ADHD and a Return to the Medical Model of Special Education.

Abstract The diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) is not a separate category of special education but nonetheless accounts for over 40 percent of all children in programs for emotional disturbance (ED) and about a fourth of all children in programs for learning disabilities (LD). While behavioral interventions are effective in school, there is evidence that comorbid diagnoses affect outcome differentially. Psychpharmacologic treatment may actually be superior to behavioral interventions, depending on this comorbidity, and may also be underutilized with children with ADHD. For these reasons, careful diagnosis may be essential, thus suggesting a return to the so-called "medical model. " Attention deficit hyperactivity disorder (ADHD) is a diagnosis of increasing concern to school professionals. The core symptoms of ADHD (inattention, hyperactivity and impulsivity) seem often to be at the very center of what school requires of a child (Barkley, 1997, 1998). Paying attention to teachers, to classroom rules, or to details of lessons is the exact starting point for effective learning to begin. Sitting still and focusing on one thing at a time is vital to completing schoolwork and to participating in class discussions. Being able to pause and reflect carefully before responding is absolutely essential to identifying correct answers and to learning accurate information. Inattention, hyperactivity and impulsivity not only interfere with these activities but also impair a child's ability to join in group activities, to play effectively in games or sports, and ultimately to develop meaningful friendships with other children. Schools often have a limited range of tolerance for individual differences of any child with problems, especially with recent emphasis on school reform that focuses on strict standards for academic achievement and intolerance of antisocial behavior (Sage & Burrello, 1994). Schools also tend to put limitations on eligibility of certain children for special education services and do not currently have a special education category specifically for attention deficit hyperactivity disorder (ADHD). Schools are thus left with available special education categories such as learning disabilities (LD), emotional disturbance (ED), and other health impairments (OHI) or with accommodating a child's disability in the regular classroom under provisions of Section 504 of the 1973 Rehabilitation ACT (Davila, Williams, & MacDonald, 1991). ADHD has nonetheless begun to focus the attention of special educators on the potential significance of a medical or psychiatric diagnosis in regard to intervention, despite their traditional reluctance to embrace the so-called "medical model. " This paper addresses (1) the current problems in special education eligibility of children with a diagnosis of ADHD; (2) the rather extensive prevalence of children with ADHD within the LD, ED and OHI categories; (3) the current status of behavioral or psychosocial interventions for ADHD used in school settings; (4) the potential importance of comorbidity patterns in ADHD for both eligibility and intervention; (5) the rather compelling evidence for efficacy of stimulant medication; and (6) the implications of possible undertreatment of children with ADHD in regard to stimulant medication. It concludes with the need to re-examine the medical model in special education in light of these developments. Eligibility of Children with ADHD for Special Education In special education, there are three categories in which children with ADHD are primarily eligible: LD, ED, and OHI. The LD category is generally reserved for a child who has intelligence in the normal range, no primary emotional disorder or visual or hearing impairments, and at least a reasonable period of instruction in the regular grades, but who still remains unable to read, write, do math, or use language at an acceptable level (Kavale & Forness, 1995). …