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PLUK News June/July 1999 Volume 13 Number 11/12
	PLUK News is published by Parents, Let's Unite for Kids, a private nonprofit organization founded in 1984 by a group of parents of children with disabilities and chronic health problems. Subscriptions are free, however, we ask that subscribers contribute $15/year toward PLUK activities. PLUK News is available in alternative formats. Editor: Katharin A. Kelker, Ed.D. Production: Roger Holt, ATP PLUK Office 516 N 32nd St Billings MT 59101-6003 800.222.7585 in MT; 406.255.0540 (voice/TT); 406.255.0523 (fax) E-mail: plukinfo@pluk.org
The contents of this newsletter were developed under a grant from the Department of Education. However, those contents do not necessarily represent the policy of the Department of Education and you should not assume endorsement by the Federal Government. Products and services described herein are not endorsed by PLUK, the U.S. Department of Education, or by the Federal Government.

Article Index

PLUK'S Annual Barn Raising Picnic Work Incentives Bill Disability Earnings Limit Increase News on IDEA Amendment ASK PLUK ??? Supreme Court Decides Olmstead GAO Suspends IDEA Report What's New in the TRIC/PLUK Library

BEST OF PLUK NEWS - Attention Deficit Disorder - 10 years How can it be detected Doctors do not overdiagnose Myths about Stimulant Drugs Ritalin to be on Time Diagnosis of ADD Reflections of a Mom Once There was a Child Management at School Stimulants have Positive Effects School Programs & IEP's Choosing a Teacher School Assessment Beyond the Myths Section 504 Plans ADD Not an Excuse ADHD in Adolescents Best Practices for Evaluation Ritalin Prescriptions Triple Ideal Teacher A Hero for Children Stimulants Overprescribed Coaching: An Approach How Not to Diagnose New Guidelines New Data on Stimulant Use Pros and Cons of Drug Holidays Is ADHD Overdiagnosed? Experts Agree ADD "Major" Problem ASK PLUK??? 10 Years of Questions on ADD

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PLUK'S Annual Barn Raising Picnic

Parents, Let's Unite for Kids (PLUK) is UPDATING our computer lab and needs a little help from its friends.

Parents, Let's Unite for Kids is holding our second annual Barn Raising and needs financial help with unbudgeted expenses for renovation of the new office and computer lab.

PLUK annually assists over 4,000 children with disabilities and their families. The organization was located at MSU-Billings since 1984 and moved into our new quarters last year. Badly needed items include; new computers, internet access, Intellikeys adaptations, and software. We are asking our friends to help in the tradition of an old-fashioned Barn Raising.

Friends of PLUK can support the renovations in two ways: by buying raffle tickets or by taking part in an old-fashioned Barn Raising Picnic on:

Sunday, August 29, 1999, from 3:00 to 6:00 p.m. at the Shiloh Barn, 2121 S. 48th St, Billings MT.

To lend PLUK a hand, come to an old-fashioned Barn Raising Picnic with Entertainment, a Silent Auction, Children's Games, and Picnic Dinner. Dinner tickets for the afternoon of fun are $5.00 per person or $10.00 for a family. Also, PLUK is raffling a handmade quilt, cedar log rocking chair, and beautiful original Montana photographs by a local artist. Raffle tickets are $5.00 apiece. This year's Silent Auction will feature guided hunting trips (deer, elk, or birds) and the use of a cabin at East Rosebud, plus many more country items and baskets.

Contributions to the Barn Raising are tax deductible. For raffle or dinner tickets, call PLUK at 255-0540 or 1-800-222-7585. You can also help by selling tickets and/or volunteering to serve on an event committee.

Good News on Work Incentives Bill

On June 16, 1999, by a vote of 99-0, the U.S. Senate passed the Work Incentives Improvement Act. This bill addresses the problem that many people with disabilities have: if they go to work full-time and earn enough money to support themselves, they lose their eligibility for medical benefits. The proposed legislation is intended to remove some of the most significant barriers to the employment of people with disabilities by:

• Providing adequate and affordable health insurance when a person on SSI or SSDI goes to work, or develops a significant disability while working. This includes expanding Medicaid options for States, continuing access to Medicare coverage under a ten-year trial program, providing grants to States to develop infrastructures to support working individuals with disabilities, and creating a time-limited demonstration program permitting States to extend Medicaid coverage to certain workers with disabilities;
• Offering a user-friendly, public-private approach to job training and placement assistance for individuals with disabilities who want to work by providing up to $23 million per year for grants to states or private organizations for outreach programs to provide accurate information on available programs to individuals with disabilities;
• Creating a new payment system for employment services to SSDI/SSI beneficiaries that rewards successful outcomes. Vocational rehabilitation, training and employment services providers would be reimbursed a portion of benefit payments saved when a beneficiary earns more than the current laws "substantial gainful activity" SGA standard. The individual with a disability would be able to choose between public or private employment service providers;
• Encouraging SSDI beneficiaries to return to work by providing assurances that cash benefits would remain available if employment proves unsuccessful. Further, using "employment" as a sole criteria for a "continuing disability review" (CDR) to determine a beneficiary's continuing eligibility to receive benefits would be prohibited. An expedited eligibility determination process would be established for individuals who lose their SSDI benefits due to work and need to return to benefit status; and
• Extending the Social Security Administration's demonstration authority, which expired in 1996 and requires SSA to conduct a demonstration that reduces SSDI benefits by $1 for every $2 earned above "Substantial Gainful Activity."

Although the bill had 77 cosponsors, Sen. Phil Gramm objected to its reliance on tax changes to pay for it. So the Senate put off finding a way to pay for the $800 million, five-year measure. Instead, it directs future negotiators to come up with unspecified spending cuts. The legislation also has considerable support in the House but is stalled over how to pay for it. It has cleared the Commerce Committee but still must move through the Ways and Means Committee, which sets tax and disability policy. Last year, the House passed similar legislation. Rep. Archer (R-TX), chairman of the Ways and Means Committee, said he was optimistic about the bill's chances in the House this year.

President Clinton referred to the Work Incentives Improvement Act in his State of the Union Address, urging Congress to make WIIA a top priority and fully fund it in the budget. The President challenged Congress to send the Work Incentives bill to him by July 26th so he could sign this legislation into law on the 9th anniversary of the enactment of the Americans with Disabilities Act (ADA).

Disability Earnings Limit Increase

People who work while receiving Social Security disability benefits are able starting July 1, 1999, to earn more. The amount of money indicating substantial gainful activity has been increased from $500 a month to $700 a month.

This increase may affect as many as 250,000 Social Security beneficiaries with disabilities.

Previous rules stated that to become eligible for Social Security Disability Insurance (DI) or Supplemental Security Income (SSI) benefits, an individual must be unable to engage in any substantial gainful activity (SGA) that exceeds $500 per month. In addition, SGA is used as a measure in determining ongoing entitlement for DI benefits. The SGA level is set by the Commissioner of Social Security through regulation.

SGA has been increased only once since 1980 and that increase occurred in 1990. The proposed increase would raise SGA to reflect the level of the growth in average wages since 1990.

Currently, less than on half of one percent of disability beneficiaries leave the rolls voluntarily and return to work. Each year since 1991, approximately 400,000 disability beneficiaries have remained on the rolls and have participated in the workforce. The higher SGA level is expected to prompt additional beneficiaries to venture into the workforce.

For more information on the change, visit Social Security Online at http://www.ssa.gov.

Not So Good News on IDEA Amendment

The U.S. Senate has passed an amendment to IDEA, the federal special education law, as part of the Juvenile Justice Bill. The IDEA amendment, introduced by Sen. Bill Frist, R-TN, permits public schools to suspend or expel a child with a disability who possesses a firearm at school or at a school function. The amendment offered jointly with Sen. John Ashcroft, R-MO, is intended to align disciplinary procedures covering children with disabilities with those for nondisabled students. The measure also would allow schools to stop educational services for expelled or suspended special education students&emdash;including FAPE guaranteed under IDEA&emdash;if relevant state law does not require regular education students to receive educational services following suspension or expulsion.

Advocates for students with special needs has long advocate against any cessation of special education services for two reasons: 1) there is a long history of school districts using disciplinary measures to "push out" students with disabilities and deny them access to education, and 2) special education students who may commit weapons violations are in even greater need of educational and behavioral interventions in order to correc their behavior and assist them in becoming productive citizens. Advocates also point out that the recent perpetrators of school violence (e.g., Columbine High School)were not special education students, and there is no evidence that special education students are more likely than other students to commit acts of violence at school.

By voice vote, Sen. Tom Harkin, D-IA, also successfully amended the Senate version of the Juvenile Justice Bill to ensure that immediate appropriate interventions and services, including mental health interventions and services, are provided a child removed from school for any act of violence. Harkin's amendment amends the measure proposed by Sen. John Ashcroft which allows districts to suspend or expel a student with a disability for up to one year and provide no special education services. In other words, Sen. Harkin's amendment requires that students who are suspended or expelled must receive services of some kind to help them with their behavior. Funds to pay for the costs of interventions and services would be appropriated through an allotment to states under the Elementary and Secondary Education Act.

The U.S. House of Representatives has its own version of the Juvenile Justice Bill (HB 1501 introduced by Rep. Bill McCollum, R-FL) which also includes amendments to IDEA. An amendment by Rep. Norwood to allow school personnel to discipline students with disabilities who carry or possess weapons in the same manner as those students without disabilities was adopted by the House by a vote of 300 to 128. Because the Norwood amendment is not identical to the Ashcroft/Frist amendment in the Senate version, a Conference Committee must reconcile the differences. The final version of H.R. 1501 will be voted on after all of the amendments are considered.

Rep. Rick Hill, Montana's only representative, had a cessation of services amendment of his own which did not pass the House, but he was a supporter of the Norwood amendment.

The Clinton Administration, meanwhile, has announced that it has a provision in its proposed reauthorization of the Elementary and Secondary Education Act (ESEA) that calls for no cessation of educational services for all children, special or regular education students. The President's version makes treatment of special and regular education students equal by providing all students, even those who have been suspended or expelled, with continuing educational services. Specifically, the summary of the legislation states in the case of students who are suspended or expelled, public schools must provide for "appropriate supervision, counseling, and educational services that will help those students continue to meet the State's challenging academic standards. President Clinton has said that he is offering this proposal because of the research evidence that shows truant and expelled youth who are without educational services or supervision commit a large portion of daytime burglaries.

Families wishing to comment on this series of legislative acts at the federal level may do so using the following avenues:

• Contact members of the Conference Committee by calling the Capitol Switchboard at 202-225-3121.
• Contact Rep. Hill at his office in Washington DC (202 225-3211), by fax: 202 225-5687, or by e-mail: Rick.Hill@mail.house.gov. If you send an e-mail message, be sure to include your mailing address. Congressman Hill only responds to e-mail via regular mail.
• Contact President Clinton via his comment line at 202-456-1414; visit the Whitehouse web site to send e-mail from the web at http://www.whitehouse.gov; or send an e-mail directly to president@whitehouse.gov.
• Contact U.S. Secretary of Education Riley at 202-401-3000 or send an e-mail to CustomerService@inet.ed.gov.

ASK PLUK???

The following questions are recent inquiries received by PLUK staff.

Q: My son will be a senior in high school next year. He is due for a three year evaluation, but the school district has already informed me that they don't have to do a comprehensive evaluation for a student who is graduating. My son needs the information from a recent evaluation in order to be eligble for accommodations at college for his learning disabilities. Is the school district correct that it is no longer requirement to do a three year re-evaluation?

A: The IDEA '97 amendments allow for some flexibility in re-evaluating students in special education. The IEP Team can decide what is necessary to do in order to assess a student properly. Since you are a member of the team, you can certainly make the case that you would like a comprehensive assessment to guide your son's education in his last year of school as well as provide documentation of his need for accommodations in public school and postsecondary education.

Also, it used to be the case that graduation per se was considered a "change in placement" and therefore it triggered the need for re-evaluation. IDEA '97 clarifies that re-evaluation is not required when a student is graduating. This provision does not apply in your son's case since he is due for a three-year re-evaluation anyway.

Q: Is a student with multiple chemical sensitivities eligible for special education under the other health impairment category?

A: A student with this diagnosis is not automatically eligible for special education, but he or she may be eligible if the student's condition affects educational performance and the student meets the eligibility criteria for OHI. OHI is the most likely category in which the student may be eligible, but the assessment should also consider whether other disabilities are present like learning disabilities.

Q: We think our son who has multiple disabilities should be eligible for an extended school year (ESY) program. But every year when we bring up the subject, school officials tell us that they do not think our son regresses significantly over the summer break. We have asked to see the data the district keeps on regression/recoupment, and none has ever been provided. How should we go about ensuring that ESY is a possibility for our son next summer? How can we make sure that data is collected and shared with us?

A: ESY services are a possibility for all students with disabilities who have current IEPs. Each special education student should be considered for ESY at least annually. Determining the need for ESY programming in excess of the normal school year must be made on an individual student basis. Eligibilty rests with the IEP Team which includes you as parents.

Eligibility should be based upon data and discussion of the IEP Team and not determined by a formula. Many regression/recoupment formulas have been invalidated because they were found to lack indivdiualziation. Each decision should occur either retrospectively (looking back on data collected) or prospectively (speculating on the likelihood that the student will regress if services are not provided). The primary elements to be used in determining the need for ESY should include:

• the likelihood of significant regression, and
• the rate of probable recoupment of skills.

The IEP Team must document that a delay or break in the services of special education and related services would result in substantial regression and slower than normal recoupment of previously gained skills as stated on the IEP. Recent court decisions also suggest that other elements can be used in determining the need for ESY:

• degrees of impairment;
• parents' ability to provide an educational structure at home;
• student's rate of progress;
• behavioral and physical problems;
• availability of alternative resources;
• student's ability to interact with non-disabled students;
• curriculum areas that need continued attention; and
• student's vocational needs.

When your son returns to school in the Fall, ask for an IEP Team meeting to revise your son's IEP to include the types of data to be collected to determine regression and recoupment. Have the IEP specify that data will be collected before and after school breaks. Indicate that you will be asking to see that data after each break. If no data is available after the first break, ask for another IEP meeting to discuss why data are not kept.

Also, keep records yourself of any other factors which may influence your son's need for ESY. His degree of impairment and his slower rate of skill acquisition may, for example, justify ESY in his individual case.

Q: Our son who is 16 has been diagnosed with dyslexia. Through special education, he has finally learned to read, but reading is still very difficult for him. He has an above average IQ but his lack of reading skills has really hampered him in all content areas. His high school grades are not great. What kind of postsecondary education is possible for him? Is there any chance he could go to college?

A: In order to pursue postsecondary education and be able to cope with the reading demands, your son may have to use some assistive technology. From your description, he can read but it is a labor intensive activity for him and a barrier to his achievement in all content areas. Fortunately for him, the technology now exists which may help him enough with reading so that he can get the content without having such a struggle with the reading process.

Screen reading software is now available fairly inexpensively. This software will read aloud text that is digitized or scanned into the computer. Most programs are set up so the software reads word by word or line by line. Some programs allow the user to click on unknown words and get the dictionary meaning read aloud.

Your son may find that using a screen reader makes printed material much more accessible to him. With this aid, he may be better able to handle the longer reading assignments in content areas and may be better prepared to pursue postsecondary education.

The time to try a screen reader is now while he is still in public school. Ask your school district to conduct an assistive technology assessment to determine if use of a screen reader would be beneficial for your son.

In terms of postsecondary options, reading skill need not be a barrier to a whole range of options including two year colleges, college or university, vocational training, or specialized schools. The real question is whether or not your son has the academic knowledge which will allow him to enter one of these options. Ask your son's high school guidance counselor to review your son's achievement testing to determine whether he is accumulating the background knowledge that will allow him to be successful in college. If vocational training seems more appropriate, you can ask, as part of your son's transition plan for special education, that your son be assessed for vocational aptitudes.

Postsecondary schools like colleges and universities have to provide the kinds of accommodations that allow students with disabilities to be successful. If your son can meet the basic entrance requirements for some type of postsecondary training, then he can expect to be accepted and provided with the accommodations like screen reading software that he needs.

For more information on this topic, call PLUK at 800-222-7585 and ask for a copy of our Transition Guide.

Q: Is Extended School Year (ESY) the same thing as summer school?

A: No. Extended School Year is an option that is available only to special education students. ESY is a program designed individually to provide training and support so the student is able to maintain skills learned during the regular school year.

Summer school, on the other hand, is an opportunity which may be offered to regular or special education students. It is not necessarily an opportunity for individualized instruction designed to meet the unique needs of a special education student.

School districts do not have to provide summer school, but they do not have to provide ESY for those special education students who require it in order to maintain skills.

Q: My son is a special education student with an ED label. He has been doing fairly well in school because of the supports provided to him by special education. However, he is being denied academic credits because of frequent absences. Most of these absences were excused and were related to his disabling condition. For example, he sees a therapist once per week and often these appointments have to be made during school hours because it is very difficult to get in to see this particular counselor. It does not seem right to me that my son's absences are officially excused, but he is still denied credits toward graduation because he has exceeded the number of allowable absences.

A: If you know in advance that your son is likely to miss a lot of school because of therapy sessions and medical treatment, you will need to ask for an IEP meeting and include in his IEP that your son is to be exempted from the school district absence poicy in regard to excused absences. If the school district is not willing to agree to this exception in his IEP, then you can of course take the matter to due process.

It is also possible for the IEP Team to agree that your son will achieve graduation by some other means than accumulating credits. He can be graduated, for example, on the basis of completing his IEP goals and objectives. This may be a more practical route for him to go.

In any case, if your son has done the academic work at a passing level, your son should not be penalized academically for absences related to treatment of his disability.

Supreme Court Decides Olmstead Case

On June 22 the Supreme rendered a decision in Olmstead, a case from Georgia concerning whether or not a state is obligated by the Americans with Disabilities Act to provide services to individuals with mental disabilities in the least restrictive environment. Montana had file an amicus brief in this case siding with the State of Georgia in saying that the ADA did not require that individuals placed in institutions to be moved out into the community.

The original Georgia case involved two women with mentally retardation who resided in the psychiatric unit of the Georgia Regional Hospital at Atlanta. Although their physicians had concluded that each of the women could be cared for appropriately in a community-based program, the women remained institutionalized at the hospital.

The women filed suit against the State of Georgia seeking placement in community care. They alleged that the State had violated Title II of ADA in failing to place them in a community-based program once their physicians determined that such a placement was appropriate.

The District Court granted partial summary judgment for the women, ordering their placement in an appropriate community-based treatment program. The court rejected the State's argument that inadequate funding, not discrimination against the women accounted for their retention in the institution. Under Title II, the court concluded, unnecessary institutional segregation constitutes discrimination per se, which cannot be justified by a lack of funding. The court also rejected the State's defense that requiring immediate transfers in such cases would fundamentally alter the State's programs.

The Eleventh Circuit Court affirmed the District Court's judgement, but remanded for reassessment of the State's cost-based defense. The District Court had left virtually no room for such a defense. The appeals court read the statute and regulations to allow the defense, but only in tightly limited circumstances. Accordingly, the Eleventh Circuit instructed the District Court to consider as a key factor whether the additional cost for treatment of the women in community-base d care would be unreasonable given the demands of the State's mental health budget.

In the Supreme Court's review of the case, the majority of the court affirmed that States are required to place persons with mental disabilities in community settings rather than institutions when the State's treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual , and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.

Justice Ginsburg, joined by Justice O'Connor, Justice Souter, and Justice Breyer, concluded that the State's responsibility, once it provides community-based treatment to qualified persons with disabilities, is not boundless. The majority of the Court agreed that States were obligated to provide a range of service options, which might include institutional care for some individuals who required that level of supervision. The Court said that the ADA does not compel States to phase out all institutions. Nor is it the ADA's mission to drive States to move institutionalized patients into an inappropriate setting, such as a homeless shelter. For some individuals, in fact, no placement outside of the institution may ever be appropriate. To maintain a range of facilities and to administer services with an even hand, the Court said the State must have some leeway setting up a continuum of services to meet a variety of needs. If, for example, the State were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated, the ADA standards would be met (e.g., reasonable accommodation). In such circumstances, a court would not have the power to order displacement of persons at the top of the community-based treatment waiting list by individuals lower down on the list who filed law suits.

President Clinton responded to the Supreme Court decision in this case in a positive way, saying that he was pleased that the Court decision upheld the purposes of the ADA by recognizing that unjustified isolation of institutionalized persons with disabilities is prohibited discrimination. Clinton pointed out that the decision should pave the way for increased access to home- and community-based long term care services and supports for persons with disabilities.

Clinton also commented that his administration is committed to finding affordable ways to enable people who need long term services and support to remain in the community if they choose to do so. President Clinton has asked Secretary Shalala and Attorney General Reno to work with all interested parties to carry out the Court's decision in a fair manner. He stressed the need for collaborative efforts to find cost-effective ways to provide more community-based services.

GAO Suspends IDEA Discipline Report Until Fall

The General Accounting Office (GAO) has postponed major work on a congressionally mandated IDEA discipline study until September or October.

The GAO study&emdash;requested by lawmakers in the fiscal year 1999 budget bill to investigate current federal special education discipline policies&emdash;requires information that the U.S. Department of Education is still in the process of collecting.

States are required to report information about both regular and special needs student's discipline problems to the Education Department by November 1st, and it is the same data the GAO needs to determine how frequently students with disabilities are disciplined in school.

The GAO, which was originally obligated to submit a preliminary report by March 1 and a final version by July 30, consulted both Congress and the Education Department before postponing the project until early fall.

Waiting to complete the report will allow the Education Department to collect more data. In addition, the GAO wants to give schools more time to implement and work with the discipline provisions of the recently released implementing regulations for the IDEA amendments of 1997.

What's New in the TRIC/PLUK Library??

The following are recent additions to the library ordered by subject area. If you are interested in checking out any materials, please call the librarian, Janice Sand at 1-800-222-7585. Materials will be mailed out anywhere in the state of Montana at no charge.

• Accommodations in higher education under the Americans with Disabilities Act (ADA); A no nonsense guide for clinicians, educators, administrators, and lawyers Gordon, Michael,, Ph.D., Editor; Keiser, Shelby, MS, Editor
• Recovery - Discovery of life beyond the pain Kraizer, Sherryll, Ph.D.
• Diagnosis and treatment of attention deficit hyperactivity disorder
• Voices from fatherhood - Fathers, sons, and ADHD Kilcarr, Patrick J., Ph.D.; Quinn, Patricia O., M.D.
• Attention deficit disorder - A different perception Hartmann, Thom
• Managing attention and learning disorders - A guide for adults McEwan Elaine K.
• Help is on the way - A child's book about ADD Nemiroff, Marc A., Ph.D.; Annunziata, Jane, PsyD
• Dr. Larry Silver's advice to parents on ADHD 2nd EDITION Silver, Larry B., M.D.
• Montana Office of Public Instruction Assessment Handbook Volume1
• Activity schedules for children with autism - Teaching independent behavior McClannahan, Lynn E., Ph.D.; Krantz, Patricia J., Ph.D.
• Asperger's syndrome - A guide for parents and professionals Attwood, Tony
• Your defiant child - 8 steps to better behavior Barkley, Russell A., Ph.D.; Benton, Christine M.
• Looking forward - A guide for parents of the child with cleft lip and palate Cox, Barbara G., M.A., ED.S.
• Lifetimes - The beautiful way to explain death to children Mellonie, Bryan; Ingpen, Robert
• We'll paint the octopus red Stuve-Bodeen, Stephanie
• Fine motor skills in children with Down syndrome - A guide for parents and professionals Bruni, Maryanne, BScOT(C)
• Creating a 21st century Head Start - Final report of the advisory committee on Head Start quality and expansion
• Dr. Weisinger's anger work out book - Step-by-step methods for greater productivity better relationships healthier life Weisinger, Hendrie, Ph.D.
• Epilepsy and the family - A new guide Lechtenberg, Richard, M.D.
• Special siblings - Growing up with someone with a disability McHugh, Mary
• BRAIN AWARE Magnetic resonance imaging (MRI)
• BRAIN AWARE Electroencephalogram (EEG)
• BRAIN AWARE Evoked response testing
• BRAIN AWARE Genetic aspects of neurodevelopmental disorders
• BRAIN AWARE Motor disabilities in children
• BRAIN AWARE Nutritional and sleep disorders in children with developmental disabilities
• BRAIN AWARE Cognitive development and neuropsychological testing
• BRAIN AWARE Speech, language, and communication disorders
• BRAIN AWARE Vision and hearing disabilities
• BRAIN AWARE Psychiatric disorders of childhood
• BRAIN AWARE Attention deficit/hyperactivity disorder
• BRAIN AWARE Personal and family issues
• BRAIN AWARE Prioritizing therapies for the multiply-disabled child
• BRAIN AWARE Financial resources
• BRAIN AWARE Long term planning for children with developmental disabilities
• Students with acquired brain injury - The school's response Glang, Ann, Ph.D.; Singer, George H.S., Ph.D.; Todis, Bonnie, Ph.D.
• Because we can change the world - A practical guide to building cooperative, inclusive classroom communities Sapon-Shevin, Mara
• Dressing for independence - Adapting clothing for kids with special needs Pompelli, Jean
• Self-care - Independent living skills manual
• Ghosts from the nursery - Tracing the roots of violence Karr-Morse, Robin; Wiley, Meredith
• Childhood feeding disorders - Biobehavioral assessment and intervention Kedesdy, Jurgen H., Ph.D.; Budd, Karen S., Ph.D.
• Start smart - Building brain power in the early years Schiller, Pam
• Best of Parent News - A sourcebook on parenting from the National Parent Information Network Robertson, Anne
• Juvenile justice: improving the quality of care Krisberg, Barry, Ph.D.
• Me, myself and I - How children build their sense of self 18 to 36 months Pruette, Kyle D., M.D.
• Many ways to learn - Young people's guide to learning disabilities Stern, Judith, M.A.; Ben-Ami, Uzi, Ph.D.
• How to do homework without throwing up Romain, Trevor
• Straight talk about psychiatric medications for kids Wilens, Timothy E., M.D.
• What to do when you are due - A comprehensive guide to prenatal care
• Helping the child who doesn't fit in
• Community recreation and people with disabilities - Strategies for inclusion Second Edition Schleien, Stuart J.; Ray, M. Tipton; Green, Frederick P.
• Consumer health and safety activities - Just for the HEALTH of it? Toner, Patricia Rizzo
• Making choices - Life skills for adolescents Halter, Mary; Lang, Barbara Fierro
• Challenge - For adolescents and young adults Kraizer, Sherryll, Ph.D.
• Entering adulthood: connecting health, communication and self-esteem A curriculum for grades 9-12 Laing, Susan J.; Bruess, Clint E.
• I can manage life - Learning to choose and grow Hooker, Dennis
• Effective communication skills - Essential tools for success in work, social, and personal situations Ludden, Marsha
• I am already successful - 80 activities on developing motivation and self-esteem Hooker, Dennis
• Moving out and making it - Interpersonal skills
• Into adolescence: enhancing self-esteem - A curriculum for grades 5-8 Zevin, Dale, MA
• Speak out - A curriculum for teaching communication skills: group leader's guide Ansell, Dorothy; Griffin, William V.
• 100 of the nation's most creative life skill activities Ansell, Dorothy; Morse, Joan M.
• Happiness, it's your choice - The skill development theory for successful change Applegate, Gary, Ph.D.
• The kid's guide to social action - How to solve the social problems you choose and turn creative thinking into positive action Lewis, Barbara A.
• Childhood disability under the social security administration supplemental security income program
• Childhood disability: a guide for school professionals
• Could this happen in your program Volume II - A collection of case studies provoking reflection, discussion, and action
• Assistive Technology Services For Students - What are these? Margolis, Leslie, Esq.; Goodman, Susan, Esq.
• Assistive technology for young children with disabilities - A guide to family-centered services Judge, Sharon Lesar; Parette, Howard P.
• Cursing brain - The histories of tourette syndrome Kushner, Howard I.
• Teens speak out - A survey of teens with chronic illness and disabilities in transition
• How to help your child succeed in school - Strategies and guidance for parents of children with ADHD and/or learning disabilities Rief, Sandra
• Learn and live Burness, Patty; Snider, William
• Asperger's syndrome - A guide for parents and professionals Attwood, Tony
• Broken Rhymes; Harm's Way; Head Spinal Cord Assembly
• Cumberland: the balanced approach
• Head injury -PBS
• Malpractice - PBS
• Mending of the mind
• Post acute rehabilitation services for people with acquired brain injury
• Problems and coping strategies of mothers, siblings and young adult males with traumatic brain injury
• Starting over: Life after a severe head injury
• TBI: effective diagnosis and treatment
• Unseen injury: Minor head trauma
• This year don't lose any friends
• Head injury in Montana
• Misconceptions of head injury
• Choices - The Craig W. Barke story
• You, me & community - Connecting the pieces
• Putting interrupted lives on a positive course
• Goals for success: Writing IEPs that work
• Decisions, decisions: What's a teenager to do?
• Grounded for life - Teenage pregnancy: afraid to say no
• Adolescents: at risk for HIV infection
• The power of choice, Program 1 Pritchard, Michael
• Acting on your values - The power of choice, program 2 Pritchard, Michael
• Self-esteem - The power of choice, program 3 Pritchard, Michael
• Drugs and alcohol - The power of choice Pritchard, Michael
• Friendship and dating - The power of choice, program 9 Pritchard, Michael
• Communicating with parents - The power of choice, program 11 Pritchard, Michael
• Raising your parents - The power of choice, program 12 Pritchard, Michael
• Identify your skills - A job search essential
• Preparing teens for the world of work - A school to work transition guide for counselors, teachers and career specialists Schilling, Dianne; Schwallie-Giffis, Pat; Giddis, W. James
• Getting the job you really want - A step-by-step guide 3rd Edition Farr, J. Michael
• More than a job - Securing satisfying careers for people with disabilities Wehman, Paul; Kregel, John

BEST OF PLUK NEWS - Attention Deficit Disorder - 10 years of articles

February 1989

Attention Deficit Disorder: how can it be detected?

How can you tell if your child's learning problems are caused by Attention Deficit Disorder? It is not easy to tell whether a child truly has ADD or is simply displaying normal distractibility and activity levels. Professionals point out that the typical symptoms of ADD apply now and then to the behavior of almost any child. Fluctuations in activity and attending levels are normal. The difference in true ADD is that symptoms of the disorder are persistent, lasting at least six months at a stretch, and they show up in different settings not just at school, for example.

The medical profession makes a distinction between two basic types of Attention Deficit Disorder: 1) ADD with hyperactivity, and 2) ADD without hyperactivity. In other words, a child can have ADD and not be hyperactive. Children with ADD who are not hyperactive have difficulty attending to some tasks and may display extreme disorganization and distractibility.

To decide whether or not a preschool child may have ADD look for such things as excessive running or climbing and frequent shifting among activities. In older children, the main signs are excessive fidgeting or restlessness, failure to complete tasks and careless work habits.

The revised third edition of the Diagnostic and Statistical Manual (DSM) the handbook used by professionals to diagnose the disorder says a child must display eight of fourteen symptoms, beginning before age 7, to be diagnosed as having the disorder.

In addition to the symptoms mentioned above, other possible symptoms include frequent interrupting or intruding, difficulty waiting turns or playing quietly, inability to stay seated when requested.

Remember however, that none of these symptoms are significant unless the child displays them much more often than his or her peers. Also, keep in mind that their developmental disorders or emotional problems, such as depression and anxiety, have similar symptoms.

Here is a simple checklist, designed by Dr Cyrus I Admads, President of the Kentucky Psychiatric Association, to detect children who may have Attention Deficit Disorder. Rate your child on the following symptoms, adding 3 points for an answer of very much, 2 points for often, 1 point for a little, and 0 for not at all.

1. Is excitable or impulsive.
2. Cries easily and often.
3. Is restless and fidgety.
4. Appears to be always on the go.
5. Is destructive.
6. Fails to finish tasks.
7. Has extreme mood changes.
8. Is easily frustrated.
9. Disturbs other children.

September 1989

Doctors do not overdiagnosis ADHD

Primary care physicians (pediatricians and family practice doctors) are not overdiagnosing Attention Deficit hyperactivity Disorder in children and, on the contrary, may be slightly underdiagnosing it, Scott Lindgren, Ph.D., said at a conference on Mental Health services for children and adolescents presented by the National Institute of Mental Health, Rockville, Maryland.

The underdiagnosing does not appear to be serious, according to Dr. Lindgren of the University of Iowa College of Medicine.

Of 457 children aged 6 to 12 years old seen by four pediatricians and eight family practice physicians, 4.8% were diagnosed as having Attention Deficit (AD) and or hyperactivity Disorder (HD). Using the Diagnostic Interview Schedule for Children (DISC), the prevalence of AD and/or HD was 12.8% based on parents reports of symptoms and 6.9% based on teacher ratings.

Physicians' diagnoses agreed more often with reports of parents than those of teachers. Of the 22 diagnosed hyperactive children in Lindgren's study, 15 were identified by parents, only eight by teachers.

In addition, oppositional and defiant behavior was apparent in one-half of the children with AD and/or HD symptoms, and anxiety disorders were present in one-third.

December 1989

Myths About Stimulant Drugs Debunked

Use of stimulant drugs like Ritalin has come under fire recently both from the media and from organized efforts to curb abuse of stimulants. In the debate over the use of stimulant medications, several myths have gained in popularity. Unfortunately, belief in these myths sometimes stands in the way of using stimulant medications in appropriate ways. Here are some common misconceptions that can be refuted by reference to medical research:

1. Stimulant medications are addicting. Although it is well-known that adults who abuse stimulant medications can become addicted- primarily because of the euphoric effect achieved at high doses- the smaller doses used in treatment of attention deficit hyperactivity disorder (ADHD) produce no euphoria and are not addictive.
2. Stimulant therapy will lead to substance abuse in the future. There is indeed a higher rate of alcoholism and drug abuse among adults who had ADHD as children. But this is perhaps "understandable" when viewed in the context of the core symptoms of ADHD; irritability, impulsivity, and emotional lability. These symptoms may be curbed by use of appropriate drugs and through counseling, but they do not always go away completely. It is more likely that the symptoms of ADHD itself may lead to drug abuse and/or alcoholism, rather than the use of stimulant drugs in treatment of the symptoms.
   According to Dr. Esther H Wender in a presentation to the American Academy of Pediatrics: "There is no evidence to support a link to Ritalin and drug abuse and delinquency, and there is evidence that treatment reduces the risk of these bad outcomes."
3. Children taking stimulant drugs will become "zombies." The calming effect of stimulant use in ADHD is not like that seen with tranquilizers. If the stimulant dosage is too high, however, children may withdraw from social activities and show signs of unresponsiveness. These effects are reversible by lowering the dosage.
4. Diets are better than drugs. Comprehensive studies done over the past 10-15 years have not been able to show an association between food additives and ADHD, nor have food additive-free diets been shown to be effective therapy. Any improvement seen after dietary manipulation is probably due to a placebo effect. Megadose vitamin therapy has not been shown to be effective either.
5. Treatment causes brain damage. There is absolutely no evidence in the medical literature to support this statement.
6. Treatment causes psychosis. A rare child will develop psychotic-like behavior while on stimulant medication, but in almost all cases, a look at the child's medical history will reveal some psychotic symptoms prior to the drug therapy.
7. Treatment leads to depression. By definition, no child with ADHD should have symptoms consistent with a major depressive disorder, but children with ADHD may have some depressive symptoms, particularly low self-esteem. A small number of children become more depressed while on medication, usually after a few months on therapy. Medication should be discontinued of depression occurs. The depressive effects are completely reversed when the drug is discontinued.
8. Taking stimulant medications lead to Tourette's Syndrome. About half of children with Tourettes syndrome had full-blown ADHD symptoms before Tourette's developed, making it difficult to determine in those children who develop Tourette's while on stimulant medication whether the syndrome should have developed any way or whether it developed as a result of the medication.

March 1992

Ritalin to be On Time

The Office of Civil Rights (OCR) has concluded that a California school district (San Ramon Valley Unified School District, 18 IDELR 465--OCR 1991) violated Section 504 regulations by failing to provide a student with his Ritalin medication at the prescribed times. A nine-year-old student with attention deficit hyperactivity disorder (ADHD) was supposed to receive his prescribed dosage of Ritalin during regular school hours. On 13 occasions, the student did not receive his Ritalin at school because he forgot to come to the principal's office to have the medication administered to him. OCR determined that Ritalin had been prescribed for the student in order to modify his ADHD synptoms. Thus, because the administration of medication is considered necessary to assist the child in benefitting from his educational program, the school district violated Reg. 104.33 by failing to make certain that the student received his Ritalin on the 13 days in question.

(Source: Special Educator, February 25, 1992, Vol. 7 (11), p. 189.)

October 1992

Diagnosis of ADD

The Office of Special Education Programs recently has ruled that if a local educational agency (LEA) believes that a medical evaluation by a licensed physician is necessary to determine whether a child suspected of having attention deficit disorder (ADD) meets the eligibility criteria under the "other health impaired" category, then the LEA must ensure that such an evaluation is conducted at no cost to the parents. On the other hand, if the LEA believes that other effective methods of measuring ADD are available, then qualified personnel other than licensed physicians may be used to conduct the evaluation, a long as the evaluation meets the requirements of federal special education regulations Other qualified personnel may include properly licensed and trained school psychologists. Recommendations for medication must, however, be made by medical, not educational , personnel (Parker, 18 IDELR 963 OSEP 1992).

October 1992

Reflections on the First Weeks of School

by a Montana Mom

He headed off to school with such high hopes--a new lunch box, a fresh haircut, new clothes, his favorite high tops. But I could tell he was scared. That last week before school started, he didn't sleep well. He was moody, touchy, easily frustrated--twice he had awakened in the middle of the night with nightmares. His fingernails he had bitten to the quick. What could be so frightening to an eight year-old about going back to school? Why was he so worried? What did he think would happen when he returned to his desk in third grade?

My son has ADHD (Attention Deficit Hyperactivity Disorder). Last spring the school district was planning to expel him. He was in constant trouble on the playground and totally distracted in the classroom. we finally took him to a doctor and got him started on medication. He took his pills twice a day for the months of April and May and there was a remarkable improvement in his behavior at school during that period of time. He got on better with his classmates and didn't get into so many fights. He paid more attention in class and got most of his work done. He didn't have to stay in from recesses. He even got a Good Citizens' Award in May. No child has ever been prouder of an accomplishment. His grandmother had his award framed, and it hangs in our kitchen over our dining table.

Over the summer we took him off the medication and he had a happy vacation doing what ranch kids like to do. Now he is back on medication and returning to school. Wouldn't everything be fine?

I watched him come home from school the first three days. He had dark circles under his eyes--he looked exhausted. He didn't want to play. Twice he fell asleep in front of the television set before he had his dinner. I became concerned. Then on Friday of the first week of school, he came rushing into the kitchen, still with dark circles under his eyes, but with a wide grin and a burst of enthusiasm.

"Mom," he said. "Guess what!"

"What is it?" I replied, giving his shoulders an affectionate squeeze.

"My teacher understands!"

"What do you mean, she understands?"

"She told me today that she has a boy with ADD who takes pills, too. She told me all about how her boy used to get in trouble at school and have to go to the principal's office every day."

I watched his face--full of animation and relief.

"My teacher says that we can work together to help me do my work. She promised that I won't ever have to stay in for recess--as long as I'm trying. And look what she gave me."

He reached into his jeans pocket and brought out a laminated ticket with his name on it. The pass said that he could go anywhere in the school any time.

I asked him what the pass was for. He said, "My teacher said that anytime I need someone to talk to or someone to help me with my temper, I can come and see her. I can even knock on the Teachers' Lounge door and she will come out to talk to me."

He started to put the ticket into his pocket and then paused. "Mom," he said. "Where should we keep my ticket? I don't want to forget it--ever."

We fixed a basket by the back door where the coats and hats are hung on hooks. When my son comes home from school, he puts his ticket in the basket. In the morning when he leaves for the school bus, he grabs his ticket and puts it in his pocket. He has no more precious possession.

That ticket and his relationship with his teacher have given my son back his confidence in himself. The medication he takes every day helps him to concentrate, and it has been a tremendous benefit for him. But his relationship with his teacher is even more important. Her empathy and concern have restored his sense of self worth. She is recognizing every little step my son takes toward greater self control and better organization of his school assignments. She is helping him to gain insight into his own behavior. What a gift this teacher is!

School has been in session for a month. My son's days in third grade are never easy or without challenges, but he is blossoming under the eye of a teacher who sees the good in him and who has helped him see the good in himself.

January 1993

Once There Was a Child

by Betty Selvig

February 1993

ADD: Management at School

Attention Deficit Disorder is a condition in children and adults which can cause an individual to have difficulty paying attention, staying on task, getting along with others, handling frustration, and controlling behavior. These difficulties can lead to school failure and strained relationships with family members and peers.

Since school is the place where ADD symptoms seem to cause children the most difficulty, school accommodations are probably the most important part of an intervention program. If children with ADD are going to be successful at all in school, they have to be treated differently. Their attending mechanisms are so fragile that they are not able to learn using the methodologies which are most common in classrooms. They cannot sit still as long, and they cannot learn by listening only. They have to be able to move, and they must have opportunities to learn by doing. As a general rule, the following types of accommodations are basic to helping children with attending problems do better in school&emdash;

Preferential Seating

ADD children do best when they are seated near the teacher or near the place where instruction is being given. It is best if they are facing the teacher when he or she is speaking and if the teacher uses their name or touches them in order to make sure they are attending.

Decrease Distractions

ADD children are more comfortable and productive when they are concentrating if unimportant stimuli are reduced or eliminated. This means they may need to be seated at the front of the row so they are not distracted by looking at all of the other children. They should be away from traffic areas and not close to the windows where they can look out. Some ADD children do better on seat work when they wear ear plugs. Others like to use study carrels with sides that cut off visual distractions and reduce noise. Some children with ADD like to have quiet background noise (e.g., music through earphones) to help them focus on fewer stimuli. Usually the children themselves are good at explaining what helps them to pay better attention. Their suggestions should, as much as possible, be honored.

Provide Feedback

ADD children need lots of information about how they are doing. They often do not have efficient learning strategies and may use trial and error methods, rather than some more productive system. Therefore, ADD children require lots of feedback about whether they are proceeding correctly. They also need to know how much time they have, how much time has elapsed, and how much time is still to go.

Children with ADD will stick to a task much longer if they are provided with periodic feedback. Often their attention must be re-directed, but then they will continue to do productive work for several minutes more until their attention lapses and they need to be re-directed again.

Help with Learning Disabilities

Many children with ADD also have learning disabilities in reading, mathematics, or language. These learning problems need to be addressed specifically so that the child can do a better job in school. Often the child will require one-on-one or small group tutoring to catch up on subject matter missed when the child was not paying attention.

Harnessing Interests

ADD children can attend for extended periods of time when they are doing something in which they are interested. Every effort should be made to teach them skills using topics or methodologies which interest them. ADD children will learn a great deal of information incidentally about a subject during the course of the time that they are working on something of interest. For example, when the class is studying Egypt, the ADD child may enjoy building a pyramid. This child may learn a lot about pyramids and why they were built at the same time that he or she is busy with the construction.

Physical Activity "Breaks"

Children with ADD definitely need frequent opportunities during the school day to get up and move for legitimate reasons (e.g., to run errands, to move from one work area to another, to pass out papers for the teacher). Short work periods broken up by periods of activity are much more productive for the ADD child than longer, sustained work periods.

Praise for Accomplishment

All children thrive on praise, but children with ADD especially need to know when they are doing something right. Even the smallest correct or compliant behavior should be recognized and encouraged.

Structure and Predictability

ADD children do not respond well to change. They do best in environments that are entirely predictable and structured around routines. They need warnings when a transition or change is about to occur. They need to understand the rules of the situation and the consequences for breaking the rules. Consequences must be applied consistently and without too much verbal elaboration.

Teacher Selection

Some teachers are better than others at working with children who have ADD. The ideal teacher for an ADD child is one who is warm and demonstrative, who provides structure but is not rigid, who uses a variety of teaching methods and accepts a variety of methods for responding, and who does not dwell too heavily on details. Whenever possible, teachers for ADD children should be "handpicked" and matched to the child's learning style. The difference in the ADD child is often dramatic when the teacher is able to respond appropriately to the child's needs.

August 1993

Stimulants Found to have Positive Effects

Stimulant medications like Ritalin have long been considered effective for the treatment of the hyperactivity associated with ADHD. New research on the use of stimulants in children suggests an even wider range of beneficial effects beyond the reduction of disruptive behavior.

For example, contrary to previous belief, the use of stimulants in reducing hyperactivity does not appear to impair a child's social functioning. Indeed, in one recent study hyperactive children treated with Ritalin showed increased positive social behavior compared with those on a placebo.

Other data suggest that Ritalin treatment results in improved interactions between hyperactive children and their mothers, teachers, and peers. Not only do children become more cooperative, but the behavior of others toward the child improves, too.

Also contrary to widespread belief, there is evidence that stimulants can improve academic performance. In two recent studies, children on Ritalin showed significant improvement on arithmetic and language tasks. This effect is thought to be due to reduced motor restlessness and impulsivity.

New research also points to long-term benefits from stimulant use in childhood. In a comparison of a group of 20 adults who had received at least 3 years of continuous Ritalin therapy during childhood and a similar group who had been hyperactive as children but had not received stimulants, the treated group led more independent lives, were more likely to be in school, and had had less psychiatric treatment and fewer car accidents. The members of the treated group were also seen as less aggressive, had better social skills, and rated themselves as having better self esteem than the untreated group. However, the untreated group had held their last job for a longer period of time and reported fewer concentration problems.

In another study, exposure to stimulants for 6 months or more during childhood was associated with better parent ratings, less police contact for alcohol and drug use, and less drunken driving in early adolescence.

In summary, it appears that taking stimulant medications may have a number of positive effects for individuals with attention deficit hyperactivity disorder, including (a) improved behavior, (b) better social relationships, (c) improved academic performance, and (d) less anti-social behavior as adults.

(Source: Tucker, M. (July 1993). Improved behavior might not be the only benefit of stimulant use. Pediatric News, p. 24.)

April 1993

School Programs & IEP's for children with ADD

Depending on their individual characteristics, children with attention deficit disorder may qualify for special education as other health impaired (OHI), learning disabled (LD), or emotionally disturbed (ED). Their Individualized Education Programs (IEPs) should include goals both for academics and behavior. In general, children with ADD require help with organizational tasks, completing assignments, and filling in the gaps in their knowledge which occur because they have not been able to pay attention.

Academics

The assessment of the child for special education provides information about the skills and concepts that the child is missing. These missing skills can then become goal areas for the IEP. For example, it may be that the child has not learned the concept of borrowing in subtraction, so the IEP can include a goal and objectives focusing on subtraction.

Classroom Modifications

A student with ADD may also require some modifications of regular classroom assignments and routines. For example, the child may benefit from having directions repeated or from having a chart of daily assignments taped on the desk. Some children with ADD do well with shortened assignments and more frequent praise for completing smaller chunks of their work. Many children with ADD benefit from legitimate opportunities throughout the school day to get up and move and to be physically involved in a learning task.

With children who have ADD, it is important that the IEP focus on a few skills that are essential for the child to learn. Other skills of lesser importance should be ignored for the time being, so that the child can concentrate on accomplishing a manageable number of tasks. For example, if a child is working on developing written language skills, then handwriting, and perhaps even spelling, may be of lesser importance. The child should feel a sense of accomplishment in generating complete sentences, even though the handwriting and spelling may be less than perfect. The focus in academics should be on achieving as much success as possible and on providing frequent praise and attention for small steps in the right direction.

Behavior

Behavior is another significant issue for the IEP. The ultimate goal for children with ADD is for them to learn to recognize their inappropriate behaviors and control them as much as possible. Again, the IEP should address working on a limited number of behaviors or habits, the ones that most need changing in order for the child to be successful in school. The goals should be set at reasonable levels and the new behaviors should be expected to develop over time, not on the first day the IEP is implemented.

It is critical that children with ADD have alternatives available to them so that they can express their emotions in acceptable ways when they are feeling frustrated, angry, or overexcited. Even children as young as first grade should be taught to recognize when their feelings are getting out of control and to remove themselves from the group in order to calm down.

Sometimes it is helpful for the teacher to signal the child with a hand gesture or a quiet word which indicates to the child it is time to "take a break." Acceptable time-outs might include leaving the classroom and walking up and down in the hall for a few minutes, taking a seat at a learning center in the back of the room, putting on earphones and listening to music, or even removal to the nurse's or principal's office. The important thing is that these time-out sessions not be viewed as a punishment, but as an acceptable time for the child to gain control and feel better again. Children who use time-out effectively should be lavishly praised because this behavior is difficult to learn and demonstrates a level of maturity and self control which is not easy for most children with ADD.

Preventative Measures

Many children with ADD run afoul of the discipline policies in regular education. Often these policies prescribe specific "punishments" for talking back to teachers, chewing gum, forgetting materials, fighting and so forth. Children with ADD are much more prone than other children to be disorganized or forgetful, or to behave impulsively. Consequently, they frequently engage in behaviors which violate school rules.

For the student with ADD, the behavior or discipline plan should be based on positive reinforcement, and for most students, should ignore negative behaviors which are not seriously disruptive (e.g. forgetting a pencil). To give the student the best chance of behaving appropriately, the following guidelines are usually helpful:

• Student should be seated away from distractions
• Student should be given frequent opportunities to get up and move
• Learning environment should be structured for success

The IEP should identify situations which are likely to cause frustration and make suggestions for eliminating these problems.

Rules Waived

If there are school rules and or policies which are not appropriate for the student with ADD, those policies can be specially waived in the discipline plan. For example, the plan may say that "this student is not subject to the school rule which requires automatic in school suspension for failing to bring materials to class three times."

Consequences

The IEP should also include a series of acceptable consequences for noncompliant behavior. The focus of these steps should be on their educational purpose. In other words, the important question is: What will the child learn from these consequences for behavior?

Agreement should be made in the IEP about when, if ever, parents will be called about discipline problems. Generally, it is wise for consequences for misbehavior which happens at school to be delivered at school. Parents should not be expected to "punish" the child additionally at home because the child will not associate the consequence with behavior at school.

Generally, the consequence of in-school or out-of-school suspension should be reserved only for extreme behaviors. Students receiving special education services may not be suspended for a period in excess of ten days for behavior related to the disability. The school and parents should agree on and specify in the IEP those behaviors that may result in out-of-school suspensions. A child should not be repeatedly suspended for the same behavior, unless those behaviors create an immediate and substantial danger to others, self, or school property.

In addition, in-school suspension, which is often used as an alternative, is suspect as a consequence because it can deprive a child of an appropriate education if it is used repeatedly.

For students with ADD, the IEP planning process can be a powerful method for determining ahead of time how behavior will be handled. If parents and school staff agree upon procedures which all find acceptable, they can work much more effectively as a team and can keep the focus on meeting the child's educational needs. When problems arise, the IEP provides a framework for resolving issues, particularly those pertaining to discipline.

February 1994

Choosing a Teacher for an ADD Child

Since children with ADD receive most or all of their education in the regular classroom setting, the teaching style of classroom teachers is an important factor in the success of the ADD child. Generally, principals make the decision about the placement of children in particular classrooms, but many principals are open to hearing parents' requests, especially when those requests are based on a student's needs. Parents of ADD children may wish to consult with the principal at the end of the school year concerning the placement of the child for the next year. During this meeting, the parents might want to discuss with the principal how their child reacts to various teaching techniques and styles. It is usually wise not to talk about specific teachers, but instead to focus on the child's needs and the types of teaching strategies that work best. This information should help the principal to decide which teacher on the staff would be the most appropriate choice. In rural schools, where the child may have the same teacher for several years, the principal or lead teacher can sometimes work with the teacher to assist him or her in adjusting teaching techniques to better meet the needs of the ADD student.

Children with ADD vary greatly so it is difficult to generalize about the type of teacher who works best with them. However, there are some common characteristics of teachers who tend to serve ADD children well, including the following:

• An ability to provide structure in the classroom without being rigid
• A willingness to ignore some irritating behaviors while concentrating on assisting a student with two or three necessary behavioral changes
• A sense of humor
• A tolerance for a wide range of abilities in the classroom
• An ability to use a variety of teaching strategies
• A belief in "second chances" or opportunities for students to redeem poor grades or earn additional credit
• An ability to teach learning and organizational strategies along with academic content
• A willingness to allow students several choices for how they respond to an assignment (e.g., tape record a speech, build a model, draw a diagram, invent a game)
• Generosity with praise and genuine interest in student accomplishment, however limited in scope
• Self confidence
• Firmness and consistency in discipline
• A low key approach to correction of behavior or classroom work.

On the other hand, students with ADD generally do not do well with teachers who have these characteristics:

• A commitment to invariably high standards for every activity in the classroom
• A belief that most learning tasks can be accomplished in only one way
• A habit of awarding of zeroes for work not completed or not turned in on time
• A tendency to change discipline approaches several times (e.g. go from a point system to student contracts and then to check marks on the board for misbehavior)
• A tendency to withhold recess as a punishment
• A tendency to react negatively to every infraction of classroom etiquette
• An unwillingness to repeat directions more than once
• A tendency to correct more often than to praise or validate
• A tendency to admonish students in front of the whole class
• A strong belief that attention deficit disorder is not a "real" disabling condition
• A strong preference for neatness
• A concern for total control in the classroom.

Not every teacher is going to be a perfect match for the child with ADD, but as much as possible, it is helpful to try to place the student with ADD in a classroom environment which provides both the structure and the flexibility that the child needs. Some advance planning with the principal is often the best way to assure that the classroom placement will be a success.

November 1994

School Assessment of Attention Deficit Disorder

Even though a student has been diagnosed outside of school as having Attention Deficit Disorder (ADD), the school district must also do its own evaluation to determine whether a student is eligible for school services.

As with all other disabling conditions, evaluation of students suspected of having ADD or ADHD should be a multistep, multi-disciplinary procedure. The school district may begin with a prereferral process in regular education. During this process, at least two regular education interventions may be tried. The results of these interventions will indicate whether or not the student's attention deficit disorder can be accommodated with simple academic or behavioral modifications which are common in the regular classroom.

If the results of prereferral interventions are not positive, then the assessment may continue on a more formal basis to determine if the ADD is adversely affecting educational performance and what types of educational services may be necessary to assist the student.

The identification of students with ADD requires a combination of clinical judgement, objective assessment, and for Other Health Impaired, a medical diagnosis. ADD must be diagnosed by a person qualified in the use of Diagnostic and Statistical Manual of Mental Disorders. Since there is a high rate of coexistence of ADD with other disabilities of childhood and adolescence any comprehensive assessments should include an evaluation of the individual's medical, psychological, educational and behavioral functioning. The more domains assessed the greater certainty there can be of a comprehensive, valid and reliable diagnosis. The taking of a detailed history, including medical, developmental, social and educational factors is essential in order to establish a pattern of chronicity (at least six months) and pervasiveness of symptoms. Augmenting the history are the standardized parent and teacher behavioral rating scales which are essential to quantifiably assess the individual with respect to adaptive functioning in a variety of settings such as home and school. Psychoeducational assessment investigating intellectual functioning, use of language, perception, attention, memory, and visual-motor functioning as well as academic achievement should often be performed.

Both the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 provide coverage for children with ADD/ADHD. Both regulations specify that a student is entitled to a comprehensive evaluation. When the disability adversely affects education performance, eligibility should be approached through the processes of IDEA. When the disability does not affect educational performance but does substantially limit one or more major life activities, eligibility should be approached through Section 504.

To be eligible for special education as Other Health Impaired the student must have a chronic or acute health problem which results in limited strength, vitality or alertness. Alertness is the ability to initiate and sustain attention on a given task. Many students with ADD have difficulty in the area of "alertness." If the student does have the limited strength, vitality or alertness, to be eligible for special education, there must be evidence that the health condition adversely affects the student's educational performance (e.g., school work or behavior) to the extent of requiring special education. Examples of significant interference with educational performance might be failing semester grades, two or more disciplinary referrals in a month associated with impulsive or overactive behavior, chronic failure to complete work, discrepancy between academic performance and potential. Evaluation of OHI must include assessment of social-emotional functioning whether or not an academic deficiency exist. Documentation may include: grades, test data, discipline records, attendance, and behavior scales.

If the student does not meet the criteria for OHI, he or she may qualify under Section 504. If the student's ADD impairs a major life activity such as learning or social development and the impairment is substantial (i.e. cannot be accommodated with informal classroom adaptations), then the student may be eligible to receive formal accommodations under Section 504.

October 1994

Attention Deficit Disorder: Beyond the Myths

MYTH: Attention Deficit Disorder (ADD) does not really exist. It is simply the latest excuse for parents who do not discipline their children.

FACT: Scientific research tells us ADD is a biologically-based disorder that includes distractibility, impulsiveness, and sometimes hyperactivity. While the causes of ADD are not fully understood, recent research suggests that ADD can be in inherited and may be due to an imbalance of neurotransmitters--chemicals used by the brain to control behavior or abnormal glucose metabolism in the central nervous system. Before a student is labeled ADD, other possible causes of his or her behavior are ruled out.

MYTH: Children with ADD are no different from their peers; all children have a hard time sitting still and paying attention.

FACT: Before children are considered to have ADD, they must show symptoms that demonstrate behavior greatly different from what is expected for children of their age and background. They start to show the behaviors characteristic of ADD between ages three and seven, including fidgeting; restlessness; difficulty remaining seated; being easily distracted; difficulty waiting their turn; blurting out answers; difficulty obeying instructions; difficulty paying attention; shifting from one uncompleted activity to another; difficulty playing quietly; talking excessively; interrupting; not listening; often losing things; and not considering the consequences of their actions.

These behaviors are persistent and occur in many different settings and situations. Furthermore, the behavior must be causing significant social, academic, or occupational impairment for the individual to be diagnosed educationally as having ADD.

MYTH: Only a few people really have ADD.

FACT: Estimates of who has ADD range from 3 to 5 percent of the school age population (between 1.46 and 2.44 million children.) While boys outnumber girls by 4:1 to 9:1, experts believe that many girls with ADD are never diagnosed.

MYTH: ADD can be prevented.

FACT: While scientists are not certain they understand the causes of ADD, they have ruled out most of the factors controlled by parents. A poor diet does not cause ADD; nor does sugar or food additives. Normal quantities of lead will not cause ADD. Since the causes of ADD are genetic and biological, the parents cannot cause ADD by being too strict or too lenient.

However, actions by the parents can influence the child's ability to control his or her ADD behavior. Recently, some studies suggest a few cases of ADD may be caused by the use of alcohol and drugs by the mother while pregnant.

MYTH: All children with ADD are hyperactive and have learning disabilities.

FACT: While a certain percentage of children with ADD also have learning disabilities, the two disorders cause different problems for children. ADD primarily affects the behavior of the child--causing inattention and impulsivity-- while learning disabilities primarily affect the child's ability to learn mainly in the area of processing information.

Not all students with ADD are hyperactive and constantly in motion; many are considered to have undifferentiated ADD (Attention Deficit Disorder without hyperactivity). Because these children do not behave in the same way as hyperactive ADD students, their disorder frequently is not recognized, and they are often considered unmotivated or lazy.

MYTH: Many children are incorrectly diagnosed as having ADD.

FACT: Educators can use screening instruments to identify children who may have ADD. Children suspected of having ADD can then be referred to a child specialist (e.g., school counselor, psychologist, pediatrician) for clinical evaluation. Observations and reports from parents and teachers are critical to proper diagnosis. Sometimes children are given intelligence, attention and achievement tests. Doctors may also administer neuropsychological tests and neurological examinations.

Most importantly, it is a team of professionals in education, medicine, and psychology who pool test and observation results and make a final determination. Since a child's hyperactivity, distractibility, and impulsive behavior may be due to other factors, such as emotional problems, poor nutrition, or learning problems, the specialists check for other causes of these behaviors before making a diagnosis of ADD.

MYTH: Medication can cure students with ADD.

FACT: Medicine cannot cure ADD but can sometimes temporarily moderate its effects. Stimulant medication such as Ritalin, Cylert, and Dexedrine is effective in 70 percent of the children who take it. In those cases, medication causes children to exhibit a clear and immediate short-term increase in attention, control, concentration, and goal-directed effort. Medication also reduces disruptive behaviors, aggression, and hyperactivity.

But medication alone has only limited short-term benefits on social adjustment and academic achievement. While medication can be incorporated into other treatment strategies, parents and teachers should not use mediation as the sole method of helping the child.

MYTH: The longer you wait to deal with ADD in students, the better the chances are that they will outgrow it.

FACT: ADD symptoms continue into adolescence for 50-80 percent of the children with ADD. Many of them, between 30-50 percent, still will have ADD as adults. These adolescents and adults frequently show poor academic performance, poor self-image, and problems with peer relationships.

MYTH: There is little parents and teachers can do to control the behavior of children with ADD.

FACT: Teachers and parents have successfully used positive reinforcement procedures to increase desirable behaviors. A behavioral modification plan can give the child more privileges and independence as the child's behavior improves. Parents or teachers can give tokens or points to a child exhibiting desired behavior such as remaining seated or being quiet and can further reward children for good school performance and for finishing homework.

Mild, short, immediate reprimands or allowing natural consequences to occur can counter and decrease negative and undesirable behaviors. Students with ADD can learn to follow classroom rules when there are pre-established consequences for misbehavior, rules are enforced consistently and immediately, and encouragement is given at home and in school.

MYTH: Students with ADD cannot learn in the regular classroom.

FACT: More than half of the children with ADD succeed in the mainstream classroom when teachers make appropriate adjustments. Most others require just a part-time support from the resource program. Teachers can help students learn by providing increased variety. Often, altering features of instructional activities or materials, such as paper color, prestation rate, and response activities, help teachers hold the attention of students with ADD. Active learning and motor activities also help. ADD students learn best when classroom organization is structured and predictable.

(Suggestions come from the Division of Innovation and Development, Office of Special Education Programs, Office of Special Education and Rehabilitative Services, U.S. Department of Education)

December 1994

Section 504 Plans for ADD

Many students with attention deficit disorder do not require special education, but need accommodations and modifications in the regular classroom. A Section 504 plan is a way that these accommodations and modifications can be spelled out clearly for all of the staff who work with the student.

Students with ADD are eligible for 504 plans if (a) they have been diagnosed by a properly licensed professional (e.g. physician, psychologist), and (b) they are in need of accommodations and modifications in order to have access to the curriculum.

To request a 504 Plan, a parent should contact the child's principal or guidance counselor and ask for a planning meeting that includes all of the teachers who work with the student. At the planning meeting, the team can develop a list of accommodations and modifications which assist the student with paying attention, managing impulsiveness, or developing organizational skills.

Here are some suggestions for possible modifications which may prove helpful:

• Position the student's desk between two students who are not ADD and close to the front of the room (near the board or the teacher).
• After giving directions, ask the student (or the whole class) if the instructions or directions are understood. If necessary, ask the student with ADD privately to repeat the directions. Observe the student to see if the assignment is being done correctly.
• Accompany oral directions with written directions (on blackboard or paper) for the student to use as a reference.
• Do not give more than one oral instruction at a time; the ADD student will not remember them.
• Mark correct and acceptable work, not mistakes. Recognizing correct work is important for restoring self-esteem.
• Do not return handwritten work to be copied over; the assignment is often not improved and this adds to frustration.
• Reversals and transpositions of letters and numbers should not be marked wrong, but pointed out for correction.
• Sloppy, messy writing occurs when a student is unmedicated. Do not criticize handwritten work at those times.
• Provide a variety of ways to respond to assignments, including using a computer with word processing, tape recording responses, or making products instead of written responses.
• Recognize and give credit for oral participation in class--again for self-esteem.
• Whenever possible, tests and quizzes should be given within 1 hour after a student takes stimulant medications. This is important because concentration and memory/recall are most enhanced at the time when the medication has become effective. If quizzes or tests are taken at other times, the student's grades may be lower than when the student is properly medicated. When low grades occur, the student should be given the opportunity for retest when he or she is properly medicated.
• Provide extra test time and assignment time (if needed) since memory/recall for students with ADD is a little slower than normal, especially when medications are wearing off.
• Make arrangements for homework assignments to reach home with clear concise directions. Assignments should be written on the board so that the student may copy them onto a homework sheet to go home. The student should be asked at the end of the day if he or she has all the books needed for homework because after the medication has worn off the student is likely to forget materials or fail to organize work to take home.
• Avoid placing the student under pressure of time or competition. Many students with ADD will be concerned about how much time they have and will not be able to perform the task or complete the test. Timed tests only encourage impulsive behavior.
• Accept homework papers or reports typed by the student or dictated and typed by someone else.
• Do not require lengthy outside reading assignments.
• Provide tutoring or one on one instruction when necessary.
• Consider matching the student's learning style with the teacher's teaching style. Some teachers definitely do better with ADD students than others.

March/April 1995

ADD is a Reason, Not an Excuse

When a child is diagnosed as having attention deficit disorder (ADD), it can be a great relief to the whole family. At last, there is a name for the child's condition and there is information available about how to handle the symptoms. For the children, too, there is a sense of relief in knowing that there is a reason why they cannot pay attention, get tasks completed, or keep their school work organized. The children learn that ADD is a neurological condition that they did not cause. No one can blame them for having ADD because it is part of their physical nature.

However, there is a danger in children with ADD believing that ADD can be an excuse for behaving inappropriately or not trying to do school work. When a child is diagnosed with ADD, it is important to lay out a plan for dealing with the symptoms which may include behavior modification, counseling, educational accommodations, and sometimes medication. A coordinated approach should relieve some of the child's anxieties and make it possible for the child to perform better in school and get along better with classmates and family members.

For treatment of ADD to be entirely successful, however, it takes more than behavior modification, counseling, accommodations, and medication. The children themselves must gradually learn how ADD affects their behavior and must acquire strategies for correcting annoying behaviors so that they can be more functional. Having ADD does not excuse a child from trying to be in control of behavior or learning to be better organized. Perhaps the most important thing for a child with ADD to learn is how to use alternative strategies to overcome the ADD symptoms and gain greater self control. When individuals learn to deal with attention deficit disorder, their sense of competence and self worth is greatly enhanced.

Here are some hints for helping children to take charge of their own ADD symptoms:

• Explain the child's condition in understandable terms. Answer his or her questions about ADD matter-of-factly.
• Ask the child for feedback about what strategies seem to help him or her stay organized (e.g., folders, Trapper notebook).
• Allow natural consequences to occur. For example, if the child loses a jacket, have him wear an old one while he is helping to earn money to pay for a new one.
• Encourage the child to indicate when he or she is feeling frustrated. Work out strategies for relieving frustration like leaving the room, finding a quiet place, listening to music tapes, going for a run.
• Help the child break down tasks into manageable parts. Provide positive feedback as each segment of the task is completed.
• Never humiliate the child if he or she has a bad day. Provide encouragement that the next day will go better.
• Encourage the child to take part in activities outside of school which are pleasurable and successful (e.g., collecting rocks, riding motorcycles, painting, hiking, fixing motors).
• Don't insist on improvement in all areas at once. Focus on just a few things at a time and let the rest go.
• Spend some time each day listening to the child explain how things are going. Help the child to understand how other people might be feeling.
• Don't allow the child to use ADD as an excuse. Make conquering or working around ADD symptoms a challenge which the child can meet.
• Let children with ADD know that they are