(Other Health Impairment)
DEFINITION
Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) includes ADHD under “other health impairment,” which means…
“…having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and adversely affects a child’s educational performance.”
[34 Code of Federal Regulations §300.8(c)(9)]
OTHER DEFINITIONS
Attention deficit-hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects 3-5 percent of all American children. It interferes with a person's ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). Some of the warning signs of ADHD include failure to listen to instructions, inability to organize oneself and school work, fidgeting with hands and feet, talking too much, leaving projects, chores and homework unfinished, and having trouble paying attention to and responding to details. There are several types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype. ADHD is usually diagnosed in childhood, although the condition can continue into the adult years.
(National Institute of Neurological Disorders and Stroke, NINDS, 2019)
In 1994, the name of the disorder was changed in a way that is confusing for many people. Since that time all forms of attention deficit disorder are officially called “Attention-Deficit/Hyperactivity Disorder,” regardless of whether the individual has symptoms of hyperactivity or not. Even though these are the official labels, a lot of professionals and lay people still use both terms: ADD and ADHD. Some use those terms to designate the old subtypes; others use ADD just as a shorter way to refer to any presentation.
(Children and Adults with Attention-Deficit/Hyperactivity Disorder, CHADD, 2020)
TYPES & CHARACTERISTICS
There are three different types of ADHD, depending on which types of symptoms are strongest in the individual:
- Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
- Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
- Combined Presentation: Symptoms of the above two types are equally present in the person.
Because symptoms can change over time, the presentation may change over time as well.
(Centers for Disease Control and Prevention, CDC, 2019)
As ADHD symptoms affect each person to varying degrees, the DSM-5 now requires professionals diagnosing ADHD to include the severity of the disorder. How severe the disorder is can change with the presentation during a person’s lifetime. Clinicians can designate the severity of ADHD as “mild,” “moderate” or “severe” under the criteria in the DSM-5.
- Mild: Few symptoms beyond the required number for diagnosis are present, and symptoms result in minor impairment in social, school or work settings.
- Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
- Severe: Many symptoms are present beyond the number needed to make a diagnosis; several symptoms are particularly severe; or symptoms result in marked impairment in social, school or work settings.
As individuals age, their symptoms may lessen, change, or take different forms. Adults who retain some of the symptoms of childhood ADHD, but not all, can be diagnosed as having ADHD in partial remission.
(CHADD, 2020)
FACTS AND STATS
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 11 percent of school-age children. Symptoms continue into adulthood in more than three-quarters of cases. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity. CHADD presents extensive data and statistics for prevalence found across years, ages, gender, and race/ethnicity as well as treatment data and other related data.
(CHADD, 2020)
CAUSES
Research has demonstrated that ADHD has a very strong neurobiological basis. Although precise causes have not yet been identified, there is little question that heredity makes the largest contribution to the expression of the disorder in the population. In instances where heredity does not seem to be a factor, difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain have all been found to contribute to the risk for ADHD to varying degrees.
(CHADD, 2020)
MEDICAL TREATMENT
There is no "cure" for ADHD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the ADHD as they mature.
The usual course of treatment may include medications such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), which are stimulants that decrease impulsivity and hyperactivity and increase attention. The U.S. Food and Drug Administration has approved the generic versions of Strattera (atomoxetine) to treat ADHD in pediatric and adult individuals. Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should include structured classroom management, parent education (to address discipline and limit-setting), and tutoring and/or behavioral therapy for the child.
(NINDS, 2019)
PROGNOSIS
Although ADHD has been less thoroughly researched in adults than in children, adults who have been correctly diagnosed with the disorder can still take advantage of whatever treatments best meet their needs. Working with one or several health and mental health care practitioners, adults with ADHD can learn to manage symptoms as they are expressed in their lives.
ADHD is a condition that affects individuals “across the lifespan.” This means that ADHD symptoms are usually experienced from one phase of life to the next, and that they extend to the various spheres of life during any particular life phase.
Children with ADHD are at risk for potentially serious problems in adolescence and adulthood: academic failure or delays, driving problems, difficulties with peers and social situations, risky sexual behavior, and substance abuse. There may be more severe negative behaviors with co-existing conditions such as oppositional defiant disorder or conduct disorder. Adolescent girls with ADHD are also more prone to eating disorders than boys. As noted above, ADHD persists from childhood to adolescence in the vast majority of cases (50–80 percent), although the hyperactivity may lessen over time.
Teens with ADHD present a special challenge. During these years, academic and life demands increase. At the same time, these kids face typical adolescent issues such as emerging sexuality, establishing independence, dealing with peer pressure and the challenges of driving.
More than 75 percent of children with ADHD continue to experience significant symptoms in adulthood. In early adulthood, ADHD may be associated with depression, mood or conduct disorders, and substance abuse. Adults with ADHD often cope with difficulties at work and in their personal and family lives related to ADHD symptoms. Many have inconsistent performance at work or in their careers; have difficulties with day-to-day responsibilities; experience relationship problems; and may have chronic feelings of frustration, guilt or blame. Individuals with ADHD may also have difficulties with maintaining attention, executive function and working memory. Recently, deficits in executive function have emerged as key factors affecting academic and career success. Executive function is the brain’s ability to prioritize and manage thoughts and actions. This ability permits individuals to consider the long-term consequences of their actions and guide their behavior across time more effectively. Individuals who have issues with executive functioning may have difficulties completing tasks or may forget important things.
(CHADD, 2020)
EDUCATIONAL IMPLICATIONS
ADHD can affect learning and development from a very young age. Child Find, public school systems, some private schools and even colleges and universities are required to help students with ADHD and other disabilities rise to meet educational challenges.
Children with all three presentations of ADHD, predominantly inattentive, predominantly hyperactive, and combined presentation, may face many challenges in a traditional school setting and may qualify for educational services and accommodations, even if their needs are minor. Two laws in particular, the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973, are specifically designed to ensure that students with disabilities receive equal access to education and school activities. Both acts guarantee a free and appropriate public education(FAPE) to all children, regardless of ability. From simple accommodations intended to “even the playing field” to special education services in typical classrooms with supplemental services, the laws are in place to provide valuable services to eligible children with disabilities.
Teachers and educators are in a unique position to help children and adolescents achieve their full academic potential. Most teachers are looking for additional training or resources on ADHD and improving the classroom experience for their students.
CHADD offers a Teacher Training Program crafted by teachers to provide other teachers with the strategies and tips to help their students with ADHD succeed. They provide many types of resources including guides, strategies, and videos for teachers through CHADD’s National Resource Center.
(CHADD, 2020)
ORGANIZATIONS & RESOURCES
Attention Deficit Disorder Association (ADDA)
https://add.org
P.O. Box 7557
Wilmington, DE 19803-9997
800-939-1019
The Attention Deficit Disorder Association (ADDA) is designated as a 501 (c) 3 nonprofit organization by the Internal Revenue Service. This international organization has been in existence since 1989. The mission of ADDA is to provide information, resources and networking to adults with AD/HD and to the professionals who work with them. In doing so, ADDA generates hope, awareness, empowerment and connections worldwide in the field of AD/HD. Bringing together scientific perspectives and the human experience, the information and resources provided to individuals and families affected by AD/HD and professionals in the field focuses on diagnoses, treatments, strategies and techniques for helping adults with AD/HD lead better lives.
C.H.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder)
https://chadd.org
4221 Forbes Blvd, Suite 270
Lanham, MD
301-306-7070
CHADD is the nation’s leading non-profit organization serving individuals with Attention-Deficit/Hyperactivity Disorder (AD/HD). Through collaborative leadership, advocacy, research, education and support, CHADD provides science-based, evidence-based information about AD/HD to parents, educators, professionals, the media and the general public. This organization has available ADHD information specialists who will answer questions; a phone number is listed on the home page.
The National Resource Center on ADHD (NRC), a program of CHADD, was established to be the national clearinghouse for the latest evidence-based information on ADHD. It is primarily funded through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) National Center on Birth Defects and Developmental Disabilities (NCBDDD). The NRC serves as a National Public Health Practice and Resource Center (NPHPRC) with the mission to provide information, education and consultation about assessment, diagnosis, treatment, and issues of health and well-being for children with ADHD and their families. The National Resource Center on ADHD maintains the NRC Library as a source for scientific-medical evidence based information on attention-deficit/hyperactivity disorder and related topics. The library includes:
- A physical library of books, monographs, audiovisuals and medical journals at CHADD's national office in Lanham, MD. This library is open to the public by appointment only.
- An online bibliographic database containing cataloged records of books, journal, magazine and web articles, DVDs, audiotapes and other material on ADHD.
Last updated March 2020.