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Attention Deficit Hyperactivity Disorder Archive 2011

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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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  • I have a teenage son, who is 13 years old, who has ADHD. I have had my share of obstacles, throughout the years, with trying to receive support from public schools.

Question:

Hi Shari,

I have a teenage son, who is 13 years old, who has ADHD. I have had my share of obstacles, throughout the years, with trying to receive support from public schools.

My son has gotten some referrals for tardies to his art class, which is his second period, first being PE in the AM. The gym is at the other end of the school, art class, is at the opposite of campus from end to end.

I recently requested accommodations to allow an extra pair of minutes to get to class. The request was denied. It has been brought up to my attention, that many students get these referrals, from this class. Not just my son.

Last year, I received tremendous support from the vice-principal. This year, there is a new vice-principal, and it felt like I had to start all over. He comes from a background of community school, and his approach is very different. I don't know what to do. I had never received a SARB letter before, after I signed the first letter, within a week, he requested a second letter. After the third, the school sends you to the school board.

His grades are not good. I feel lost. And also, that he is being treated, like a typical student. And Andy (my son) is not a typical student. Don't know where to turn from here. Can you help?
 
Lorena


Answer:

Hello, Lorena-

Thank you for sharing your concerns about your son. You bring up some interesting questions about services for students with ADHD. Receiving support from an individual school professional is gratifying, however, to ensure that support follows your son from year to year, you may want to request an evaluation to provide him with a written plan.

Since you say that your son is not a typical student, he may benefit from accommodations to the core curriculum to “level the playing field.” Accommodations do not change the standards to which your son must still be accountable, but make instruction accessible.

Section 504 is part of the civil rights act that insures that students with handicapping conditions have access to the core curriculum. If your son does not already have an accommodation plan under Section 504, if he has not been assessed by the school district for services, or if you feel he may need to be re-assessed for services, you may want to request an evaluation by the school. You should put this request in writing. Request that he be evaluated in all areas of suspected disability. A medical diagnosis is not sufficient to make a student eligible for accommodations or services, however, consider including information about his ADHD assessment and any other  evaluations he has had.

By law, schools must respond “within a reasonable time period” for Section 504 services. In California, for special education services, school districts must respond with an assessment plan within 15 days and then you must respond to their offer within 15 days.  There is an additional timeline for the district to complete a formal assessment.

Schools are required to respond to your request, but are not required to evaluate your child unless school data supports the need for an evaluation. In response to your letter, the school district may offer early intervention services, Section 504 accommodations, evaluation for special education services, or can decline services even though your child may receive non-school services. If the school responds that your child is not eligible for services, this does not mean that he does not have educational needs, simply that these needs are not at a level required for additional services through the school.

Schools will often refer your request to a student study team. The team consists of persons who know him well and are able to understand and interpret school evaluations.  For example, persons who might serve on this team include:

  • teachers
  • school nurse
  • principal or administrative designee
  • school psychologist
  • parents and/or family members
  • social workers
  • specialists

To consider eligibility for Section 504 accommodations, formal testing is not required. A variety of sources can be used to gather information such as:

  • teachers’ reports
  • parent/family information
  • home language survey
  • report cards
  • response to interventions
  • standardized tests
  • referral forms
  • disciplinary records
  • health records
  • prior Section 504 or Special Education evaluations or services
  • private evaluation reports
  • attendance records

Students who receive accommodations are held to the same disciplinary code as typical students unless explicitly outlined in their 504 plan. In addition, as part of early intervention services under IDEA 2004, you may be able to request a positive behavior support plan or small group instruction in basic life skills such as time management. Rather than excusing your son from being accountable for tardiness, this approach might teach a valuable life skill that applies to employment, family, and community activities. 

Best wishes in supporting your son. For further exploration, the resources below contain detailed explicit information about your options. 

Resources

Community Alliance for Special Education (CASE) and Protection and Advocacy Inc. (PAI) Special Education Rights and Responsibilities, Chapter 2. Available online at: http://www.disabilityrightsca.org/pubs/504201.htm

Nielsen, Mary Anne. Understanding Section 504: An Online Training.  California Department of Education.  Available online at: http://www.dcn-cde.ca.gov/504/Units/504index.htm


  • Can an assistive technical device such as a Classmate Reader help my son who is dyslexic and is diagnosed with ADHD?  Also, what about using the Barton Reading System?

Question:

Hello,

My dear son is nine years and in the 4th grade. He has had an IEP since second grade for specific learning disabilities, has been diagnosed with ADHD and more recently dyslexia. In our most recent IEP team meeting I suggested the assessment for and implementation of assistive technology i.e the Classmate Reader. I am convinced that using this tool in class and home will help him in reading and completing assignments because in my opinion he is very dyslexic.

Of course, there was opposition and hesitation from almost everyone else on the team. I was not surprised. They continually suggest medication and placement in a special day class as the appropriate interventions. I am not sure how to convince them that the use of assistive technology would be of great value. I know that they have to consider it, but under what circumstances will they legitimately be able to refuse it? I am convinced that the opposition is primarily due to budget restraints. Why is this my son’s fault?

Also, do you have any input on the use of the Barton Reading System and how this may be incorporated into his IEP plan?  Your input and feedback would be most greatly appreciated.

Best regards,
Amber


Answer:

Hi Amber,

Thank you for sharing your concerns.  To best address your questions, two of us have collaborated to provide answers from our respective areas of expertise.  Betsy Caporale, Assistive Technology Specialist, will address your question regarding the Classmate Reader and Shari Gent, Education Specialist, will offer information about the Barton Reading System.

Assistive Technology

The Classmate Reader is one of several text readers available on the market today.  Other options include the iPad, Nook, and Kindle, to name a few.  Classmate Reader offers many unique features that make it particularly useful for students who are struggling readers, including capability to access a variety of file formats, speed adjustment for MP3 files, highlighting, bookmarks, note-taking support and an on-board dictionary. 

In order to determine if a text reader such as the Classmate Reader will be a useful tool for your son, his IEP team will need to conduct an Assistive Technology  (AT) assessment.  Most districts have an AT Specialist who will spearhead this process. The AT assessment should be a collaborative effort involving your son’s teacher, service providers and, most importantly, your son himself.  The team will want to evaluate how the Classmate Reader might help your son meet his IEP goals.  They should also explore other AT tools and strategies (both low and high tech) that might be appropriate.

 To determine the most appropriate AT tools and strategies, the team will want to conduct a feature match which clearly identifies your son’s specific skill levels and needs,  as well as the features of  the AT tools being considered.  For exampe, when considering a tool such as a text reader, the team needs to confirm that the student has the fine motor skills, visual acuity, and mental aptitude to operate the device independently.  Members of the AT assessment team will need to spend time observing your son across all academic environments, and conduct numerous trials with the AT tools and strategies being considered.  It is also crucial to determine whether your son is motivated to use a particular AT device.  Many students refuse to use AT because they don’t want to stand out or look “different” than their peers.  Unfortunately this issue is often overlooked, resulting in AT devices being rejected or abandoned after a short time.

Once the assessment has been completed and AT solutions have been determined, the team will need to address the following questions:

  • How and when will AT be implemented across the school day?
  • Who will be responsible for the implementation of AT?
  • How will instruction and assignments be modified using AT?
  • Who will be responsible for making these modifications?
  • Who will provide the necessary AT training for the student and staff?
  • Who will be responsible for the maintenance of any electronic AT devices?
  • Will an AT device be needed to complete homework assignments?

As you can see, AT “consideration” is a lengthy, complex, procedure which requires the input and expertise of many different specialists.    Keep in mind that as a student’s skill levels and academic environments change, so will his or her AT needs, therefore, the  AT assessment and consideration process is ongoing, and will continue throughout a student’s academic career.

I hope this information will help guide you and your son’s IEP team in selecting appropriate assistive technology!

Education

The Barton Reading and Spelling System is a program designed by Susan Barton to teach decoding and spelling skills.  The program is designed to primarily use tutors and is most effectively implemented in a 1:1 setting.  There are ten levels covering these topics: phonemic awareness, consonants and short vowels, closed and unit syllables, multisyllable words and vowel combinations, prefixes and suffixes, silent “e” words, vowel-r combinations, vowel digraphs, the influence of foreign languages, and Latin and Greek roots.  The program purports to address decoding and spelling skills from pre-reading through the ninth grade level.  Influenced by the well-researched Orton-Gillingham multisensory system, the Barton System uses attractive and appealing color-coded letter tiles to teach students to recognize sound patterns and sound out and spell words. 

A personal review of the Barton program indicated a program that is readily accessible to parents, tutors and teachers.  The user-friendly website includes detailed video clips of the developer modeling implementation so potential users can judge the program for themselves.  Interested parties can order DVDs that explicitly demonstrate the program so the user can practice and review each teaching strategy.  Because of this video training component, a volunteer with no background in reading instruction could conceivably use the tutoring strategies. 

The developer suggests that optimum results are achieved with 1:1 tutoring that takes place at least twice weekly.  Progress through the program depends on the student, the setting, and the frequency of instruction.  She states that optimum progress can be made when students are tutored daily for 45 minutes to one hour and claims that the student with “average” dyslexia can progress through the entire program in two to three years given instruction at least twice weekly.  By the end of the program, the developer claims that the student should be reading at the mid-ninth grade level.  She states that results will be slower if the student is distractible, if the program is offered in a small group setting, or if the child has severe learning problems.  Since your son has been diagnosed with ADHD, I would suggest that you would heed this caution.

The website cites testimonials and research articles that support the efficacy of the program.  The sheer number of citations would seem to prove the efficacy of the system.  Some of the studies do seem to show significant gains in decoding skills.  However, the fact that the research exists is not enough to prove that the program works.  The research done must be well-designed to prove anything.  Unfortunately, most agencies that review research and recommend programs have concluded that not enough well-designed research has been done to prove that Barton program is, in fact effective. 

For example, the Florida Center for Reading Research cited on the Barton website discusses the primary research done on Barton Reading in Pleasanton, California.  The conclusion of the Florida Center was, “because of the design of the study (i.e. lack of control group, pre/post-test design), it cannot be determined that the gains reported are the direct result of the Barton Reading & Spelling System.  The study also did not report average amount of improvement on the GORT-4 across all students, or how many students made significant progress on this test.” 

The United States Department of Education Institute of Education Sciences (IES) provides compilations of research and recommendations for intervention programs proven to be effective.  When reviewing reading programs to recommend for students that I serve, I like to check U.S. Department’s website, “What Works Clearinghouse” at http://ies.ed.gov/ncee/wwc/  The Barton System was reviewed by the IES in July, 2010.  Under the topic of effectiveness, the IES review states:

No studies of the Barton Reading & Spelling System that fall within the scope o the Students with Learning Disabilities review protocol meet What Works Clearinghouse (WWC) evidence standards.  The lack of studies meeting WWC evidence standards means that, at this time, the WWC is unable to draw any conclusions based on research about the effectiveness or ineffectiveness of the Barton Reading & Spelling System on students with learning disabilities.

The WWC reviewed thirteen studies released between 1989 and 2009.  None of the studies met the rigorous standards of the WWC for appropriate research design.

Another concern is the somewhat misleading claim by the Barton developers that the program is approved by the California Department of Education.  True, the Department has cleared the program for “social content.”  According to the California Department of Education website, this approval does not constitute adoption by the State Board of Education, but indicates that the instructional material meets the following statutes:

  • Portray accurately and equitably the cultural and racial diversity of American society;
  • Demonstrate the contribution of minority groups and males and females to the development of California and the United States;
  • Emphasize people in varied, positive, and contributing roles in order to influence students' school experiences constructively; and
  • Do not contain inappropriate references to commercial brand names, products, and corporate or company logos.

Being cleared for social content does not constitute an endorsement for reading intervention.  A number of reading intervention programs have been approved for adoption by the California State Board of Education. If your child attends a California school district, you might be interested in checking out this list of fully researched and approved programs for students “two or more grade levels below grade level” is located at:

http://www.cde.ca.gov/pd/ca/ma/mardsbeprvdrread.asp

Finally, when working with your school district to choose a reading intervention for your son, I would urge you to keep in mind that decoding and spelling are not the only reading skills that should be taught.  In 1997, Congress asked the National Institute of Child Health and Development (NICHD) to work with the U.S. Department of Education in establishing a National Reading Panel that would evaluate existing research and evidence to find the best ways of teaching children to read.  This panel found that effective reading instruction includes a combination of these techniques:

  • Phonemic awareness
  • Fluency
  • Guided oral reading
  • Vocabulary study
  • Reading comprehension

Most children benefit from a well-rounded reading program that targets all areas of the reading process. For more information, please visit http://www.nationalreadingpanel.org.

Good luck in your search for the right program for your son.  I hope this information will assist you.


  • Can young girls with AD/HD have behavior symptoms such as being defiant and acting out?

Question:

Hi, Shari,

My husband attended a the discussion of pre-teen/teen girls behavior w/ADHD where the speaker said that girls with ADHD are often first identified late as teens and that the first obvious symptoms are depression and anxiety.  Can this behavior be exhibited in younger girls like at 8 or 9 yrs old.?  And is it common for this behavior at a much younger age? Our daughter is adopted and in counseling - learning to identify feelings. However, we don’t think everything is related to the adoption.  The behavior seen is:

Tantrums-screaming, saying "you don’t love me", "you don’t like me", "I wish I wasn’t here"
Destroying things during tantrums
Defiance
Disorganization
Poor judgment-punching her brother in the nose to show him a martial art move
Making poor decisions
Impulsive-can’t stop when told to

Thanks for your feedback.
Donna


Answer:

Dear Donna;

Thank you for sharing your concerns about your daughter.  I am glad to hear that she is in counseling because, from your description, her behaviors are severe enough to be a source of stress to your family.

Many, but not all, girls with AD/HD, do not demonstrate symptoms of hyperactivity and impulsivity and their symptoms are often overlooked when younger.  The typical younger girl with AD/HD often shows signs of inattentive behavior, but because she does not draw attention to herself by acting out, she does not receive the AD/HD diagnosis.

Some studies estimate that diagnosis of as many as 50% to 75% of girls with ADHD are missed. In addition, girls with ADHD are diagnosed on average five years later than boys—boys at age 7, girls at age 12. Five crucial years girls could be getting help are lost.  When, as a result of her inattention, she experiences school failure and peer rejection, the girl with AD/HD can become depressed and anxious.  The first diagnosis is often depression or anxiety and, following this, the underlying AD/HD may be discovered.  For further description about girls with AD/HD, please see the Ask A Specialist Archives from 2003 and the Resources section.

The concerns that you have described, are symptomatic of a child who is experiencing emotional disregulation and impulsivity.  These could be symptoms of a number of conditions including AD/HD hyperactive-impulsive or combined type, reactive attachment disorder (RAD), or depression or other mood disorder. Any of these disorders can produce symptoms that mimic AD/HD but could also be conditions co-occurring with AD/HD.  Regardless of the label, you will want to work with your child’s therapist to begin to help your daughter develop internal controls. 

Behavior is a form of communication.  Try to understand the purpose that your daughter’s behavior serves for her.  What does she want to get or what is she rejecting by engaging in disruptive behavior?  I do not know your daughter well enough to prescribe specific steps you should take, but I would suggest you share these questions with her therapist.

Many children who demonstrate explosive and defiant behaviors are demonstrating their need for limits.  Children who lack trust in the world around them for whatever reason, as well as children with executive function disorder, do best when provided with external structure that helps them learn to define limits. There is probably no easy, short-term fix. You may have to develop special parenting skills to use over the course of your child’s life.

One popular and effective strategy involves setting up a home “token economy.”  The token economy strategy is based on the premise that children’s behavior can be shaped by rewards and other consequences.  Children and Adults with Attention Deficit Disorder (CHADD) sponsors a series of educational classes,”Parent to Parent”, that include information about specialized behavior management strategies for families.  Dr. Russell Barkley also describes the steps to creating this type of program in his book, Taking Charge of ADHD. (See Resources.)

One simple strategy you can start with while developing those specialized behavior management skills is spending “special time” with each of your children.  “Special Time” is a strategy first described by Dr. Barkley.  Because many AD/HD children engage in activities which elicit a negative reaction, many parents of these children attempt to interact less often with them than with their typical children.  When interactions occur, they may be corrective or coercive in nature.  For this reason, many AD/HD children experience fewer rewards when relating to adults and therefore are less motivated to comply. 

In “Special Time”, parents choose a fifteen to twenty 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.  You should avoid asking questions or suggest other activities.  During the play period, your role is to describe the play activity in positive terms, ignoring any mildly disruptive behavior.  You might also want to spend periods of “Special Time” with your child’s typical siblings.  For more information about some basic ways to build a relationship with your child, see http://www.askaspecialist.ca.gov/archives/ADHD/2008.html

Love and Logic  is another specialized approach that you might want to explore.  The parenting component, Parenting with Love and Logic by Jim Faye and Foster W. Cline, M.D. is based on the premise that we should "lock in our empathy, love, and understanding" prior to telling kids what the consequences of their actions will be. The parenting course, Becoming a Love and Logic Parent, aims to teach parents how to hold their child accountable.. This method causes the child to see their parent as the "good guy" and the child's poor decision as the "bad guy." The goal is for the child to develop an internal voice that says, "I wonder how much pain I'm going to cause for myself with my next decision?" The Love and Logic approach suggests that children who develop this internal voice become more capable of standing up to peer pressure and taking responsibility for their actions.
Dr. Ross Greene suggests another alternative called Collaborative Problem-Solving (CPS). CPS is based on the premise that if the child could do well, they would do well. In other words, if your daughter had the skills to demonstrate adaptive behavior, she would not be exhibiting challenging behavior because doing well is always preferable to not doing well.  Dr. Greene suggests an alternative to rewards and punishments, believing that challenging behavior is a result of “lagging skills and unsolved problems.”  Your role as a parent becomes that of coaching your child in problem-solving and teaching her new behavioral skills.

Finally, you may be interested in checking out “The Incredible Five Point Scale.”  Originally designed for children with symptoms on the autism spectrum, this strategy teaches the child to use a visual support to recognize impending explosive behavior and make an appropriate choice about how to express their frustration, anger, or anxiety.

Resources about girls with AD/HD:

Adams, Caralee. Girls and ADHD: Are You Missing the Signs? Scholastic Instructor online edition. http://www2.scholastic.com/browse/article.jsp?id=11532

Gent, S. Ask A Specialist Archive, 2003. California Department of Education. http://www.askaspecialist.ca.gov/archives/ADHD/2003.html

 

Quinn, P. & Nadeau, K. Understanding Girls with ADHD, Part 1. National Center for Gender Issues and ADHD, Monograph Series. http://www.ncgiadd.org/pdf/GirlswithADHD.pdf

Resources for home behavioral strategies:

Barkley, R. (2000) Taking Charge of ADHD: The Complete Authoritative Guide for Parents, Revised Edition. New York, New York: Guilford Publications.

Buron, K.& Curtis, M. (2003) The Incredible Five Point Scale. Shawnee Mission, KS: Autism Asperger Publishing Company.  Although this book was originally designed to use with children who have symptoms on the autism spectrum, the strategy can be easily adapted for any child with emotional regulation or anxiety difficulties.

Children and Adults with Attention Deficit Disorder (CHADD). www.chadd.org This group offers “Parent to Parent” training throughout the country both in person and online.  Training in designing home behavior management systems is shared by trained parents of children with AD/HD.

Cline, F.& Faye, J. (2006) Parenting with Love and Logic, New Edition. Navpress Publishing. More information about training available at www.loveandlogic.com

Gent, S. Ask A Specialist Archive, 2008. http://www.askaspecialist.ca.gov/archives/ADHD/2008.html

Greene, R. (2010) The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. New York, New York: Harper Collins.  This is the classic resource for parenting acting out children.


  • Reasons why we see an increase in ADHD

Question:

Hi, Shari-

I have heard that the rate of ADHD has gone up to almost 10%.  What is the reason for the increase?  Are environmental toxins playing a role here?  How can a tenth of our children have a mental disorder like this?

Evelynn, Resource Specialist


Answer:

Dear Evelynn;

The new statistics you mention are based on a telephone survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) as part of the National Survey of Children’s Health, a landline study. This survey took place in 2007 and results were reported in the Morbidity and Mortality Weekly Report, November, 2010. A previous and similar study by the same agency took place in 2003. The conclusions about an increase in reported incidence came from a comparison between the two surveys. 

The CDC reported an increase of approximately 3% per year from 1997-2008.  The greatest increase was in the 14-17 year old age range. This brings the current incidence of parents reporting that their child has been diagnosed with ADHD, to about 9.5%

Research continues to be conducted to investigate why the increase has taken place.
When interpreting the increase, be sure to consider the difference between the number of children reported to have ADHD and the number who actually have the disorder. Whether the increase in reported incidence is simply related to changes in diagnostic practices and public perception about ADHD or to an actual increase in the number of cases of childhood ADHD is not clear.  Therefore, tying the increase to any particular cause such as environmental toxins is premature.

The CDC reported that the incidence seems to increase moving across the country from west to east – the east coast has the highest reported rates.  Nevada has the lowest reported incidence, California the second lowest. North Carolina has the highest reported incidence at 15.6 %. The CDC’s hypothesis about the reasons for the increase has been:

  • Possible stepped up developmental screening efforts
  • Increased awareness campaigns
  • Less stigma surrounding ADHD
  • Better portfolio of treatment options

 

They postulated that the great differences between states are related to:

  • Differences in state-based policies, for example health insurance coverage
  • Difference in demographic risks across states, ie, poverty
  • State based efforts around developmental screening and quality improvement
  • Differences in the practice patterns across states (who treats AD/HD)

 

Environmental toxins have not yet been demonstrated to be linked to the increase in reported ADHD. However, four studies published in 2010 found children’s symptoms of ADHD to correlate significantly with the amount of insecticide or other chemical residues in children’s blood, urine, serum, cord blood or their mother’s gestational blood. 

Although the studies do not conclusively provide a link, the author of a study on pesticides suggested that the most likely source of the insecticide residue was fruits and vegetables, especially unwashed produce.  The study on cord blood found an increase in ADHD symptoms when children exposed to polychlorinated biphenyls (PCB’s), chemicals leaking from materials used in construction, industry, and consumer products. A study of polyfluoroalkyl (PFC’s) found significant correlation between child serum levels at age twelve to fifteen and a diagnosis of ADHD.

The studies have a number of limitations that preclude making a direct link that would establish that the toxins directly caused AD/HD. For example, mothers exposed to these chemicals while pregnant may also have experienced other health hazards that are the real cause. Environments contaminated with the chemicals may also be contaminated in other ways, such as with heavy metals, that may not have been factored out in the studies. In some cases, the tests were not done on the actual chemicals, but on the breakdown of the chemicals.  In some of the studies, some checklists that were used for identifying ADHD were not up to date and may not have reflected a true diagnosis of ADHD. (Arnold)

Although direct causality between chemical exposure and ADHD cannot be proven at this time, Dr. Arnold recommends that we all take some common sense precautions:

  • Wash fruits and vegetables thoroughly using soap or other cleansing method.
  • If organic produce is too expensive to purchase, consider limiting purchase of organic items to those that cannot be scrubbed such as leafy greens and berries.  Wash these gently.
  • Check with your local water company to find the results of tests that are done for possible contaminants in your drinking water.
  • Thoroughly air out for a day or two any freshly painted or newly carpeted area.
  • Use household insecticides sparingly.  Try alternatives such as boron or electric bug zappers.

 

Resources

For the general reader:
Arnold, L. Do Environmental Toxins Contribute to ADHD Symptoms? Attention December, 2010. 

Centers for Disease Control and Prevention. Increasing Prevalence of Parent-Reported AD/HD Among Children United States, 2003-2007. Morbidity and Mortality Weekly Report. November 12, 2010 / 59(44);1439-1443
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm?s_cid=mm5944a3_w

Primary research:
Bouchard MF, Bellinger DC, Wright RO, & Weisskopf MG. Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides. Pediatrics, June 2010, 125(6). May 17, 2010, Online Early.

Bridget M. Kuehn. Increased Risk of ADHD Associated With Early Exposure to Pesticides, PCBs. Journal of the American Medical Association, July 7, 2010, 304(1).

Hoffman K, Webster TF, Weisskopf MG, Weinberg JV, Verónica M. Exposure to Polyfluoroalkyl Chemicals and Attention Deficit Hyperactivity Disorder in U.S. Children Aged 12-15 Years. Environmental Health Perspectives, June 15, 2010, Online Early.

Marks AR, Harley K, Bradman A, Kogut K, et al. Organophosphate Pesticide Exposure and Attention in Young Mexican-American Children. Environmental Health Perspectives, August 19, 2010, Online Early.

Sagiv SK, Thurston SW, Bellinger DC, Tolbert PE, et al. Prenatal Organochlorine Exposure and Behaviors Associated With Attention Deficit Hyperactivity Disorder in School-Aged Children. American Journal of Epidemiology, January 27, 2010, Online Early.