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Attention Deficit Hyperactivity Disorder Archive 2015-16

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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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  • Positive behavioral support and school discipline

Question:

Hello!

I have an inquiry about my six year old son who was recently diagnosed with ADHD, predominately inattentive.

As of last month, he has begun his 504 plan and is benefiting from reinforcements by using a class schedule chart and earns a star per each productive period. He has been doing MUCH better with the exception of transitioning from recess to the classroom. The punishment is via a school wide procedure of getting a warning by turning to a “yellow card” on the classroom behavioral chart and then to a “red card” after a warning. The red card means the child gets detention during lunch or after school. He has had 6 this year alone. I feel this very subjective and is not effective in creating self-management skills in my child who so greatly needs assistance in that area.

Can I opt out of a school-wide behavioral chart and replace it with a positive behavioral intervention? Can I get that legally documented on his 504 plan to safeguard my son from external modes of control and promote his executive functioning with positive methods? It can even be something as simple as taking his name off of the chart and when something happens, to ask him “what would be a better choice?” It doesn’t need to be fancy, but it shouldn’t be humiliating and punitive.

Thanks!
Nicolle


Answer:

Hello Nicolle-

Your concerns about teaching your child the appropriate behavior are well-founded. Punishment is a reactive strategy that generally is not effective in teaching skills that a child has not developed. At age six, your son likely has not had experienced success in transitioning and the skill may not be well established. In addition, children with ADHD are often up to 30% delayed when compared to their age peers in social relationships and self-control, also known as “executive function.” The transition from an unstructured setting to a structured setting is the most problematic type of transition for students with ADHD. Transitioning from recess back to a classroom activity is one such transition. While the loss of recess or lunch privileges may be effective for the majority of children, children with ADHD may not have the prerequisite skills to change their transition behavior in response to a negative consequence.

Proactive strategies are generally more effective than reactive strategies. Proactive occur when the antecedent rather than the consequence is changed. By “antecedent” I mean those events that occur in the environment before the problem behavior occurs. Behavior is communication. Students engage in both desirable and disruptive behavior in order to either “get” or “avoid” something, generally attention, a particular desired object or sensory stimulation. For example, the child who makes disruptive noises in the classroom may be communicating that he needs more social attention from his peers, or may be communicating that the work is too hard and he needs help. The child who runs around the room upon returning from recess, may be communicating that he is having difficulty calming down after the excitement or recess or that he does not remember what he needs to do when he re-enters the room.

When those strategies used universally for all students (Tier 1) are not effective in promoting positive behavior, a functional behavioral assessment (FBA) should be considered. An FBA would pinpoint the observable disruptive behavior and explore the reasons why, or the function for your son’s difficulty transitioning from recess to class. After pinpointing the function for the behavior, a good FBA will also suggest an appropriate “replacement behavior” that serves the same function for your son but is more prosocial. This functionally equivalent behavior is sometimes referred to as a “FERB.”

Since I have not conducted an FBA of your son’s return from recess, I do not know the observable behaviors he demonstrates or their function. However, some examples of replacement behaviors in general are:

Example problem behavior

FERB

Running around the room after recess

Engage in a deep breathing exercise before entering the room

Wandering around the room talking to peers

Use a checklist of steps to take to engage in and activity

Student tears up paper when frustrated

Use a visual such as an emotional thermometer to identify frustration and follow a specified procedure for dealing with it such as asking for help or using a multiplication chart.

Since detention, the intervention generally used for most students has not worked for your son, you may want to consider requesting an FBA and Behavior Intervention Plan (BIP.) Depending on your situation, requesting an assessment may be a more effective strategy than asking to “opt-out” of the intervention most students receive. You may want to consider putting your request in writing and listing the reasons for your concerns.

  • How to prevent lost assignments in elementary/middle school

Question:

Hello Shari-

My ten year-old son has been diagnosed with ADHD. Right now, the biggest problem is that although he does his homework (I always check to be sure it’s done) the papers never get to school. I don’t know where they go! Either they fall out of his binder – he won’t put on hole reinforcers - or he doesn’t turn them in. It’s really frustrating as he doesn’t get any credit for doing his work when both he and I know he did it.  So you have any suggestions?

Fran


Answer:

Hi Fran-

This is a common problem for many children with ADHD.I would like to suggest approaching it in two ways: first, by exploring a secure physical means to transport papers back and forth to school and second, by recruiting the cooperation of your son’s teacher to create a transportation plan.

Unfortunately, the typical binder used by elementary school children does not trap papers inside. When you purchase a binder, consider buying a zipper type binder like the one below:


Other advantages of this type of binder are that there is a zippered pocket to hold pencils, calculator, phone, etc., and a tabbed pocket for additional papers.

An alternative is the portfolio binder. All your son need do is drop the papers into the appropriate slot. No need to open and close the ring. The only disadvantage of this type of paper transport system is that there is no pocket option for carrying pencils and pens. However, you may be able to do this in other ways.


One specialized portfolio by Pendaflex is color coded for easy filing by subject.


It will be important for you to communicate with your son’s teacher about performing a daily binder check before school and after school. This need not be done by the teacher him or herself if they object, although that would be ideal. There may be a resource specialist or paraprofessional that would be able to check with your son for five minutes before school. The before class binder check will determine if he has successfully transported his work to school without loss. If he does not have all his homework at the beginning of the day, depending on your arrangement you may want to have the teacher text, email and/or phone you or have your son re-do missing work on the spot before entering class or during a free period. If he has actually finished the homework once, doing it again, should be easy, though probably not much fun. Thus there are some natural and concrete consequences for losing the work.

The teacher will need to communicate with you about the work coming home. When your son arrives home, check to be sure he has everything he needs. You may want to set up a buddy system with a classmate so he can get copies of anything he is missing from his friend.

  • “Where’s My Notebook” podcast.

Question:

I heard you on the “Where’s My Notebook” podcast and I wanted to know if you have a copy of a letter to issue to the teachers for best practices? I really enjoyed your podcast; you were very knowledgeable. Thank you for your work to assist us on this journey!!!

Annetta


Answer:

Hello Annetta-

Before I describe the letter in more detail, I’d like to recommend a resource you should know about. Children and Adults with Attention Deficit Disorder (CHADD) is a nonprofit organization that provides support and advocacy for individuals, families and professionals coping with the impact of ADHD. Local volunteers, very often parents of children and teens with ADHD facilitate in person support groups locally.

The CHADD website is chock full of useful and well-researched information about ADHD in general and about educational and parenting strategies. In particular, you will be interested in Parent to Parent Training (P2P) that is offered at local CHADD chapters and “on demand” in an online course. One topic covered in P2P is how to put together an information letter and/or packet about your child for the teacher at the beginning of the year. Please visit the link below for more information about this free training:

Often I recommend that parents prepare a letter and information about their child to share with their child’s teacher at the beginning of the year. The purpose of this letter is to share enough personal information that the teacher can establish a personal connection and relationship with your child, to make the teacher aware of your child’s IEP goals and/or Section 504 Plan accommodations, and to open up the opportunity for further regular communication. Be sure to send a copy of this letter to all teachers involved and consider sending it to coaches, school counselor, after school caretakers, and other extracurricular activity advisors.
Consider including these points in your letter:

  • Parent(s) names and address or addresses. Be sure to include both parents if you live separately and have joint responsibility for making educational decisions.
  • Phone and fax number and e-mail address. Clarify the best way and times you can be reached. Be sure to let the teacher know that she or he is welcome to contact you.
  • Your child’s extracurricular interests and hobbies in a few short sentences.
  • The overall IEP goals and/or accommodations given to your child. Do not write lengthy descriptions of these as they are available in the legal documents and your child’s busy teacher will appreciate a short, simple description.
  • A brief description of any formal behavior plan you child may have. You may want to mention some ideas that may have worked for you at home, also.
  • Suggestion for a home-school communication system, such as through e-mail or via notebook. Suggest something that is realistic for you and be open to alternatives.

Think about including a digital picture of your child in your letter. You may also want to attach a printed article about the typical educational impact of ADHD and executive function disorder. Many teachers are not aware that ADHD can affect the way that a child processes information in addition to behavior. The article “Ten Myths about ADHD And Why They Are Wrong” by Thomas Brown is in the public domain and can be easily downloaded from “Attention Magazine” on the CHADD website here:

http://www.chadd.org/Membership/Attention-Magazine.aspx

You might consider directing your child’s teacher to the CHADD website which contains a series of videos entitled “Tips for Teachers” at this web page:

http://www.chadd.org/Understanding-ADHD/For-Professionals/For-Teachers/Tips-for-Teachers-Video-Series.aspx

With education, parents can serve as an “expert” resource for their child’s teacher. After all, parents are in a position to know their children and see their growoth over the course of many years. I wish you the best in search to provide a quality education for your child.

  • Qualifying a Student with ADHD for Special Education

Question:

Hi Ms. Gent,

I am a graduate student, and I had a question about the qualifications for ADHD (in terms of qualifying for an IEP). Currently we've been learning that children with ADHD who need special education typically qualify for special education under the Other Health Impairment category. However, in talking with my site supervisor, he indicated that he will sometimes try to qualify them under Specific Learning Disability with the processing deficit of Attention/Executive Functioning. In your professional opinion, which category tends to be the "better fit" for these students.

Thanks so much,

Olivia


Answer:

Hello, Olivia-

What a great question!  In my experience, the best designation depends on the needs and characteristics of the student.  Generally speaking, students can more easily qualify under Other Health Impaired, but changes following IDEA 2004 have made the category of learning disability (SLD) more inclusive. Emotional Disturbance (ED)is a third category that may be appropriate for a student with ADHD when that student has coexisting mental health conditions or has extreme issues with emotional regulation. My response will focus on the two categories in your question.  In considering the appropriate category, remember that Attention-Deficit/ Hyperactivity Disorder (ADHD) itself is not one of the thirteen federal handicapping conditions under IDEA-2004.

In California, a key issue affecting eligibility of students with ADHD as learning disabled is the traditional discrepancy model. Under this model, the school must show a discrepancy between ability and achievement of 1.5 standard deviations using standardized tests. California is now encouraging a voluntary change to looking at how a student responds to successive interventions before qualifying that student as “disabled.”  In the past, using the discrepancy model, especially when this is restricted to standardized testing, limited the number of students with ADHD eligible as SLD.

Under California Administrative Code, tit. 5, § 3030, a child can qualify as having “Other Health Impairment” (OHI) when he or she has:

limited strength, vitality or alertness, including heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment that:

A. Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

B. Adversely affects a child’s educational performance.

Notice that the law is not very specific as to what constitutes “adversely affects” leaving it open for interpretation. This makes it easier to qualify a child for services when the child’s problems are related to executive functions affecting work completion and ability to focus attention.

The criteria for learning disability are somewhat more specific and complex.  The student must have a disorder in one or more basic psychological processes “involved in understanding or in using language, spoken or written, that may have manifested itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations”.  As your site supervisor mentioned, “attention” is listed among other basic psychological processes. 

A. The learning problem cannot be the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage.

B. The public agency involved in determination of eligibility “may consider whether a pupil has a severe discrepancy between intellectual ability and achievement” in a variety of areas.

C. Whether or not a student has a significant discrepancy should “take into account all relevant material which is available on the pupil. No single score or product of scores, test or procedure shall be used as the sole criterion for the decisions of the IEP team as to the pupil’s eligibility for special education.”

The law then goes on to describe how to determine “significant discrepancy” in a very specific way. The first way is through the use of standardized tests.  The law makes clear that no one test should be used. The exact statistical requirements are described:

A severe discrepancy is demonstrated by: first, converting into common standard scores, using a mean of 100 and standard deviation of 15, the achievement test score and the intellectual ability test score to be compared; second, computing the difference between these common standard scores; and third, comparing this computed difference to the standard criterion which is the product of 1.5 multiplied by the standard deviation of the distribution of computed differences of students taking these achievement and ability tests. A computed difference which equals or exceeds this standard criterion, adjusted by one standard error of measurement, the adjustment not to exceed  4 common standard score points, indicates a severe discrepancy when such discrepancy is corroborated by other assessment data which may include other tests, scales, instruments, observations and work samples, as appropriate

In practice, many school districts stop here, feeling that to qualify a student, they must use standardized test results. However, the law clarifies further, now allowing the districts to use other measures:

(C) If the standardized tests do not reveal a severe discrepancy as defined in subparagraphs (A) or (B) above, the individualized education program team may find that a severe discrepancy does exist, provided that the team documents in a written report that the severe discrepancy between ability and achievement exists as a result of a disorder in one or more of the basic psychological processes. The report shall include a statement of the area, the degree, and the basis and method used in determining the discrepancy. The report shall contain information considered by the team which shall include, but not be limited to:

1. Data obtained from standardized assessment instruments;

2. Information provided by the parent;

3. Information provided by the pupil's present teacher;

4. Evidence of the pupil's performance in the regular and/or special education classroom obtained from observations, work samples, and group test scores;

5. Consideration of the pupil's age, particularly for young children; and

6. Any additional relevant information.

(5) The discrepancy shall not be primarily the result of limited school experience or poor school attendance.

Achievement is often assessed under optimal conditions for the student with ADHD. Testing is usually done in a quiet environment with 1:1 attention. Because of this, the student with ADHD may not demonstrate a discrepancy between ability and achievement during eligibility testing. Yet they may be failing in school because they are not turning in work or because the classroom environment is full of distractions not present in the testing situation. Therefore, when exploring SLD as a possible qualifying condition, it is important to look at 4) evidence of the pupil’s performance and 6) any additional relevant information.  Work samples and records of assignments completion are especially relevant.

The California Department of Education (CDE) strongly encourages districts to implement Multi-Tiered Systems of Support (MTSS.) This system looks at effect of successive interventions on the student’s performance to rule out poor instruction as a cause for the child’s school difficulties. Ideally, a child will have the opportunity for targeted small group instruction in his or her area of weakness. For example, if a student has difficulty completing work due to executive function difficulties, they may have small group intervention that focuses on this skill.

In summary, if attempting to qualify a student as SLD, be sure to take into consideration factors other than formal testing. If a student still does not seem to qualify, but really needs an individualized education plan, by all means also consider OHI criteria. Many times, although a student is found eligible as SLD, the problem is not academic skills but executive functions. Be sure to address these in the student’s goals. The actual category is not as important as getting the student the services he or she needs.