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- Herausgeber: John Wiley & Sons
- Kategorie: Bildung
- Sprache: Englisch
The most up-to-date and comprehensive vital resource for educators seeking ADD/ADHD-supportive methods How to Reach and Teach Children and Teens with ADD/ADHD, Third Edition is an essential guide for school personnel. Approximately 10 percent of school-aged children have ADD/ADHD--that is at least two students in every classroom. Without support and appropriate intervention, many of these students will suffer academically and socially, leaving them at risk for a variety of negative outcomes. This book serves as a comprehensive guide to understand and manage ADHD: utilizing educational methods, techniques, and accommodations to help children and teens sidestep their weaknesses and showcase their numerous strengths. This new 2016 edition has been completely updated with the latest information about ADHD, research-validated treatments, educational laws, executive function, and subject-specific strategies. It also includes powerful case studies, intervention plans, valuable resources, and a variety of management tools to improve the academic and behavioral performance of students from kindergarten through high-school. From learning and behavioral techniques to whole group and individualized interventions, this indispensable guide is a must-have resource for every classroom--providing expert tips and strategies on reaching kids with ADHD, getting through, and bringing out their best. * Prevent behavioral problems in the classroom and other school settings * Increase students' on-task behavior, work production, and academic performance * Effectively manage challenging behaviors related to ADHD * Improve executive function-related skills (organization, memory, time management) * Apply specific research-based supports and interventions to enable school success * Communicate and collaborate effectively with parents, physicians, and agencies
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Contents
Cover
Praise for
How to Reach and Teach Children and Teens with ADD/ADHD
Title Page
Copyright
Dedication
About the Author
Acknowledgments
Preface
Part 1: Key Information for Understanding and Managing ADHD
Section 1.1: Understanding ADHD
Clarifying Terms and Labels
Descriptions and Definitions
Signs and Symptoms
Three Presentations of ADHD
Statistics and Risk Factors
ADHD and Coexisting Disorders
ADHD Look-Alikes
What Is Currently Known about ADHD
ADHD Brain Differences
Causes of ADHD
Girls with ADHD
Positive Traits and Strengths
ADHD and the Impact on the Family
Section 1.2: ADHD and Executive Function Impairment
Definitions of Executive Function (EF)
EF Analogies and Metaphors
EF Components
EF Dysfunction in ADHD
Models Explaining Executive Function Impairment in ADHD
Other Information about Executive Functions
What Parents and Teachers Should Keep in Mind
Section 1.3: Making the Diagnosis: A Comprehensive Evaluation for ADHD
Clinical Evaluation for ADHD
DSM-5 Criteria
Components of a Comprehensive Evaluation for ADHD
Pursuing an ADHD Evaluation
What Teachers and Other School Professionals Need to Know
Section 1.4: Multimodal Treatment for ADHD
Multimodal Intervention
Additional Points to Keep in Mind
Caution about Alternative Treatments
Section 1.5: Medication Treatment and Management
Stimulant Medications in the Treatment of ADHD
Nonstimulant ADHD Medications
Other Medications
Additional Information
If a Child or Teen Is Taking Medication: Advice for School Staff and Parents
Section 1.6: Behavioral Therapy for Managing ADHD
General Principles of Behavior Modification
Home-Based Behavioral Treatment
School-Based Behavioral Treatment
Child-Based Behavioral Treatment
Section 1.7: Critical Factors in the Success of Students with ADHD
Section 1.8: ADHD in Preschool and Kindergarten
Developmental Signs and Symptoms in Young Children
Red Flags for Possible Learning Disabilities
What the Research Shows
Evaluation, Diagnosis, and Intervention
More Strategies and Tips for Parents
Kindergarten Academic Skills and Expectations
Research-Supported Intervention Programs for Preschool and Kindergarten
Strategies and Tips for Preschool and Kindergarten Teachers
Strategies and Tips for Early Childhood Teachers*
Section 1.9: ADHD in Middle School and High School
For All Kids This Age
ADHD-Related Challenges and Needs
Addressing Coexisting Disorders
School Supports
Aiding the Transition to Middle or High School
Transition Plans
Warning Signs (Red Flags) in Middle School and High School
Warning Signs of Learning Disabilities in Teens
Understanding Their ADHD and Self-Advocacy
The Value of Mentorship
Part 1 References
Part 1 Additional Sources and Resources
Part 2: Managing the Challenge of ADHD Behaviors
Section 2.1: Proactive Classroom Management
Classroom Management Tips
Environmental Supports and Accommodations in the Classroom
Common Triggers or Antecedents to Misbehavior
Address Student Misbehavior
Section 2.2: Preventing Behavior Problems during Transitions and Less Structured Times
Section 2.3: Class (Group) Behavior Management and Incentive Systems
Positive-Only Group Reinforcement Systems
What to Do about Students Whose Behavior Interferes with Group Success
Points to Keep in Mind
Section 2.4: Individualized Behavior Supports and Interventions
Target Behaviors
Individualized Interventions
Functional Behavioral Assessments (FBAs) and Behavioral Intervention Plans (BIPs)
Section 2.5: Strategies to Increase Listening, Following Directions, and Compliance
Strategies and Tips for Teachers
Increasing Compliance
Oppositional Defiant Disorder and ADHD
Section 2.6: Managing Challenging Behavior: Strategies for Teachers and Parents
Strategies for Emotional Regulation and Control
Dealing with Argumentative and Oppositional Behavior
Section 2.7: School-Based Social Skills Interventions
ADHD-Related Difficulties
Skill Deficits versus Performance Deficits
The Impact on Children and Families
Classroom Interventions
Schoolwide Programs and Interventions
Goal-Setting Tips
Social Skill Lesson Plan
Report Form: Social Skills
Part 2 References
Part 2 Additional Sources and Resources
Part 3: Instructional, Learning, and Executive Function Strategies
Section 3.1: Attention!! Strategies for Engaging, Maintaining, and Regulating Students' Attention
Getting and Focusing Students' Attention
Maintaining Students' Attention through Active Participation
Keeping Students On-Task During Seatwork
Teacher Tips for Helping Inattentive, Distractible Students
Self-Monitoring Attention (Self-Regulatory Techniques)
Section 3.2: Research-Based Instructional Approaches and Interventions
Universal Design for Learning (UDL)
Differentiated Instruction
Response to Intervention (RTI)
Peer-Mediated Instruction and Intervention
Blended Learning
Designing Interventions for Struggling Learners: Key Instructional Components
Section 3.3: Organization and Time Management
What Teachers Can Do to Help with Organization
What Teachers Can Do to Help with Time Management
Section 3.4: The Homework Challenge: Strategies and Tips for Parents and Teachers
Homework Tips for Parents
Homework Tips for Teachers
Section 3.5: Learning Strategies and Study Skills
What Are Learning Strategies?
Metacognition and Metacognitive Strategies
Cognitive Learning Strategies
More Learning and Study Strategies
Section 3.6: Memory Strategies and Supports
Definitions and Descriptions of Working Memory
Working Memory Deficits and ADHD
Difficulties Associated with Poor Working Memory
Supports and Accommodations for Memory Weaknesses
Cognitive Working Memory Training (CWMT) Programs
Mnemonics
Music and Rhyme
Other Memory Strategies and Tips
Multimodal and Memory Techniques for Learning Multiplication Tables
Memory Techniques for Other Hard-to-Remember Information
Part 3 References
Part 3 Additional Sources and Resources
Part 4: Strategies and Supports for Reading, Writing, and Math
Section 4.1: Common Reading and Writing Difficulties
The Reading Process: What Good Readers Do
Coexisting Learning Disabilities
Common Reading Errors and Weaknesses in Students with ADHD
Steps of the Writing Process and Potential Problems
Why Writing Is a Struggle
Section 4.2: Decoding, Fluency, and Vocabulary
Word Recognition and Decoding
Fluency
Section 4.3: Reading Comprehension
Strategies throughout the Reading Process
The Importance of Teacher Modeling of Strategic Reading
Graphic Organizers
More Key Comprehension Strategies
Other Reading Comprehension Strategies
Classroom Book Clubs
Section 4.4: Writing: Strategies, Supports, and Accommodations
Prewriting, Planning, and Organizing
Strategies for Building Skills in Written Expression
Strategies for Revising and Editing
Mnemonic Proofreading Strategies
Other Tips for Teachers
Strategies to Bypass and Accommodate Writing Difficulties
Section 4.5: Spelling and Handwriting
Helping Children with Spelling Difficulties
Improving Handwriting and Legibility of Written Work
Section 4.6: Mathematics
Math Difficulties Associated with ADHD and Learning Disabilities
Mathematics: Standards and Student Expectations
Mathematics Instruction
More Math Strategies, Supports, and Accommodations
Connecting Math to Writing and Literature
Part 4 References
Part 4 Additional Sources and Resources
Part 5: Personal Stories and Case Studies
Section 5.1: A Parent's Story . . . What Every Teacher, Clinician, and Parent of a Child with ADHD Needs to Hear
Vincent (Seventeen Years Old, High School Senior)
Everything Ripples: The Education of Vincent and Victoria
Notes on Section 5.1
Section 5.2: Student Case Studies and Interventions
Chloe (Seven Years Old, First Grade)
Student Profile
Current Performance Levels
Desired Outcomes for Chloe
Intervention Plan
Teaming with Parents
Anne (Eleven Years Old, Sixth Grade)
Student Profile
Follow-up (Reported Spring Trimester of Sixth-Grade School Year, Provided by Mrs. Shorter)
Follow-up (Tenth-Grade School Year)
Part 5 References
Part 6: Collaborative Efforts and School Responsibilities in Helping Students with ADHD
Section 6.1: Teaming for Success: Communication, Collaboration, and Mutual Support
The Necessity of a Team Approach
The Parents' Role in the Collaborative Team Process
The Educators' Role in the Collaborative Team Process
The Clinicians' Role in the Collaborative Team Process
Cultural Sensitivity in Communication with Parents
Section 6.2: The Role of the School's Multidisciplinary Team
The Student Support Team (SST) Process
Multi-Tier System of Supports (MTSS)
If You Suspect a Student Has ADHD: Recommendations for Teachers and Other School Personnel
School-Based Assessment for ADHD
Section 6.3: School Documentation and Communication with Medical Providers and Others
Communication with Physicians
Communication between Schools
Teacher Documentation
Section 6.4: Federal Laws and Educational Rights of Students with ADHD
Individuals with Disabilities Education Act (IDEA)
Section 504 of the Rehabilitation Act of 1973
Americans with Disabilities Act Amendments Act of 2008 (ADAAA)
Which Is More Advantageous for Students with ADHD: An IEP or a 504 Plan?
Disciplining Students with Disabilities under IDEA 2004
Part 6 References
Part 6 Additional Sources and Resources
Appendix: Forms
Index
End User License Agreement
Guide
Cover
Table of Contents
Begin Reading
Part 1
Chapter 1
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Praise for How to Reach and Teach Children and Teens with ADD/ADHD
“Sandra Rief's newest book could easily be every educator and parent's “go to” handbook for ADD/ADHD! In many classrooms across the country, educators often emphasize the use of medication to treat ADD/ADHD. Sandra, however, emphasizes that there is much that can be done behaviorally as well. She has included a plethora of interventions and strategies to address difficult behaviors, many of which can be easily implemented in both home and school settings. This book is a must-read for anyone living or working with children with ADD/ADHD!”
—Rebecca Moyes, M.Ed., educator, consultant, author of Executive Function Dysfunction
“I am pleased and honored to endorse this latest edition of Sandra Rief's book on ADHD. Based on sound scientific evidence, it provides an excellent contemporary view of ADHD and the problems it poses for self-regulation and executive functioning. It also powerfully sets forth the many risks the disorder can pose for impairments in major life activities across child and teen development if not properly treated. Of all of the areas of impairment, it is the school setting in which ADHD can have the greatest adverse effects in the lives of most children with the disorder. But more than this review of the facts, the book is dense with numerous recommendations for educators and school mental health professionals for managing ADHD effectively in school settings so as to promote better development, adjustment, and success at effectively dealing with the many difficulties ADHD may pose across a child's education.”
—Russell A. Barkley, Ph.D., Clinical Professor of Psychiatry, Medical University of South Carolina
“From lesson planning to classroom management, this book has always been one of the most frequently-consulted resources throughout my career. I found the information and strategies in this new edition to be so important for teachers to understand and best help students with ADHD.”
—Jaime Barker, High School Language Arts Teacher, Jersey City, NJ
“This is an exceptionally clear and well organized book. It is a must-have resource for any special education teacher that teaches students with ADHD and Executive Functioning Impairment.”
—Laura J. Mizrahi, Special Education Teacher, Churchill Elementary School, Homewood, IL
“I have used Rief's books in my credential classes instructing students earning their M.Ed. in Special Education or their first teaching credential. This new edition is clear, to-the-point and extremely beneficial for all educators.”
—Stacey J. Kasendorf, M.Ed., San Diego State University, Adjunct Faculty, Special Education Department
Practical Techniques, Strategies, and Interventions
How to Reach & Teach Children & Teens with ADD/ADHD
Third Edition
Sandra F. Rief
Copyright © 2016 by Sandra F. Rief. All rights reserved.
Published by Jossey-BassA Wiley Brand
One Montgomery Street, Suite 1000, San Francisco, CA 94104–4594—www.josseybass.com
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www.wiley.com/go/permissions.
Permission is given for individual classroom teachers to reproduce the pages and illustrations for classroom use. Reproduction of these materials for an entire school system is strictly forbidden.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read.
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Library of Congress Cataloging-in-Publication Data
Names: Rief, Sandra F.
Title: How to reach and teach children and teens with ADD/ADHD / Sandra F. Rief.
Description: Third edition. | San Francisco, California : Wiley, 2016. | Includes bibliographical references and index.
Identifiers: LCCN 2016018130 (print) | LCCN 2016019274 (ebook) | ISBN 9781118937785 (paperback) | ISBN 9781118937808 (pdf) | ISBN 9781118937792 (epub)
Subjects: LCSH: Attention-deficit-disordered children–Education–United States–Handbooks, manuals, etc. | Attention-deficit-disordered youth–Education–United States–Handbooks, manuals, etc. | Hyperactive children–Education–United States–Handbooks, manuals, etc. | Classroom management–United States–Handbooks, manuals, etc. | BISAC: EDUCATION / Special Education / General.
Classification: LCC LC4713.4 .R54 2016 (print) | LCC LC4713.4 (ebook) | DDC 371.94–dc23
LC record available at https://lccn.loc.gov/2016018130
9781118937785 Paperback9781118937808 ePDF9781118937792 ePub
Cover image: © Caiaimage/Robert Daly/Getty Images, Inc., © Alistair Berg/Getty Images, Inc.Cover design: Wiley
Dedication
This book is dedicated in memory of my beloved son, Benjamin, and to all of the children who face struggles in their young lives each day with loving, trusting hearts, hope, and extraordinary courage. I also dedicate this book in loving memory of Levana Estline—dear friend, exceptional teacher, and a blessing to all who knew her.
About the Author
Sandra F. Rief, MA, is an internationally known speaker, educational consultant, and author, specializing in practical and effective strategies for helping students with ADHD and learning disabilities succeed in school. She has written several books and presented numerous seminars, workshops, and keynotes nationally and internationally on this topic. Sandra has trained thousands of teachers in the United States and throughout the world on best practices for helping students with ADHD, and has worked with many schools in their efforts to provide interventions and supports for students with learning, attention, and behavioral challenges.
Among some of the other books she has authored (published by Jossey-Bass/Wiley) are The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders, Second Edition(2015),The Dyslexia Checklist: A Practical Reference for Parents and Teachers(coauthored with J. Stern, 2010), The ADD/ADHD Checklist: An Easy Reference for Parents and Teachers, Second Edition(2008), How to Reach and Teach All Children Through Balanced Literacy(coauthored with J. Heimburge, 2007), and How to Reach and Teach All Children in the Inclusive Classroom: Practical Strategies, Lessons, and Activities, Second Edition(coauthored with J. Heimburge, 2006).
Sandra also authored these laminated guides (published by National Professional Resources, Inc.): Executive Function: Skill-Building and Support Strategies for the Elementary Classroom (2016), Executive Function: Skill-Building and Support Strategies for Grades 6–12 (2016), Dyslexia: Strategies, Supports & Interventions (2010), Section 504: Classroom Accommodations (2010), and ADHD & LD: Classroom Strategies at Your Fingertips(2009).
Sandra developed and presented these acclaimed educational DVDs as well: ADHD & LD: Powerful Teaching Strategies and Accommodations (with RTI); How to Help Your Child Succeed in School: Strategies and Guidance for Parents of Children with ADHD and/or Learning Disabilities; ADHD: Inclusive Instruction and Collaborative Practices; and, together with Linda Fisher and Nancy Fetzer, Successful Classrooms: Effective Teaching Strategies for Raising Achievement in Reading and Writing and Successful Schools: How to Raise Achievement and Support “At-Risk” Students.
Sandra is formerly an award-winning special education teacher from San Diego Unified School District (California Resource Specialist of the Year), with more than two decades of experience teaching in public schools. Presently, Sandra is an instructor for continuing education and distance learning courses offered through a few universities on instructional and behavioral strategies and interventions for reaching and teaching students with ADHD, LDs, and other mild to moderate disabilities. She received her BA and MA degrees from the University of Illinois. For more information, visit her website at www.sandrarief.com.
Acknowledgments
My deepest thanks and appreciation to
My precious, beautiful family (which has grown and blossomed since the first and second editions of this book): Itzik, Ariel, Anna, Jackie, Jason, Maya, Jonah, Ezra, Gil, Sharon, Daniella, and Raquel. You are everything to me, and I love you all so much.
All of my former students and other wonderful children who have touched my heart and inspired me throughout the years to keep learning what we can do to better reach and teach them.
The special families who have shared with me their struggles and triumphs and allowed me to be part of their lives.
All of the amazing, dedicated educators I have had the great fortune to work with and meet over the years; thank you for sharing with me your creative strategies, ideas, and insights.
The extraordinary parents (especially the wonderful volunteers in CHADD and other organizations worldwide) whose tireless efforts have raised awareness about ADHD and, as a result, have improved the care and education of our children.
All the researchers and practitioners in the different fields dedicated to helping children and families with ADHD, LDs, and other disabilities, from whom I have learned so much.
Diana Anderson-Goetz for writing the extraordinarily powerful family story found in Section 5.1 of this book. I am so grateful to Diana and her wonderful husband and children (Vincent and Victoria) for so courageously and generously sharing their very personal and poignant story that is a must-read for teachers, clinicians, and parents of children with ADHD.
Karen Easter, one of the mothers I was privileged to meet and befriend at one of my workshops, for sharing her wonderful original poems in this book and earlier editions.
Decker Forrest, an incredibly talented former student of mine, who was in the eighth grade at the time he drew the illustrations in this book (first published in the 1993 edition).
Dan's mother, Jill, for writing and sharing her son's story on the value of mentorship, which was first published in the original edition (1993) of this book, and Dan, for generously providing his update, in Section 1.9.
Christine Kreider, Shannon Prior, Itzik Rief, and Julie Heimburge for creating and sharing some of the charts and forms found in the appendix.
Beverly Shorter and T. Cohen for writing and sharing their wonderful student case studies found in Section 5.2.
Beth Black for sharing her exemplary high school writing strategies in Section 4.4.
Joe, Susan, Mike, Amy, Joseph, John, Brita, and Brad, who allowed me to interview them and share their experiences, insights, and tips in excerpts throughout this book.
Marjorie McAneny, my wonderful editor at Jossey-Bass/Wiley in San Francisco, for her guidance and expertise and for making it a pleasure to write this book and the others we have worked on together over the years. To all of the team I'm privileged to work with at J-B/Wiley . . . you're the best.
Preface
This book offers comprehensive guidance to everyone engaged in the positive education of children and teens who have been diagnosed with ADHD or who show signs and symptoms of this disorder. Whether you are a classroom teacher or a parent; a special education teacher, counselor, or psychologist; or a school or district administrator, this book will be a valuable resource. You'll find information, techniques, and strategies to help these students succeed. While the book addresses the specific needs of students with ADD/ADHD, the strategies are also appropriate and recommended for all children and teens who appear to have executive function weaknesses or who are experiencing any learning, attention, or behavioral difficulties.
This third edition has been completely revised and updated since the second edition, which was published a decade ago. Because much of the information and strategies are for teens as well as children, I revised the title as well, to reflect the inclusion of adolescents. When I wrote the first edition of this book (then titled How to Reach and Teach ADD/ADHD Children) back in 1993, awareness of attention-deficit/hyperactivity disorder, as well as information and resources available to parents and teachers, were minimal at best. There were no other published books at that time addressing the educational needs of students with ADD/ADHD, providing practical strategies to implement at home and school to help these children succeed in school.
Since that time, a tremendous amount of information has become easily accessible, and far more resources than ever before are available to parents, educators, and those who work with and treat children and teens with ADHD. However, there is still a great deal of misinformation and many myths surrounding this disorder. There are still countless children and teens who have ADHD and who have been suffering and experiencing school failure due to their lack of identification or treatment and misinterpretation of their behaviors by teachers and others, who don't understand this brain-based disorder and its impact.
For easy use, this resource is organized into six parts providing comprehensive, up-to-date, practical guidance on a variety of topics relevant to parents and educators, as well as reproducible tools in the appendix, and additional resources. There are thirty-four sections filled with useful information and strategies within these categories:
Part 1: Key Information for Understanding and Managing ADHD
Part 2: Managing the Challenge of ADHD Behaviors
Part 3: Instructional, Learning, and Executive Function Strategies
Part 4: Strategies and Supports for Reading, Writing, and Math
Part 5: Personal Stories and Case Studies
Part 6: Collaborative Efforts and School Responsibilities in Helping Students with ADHD
A lot of the content of this book has been adapted not only from the 2005 edition but from my other books published by Jossey-Bass/Wiley, particularly these sources (which you may be interested in exploring for further information, tools, and strategies):
The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders, Second Edition
(2015)
The Dyslexia Checklist: A Practical Guide for Parents and Teachers
(coauthored with Judith Stern, 2010)
The ADD/ADHD Checklist: An Easy Reference for Parents and Teachers, Second Edition
(2008)
For even more information and tools, find the bonus content as well as the appendix materials provided online at this link: www.wiley.com/go/adhdreach. The password is the last five digits of the ISBN, which is 9781118937785. See the table of contents for bonus content topics. Some of the management charts and forms in the appendix can be customized to your needs when accessed online before printing.
A number of strategies and recommendations in this book come from what I have learned from my many students with ADHD and learning disabilities, their families, and my colleagues during the twenty-three years I was teaching in public schools. In addition, I have had the privilege of observing hundreds of classrooms and working with scores of educators across the United States and internationally. I am grateful for the openness of the many wonderful teachers and parents, who so willingly shared their ideas, strategies, struggles, and successes. Their stories and insights have inspired me and taught me so much.
I have been very fortunate to meet extraordinary people over the years who have generously and openly shared with me their experiences and insights. Throughout this book, there are excerpts of some interviews I have conducted with teens and adults from across the country who grew up with ADHD, authentic case studies from teachers, and the powerful personal story (Section 5.1) written by a friend of mine and mother of two (now adult) children with ADHD. I urge you all to read them. These interviews and accounts illustrate the positive difference that a single caring adult (particularly a teacher) can make in the life of a child or teen with ADHD. The writing on a plaque my friend saw years ago (author unknown) beautifully summed it up this way:
“Teachers affect eternity. One can never tell where their influence ends.”
It is always preferable to be able to identify children with ADHD or any special needs early and then initiate interventions and supports at a young age in order to avoid some of the frustration, failure, and subsequent loss of self-esteem. However, it is never too late to help a child. In many cases, the kind of help that makes a difference does not take a huge effort on our part. Sometimes even small changes (such as in the way we respond to our child or teen) can lead to significant improvements. If I am able to convey any single message with this book, I wish for it to be one of hope and optimism. When we work together—providing the necessary structure, guidance, encouragement, and support—each and every one of our children can succeed!
Sandra F. Rief
Part 1Key Information for Understanding and Managing ADHD
Section 1.1:
Understanding ADHD
Section 1.2:
ADHD and Executive Function Impairment
Section 1.3:
Making the Diagnosis: A Comprehensive Evaluation for ADHD
Section 1.4:
Multimodal Treatment for ADHD
Section 1.5:
Medication Treatment and Management
Section 1.6:
Behavioral Therapy for Managing ADHD
Section 1.7:
Keys to School Success for Students with ADHD
Section 1.8:
ADHD in Preschool and Kindergarten
Section 1.9:
ADHD in Middle School and High School
Section 1.1Understanding ADHD
Clarifying Terms and Labels
ADHD (attention-deficit/hyperactivity disorder) is the umbrella term or diagnostic label established by the American Psychiatric Association. It is inclusive of three presentations (or kinds) of the disorder: predominantly inattentive, predominantly hyperactive-impulsive, and combined (meeting diagnostic criteria for both inattentive and hyperactive-impulsive ADHD). Many people prefer to use the term ADD when referring to individuals with predominantly inattentive ADHD, and that presentation is also referred to as such in federal education law (IDEA). Although I use ADD/ADHD in the title of this book, as I have done since the first edition was published in 1993, throughout the remainder of this book, I will be using only the label of ADHD, which is inclusive of all three presentations of this disorder.
Descriptions and Definitions
Some of the definitions and descriptions of ADHD have been changed or refined as a result of all that we have learned in recent years from neuroscience, brain imaging, and clinical studies, and likely will continue to change in the future. Until recently, ADHD was classified as a neurobehavioral disorder, characterized by the three core symptoms of inattention, impulsivity, and sometimes hyperactivity.
It is now recognized that ADHD is a far more complex disorder, involving impairment in a whole range of abilities related to self-regulation and executive functioning. This more recent understanding of ADHD is reflected in some of the following descriptions, as shared by leading ADHD authorities and based on the most widely held beliefs of the scientific community at this time:
ADHD is a neurobiological disorder characterized by chronic and developmentally inappropriate degrees of inattention, impulsivity, and in some cases hyperactivity, and is so pervasive and persistent that it interferes with a person's daily life at home, school, work, or other settings.
ADHD is a disorder of self-regulation and executive functions.
ADHD is a brain-based disorder involving a wide range of executive dysfunctions that arises out of differences in the central nervous system—both in structural and neurochemical areas.
ADHD represents a condition that leads individuals to fall to the bottom of a normal distribution in their capacity to demonstrate and develop self-control and self-regulatory skills.
ADHD is a developmental impairment of the brain's self-management system. It involves a wide range of executive functions linked to complex brain operations that are not limited to observable behaviors.
ADHD is a neurological inefficiency in the area of the brain that controls impulses and is the center of executive functions.
ADHD is a dimensional disorder of human behaviors that all people exhibit at times to certain degrees. Those with ADHD display the symptoms to a significant degree that is maladaptive and developmentally inappropriate compared to others at that age.
ADHD is a common although highly varied condition. One element of this variation is the frequent co-occurrence of other conditions.
Signs and Symptoms
In making a diagnosis of ADHD, a qualified clinician does so based on the criteria set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013 by the American Psychiatric Association, which is discussed further in Section 1.3. The DSM lists nine specific symptoms under the category of inattention and nine specific symptoms under the hyperactive-impulsive category. Part of the diagnostic criteria for ADHD is that the child, teen, or adult often displays a significant number of symptoms of either the inattentive or the hyperactive-impulsive categories or in both categories.
Following are lists of behaviors or observable symptoms that are common in children and teens with ADHD. Those symptoms that are found in the DSM-5 criteria are italicized and listed as the first nine bullets in each category. Additional symptoms associated with ADHD are also included; they are not italicized.
Most people display some of the following behaviors at times and in different situations to a certain degree. Those who have the disorder have a history of frequently exhibiting many of these behaviors beyond the normal range developmentally when compared to their peers, in multiple settings (such as home, school, social, and workplace), and to the degree that they interfere with or reduce the quality of their functioning. Such a history is a red flag that an evaluation for ADHD by a well-qualified professional should be considered.
Symptoms of Inattention and Associated Problems
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (for example, loses focus, side-tracked). Note: This is not due to oppositional behavior or failure to understand instructions.
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (for example, school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities.
Has difficulty concentrating and is easily pulled off task.
Tunes out, daydreams, may appear “spacey.”
Requires a lot of adult prompts and refocusing to complete tasks.
Has many incomplete assignments and unfinished tasks.
Has difficulty working independently; needs a high degree of supervision and redirecting of attention to task at hand.
Exhibits poor listening: not following directions, being pulled off topic in conversations, not focusing on the speaker.
Makes many errors with academic tasks requiring attention to details and accuracy (such as math computation, spelling, and written mechanics).
Cannot stay focused on what he or she is reading (loses place, misses words and details, needs to reread the material).
Exhibits poor study skills, such as test-taking and note-taking skills.
Goes off topic in writing, losing train of thought.
Makes many written errors in capitalization and punctuation; has difficulty editing own work for such errors.
Makes numerous computational errors in math due to inattention to operational signs (plus, minus, multiplication, division), decimal points, and so forth.
Appears to have slower speed of processing information (for example, responding to teacher questions or keeping up with class discussions).
Misses verbal and nonverbal cues, which affects social skills.
Does not participate in class, or participates minimally.
Symptoms of Hyperactivity and Impulsivity and Associated Problems
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor.”
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his or her turn.
Often interrupts or intrudes on others (for example, butts into conversations or games).
Has difficulty keeping hands and feet to self.
Knows the rules and consequences, but repeatedly commits the same errors or infractions of rules.
Has difficulty standing in lines.
Gets in trouble because he or she cannot stop and think before acting (responds first, thinks later).
Does not think or worry about consequences, so tends to be fearless or to gravitate toward high-risk behavior.
Is accident prone and breaks things.
Has difficulty inhibiting what he or she says, making tactless comments; says whatever pops into his or her head and talks back to authority figures.
Begins tasks without waiting for directions (before listening to the full direction or taking the time to read written directions).
Hurries through tasks, particularly boring ones, and consequently makes numerous careless errors.
Gets easily bored and impatient.
Does not take time to correct or edit work.
Disrupts, bothers others.
Is highly energetic, in almost nonstop motion.
Engages in physically dangerous activities (for example, jumping from heights, riding bike into the street without looking); hence, has a high frequency of injuries.
Cannot sit still in chair (is in and out of chair, rocks and tips chair over, sits on knees, or stands by desk) or sit long enough to perform required tasks.
Engages in a high degree of unnecessary movement (pacing, tapping feet, bouncing leg, tapping pencil, drumming fingers).
Seems to need something in hands; finds or reaches for nearby objects to play with or put in mouth.
Intrudes in other people's space; has difficulty staying within own boundaries.
Cannot wait or delay gratification; wants things immediately.
Is constantly drawn to something more interesting or stimulating in the environment.
Hits when upset or grabs things away from others (not inhibiting responses or thinking of consequences).
Becomes overstimulated and excitable and has difficulty calming himself or herself or settling down.
Appears to live in the moment, acting without foresight or hindsight.
Is easily pulled off task, affecting work performance and class participation.
Is a greater challenge to motivate and discipline (not responding as well to typical rewards or punishments effective for most students).
Other Common Difficulties Experienced by Children and Teens with ADHD
In addition to symptoms related to inattention, hyperactivity, and impulsivity, other challenges related to executive function and self-regulation weaknesses as well as common coexisting conditions (such as learning disabilities) are often evident in individuals with ADHD. Some include the following:
Social and Emotional
Experiences a high degree of emotionality (for example, has temper outbursts, is quick to anger, gets upset, is irritable or moody)
Is easily upset or frustrated and has a hard time coping with or managing his or her anger and other negative emotions
Is overly reactive; is easily provoked to engage in fighting and inappropriate means of resolving conflicts
Has difficulty with transitions and changes in routine or activity
Displays aggressive behavior
Receives a lot of negative attention and interaction from peers and adults
Has difficulty working in cooperative groups or getting along with peers in work or play situations
Gets along better with younger children
Has immature social skills
Organization and Time Management
Is disorganized—frequently misplaces or loses belongings; desks, backpacks, lockers, and rooms are often messy and chaotic
Is unprepared with materials and books needed for schoolwork and homework
Has poorly organized work, such as writing assignments
Has little or no awareness of time; is chronically late; often underestimates the length of time a task will require to complete or how long it takes to get somewhere
Has great difficulty with long-term assignments and projects, scrambling at the last minute to complete important assignments
Misses deadlines and due dates
Other Executive Skills
Has forgetfulness/memory issues (not remembering or following all parts of the directions, not remembering to turn in homework even when he or she completed it)
Has difficulty with planning and follow-through (failing to think through all of the steps or components of a task and having particular difficulty with long-term assignments and projects)
Has difficulty with tasks requiring a heavy memory load
Plans poorly for assignments and projects
Has difficulty prioritizing
Has difficulty initiating or getting started on tasks
Learning, Language, Academic
Has learning and school performance difficulties; is not achieving or performing to the level that is expected given his or her apparent ability
Has language and communication problems (for example, not sticking to topic, not fluent verbally)
Employs inefficient learning strategies
Has poor handwriting and fine motor skills
Experiences problem-solving difficulties
Performs inconsistently: one day can perform a task, next day cannot
Takes a lot longer than average time to process information or complete tasks and assignments
Has difficulty with reading comprehension, written expression, mathematical problem solving (or other complex or lengthy academic tasks that require a heavy working memory load, planning and organization of thoughts and information, and self-monitoring or self-correction throughout the process)
(If learning disabilities, such as dyslexia, coexist) Has more significant difficulty with basic reading skills (word recognition and fluency, writing, spelling)
Note: Academic difficulties related to inattention, impulsivity, and executive dysfunctions will be discussed in depth in Part 4 of this book.
Three Presentations of ADHD
As noted earlier, there are three types or what are now called “presentations” of ADHD, based on the symptoms. Although all people will exhibit these behaviors at times to a certain degree, for those with ADHD, the symptoms far exceed that which is normal developmentally (in frequency, level, and intensity), have been evident and problematic in multiple settings for at least the past six months, and interfere with the person's functioning or development. There are other diagnostic criteria that must be met as well, which will be described in more depth in Section 1.3.
Predominantly Inattentive
This presentation is what some people prefer to call ADD, because those who receive this diagnosis do not have the hyperactive symptoms. They may show some of them, but not a significant amount. These children and teens often slip through the cracks and are not as easily identified or understood. Because they do not exhibit the disruptive behaviors associated with ADHD, it is easy to overlook these students and misinterpret their behaviors and symptoms as “not trying” or “being lazy.” Many girls have the predominantly inattentive presentation of the disorder.
Be aware that people with ADHD who have significant attention difficulties are often able to be focused and to sustain attention for long periods of time when they play video games or are engaged in other high-interest, stimulating, and rapidly changing activities. In fact, many hyper-focus on such activities and have a hard time disengaging from them.
Predominantly Hyperactive-Impulsive
Individuals with this presentation of ADHD have a significant number of hyperactive-impulsive symptoms. They may have some inattentive symptoms that are developmentally inappropriate, but not a significant number of them.
Hyperactive-impulsive ADHD (without the inattention) is most commonly diagnosed in early childhood. Children receiving this diagnosis are often reclassified as having the combined presentation of ADHD when they get older and the inattentive symptoms emerge more and become developmentally significant.
Combined
This is the most common presentation of ADHD—a significant number of symptoms exist in both the inattentive category and the hyperactive-impulsive category.
Please note: More information on signs and symptoms of ADHD is found in other sections of this book, such as those describing executive function difficulties, symptoms in girls, and what ADHD looks like at different grade levels or ages (preschool through high school).
Formula ONE for Disaster
take ONE impulsive child
add ONE forbidden object
multiply by ONE minute
to equal
ONE predictable trip to the emergency room . . .
Karen Easter ©1995
Statistics and Risk Factors
The number of people estimated to have ADHD varies, depending on the source, which can be confusing. Here are some of the reported prevalence rates:
Conservatively 5–8 percent of school-age children have ADHD (Barkley, 2013).
Approximately 11 percent of children four to seventeen years of age (6.4 million) have been diagnosed with ADHD as of 2011, according to the results of surveys that asked parents whether their child received an ADHD diagnosis from a health care provider (Centers for Disease Control and Prevention [CDC], n.d.).
Based on the CDC analysis of data from the National Survey of Children's Health, which has been collected every four years since 2003, the percentage of children diagnosed with ADHD increased from 7.8 percent in 2003 to 9.5 percent in 2007 and to 11.0 percent in 2011 (CDC, n.d.).
The worldwide prevalence of ADHD for children is approximately 5 percent, based on a review of over one hundred studies comprising subjects from all world regions (Polanczyk et al., 2007).
Studies throughout the world have reported the occurrence of ADHD in school-age children as being between 5 and 12 percent. This means that on average, there are at least one to three children in every class with ADHD (Centre for ADHD Awareness, Canada, n.d.).
ADHD is associated with a number of risk factors. ADHD places those who have this disorder at risk for a host of serious consequences, which increases the urgency of early identification, diagnosis, and proper treatment. Numerous studies (Barkley et al., 2002; Barkley, 2013) have demonstrated the increased risk of negative outcomes associated with those who have ADHD. Compared to their peers of the same age, youth with ADHD experience
More serious accidents and hospitalizations, and significantly higher medical costs than those children without ADHD
More school failure and dropout
More delinquency and altercations with the law
More engagement in antisocial activities
More teen pregnancy and sexually transmitted diseases
Earlier experimentation with and higher use of alcohol, tobacco, and illicit drugs
More trouble socially and emotionally
More rejection, ridicule, and punishment
More underachievement and underperformance at school or work
Dr. Russell Barkley (2013), one of the world's leading ADHD experts and researchers, has also found the following to be true:
Up to 58 percent of youth with ADHD may be retained in a grade in school at least once.
As many as 35 percent fail to complete high school.
For half of children with ADHD, social relationships are seriously impaired.
More than 25 percent of ADHD youth are expelled from high school because of serious misconduct.
More than 30 percent of youth with ADHD have engaged in theft.
More than 40 percent of youth with ADHD drift into early tobacco and alcohol use.
Adolescents and young adults with a diagnosis of ADHD have nearly four to five times as many traffic citations for speeding, two to three times as many auto accidents, and accidents that are two to three times more expensive in damages or likely to cause bodily injuries as young drivers without ADHD.
Note: Compared to the general population, people with ADHD are at greater risk than others for negative outcomes (as described). However, when children with ADHD are provided with supports and effective treatments and intervention, the risks are reduced substantially.
ADHD and Coexisting Disorders
ADHD is often accompanied by one or more other conditions or disorders—psychiatric, psychological, developmental, or medical. Because symptoms of these various disorders commonly overlap, diagnosis and treatment can be complex. The word comorbidity is the medical term for having coexisting disorders (co-occurring and presenting at the same time as ADHD).
Approximately two-thirds of individuals with ADHD have at least one other coexisting condition, such as learning disabilities, oppositional defiant disorder, anxiety disorder, conduct disorder, Tourette Syndrome, or depression (MTA Cooperative Group, 1999; National Resource Center on AD/HD, 2015). The most common conditions comorbid with ADHD in childhood are oppositional defiant disorder (ODD) and conduct disorder (CD). In adulthood, the most common comorbid conditions with ADHD are depression and anxiety (Goldstein, 2009).
Coexisting disorders can cause significant impairment above and beyond the problems caused by ADHD. It can take time for all the pieces of the puzzle to come together, and parents, teachers, and clinicians need to monitor the child's development and any emerging concerns. Effective intervention will require treatment for the ADHDandthe other conditions.
Common Coexisting Conditions and Disorders
The reported prevalence of specific coexisting conditions and disorders accompanying ADHD varies depending on the source. Most sources indicate the following ranges:
Oppositional defiant disorder (ODD). Approximately 40 percent of children and teens with ADHD develop ODD (National Resource Center on AD/HD, 2015). It occurs eleven times more frequently in children with ADHD than in the general population (Barkley, 2013).
Anxiety disorder. Up to 30 percent of children and up to 53 percent of adults with ADHD have this disorder (National Resource Center on AD/HD, 2015).
Conduct disorder (CD). Approximately 27 percent of children, 45–50 percent of adolescents, and 20–25 percent of adults have this disorder (National Resource Center on AD/HD, 2015).
Bipolar. Up to 20 percent of people with ADHD may manifest bipolar disorder (National Resource Center on AD/HD, 2015).
Depression. Approximately 14 percent of children with ADHD and up to 47 percent of adolescents and adults have this disorder (National Resource Center on AD/HD, 2015).
Tics, Tourette Syndrome. About 7 percent of those with ADHD have tics or Tourette Syndrome, but 60 to 80 percent of Tourette Syndrome patients also have ADHD (National Resource Center on AD/HD, 2015).
Learning disabilities. The reported range is from 20 to 60 percent, with most sources estimating that between one-quarter and one-half of children with ADHD have a coexisting learning disability (such as dyslexia). “Up to 50 percent of children with ADHD have a coexisting learning disorder, whereas 5 percent of children without ADHD have learning disorders” (National Resource Center on AD/HD, 2015, p. 2).
Obsessive-compulsive disorder (OCD). Up to one-third of people with ADHD may have OCD (Goodman, 2010; Kutscher, 2010).
Sleep disorders. One-quarter to one-half of parents of children with ADHD report that their children suffer from a sleep problem, especially problems with falling asleep and staying asleep (National Resource Center on AD/HD, 2015).
Other Disorders and Conditions
Between 12 and nearly 20–30 percent of children and teens with ADHD also have some form of challenge in the area of speech and language (National Resource Center on AD/HD, 2015; Spencer, 2013).
Autism spectrum disorder (ASD) is now recognized as a possible coexisting disorder with ADHD and was added to the
DSM-5
as such.
ASD symptoms are more common in children with ADHD than in the general population. In some studies, nearly 50 percent of youth with ASD meet diagnostic criteria for ADHD (Goldstein, 2010).
Identifying and Treating Coexisting Disorders
Most children with ADHD have some school-related achievement, performance, or social problems. It is important that they receive the educational supports and interventions they need.
Because a high percentage of children with ADHD also have learning disabilities, such as dyslexia, the school district should evaluate the student when a possible learning disability is suspected. Parents are advised to request an evaluation if they are concerned that their child may have coexisting learning disabilities.
Parents, educators, and medical and mental health care providers should be alert to signs of other mental health disorders that may exist or emerge, often in the adolescent years, especially when current strategies and treatments being used to help the child or teen with ADHD are no longer working effectively. Anxiety disorder and depression can easily go unrecognized and overlooked. There is a high rate of these internalized disorders, particularly among teenage girls.
ADHD Look-Alikes
Not everyone who displays symptoms of ADHD has the disorder. There are a number of other conditions and factors (medical, psychological, learning, psychiatric, emotional, social, and environmental) that can cause inattentive, hyperactive, and impulsive behaviors that resemble ADHD or that may coexist with ADHD, such as
Learning disabilities
Sensory impairments (hearing, vision, or motor problems)
Substance use and abuse (of alcohol and drugs)
Oppositional defiant disorder
Conduct disorder
Allergies
Posttraumatic stress disorder (PTSD)
Anxiety disorder
Depression
Obsessive-compulsive disorder
Sleep disorder
Bipolar disorder
Thyroid problems
Rare genetic disorders (for example, Fragile X syndrome)
Seizure disorders
Sluggish cognitive tempo
Lead poisoning
Hypoglycemia
Anemia
Fetal alcohol syndrome and fetal alcohol effects
Chronic illness
Language disorders
Auditory processing disorders
Visual processing disorders
Tourette Syndrome
Autism spectrum disorder
Developmental delays
Sensory integration dysfunction
Low intellectual ability
High intellectual ability or giftedness
Chronic ear infections
Severe emotional disturbance
Side effects of medications being taken (such as antiseizure or asthma medication)
Emotional and environmental factors that have nothing to do with ADHD can also cause a child or teen to be distracted and unable to concentrate, or to exhibit acting-out or aggressive behaviors—for example, if the child or teen is experiencing high-stress circumstances, such as the following:
Experiencing or witnessing abuse or violence
Family stresses (for example, divorce and custody battles, death of a loved one, financial difficulties)
Bullying or peer pressure and other social issues
A chaotic, unpredictable, unstable, or neglectful home life with inappropriate expectations placed on the child
Inattention and disruptive classroom behaviors can be school related (having nothing to do with ADHD). Students may display those behaviors if they are in a school environment with these characteristics:
A pervasive negative climate
Poor instruction and low academic expectations
Nonstimulating and unmotivating curriculum
Ineffective classroom management
What Is Currently Known about ADHD
ADHD has been the focus of a tremendous amount of research, particularly during the past three decades. Literally thousands of studies and scientific articles have been published (nationally and internationally) on ADHD. All of the advances in neuroscience and the sophisticated brain imaging technologies and genetic research in recent years have dramatically increased our knowledge of ADHD—the brain differences and probable causes of the disorder.
What We Know
ADHD is not a myth. It has been recognized as a very real, valid, and significant disorder by the US surgeon general, the National Institutes of Health, the US Department of Education, the Centers for Disease Control and Prevention, and all of the major medical and mental health associations.
ADHD is not new. It has been recognized by clinical science and documented in the literature since 1902 (having been renamed several times). Some of the previous names for the disorder were
minimal brain dysfunction, hyperactive child syndrome,
and
ADD
with or without hyperactivity.
There is no quick fix or cure for ADHD, but it is treatable and manageable. Proper diagnosis and treatment can substantially decrease ADHD symptoms and impairment in functioning and greatly increase positive outcomes.
ADHD is not just a childhood disorder. Up to 80 percent of children diagnosed with ADHD continue to have the disorder into adolescence, and 50–65 percent will continue to exhibit symptoms into adulthood (Barkley, 2013).
ADHD is a neurobiological disorder that is a result of different factors, the most common cause by far being genetic in origin. Heredity accounts for most cases of ADHD, but there are other problems and factors that occur prenatally, during birth, or in childhood that might interfere with a child's brain development and be contributing causes of ADHD.
Regardless of the underlying cause, there are on average differences in both the size and function of certain areas of the brain in individuals with ADHD (Wolraich & DuPaul, 2010).
ADHD exists across all populations, regardless of race, ethnicity, gender, nationality, culture, and socioeconomic level. Many children, teens, and adults with ADHD slip through the cracks without being identified or receiving the intervention and treatment they need.
ADHD can be managed best by multimodal treatment and a team approach. We know that it takes a team effort on the part of parents, school personnel, clinicians, and other professionals to be most effective in helping children and teens with ADHD. No single intervention effectively manages ADHD for most people with the disorder, and intervention needs change over time.
ADHD is diagnosed at least two to three times more frequently in boys than girls, although many more girls may actually have ADHD than are identified.
ADHD is
not
the result of poor parenting. ADHD is
not
laziness, willful misbehavior, or a character flaw. The challenging behaviors that children with ADHD exhibit stem from neurobiological differences. Their behaviors are not deliberate. Children with ADHD are often not even aware of their behaviors and their impact on others.
Although ADHD is most commonly diagnosed in school-age children, it can be and is diagnosed reliably in younger children and adults.
Most children who are diagnosed and provided with the help they need are able to manage the disorder. Parents should maintain a positive mind-set and be optimistic about their child's future. ADHD does not limit their child's potential. Countless highly successful adults in every profession and walk of life have ADHD.
Medication therapy and behavioral therapy are research-validated, effective treatments for ADHD. Medications used to treat ADHD are proven to work effectively for reducing the symptoms and impairment in 70–95 percent of children diagnosed with ADHD. Use of a token economy or daily report card system between home and school are among the behavioral interventions and programs that help in the management of ADHD. (See Sections 1.5, 1.6, 2.3, and 2.4 for more on these topics and tools to use.)
