Deficit Disorder (CHADD) in cooperation with the U.S. Centers for Disease Control and Prevention. “What We Know: Information Sheets on AD/HD”. Website: http://www.help4adhd.org/
Reif, S.(2005) How to Reach and Teach Children with ADD/ADHD, second edition. San Francisco, CA: Jossey-Bass
Zeigler Dendy, C. editor. (2006) CHADD Educator’s Manual. Landover, MD: CHADD
Aren’t students with AD/HD or a medical condition automatically qualified for the IEP or some sort of Special Education?
Our family resides in California. My daughter was diagnosed with ADHD when she was in the 1st grade and has taken medication since then.
My daughter is now in the 10th grade and has barely passed each grade since beginning Middle School. Last year, in her ninth grade year, the High School tested her for special education services and concluded that she does not qualify for Special Education or any other programs. She tested above average in most areas.
The psychologist that performed the testing said that she has very noticeable problems with retention and retaining what she hears or reads. She also said that my daughter is very easily distracted.
The problem is when you put her back in a normal classroom setting she can't seem to handle it. The first semester of this year she failed three classes. Is there anything that I can do? Aren’t students with AD/HD or a medical condition automatically qualified for the IEP or some sort of Special Education?
Thank you very much!!
You and your daughter are facing a difficult situation. Unfortunately, students with AD/HD or other medical diagnoses are not automatically eligible for special education or even for Section 504 accommodations. One of the hardest facts about educational law for most of us to accept is that the educational law does not mandate that all students must be successful. In fact, the law gives students equal opportunity to fail.
IDEIA 2004 (Students with Disability Educational Improvement Act of 2004), the federal law governing special education specifies that a student may qualify for special education under any of thirteen qualifying conditions. AD/HD is not listed as one of these conditions. Students with AD/HD generally qualify under the category of Other Health Impaired (OHI), Learning Disabled (LD), or Emotionally Disturbed (ED).
In order for a student to qualify for special education, a student must meet the criteria for one of the thirteen conditions and also demonstrate that he or she requires specially designed instruction. I hesitate to comment about your daughter’s specific situation because I do not know her or the school district, but from the information you have shared, I would guess that because she tests in the above average range, even though she is failing classes, she has demonstrated that she is learning.
A student who qualifies for special education automatically qualifies for accommodations under Section 504 of the Civil Rights Act. Unlike IDEIA 2004, Section 504 is a civil rights law rather than an educational law and does not provide the districts with funding for interventions. The intent of the law is to “level the playing field” so that all students are guaranteed access to the core curriculum. Students who do not qualify for special education can still qualify for accommodations under Section 504 if they:
- have a physical or mental impairment which substantially limits one or more major life activities;
- have a record of such an impairment; or
- are regarded as having such an impairment.
The key here is the term “substantially limits.” School districts are given the freedom to provide their own definition of this term but many rely on the definition provided by the Americans with Disabilities Act (ADA). ADA defines “substantially limited to mean that the individual 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.” [29 CFR 1630.3 (j)(1)(ii ]. In schools, this means that a student who is able to learn at the level of the average student in the class may not, depending the school district definition of “substantially limited”, qualify for Section 504 accommodations. Apparently, your district has chosen to interpret the law to exclude your daughter because of her above average test scores.
I know this is unsettling, but I can only suggest that parents also have responsibility for our child’s education. Talk with your daughter and try to understand the reasons for her failure. For example,:
- Does she fail the same subject over and over, or different subjects each year?
- Does she have trouble getting along with some teachers?
- Is she failing because she does not do her homework or because she does poorly on tests?
- If she does the homework, is she failing because she loses the work and fails to turn it in?
If homework is the problem, many parents pair their students up with other students to complete the work together or engage in quiet work themselves during homework time to provide a model. Some families hire tutors to coach their students for tests. You may be able to find a student mentor at you daughter’s high school or an inexpensive tutor at a local community college. If your daughter has difficulty getting along with a teacher, try talking to a counselor with her.
In an ideal world, many of us would like to see AD/HD be a designated handicapping condition. Until then, we are often our children’s best support.
Nielsen, Mary Anne. Understanding Section 504, an Online Training. www.dcn-cde.ca.gov
Children and Adults with Attention Deficit Disorder (CHADD). Educational Rights for Children with Attention-Deficit/Hyperactivity Disorder (AD/HD): A Primer for Parents. A free book available in Spanish and English at www.chadd.org
Special Education Division, California Department of Education (2002). California Special Educaiton Programs: A Composite of Laws, Twenty-fourth Edition.
Wrights Law Special Education Law and Advocacy. www.wrightslaw.com