Archived Information

**SECTION II**

**STUDENT CHARACTERISTICS**

**Modules**

1\. Infants and Toddlers with Disabilities Served Under IDEA, Part H

2\. Children Served Under IDEA, Part B Preschool Grants Program

3\. Students Served Under IDEA, Part B

4\. Students with Attention Deficit/Hyperactivity Disorder

**Infants and Toddlers with Disabilities Served Under IDEA, Part H**

Part H of the Individuals with Disabilities Education Act (IDEA) was
adopted by Congress in 1986. Part H was designed to address the needs of
infants and toddlers with disabilities and their families through a
"statewide system of coordinated, comprehensive, multidisciplinary,
interagency programs providing appropriate early intervention services
to all infants and toddlers with disabilities and their families" (20
U.S.C. §1476 (a)).

Formulation of the goals for Part H and early intervention was
influenced by multiple factors, including the historical context that
led to the passage of Part H, the actual language used in the Part H
legislation and regulations, and the professional literature. Part H
contains the following purpose statement:

The Congress finds that there is an urgent and substantial need:

\(1\) To enhance the development of infants and toddlers with
disabilities and to minimize their potential for developmental delay,

\(2\) To reduce the educational costs to our society, including our
Nation's schools, by minimizing the need for special education and
related services after infants and toddlers with disabilities reach
school age,

\(3\) To minimize the likelihood of institutionalization of individuals
with disabilities and maximize the potential for their independent
living in society,

\(4\) To enhance the capacity of families to meet the special needs of
their infants and toddlers with disabilities (20 U.S.C. §1471), and

\(5\) To enhance the capacity of State and local agencies and service
providers to identify, evaluate, and meet the needs of historically
underrepresented populations, particularly minority, low-income,
inner-city, and rural populations (20 U.S.C. §1471).

This statement sets forth a broad set of goals for early intervention
programs and emphasizes serving both children and families.

Part H provides Federal funds to assist States in planning and
implementing a system of early intervention services to:

\(1\) develop and implement a statewide, comprehensive, coordinated,
multidisciplinary, interagency ­program of early intervention services
for infants and toddlers with disabilities and their families;

\(2\) facilitate the coordination of payment for early intervention
services from Federal, State, local, and private sources;

\(3\) enhance their capacity to provide quality early intervention
services and expand and improve existing early intervention services
being provided to infants and toddlers with disabilities and their
families (20 U.S.C. §1471).

The first year of implementation for Part H was 1987. Part H was
designed to be phased in over a 5-year period. However, it was later
amended by adding two 1-year extensions to permit States to fully
implement the law. All States provided an assurance that they had
implemented Part H as of September 30, 1994. Funding for the program has
increased from \$50 million in FY 1987 to \$316 million in FY 1996.

Infants and toddlers from birth through age 2 are eligible for Part H
services if they:

\(1\) Are experiencing developmental delays, as measured by appropriate
diagnostic instruments and procedures in one or more of the following
areas:

> \(i\) Cognitive development.
>
> \(ii\) Physical development, including vision and hearing.
>
> \(iii\) Communication development.
>
> \(iv\) Social or emotional development.
>
> \(v\) Adaptive development; or

\(2\) Have a diagnosed physical or mental condition that has a high
probability of resulting in developmental delay (34 CFR 303.16).

States have the discretion to serve infants and toddlers and their
families who are "at risk of having substantial developmental delays if
early intervention services are not provided" (34 CFR 303.16). In 1995,
13 States and one Outlying Area served at-risk infants and
toddlers[^1].1

Children eligible to receive services under Part H must have an
individualized family service plan (IFSP) in place.

This section discusses the increasing number of infants and toddlers
with disabilities who are being served under Part H of IDEA, the
distribution of these children by age, and the percentage of infants and
toddlers served in the resident population. (Further discussion on Part
H can be found in "The Part H Longitudinal Study (PHLS)" in Section
IV.1.)

**Figure II-1**

**Number of Infants and Toddlers with Disabilities Served Under IDEA,
Part H**

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System
(DANS).![](media/image1.wmf){width="4.029861111111111in"
height="3.45in"}

**Number of Infants and Toddlers Served**

Figure II-1 shows the number of infants and toddlers and their families
who have received servic­es since December 1992.[^2] Counts prior to
December 1992 were considerably higher than the 1992 count. Discussions
with State representatives indicate that these earlier counts were
somewhat inflated because States had difficulty providing unduplicated
counts of infants and toddlers served, and some States counted infants
and toddlers who did not have an IFSP in place.

Since 1992, the States have reported a steady increase in the number of
children served. During the past 4 years, the number of infants and
toddlers served has increased by 22.4 percent. Ten States\--Arkansas,
California, Florida, Kansas, Kentucky, Mississippi, Montana, New Mexico,
New York, and Oregon\--reported increases of more than 50 percent, while
10 States and jurisdictions\--Alaska, Arizona, District of Columbia,
Massachusetts, Missouri, New Hampshire, North Carolina, Tennessee,
Virginia, and Washington\--reported serving fewer infants and toddlers
with disabilities in 1995 than in 1992.

States vary in the percentage of infants and toddlers served under Part
H. In 1995, six States served less than 1 percent of their resident
birth to age 3 population under Part H, while 33 States served 1 to 2
percent of their resident population through Part H. Eight States served
from 2 to 3 percent of the population. Four States served more than 3
percent of the population under Part H. One of those States, Hawaii,
continues to serve the highest percentage among all States (6.73
percent). (See Appendix table AH1.)

It is likely that the overall growth in the number of infants and
toddlers served is in part related to child find and public awareness
efforts. Almost 50 percent of the children served in 1995 were in the 2-
to 3-year-old range, whereas approximately 17 percent of the infants
were 1 year old or younger, as shown in table II-1. Only the 2- to
3-year-old age group had an overall increase during the 4-year period of
1992-95.

A small study conducted in Colorado, North Carolina, and Pennsylvania
sampled the families of 155 infants and toddlers with disabilities in
early intervention programs in three counties of each State. The study
found that average age of referral to the program was 12.1 months in
Colorado, 10.6 months in North Carolina, and 7.7 months in Pennsylvania.
The most commonly used referral source was a physician or nurse (50
percent). The study also found that the sample collected in May of 1994
consisted of 24 (15 percent) infants ages birth to 1, 64 (41 percent)
infants ages 1 to 2, and 70 (44 percent) toddlers ages 2 to 3 (Kochanek
& Buka, 1994).

**Table II-1**

**Percentage Distribution of Ages of Infants and Toddlers Served Under
IDEA, Part H 1992-95**

  --------------- -------------- ------------- ------------- ---------------
  **Year**        **Ages**                                   

                  **Birth to 1** **1 to 2      **2 to 3      **Total\*\***
                                 Years Old**   Years Old**   

  **1992\***      18.8           34.2          47.1          100.0

  **1993\***      20.3           35.1          44.6          100.0

  **1994**        17.9           33.4          48.7          100.0

  **1995**        16.8           33.4          49.8          100.0
  --------------- -------------- ------------- ------------- ---------------

\* Includes infants and toddlers with disabilities served under the
Chapter 1 Handicapped Program.

\*\* Due to rounding, totals may not sum to 100 percent.

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

**The Early Education Program for Children with Disabilities**

The Office of Special Education and Rehabilitative Services (OSERS) in
the U.S. Department of Education administers a variety of programs
related to improving the quality and quantity of services to young
children with special needs and their families. Selected early childhood
projects are sponsored by OSERS and administered by the Office of
Special Education Programs (OSEP) through the Early Education Program
for Children with Disabilities (EEPCD).

These early childhood initiatives include demonstration projects,
in-service training projects, outreach projects, research institutes,
research and experimental projects, statewide data system projects, and
a technical assistance center that support programs for infants,
toddlers, and preschoolers with disabilities.

EEPCD, originally named the Handicapped Children's Early Education
Program (HCEEP), was established in 1968 with a mandate to set up model
demonstration projects for the delivery of special education and related
services to young children with disabilities, from birth through the
third grade. Three major needs were identified for early intervention
programs: (1) locally designed ways to serve infants, young children,
and their families; (2) more specific information on effective programs
and techniques; and (3) distribution of visible, replicable models
throughout the country.

Two major assumptions underlie this program: (1) only through early
intervention with tested and successful program models can the highest
quality services be provided for children with disabilities, and (2) the
program should provide models of services rather than be a direct
service delivery program. HCEEP was intended to provide an opportunity
for any public or private nonprofit organization to develop and
demonstrate high-quality services for a selected group of children and
their families. It also was intended to provide an opportunity to
demonstrate the effectiveness of locally designed approaches and
disseminate those ideas across the nation to other agencies that might
choose to use the model rather than develop their own program. EEPCD
currently supports 109 projects, including 35 demonstration projects, 18
in-service training projects, 49 outreach projects, 6 research
institutes, and 1 national technical assistance center.

The demonstration projects address a range of topics, including
multidisciplinary intervention services for child and family;
interagency collaboration in the provision of services; service delivery
models; developmentally appropriate practices; transitioning children
with disabilities into community settings; increasing and improving
child care options for children with disabilities; curriculum
development; evaluation of child progress; services for infants with
special health needs, including HIV infection and AIDS, or exposure to
drugs in utero; and assistive technology. Projects in this priority area
are developing and evaluating in-service training models that will
prepare professionals and paraprofessionals to provide, coordinate, or
enhance early intervention, special education, and related services for
infants and toddlers with disabilities and/or for preschool children
with disabilities. Outreach projects engage in awareness activities;
stimulation of model replication sites; training of professionals,
paraprofessionals, and parents; promotion of State involvement; product
development and dissemination; and consultative activities. Outreach
efforts have contributed significantly to informing people about
effective programs for young children, to providing improved training
and services, and to building continuity and interagency/inter State
collaborations. During 1995-96, four research institutes were funded.
These institutes address interventions for children affected by parental
substance abuse; barriers to the inclusion of preschool-age children
with disabilities in classroom and community settings; influences on
service patterns and utilization in early intervention and preschool
programs; and the adoption of successful early intervention practices in
children's early elementary education in order to improve the education
of children with disabilities.

**Summary**

The increase in the number of infants and toddlers served under Part H
(22.4 percent) since 1992 has been greater than the growth in the number
of children and youth served under the Part B program for this same
period (10.6 percent). However, the Part H growth rate is comparable to
the growth rate of the number of children ages 3 through 5 that are
served under Part B (20.4 percent). This growth in services to young
children reflects one of the OSEP's policy goals\--to strengthen early
intervention to enable every child to start school ready to learn. Early
intervention programs can benefit both the child and the family by
helping the child become more involved in both the community and the
family and can diminish or pre-vent further developmental limitations
and secondary or tertiary disabilities (Guralnick & Bennett, 1987).

The overall percentage of infants and toddlers with disabilities served
under Part H as a function of the resident population has also
increased, from 1.2 percent in 1992 to 1.5 percent in 1995. However,
these percentages vary across the States. Children with disabilities
ages 2 to 3 continue to be the most dominant age group, representing
almost half of all those served under Part H.

**References**

Guralnick, M.J. & Bennett, F.C. (1987). *The effectiveness of early
intervention for at-risk and handicapped children*. Orlando: Academic
Press.

Kochanek, T.T. & Buka, S.L. (1994). *The Early Childhood Research
Institute on Service Utilization: Study environments and a portrait of
children, families and service providers within them*. The University of
North Carolina Rhode Island College Center for Family Studies: Early
Childhood Research Institute on Service Utilization.

**Children Served Under IDEA, Part B Preschool Grants Program**

The Preschool Grants Program, authorized under Section 619 of IDEA, Part
B, was established to provide grants to States to serve young children
with disabilities. All States and Outlying Areas have participated in
the program since FY 1992.

Over the years, the preschool special education programs administered by
those States have evolved, and now many States are involved in a variety
of education reform efforts. Many of the efforts at the preschool level
have focused on increasing collaboration between regular and special
education agencies, revising funding policies, establishing transition
agreements between agencies serving infants and toddlers birth through 2
years old with disabilities, and developing programmatic guidelines and
policies. In many cases, these changes have influenced settings in which
eligible children are served.

The following sections will highlight several key aspects of the
Preschool Grants Program, including:

\(1\) Grant Awards for the Preschool Grants Program;

\(2\) Number of Preschoolers with Disabilities Served;

\(3\) Current Educational Reform Efforts; and

\(4\) Educational Placements of Preschoolers with Disabilities.

**Grant Awards for the Preschool Grants Program**

States and Outlying Areas are awarded Preschool Grants Program funds
based on the number of 3- through 5-year-old children with disabilities
served on December 1 of the previous year. In FY 1996, Congress
appropriated \$360,409,000, only slightly more than the \$360,265,000
appropriated in FY 1995. However, the number of children served
increased 4.9 percent, from 522,710 on December 1, 1994, to 548,441 on
December 1, 1995. Grant awards made to each State in FY 1996 are shown
in table AG1 in Appendix A.

States and Outlying Areas may set aside up to 20 percent of their
Section 619 set-aside funds for the planning and development of a
statewide comprehensive service delivery system for children with
disabilities from birth through age 5 years; for the provision of direct
and support services for children with disabilities ages 3 through 5
years; and at the State's discretion, for the provision of a free
appropriate public education (FAPE) to 2-year-old children with
disabilities who will reach age 3 during the school year. According to
the 1996 *Section 619 Profile*, 20 States have retained the full 20
percent for this purpose. The most common uses of these funds were
training activities, technical assistance, development of program
materials, and planning or coordination activities. An additional 5
percent of Section 619 funds can be retained for administrative use.
Among the 47 States that answered this survey question, 37 set aside the
full 5 percent for this purpose, and two States reported using 0
percent. The remaining States reported using 4 percent (3 States), 3
percent (2 States), 2 percent (0 States), and 1 percent (3 States).

**Number of Preschoolers with Disabilities Served**

The Preschool Grants Program continues to grow. The growth in the number
of preschool children (30 percent from 1991-92 to 1995-96) (see figure
II-2) who received special education services under IDEA exceeded the
growth in the general preschool population (8.3 percent from 1991-92 to
1995-96). This relationship is demonstrated in the increase in the
percentage of preschool children served under IDEA of the general
population from 3.8 percent to 4.6 percent over this period.

The total percentage of the resident population ages 3-5 served under
the program within each State continues to vary greatly (see table AA10
in Appendix A). Kentucky serves the highest percentage (9.2 percent),
while the District of Columbia serves the lowest (1.6 percent). However,
41 States are serving 3 to 6 percent of their resident ages 3-5
population.

**Figure II-2**

**Number of Children Ages 3-5 Served on December 1, 1991, Through
December 1, 1995**

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System
(DANS).![](media/image2.wmf){width="3.95in" height="3.45in"}

**Current Educational Reform Efforts**

Many States apply the general educational reform efforts that are made
within their States to programs that serve children ages 3-5 with
disabilities. According to the *Section 619 Profile (Seventh Edition)*,
18 States have revised their Section 619 programs to reflect some of the
general education reform efforts. These States have made changes in the
following areas:

administrative organization;

collaborative statements with other agencies;

guidelines;

outcome assessments;

preschool special education criteria/classification;

program evaluation procedures;

program standards; and

vision and goal-setting statements.

This section will highlight some of the reforms that have taken place in
Rhode Island, Kentucky, and Minnesota. Telephone interviews were
conducted with the Section 619 coordinators of these States. These
States were chosen because of the innovative changes to their programs
that serve eligible preschoolers. All three have promoted collaborative
arrangements among agencies that serve children and families.

In Kentucky, local districts collaborate with other agencies in several
ways. First, duplication of programs and serices to the same children is
avoided through careful planning. This entails allowing local agencies
to operate the preschool program through contractual agreements with
Head Start and other existing preschool programs. Second, blended or
shared classrooms in which the children in a room are financially
supported through several funding sources and agencies (such as the
State, Head Start, Chapter 1, private tuition, or other sources) are
encouraged. In a blended classroom, costs are shared, but separate audit
trails are maintained for each source. The classroom must meet the
operating requirements of each funding source, and children must receive
all services for which they are eligible. Third, local agencies work
with child care providers and local family resource centers to assist in
the coordination of before- and after-school child care. Fourth,
collaborative agreements with medical, health, mental health, and social
service agencies are fostered to meet the comprehensive needs of
children and families. In 1994-95, 62 percent of the districts operated
State-funded services in a collaborative arrangement with an outside
agency. As a result of these efforts, 90 percent of children ages 3-5
were served in regular classes, 5 percent in resource rooms, and 2
percent in separate classes during the 1994-95 school year.

Similarly, in Rhode Island, preschool special education programs have
been blended into general early childhood programs. A shared vision
statement was developed by early childhood special educators and regular
early childhood educators. All professional training is now done
jointly, including summer institutes on inclusion practices and
professional development in-service training. Curriculum planning, which
has a strong emphasis on family involvement and assessments and
evaluations, is also conducted jointly. During the 199495 school year,
93 percent of the preschool students were served in either regular
classes, resource rooms, or separate classes. Among the 93 percent, 48
percent were served in regular classes.

In 1995, Minnesota unified services from a variety of programs that were
previously handled by six separate State agencies for children and their
families into one State agency called the Department of Children,
Family, and Learning. Prior to that time, the Department of Education
was the lead agency. The other five agencies that joined this
collaborative effort were (1) the Department of Human Services, (2) the
Department of Economic Security, (3) Minnesota Planning, (4) the
Department of Corrections, and (5) the Department of Public Safety.
Doing so allows the agency greater flexibility in using funding sources
and promotes collaboration among previously separate entities. The new
agency seeks to develop public policies that recognize that children's
economic, psychological, and educational needs are inseparable.

**Educational Placements of Preschoolers with Disabilities**

OSEP collects data on preschoolers with disabilities who are served in
each of eight different placements: regular class, resource room,
separate class, separate school (public and private), residential
facility (public and private), and homebound/hospital. Because these
placement categories may not reflect all of the placement categories
specific to preschoolers, OSEP provides optional instructions to States
and Outlying Areas about reporting counts of preschoolers in each of the
placement categories. TableII-2 includes a definition of each placement
category as it applies to preschoolers with disabilities.

As shown in figure II-3, just over 50 percent of children ages 3-5 with
disabilities were served in regular class placements on December 1,
1995. This is a 2 percent increase over the percentage served on
December 1, 1994. The second most frequently used setting was separate
class placement, followed by resource room. The percentage of children
served in these two settings has remained fairly stable from December 1,
1994, to December 1, 1995. The use of separate facilities, both public
and private, has declined (from 8.92 percent on December 1, 1994, to 5.5
percent on December 1, 1995), while the use of residential facilities
has remained stable (0.3 percent to 0.2 percent) and the use of
home/hospital placements rose slightly (1.9 percent to 2.6 percent).

Table II-2

Educational Environments for Preschoolers with Disabilities

***[Regular class]{.underline}*** includes children who receive services
in programs designed primarily for nondisabled children, provided the
children with disabilities are in a separate room for less than 21
percent of the time receiving services. This may include, but is not
limited to, Head Start centers, public or private preschool and child
care facilities, preschool classes offered to an age-eligible population
by the public school system, kindergarten classes, and classes using
co-teaching models (special education and general education staff
coordinating activities in a general education setting).

***[Resource room]{.underline}*** includes children who receive services
in programs designed primarily for nondisabled children, provided the
children with disabilities are in a separate program for 21 to 60
percent of the time receiving services. This includes, but is not
limited to, Head Start centers, public or private preschools or child
care facilities, preschool classes offered to an age-eligible population
by the public school system, and kindergarten classes.

***[Separate class]{.underline}*** includes children who receive
services in a separate program for 61 to 100 percent of the time
receiving services. It does not include children who received education
programs in public or private separate day or residential facilities.

***[Separate school]{.underline}*** includes children who are served in
publicly or privately operated programs, set up primarily to serve
children with disabilities, that are NOT housed in a facility with
programs for children without disabilities. Children must receive
special education and related services in the public separate day school
for greater than 50 percent of the time.

***[Residential facility]{.underline}*** includes children who are
served in publicly or privately operated programs in which children
receive care for 24 hours a day. This could include placement in public
nursing home care facilities or public or private residential schools.

***[Homebound/hospital]{.underline}*** includes children who are served
in either a home or hospital setting, including those receiving special
education or related services in the home and provided by a professional
or paraprofessional who visits the home on a regular basis (e.g., a
child development worker or speech services provided in the child's
home). It also includes children 3-5 years old receiving special
education and related services in a hospital setting on an inpatient or
outpatient basis. However, children receiving services in a group
program that is housed at a hospital should be reported in the separate
school category. For children served in both a home/hospital setting and
in a school/community setting, report the child in the placement that
comprises the larger percentage of time receiving services.

Source: OSEP Data Dictionary, Office of Special Education Programs, U.S.
Department of Education.

**Figure II-3**

**Number and Percentage of Children Ages 3-5 Served in Different
Educational Placements on December 1, 1995**

![](media/image3.wmf){width="3.9472222222222224in"
height="2.2777777777777777in"}

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

Summary

The number of children served each year continues to increase, although
the funds appropriated have remained almost level over the past 2 years.
States continue to use the full continuum of placement options. However,
there has been an increase in the number of children served in regular
class placements, and the use of separate facilities has declined.

Creative ways of administering services are being developed. As shown in
the examples in this module, State and local agencies are increasing the
level of collaboration among agencies. This, in turn, is making access
to services easier for families.

**Reference**

deFosset, S., Hardison, M., Ward-Newton, J. (1996). *Section 619
profile-seventh edition*. Chapel Hill, NC: National Early Childhood
Technical Assistance System.

**Students Served Under IDEA, Part B**

Children with disabilities are guaranteed a FAPE under IDEA. Part B
programs support children and youth with disabilities ages 3 through 21.
This module focuses mainly on children ages 6-21.

Until 1994, children and youth with disabilities were also served under
the Chapter 1 Handicapped Program. In October 1994, the Improving
America's School Act (IASA) was enacted, which reauthorized the
Elementary and Secondary Education Act of 1965 (ESEA). However, the
Chapter 1 Handicapped Program was not reauthorized. Beginning with the
FY 1995 appropriation, all children with disabilities were served under
programs authorized by IDEA. The IASA included a number of amendments to
IDEA to provide for a smooth transition to serving all children.

Table II-3 summarizes the amount of IDEA, Part B funding appropriated to
States and Outlying Areas for FY 1977 through FY 1996. Funding increased
steadily from \$251,770,000 in 1977 to \$2,323,837,000 in 1996. The per
child allocation rose from \$71 in 1977 to \$418 in 1995. However, in
1996 the amount allocated for the 1996-97 school year did not correspond
to the increase in the number of students with disabilities that were
served, and consequently the per child allocation dropped to \$413.
However, the appropriation for FY 1997 is \$3,107,522,000. This amount
will significantly increase the per child alloca-tion for the 1997-98
school year.

This section examines the number and the changes in the number of
students served under IDEA, Part B over time and further examines these
changes by age group and disability. The proportion of students served
as a function of total enrollment and resident population is also
pre-sented. Note that for ease of reference, the numbers of students
served are discussed only in terms of IDEA. For the years 1976-77
through 1993-94, these numbers include those children from birth through
age 21 served under the Chapter 1 Handicapped Program.

**Table II-3**

**IDEA, Part B State Grant Program: Funds Appropriated, 1977-96**

+-----------------------+-----------------------+-----------------------+
| **Appropriation       | **IDEA, Part B**      | **Per Child           |
| Year**                |                       | Allocation^/^**       |
|                       | **State Grants^a/^**  |                       |
+-----------------------+-----------------------+-----------------------+
| 1977                  | \$ 251,770,000        | \$71                  |
|                       |                       |                       |
| 1978                  | 566,030,000           | 156                   |
|                       |                       |                       |
| 1979                  | 804,000,000           | 215                   |
|                       |                       |                       |
| 1980                  | 874,190,000           | 227                   |
|                       |                       |                       |
| 1981                  | 874,500,000           | 219                   |
|                       |                       |                       |
| 1982                  | 931,008,000           | 230                   |
|                       |                       |                       |
| 1983                  | 1,017,900,000         | 248                   |
|                       |                       |                       |
| 1984                  | 1,068,875,000         | 258                   |
|                       |                       |                       |
| 1985                  | 1,135,145,000         | 272                   |
|                       |                       |                       |
| 1986                  | 1,163,282,000         | 279                   |
|                       |                       |                       |
| 1987                  | 1,338,000,000         | 316                   |
|                       |                       |                       |
| 1988                  | 1,431,737,000         | 332                   |
|                       |                       |                       |
| 1989                  | 1,475,449,000         | 336                   |
|                       |                       |                       |
| 1990                  | 1,542,610,000         | 343                   |
|                       |                       |                       |
| 1991                  | 1,854,186,000         | 400                   |
|                       |                       |                       |
| 1992                  | 1,976,095,000         | 410                   |
|                       |                       |                       |
| 1993                  | 2,052,730,000         | 411                   |
|                       |                       |                       |
| 1994                  | 2,149,686,000         | 413                   |
|                       |                       |                       |
| 1995                  | 2,322,915,000^c/^     | 418                   |
|                       |                       |                       |
| 1996                  | 2,323,837,000         | 413.^d/^              |
+-----------------------+-----------------------+-----------------------+

a/ The figures from 1977 through 1994 include amounts appropriated to
the Federated States of Micronesia and the Republic of the Marshall
Islands. In 1995, those entities received no appropriations.

b/ The per child allocation excludes children and funds for the Outlying
Areas and Bureau of Indian Affairs (BIA) and is based on the child count
information available as of July 1 of the fiscal year.

c/ This amount includes \$82,878,000 added to the Grants to States
appropriation because of the elimination of the Chapter 1 Handicapped
Program.

d/ This allocation was derived by dividing the total appropriations for
the 50 States, District of Columbia, Outlying Areas, and BIA by the
total number of children served in all of those areas.

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

**Total Number of Children and Youth Served**

A total of 5,619,099 children and youth with disabilities ages 3 through
21 were served under IDEA, Part B during the 1995-96 school year (see
table II-4), an increase of 188,876 (or 3.5 percent) from the previous
year. The increase in the number of students with disabilities served
resulted in an increase in the percentage of children with disabilities
enrolled in school. The percentage of children ages 6 through 17 with
disabilities enrolled in school increased from 10.4 percent in 1994-95
to 10.6 percent in 1995-96.1. There was also an increase in the
percentage of children in the resident population served in special
education. The percentage of children with disabilities ages 3 through
21 in the resident population increased from 7.7 percent in 1994-95 to
7.9 percent in 1995-96.

Total school enrollment decreased from 45,090,301 in 1976-77 to
38,925,000 in 1984-85. Since 1985-86, enrollments have increased
steadily. The 1995-96 enrollment count of 45,363,691 represents a net
increase of 6,438,691 (16.5 percent) in enrollment since the 1984-85
school year.

The resident population ages 6 through 17 decreased from 46,337,802 in
1976-77 to 41,436,000 in 1985-86, and then gradually increased to
45,109,401 in 1995-96. There has been a net decrease of 1,228,401 (-2.7
percent) in the number of students ages 6 through 17 since 1976-77.
There was also a decrease in the 18 through 21 age group, from
17,014,688 in 1976-77 to 14,032,177 in 1995-96 (-2,982,511 or -17.5
percent). The 3 through 5 age group increased during this period, from
9,429,510 to 12,060,235.

**Table II-4**

**Students Served Under IDEA, Part B^[a]{.underline}/^: Number and
Percentage Change, School Years 1976-77 Through 1995-96**

+------------------+---------------+---------------+------------------+
| **School Year**  | **Change in   | **Total       | **Percentage     |
|                  | Total Number  | Served        | of**             |
|                  | Served From   | ^[c]{.u       |                  |
|                  | Previous Year | nderline}/^** | **0-21           |
|                  | (%)**         |               | Population**     |
+------------------+---------------+---------------+------------------+
| **1976‑77**      | \--           | 3,708,601     | 4.52             |
|                  |               |               |                  |
| **1977‑78**      | 1.9           | 3,777,300     | 4.65             |
|                  |               |               |                  |
| **1978‑79**      | 3.8           | 3,919,073     | 4.87             |
|                  |               |               |                  |
| **1979‑80**      | 3.0           | 4,036,219     | 4.98             |
|                  |               |               |                  |
| **1980‑81**      | 3.5           | 4,177,689     | 5.15             |
|                  |               |               |                  |
| **1981‑82**      | 1.3           | 4,233,282     | 5.20             |
|                  |               |               |                  |
| **1982‑83**      | 1.5           | 4,298,327     | 5.40             |
|                  |               |               |                  |
| **1983‑84**      | 1.0           | 4,341,399     | 5.50             |
|                  |               |               |                  |
| **1984‑85^[b]    | 0.5           | 4,363,031     | 5.50             |
| {.underline}/^** |               |               |                  |
|                  | 0.2           | 4,370,248     | 5.56             |
| **1985‑86**      |               |               |                  |
|                  | 1.2           | 4,421,601     | 5.64             |
| **1986‑87**      |               |               |                  |
|                  | 1.4           | 4,485,702     | 5.73             |
| **1987‑88**      |               |               |                  |
|                  | 1.8           | 4,568,063     | 5.82             |
| **1988‑89**      |               |               |                  |
|                  | 2.4           | 4,675,619     | 5.93             |
| **1989‑90**      |               |               |                  |
|                  | 2.8           | 4,807,441     | 6.07             |
| **1990‑91**      |               |               |                  |
|                  | 3.7           | 4,986,039     | 6.20             |
| **1991‑92**      |               |               |                  |
|                  | 3.4           | 5,155,853     | 6.38             |
| **1992‑93**      |               |               |                  |
|                  | 4.0           | 5,363,766     | 6.60             |
| **1993‑94**      |               |               |                  |
|                  | 1.2           | 5,430,223     | 6.63             |
| **1994‑95**      |               |               |                  |
|                  | 3.5           | 5,619,099     | 6.79             |
| **1995-96**      |               |               |                  |
+------------------+---------------+---------------+------------------+

[a]{.underline}/ The data for 1976-77 through 1993-94 include children 3
through 21 years of age served under IDEA, Part B and children birth
through 21 served under the Chapter 1 Handicapped Program. Funding for
the two programs was merged in 1994 as a result of the passage of the
IASA. The totals for 1994-95 and 1995-96 reflect only children ages 3
through 21. The totals do not include infants and toddlers from birth
through age 2 served under Part H.

[b]{.underline}/ Beginning in 1984-85, the number of children with
disabilities reported for the most recent year reflects revisions to
State data received by OSEP between the July 1 grant award date and
October 1. Updates received from States for previous years are included,
so totals may not match those reported in previous annual reports to
Congress. Before 1984-85, reports provided data as of the grant award
date.

[c]{.underline}/ Although States must serve all eligible children with
disabilities, funds are provided only for up to 12 percent of the
State's total population ages 3 through 17, except in Massachusetts.
This is commonly referred to as "the 12 percent cap."

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

**Age Groups of Students Served Under IDEA, Part B**

The largest age group of students (2,581,061 or 45.9 percent) with
disabilities served in 1995-96 under IDEA, Part B were ages 6 through
11. Students with disabilities ages 12 through 17 were the next largest
age group served; 2,237,124 (39.8 percent) students received services in
this age group (see table II-5). The remaining age groups, ages 3
through 5 (548,441 children) and ages 18 through 21 (252,473 students)
made up less than 15 percent of the students served. The largest
increase in the percent of students served occurred in the 18 through 21
(5.8 percent) and 3 through 5 (4.9 percent) age groups.

**Table II-5**

**Number of Students Served Under IDEA, Part B by Age Group: School
Years 1994-95 Through 1995-96**

+---------+---------+---------+---------+---------+---------+-------+
| **Age   | **19    | **Pe    | **19    | **Pe    | **C     |       |
| Group** | 94‑95** | rcent** | 95‑96** | rcent** | hange** |       |
|         |         |         |         |         |         |       |
|         |         | **of    |         | **of    |         |       |
|         |         | Total** |         | Total** |         |       |
+---------+---------+---------+---------+---------+---------+-------+
|         |         |         |         |         | **N     | *     |
|         |         |         |         |         | umber** | *Perc |
|         |         |         |         |         |         | ent** |
+---------+---------+---------+---------+---------+---------+-------+
| **3-5** | 522,710 | 9.63    | 548,441 | 9.76    | 25,731  | 4.9   |
+---------+---------+---------+---------+---------+---------+-------+
| *       | 2,      | 46.32   | 2       | 45.93   | ‑2,     | 2.6   |
| *6-11** | 515,487 |         | ,581,06 |         | 257,381 |       |
+---------+---------+---------+---------+---------+---------+-------+
| **      | 2,      | 39.66   | 2,      | 39.81   | 83,676  | 3.9   |
| 12-17** | 153,448 |         | 237,124 |         |         |       |
+---------+---------+---------+---------+---------+---------+-------+
| **      | 238,578 | 4.39    | 252,473 | 4.49    | 13,895  | 5.8   |
| 18-21** |         |         |         |         |         |       |
+---------+---------+---------+---------+---------+---------+-------+
| *       | 4,      | 85.98   | 4,      | 85.75   | 149,250 | 3.2   |
| *6-17** | 668,935 |         | 818,185 |         |         |       |
+---------+---------+---------+---------+---------+---------+-------+
| *       | 4,      | 90.37   | 5,      | 90.24   | 163,145 | 3.3   |
| *6-21** | 907,513 |         | 070,658 |         |         |       |
+---------+---------+---------+---------+---------+---------+-------+
| *       | 5,      | 100.00  | 5,      | 100.00  | 188,876 | 3.5   |
| *3-21** | 430,223 |         | 619,099 |         |         |       |
+---------+---------+---------+---------+---------+---------+-------+

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

As stated earlier, child count data by age group for all children served
under IDEA, Part B only exist from 1987-88 forward. The largest
percentage increase between 1987-88 and 1995-96 occurred in the 3
through 5 age group, which increased by 63.3 percent (212,670). This was
followed by the 12 through 17 (25.8 percent or 459,511) and 6 through 11
(21.9 or 463,535) age groups. The 18 through 21 age group only increased
by 12.2 percent over the same period. There was a concomitant increase
in the percentage of children served under IDEA, Part B in the resident
population. These increases occurred in all age groups.

**Disabilities of Students Served**

OSEP collects information on the primary disability condition of
children ages 6 through 21 served under IDEA. As in the past, the
largest disability categories continue to be specific learning
disabilities (2,597,231 or 51.2 percent), speech or language impairments
(1,025,941 or 20.2 percent), mental retardation (585,308 or 11.5
percent), and serious emotional disturbance (438,217 or 8.6 percent).

The largest relative increases from 1994-95 to 1995-96 occurred in the
traumatic brain injury (30.1 percent), autism (27.2 percent), and other
health impairments (24.5 percent) categories (see table II-6). Most
States attributed the increases in the two newest categories, traumatic
brain injury and autism, to the reclassification of students at the time
of triennial re-evaluations. The increase in the other health
impairments category was generally attributed to increased service to
students with attention deficit/hyperactivity disorder.

**Table II-6**

**Change in the Number of Students Age 6-21 Served Under IDEA, Part B
From 1994-95 to 1995-96 by Disability**

+-----------------+---------+-------+--------+------+-------+-------+
| **Disability    | **19    | **Pe  | **199  | *    | **C   |       |
| Category**      | 94-95** | rcent | 5-96** | *Per | hange |       |
|                 |         | of    |        | cent | Based |       |
|                 |         | To    |        | of   | on    |       |
|                 |         | tal** |        | Tot  | N     |       |
|                 |         |       |        | al** | umber |       |
|                 |         |       |        |      | Ser   |       |
|                 |         |       |        |      | ved** |       |
+-----------------+---------+-------+--------+------+-------+-------+
|                 |         |       |        |      | **Num | **Pe  |
|                 |         |       |        |      | ber** | rcent |
|                 |         |       |        |      |       | ^[a]{ |
|                 |         |       |        |      |       | .unde |
|                 |         |       |        |      |       | rline |
|                 |         |       |        |      |       | }/^** |
+-----------------+---------+-------+--------+------+-------+-------+
| **Specific      | 2,      | 51.2  | 2,5    | 51.2 | 8     | 3.5   |
| Learning**      | 510,224 |       | 97,231 |      | 7,007 |       |
|                 |         |       |        |      |       |       |
| *               |         |       |        |      |       |       |
| *Disabilities** |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Speech or     | 1,      | 20.8  | 1,0    | 20.2 | 5,610 | 0.5   |
| Language**      | 020,331 |       | 25,941 |      |       |       |
|                 |         |       |        |      |       |       |
| **Impairments** |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Mental        | 570,518 | 11.6  | 5      | 11.5 | 1     | 2.6   |
| Retardation**   |         |       | 85,308 |      | 4,790 |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Serious       | 428,049 | 8.7   | 4      | 8.6  | 1     | 2.4   |
| Emotional**     |         |       | 38,217 |      | 0,168 |       |
|                 |         |       |        |      |       |       |
| **Disturbance** |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Multiple      | 89,620  | 1.8   | 94,156 | 1.9  | 4,536 | 5.1   |
| Disabilities**  |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Hearing       | 65,204  | 1.3   | 68,070 | 1.3  | 2,866 | 4.4   |
| Impairments**   |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Orthopedic**  | 60,467  | 1.2   | 63,200 | 1.2  | 2,733 | 4.5   |
|                 |         |       |        |      |       |       |
| **Impairments** |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Other         | 107,133 | 2.2   | 1      | 2.6  | 2     | 24.5  |
| Health**        |         |       | 33,419 |      | 6,286 |       |
|                 |         |       |        |      |       |       |
| **Impairments** |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Visual        | 24,713  | 0.5   | 25,484 | 0.5  | 771   | 3.1   |
| Impairments**   |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Autism**      | 22,664  | 0.5   | 28,827 | 0.6  | 6,163 | 27.2  |
+-----------------+---------+-------+--------+------+-------+-------+
| **D             | 1,331   | 0     | 1,362  | 31.0 | 31    | 2.3   |
| eaf‑blindness** |         | .0^[b |        |      |       |       |
|                 |         | ]{.un |        |      |       |       |
|                 |         | derli |        |      |       |       |
|                 |         | ne}/^ |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **Traumatic     | 7,259   | 0.1   | 9,443  | 0.2  | 2,184 | 30.1  |
| Brain Injury**  |         |       |        |      |       |       |
+-----------------+---------+-------+--------+------+-------+-------+
| **All           | **4,90  | **10  | *      | *    | *     | **    |
| Disabilities**  | 7,513** | 0.0** | *5,070 | *100 | *163, | 3.3** |
|                 |         |       | ,658** | .0** | 145** |       |
+-----------------+---------+-------+--------+------+-------+-------+

[a]{.underline}/ The percent of change is calculated in the following
manner: The number served in 1994-95 is subtracted from the number
served in 1995-96. The result is then divided by the total number served
in 1994-95.

[b]{.underline}/ This percent is rounded to the nearest tenth. The
actual percent is .027.

[c]{.underline}/ This percent is rounded to the nearest tenth. The
actual percent is .026.

Source: U.S. Department of Education, Office of Special Education
Programs, Data Analysis System (DANS).

**Summary**

There has been a steady increase in the number of students served under
IDEA, Part B. It is important to note that two different underlying
demographic factors existed during this period. During the first 10
years of the program, the growth in the IDEA, Part B count occurred
while population and enrollment counts were decreasing. Early growth in
the special education count occurred as IDEA was more fully implemented,
and services were expanded to more fully serve the eligible population.

During the second 10 years of the program, growth in the special
education counts coincided with increases in enrollment and population.
However, the percentage of students enrolled in special education has
increased at a slightly higher rate than has the total school age
population. The percentage of children receiving special education ages
6 through 17 enrolled in schools increased from 9.6 percent in 1987-88
to 10.6 percent in 1995-96. The percentage of children ages 3 through 21
receiving special education in the resident population increased from
6.6 percent in 1987-88 to 7.9 percent in 1995-96.

There are several explanations for the growth in the special education
population over this period. As mentioned earlier, there was a natural
growth in the numbers in the early years of the program as States fully
implemented IDEA. The ability to identify children with disabilities may
have also improved as a result of new developments in the assessment of
children and in medical tests. The program has also expanded the age
range of students served.

**Students with Attention Deficit/Hyperactivity Disorder**

In recent years, much emphasis has been placed on the proper diagnosis
and treatment of students with attention deficit/hyperactivity disorder
(ADHD). The American Psychiatric Association (APA) (1994) estimates that
children with attention deficit/hyperactivity disorder comprise between
3 and 5 percent of the school-age population nationally, though many of
these children may not require special education.

Providing effective programs to educate students with attention
deficit/hyperactivity disorder poses a unique set of challenges \-- for
families and teachers alike. Many children with attention
deficit/hyperactivity disorder have difficulty learning to read (Dykman,
Ackerman, & Raney, 1994). Other academic subjects that children with
this disorder may find difficult include (1) mathematics (Cantwell &
Baker, 1991), (2) written communication (Anderson et al., 1987), and (3)
spelling (Zentall, 1993). In addition, children with attention
deficit/hyperactivity disorder often have difficulty developing
age-appropriate social skills. For example, many children have low
levels of self-esteem (Barkley, 1990); are easily frustrated, especially
when faced with novel or challenging tasks (DuPaul, 1991); and have
difficulty establishing friendships with other children (Swanson, 1992).

Given these challenges, this module will discuss several important
issues related to the education of school-aged students with attention
deficit/hyperactivity disorder. These issues include:

• What is attention deficit/hyperactivity disorder?

• How should students with attention deficit/hyper-activity disorder be
identified?

• What are the legal rights of students with attention
deficit/hyperactivity disorder? and

• What are effective treatments for students with attention
deficit/hyperactivity disorder?

**What Is Attention Deficit/Hyperactivity Disorder?**

Children with attention deficit/hyperactivity disorder share common
clinical syndromes associated with problems of inattention,
hyperactivity, and impulsivity (Shaywitz & Shaywitz, 1988). In addition,
many children with attention deficit/hyperactivity disorder experience
co-occurring disabilities, such as specific learning disabilities or
serious emotional disturbance (Forness et al., 1992).

Clinical descriptions of children with attention deficit/hyperactivity
disorder symptoms have existed in the research literature for almost 100
years. For example, Still (1902), perhaps the first clinician to report
the disorder, described a group of 20 children who exhibited aggressive,
impulsive, and defiant behaviors. Other researchers, such as Ebaugh
(1923) and Stryker (1925), described children who exhibited difficulty
maintaining attention, regulating their own activity levels, and
controlling impulsive behavior. Today, these three symptoms continue to
be the key distinguishing characteristics of children with attention
deficit/hyperactivity disorder (McKinney, Montague, & Hocutt, 1994).

Over the past 50 years, there has been some change in the terminology
used to label children with attention deficit/hyperactivity
disorder\--although the major symptoms associated with the disorder have
remained constant. For example, these children were often identified as
having "minimal brain damage" (e.g., Strauss & Lehtinen, 1947) in the
1940s, while the term "hyperactive child syndrome" (e.g., Chess, 1960)
was more common in the 1950s and 1960s. The APA initially defined
attention deficit disorder as "hyperkinetic reaction syndrome," in 1968,
and renamed the disorder as "attention deficit disorder" in 1980. The
APA introduced the term attention deficit/hyperactivity disorder in
1987.

The *Diagnostic and Statistical Manual of Mental Disorders Fourth
Edition* (DSM-IV), published by the APA in 1994, contains the most
commonly accepted clinical definition of attention deficit/hyperactivity
disorder (see table II-7). According to the DSM-IV, a child's attention
deficit/hyperactivity disorder symptoms must meet several criteria,
including:

• **Severity.** The child's attention deficit/hyperactivity disorder
symptoms must be more frequent and severe than is typical of other
children at similar developmental levels;

• **Early Onset.** At least some of the child's attention
deficit/hyperactivity disorder symptoms must have begun before 7 years
of age; and

• **Duration.** The child's attention deficit/hyperactivity disorder
symptoms must have persisted for at least 6 months prior to the
diagnosis.

The DSM-IV categorizes a child's attention deficit/hyperactivity
disorder symptoms within two general categories: (1) inattentive
behaviors, such as making careless mistakes or being very disorganized
and (2) hyperactive/impulsive behaviors, such as excessively fidgeting
or interrupting others. These two categories yield three main types of
attention deficit/hyperactivity disorder:

• **Attention Deficit/Hyperactivity Disorder-Predomi-nantly Inattentive
Type.** The child exhibits at least six of the nine symptoms for
inattention but does *not* meet the hyperactivity-impulsivity criteria.

• **Attention Deficit/Hyperactivity Disorder-Predominantly
Hyperactive-Impulsive Type.** The child exhibits at least six of the
nine symptoms for hyperactivity-impulsivity but does *not* meet the
criteria for inattention.

**Table II-7**

**Attention Deficit/Hyperactivity Disorder**

A. According to the DSM-IV, a person with Attention
Deficit/Hyperactivity Disorder must have either (1) or (2):

> \(1\) six (or more) of the following symptoms of **inattention** have
> persisted for at least 6 months to a degree that is maladaptive and
> inconsistent with developmental level:

*Inattention*

\(a\) often fails to give close attention to details or makes careless
mistakes in school work, work, or other activities

\(b\) often has difficulty sustaining attention in tasks or play
activities

\(c\) often does not seem to listen when spoken to directly

\(d\) 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)

\(e\) often has difficulty organizing tasks and activities

\(f\) often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)

\(g\) often loses things necessary for tasks or activities (e.g., toys,
school assignments, pencils, books, or tools)

\(h\) is often easily distracted by extraneous stimuli

\(i\) is often forgetful in daily activities

\(2\) six (or more) of the following symptoms of
**hyperactivity-impulsivity** have persisted for at least 6 months to a
degree that is maladaptive and inconsistent with developmental level:

*Hyperactivity*

\(a\) often fidgets with hands or feet or squirms in seat

\(b\) often leaves seat in classroom or in other situations in which
remaining seated is expected

\(c\) often runs about or climbs excessively in situations in which it
is inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness).

\(d\) often has difficulty playing or engaging in leisure activities
quietly

\(e\) is often "on the go" or often acts as if "driven by a motor"

\(f\) often talks excessively

*Impulsivity*

\(g\) often blurts out answers before questions have been completed

\(h\) often has difficulty awaiting turn

\(i\) often interrupts or intrudes on others (e.g., butts into
conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused
impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings
(e.g., at school \[or work\] and at home).

D. There must be clear evidence of clinically significant impairment in
social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other Psychotic
Disorder and are not better accounted for by another mental disorder
(e.g., Mood Disorder, Anxiety Disorder, Disassociative Disorder, or a
Personality Disorder).

**Attention Deficit/Hyperactivity Disorder, Combined Type:** if both
Criteria A1 and A2 are met for the past 6 months.

**Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive
Type:** if Criterion A1 is met but Criterion A2 is not met for the past
6 months.

**Attention Deficit/Hyperactivity Disorder, Predominantly
Hyperactive-Impulsive Type:** if Criterion A2 is met but Criterion A1 is
not met for the past 6 months.

Source: American Psychiatric Association (1994). *Diagnostic and
statistical manual for mental disorders*. Washington, DC: Author. pp.
83-85.

• **Attention Deficit/Hyperactivity Disorder-Combined Type.** The child
exhibits at least six of the nine symptoms for both inattention and
hyperactivity-impulsivity.

The DSM-IV manual advises clinicians to use evidence of the child's
behavior over the 6 months prior to his or her diagnosis to confirm
which of these three syndromes is most applicable. However, according to
the APA, most children with attention deficit/hyperactivity disorder are
likely to meet the criteria for the attention deficit/hyperactivity
disorder-combined type.

**How Should Students with Attention Deficit/Hyperactivity Disorder Be
Diagnosed?**

Although there is no single test for attention deficit/hyperactivity
disorder (APA, 1994), an accurate diagnosis can be made by obtaining
information about the child from several sources, including (1) personal
histories on the child and his or her family, (2) tests and
questionnaires that assess the child's behavior, and (3) direct
observation of the child in several settings (U.S. Department of
Education, 1994). Collecting such detailed information on *each* child
identified as having difficulty paying attention or with
hyper-active/impulsive behavior helps avoid problems of over-identifying
(or underidentifying) children with attention deficit/hyperactivity
disorder (Milich, Pelham, & Hinshaw, 1985).

The Professional Group for Attention and Related Disorders (PGARD)
(1990) recommends a two-tier evaluation process to properly identify
children with attention deficit/hyper-activity disorder (see table
II-8):

• **Tier 1 (Clinical Evaluation)** is used to determine whether the
child's symptoms meet commonly accepted standards for an attention
deficit/hyperactivity disorder diagnosis, such as those suggested by the
DSM-IV; and

• **Tier 2 (Educational Evaluation)** is used to document that the
child's attention deficit/hyperactivity disorder symptoms have a
substantial, negative impact on his or her classroom performance.

**Table II-8**

**PGARD System for Identifying Children with ADHD**

**CLINICAL EVALUATION**

A clinical evaluation assesses whether the child is manifesting symptoms
of ADHD. There are three objectives: (1) assess problems of inattention,
impulsivity, and hyperactivity that the child is currently experiencing;
(2) assess the severity of these problems; and (3) gather information
about other disabilities that may be contributing to the child's ADHD
symptoms.

Child rating scales are the best available tools to determine the
presence of ADHD symptoms. Numerous rating scales exist, including:

• *Child Behavior Checklist*, *Teacher Report Form*, and *Parent Report
Form*, by Achenbach and Edelbrock (1983, 1986), and

• *Conners Parent Rating Scale* and *Conners Teacher Rating Scale* by
Conners (1989, a, b).

As with all psychological tests, child rating scales have a range of
measurement error. Appropriate scales have satisfactory norms for the
child's chronological age and ability levels.

Collecting information about the child's ADHD symptoms from several
different sources helps ensure that the information is accurate.
Appropriate sources of information include the child's parents,
teachers, and medical doctors. It is also important to review both the
child's previous medical history as well as his or her school records.

**EDUCATIONAL EVALUATION**

An educational evaluation assesses the extent to which a child's
symptoms of ADHD have had an adverse effect on his or her performance at
school. The evaluation involves both 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 different ADHD symptoms in the classroom. The frequency with
which the child with ADHD exhibits behaviors associated with ADHD
symptoms are compared to norms for other children of the same age and
gender. It is also important to compare the behavior of the child with
ADHD with that of other children in the class. It is best to collect
classroom observations during two or three different observations across
several days. Each observation typically lasts about 20-30 minutes.

An educational evaluation also includes an assessment of the ***child's
productivity*** in completing seat work and other academic assignments.
It is important to collect information about both the percentage of work
completed as well as the accuracy of the work. The productivity of the
child with ADHD can be compared with the productivity of other children
in the class.

**Source**: Adapted from U.S. Department of Education (1994). *Attention
deficit disorder: Adding up the facts*. Washington DC: Office of Special
Education Programs, U.S. Department of Education, pp. 3-4.

Families, teachers, psychologists, and pediatricians must work as a team
to diagnose children with attention deficit/hyperactivity disorder
(Lahey et al., 1987). Each of these team members is able to provide
critical data regarding an individual child. For example, at what age
did the behaviors begin to appear? How often do they occur? To what
extent do they occur? Where do they occur? How are these behaviors
affecting the children's academic, emotional, and social lives? By
pooling all of this knowledge among the team members, it is possible to
get an overall picture of whether a child should be diagnosed as having
attention deficit/hyperactivity disorder (Mash, 1989). This information
is also critical in developing appropriate treatment programs, including
determining the child's need for services, under IDEA or other Federal
legislation.

**What Are the Legal Rights of Students with Attention
Deficit/Hyperactivity Disorder?**

Children with attention deficit/hyperactivity disorder may be eligible
for special education and related services under IDEA or under Section
504 of the Rehabilitation Act of 1973, as amended. As is true for
students with any other disability, students with attention
deficit/hyperactivity disorder are not automatically eligible for
services under these two Acts. They must meet the eligibility criteria
of the Acts to receive services. This section outlines those criteria.

**Eligibility Under IDEA**

IDEA, Part B requires that each State have in effect a policy that
ensures all children with disabilities the right to a FAPE (20 U.S.C.
1412(1)). It is the State educational agencies' (SEAs) and local
educational agencies' (LEAs) affirmative obligation to evaluate a child
who is suspected of having a disability to determine the child's need
for special education and related services (Davila, Williams, &
MacDonald, 1991).

Although attention deficit/hyperactivity disorder is not a separate
disability category under IDEA, children with the disorder who require
special education and related services because of the disorder are
eligible for services under the "other health impairments" category of
IDEA, Part B when the child's disorder is a chronic or acute health
problem that results in limited alertness and adversely affects his or
her educational performance. Children with attention
deficit/hyperactivity disorder may also be eligible for services under
other eligibility categories such as the "specific learning disability"
or "serious emotional disturbance" categories of IDEA, Part B when they
have those conditions in addition to their attention
deficit/hyperactivity disorder.

**Programs and Services Under Section 504**

If a child with attention deficit/hyperactivity disorder is found to be
ineligible for services under IDEA, Part B, the requirements of Section
504 of the Rehabilitation Act of 1973 are applicable, if the child has a
disability as defined by this legislation. Section 504 defines a person
with a disability as "any person who has a physical or mental impairment
which substantially limits a major life activity (e.g., learning)" (34
CFR 104.3 (j)).

Depending on the nature and severity of his or her condition, a child
with attention deficit/hyperactivity disorder may (or may not) fit the
eligibility definitions contained in IDEA, Part B or Section 504. As a
result, not all children with attention deficit/hyperactivity disorder
are entitled to services under one of these Acts.

If the child qualifies for services under Section 504, the LEA must make
an individualized determination of the child's needs for general or
special education and related aids and services (34 CFR 104.35).
Individualized educational services must be provided to each child.
Depending on the needs of individual children, these services can
include (1) curriculum adjustments, (2) alternative classroom
organization and management, (3) specialized teaching techniques and
study skills, (4) use of behavioral management, and (5) increased
parent/teacher collaboration. These types of supplementary aids and
services enable some children with attention deficit/hyperactivity
disorder to succeed in general education settings without special
education services (Pfiffner & Barkley, 1990).

**What Are Effective Treatments for Children with Attention Deficit/**

**Hyperactivity Disorder?**

Different treatments, with varying known effects and limitations, are
used by doctors, psychologists, and teachers who work with children with
attention deficit/hyperactivity disorder. Two types of standard
treatments involve psychostimulant medications and educational programs
(Pelham & Murphy, 1986). This section of the module describes current
research on the effectiveness of these treatments.

**Attention Deficit/Hyperactivity Disorder**

**and Medication**

Medication for children diagnosed with attention deficit/hyperactivity
disorder has become an issue of increasing public concern as more and
more children across the country are diagnosed with attention
deficit/hyperactivity disorder and prescribed drugs for treatment (Read,
1995). As Ross and Ross (1976) pointed out over 20 years ago, the
limitations and the benefits of prescribing drugs as a treatment for
attention deficit/hyperactivity disorder need careful examination.

Stimulants such as methlphenidate (i.e., Ritalin®), as well as pemoline
(i.e., Cylert®) and amphetamines (e.g., Dexedrine®), are not effective
for one out of every five children who take them (Silver, 1990). While
the effects of these medications cause some children to exhibit clear
and immediate short-term increases in attention, control, concentration,
and goal-directed effort (Kavale, 1982), the long-term benefits of
medication on social adjustment and academic achievement are limited
(Gadow, 1983).

Medication can also have negative side effects (Forness, Sweeney, & Toy,
1996). For example, some children may lose weight, lose their appetite,
or have problems falling asleep. Less common side effects include slowed
growth, tic disorders, and problems with flexible thinking or with
social interaction. These effects usually can be eliminated by reducing
dosages or changing to different medications altogether, but careful
monitoring is necessary (Runnheim, Frankenberger, & Hazelkorn, 1996).

**Attention Deficit/Hyperactivity Disorder,**

**Education, and Public Schools**

Although medication helps some children with attention
deficit/hyperactivity disorder to manage their behavior for a short
period, medication alone is not sufficient to ensure that these children
learn and achieve at school (Swanson, 1994). All children with attention
deficit/hyperactivity disorder need effective educational programs to
stay on task and learn (U.S. Department of Education, 1994).

Research shows that many children with attention deficit/hyperactivity
disorder can be taught effectively in general education classrooms, as
the practices used by skilled teachers benefit not only the child with
the disorder but his or her nondisabled classmates as well (Rief, 1993).
Those teachers who are most successful with children with attention
deficit/hyperactivity disorder often use a three-part approach,
integrating different practices developed and validated through research
on children's learning and achievement over the past 25 years. This body
of research has provided information about the characteristics of
effective programs for educating a child with attention
deficit/hyperactivity disorder. Successful educational programs are
based on three key principles:

• **Effective Teaching Practices** can involve several different
techniques to support active, sustained learning (Collagen & Sternberg,
1987). For example, skilled teachers can (1) provide clear models
demonstrating how proficient students learn (e.g., Englert et al.,
1991), (2) assign students of different ability levels to work together
(Greenwood et al., 1992), and (3) provide students with adequate
feedback on their performance (McKinney, Osborne, & Schulte, 1993). Such
effective teaching practices, which were originally developed for
children with learning and behavioral problems, are increasingly being
used successfully with children with attention deficit/hyperactivity
disorder (Fiore & Becker, 1994).

• **Behavior Modification Techniques** can help children with attention
deficit/hyperactivity disorder learn how to manage their behavior in a
variety of different school settings, including the classroom, the
lunchroom, and the playground. Techniques such as verbal praise or other
positive reinforcement are some of the most commonly used classroom
practices (McGinnis & Goldstein, 1984). Skilled teachers can use these
techniques effectively not only with their children with attention
deficit/hyperactivity disorder, but also with other students with
disabilities (Walker, Colvin, & Ramsey, 1995) as well as nondisabled
students (O'Leary & O'Leary, 1977).

• **Classroom Modifications** are made in response to the needs of
individual children with attention deficit/hyperactivity disorder
(Pfiffner & O'Leary, 1993). These modifications generally involve
restructuring the instructional environment in the classroom (Broward
County Public Schools, 1995). Teachers can make physical accommodations,
such as providing a special seat for a child with attention
deficit/hyperactivity disorder (Forness & Walker, 1991), or
modifications of the learning environment, such as providing follow-up
instructions for class-room assignments (Zentall, 1993).

At present, there is a continuing need for additional, rigorous research
demonstrating the effectiveness of combining different treatments for
children with attention deficit/hyperactivity disorder (Abikoff, 1987).
For example, although Horn et al. (1991) initially reported that a low
dosage of medication combined with behavioral interventions helped
reduce problems with classroom discipline, children with attention
deficit/hyperactivity disorder who received the combined treatment did
not maintain their appropriate behaviors 9 months after leaving the
treatment program (Ialongo et al., 1993).

OSEP is currently collaborating with the National Institute of Mental
Health to investigate the long-term effectiveness of multimodal
treatments for children with attention deficit/hyperactivity disorder.
This study compares the effects of different treatment programs that
involve the use of medication and intensive, home-school
intervention\--both alone and in combination. This study, which is
following more than 600 children with attention deficit/hyperactivity
disorder at six sites for 2 years, will provide critical information
about which treatment program works best for which children with
attention deficit/hyperactivity disorder, in which settings, and for how
long.

**Summary**

In States and localities across the country, families and educators are
concerned about how to effectively educate children with attention
deficit/hyperactivity disorder. The challenges that parents and teachers
face, each day, include teaching children with attention
deficit/hyperactivity disorder how to maintain their attention and
control their hyperactivity and impulsivity. Teachers are also
challenged to individualize educational programs in ways that help
children with attention deficit/hyperactivity disorder successfully
learn and achieve at school.

Recent research has begun to identify the distinguishing characteristics
of effective programs for children with attention deficit/hyperactivity
disorder. The results of these studies suggest that:

• Children with attention deficit/hyperactivity disorder can often be
taught effectively in general education classrooms;

• Medication helps some children with attention deficit/

> hyperactivity disorder to control their behavior, but medication alone
> is often *not* sufficient to ensure that these children learn and
> achieve at school;

• Many effective educational programs for children with attention
deficit/hyperactivity disorder include individualized academic
instruction, behavior management techniques, and classroom
modifications;

• Many educational practices that are useful in teaching children with
attention deficit/hyperactivity disorder are also beneficial to all
children in the class; and

• Teachers, parents, psychologists, and health care providers should
work together as a team to help identify and serve children with
attention deficit/hyperactivity disorder effectively.

Today, there is a continuing Federal commitment, through IDEA, Part B,
and Section 504 of the Rehabilitation Act, to ensure that the needs of
all eligible children with attention deficit/hyperactivity disorder are
met. This support, combined with continuing efforts by teachers and
parents to implement effective practices validated through research,
will hopefully lead to improved results for children with attention
deficit/hyperactivity disorder and their families.

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[^1]: States serving at-risk infants and toddlers were Arkansas,
    California, Colorado, Hawaii, Indiana, Maine, Massachusetts, New
    Hampshire, New Mexico, North Carolina, Ohio, Rhode Island, and
    Wisconsin, Guam also serves these children.

[^2]: 3 Counts of infants and toddlers served prior to 1994-1995 include
    infants and toddlers served under the Chapter 1 Handicapped Program.