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Research on the educational implications of attention deficit hyperactivity disorder.

* Studies examining the academic achievement of children with attention deficit hyperactivity disorder (ADHD) indicate that they are more likely than children without disabilities to receive lower grades in academic subjects and lower scores on standard measures of reading and math (Barkley, Fischer, Edelbrock, & Smallish, 1990; Wener, 1990, p. 188). For example, more than 80% of 11-year-olds with ADHD were reported behind at least 2 years in reading, spelling, math, or written language (Anderson, Williams, McGee, & Silva, 1987). These learning difficulties contribute to follow-up reports that over half of the children with ADHD who are taught in regular classrooms will experience school failure or fail at least one grade by adolescence (Barkley et al., 1990; Brown & Borden, 1986; Minde et al., 1971), and over one third will fail to finish high school (Weiss & Hechtman, 1986). Children with ADHD in the regular classroom face a risk of school failure two to three times greater than that of other children without disabilities but with equivalent intelligence (Rubinstein & Brown, 1981). I maintain that the educational manifestations and outcomes of ADHD have received insufficient attention.


Attentional "deficit" is more accurately described as attentional "bias." An attentional deficit connotes a lack of attention, whereas an attentional bias more correctly connotes adequate attention, memory, and comprehension, but associated with specific tasks, time periods, and conditions. To understand how attentional bias can result in educational deficits, we must see the consistency of attentional response to specific tasks and conditions.

Students with ADHD selectively attend to novelty, such as color, changes in size, and movement (Copeland & Wisniewski, 1981; Radosh & Gittelman, 1981). Any strong stimulus can captivate the attention of these children, and they are more likely than students without ADHD to attend to what is immediately salient. Attention to novelty can produce difficulty: (a) during early selective-attention performance--failure to focus on relevant stimuli that are neutral, subtle, small/detailed, less salient, or embedded within tasks (e.g., Tant & Douglas, 1982)--and (b) during later performance--failure to sustain attention. Decreased activity and improved performance coincide with practice on selective-attention tasks, whereas increased activity and performance losses accrue over time on sustained-attention tasks. Selective-attention tasks typically require a search for the physical location of important stimuli within a multiple-stimulus field. Almost all tasks that are new, complex, or unstructured have selective-attention requirements.

On the other hand, almost any practiced task that has a relatively stable level of performance can be defined as a sustained-attention task. Clearly there is less novelty after exposure to any task or setting. Because it would be more difficult for students with ADHD to remain alert under conditions of decreasing novelty (Zentall & Zentall, 1983), a second problem resulting from attentional bias is difficulty in sustaining attention. Problems in sustained attention mean more errors during later performance and more activity over time (from morning to afternoon, the beginning of a task to the end, early in a situation to later; Zentall, 1985a). Our work has shown that the longer the duration assessed (without breaks or novelty added), the greater or more probable are group differences. There have been recent questions, however, about a greater loss over time for students with ADHD, because Group X Time interactions have been infrequently documented in performance (van der Meere, Wekking, & Sergeant, 1991). (Note that using interactions as the criterion fails to take into account that the analysis of variance has low power to detect nonadditivity, relative to tests of main effects; Wahlsten, 1990.) In subsequent work, however, Alberts and van der Meere (1992) observed that visual off-task behavior increased over time without a loss in task accuracy. These authors concluded that off-task behavior (i.e., attention to novelty) may have helped reduce performance losses over time.

Performance and behavioral dissolutions are worse when sustained attention is required to attend to repetitive task stimuli or responses. Researchers have documented several specific attentional problems for students with ADHD: (a) inability to sustain attention to repetitive stimuli (e.g., Zentall, 1985b, 1986); (b) avoidance of verbal rehearsal unless reinforced at high rates (e.g., Hallahan, Tarver, Kauffman, & Graybeal, 1978); and (c) more behavioral problems when information is repeated (Shroyer & Zentall, 1986). In our work, we have found that when tasks involve repeated exposure to stimuli of decreasing novelty, students with ADHD show increased activity and impulsive responding, especially during later trials (e.g., Zentall, 1985b, 1986; Zentall, Falkenberg, & Smith, 1985; Zentall & Zentall, 1976). Difficulty in sustaining attention to repetition also appears to mitigate against the development of rote skills. For example, memory deficits do not occur on short-term memory tasks (Douglas, 1972) but do occur during sustained performance, with the requirements for rehearsal or mnemonics (August & Garfinkel, 1990; Douglas, 1980; Felton, Wood, Brown, & Campbell, 1987; Weingartner et al., 1980).

The academic tasks reviewed here may initially require selective attention and later require sustained attention, and the same task may require selective attention for young children and for students with co-occurring learning disabilities, while requiring sustained attention for older youth.

Spoken Language

Listening Tasks. Listening requires the ability to select out and attend to a message while ignoring competing (overlapping or contiguous) information. In general, we find that increasing the selective attentional requirements by adding detail or description are more likely to disrupt listening comprehension of students with ADHD. Specifically, when stories were embedded with added description, youth with ADHD demonstrated poorer listening comprehension than matched controls, even though listening time was held constant (Shroyer & Zentall, 1986). Another form of contiguous, nonessential information is detail. When given a choice in a listening task, students with ADHD requested additional global cues ("it looks like") more often than additional detail ("it has the following parts") (Zentall & Gohs, 1984).

When nonrelevant stimulation overlaps important information, performance deficits are also observed. For example, background classroom conversations (but not noise) may overlap the internal conversations necessary for problem solving. For this reason, added conversational noise disrupted the performance of young children with ADHD--when the tasks they were performing were more difficult for them than they were for the comparisons, even though we partialled achievement out of the analyses (see Zentall & Shaw, 1980). Consistent with these experimental findings are self-report data that students with ADHD did not prefer background noise/conversation, even though they did report greater preferences than comparisons for social and activity stimulation (Zentall & Smith, 1992).

The greater disruptive effects of added detail, description, and overlapping conversations may be related to the ephemeral nature of auditory information. It is difficult to reexamine or preview verbal statements. Difficulty in selectively listening in a complex context may contribute to or be exacerbated by language disorders, observed especially for young and clinic-referred children. For example, two thirds of a clinic-referred sample had language disorders (Love & Thompson, 1988), even though at advanced grades and using nonclinic samples, language disorder was either no longer present (McGee, Partridge, Williams, & Silva, 1991) or very specific in nature (e.g., grammatical closure; see Zentall, 1988).

Language Production Tasks. Difficulty in sustaining attention to covert thought could also explain observed language production deficiencies. For instance, we found students with ADHD more talkative than their classmates only when they initiated conversations, and less talkative when asked to respond (Zentall, 1980, 1988, 1989b). Specifically, they failed to elaborate without external cues or scaffolding, such as pictures or beginning or ending cues (Zentall, 1988). Cues may help focus and maintain attention to covert events (e.g., when making up stories); but they may be unnecessary for self-initiated conversations, which typically involve commentary about or associations to current tasks, topics, or environments. That these children may require scaffolding is supported by findings that students with ADHD had more auditory memory errors and sat for less time with auditory instructions alone than with combined instructions plus a visual model (Carter & Shostak, 1980). Added visual cues "normalized" their skill in following directions, though visual cues had little effect on comparisons. Similarly, students with ADHD performed worse than comparisons in free recall, but not on cued recall (Hamlett, Pellegrini, & Conners, 1987; Weingartner et al., 1980).

Written Language

Math. Initial exposure to math problems, whether word problems or computations, involves selective-attention requirements. In word problems, some of the selective-attention requirements are related to reading. In a review of work in this area and excluding studies that failed to control for possible group differences in IQ or in reading, we have documented that cognitive ability (including memory) and reading contribute to the skills needed to eliminate extraneous information, handle multiple operations, and reorganize verbal information (Zentall & Ferkis, 1993). What is not explained by IQ, reading, or computational differences appears to be specifically related to difficulty with problems that have changes in action, operation, and order of operation (Zentall, 1990; Zentall & Ferkis, 1993). Failure to selectively attend to subtle cues could account for deficits observed with problem changes. However, difficulty with math concepts (e.g., measurement and distance) similarly cannot be understood as an outcome of lower IQ/memory. This finding awaits further analysis.

Of all the academic areas assessed on the Wide Range Achievcment Test-Revised (WRAT-R) math computation is the area in which students with ADHD are most likely to fall behind (Nussbaum, Grant, Roman, Poole, & Bigler, 1990). We have documented that deficits are not due to cognitive disabilities that often co-occur for children with ADHD (e.g., as may co-occur with spelling or reading deficits). Controlling for IQ, we still documented consistent differences in the speed of calculating computations (Ackerman, Anhalt, Holcomb, & Dykman, 1986; Zentall, 1990; Zentall, Smith, Lee, & Wieczorek, 1993). Slower calculation speed has been demonstrated for students with ADHD, even when performance scores were adjusted for their slower typing speed (Zentall & Smith, in press). Slow speed may be attributed to a failure to sustain attention to repetition and thus to overlearn rote skills. The few math problems attempted by students with ADHD (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991; Zentall & Smith, in press) can be attributed to a combination of slower computational and visual-motor speed, and to off-task behavior.

Reading. About 9% of students with ADHD have been characterized as having true reading disabilities, defined by reading achievement discrepant from full-scale IQ potential and age expectancy (e.g., Halperin, Gittelman, Klein, & Rudel, 1984). Percentages are reported as high as 24%, relative to 8% of comparisons, 39% of clinic referred samples (August & Garfinkel, 1989, 1990), or 35% when preschoolers with ADHD were reassessed at age 15, relative to 10% of a developmental control (Love & Thompson, 1988). Disabilities in reading are less frequently found in general education samples (e.g., August, 1987; Zentall & Dwyer, 1988; Zentall & Meyer, 1987).

In studies that have selected students with ADD and ADHD, with and without reading disorder, and controls, and also measured IQ, researchers have documented that intelligence and phonological skills account for the reading retardation observed (e.g., Ackerman, Dykman, & Gardner, 1990; August & Garfinkel, 1990; Dykman & Ackerman, 1991; Halperin et al., 1984; McGee et al., 1989). That is, researchers have reported that students with ADD and RD have significantly lower verbal IQs and sometimes lower performance IQs. However, some researchers have controlled for IQ and still found that students with ADHD performed worse than comparisons in reading (August & Garfinkel, 1989; Tant & Douglas, 1982). McGee et al. (1991) also reported poorer reading, relative to a developmental control. Thus, characteristics associated with ADHD have implications for some reading problems. Teachers may observe difficulties in reading comprehension only in requirements for comprehension of long passages. Further, students with ADHD are less likely to fall behind in vocabulary than in comprehension, because vocabulary does not appear to be associated with sustained attention (Nussbaum et al., 1990).

Spelling. August and Garfinkel (1989) reported that 38% of students with ADHD had spelling disabilities, defined by discrepancy from IQ expectancy. In group statistics, differences in spelling achievement remain when IQ is partialled out of the analysis (August & Garfinkel, 1990). Spelling is initially a selective-attention task in its requirement to identify relevant letters--within a context of an irregular sound-symbol relationship. The selective-attention character of this task is documented by improved performance simply as a function of practice (Fitzgerald, Fick, & Milich, 1986) and by failure to find improvements in spelling accuracy from psychostimulant medication (Douglas, Barr, O'Neill, & Britton, 1986). These researchers demonstrated that increased effort, produced by stimulant medication, did not improve accuracy. However, when the selective-attention requirements were altered by reducing the number of words to be mastered to only five words, psychostimulant medication did improve accuracy (Stephens, Pelham, & Skinner, 1984).

Handwriting. Some tests have failed to yield group differences in manual dexterity and coordination (e.g., van der Meere et al., 1991), but researchers have documented visual-motor deficits for these students (McGee et al., 1991; Minde et al., 1971; Zentall & Kruczek, 1988). Students with hyperactivity have slower motor-response speed, more typing errors (Zentall & Smith, in press), and slower perceptual speed (Plomin & Foch, 1981). These are also characteristics of students with ADD, without hyperactivity (Barkley, Grodzinsky, & DuPaul, 1992).

When visual-motor differences are found and are partialled out of the analyses, group differences in handwriting errors are "washed out" (Zentall & Kruczek, 1988). These results could suggest that the often illegible handwriting of students with ADHD is the result of visual-motor deficits. Alternatively, both handwriting and visual-motor performance may be outcomes of a third variable, failure to sustain attention to repeated practice. We have documented that requirements for longer time on task do exacerbate errors. That is, students with hyperactivity had more errors and poorer handwriting ratings than comparisons after adaptation/practice on a copying task, even though the matching procedures employed precluded initial group differences (Zentall & Kruczek, 1988).


What is easily recognized and therefore salient in the early identification of students with ADHD is excessive verbal and motoric activity. Their excessive activity is manifested across the contexts of home, school, and clinic, and across settings defined as free and restrictive play, task and non-task, social and nonsocial, sleep and awake (Zentall, 1985a). That is, although different settings elicit different behavioral rates, group differences were observed in all contexts. For children with hyperactivity, it was the properties within the settings (novelty, task difficulty) that set the occasion for differential changes in their behavior.

Although professionals in special education have moved away from the term hyperactivity toward inattention, activity has been found to be a better marker (Porrino et al., 1983)--perhaps because problems in attention characterize most childhood disorders. For example, we have found that 53% of children with learning disabilities (LD) were rated by their teachers as having impulsivity/inattention, whereas only 13% had characteristics that included hyperactivity (Zentall, 1990). What typifies activity is not only its intensity (loudness, frequency) but the fact that it is variable. It should not be confused with the repetitive motor or verbal activity associated with anxiety and autism (see Zentall & Zentall, 1983) or with side effects of high doses of psychostimulant medication.

Activity per se has more social than educational implications, unless it is manifested at a very high rate, and the student is required to remain still while learning. When the student must continuously divert energy from learning to behavioral inhibition, activity may have serious academic outcomes. We have also observed that students with ADHD failed to repeat activity patterns long enough to establish routines. Students with ADHD recognized that they did not have routine locations for books when returning home from school, that they lost things at school, had difficulty finding homework (even after doing it), and failed to complete tasks (Zentall, Harper, & Stormont-Spurgin, in press). Failure to establish routines may also contribute to low desk-neatness ratings for these youth (Atkins, Pelham, & Licht, 1989).


Impulsivity, a third major characteristic of ADHD, represents the child's difficulty in withholding active responses (blurting out statements, grabbing materials). Impulsivity produces academic errors, primarily because an individual fails to wait long enough to consider alternative information, consequences, or responses. Impulsivity is identified in tasks with delay requirements (i.e., unclear, ambiguous, detailed, or complex tasks). In delay situations or tasks, these children appear to respond to what is salient or immediately available.

Generally, failure to delay or wait produces (a) poor multiple-choice performance, which requires attending to multiple items before responding; (b) poor planning skill, which requires holding back overt responses, while making covert ones; and (c) failure to read directions or ask for help, because this requires waiting. For example, Hoy, Weiss, Minde, and Cohen (1978) documented that students with ADHD performed worse than controls only when a five-response multiple-choice format was used, but not with two choices. Performance deficits on multiple-choice tasks may be documented on the Matching Familiar Figures Test (MFFT) (Kagan, Rosman, Day, Albert, & Phillips, 1964). Students with ADHD performed worse (more errors and less time) on this task than did controls with equivalent IQ (e.g., Homitidis & Konstantareas, 1981; Zentall & Dwyer, 1988). Poor performance on such tasks could also be explained by students' difficulty with detail or with sustaining attention, or overreliance on global cues (see Zentall & Gohs, 1984). However, impulsivity assessed on the MFFT, like inattention assessed on vigilance tasks, fails to differentiate students with ADHD from students with other disabilities (e.g., Firestone & Martin. 1979).

Failure to delay may contribute to poor planning or organizational skills that characterize students with ADHD and account for 2 of the 14 diagnostic criteria of DSM-III-R (American Psychiatric Association, 1987). In our work, we have found that students with ADHD are aware they fail to plan ahead or anticipate final steps (Zentall et al., in press). Their attempts to plan are disorganized in nature (e.g., Sequential Organization Test; August & Garfinkel, 1990).

Students with ADHD are also less likely to ask for help. That is, they do not request additional confirmatory information when it involves delaying action (e.g., Whalen, Henker, Collins, McAuliffe, & Vaux, 1979). In nondelay settings, such as one-on-one interactions, students with ADHD do not differ in the number of task-related questions or statements directed to a playmate (e.g., Madan-Swain & Zentall, 1990) and may request more feedback from their mothers (Campbell, Endman, & Bernfeld, 1977). Thus, it does not appear that these students are generally unwilling to ask; but they have greater difficulty tolerating instructional delays, which in math and reading consume 20% of class time (Baker & Zigmond, 1990)--not counting the time a single student might have to wait for help.

Alternatively, not asking for help may result from the difficulty these children have in formulating requests for assistance. In support, research has indicated that students with ADHD asked more trial-and-error and fewer problem-constricting questions (Tant & Douglas, 1982; Whalen ct al., 1979). To control for the ability to ask for information, we conducted a study in which the student obtained additional cues by pressing a buzzer--without verbalizing and without delay (Zentall & Gohs, 1984). In this study, preschool students with ADHD requested as many cues as comparisons, were generally as motivated, and were able to delay making a choice on an ambiguous task. Thus, failure to ask may be specifically related to the delays incumbent with such requests or to difficulty in the formulation of requests.


I present the hypothesis that students with ADHD have an attentional preference for novelty and a greater need for active responding. I have maintained that activity level is similar to IQ or height, following a genetically-based normal curve. (Exogenous factors can contribute to individual differences in activity, in the same way that external insult can alter IQ.) Other researchers have similarly argued for the heritability of activity level (e.g., Willerman, 1973). Researchers have documented a genetic factor in ADHD; some have reported findings of similar characteristics for anywhere from 60% to 75% of the relatives of students with ADHD and from 30% to 50% of their siblings (Goodman & Stevenson, 1989; Welner, Welner, Stewart, Palkes, & Wish, 1977).

The biogenetic basis lies in individual differences in physiology. Reduced physiological reactivity to intenral and external sources of stimulation produces a need for stimulation by the organism, which in turn produces changes in attention and activity. That is, in some situations and tasks, we all need more stimulation to perform effectively. For example, to get focused in the morning, we may need the stimulation of coffee; sometimes in the evening, when stress and stimulation reach a peak, we bring ourselves back to a more comfortable level, perhaps using alcohol or TV. Children, who do not have chemical or cognitive avenues of optimizing effective stimulation, are more reliant on behavioral means. Students with ADHD have a greater need for stimulation; or, as reported in the literature, they are physiologically underactive or underreactive to stimulation or to differences among stimuli (e.g., Rosenthal & Allen, 1978; Satterfield, Schell, Nicholas, Satterfield, & Freese, 1990). Although the exact physiological mechanisms (e.g., brain structures, neurotransmitters, brain glucose, or blood supply) will continue to be advanced in the literature, the consistency of behavioral response to stimulus events has provided the basis for this theoretical explanation.


Attentional bias to novelty for students with ADHD produces a pattern of difficulty during early performance (i.e., selective attention) and during later performance (i.e., sustained attention) that has educational and treatment implications. The implications of ADHD for early performance is that strong stimulation differentially captivates the attention of these youth. If what is salient is not important and is contiguous with or overlaps important task information, disrupted performance will be manifested. For example, students with ADHD have greater difficulty listening to important messages, when they are presented with unimportant detail. These students also have more difficulty thinking while in the presence of interesting conversation. Failure to selectively attend to small changes could explain some of the deficits observed with mixed-action, -operation, and -order of operation word problems.

In general, interventions for selective attention can be derived from findings that stimulation can guide or disrupt performance, depending on its placement. Some earlier work (both basic and applied--Rosenthal & Allen, 1980; Zentall, Zentall, & Barack, 1978; Zentall, Zentall, & Booth, 1978) demonstrated that when color was placed on unimportant task features, it interfered with complex or new task performance more for students with ADHD than for comparisons. However, if practice on a task preceded the appearance of nonrelevant stimulation, the performance of students with ADHD was not disrupted more than for comparisons (e.g., van der Meere & Sergeant, 1988). Furthermore, added color can differentially improve performance when (a) added to increase important task features (Zentall & Kruczek, 1988) or (b) added later after the task was practiced in a simple form (e.g., Zentall, 1989a).

Spelling is an example of a selective-attention task, especially with more response choices or words to learn. With spelling, color stimulation should be added after the student has practiced the task. For example, in a spelling-related task in which the student found words by identifying their correct spellings within an embedded letter context (word discovery task), students with ADHD performed better with psychostimulant medication (Douglas et al., 1986; Douglas, Barr, Amin, O'Neill, & Britton, 1988). Douglas and associates, however, noted that the medication was administered after the task had been practiced and that the timing may have been critical to the benefits derived. Our work supports these conclusions (e.g., Zentall, 1989a). Students with ADHD responded differently and better than comparisons by selecting correctly spelled words from six choices when they were first presented with black letters followed by color added to important irregular) letters, relative to when color was presented first. Although the groups did not differ overall in spelling performance because of our matching procedures, the students with ADHD made fewer errors than the comparisons when color was added late. In related work, students with ADHD also performed better in Week I with traditional spelling instruction relative to novel materials (e.g., color graphics and nonrelevant animation--Fitzgerald et al., 1986; or color, movement, size--Zentall, Zentall, & Booth, 1978). Spelling gains were derived from novelty only during later trials (Zentall, Zentall, & Booth, 1978).

For failure to sustain attention, the educational implications are found primarily during simple (narrow-focus) tasks--requiring extended time, repetition of similar motor responses--or in a context of decreasing novelty. It is under these conditions that students with ADHD differ from comparisons and seek alternative stimulation. The educational implications are failure to complete tasks or overlearn rote skills, such as math computations. Handwriting requires repetitive actions, and performance deteriorates over time for students with ADHD, relative to handwriting-matched controls. Sustained attention can also be required when the student is asked to talk about a topic, follow directions, or memorize; but deficits show most often when external cues and scaffolding are unavailable. Finally, reading comprehension can involve sustained attention; and in the absence of sufficient stimulation, students may skip enough material to reduce their comprehension.

Research has generally indicated that to improve sustained attention performance for students with ADHD, (a) color novelty improves performance (Rugel, Cheatam, & Mitchell, 197 8; Zentall, 1985b, 1986); (b) novel settings of tests, films, and games improve behavior, relative to more frequently occurring contexts (Zentall, 1980); (c) music novelty improves math productivity (Scott, 1970; Szeibel, Abikoff, & Courtney, 1989); and (d) psychostimulant medication produces reliable gains in math facts (i.e., in the number attempted, correct, correct per minute, and self-corrected; Douglas et al., 1986, 1988) and in handwriting performance (Gadow, 1983). Although handwriting typically requires sustained attention, it can have selective attention requirements for young children. For this age group, color should be used, for example, to draw attention to the areas on the letters that children with ADHD fail to close (Zentall & Kruczek, 1988). For adolescents, however, for whom handwriting is an overlearned sustained-attention task, added color (both relevant and nonrelevant) reduced handwriting errors for youth with attentional disorders but not for handwriting-matched comparisons (Zentall et al., 1985).

Similarly, in reading comprehension, additional physical stimulation may help to sustain attention. For example, Bremer and Stem (1976) examined off-task behavior and reading performance of boys with and without hyperactivity under noisy and quiet conditions. Although reading performance was not affected by noise, an analysis of those hyperactive children who were drawn off task in the quiet condition, a majority (four out of five) had skipped one fourth of the reading material. Reading-omission errors in the quiet condition were significantly greater than those observed for the reading-matched comparisons. Similarly, Dubey and O'Leary (1975) documented that students with hyperactivity and reading disabilities were more likely to skip words, phrases, and lines, and thus read with more errors and poorer reading comprehension in a silent reading condition than when reading out loud.

Activity has few educational implications, except when it is manifested as impulsivity on multiple-choice tasks or during planning and waiting. For students with ADHD, waiting can be tolerated as long as verbal and motor responses are possible during the interim. Some researchers have found that gross motor activities increase attention to task and decrease teacher ratings of hyperactivity or aggression (e.g., Elsom, 1980; McGimsey & Favell, 1988; Walker, 1980). We have documented that students with ADHD differ from comparisons in behavior and impulsivity (commission errors) only during a "passive" sustained attention task (i.e., Zentall & Meyer, 1987). That is, providing active responses normalized the behavior and attentional performance of students with ADHD.


Changes in the nature of the task and in response requirements are some important but neglected accommodations for students with ADHD. Changes in responding include programming routines and active responses (not handwriting) into and between lessons. Changes in the task include adding novelty, especially later, to help students with ADHD maintain alertness. For example, most students with ADHD would not be considered deficient in attention in response to games. These children will seek out stimulation when their tasks are overly familiar or repetitive. When tasks are complex or unstructured, novelty should be added to guide attention to what is important.

Children will also seek out alternative stimulation when their tasks are either too easy or too difficult. It is my contention that when teachers must assign treatment priorities, they should address any co-occurring learning disabilities, language differences, talent/giftedness, or retardation before they provide accommodations for ADHD. The relatively high rates of co-occurring ADHD with learning disabilities suggest that assessment of either disorder is likely to be confounded by characteristics of the other. The entanglement can be reduced when task difficulty is not a factor and the child can make task-appropriate responses.

Finally, even though many educational difficulties are associated with the characteristics of ADHD, researchers have documented positive educational outcomes. For example, in spoken language, an attentional bias to novelty appears to contribute to greater creativity in the stories told by students with ADHD than documented for their classmates (Zentall, 1988). Thus, we also need to recognize the potential energy, creativity, leadership, and spontaneity of students with ADHD when determining accommodations for them.


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SYDNEY S. ZENTALL (CEC #762), Professor of Special Education and Psychological Sciences, Purdue University, West Lafayette, Indiana.

Support for the preparation of this manuscript was provided by Grant #H029K20306 funded by the Office of Special Education and Rehabilitative Services of the U.S. Department of Education. The article does not necessarily reflect the position or policy of the funding agency.

Address correspondence and reprint requests to Sydney S. Zentall, Department of Educational Studies, Purdue University, West Lafayette, IN 47907.
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Author:Zentall, Sydney S.
Publication:Exceptional Children
Date:Oct 1, 1993
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