chapter15

If you’re among the many parents who first learned of their children’s behavior problems through teachers, you already know that children with ADHD have some of their greatest difficulties in adjusting to the demands of school. Numerous studies show that the vast majority of children with ADHD are doing substantially worse in school than typical children in the same grade. A third or more of all children with ADHD will be held back in school in at least one grade during their educational career, up to 35% may never complete high school, and their academic grades and achievement scores are often significantly below those of their classmates. Between 40 and 50% of such children will eventually wind up receiving some degree of formal services through special education programs, such as resource rooms, and up to 10% may spend their entire school day in such programs (known as self-containing programs). Complicating this picture is the fact that more than half of all children with ADHD also have serious problems with oppositional behavior. This helps explain why between 15 and 25% of such children will be suspended or even expelled from school because of their conduct problems.

A 2011 study by Dr. Michelle Demaray and Lyndsay Jenkins at Northern Illinois University found that children with ADHD differed from typically achieving children in four major areas in their school functioning: poorer engagement with academic work, poorer social skills, less motivation to learn and do well in school, and worse study skills. Problems in these areas were directly related to the degree of difficulty the children were likely to be having in school.

Teachers frequently respond to the challenging problems exhibited by children with ADHD in these and other areas of school performance by becoming more controlling and directive. Over time, their frustrations with these difficult children may make them more hostile in their interactions as well. While we are not sure how negative child–teacher relationships affect the long-term adjustment of children with ADHD, experience tells us that they can certainly worsen the already poor academic and social achievement of these children, reduce their motivation to learn and participate in school, and lower the children’s self-esteem. All of this may ultimately result in school failure and dropping out.

A positive teacher–student relationship, to the contrary, may improve a child’s academic and social adjustment, not only in the short term but also over the long term. Adults who were diagnosed with ADHD as children have reported that a teacher’s caring attitude, extra attention, and guidance were “turning points” in helping them overcome their childhood problems.

The fact is that the single most important ingredient in your child’s success at school is your child’s teacher. It is not the name of the school program your child is in, the school’s location, whether the school is private or public, whether or not it is relatively wealthy, or even the size of the class. It is first and foremost your child’s teacher—particularly the teacher’s experience with ADHD and willingness to provide the extra effort and understanding your child will require for a successful school year. In 2008, Dr. Jody Sherman and colleagues at the University of Alberta, Canada, published a review of the scientific and clinical literature on what factors or characteristics of a teacher were important to the school success of a child with ADHD (Educational Research, Vol. 50, No. 4, pp. 347–360). Among the most important factors they identified were teacher patience, knowledge of ADHD, knowledge of useful teaching techniques for managing ADHD in the classroom, ability to collaborate with an interdisciplinary team on the child’s treatment, and positive attitude toward children with special needs.

The difference that your child’s teacher can make is illustrated in a 15-year-old’s poignant account of his school history in the sidebar in this chapter (Attention Deficit through the Eyes of a Child). So you should not wait until August to find out who will be your child’s teacher for the coming school year. Nor should you allow some computer or school bureaucrat to make a random selection. You should start negotiating with the principal for the best possible teacher for the next academic year as early as March or April.

The main focus of this chapter, therefore, is on how to find the best teacher—and, should the available teachers be unfamiliar with the methods that help children with ADHD succeed in school, on how to help them gain that knowledge to serve your child best. The rest of the chapter addresses secondary matters that are nonetheless commonly of concern to parents: what to look for in a school, classroom structure and curriculum, what type of placement is best for children with ADHD, and whether retention (especially in kindergarten) is likely to serve a child’s interests.

Attention Deficit through the Eyes of a Child
by Alan Brown, age 15

I often wondered why I wasn’t in group time in kindergarten. The teacher sent me in the corner to play with a toy by myself. Because of being singled out, I didn’t have many friends. I was different, but I didn’t know why or what it was. Toward the middle half of first grade the teacher called my mom in for a conference. She was telling my mom, “I’m always having to call on Alan. ‘Alan, be still, please. Yes, you can sharpen your pencil for the third time. You have to go to the bathroom again?’ ” That evening my teacher educated my mom. She told my mom about attention deficit disorder (ADD). [Author’s note: ADD as Alan uses the term here is ADHD (or ADD with hyperactivity, as it was formerly defined by the American Psychiatric Association), not ADD without hyperactivity as described in Chapter 7.] My teacher suggested taking me to the doctor and letting him run some tests. Mom and I went to see the doctor. After some testing the doctor put me on Ritalin. Within about 2 weeks the teacher said I was completing my homework, making good grades, and feeling good about myself. Although we (my mom and I) thought our battle was won, we had no idea what adventures were waiting for us.

Second grade went by. I was doing OK in school. My teacher would usually write on my report card, “Alan worked hard this 6 weeks. Encourage him to read at home.” I hated to read; it was so hard to understand what I had read. I loved to play outside, run in the field, and ride on my bicycle. A free spirit.

By the time I got to third grade things were getting off track. I felt like nothing I did was right. I would try to do good work. My teacher would write on my papers, “Needs to concentrate more on answers,” “Needs to turn in all work,” “Needs to follow directions.” I really didn’t think my teacher liked me. She was very stern, never seemed to smile, and was always watching me.

Fourth grade was the year everything in my world fell apart! Before school started, my mom took me to see the doctor the way we did every year. The doctor prescribed the same dose as I had taken the year before. He didn’t want to raise my dosage unless he really had to.

First 6 weeks passed. I didn’t do very well, but the doctor said it might be the new school year or getting settled in and used to a new teacher. My mom told the teacher the doctor was considering raising my Ritalin dosage. The teacher said something had to be done because my grades were low. I wasn’t always prepared for class, was slow getting my books out, and always needed to go to my locker because I had forgotten something. My doctor did raise my medication to one pill in the morning and one pill at lunch. Everyone in the room would say, “Dummy has to go take his pill.”

My teacher wanted to make me concentrate better, so one day she put my desk in the far corner, separated from the rest of the class. A few days had passed. I still wasn’t finishing my work on time, but I was trying to do the work correctly. The teacher didn’t care; it wasn’t finished. She then put a refrigerator box around my desk so I couldn’t see anyone in class. I could hear as other kids in class would make fun of me. It really hurt; I was ashamed of myself and mad at my teacher. I couldn’t tell my mom because I might get in trouble. I hated school, didn’t like my teacher, and started not liking myself. Imagine a 9-year-old going through this day after day. It was hard to face the next day. A week had passed, and I poked holes in the cardboard so I could see who was making fun of me. I started peeping through the holes, making the other kids laugh. The teacher would get so annoyed. So I became the class clown. I was expelled for 2 days. When my mom found out what was going on, boy, did she get angry.

She was mad that the teacher would do this and mad that the principal allowed it, and no one could see what this was doing to me.

Mom called my doctor, explained what was going on, asked him to recommend a specialist. We needed some help! I remember my mom cried over the phone. It scared me. I thought I was really in trouble, but instead, she put me in her lap, kissed my cheek, gave me a hug, and said, “You’re special to me, and I love you. Together we are going to get through this.” It made me feel good because moms can always fix everything.

The next day Mom explained that we were going to meet someone special, someone I could talk to. I was kind of nervous. This person was a licensed clinical social worker. She was nice. I played games while we talked. After a while I felt like she was a friend. It was time to meet with the principal to return to school. Mom and I went to the office. The principal wanted to give my place to a more deserving student, a higher academic achiever. It would make the school look better. At that point Mom asked about my rights as a handicapped student. She didn’t like the thought that no one seemed to care what they had done to me, and she said so. At that point the principal made a phone call to one of his friends, also a principal. It had something to do with Mom not going to the school board meeting to discuss this matter.

I was going to a new school, a school close to where my mom worked, thanks to that phone call.

On the way home that day Mom explained to me that what they had done to me wasn’t right and they should be ashamed. She said that there were a lot of smart, successful people in this world who were not happy with themselves. She said, “It’s more important in life to be happy and know within yourself that no matter what comes your way you can survive. Academics are important, but self-worth is too.”

The new school was a more positive atmosphere; my grades came up. The doctor changed my medication to a slow-release pill so I didn’t have to leave class to take it anymore.

Fifth grade came along. It was great! I had the best teacher; she smiled a lot and was flexible yet had a structured day planned. One day I remember she asked me to go to the closet and get the book Charlotte’s Web. I went to the closet and found the most wonderful book, King of the Wind, a story about a horse. I hid the book Charlotte’s Web and told the teacher I couldn’t find it but that this horse book was there and I really liked horses. All along the teacher knew those books were in that closet. She thought if King of the Wind looked that interesting to me, maybe it would be worth doing instead of Charlotte’s Web. After reading the book, I wrote a report about the story. The teacher was so impressed. She posted the book report in front of the class and made a comment on my report card. I was so proud—proud of myself. I was on track again; life was great. My parents were going to be so proud.

Sixth grade came, and I did fairly well. I had to change classes. It was hard to adjust to better organization skills. I color-coded folders for classes and kept a schedule of where and when classes were.

Seventh grade was a little rocky, but I made it. There were more students. I kind of got lost in the shuffle. By eighth grade it was a struggle every day. More peer pressure to fit in, and I was going through a lot of changes, puberty. I would find myself daydreaming a lot, wanting to be with my grandfather. In the summer I got to spend a lot of time with him. Grandfather owned his own business, and he taught me a lot. Learning was fun that way. It was hands-on learning. Anyway, that year my report card read, “Needs to finish work. Didn’t turn in all papers. Needs to show more effort.” I dreaded every day. Sometimes I even cried when I was by myself. How could I get these people to understand me? I went to automatic shut-off; everything seemed negative with school.

Summer came. I needed a break; I worked with Grandfather. That summer my family spent a lot of time preparing me for high school.

High school! What a big step! I was growing up. More things were going to be expected of me. I wanted to fit in and not be a jerk or dork.

My parents warned me about wrong crowds and told me high school grades were really important to my future. What pressure! My mom talked to the guidance counselor about my having ADD. The counselor assured her I would do just fine.

I was really nervous the first day, but guess what? All freshmen are. The first 6 weeks went by. Not all of my teachers had taken the time to read my school records. They didn’t realize I had ADD. Boy, did things get out of hand.

Later that year, when Mom went in for a conference, one of my teachers said, “I would never have guessed Alan was ADD.” Mom looked surprised. The teacher said, “He dresses so nice, has a clean haircut, and shows respect for teachers, not a smart aleck. He doesn’t get into trouble.” Mom rolled her eyes but didn’t say anything until we got into the car. “Alan, that teacher doesn’t understand about ADD. It’s no respecter of persons. Anyone can get it. It’s not a shame to have ADD. At least we know what we are dealing with. Remember, build on your strengths rather than magnify your weaknesses. Ignore that teacher’s comment. She needs to be better educated in this field. School isn’t just for ABCs anymore!”

I wanted to belong. I acted tough, even started to tell lies. I told stories that made me look big in people’s eyes, but everyone knew they were lies. I just made things worse. In high school you are with a lot of people every day. You meet lots of teachers. Some teachers are there just to earn a paycheck, and there are a few who really care about the students they have. I have such a teacher. She took time for me, time to try to understand me better. When I needed someone to stand up for me, this teacher did.

Once, a teacher asked everyone to write a story as if they were in a make-believe world. She asked me about my ideas. I replied, “I deal in the real world.” This really puzzled the teacher. I am 15 now. I have to deal in the real world. Dreaming is nice. Being an ADD student takes all my energy to meet the goals I have set for myself.

Through my years in school so far, I’ve been through a lot. My mom says I have a good heart; I care about those in need. I’m not dumb. You can’t always measure smartness by tests. I feel I’m doing better in school. The school psychologist has become an important tool for me. I can talk to him when I get a teacher who doesn’t understand, if I disagree with something, or if I’m just having problems. It helps to talk to someone who understands. What I’m trying to say is: No matter what comes my way, I can survive.

I have those who really care, and from that I draw my strength.

A first step in helping a child with ADHD achieve educational success is to choose the right school. In the real world, many of us don’t have such a choice. Either economics rule out private school or the community is not large enough to provide a variety of options. In these cases, you select the options that are available to you, which often can come down again to getting the best possible teacher. Still, more and more parents today—whether their children have ADHD or not—are basing their housing decisions on the local school system, so if your child has ADHD you may want to know what to look for in a school.

1. Speak with principals about their awareness of ADHD as an educational disability, how much in-service training the teachers have had on the disorder, and how receptive the school is to taking in such children.

2. If the school accepts such children, inquire about class sizes. They should be as small as possible (12–15 is ideal, and 30–40 is absurd). Also, what extra assistance is available to help a teacher? Does the school have school psychologists, psychiatrists, clinical psychologists, and special educators to consult with teachers about children who have problems? Are there master teachers within the school who have extra training in ADHD, learning disorders, or behavior disorders, and who can serve as advisers or mentors to younger, less experienced, or less knowledgeable teachers on classroom management methods for dealing with ADHD?

3. What is the school’s attitude toward the use of behavior-modifying drugs by children with ADHD? Some schools believe that medication is neither necessary nor beneficial. These schools are clearly out of touch with the scientific literature and should be avoided. Even if your child is not currently taking any medicine, if at some point she needs it, you will want a school that is knowledgeable and cooperative.

What mechanisms does the school have in place for the administration and monitoring of medication? Most schools have formal policies about such matters. Many schools require, for example, a signed statement from a physician about the type and dosage of medication and the timing of its administration. Public schools also often require the physician to submit a separate approval form to the state department of education before they will permit medicines to be given at school. Fortunately, with the recent development of long-acting ADHD medications, it is becoming less common for children to need to take medication during school hours; a dose of one of these newer medications once in the morning before school can often be enough to get them through the school day with sufficient medication in their bloodstream.

4. Does the school have formal procedures for disciplinary actions and appeals of those decisions? If so, get a copy of the written policies to see what rights your child may have should behavior problems necessitate disciplining him for misconduct. Then determine how comfortable you are with these policies. Be sure they are not just punitive, but also stress the efforts the school is likely to make to help him avoid repeating the offenses.

5. Does the principal encourage open and frequent home–school communication? Will you be welcome to drop by the school periodically to see how your child is doing? Can you request parent–teacher conferences without a lot of red tape? Is the input of parents valued by the school? Some schools will provide daily journals that the children take back and forth between home and school each day. The journal can indicate what was studied in each major subject and what the homework in that subject is each day. The children are often the ones to complete this information after each subject period, and the teacher then adds brief comments. These journals are great for keeping you informed about your child’s performance each day. Other schools allow or even encourage teacher–parent contact via e-mail for much the same purposes.

6. If you feel it necessary, is the school staff open to having an outside professional or expert visit the school with you to discuss your child’s ADHD, educational program, and perhaps make further recommendations to improve it? If the school principal or teacher seems defensive about such outside advice, find another school.

7. How many other children entering your child’s grade or class also have behavioral, learning, or emotional problems? Most teachers can handle only a few such children in any regular classroom with other typically functioning children. If there are more than two or three per class, ask for a different classroom or find another school.

In making the best possible choice for your child, you need to evaluate teachers on the basis of two factors, as noted in the research review by Dr. Sherman and colleagues above: knowledge and attitude.

Unfortunately, many teachers are uninformed about ADHD or are out of date in their knowledge of the disorder and its management. We have found that some teachers have a poor grasp of the nature, course, outcome, and causes of this disorder. They also may have misperceptions about which treatments are helpful and which are not. When this is the case, little positive change will result from attempting to establish curriculum adjustments and behavior management programs within that classroom. Just as the first step in helping your child was for you to become educated about ADHD, the initial step of school intervention is the education of teachers about the disorder. Armed with the information in this book, you should be able to determine from interviews with the principal and teachers whether a particular teacher is informed on ADHD. If not, you can do a lot to help.

By understanding the methods presented here and in Chapter 16, you become equipped to pass along recommendations to your child’s teacher for possible implementation. You can also raise these techniques as suggestions at school conferences about your child’s school performance or can even request, when appropriate, that some of them become a formal part of your child’s written individualized education program (IEP) if your child is going to be receiving special educational services.

You can also help educate the teacher by providing brief reading materials such as those listed in “Suggested Reading and Videos” at the back of this book or even by sharing this book. In addition, I have made two DVDs (ADHD—What Do We Know? and ADHD in the Classroom) that summarize the disorder and cover issues of classroom management; many teachers have found them more convenient than reading materials. Finally, we recommend the video Classroom Interventions for ADHD by Drs. George J. DuPaul and Gary Stoner. (For full information about all these videos, again see “Suggested Reading and Videos.”)

What Is the Teacher’s Attitude toward ADHD and Behavior Modification Techniques?

Whether any individual teacher can and will adopt the behavioral programs advocated in this book is greatly influenced by the teacher’s educational training and philosophy, as well as by his or her personal experience and beliefs about the educational process. In some cases, intensive training of your child’s teacher by a school or clinical psychologist expert in these behavioral programs may be required. Children with ADHD who had teachers who are more domineering in these consultations and less open to the advice and information of the consultant had worse outcomes in school, according to research conducted in 2009 by Dr. William Erchul at North Carolina State University, Dr. George DuPaul at Lehigh University, and collaborators at other universities. Such teachers are substantially less likely to implement any of the consultant recommendations or to make changes in their classrooms for individual children having ADHD. Even with training, “booster” visits by the professional to the school following training may be necessary to maintain the teacher’s use of the procedures. Teachers who use a permissive approach to education are often unlikely to use behavior modification, out of misplaced concern that these methods are too mechanical and do not adequately foster a child’s natural development and motivation to learn. This is certainly not true. In some cases, these beliefs may be altered through the success of a consultation with a professional trained in behavioral programs. In other cases, such beliefs will not change and may greatly interfere with the effective use of behavioral programs in your child’s classrooms. In such a case, a transfer to an alternative teacher with a philosophy more consistent with using behavioral programs may be beneficial.

In cases of poor teacher motivation or a conflicting philosophy, be assertive. Press the school administrators for either greater teacher accountability or a transfer of your child to another classroom or school, rather than waste a year of your child’s education. Where this is not possible, you may have to supplement your child’s education outside of school through additional tutoring, summer school review programs, and your extra involvement at home in reviewing schoolwork.

Some teachers resist behavioral techniques not because of a conflicting teaching philosophy, but because they believe the problems of children with ADHD are socially based, stemming from conflicts or chaos at home, or that medication is the only solution because ADHD has a biological basis. Other teachers may resent altering their teaching style if they believe this suggests their own behavior is causing a child’s problems.

“Her teacher doesn’t believe in ADHD. She says that too many children are being labeled and given excuses for their misconduct. How can I deal with her?”

Another important thing to consider is how well adjusted your child’s teacher is and whether other parents have filed complaints against this teacher for incompetence, “malpractice,” or ineffective teaching. You certainly cannot request that each of your child’s teachers undergo a psychological evaluation, but you can seek information from the principal or other school staff members about that teacher’s reputation in dealing with children with behavior problems. You can also ask for the names of parents whose children are currently in that teacher’s care, so you can call those parents to get a clearer view of that teacher’s competence.

Overall, the importance of a close collaboration among you, your child’s teacher, and any professional experts on the treatment team cannot be stressed enough. However, successful collaboration can easily be hindered by attitude—not just the teacher’s, but yours as well. Are your efforts being hampered by an attitude formed by a long history of conflicts with school personnel? Or are your expectations unrealistic? Are you waiting for the school to “cure” your child’s problems while you remain passive or uninvolved? If your child is having few difficulties at home, have you persuaded yourself that poor teaching or management at school is causing your child’s difficulties in the classroom? Be sure to reexamine your attitudes periodically to see if they’re hindering the collaborative process.

If antagonism has arisen between you and a teacher, it is quite likely to undermine any intervention. In that case, you may want to ask a professional consulting with you to come to the school to help mediate consultations with the teacher.

Also be aware that in many cases the behavioral programs suggested here will need to be combined with medication to treat the school problems of a child with ADHD. Recent research shows that the combination of behavioral programs and medication produces improvements that are superior to either treatment used alone. Therefore, if your child is having serious problems with school adjustment, you should give thoughtful consideration to using medication (see Chapters 18 and 19).

Finally, when you find one or more good, sensitive teachers for your child, be supportive and praising; assist the teachers in any way you can; be open to the teachers’ suggestions of what you can do to help; and convey your approval and admiration not only to the teachers but also to the school principal. This can greatly strengthen your relationship with such teachers, increase their desire to tailor their classroom programs to your child’s special needs and abilities, assist you in finding future teachers of similar thinking as your child progresses through that school, and encourage them to come to your defense and your child’s when decisions about educational programming must be made by school administrators. Positive attention to your child’s teachers builds a stronger relationship with them, just as it does with your child.

Various factors related to the structure of the classroom environment, classroom rules, and the nature of work assignments are important to consider if you are to help your child at school. In the past, professionals told parents and teachers to reduce the amount of stimulation in the classroom because it could lead to excessive distractibility in children with ADHD. Research evaluating such measures found, however, that they did not improve classroom behavior or academic performance in such children. Similarly, suggestions that traditional classrooms are too restrictive and that classrooms affording greater freedom and flexibility are best have not been supported by research.

There are several features of the classroom, however, that may need some adjustments when a teacher is working with your child. Keep these things in mind when you are shopping for next year’s classroom and teacher for your child. Remember them as well when you meet with that teacher to plan the approach to the school year. Believe it or not, one important point is the seating arrangement in the classroom. Research shows that a traditional desk arrangement in rows facing the front of the classroom, where the teacher typically locates while lecturing, is far better for children with ADHD than modular arrangements, where several or more children share a larger table, especially if they face each other while working. Such arrangements seem to provide too much stimulation and too many opportunities for social interaction with other children, which distract a child with ADHD from attending to the teacher or classwork.

You can also ask that your child be moved closer to the teacher’s desk or wherever the teacher spends the most time while instructing the class. This not only discourages classmates from giving your child attention for disruptive behavior, but also makes it easier for the teacher to monitor your child and to dispense rewards and fines quickly and easily. Altering seating arrangements is sometimes as effective as a reward program in increasing appropriate classroom behavior.

Classrooms that are physically enclosed (with four walls and a door) are usually much better for a child with ADHD than so-called open classrooms. Open classrooms are usually noisier and contain more visual distractions. Research shows that noisy environments are associated with less attention to work and higher levels of disruptive behavior in children with ADHD.

A well-organized and predictable classroom routine is also helpful. The posting of a daily schedule and classroom rules can add to this sense of structure. Use of feedback charts at the front of the class that display how children are doing in following rules, behaving, and working may also help your child with ADHD.

In some cases, “nag tapes” are particularly helpful. While this is not really a factor in classroom structure, it is an example of the type of measure the school should be open to using. Before doing work at his desk, the child takes out a small portable digital recorder, puts on an earpiece so the recording does not distract other students, and turns on the player. The child then proceeds to do the work while the recorder plays reminders to him—usually using the father’s voice, since we know children with ADHD tend to listen better to their fathers than their mothers—to remain on task, not bug others, and the like. The effectiveness of these tapes will depend greatly on their being combined with consistent methods for enforcing rules and with the use of rewards and punishments for working and proper conduct.

The following additional changes to classroom structure and curriculum are likely to be helpful:

1. As is true for all children, academic tasks should be well matched to the child’s abilities. For children with ADHD, increasing the novelty and interest level of the tasks through use of increased stimulation (for example, color, shape, texture) seems to reduce disruptive behavior, enhance attention, and improve overall performance.

2. The teacher should change the style of presenting lectures and task materials to help maintain the interest and motivation of children with ADHD. When low-interest or passive tasks are assigned, they should be interspersed with high-interest or active tasks to optimize attention or concentration. Tasks requiring an active as opposed to a passive response may also allow children with ADHD to better channel their disruptive behaviors into constructive responses. In other words, give a child with ADHD something to do as part of the class lecture, work assignment, or activity, and the child’s behavior will be less of a problem.

3. Academic assignments should be brief to fit with a child’s attention span. A good rule of thumb is to assign the amount of work that would be appropriate for a child 30% younger. Feedback regarding performance of assignments should be given immediately, and time limits for getting work done should be short. This can be aided by the use of timers, such as clocks or cooking timers.

4. A child’s attention during group lessons may be enhanced by delivering the lesson in an enthusiastic yet task-focused style, keeping it brief, and allowing frequent and active child participation. A teacher who pretends to be more like an actor—who is vibrant, enthused, and emotionally charged—will get much more attention than one who drones on about some dry subject.

5. Mixing classroom lectures up with brief moments of physical exercise may also be helpful. This reduces the sense of fatigue and monotony that children with ADHD may experience more often than typical children during extended academic work periods. The teacher can try jumping jacks by the desk, a quick trip outside the classroom for a brisk 2-minute run or walk, forming a line and walking about the classroom in “conga line” fashion, or other such brief physical activities. These can rejuvenate the attention span not only of a child with ADHD but of other children as well.

6. The teacher should schedule the difficult academic subjects in the morning and leave the more active, nonacademic subjects and lunch to the afternoon periods unless the child is on an ADHD medication. It is well known that the ability of a child with ADHD to concentrate and to inhibit behavior decreases greatly over the school day (see Chapter 4).

7. Whenever possible, classroom lectures should be augmented with direct-instruction materials—short, highly specific drills of important academic skills or, even better, computers with software that does the same thing.

In many cases, the measures described so far and the programs presented in Chapter 16 will be sufficient, especially for children with mild-to-moderate ADHD symptoms or for children whose inattention and behavioral problems are controlled with medication. However, in other cases, especially those with severe ADHD symptoms and accompanying problems of opposition, aggression, or learning disabilities, alternative educational placements—for example, special education or private school—may be necessary. Ideally, these placements should include classes with a small student–teacher ratio, and the classes should be taught by teachers with expertise in behavior modification.

Obtaining special educational services for children with ADHD is often a difficult process. Many such children did not previously qualify for special educational services according to the guidelines specified in Public Law 94-142, the predecessor of the current Individuals with Disabilities Education Act (IDEA). Now they do! If your child with ADHD is failing, he may be eligible for formal special education services under this law under the category known as “Other Health Impaired.” Ask your school district to explain the IDEA and your child’s rights under it. Keep in mind, however, that your child must be experiencing a significant impairment in school performance because of ADHD to get special education services; a diagnosis alone is insufficient.

Unfortunately, a child with ADHD but without associated problems is likely to be eligible for little special education in most states. When associated problems do exist, such as learning disabilities or emotional disturbances (particularly aggression and defiance), the child will probably be assigned to classes that focus on those problems. Certainly, children with ADHD who have significant speech and language or motor development problems are likely to receive speech, occupational, and physical therapy, or even adaptive physical education, provided that these developmental problems are sufficient to interfere with academic performance.

Although the situation has improved markedly in the past decade in many school districts, you may need to bring pressure on your school district to abide by the existing laws. Efforts have been underway since 1991 by national parent support associations to force states to follow the recommendations of the federal government to improve services for children with ADHD, but any further improvements may hinge on the need to limit any costs that would escalate for school districts opening their special educational programs to another disabled population.

In the meantime, it is essential that you become familiar with federal, state, and local district guidelines. You can get all of this information from your school district. Other information of help to you can be found in the second edition of All About ADHD: The Complete Practical Guide for Classroom Teachers by Dr. Linda Pfiffner, coauthor of this chapter. You can also find sound advice in other books, such as the second edition of How to Reach and Teach Children with ADD/ADHD by Dr. Sandra Rief, Problem-Solver Guide for Students with ADHD by Dr. Harvey Parker, the CHADD Educators Manual by Mary Fowler (second edition by Chris Dendy), ADD and the Law by attorneys Peter Latham and Patricia Latham, and Turning the Tide by Karen Richards and John Lester. For full information about all of these books, see “Suggested Reading and Videos” at the end of this volume.

In addition, you should become acquainted with the director of special education within your school district. You are only as good as your personal telephone directory or contact list in dealing with the educational problems of your child. A good file of telephone numbers can go a long way toward locating resources within the private sector, such as private schools, formal and informal tutoring programs, and special summer camps. Also contact your local parent support association (for example, your local branch of CHADD or ADDA—see “Support Services for Parents” at the end of the book) for advice on resources in your area for school problems. These organizations can sometimes even send a professionally trained advocate with you to school meetings. In some cases, you may need to get a second opinion about your child’s problems because you disagree with the school staff over the nature and extent of those problems and the child’s eligibility for services.

It is also important to understand the concept of the “least restrictive environment” as it applies to decisions regarding special educational placement. The IDEA makes it clear that special services are to be provided so that children with disabilities are not unreasonably precluded from interactions with nondisabled peers. School districts are therefore likely to err in the direction of placing children with ADHD in the least restrictive environment necessary to manage their academic and behavioral problems. That is, they may put the children in the program that provides the greatest contact with normally functioning students. Some teachers are not always in agreement with this system. They prefer that even children with mild ADHD be removed to special educational settings, rather than have to adjust their classroom curriculum and behavior management style to accommodate the needs of these children. Parents may be equally biased toward special education, believing that the smaller class sizes, better trained teachers, and greater teacher attention they provide are preferable. School districts are likely to resist these pressures, so as not to violate the rights of children to placement in the least restrictive environment or risk legal action for doing so. Parents may find this frustrating, but must understand the philosophy behind this placement bias and its basis in law.

Anywhere from 23 to 40% of children with ADHD will be retained in a grade at least once before reaching high school, mostly in the early elementary years. Therefore, many parents will have to determine whether retention is the solution to their own child’s difficulties.

It’s understandable that retention would be recommended in so many cases since children with ADHD often display the characteristics of children who are immature for their age. Many teachers might reasonably recommend “another year to grow up.” Yet many studies have failed to identify any significant advantages in achievement as a result of delaying school entry, and more recent ones have identified multiple harms that occur to children in association with their having been retained. These adverse effects include loss of interest in school, loss of motivation to learn, increased aggressiveness in boys primarily and increased depression in girls primarily. Retained children are also more likely to be rejected by their peers following retention and are much less likely to complete high school than other children with similar problems who were not retained. School difficulties associated with ADHD are not due just to a brief developmental immaturity, and so repeating the same approach for a second year is not likely to help. It does not, after all, address the specific problems of ADHD. And, in fact, a child who repeats a grade may be bored when reviewing the old material and thus may be doomed to fail. Taken to its extreme, this solution could result in what one mother said was “having him repeating every single grade. At that rate, he would graduate at 30!”

In a study conducted by Dr. Linda Pagani thousands of children in the Montreal public schools were followed for many years of their education. One purpose of this study was to see if grade retention benefited or harmed schoolchildren. The study found that this practice resulted in no measurable benefits to the future of the children who had been retained and that the practice was harmful in many ways. The children who had been retained often lost interest in school and learning, developed further problems with peer relations, and often became more aggressive. My own follow-up study with Dr. Mariellen Fischer found that children with ADHD who had been retained in grade were also more likely to quit school before completing high school. The earlier the grade retention occurred, the more harmful it was found to be. Dr. Pagani’s study supports my own recommendation that children not be retained in their grade as a means of dealing with their learning or behavioral problems.

While retaining a child in a grade is not advisable once she has started formal schooling, it can be wise to consider keeping a young child in kindergarten an additional year before letting her progress to first grade. What factors should you consider in such a decision?

In general, if a child is mentally capable of completing the work at the next grade level, then a different type of academic environment (for example, greater reinforcement, smaller class) is preferable to retention. If a global delay is identified in academic achievement or intelligence based on psychological testing of the child, retention can be recommended. If not, the child should be promoted, with supportive educational services provided in the delayed areas.

Parents and children have commented on the social problems of retention when the children were bigger than their classmates. So retention might seem wiser when a kindergartener is small in stature and/or has a birthday near the school district’s cutoff for first grade.

The impulsivity and low frustration tolerance, among other characteristics, that mark the emotional immaturity of children with ADHD are not likely to be cured by another year in kindergarten or any other grade. Instead, some type of intervention, such as a program of social skills training within the school setting, might be helpful. My colleagues and I have used the social skills training program called Skillstreaming, by Drs. Ellen McGinnis and Arnold Goldstein (see “Suggested Reading and Videos”). It has been used successfully by regular classroom preschool and elementary teachers within the typical academic curriculum.

In fact, many of a child’s difficulties can be addressed through remedial services provided in the regular classroom as an alternative to retention. Occupational therapy can be used, and recommendations can be given by the occupational therapist for the regular classroom teacher to use in the classroom. Speech and language therapy may also be beneficial, especially when it focuses on communication, in which case such therapy becomes an effective social skills program.

As already discussed, teachers vary considerably both in what they expect their students to be able to do and in their attitude toward disorders like ADHD. A number of relatively simple behavioral strategies (discussed in Chapter 16) can be used in the regular classroom by a teacher who is open to this approach, thus eliminating the need for retention. So the choice of a teacher is a critical determinant in the decision about whether to retain a child.

In addition to regular kindergarten or regular first grade, there are options that may be available within the school district. These include a language-based kindergarten or first grade, which provides a supportive language-based curriculum and a smaller student–teacher ratio. You could also ask about a K–1 transitional program, which is often used for children who are somewhat slow in development. Because they provide a lot of feedback and do so immediately, computers can be very useful for young children with ADHD. It is a rare child with ADHD who doesn’t like computer games. Using such games to enhance learning of academic skills can be a helpful aid to a regular classroom curriculum. A number of computer programs—Reader Rabbit and Math Blaster, for example—enhance reading and math readiness. So, in general, even when retention is recommended and especially when it is not, considerable attention needs to be directed toward what type of teaching approach was provided last time and what can be done this time to make sure it is more effective.

15

Off to School on the Right Foot

MANAGING YOUR CHILD’S EDUCATION

with Linda J. Pfiffner, PhD