• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in 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 (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities

• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

• Often fidgets with hands or feet or squirms in seat
• Often leaves seat in classroom or in other situations in which remaining seated is expected
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults, may be limited to subjective feelings of restlessness)

• Often has difficulty playing or engaging in leisure activities quietly
• Is often “on the go” or often acts as if “driven by a motor”
• Often talks excessively

• Parent Interview
  Detailed description of the child’s symptoms over time
  Developmental history
  Psycho-social history of the nuclear and extended family
• Child Interview
  Child’s perception of the described symptoms
  Child’s social-emotional status related to the symptoms
• Personality Testing (optional) Rule out co-existing disorders:
  • Depression
  • Anxiety
  • Other mental health disorders

• Teacher and Parent Rating Scales
  Checklists and rating Scales which address behavioral symptoms of hyperactivity, inattention, impulsivity, and social-emotional functioning
• Psychological and Educational Testing
  Standardized measures of:

• Cognitive ability and/or memory
• Visual-motor integration
• Academic skill development
• Sustained attention-concentration and impulse control

Will my child outgrow pediatric ADHD?

Most children diagnosed in childhood continue to demonstrate ADHD symptoms into adulthood. The specific ADHD symptoms, however, appear quite different as the child matures and learns coping strategies. Children with symptoms of “hyperactivity” often appear to be less physically active in adolescence, although they may continue to experience “internal restlessness.” In addition, adolescents and adults develop strategies whereby they “bypass” ADHD symptoms. In some cases individuals learn to “channel” the negative behaviors associated with these symptoms into positive outcomes (e.g., the ADHD child becomes an innovative entrepreneur due to high energy and a unique vision).

What pediatric ADHD treatment options are available?

Children and adolescents with ADHD have a variety of needs. Some children require specific accommodations in the school setting, some need support with social-emotional functioning, and others need practical support. Medication also has been beneficial to most individuals. Generally, however, optimal pediatric ADHD treatment includes a variety of interventions, which are individualized for a particular child’s needs. In other words, one treatment option alone is not recommended. In many cases the combination of treatment options works synergistically. Commonly accepted treatment options include:

• Educational interventions
• Use of medication
• Individual or family therapy
• Parenting skills training

• Social skills training
• Parent-child support groups
• Practical support

Your child at school

Your child has been given a diagnosis of Attention-Deficit/Hyperactivity Disorder. Pediatric ADHD is a condition affecting approximately three percent of school-age children. Characteristics of pediatric ADHD may include:

1. Poorly sustained attention and vigilance: Poor persistence of effort over time; interest lost quickly; work left incomplete.
2. Impulsivity: Difficulty delaying gratification; living for the moment; acting without thinking of consequences.
3. Hyperactivity: Difficulty regulating and modulating activity level to fit changing demands of environment; physically restless.
4. Diminished rule-governed behavior: Rules known but used inconsistently to control behavior; increased need for supervision and management.
5. Variability of task performance and inconsistent memory retrieval.

Part of your child’s pediatric ADHD treatment plan may include a trial of stimulant medication.  When children respond well to medication they are able to maintain their focus and concentration for longer periods of time.  Secondary gains from medication may include less disruptive behaviors, less impulsivity, and more positive peer interactions.  However, research suggests that the most effective intervention for children with pediatric ADHD is the use of medication in conjunction with modifications in the environment.  The teacher’s accepting and nonjudgmental attitude is extremely important, since the child with ADHD is not able to change or control certain behaviors merely by “trying harder.”

The classroom teacher plays an important role in a child’s successful adjustment.  The following suggestions may be helpful in planning your child’s educational program.

Modify the physical environment:

• Have this child sit in front of the room, away from the door, activity centers, and attractive bulletin boards.
• Give this child the option of a “private office” or study carrel for independent work. This child may need additional monitoring and support when working in groups.
• Provide structure, predictability, and consistency. Simplify classroom routines and transitions when possible.

• Stand near this child when presenting information or giving directions, and monitor his/her response.
• Model strategies for organizing time, space and materials in the classroom.
• Allow some restlessness and provide periodic exercise breaks. This child may benefit from a larger space around his/her desk due to high activity level.
• Do not make recess or specialist activities (physical education, art, music) contingent on classroom performance.

• Be sure this child’s attention is focused when giving instructions or directions. Cue this child to prepare to attend with a pre-determined signal.
• Give directions slowly using simple sentences and vocabulary. When needed, ask this child to repeat them in his/her own words.
• Provide “advance organizers” (such as vocabulary lists, outlines of main ideas, or explanations of key concepts) to be covered in class.

• Include visual cues, manipulative materials and active student participation in each lesson.
• Reward thoughtful, “think aloud” approaches rather than speed of responding.
• Provide this child with opportunity to prepare for discussions. Give this child information on the content to be covered so he/she has a frame of reference.

• Reduce visual clutter (e.g. cute pictures, etc.) on worksheets. Reduce number of problems on page. Use enlarged type and allow additional space between sentences or problems.
• Highlight key words in directions and central features on a page. Divide work pages into sections with specific time expectations for each section.
• Shorten assignments but stress and reinforce accuracy. Decreasing workload to fit this child’s attention span will encourage work completion and a sense of closure.
• Break long assignments into daily tasks, and structure with concrete examples. Provide a sample of the finished product.
• Provide self-correcting materials and computer-assisted instruction for immediate feedback.

• Modify assignments consistently in both classroom work and in homework. Sending incomplete classroom work home often proves to be counter-productive for most children. When possible, homework should be at a level where this child is able to complete it independently.
• Provide extra copies of textbooks to be kept at home. For each class, arrange a “study buddy” for this child to call with homework questions.
• Avoid long tests. Provide frequent short quizzes and opportunity for retest, or for discussion to demonstrate mastery. This will be especially important when test scores are not consistent with daily assignments and classroom performance.
• Provide alternate environments with fewer distractions for test taking.
• Allow tests to be taken in an untimed condition.

Teach organizational strategies:

• Provide daily practice in use of such things as desk organizers, work folders, an assignment book and a planning calendar. Daily check-ins with teachers or a counselor often ensure that assignments have been recorded accurately and thoroughly.
• Provide study guides for upcoming tests, or provide practice tests prior to unit tests.
• Develop a system for keeping track of completed/uncompleted work. Provide detailed checklists to allow self-monitoring of satisfactory completion.

Guide this child in taking responsibility for his/her own behavior:

• Include social skills and problem-solving training as part of the regular classroom curriculum.
• Define and reinforce specific positive behaviors and productivity. Conduct a reinforcement survey with this child to identify reinforcement preferences.
• Encourage this child to develop and use self-monitoring procedures (e.g. reminding his/her to check work for accuracy once it is completed).

• Develop contingency contracts for specific behavioral goals with specific reinforcement included (e.g. this child will earn 20 extra minutes of computer time when 4 out of 5 math assignments are turned in with 90 percent accuracy).
• Work closely with parents to maintain consistency regarding behavioral goals, homework expectations and reward systems.

Your adolescent at school

Many adolescents with ADHD continue to need monitoring of homework and help with organization.  Building a support system within the school setting is an important step toward independence.  A coach or a mentor can provide direct teaching of study skills and organizational strategies and on-going supervision of their use.  A counselor can serve as an advocate with other teachers and provide positive support in resolving conflict relationships.

These strategies and direct suggestions may help your adolescent take more responsibility for his/her own learning:

• Take an active part in setting realistic goals for increasing your work completion and improving your grades.
• Use an assignment book and a planning calendar to keep track of assignments due and break long assignments into daily tasks.
• Use study guides and teacher outlines to prepare for tests.
• Develop checklists for keeping track of assignments that have been completed and turned in.
• Block out daily study time with specific tasks to be completed.

• If possible, obtain extra copies of textbooks to be kept at home.  Get the telephone number of e-mail address of a friend in each class in case you have questions about assignments.
• Request a distraction-free room and extended time for taking major tests, final exams, and college entrance exams.
• Choose a place in the classroom that does not interfere with your paying attention to the teacher.  Save socializing for break time.
• Arrange a check-in time with your advisor to organize each day and check for assignment completion.