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Issues in the education of students with attention deficit disorder: introduction to the special issue.


* This special issue of Exceptional Children presents current information on a topic of major significance to both general and special education: the education of children and youth with attention deficit disorder (ADD). This issue is intended to inform the field about (a) the current definition and conceptualization of ADD, (b) assessment and identification of students with ADD, (c) the educational characteristics of students with ADD, and (d) interventions for ameliorating the attentional and behavioral problems manifested by students with ADD. We hope to stimulate discussion among educators as they develop or refine policies, procedures, and practices necessary to provide an appropriate public education for children with ADD under either Section 504 of Public Law 93-112 or the Individuals with Disabilities Act (IDEA).


Definition of Attention Deficit Disorder

Currently, the definition of ADD is established by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised (DSM-III-R) (APA, 1987). DSM is a clinical manual that describes behavioral symptoms of all disorders currently recognized by the APA and specifies the diagnostic criteria for each. Periodically, the criteria and symptom descriptions of various disorders are reviewed and modified based on current research and field trials on their clinical utility in practice.

The term attention deficit disorder was first used in DSM-III (APA, 1980). DSM-III changed the conceptualization of the disorder from one that was defined primarily as the presence of hyperactive-impulsive behavior in DSM-II (APA, 1968) to one that reflected developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. Also, DSM-III listed the behavioral symptoms of each feature separately and specified two primary subtypes based on the presence (ADDH) or absence (ADD no H) of hyperactivity. However, because ADD without hyperactivity was seldom classified in the subsequent field trials (Shaywitz & Shaywitz, 1988), the revised edition (APA, 1987) maintained the three primary features of inattention, impulsivity, and hyperactivity, but listed the three types of symptoms together in a composite syndrome called attention deficit hyperactivity disorder (ADHD).

At the same time, evidence was found for the validity of ADD without hyperactivity as a distinct subtype (Lahey & Carlson, 1991). Of particular interest in educational assessment are findings suggesting that ADD without hyperactivity may co-occur more often with learning disabilities (LD), whereas ADD with hyperactivity may be more frequent among children with disruptive behavior disorders (Barkley, DuPaul, & McMurray, 1990; Hynd et al., 1991; Lahey & Carlson, 1991). As a result of these findings and the opinion of many scientists and clinicians, it is anticipated that DSM-IV will contain separate criteria for ADD with and without hyperactivity and will clarify the distinctions between the two (see McBurnett, Lahey, & Pfiffner, this issue).

Congressional Action

While Congress was considering the 1990 amendments to the Education of the Handicapped Act, advocates of children and youth with ADD argued that these students have a problem that reduces their educational performance and proposed that ADD become a qualifying disability for special education and related services (Aleman, 1991). Many educational organizations (e.g., the National Association of State Directors of Special Education, the National Education Association, and CEC), however, objected to the inclusion of ADD as a separate disability category. These groups argued that (a) many children and youth with ADD already qualify for special education and related services because they also have learning disabilities or serious emotional disturbance; (b) if all students with ADD were to become eligible for special education, limited resources would be diverted away from students with more serious disabilities; and (c) ADD is difficult to define or identify (Aleman, 1991).

After considerable debate, Congress required the Office of Special Education Programs (OSEP) of the U.S. Department of Education, to (a) collect public comments on several questions about ADD and report the findings to Congress, and (b) establish centers to synthesize and disseminate current knowledge about ADD (Aleman, 1991).

Department of Education Action

To comply with the first part of the congressional mandate, the Department of Education published a "Notice of Inquiry" in the November 29, 1990, Federal Register concerning questions about the education of students with ADD. Essentially, the questions focused on the unique characteristics and educational needs of children and youth with ADD and possible IDEA eligibility criteria for this population. The comments were collected and reviewed, and a summary was transmitted to the Congress in May, 1991. In September 1991, several agencies--the Office of Special Education and Rehabilitative Services, the Office of Civil Rights, and the Office of Elementary and Secondary Education of the Department of Education--issued a policy memorandum based on the comments (Davila, Williams, & MacDonald, 1991). The memorandum stated that a child with ADD may qualify for special assistance or accommodations in general education under Section 504 of the Rehabilitation Act of 1973 or, if meeting appropriate criteria for a particular disability, for special education and related services under IDEA. Thus, this memorandum emphasized the fact that the appropriate education of students with ADD is a responsibility of both general and special education and involves both Section 504 and IDEA.

To comply with the second part of this mandate, OSEP has funded several centers and has initiated other projects.

* Two centers were established to synthesize

the research literature relevant to assessment

and identification; these are located at the University

of Arkansas and the University of

Miami, Florida.

* Two other centers were established to synthesize

the research literature relevant to intervention;

these are located at the Research

Triangle Institute in North Carolina and the

University of California at Irvine.

* A fifth center, the Federal Resource Center at

the University of Kentucky, was to identify

promising practices being used in schools to

educate children and youth with ADD.

In addition, the OSEP Division of Personnel

Preparation has supported 14 projects as of

this writing to develop and provide training to

general and special educators to enhance their

knowledge and skills to better meet the educational

needs of students with ADD.

The work of each center, as well as the work of other researchers in the field, is represented in this special issue. The articles by researchers at the centers are based on comprehensive syntheses that they helped prepare for OSEP. Some of the issues involved in the education of students with ADD are addressed in this special issue. More information from the syntheses will be disseminated to general and special educators by the Chesapeake Institute in Washington, DC, recently funded by OSEP as part of its emphasis on dissemination.


Although the research on ADD since 1980 has been voluminous, this body of knowledge has not been readily accessible to educational audiences. For example, we reviewed over 1,300 articles for the University of Miami ADD Center's synthesis of research on assessment and identification and found only 11% in educational journals. Our ERIC search yielded 152 articles, of which 38 pertained to assessment and identification. By comparison, our search of psychological research yielded 1,127 articles relevant to assessment and identification. Accordingly, our goal for this issue is to provide the broadest possible overview to better acquaint EC readers with the research base on ADD. Also, we chose topics we felt would stimulate and inform the ongoing professional dialogue and debate in the field of special education concerning the education of students with ADD.

The first article, by McBurnett, Lahey, and Pfiffner, presents the most recent information about forthcoming changes in the definition of ADD. McBurnett and colleagues describe and clarify the changes in the way ADD has been conceptualized and defined since 1980; discuss the development of DSM diagnostic criteria; and, most important, describe the new criteria and results of the clinical field trials conducted by Benjamin Lahey.

The second article, by Riccio, Hynd, Cohen, and Gonzalez, reviews recent research on the neuroanatomical, neurochemical, and neurophysiological systems related to ADD. Like a learning disability, ADD is conceptualized as an intrinsic disorder that is presumed caused by central nervous system dysfunction. The first article has direct relevance to how we conceptualize the primary manifestations for ADD for the purpose of assessment and operational definition in practice, and the second pertains to how we view the disorder as a potentially disabling condition.

The third article, by McKinney, Montague, and Hocutt, provides an overview of the general methods used to assess ADD and addresses issues pertaining to assessment for educational purposes. Noting the limitations of the knowledge base, this article focuses on the question of what constitutes a comprehensive assessment for educational purposes. In the next article, Dykman and Ackerman provide an in-depth probe of the literature on ADD subtypes and co-occurring learning disabilities and emotional/behavioral problems. Dykman and Ackerman draw on their own research in this area and present other comparative research concerning ADD with and without hyperactivity and the relationship between hyperactivity-impulsivity and aggressive behavior.

The remaining articles focus on the literature that is relevant to instruction, the evaluation of approaches to intervention, and a study of promising practices in the field. In the fifth article, Zentall reviews the literature on how inattention, impulsivity, and activity level affect students' academic performance on various subject matter tasks. Also, she discusses the effects of various instructional variables and methods for changing the nature of the task and response requirements to better accommodate the needs of students with ADD. The next article, by Swanson and colleagues, reviews the literature on the effects of stimulant medication. Swanson et al. provide a succinct summary of what educators can expect from stimulant medication, as well as what they cannot expect with respect to its effect on ADD symptoms, academic skills acquisition, and achievement.

In the seventh article, Fiore, Becker, and Nero report the results of their synthesis of research on interventions with respect to behavior management, academic instruction, home-school collaboration, and comprehensive programs. Although many strategies have been evaluated as effective, Fiore and colleagues point to several limitations that qualify the conclusions that can be drawn and to significant questions that have not been addressed concerning comprehensive programs and school-based implementation. Finally, Burcham, Carlson, and Milich report on a study conducted at the Federal Resource Center to identify and evaluate school practices that are being implemented. They describe a novel strategy for identifying and evaluating practices submitted by practitioners and summarize the common features of those practices selected as "promising" by experts in the field.


We wish to emphasize the leadership and supportive roles that the OSEP staff have played in the work of the five centers and in the efforts to disseminate the findings. Specifically, Judy Schrag, former Director of OSEP, has been keenly interested in and supportive of the work the centers have done. We appreciate her leadership at OSEP and with the centers.

We also acknowledge the leadership of Ellen Schiller, Chief of the Directed Research Branch in the Division for Innovation and Development, and Jane Hauser, the Project Officer for the centers, in organizing and guiding the centers' work. Schiller and Hauser conducted an excellent conference to frame the methodologies that would be used to synthesize the literature around the issues addressed by each center. They worked closely with the directors and staff and fostered an outstanding level of collaboration among the four research centers, the Kentucky center, and the agency. They planned and implemented a challenging and informative National Forum on ADD in Washington, DC in January 1993 that was attended by parents, researchers, and practitioners representing all relevant disciplines and organizations. Schiller and Hauser are directing and fostering the dissemination phase of this initiative, in collaboration with the Chesapeake Institute and the centers. We want to express our professional respect and personal affection for these leaders. The centers, and indeed the field, are indebted to them.


Aleman, S. R. (1991). CRS report for Congress: Special education for children with attention deficit disorder: Current issues. Washington, DC: Congressional Research Service. American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed., DSM-II). Washington, DC: Author. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed., DSM-III). Washington, DC: Author. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev., DSM-III-R). Washington, DC: Author. Barkley, R. A., DuPaul, G., & McMurray, M. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775-789. Davila, R. R., Williams, M. L., & MacDonald, J. T. (1991). Memorandum to chief state school officers re: Clarification of policy to address the needs of children with attention deficit disorders with general and/or special education. Washington, DC: U.S. Department of Education. Hynd, G. W., Lorys, A. R., Semrud-Clikeman, M., Nieves, N., Huettner, M. I. S., & Lahey, B. B. (1991). Attention deficit disorder without hyperactivity: A distinct behavioral and neurocognitive syndrome. Journal of Child Neurology, 6, 35-41. Lahey, B., & Carlson, C. (1991). Validity of the diagnostic category of attention deficit disorder without hyperactivity: A review of the literature. Journal of Learning Disabilities, 24(2), 110-120. Shaywitz, S. E., & Shaywitz, B. A. (1988). Attention deficit disorder: Current perspectives. In J. F. Kavanagh & T. J. Truss (Eds.), Learning disabilities (pp. 369-523). Parkton, MD: York.


ANNE M. HOCUTT (CEC #121), Research Investigator, Miami Center for Research on Attention Deficit Disorder, and Adjunct Assistant Professor, Department of Educational and Psychological Studies, University of Miami, Coral Gables. JAMES D. MCKINNEY (CEC #100), Professor of Education, University of Miami, Coral Gables, and Director of the Miami Center for Research on Attention Deficit Disorder. MARJORIE MONTAGUE (CEC #114), Associate Professor of Education, University of Miami, Coral Gables, and Co-Director, Miami Center for Research on Attention Deficit Disorder.

Preparation of this manuscript was supported in part by Grant No. H023S10013 from the Office of Special Education Programs, U.S. Department of Education. The article does not necessarily reflect the position or policy of the funding agency.


We thank The Council for Exceptional Children (CEC) for its commitment to address issues concerning the education of children with ADD and the Editor and Associate Editors of Exceptional Children for their commitment to an in-depth, focused discussion of ADD in this special issue. We are particularly indebted to Naomi Zigmond for her assistance in making this issue a reality. Clearly, we are also indebted to all of the authors who have contributed to this issue and worked so diligently to write and revise the articles, in addition to their other duties. Finally, we owe special gratitude to Judy Harris, our graduate assistant, and to Laura Brennan, our secretary, for their considerable assistance in contacting various individuals, taking on additional duties to give us time to edit the manuscripts, and generally keeping us on track.
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Author:Hocutt, Anne M.; McKinney, James D.; Montague, Marjorie
Publication:Exceptional Children
Date:Oct 1, 1993
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