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Attention Deficit Hyperactivity Disorder 2016-17

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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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  • new!New Federal Guidelines Regarding ADHD

In July 2016, on the anniversary of the Americans’ with Disabilities Act, the US Department of Education issued new guidance for public schools regarding ADHD. Diagnosing and providing services for ADHD has long been somewhat murky territory for schools. IDEA 2004 specifies thirteen categories that may qualify for special education services. ADHD is not specifically called out as one of these categories, but is included under “Other Health Impaired.” A student with ADHD may also qualify under the categories of Specific Learning Disability (SLD) or Emotional Disturbance (ED), if they meet the criteria applicable to those categories.

In addition, even if a student does not qualify for special education services, he or she may qualify for accommodations under Section 504 of the Rehabilitation Act of 1973. According to the Office of Civil Rights (OCR) (see Press Office in Resources), in the past five years, over 16,000 complaints have been filed alleging discrimination on the basis of disability in elementary and secondary education programs. More than 10 percent of these involve allegations of discrimination against students with ADHD. The most common complaint has been regarding academic and behavioral problems these students experience when they are not evaluated for a disability in a timely or proper manner, or when they do not receive needed special education or related supports and services.

The thirty-five page “Resource Guide on Students with ADHD” includes an overview of Section 504, Americans with Disabilities Act (ADA), and IDEA requirements. The bulk of the “Resource Guide” details how schools must identify, evaluate, make placement determinations about students with ADHD, and otherwise ensure nondiscrimination under Section 504. Highlights of specific requirements outlined for school districts when providing supports and evaluations under Section 504 include:

  • Section 504 requires a school district to identify and conduct an evaluation of any student who needs or is believed to need special education or related services because of a disability. The evaluation must be conducted in a timely and appropriate manner and may not reflect mistaken assumptions based on gender, race or ethnicity.
  • Schools must consider the presence of a disability broadly. Extensive analysis is not required. If a student has been diagnosed with ADHD the Office of Civil Rights (OCR) will presume that that student has a disability, and qualifies for protection under Section 504. The district must provide evidence to the contrary should it choose not to provide protection.
  • School districts are advised not to rigidly require the collection of intervention data as might be typical under Response to Intervention when this might delay the evaluation. “It would be a violation of Section 504 to delay the evaluation in order to first implement an intervention that is unrelated to the evaluation, or to determining the need for special education or related aids and services.”
  • A medical evaluation is not required to identify a student as having ADHD for the purposes of Section 504 eligibility. If a school district chooses to make a medical diagnosis necessary, the district must provide this at no cost to the family.
  • Evaluations must include any possible co-existing disorders related to ADHD that may affect the type of services a student should receive. Up to 70% of students with ADHD have co-existing conditions that can include depression, anxiety, and learning disability among others. The Guidance cites depression as an example. A student with ADHD who is easily distracted and unfocused may have a need for behavioral and executive function supports to improve focus and organizational skills. The student who presents with ADHD and depression may have these needs along with the need for additional supports to address issues such as lethargy and withdrawal.
  • When evaluating students with ADHD who achieve a high level of academic success, school districts need to consider whether the student may be still be substantially limited in a major life activity due to the time and effort the student must spend to read, write or learn compared to students without ADHD. Students with behavioral or social problems without specific academic difficulty may still be eligible for 504 protection.
  • Mitigating measures such as medication and outside tutoring cannot be used to exclude a student from eligibility.
  • Although Section 504 does not provide funding for services, Section 504 services are not and should not be limited to services that are free or low cost to the school district and can include services that are also provided under IDEA such as special education or related services if these services are necessary to receive an appropriate education under Section 504.

It is important for both parents and schools to be aware of the Guidelines. New, clearer guidelines for providing services and supports for students with ADHD will reduce confusion and hopefully make the process of evaluation and support easier and more efficient for school districts while ensuring that the rights of students are protected.

Resources:

Alpern, I.; Durheim, M.;Cohen, M. (December 2016) ”What Does the New Guidance Mean for Students with ADHD?” Attention Magazine, Volume 23, No. 6. CHADD.org

US Department of Education, Office for Civil Rights (July 2016). Dear Colleague Letter and Resource Guide on Students with ADHD. Available at https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201607-504-adhd.pdf

US Department of Education, Office for Civil Rights (July 2016). Know Your Rights: Students with ADHD. Available at https://www2.ed.gov/about/offices/list/ocr/docs/dcl-know-rights-201607-504.pdf

US Department of Education Press Release. July 26, 2016 available at https://www.ed.gov/news/press-releases/us-department-education-releases-guidance-civil-rights-students-adhd

  • Teen substance abuse and ADHD

Question:

My 16 year-old daughter with ADHD, is depressed, failing school, and was expelled for marijuana in early October. She has a long history of over reacting to social problems, feeling persecuted, and we have tried moving her from school to school.

She refuses psycho-therapy, but has been quite responsible in keeping a new medication regimen of Prozac and Adderall from the pediatrician she has seen all her life. My wife and I had no choice but to move her yet again to an online school after expulsion. She refuses to try another traditional school, for fear she can’t make friends, embarrassed that she will always be an odd ball. She admits she is terribly isolated with no SPED support or real teaching interaction, and is failing again. She lies about participating in live online classes which are required then becomes combative and locks herself in her room. She won’t read her English texts, admits to needing tutors, then refuses them. Ironically, she maintains good relations at summer camp, away from home, for whole summers, five years, same camp. This past summer, she applied, was accepted and was great as a Counselor in Training (CIT) at the same camp. She stays in contact with other campers throughout the year.

Help! She is kind, bright and engaging, never disrespectful to teacher or students whom she feels hate her, but won’t show up for help offered...now logistically unavailable in online school. Tough love? Let her fail and dropout of school at sixteen? Please suggest any guidance...we are losing her and desperate...but she can’t see the long term real life peril of her behavior.

Please offer any suggestions.
Corey


Answer:

Hello Corey-
I am sorry to hear about your daughter’s difficulties. This must be a difficult situation for you and your daughter and your whole family. I don’t know your daughter so it’s difficult for me to offer specific advice, but some suggestions might be helpful.

By acting out and refusing support, your daughter may be trying to communicate her frustration with academics. She may not believe that she can be successful. Ninety percent of students with ADHD have academic problems. In addition to ADHD, your daughter may have additional learning disabilities that have not been detected. One option to consider is obtaining additional assessment to assist in identifying any other difficulties that may be interfering. University medical clinics often offer assessment focusing on ADHD and possible co-existing learning disabilities or other conditions that are common with ADHD. Age sixteen is a good time to update her assessment as she will need a recent assessment should she be interested in receiving accommodations for College Board testing or college/community college.

Teens with ADHD are at a 2.5 times higher risk for substance abuse than typical teens. Teens with ADHD are 1.5 times more likely to abuse marijuana than typical teens. (Harstad & Levy, 2014). Notwithstanding the fact that several states have legalized recreational use of marijuana by adults, research indicates mixed results on the long term effects of marijuana on brain development. Many studies show increased risk of damage to both white and grey matter resulting in reduced memory and executive abilities, particularly for those who begin using before age 16 (2015, Weir.) Fortunately, your daughter is willing to take medication, which offers some protection against substance abuse; however, the dose she is receiving may need to be re-evaluated. Teens often self-medicate when the medication is not adequate. Having your daughter’s medication re-evaluated would give her a new opportunity to re-connect with her pediatrician who she seems to trust. If possible, it might be a good idea for you to conference with her doctor also to express your concerns and share with him/her the current challenges.

Research exists to indicate that cognitive-behavioral therapy and other forms of family therapy can be successful in treating substance abuse in teens with ADHD. (Slesnick, Kaminer, Kelly, 2008 cited in “Substance Abuse and ADHD”, www.chadd.org .) Since your daughter is not willing to participate in therapy, perhaps you and your wife might be able to set an example by seeking out therapy and support to help you cope with her difficulties. Children and Adults with Attention Deficit Disorder (CHADD) offers online and in person support groups for families where you can connect with others experiencing similar challenges. The CHADD website (www.chadd.org ) also offers much practical information about the effects of and ways to cope with ADHD. CHADD also offers trainings in person and online that teach about behavioral strategies for teens with ADHD. “Parent to Parent” trainings are presented by other trained parents who have experienced family life with children with ADHD. An additional online resource, www.understood.org , offered individualized information about learning and attention issues.

Your family may need to learn to structure your home and daily schedule to support appropriate behavior for your daughter. For example, you may need to set up a system of rewards and privileges that are contingent on appropriate behavior. If possible, it is best to work with a therapist well-versed in behavioral techniques for teens. Above all, remember not to personalize your teen’s behaviors. Instead remember, that in most cases, it is not your daughter, but her ADHD which presents a barrier to learning.

I hope this short response points you in the right direction for beginning to make positive changes in your daughter and family. Please keep me posted about your progress.

Best, of luck,

Shari

References:
Harstad, E. & Levy, S. (2014) “Attention Deficit/Hyperactivity Disorder and Substance Abuse.” Pediatrics. July 2014, Vol. 134, Issue 1

Weir, K. (2015) “Marijuana and the Developing Brain.” American Psychological Association. November 2015, Vol 46, No. 10. Print version: page 48

  • Is it too late to be evaluated for ADHD?

Question:

I am an Instructional Aide for RSP at an elementary school. However, I am interested in finding out if a high school senior can have a 504 classification made initially in elementary school reevaluated now or is it too late? I'm asking this because my friend's daughter is at risk of failing her senior year and not graduating but she was identified as being covered under 504. She has not received any accommodations during her time in high school. I also don't know for what, specifically, but suspect given her learning difficulties that it could be due to ADD or ADHD. Her mom believes it's too late to prevent her daughter from failing and has resigned herself to her daughter having to repeat senior year. I hope this is not the case and that this particularly talented and kind student is not forever discouraged about being successful in an academic environment.

Thanks,
Onethia

Recent update:
Thank you so much for responding. She almost didn't graduate but made it at the last minute. Now she's at a community college. She is struggling with math and has voiced frustration about this. Her mother has said that the school district doesn't have record of the 504. She believes that getting her daughter a tutor is sufficient. However, can the student still be reevaluated even though records have been lost or misplaced? Thanks again.


Answer:

Hello Onethia-

Bravo to you for advocating for your friend’s daughter! It is never too late to be evaluated for ADHD. In fact, senior citizens often search out evaluations and find that receiving appropriate treatment transforms their lives, addressing problems they have had since childhood. At least 75% of children with ADHD continue to experience symptoms into adulthood.  In addition to academic difficulties, untreated teens and adults with ADHD are at risk for automobile accidents, risky sexual behavior, and substance abuse. Adolescent girls and women are at risk for depression and eating disorders. Untreated adults have inconsistent performance in the workplace and relationship problems. Of course the earlier that appropriate treatment is received, the sooner quality of life can be improved. Getting appropriate support for ADHD involves much more than 504 accommodations, and a student or adult can definitely be evaluated even when past records are unavailable.

If your friend chooses to have her daughter evaluated by a physician and he or she finds that medication is appropriate, your friend’s daughter may discover that she is better able to concentrate and to persevere on academic tasks. Depending on the type prescribed, medication may be helpful in minimizing mood swings. There is some evidence to indicate that some medications may improve working memory. In addition, medications improve hyperactivity and sometimes improve gross and fine motor coordination. Stimulant medication treatment is effective in these areas for up to 80% of individuals with ADHD. However, medication will not automatically improve grades or organizational skills. These are areas that still need to be addressed through accommodations and direct instruction.

Your friend’s daughter can be assessed by a physician, child and adolescent psychiatrist, clinical psychologist, clinical social worker, or neurologist. Depending on school district policy, preliminary screening can take place at school or at the disability services center of a community college. However, a comprehensive ADHD assessment should differentiate for health conditions such as some thyroid conditions that can mimic ADHD symptoms, for learning disability, and for other mental health conditions. In your friend’s daughter’s case, screening for learning disability in mathematics would be especially important. As mentioned above, past record of evaluation is not essential; however, some information about your friend’s daughter’s relevant history will be required. If the daughter consents, her mother, you, or other persons can participate and provide evidence of past concerns.

Good luck to you and your friend! I hope your friend’s daughter is able to receive the support she needs.