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My Comments to

“Learning Accommodations for ADD Students”

by Anne McCormik and Faith Leonard

The chapter summarizes accommodations for persons with Attention Deficit

(Hyperactivity) Disorder (ADD/ADHD) which need to be provided during tertiary

education. First the academic and emotional difficulties are presented, then common

accommodations are reviewed. The authors encourage learners with ADHD to become

their own advocates by knowing what accommodations works for them.

Goldstein (1936, 1939) found in WW I soldiers with brain injuries that had

disorganized behavior, hyperactivity, perseveration, and distractibility. Werner and

Strauss replicated Golstein’s findings with children with supposed brain damage (hence,

the initial name of the condition of Strauss Syndrome). Cruickshank studied the same

characteristics with children with cerebral palsy and normal intelligence, which

demonstrated that people without intellectual disabilities can display distractibility and

hyperactivity (the label changed from “minimal brain injury” to “hyperactive child

syndrome”) (Hallahan & Kauffman, 2003). The label of this condition changed in the

Diagnostic and Statistical Manual of Mental Disorders (DSM) subsequently to Attention

Deficit Disorder (ADD), later it allowed subtypes of ADD with and without

Hyperactivity.

Currently, the DSM manual uses the term of ADHD to include 4 subtypes:

1) ADHD, predominantly Inattentive type;

2) ADHD, predominantly Hyperactive type;

3) ADHD, Combined type; and

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4) ADHD Not Otherwise Specified (APA, 2000).

One-third to one-half of the referrals for special education services is made based

on observations of some conditions described in the ADHD section of the DSM. Along

with Learning Disabilities (LD), and Emotional Behavioral Disabilities (EBD), ADHD

represents the class of high-incidence disabilities, accounting for as much as 3-5% of the

school age population. However, because ADHD is not considered a separate category by

the US Department of Education, it is difficult to estimate how many students with

ADHD are served in special education (Hallahan & Kauffman, 2003). Today, ADHD is

often the subject of criticism, being referred to as a “phantom” or “bogus” condition –

sort of a fashionable, trendy diagnosis for people who are basically unmotivated. This

may be a factor as to why IDEA doesn’t categorize ADHD as a disability, but rather falls

under the category of Other Health Impairment. Someone who has been around a person

who is truly ADHD would know that this cannot be true.

It is estimated that the boy to girl ratio affected by this condition ranges from

2.5:1 to 5.1:1 (Barkley, 1998). This may be due perhaps to the fact that boys tend to

exhibit more aggressive behavior (makes them more noticeable) than girls.

Causes are presumed to lay within neurological dysfunctions, rather than in an

actual brain damage, and within the heredity of these dysfunctions. Neuroimaging

techniques, such as MRIs, PET scans, and fMRIs, reveal that the most affected areas of

the brain are the frontal and prefrontal lobes (responsible for executive functions), basal

ganglia (responsible for coordination and control of movement), and cerebellum

(responsible for coordination and motor behavior). It is presumed that an imbalance in the

neurotransmitters serotonin and dopamine (too low in the prefrontal and frontal lobes and

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too high in the basal ganglia) levels are the main neurological chemicals involved in the

mediation of the ADHD symptoms. Executive functions are the cognitive abilities that

“guide thought and behavior in accordance with internally generated goals or plans”

(Wikipedia, 2007), and encompass: memory, learning, language and reasoning (such as

attention, working memory, decision-making, planning, sequencing, problem solving

initiation of action, self-control and self-regulation through inner speech, etc.). In short,

persons diagnosed with ADHD encounter problems with: behavioral inhibition, executive

functions, goal-directed behavior, adaptive skills, social skills, and drug abuse.

Superimposed conditions with ADHD may be LD (10% to 25%), EBD (25% to 50%),

substance abuse conditions (alcoholism, dependence on drugs such as cocaine or

medications, tobacco, etc.)

The treatment of ADHD is primarily educational, medicational (on as needed

basis), and psychological counseling. The medications widely used for treating ADHD

are psychostimulants such as Ritalin, Adderall. However, medication should never be the

first intervention (the use of Ritalin for ADHD has doubled every 4-7 years since 1971).

If a teacher/professor recommends to parents or students the use of medication as

regulation, then the school has to pay for it; if the school refuses, then the professor pays

for it.

It is estimated that about two-thirds of the children diagnosed with ADHD in

childhood continue to display the condition into adulthood. Therefore, the educational

strategies could be employed throughout the educational experience of the person

diagnosed with ADHD, including during tertiary education. It is good to know that the

majority of students with ADHD are served in the general education settings, therefore

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the accommodations are also possible throughout the tertiary education. There are several

classroom characteristics that would be extremely helpful in teaching the student with

ADHD including predictability, structure, shorter work periods, small teacher to pupil

ratio, increase individualized instruction, and an interesting curriculum. Teachers should

generally work with a tem of parents, special educators, school psychologists,

administrators, and healthcare professionals in developing ideas to improve the learning

of students with ADHD. The strategies should be individualized to meet the needs of

each student. Because students with ADHD are easily distracted, the students’ desks

should be placed in the front of the room. Eye contact should be maintained with the

student as much as possible. It is helpful to reduce the amount of materials during work

time so there are not extra materials to distract the student. The professor should: provide

the student with both verbal and visual directions and remind the student often of the task

at hand; provide clear and consistent transitions between activities; warn the students a

few minutes ahead of the time of transition; allow students to keep track of their own

behavior (self-regulating – self-monitoring and self-evaluating – “Am I working?”

strategy) (for younger students, the teacher should have a timer); and help with

organizational skills by having the student buy a calendar or organizer. In general, the

students’ schedule needs to be clear, predictable, with an uncomplicated routine and

structure. Students with ADHD react very well to behavioral modification strategies such

as: the use of reinforcement and rewards systems (i.e. verbal praise or extra time on the

computer) to increase their attention; developmentally appropriate time-out; and

communication with parents to set consistent rules in the classroom and at home. Self-

regulation strategies may include:

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1) SLAM – Stop, look at the person, ask a question to clarify, make a response.

2) FAST – Freeze and think, Alternate solutions, solution evaluations.

Early intervention is very important because it sets the stage for self-regulation of

behavior through coaching.

Discussion points:

1. Discuss the academic and emotional difficulties that people with ADHD

may experience.

2. Discuss the learning accommodations that people with ADHD may

need.

3. Share any experiences you may have had in teaching people with

disability, especially with ADHD.

References:

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Adams, M. (2000). Readings in diversity and social justice: An anthology on racism,

antisemitism, sexism, heterosexism, ableism, and classism. New York and

London: Routledge. (pp.369-373)

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental

Disorders (4th ed., text rev.). Washington, DC: Author.

Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A clinical handbook for

diagnosis and treatment. New York: Guilford Press.

Goldstein, K. (1936). The modification of behavior consequent to cerebral lesions.

Psychiatric Quarterly, 10, 586-610.

Goldstein, K. (1939). The Organism. New York: American Book Co.

Hallahan, D. P., & Kauffman, J. M. (2003). Exceptional Learners: An Introduction to

Special Education. Boston: Allyn and Bacon.

Wikipedia.(2007). Executive Functions. Retrieved October 28, 2007 from

http://en.wikipedia.org/wiki/Executive_functions