According to the American Psychiatric Association, 3 to 5 percent of the U.S. student population has attention deficit hyperactivity disorder (ADHD). Because of the prevalence of this disorder, laws have been established to help ensure the special needs of these students are met.
Two key federal mandates protect the rights of eligible children with ADHD: the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973. The regulations implementing these laws are 34 CFR (Code of Federal Regulations) sections 300 and 104, respectively, which require school districts to provide a "free appropriate public education" to students who meet their eligibility criteria.
Individuals with Disabilities Education Act
IDEA provides funds to state education agencies to provide special education and related services to children evaluated in accordance with IDEA and found to have at least one of 13 specific categories of disabilities and who thus need special education and related services. The requirements and qualifications for IDEA are more stringent than those of Section 504.
Some parents might believe getting their children special education services under IDEA is just a matter getting an ADHD diagnosis from a physician, psychologist or other qualified professional. However, the diagnosis does not automatically qualify the child for special education and related services. Instead, a group of qualified professionals and the child's parent(s) determine whether he or she qualifies under IDEA. According to this law, each school district must ensure each child being considered for special education and related services receives a full and individual evaluation. The child's individualized education program (IEP) team then uses the results of this assessment along with the assessment from the health care provider who diagnosed ADHD to determine the child's educational needs.
Although this law doesn't specifically address ADHD, the disorder may be considered under the "Other Health Impairment" category if the disability results in limited strength, vitality or alertness: If a child's ADHD causes a heightened alertness to environmental stimuli that limits her or his alertness to the educational environment, then the child might qualify under IDEA. Children with ADHD also may be eligible for services under the "Specific Learning Disability," "Emotional Disturbance" or other relevant disability categories of IDEA if they have those disabilities in addition to ADHD.
After a child is deemed eligible for special education and related services under IDEA, her or his evaluation team develops an IEP that includes a statement of measurable annual goals, including benchmarks or short-term objectives that reflect the student's needs. The IEP goals are determined with input from the parents and can't be changed without the parents' knowledge.
Section 504 of the Rehabilitation Act of 1973
Although a child with ADHD may not be eligible for services under IDEA, he or she may qualify under Section 504 of the Rehabilitation Act of 1973. This part of the law ensures a free, appropriate education for all children who have a physical or mental impairment that substantially limits one or more major life activities. If it can be demonstrated that a child's ADHD adversely affects her or his learning--a major life activity in the life of a child--the student may qualify for services under Section 504.
The qualification process for Section 504, like IDEA, requires a student be evaluated to determine that his or her ADHD requires special education or related services or supplementary aids and services. Therefore, if a child's ADHD does not interfere with learning, then that student may not be eligible for services under Section 504.
Unlike IDEA, students who qualify for Section 504 aren't required to have an IEP, but the lack of a plan should not hinder their access to regular or special education and related aids or services designed to meet their individual educational needs as adequately as the needs of nondisabled students are met.
Components of a Comprehensive Evaluation
A diagnosis of ADHD is multifaceted and includes behavioral, medical and educational data. One component of the diagnosis includes comprehensive interviews with parents, teachers and health care professionals. These interviews help evaluators determine the child's specific behavior characteristics, when the behavior began, duration of symptoms, whether the child displays the behavior in various settings and coexisting conditions. The American Academy of Pediatrics stresses that a thorough examination for any such coexisting condition should be an integral part of any evaluation because a variety of psychological and developmental disorders frequently coexist in children being evaluated for ADHD.
Specific questionnaires and rating scales are used to review and quantify the behavioral characteristics of ADHD. The American Academy of Pediatrics, which has developed clinical practice guidelines for diagnosing and evaluating children with ADHD, finds behavioral rating scales accurately distinguish between children with and without ADHD. Appropriate scales have satisfactory norms for the child's chronological age and ability levels. But as with all psychological tests, child-rating scales do have a range of measurement error.
The educational evaluation assesses the extent to which a child's ADHD symptoms impair her or his performance at school. The evaluation involves direct observations of the child in the classroom as well as a review of his or her academic productivity.
Classroom observations are used to record how often the child exhibits various ADHD symptoms in the classroom. Behaviors targeted for classroom observation may include the following:
- Problems of inattention, such as becoming easily distracted, making careless mistakes, or failing to finish assignments on time
- Problems of hyperactivity, such as fidgeting, getting out of an assigned seat, running around the classroom excessively or striking out at a peer
- Problems of impulsivity, such as blurting out answers to the teacher’s questions or interrupting the teacher or other students in the class
- More challenging behaviors, such as severe aggressive or disruptive behavior
The frequency with which the child with ADHD exhibits these and other target behaviors are compared to norms for other children of the same age and gender. Comparing the behavior of the child with ADHD to the behaviors of other children in his or her classroom is also important. This information is best collected during two or three different observations across several days. Each observation typically lasts about 20 to 30 minutes.
The educational evaluation also includes an assessment of the child's ability to complete classwork and other academic assignments. Information about both the percentage of work completed as well as the accuracy of the work is included. Evaluators may also compare the child's productivity to the productivity of other children in the class.
A medical evaluation assesses whether the child is manifesting symptoms of ADHD based on the following three objectives:
- To assess problems of inattention, impulsivity and hyperactivity the child is currently experiencing
- To assess the severity of these problems
- To gather information about other disabilities that may be contributing to the child's ADHD symptoms
IDEA does not necessarily require a school district to conduct a medical evaluation to determine whether a child has ADHD. If a public agency believes a medical evaluation is needed as part of the eligibility evaluation, then the school district must ensure this evaluation is conducted at no cost to the parents.
The American Academy of Pediatrics has published a clinical practice guideline that provides recommendations for assessing and diagnosing school-aged children with ADHD. Intended for use by primary care clinicians involved in the identification and evaluation process, the guideline was developed by a committee that included pediatricians and experts in neurology, psychology, child psychiatry, child development and education, as well as experts in epidemiology (the medical science that studies the possible causes of diseases) and pediatrics. The recommendations are designed to provide a framework for diagnostic decision making and include the following:
- Medical evaluation for ADHD should be initiated by the primary care clinician. Questioning parents regarding school and behavioral issues, either directly or through a previsit questionnaire, may help alert physicians to possible ADHD.
- In diagnosing ADHD, physicians should use the criteria set forth in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
- The assessment of ADHD should include information obtained directly from parents or caregivers, as well as classroom teachers or other school professionals, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.
- Evaluation of a child with ADHD should also include assessment of coexisting conditions such as learning and language problems, aggression, disruptive behavior, depression or anxiety.
So what can a student expect once he or she has been found eligible for special education and services? Both IDEA and Section 504 require schools to provide special education or to make modifications or adaptations for students whose ADHD adversely affects their educational performance. Such adaptations may include the following:
- Curriculum adjustments
- Alternative classroom organization and management
- Specialized teaching techniques and study skills
- Use of behavior management
- Increased parent/teacher collaboration
Eligible children with ADHD must be placed in regular education classrooms, to the maximum extent appropriate to their educational needs, with the use of supplementary aids and services if necessary. Of course, the needs of some children with ADHD cannot be met solely within the confines of a regular education classroom, and they may need special education or related aids or services provided in other settings.
More information about the public school education services available for children with ADHD is available from these U.S. Department of Education sources: