Promising Practices for Serving Students with Attention Deficit Hyperactivity Disorder.

Researchers Identify the Bare Essential: Administrative Support

School administrators now face the daunting challenge of providing leadership to meet the needs of students with attention deficit hyperactivity disorder.

About 5 percent of school-aged children have ADHD, according to conservative estimates. That translates to about one child in every classroom.

Parents of these children are demanding appropriate services, and teachers need support in delivering such services. To learn how schools are educating students with ADHD, we undertook a two-year study at the University of Kentucky funded by the U.S. Department of Education to identify promising school-based practices for serving these children and their families.

Informed Leadership

After reviewing more than 500 nominations, we selected 25 promising practices in 18 states. We interviewed school administrators, teachers, parents, and related service personnel and observed in classrooms to collect detailed information about how these schools are meeting the educational needs of students with ADHD.

Clearly, schools engaged in promising work with students who have ADHD have school administrators who are informed about ADHD and support the development of promising practices through their leadership, direction, and communication with staff, parents, board members, and the community. The interviews and observations reinforced the idea that the school administrator is important in facilitating an appropriate education for children with ADHD.

Individual approaches differ, yet we found a central theme among all the districts we visited: The school administrator's leadership and direction supports the development of innovative practices.

Administrators clearly have the greatest opportunity to shape the culture of the educational environment by using the power inherent in their position, whether as superintendent or principal. Their leadership will determine the attitude and direction that any school has toward providing appropriate services for students with ADHD.

In a district providing effective services, central-office administrators set a positive district climate, stating the district's vision and philosophy toward educating children with ADHD. The statement and its accompanying policies were submitted to the board for approval and then communicated to the community at large.

At the building level, principals took time to interact with students and teachers. They visited classrooms and met with parents and students to discuss students' academic and behavior goals. They also served on the team that designed educational plans for the children. They helped assign students with ADHD to specific classrooms, matching learning styles with teaching styles.

Coordinated Plans

The effective administrator not only is knowledgeable and visible in support of these services to students with ADHD but also provides direction by developing and evaluating policy and procedures, setting district goals, assuring the development of action plans, and facilitating staff training.

* Policy and Procedures.

Full support and understanding by the district's administration undergirds the development and implementation of practices for students with ADHD. Districts that were effective had developed clear districtwide policies for educating students with ADHD. They had written procedures for referral, identification, and parent involvement, and these procedures were part of the district's handbook or operational manual.

Broward County, Fla., Public Schools developed plans to serve students with ADHD under Section 504 of the Vocational and Rehabilitation Act of 1973, primarily in the regular classroom. Instrumental to the success of Broward County's program has been upper administration's commitment to fund a professional staff position to coordinate efforts to serve children eligible for services.

The school district has developed a wide range of materials, including a handbook that outlines procedures to implement Section 504, a series of forms to help schools comply with guidelines, and a videotape explaining the process, that has been used for training throughout the district.

* Goal Setting.

Districts with the most promising practices had school administrators who were facilitating shared goals among the district staff. This, of course, increased the staffs interest and commitment and the effectiveness of the practice. Efforts seemed most effective when the staffs focus was limited to one or two high-priority goals.

We saw an example of effective goal setting in the Wake County, N.C., School District. The district selected two major goals: effectively evaluating students and providing effective interventions.

The district set out to develop an effective assessment procedure for students suspected of having ADHD. A team of educators developed an assessment procedures manual and provided in-service training to all staff regarding implementation details.

Wake County relies on districtwide teacher-assistance teams to develop modifications to serve children with ADHD in the regular classroom. If more intense services are required, this system typically uses special education support.

* Action Planning.

Districts and schools that were effective in implementing school services for children with ADHD had developed a specific action plan to reach established goals. Components of these action plans included necessary activities, needed resources, person responsible for the activity, and timelines for completion of the activity.

After the plan was developed, the administrator distributed copies and explained to all staff, students, parents, and the community how it would be operationalized.

We saw an example of effective action planning in the Irvine, Calif., Unified School District. The administrators developed a comprehensive, highly organized set of plans to serve children with ADHD. They initiated a program to serve these students in the regular classroom using paraprofessional aides trained as behavioral specialists.

The duties of the paraprofessionals were specific and included implementation of behavior modification plans and social skills training. School-level administrators also were involved in implementing reinforcement plans.

The most effective school district practices for students with ADHD were implemented on a buildingwide basis at least. These practices are ineffective when an isolated teacher tries to meet the needs of a child with ADHD. Only when the practice is understood and adopted by the entire staff does effective programming produce the desired outcome. Support from the administrator is essential if the program is going to be internalized by all building personnel.

Jefferson County, Ky., Public Schools outlined the benefits of having schoolwide discipline plans, particularly for students with ADHD. When the rules, negative consequences, and rewards were consistent throughout the building, students did not constantly test the system.

* Staff Development.

Districts that were successful in developing programs for effectively serving students with ADHD had ongoing staff development. District personnel cannot begin to consider the proper approaches to management of the educational needs of children with ADHD until they have a sufficient knowledge base. The school administrator must ensure that all district staff gain a working knowledge in applying research-based effective practices in educating students with ADHD.

An introductory educational program on ADHD for teachers is "Attention Deficit Hyperactivity Disorder--Diagnosis and Management." This six-hour educational program, which includes a scripted manual and a videotape, covers topics such as how to identify ADHD in the classroom, medication, family intervention, and teaching and classroom management strategies. It was developed at the University of Kentucky.

* Evaluation.

Schools engaged in promising work with students with ADHD made a commitment to regular and ongoing evaluation of the policies and procedures that the district developed and implemented. This evaluation process ensures that the policies are kept current, are consistently implemented, and are having the desired effects.

For example, the paraprofessional program in Irvine, Calif., is evaluated routinely to assess its effectiveness for students with ADHD. The amount of building administrator time consumed by discipline issues for children participating in the program is compared with the amount of time spent before such participation. The dramatic drop in time spent on discipline issues with children with ADHD while they were being served was one of the points strongly supporting the continuation of the paraprofessional program.

Creative Response

Much work lies ahead as public school administrators attempt to respond creatively and humanely to the needs of children with ADHD.

These children with invisible disabilities present challenges to the most sophisticated teacher and parent. Administrators who rise to this challenge can create a climate where all children can recognize their competencies and become lifelong learners.

Barbara Burcham is a school psychologist and ADHD program consultant at University of Kentucky. Laurance Carlson, former director of the Federal Resource Center at University of Kentucky, is a consultant with the Idaho Department of Education.

A Tale of Two Terms: ADD vs. ADHD

Often the terms attention deficit hyperactivity disorder and attention deficit disorder are used interchangeably.

The terminology and labeling used in the diagnosis of this disorder is somewhat perplexing because of changes over the years. The continuing evolution of labels has caused confusion among educators, parents, physicians, and researchers.

The American Psychiatric Association, the group that drives the labeling process, recently debated these terms quite feverishly. The labeling scheme that resulted is detailed in the APA's Diagnostic and Stalistical Manual, fourth edition, published in 1994.

The manual describes ADHD under the broad category of children with disruptive behavior and attention disorders and lists four categories:

* The first type is "ADHD, predominantly inattentive type." This is the child who is referred to as ADD without the "H". Extreme overactivity is not a requirement for this diagnosis.

* The second type is "ADHD, predominantly hyperactive-impulsive type." This child can be inattentive and distractible, but the primary concern is the child's extreme overactivity and inability to inhibit his or her impulses.

* The third type is referred to as "combined type," which is the classic hyperactive, inattentive, and impulsive child.

* The fourth category is referred to as "ADHD, not otherwise specified."

Children with ADD without hyperactivity are seen as daydreamers and display less disruptive behavior than those children who are ADHD. Problems with peer relationships exist regardless of the presence of hyperactivity. The overall prevalence of ADHD is much higher in boys than in girls, but when considering just children with ADD without hyperactivity, there are more girls than boys.

Specific criteria in the APA manual allow health care professionals to assess whether a child receives a diagnosis of ADHD and specifically which type. That diagnosis is based on the accumulation of symptoms that are developmentally inappropriate, occur across a number of settings, and cause significant impairment in social or educational functioning.

Diagnosis of ADHD using the American Psychiatric Association criteria typically is done by health care professionals. Often the school-based identification and treatment of these children has little to do with the APA's specific diagnostic system. Whether the child is called ADHD or ADD is less important to educators than the behaviors exhibited by the child and how they interfere with his or her schooling experience.

--Barbara Burcham and Laurance Carlson

Selected ADD Resources

* "Promising Practices in Identifying and Educating Children with ADD," a research study by Barbara Bur-chain and Laurance Carlson, available from ERIC Document Reproduction Service, 800-443-ERIC. Publication number: ED 363-088.

* Administrative Intervention: A School Administrator's Guide to Working with Aggressive and Disruptive Students, by Donald Black and John Downs, available from Sopris West Inc., 303-651-2829.

* Exceptional Children published a special issue (October/November 1993) on educating children with ADD, available from The Council for Exceptional Children, 703-264-9448.

* "Attention Deficit Hyperactivity Disorder--Diagnosis and Management," a six-hour staff development program with videotape and manual, available from Kentucky Department of Education, 502-564-2672.

* "Comprehensive Assessment of Children and Youth with Attention Deficit Hyperactivity Disorder," by Barbara Burcham and Stephen DeMers, to be published in Spring 1995 issue of Intervention in School and Clinic, available by calling 512-451-3246.

* The ADD Warehouse Catalog includes books, videotapes, and training and assessment programs. It is available by calling 800-233-9273.