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ADHD: Discussion & scenarios for communication

ADHD - Attention Deficit Hyperactivity Disorder

All parents worry:

Will my child be all right?
How can I do what is best for my child?
Parents feel guilty if they have their child on medication and guilty if they do not.
Most parents hunger for information, answers, and most of all,
understanding of their children and how they can help them.

Patricia Kennedy, Leif Terdal, Lydia Fustetti. The Hyperactive Child Book



This page includes information on Attention Deficit Hyperactivity Disorder (ADHD) to discuss and communicate different student scenarios with educators, parents and others.

Parents feel guilty if they have their child on medication and guilty if they do not.

Most parents hunger for information, answers, and most of all, understanding of their children and how they can help them.

Is attention deficit-hyperactivity disorder biophysical?

Dr. Alan Zametkin's research shows that the brains of hyperactive individuals are physically different. Their brains are considered sluggish and under stimulated in certain areas.

Recent information using MRI imaging to compare how the brain functions for students with ADHD and those without ADHD suggests there is a difference.

Primary ADHD is biophysical (the child is born that way).

ADHD is a disorder defined by clinical symptoms not by cause.

By three main characteristics:

  1. impulsivity
  2. inability to pay attention and
  3. hyperactivity

Other characteristics:

  • Most researchers agree 3 to 5 percent of the general population are ADHD.
  • ADD and ADHD are not the same disorder, although they respond to the same medications and behavioral management programs.
  • The inability to pay attention is also found in Attention Deficit Disorder (ADD)
  • Primary ADHD is biophysical (the child is born that way).

Are ADD and ADHD the same?

ADD and ADHD are not the same disorder, although they respond to the same medications and behavioral management programs.

What is impulsivity?

Child does things without thinking first:

  • running out in the street
  • hitting another child
  • taking apart a toy
  • blurting out an answer in class without being called on
  • difficulty waiting their turn and following rules

What is the inability to pay attention?

  • unable to pay attention at home and at school
  • a child can be told something "a million times," and still does not seem to understand

What is hyperactivity?

Being very busy, but not accomplishing much.

To confirm ADHD there should be?

A confirmation of all three characteristics by at least two sources:
parents, teachers, or doctors. (impulsivity, inability to pay attention, and hyperactivity0

What behavioral information might a teacher or parent report?

That the student has

  • poor attention span,
  • poor impulse control,
  • poor compliance with instructions
  • poor self-control and
  • a report that the child knows what will happen if he breaks the rules but cannot control her or him self and breaks them anyway.

What would a psychologist report?

The behavior problems have placed the child in the top 3 percent for symptoms of ADHD as compared with other children of the same age and sex.

What would be reported about duration of the symptoms?

  • a persistence of symptoms over time and in many situations
  • have occurred at least six months to a year.
  • began in early childhood and before five years of age.
  • are ongoing and occur in multiple settings.

What would be reported about the student’s IQ?

The child has an IQ of 70 or higher.

What characteristic should be excluded when diagnosing Primary ADHD?

  • mental retardation
  • deafness
  • blindness
  • gross brain damage
  • severe language delay
  • childhood psychosis
  • autism
  • cerebral palsy
  • severe emotional disturbances

They could have some of the problems on this list:

  • Purposeless selection of cues--listens to the air conditioner instead of the math lesson
  • Weak resistance to distraction--easily distracted by all types of cues
  • Persistence - is unable to stick with a task (gives up very easily)
  • Inefficiencies of motor activity--or unproductive over activity: on the go, but going nowhere
  • Insatiability--wants all the toys in the toy box, but when he has them, demands more
  • Impulsive - acts without thinking
  • Academic failure--poor school work
  • Social failure--poor peer relations, difficulty making or keeping friends
  • Performance inconsistency--has good days and bad days. Some days he understands his math with no problem; the next day, the same material is like a foreign language
  • Attention difficulties--has trouble staying on task
  • Diminished self-esteem--feels badly about himself
  • Disorganized--difficulty in organizing how to do tasks

In general, parents should take the child for evaluation if they feel the child has problems with impulsivity, inattention, and hyperactivity AND if someone else, like the teacher or the physician, also feels the child is having trouble with the same three things in comparison to other children of the same age, sex, and mental ability.

Professionals now think that only 30 to 40 percent of children with ADHD outgrow it as adults, and they are usually mild cases.

ADHD is thought to be associated with a disturbance in functioning of neurotransmitters in the brain. Neurotransmitters like dopamine, nor-epinephrine, and serotonin are now thought to occur at different levels among individuals who have hyperactivity than among those who have normal abilities to sustained attention and arousal.

Possible Causes

  • Toxins affecting the fetus during pregnancy: alcohol, heroin, methadone, and cocaine.
  • Toxins affecting the child after birth: lead poisoning
  • Genetic factors: 
    • Increased incidence of problems associated with ADHD occurring in siblings of ADHD children.
    • Sex differences...boys around the world show rates of ADHD incidence about three times as high as girls.


Head injuries are not associated with ADHD.

Allergies from food additives such as salicylateds, dyes, and preservatives do not cause hyperactive behavior allergic or toxic reactions in children. Well-controlled studies using a double-blind research method do not support the view that diet (Feingold Diet) improves the behavior of hyperactive children. However, some infants and young children clearly show adverse reactions to some foods and the numbers of foods that can cause problematic reactions are much more extensive than suggested by Dr. Feingold. See a study by Dr. S. Allan Bock in The Journal of Pediatrics (1987). If a child has a behavioral reaction, related to an allergic reaction, there will also be a secondary reaction, such as a stomachache, diarrhea, vomiting, skin reaction, nasal congestions, or wheezing. The child's behavior change is most likely a direct response to discomfort from the symptoms of the food reaction.

Research shows overwhelmingly that sugar does not cause hyperactivity. Parents and others may observe overactive behavior during sugar fest like birthday parties and Halloween, but the behavior can be attributed to the emotional excitement of the event rather than the sugar consumed.

Important Aspects of Medical History to Consider

  • Medications: such as theophylline (which can cause jittery behavior or inability to concentrate) for asthma, or phenobarbital (which can cause over activity) for epilepsy.
  • Drugs the mother took during pregnancy.
  • Does the child have metabolic problems, such as phenylketonuria (PKU), or has there been lead poisoning or an ongoing illness? Has he had congenital heart disease leading to hypoxia (low oxygen levels in the blood), or has his heart ever stopped and been revived?
  • Or any of the following conditions: under-or overactive thyroid, recurrent diabetic problems, diabetic coma, hypoglycemia (low blood sugar), ongoing anemia, and food allergies. 

Also might want to know:

  • His or her developmental history. When did s/he sit up, walk, say first words?
  • Family history: blood relatives of the child who have allergies, autoimmune diseases, seizure disorders, learning problems, or instances of retardation. Are other people in the family hyperactive?
  • Social history: Changes in the child's life. Is there a fun parent and a wicked witch of the west parent? Do the parents have realistic expectations?
  • Medical history: 
    • General temperament and emotional health such as anxiety, phobia, oppositional behavior, anger, sadness, depression, abuse, bizarre behavior, autism, and psychotic disorder. 
    • Physical health such as speech and hearing problems, visual difficulty, neurological disorders like muscular dystrophy, evidence of any minor seizures, heart disease, hypoglycemia, and food allergies.
    • Has there been a recent neurological exam? This is important because sometimes a child is misdiagnosed as having being hyperactive when s/he has other neurological problems or delays. A neurological exam will test: coordination, memory, ability to put things in sequence, and fine-motor skills.
  • School functioning: 
    • Can s/he follow directions? Wait his or her turn? Finish work? Listen? Stay on-task?
    • Is there any learning disabilities? Perception (visual or auditory or both), listening comprehension, basic reading skills, reading comprehension, memory (both short-term and long-term), sequencing, oral expression, written expression, spelling, math calculation, math reasoning, and fine-motor skills (in handwriting or other skills).
    • What are the child's fine-motor skills, eye-hand coordination, and tracking skills. Skill, or lack of skill, when coloring, drawing, cutting paper, and throwing a ball and catching it can indicate possible learning difficulties. A talented teacher takes time to observe and check each child's skill level without students knowing.

Rating Scales to collect information: 

  • Achenbach Child Behavior Rating Scales
  • Barkley's Home and School Social Questionnaires
  • Conner's Rating Scales (Teacher's Questionnaire and Parent's Questionnaire)
  • Vineland Adaptive Scales

Seven Kinds of Attention

  1. State of Arousal: alertness and excitability
  2. Impulsivity/Reflectivity: The length of time a person thinks before acting. Fast reaction time is sometimes appropriate (Sports, Nintendo)
  3. Cognitive Tempo: rate that it takes to complete a task
  4. Filtering Distractions: ability to ignore background activity and focus on a task
  5. Purposeful Focus: ability to identify what is important to attend to.
  6. Persistence: the length of time a person can pay attention to a task
  7. Self-monitoring: the ability of a person to control their attention

Over 75% of children with ADHD can be helped with medication.

Stimulants like Adderall, Concerta, Strattera, Ritalin, Dexedrine, and Cylert stimulate neurotransmitters in the brain, like dopamine, to help the brain work better. The word stimulant applied to these medications does not mean they increase the user physical active. Instead they stimulate the brain to:

  1. improve the attention span
  2. reduce impulsive behavior
  3. reduce disruptive behavior
  4. increase compliant behavior

Dosage should be set according to body weight. Some physicians use set dosages of 5 mg, 10 mg, 15 mg, and 20 mg of medication instead of calculating for body weight. Dosages should be individualized, based on an individual's response to the medication. Also there are sustained-release forms that maintain a constant release for eight to twelve hours.

Market shares in 2006: Adderall 36%, Concerta 28%, Strattera 23%, Ritalin 8%, and all others 5%.

Stimulant medications are usually not effective before age five. Preschool children usually respond better to behavioral management strategies than to medication, but there are exceptions. If stimulants were tried and they were not effective, the parents may not be willing to try them again when the child is older and the central nervous system matures so medication may be helpful. If medication works, it is likely it will be need for many years.

It is important that parents understand that for most children with ADHD that when the school day is over the effects of a stimulant medication are over as well. Thus, not relieving parents of the problems associated with ADHD.

Side Effects: To determine if a child is having a negative reaction from the medication baseline data should be collected for a week or so before the start of treatment. Rating scales like the Conners may be used. Possible side effects of stimulant medications are:

    1. Difficulty sleeping, especially if medication is given later in the day.
    2. Stares or daydreams
    3. Lack of interest in activities
    4. Decreased appetite
    5. Increased irritability
    6. Body complaints (headaches, stomach aches, dizziness)
    7. Increased crying or signs of anxiety
    8. Increased blood pressure and heart rate
    9. One child in a hundred develops tics (involuntary motor and vocal spasms)
    10. Stimulant medications are not addictive.

Behavioral Interventions 

A hyperactive child can achieve in a structured environment



David was referred for a multidisciplinary evaluation.

He was not functioning well in school, and the teachers and the principal thought he might be hyperactive. He was disruptive in class and pestered other children during quiet time. During class assignments he tried to peek at other students' papers.

He finished his papers incorrectly, despite his teacher's multiple attempts to talk with him and give additional help. Although David did poorly in school, he still liked school, and he was exceptionally talented in art class and at building projects.

When performing these tasks, he was in "a world of his own" and would spend more than the required time on favorite assignments. In addition to believing he was hyperactive, his teachers felt he was a very visual child.

Does David have ADHD?

The Multidisciplinary Team found:

David had a moderate hearing loss that made verbal learning difficult for him. His attempts to see his classmate's papers were not done as impulsive or attention-seeking behavior, but rather to find out what he was supposed to be doing, since he could not hear the directions.


Seven-year-old Lori started having trouble in second grade. She had been in the top reading group in first grade, but second-grade reading was a struggle.

Lori was easily distracted and her work became careless and incomplete.

She had two or three good friends in first grade, but this year she had none, since she would hit the other children at the least provocation.

Her second-grade teacher was beginning to think Lori might be hyperactive.

Does Lori have ADHD?

A phone call to Lori's parents revealed that Lori’s parents were going through a messy divorce.

Lori did not exhibit attention problems before the divorce. Her problems in school were probably related to emotional and social problems she was dealing with at home with her mom and dad.

The team looked at Lori and found two tip-offs.

Lori had no symptoms of hyperactivity before age seven, and a change occurred in her social adjustment as well as her academic skills. Helping Lori deal with her family problems eliminated her behavior problems and inattention.


Martha, age two and a half, "does not obey and grabs things," according to her parents, Mr. and Mrs. Robinson.

When they brought Martha to a psychologist for a consultation. They reported Martha did not obey often. She threw terrible temper tantrums and had "a mind of her own".

The father added, "My wife and I can't even read to her. She just grabs things.”

The psychologist asked the parents to play with Martha in a playroom.

The psychologist observed them through a one-way mirror.

During this time, Mr. Robinson picked up a picture book and suggested,

"Martha, let me read to you.

"Martha came over and sat next to her father. As he opened the book, she reached for the page.

"No! Keep your hands off the book. Sit and listen while I read!"

Martha reached again, trying to touch the objects on the page.

"No, get your hands off," Mr.. Robinson repeated in a louder voice.

He never did read the book. Instead he repeated, "Don't! Stop that!"

Martha slapped at the book and walked away.

Does Martha have ADHD?


John's mother came into her pediatrician's office requesting a cage for her son.

  • John, seven years old and her third child, was in constant motion, impulsive, and unable to follow any directions.
  • If he was asked to go to his room to pick up his blue shirt and place it in the hamper, he would be found playing in his room with the shirt still on the floor.
  • He was on the move even before he was born, being her most active child in utero.
  • John never seemed to have a schedule, seldom needed sleep, and could be found wandering the house during the night after he mastered climbing out of his crib.
  • Discipline did not seem to work, nor did all the parenting techniques used on the other two boys.
  • He never stayed on the time-out chair, and spankings did no good.
  • John seemed totally oblivious to his behavior: he would be eating a piece of forbidden cake and with the cake in his hand, would deny any knowledge of having taken it.
  • He never finished anything he started and, except playing a video game.
  • He would watch TV on the run.
  • The problem in school was staying on task and keeping track of what was happening in the classroom.
  • He was capable of doing the Work.
  • He would forget to take home the book he needed for his homework.
  • When he completed his homework, he would forget to put the homework in his backpack or forget to hand it in when he was in class.

Does John have ADHD?

John is a child with Primary ADHD.


Robert goes to the resource room for special help in reading and is almost two years behind in his reading ability. When he is called upon to read in his social studies class he never knows his place, shuffles through the pages, and can become the class clown.

  • He has stated several times rather loudly that he did not need to learn about social studies.
    He has been disciplined many times about his inattention with no change in his behavior.
    There has never been a problem reported in gym class, shop, or music.

Does Robert have ADHD?

His problems arose in areas where he had an underlying weakness and he used his "inattention" as a conscious strategy or learned behavior to avoid humiliation.


Pat Kennedy's son Max was four years old when his local pediatrician diagnosed him as hyperactive. Though Max could add single-digit numbers at four, his speech development was unusual and behind that of other children his age and he had trouble with pen-and-paper tasks.

  • At age five and a half, Max had surgery to correct problems from repeated ear infections.
  • With improved hearing, his ability to speak improved, too.
  • When he started school, he ran into more difficulties.
  • School personnel repeatedly told Pat that Max was retarded.
  • Because of Max's skill in some areas, she did not believe them.
  • A series of tests given by the school proved Pat was correct.
  • However, the school still was not sure what was wrong with Max. The school strongly suspected he might be emotionally disturbed. His mother and pediatrician both disagreed with that.

Does Max have ADHD?

From the team's evaluation, a true picture of Max emerged. Max had Primary ADHD, learning disabilities, and motor dyspraxia (painful movements).


You are a third grade teacher and Mrs. Jones's son, Erik, is inattentive, often out of his seat, and not "tracking" in his third-grade class.

Should you suggest he might have ADHD?

You have considered and confirmed:
1. impulsivity,
2. inability to pay attention and
3. hyperactivity.

You have not had it confirmed with parents or a doctor.

Should you call Mrs. Jones?

You decide to call Mrs. Jones and see what she has to offer.

Mrs.. Jones remarks:

"We just moved. Everything has changed. We live in a new house. We are new in town. His nearest friend is a thousand miles away. Furthermore, he was a solid student his first two years in school."

Flip-Flop Girl
by Katherine Paterson

Parent X

A parent of one of your students describes how a physician or psychologist made a diagnosis of ADHD.

Their description of the diagnostic procedure generally describes a brief interview they had with the doctor or psychologist.

What do you say?

  • For an accurate diagnosis of ADHD, information must be gathered from several settings, such as home and school, and other possible causes of the child’s behavior must be seriously considered.
  • A multidisciplinary team evaluation is the safest and most dependable way to determine if a child is ADHD.

Parent Y

"Bobby is hyperactive. I’m going to have the doctor put him on Ritalin."

What would be your response?

  • I wouldn't feel very comfortable putting Bobby on Ritalin until I looked into learning disabilities and some other possible causes of his attention problems.
  • I know that a lot of hyperactive children have learning disabilities as well.
  • If he is hyperactive, I would be concerned he may have learning disabilities, too, and I know how important it is to identify the strengths and weaknesses of any child with attention problems.
  • If you would like we could have a referral team that includes a learning disabilities specialist and a child psychologist evaluate Bobby.

"Okay, but why don't I go ahead and have my family doctor prescribe the medication it couldn’t hurt to try the medication? We could be wasting valuable time if we just wait to find out."


  • ADHD can be mild, moderate, or severe, and it is important to know just what you're dealing with.
  • You can always call the American Academy of Pediatrics or Physician's Referral and ask for a referral to either a developmental pediatrician or a child psychiatrist.
  • Ask the pediatrician and the child psychologist if they can run tests for neurodevelopment, speech and hearing, learning disabilities and psychological tests.
  • It will be good too know what his strengths are and what weakness, if any. In order to maximize any benefit from treatment the more you know the better the results will be.



Management - Self development & individual, group, & classroom management