IDENTIFYING AND TREATING 

ATTENTION DEFICIT 

HYPERACTIVITY DISORDER: 

A RESOURCE FOR SCHOOL AND HOME 

2003 
Identifying and Treating 

Attention Deficit 

Hyperactivity Disorder: 

A Resource for School and Home 

2003 

U.S. Department of

Education 
This report was produced under U.S. Department of Education Contract No. HS97017002 with the American 

Institutes for Research. Kelly Henderson served as technical representative for this project. 

U.S. Department of Education 

Rod Paige 

Secretary

Office of Special Education and Rehabilitative Services 

Robert H. Pasternack 

Assistant Secretary

Office of Special Education Programs 

Stephanie Lee 

Director

Research to Practice Division 

Louis C. Danielson 

Director

August 2003

This report is in the public domain. Authorization to reproduce it in whole or in part is granted. While permission to 

reprint this publication is not necessary, the citation should be: U.S. Department of Education, Office of Special 

Education and Rehabilitative Services, Office of Special Education Programs, Identifying and Treating Attention 

Deficit Hyperactivity Disorder: A Resource for School and Home, Washington, D.C., 20202. 

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205-8113. 
CONTENTS 

Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and 

Home............................................................................................................................................... 1 

What Causes ADHD? ................................................................................................................. 2 

How Do We Identify ADHD? .................................................................................................... 3 

Legal Requirements for Identification of and Educational Services for Children With ADHD.... 5 

Behavioral Evaluation............................................................................................................. 6 

Educational Evaluation ........................................................................................................... 7 

Medical Evaluation ................................................................................................................. 8 

What Are the Treatment Options? .............................................................................................. 9 

Behavioral Approaches........................................................................................................... 9

Pharmacological Approaches................................................................................................ 10 

Multimodal Approaches........................................................................................................ 12

How Does ADHD Affect School Performance? .......................................................................... 13 

Helpful Hints............................................................................................................................. 13 

Tips for Home ....................................................................................................................... 14 

Tips for School...................................................................................................................... 15 

References..................................................................................................................................... 16 

i
IDENTIFYING AND TREATING ATTENTION DEFICIT HYPERACTIVITY 

DISORDER: A RESOURCE FOR SCHOOL AND HOME 

We have all had one of these experiences at one time or another. Perhaps it was at the grocery 

store, watching frustrated parents call their children’s names repeatedly and implore them to “put 

that down.” Maybe it was a situation at school with a child who could not seem to sit still and 

was always in motion. Maybe we noticed a child who appears always to be daydreaming in 

class—the student who will not focus on an activity long enough to finish it. Possibly the child is 

bored with a task, seemingly as soon as it has begun, and wants to move on to something else. 

We all puzzle over these challenging behaviors. 

Attention Deficit Hyperactivity Disorder (ADHD) has many faces and remains one of the most 

talked-about and controversial subjects in education. Hanging in the balance of heated debates 

over medication, diagnostic methods, and treatment options are children, adolescents, and adults 

who must manage the condition and lead productive lives on a daily basis. 

What is ADHD? 

Definition 

Core Categories 

Comorbidity

Social Impact

Prevalence 

• 

• 

• 

• 

• 

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that involves 

problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent 

with the age of the child. We are now learning that ADHD is not a disorder of attention, as had 

long been assumed. Rather, it is a function of developmental failure in the brain circuitry that 

monitors inhibition and self-control. This loss of self-regulation impairs other important brain 

functions crucial for maintaining attention, including the ability to defer immediate rewards for 

later gain (Barkley, 1998a). Behavior of children with ADHD can also include excessive motor 

activity. The high energy level and subsequent behavior are often misperceived as purposeful 

noncompliance when, in fact, they may be a manifestation of the disorder and require specific 

interventions. Children with ADHD exhibit a range of symptoms and levels of severity. In 

addition, many children with ADHD often are of at least average intelligence and have a range of 

personality characteristics and individual strengths. 

Children with ADHD typically exhibit behavior that is classified into two main categories: poor 

sustained attention and hyperactivity-impulsiveness. As a result, three subtypes of the disorder 

have been proposed by the American Psychiatric Association in the fourth edition of the 

Diagostic and Statistical Manual of Mental Disorders (DSM-IV): predominantly inattentive, 

predominantly hyperactive-impulsive, and combined types (Barkley, 1997). A child expressing 

hyperactivity commonly will appear fidgety, have difficulty staying seated or playing quietly, 

and act as if driven by a motor. Children displaying impulsivity often have difficulty 

participating in tasks that require taking turns. Other common behaviors may include blurting out 

answers to questions instead of waiting to be called and flitting from one task to another without 

finishing. The inattention component of ADHD affects the educational experience of these 

children because ADHD causes them to have difficulty in attending to detail in directions, 

sustaining attention for the duration of the task, and misplacing needed items. These children 

1
often fail to give close attention to details, make careless mistakes, and avoid or dislike tasks 

requiring sustained mental effort. 

Although these behaviors are not in themselves a learning disability, almost one-third of all 

children with ADHD have learning disabilities (National Institute of Mental Health [NIMH], 

1999). Children with ADHD may also experience difficulty in reading, math, and written 

communication (Anderson, Williams, McGee, & Silva, 1987; Cantwell & Baker, 1991; Dykman, 

Akerman, & Raney, 1994; Zentall, 1993). Furthermore, ADHD commonly occurs with other 

conditions. Current literature indicates that approximately 40–60 percent of children with ADHD 

have at least one coexisting disability (Barkley, 1990a; Jensen, Hinshaw, Kraemer, et al., 2001; 

Jensen, Martin, & Cantwell, 1997). Although any disability can coexist with ADHD, certain 

disabilities seem to be more common than others. These include disruptive behavior disorders, 

mood disorders, anxiety disorders, tics and Tourette’s Syndrome, and learning disabilities 

(Jensen, et al., 2001). In addition, ADHD affects children differently at different ages. In some

cases, children initially identified as having hyperactive-impulsive subtype are subsequently 

identified as having the combined subtype as their attention problems surface. 

These characteristics affect not only the academic lives of students with ADHD, they may affect 

their social lives as well. Children with ADHD of the predominantly hyperactive-impulsive type

may show aggressive behaviors, while children of the predominantly inattentive type may be 

more withdrawn. Also, because they are less disruptive than children with ADHD who are 

hyperactive or impulsive, many children who have the inattentive type of ADHD go 

unrecognized and unassisted. Both types of children with ADHD may be less cooperative with 

others and less willing to wait their turn or play by the rules (NIMH, 1999; Swanson, 1992; 

Waslick & Greenhill, 1997). Their inability to control their own behavior may lead to social 

isolation. Consequently, the children’s self-esteem may suffer (Barkley, 1990a). 

In the United States, an estimated 1.46 to 2.46 million children (3 percent to 5 percent of the 

student population) have ADHD (American Psychiatric Association, 1994; Anderson, et al., 

1987; Bird, et al., 1988; Esser, Schmidt, & Woemer, 1990; Pastor & Reuben, 2002; Pelham, 

Gnagy, Greenslade, & Milich, 1992; Shaffer, et al., 1996; Wolraich, Hannah, Pinock, 

Baumgaertel, & Brown, 1996). Boys are four to nine times more likely to be diagnosed, and the 

disorder is found in all cultures, although prevalence figures differ (Ross & Ross, 1982). 

What Causes ADHD? 

ADHD has traditionally been viewed as a problem related to attention, stemming from an 

inability of the brain to filter competing sensory inputs such as sight and sound. Recent research, 

however, has shown that children with ADHD do not have difficulty in that area. Instead, 

researchers now believe that children with ADHD are unable to inhibit their impulsive motor 

responses to such input (Barkley, 1997; 1998a). 

It is still unclear what the direct and immediate causes of ADHD are, although scientific and 

technological advances in the field of neurological imaging techniques and genetics promise to 

clarify this issue in the near future. Most researchers suspect that the cause of ADHD is genetic 

or biological, although they acknowledge that the child’s environment helps determine specific 

behaviors. 

Imaging studies conducted during the past decade have indicated which brain regions may 

malfunction in patients with ADHD, and thus account for symptoms of the condition (Barkley, 

2
1998a). A 1996 study conducted at the National Institutes for Mental Health (NIMH) found that 

the right prefrontal cortex (part of the cerebellum) and at least two of the clusters of nerve cells 

known collectively as the basal ganglia are significantly smaller in children with ADHD (as cited 

in Barkley, 1998a). It appears that these areas of the brain relate to the regulation of attention. 

Why these areas of the brain are smaller for some children is yet unknown, but researchers have 

suggested mutations in several genes that are active in the prefrontal cortex and basal ganglia 

may play a significant role (Barkley, 1998a). In addition, some nongenetic factors have been 

linked to ADHD including premature birth, maternal alcohol and tobacco use, high levels of 

exposure to lead, and prenatal neurological damage. Although some people claim that food 

additives, sugar, yeast, or poor child rearing methods lead to ADHD, there is no conclusive 

evidence to support these beliefs (Barkley, 1998a; Neuwirth, 1994; NIMH, 1999). 

How Do We Identify ADHD? 

Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of 

these behaviors may be normal for their age or developmental stage. These behaviors must be 

exhibited to an abnormal degree to warrant identification as ADHD. Even with older children, 

other factors (including environmental influences) can produce behaviors resembling ADHD. 

The criteria set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental 

Disorders (DSM-IV) are used as the standardized clinical definition to determine the presence of

ADHD (see DSM-IV Criteria for ADHD). A person must exhibit several characteristics to be 

clinically diagnosed as having ADHD: 

Severity. The behavior in question must occur more frequently in the child than in other 

children at the same developmental stage. 

Early onset. At least some of the symptoms must have been present prior to age 7. 

Duration. The symptoms must also have been present for at least 6 months prior to the 

evaluation. 

Impact. The symptoms must have a negative impact on the child’s academic or social life. 

Settings. The symptoms must be present in multiple settings. 

The specific DSM-IV criteria are set forth in the following chart. 

DSM-IV Criteria for 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

3
(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 or 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

(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: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. 

Washington, DC, American Psychiatric Association, 1994. 

4
LEGAL REQUIREMENTS FOR IDENTIFICATION OF AND 

EDUCATIONAL SERVICES FOR CHILDREN WITH ADHD 

Two important federal mandates protect the rights of eligible children with ADHD—the 

Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 

1973 (Section 504). The regulations implementing these laws are 34 CFR sections 300 and 104, 

respectively, which require school districts to provide a “free appropriate public education” to 

students who meet their eligibility criteria. Although a child with ADHD may not be eligible for 

services under IDEA, he or she may meet the requirements of Section 504. 

The requirements and qualifications for IDEA are more stringent than those of Section 504. 

IDEA provides funds to state education agencies for the purpose of providing special education 

and related services to children evaluated in accordance with IDEA and found to have at least 

one of the 13 specific categories of disabilities, and who thus need special education and related 

services. Attention Deficit Hyperactivity Disorder may be considered under the specific category 

of “Other Health Impairment” (OHI), if the disability results in limited strength, vitality, or 

alertness, including a heightened alertness to environmental stimuli that results in limited 

alertness with respect to the educational environment and that is due to chronic or acute health 

problems. 

Under IDEA, each public agency—that is, each school district—shall ensure that a full and 

individual evaluation is conducted for each child being considered for special education and 

related services. The child’s individualized education program (IEP) team uses the results of the 

evaluation to determine the educational needs of the child. The results of a medical doctor’s, 

psychologist’s, or other qualified professional’s assessment indicating a diagnosis of ADHD may 

be an important evaluation result, but the diagnosis does not automatically mean that a child is 

eligible for special education and related services. A group of qualified professionals and the 

parent of the child determine whether the child is an eligible child with a disability according to 

IDEA. Children with ADHD also may be eligible for services under the “Specific Learning 

Disability,” “Emotional Disturbance,” or other relevant disability categories of IDEA if they 

have those disabilities in addition to ADHD. 

After it has been determined that a child is eligible for special education and related services 

under IDEA, an IEP is developed that includes a statement of measurable annual goals, including 

benchmarks or short-term objectives that reflect the student’s needs. The IEP goals are 

determined with input from the parents and cannot be changed without the parents’ knowledge. 

Although children who are eligible under IDEA must have an IEP, students eligible under 

Section 504 are not required to have an IEP but must be provided regular or special education 

and related aids or services that are designed to meet their individual educational needs as 

adequately as the needs of nondisabled students are met. 

Section 504 was established to ensure a free appropriate education for all children who have an 

impairment—physical or mental—that substantially limits one or more major life activities. If it 

can be demonstrated that a child’s ADHD adversely affects his or her learning—a major life 

activity in the life of a child—the student may qualify for services under Section 504. To be 

considered eligible for Section 504, a student must be evaluated to ensure that the disability 

requires special education or related services or supplementary aids and services. Therefore, a 

child whose ADHD does not interfere with his or her learning process may not be eligible for 

5
special education and related services under IDEA or supplementary aids and services under 

Section 504. 

IDEA and Section 504 require schools to provide special education or to make modifications or 

adaptations for students whose ADHD adversely affects their educational performance. Such 

adaptations may include curriculum adjustments, alternative classroom organization and 

management, specialized teaching techniques and study skills, use of behavior management, and 

increased parent/ teacher collaboration. Eligible children with ADHD must be placed in regular 

education classrooms, to the maximum extent appropriate to their educational needs, with the use 

of supplementary aids and services if necessary. Of course, the needs of some children with 

ADHD cannot be met solely within the confines of a regular education classroom, and they may 

need special education or related aids or services provided in other settings. 

Components of a Comprehensive Evaluation 

Behavioral 

Educational 

Medical 

• 

• 

• 

A diagnosis of ADHD is multifaceted and includes behavioral, medical, and educational data 

gathering. One component of the diagnosis includes an examination of the child’s history 

through comprehensive interviews with parents, teachers, and health care professionals. 

Interviewing these individuals determines the child’s specific behavior characteristics, when the 

behavior began, duration of symptoms, whether the child displays the behavior in various 

settings, and coexisting conditions. The American Academy of Pediatrics (AAP) stresses that 

since a variety of psychological and developmental disorders frequently coexist in children who 

are being evaluated for ADHD, a thorough examination for any such coexisting condition should 

be an integral part of any evaluation (AAP, 2000). 

Behavioral Evaluation 

Specific questionnaires and rating scales are used to review and quantify the behavioral 

characteristics of ADHD. The AAP has developed clinical practice guidelines for the diagnosis 

and evaluation of children with ADHD, and finds that such behavioral rating scales accurately 

distinguish between children with and without ADHD (AAP, 2000). Conversely, AAP 

recommends not using broadband rating scales or teacher global questionnaires in the diagnosis 

of children with ADHD. They suggest using ADHD-Specific rating scales including: 

 CPRS-R:L-ADHD Index 

(Conners Parent Rating Scale—1997 

Revised Version: Long Form, ADHD Index Scale) 

 CTRS-R:L-ADHD Index 

(Conners Teacher Rating Scale—1997 

Revised Version: Long Form, ADHD Index Scale) 

 CPRS-R:L-DSM-IV Symptoms 

(Conners Parent Rating Scale—1997 

Revised Version: Long Form, DSM-IV Symptoms Scale) 

6
 CTRS-R:L-DSM-IV Symptoms 

(Conners Teacher Rating Scale—1997 

Revised Version: Long Form, DSM-IV Symptoms Scale) 

 SSQ-O-1 

(Barkley’s School Situations Questionnaire—Original Version, Number of Problem

Settings Scale) 

 SSQ-O-II 

(Barkley’s School Situations Questionnaire—Original Version, Mean Severity Scale) 

(Taken from Green, Wong, Atkins, et al. (1999). Diagnosis of Attention 

Deficit/Hyperactivity Disorder. Technical Review 3. Rockville, MD: U.S. Department of

Health and Human Services, Agency for Health Care Policy and Research, as cited in 

AAP, 2000). 

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, other diagnosticians such as psychologists, occupational therapists, speech 

therapists, social workers, and physicians. 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 impair his 

or her academic performance at school. The evaluation involves direct observations of the child 

in the classroom as well as a review of his or her academic productivity. 

Behaviors targeted for classroom observation may include: 

• 

• 

• 

• 

Problems of inattention, such as becoming easily distracted, 

making careless mistakes, or failing to finish assignments on 

time; 

Problems of hyperactivity, such as fidgeting, getting out of an 

assigned seat, running around the classroom excessively or 

striking out at a peer; 

Problems of impulsivity, such as blurting out answers to the 

teacher’s questions or interrupting the teacher or other students 

in the class; and 

More challenging behaviors, such as severe aggressive or 

disruptive behavior. 

Classroom observations are used to record how often the child exhibits various ADHD 

symptoms in the classroom. The frequency with which the child with ADHD exhibits these and 

other target behaviors 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 to the behaviors of other 

children in his or her classroom. 

It is best to collect this information during two or three different observations across several 

days. Each observation typically lasts about 20 to 30 minutes. 

7
In order to receive special education and related services under Part B of IDEA, a child must be 

evaluated to determine (1) whether he or she has a disability and (2) whether he or she, because 

of the disability, needs special education and related services. The initial evaluation must be a 

full and individual evaluation that assesses the child in all areas related to the suspected disability 

and uses a variety of assessment tools and strategies. As discussed in the section on Legal 

Requirements (above), a child who has ADHD may be eligible for special education and related 

services because he or she also meets the criteria for at least one of the disability categories, such 

as specific learning disability or emotional disturbance. It is important to note that the assessment 

instruments and procedures used by educational personnel to evaluate other disabilities—such as 

learning disabilities—may not be appropriate for the evaluation of ADHD. A variety of 

assessment tools and strategies must be used to gather relevant functional and developmental 

information about the child. 

An educational evaluation also includes an assessment of the child’s productivity in completing 

classwork 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 to the productivity of other children in the class. 

Once the observations and testing are complete, a group of qualified professionals and the 

parents of the child will review the results and determine if the child has a disability and whether 

the child needs special education and related services. Using this information, the child’s IEP 

team, which includes the child’s parents, will develop an individualized educational program that 

directly addresses the child’s learning and behavior. If the child is recommended for evaluation 

and determined by the child’s IEP team not to meet the eligibility requirements under IDEA, the 

child may be appropriate for evaluation under Section 504. 

Medical Evaluation 

A medical evaluation assesses whether the child is manifesting symptoms of ADHD, based on 

the following three objectives: 

• 

• 

• 

To assess problems of inattention, impulsivity, and hyperactivity that the child is currently 

experiencing;

To assess the severity of these problems; and 

To gather information about other disabilities that may be contributing to the child’s ADHD 

symptoms. 

Part B of IDEA does not necessarily require a school district to conduct a medical evaluation for 

the purpose of determining whether a child has ADHD. If a public agency believes that a 

medical evaluation by a licensed physician is needed as part of the evaluation to determine 

whether a child suspected of having ADHD meets the eligibility criteria of the OHI category, or 

any other disability category under Part B, the school district must ensure that this evaluation is 

conducted at no cost to the parents (OSEP Letter to Michel Williams, March 14, 1994, 21 

IDELR 73). 

In May 2000, the American Academy of Pediatrics (AAP) published a clinical practice guideline 

that provides recommendations for the assessment and diagnosis of school-aged children with 

ADHD. The guideline, developed by a committee comprised of pediatricians and experts in the 

fields of neurology, psychology, child psychiatry, child development, and education, as well as 

8
experts in epidemiology and pediatrics, is intended for use by primary care clinicians who are 

involved in the identification and evaluation process. The recommendations are designed to 

provide a framework for diagnostic decisionmaking and include the following: 

Medical evaluation for ADHD should be initiated by the primary care clinician. 

Questioning parents regarding school and behavioral issues, either directly or through a 

pre-visit questionnaire, may help alert physicians to possible ADHD. 

• 

• 

• 

• 

• 

In diagnosing ADHD, physicians should use DSM-IV criteria. 

The assessment of ADHD should include information obtained directly from parents or 

caregivers, as well as a classroom teacher or other school professional, regarding the core 

symptoms of ADHD in various settings, the age of onset, duration of symptoms, and 

degree of functional impairment. 

Evaluation of a child with ADHD should also include assessment of co-existing 

conditions such as learning and language problems, aggression, disruptive behavior, 

depression, or anxiety. 

What Are the Treatment Options? 

Although at present no cure for ADHD exists, there are a number of treatment options that have 

proven to be effective for some children. Effective strategies include behavioral, 

pharmacological, and multimodal methods. 

Behavioral Approaches 

Behavioral approaches represent a broad set of specific interventions that have the common goal 

of modifying the physical and social environment to alter or change behavior (AAP, 2001). They 

are used in the treatment of ADHD to provide structure for the child and to reinforce appropriate 

behavior. Those who typically implement behavioral approaches include parents as well as a 

wide range of professionals, such as psychologists, school personnel, community mental health 

therapists, and primary care physicians. Types of behavioral approaches include behavioral 

training for parents and teachers (in which the parent and/or teacher is taught child management 

skills), a systematic program of contingency management (e.g. positive reinforcement, “time 

outs,” response cost, and token economy), clinical behavioral therapy (training in problemsolving and social skills), and cognitive-behavioral treatment (e.g., self-monitoring, verbal selfinstruction, development of problem-solving strategies, self-reinforcement) (AAP, 2001; 

Barkley, 1998b; Pelham, Wheeler, & Chronis, 1998). In general, these approaches are designed 

to use direct teaching and reinforcement strategies for positive behaviors and direct 

consequences for inappropriate behavior. Of these options, systematic programs of intensive 

contingency management conducted in specialized classrooms and summer camps with the 

setting controlled by highly trained individuals have been found to be highly effective 

(Abramowitz, et al., 1992; Carlson, et al., 1992; Pelham & Hoza, 1996). A later study conducted 

by Pelham, Wheeler, and Chronis (1998) indicates that two approaches—parent training in 

behavior therapy and classroom behavior interventions—also are successful in changing the 

behavior of children with ADHD. In addition, home-school interactions that support a consistent 

approach are important to the success of behavioral approaches. 

The use of behavioral strategies holds promise but also presents some limitations. 

Behavioral strategies may be appealing to parents and professionals for the 

following reasons: 

Behavioral strategies are used most commonly when parents do not want to 

give their child medication;

9
Behavioral strategies also can be used in conjunction with medicine (see 

multimodal methods); 

Behavioral techniques can be applied in a variety of settings including school, 

home, and the community; and 

Behavioral strategies may be the only options if the child has an adverse 

reaction to medication.

• 

• 

• 

The research results on the effectiveness of behavioral techniques are mixed. While studies that 

compare the behavior of children during periods on and off behavior therapy demonstrate the 

effectiveness of behavior therapy (Pelham & Fabiano, 2001), it is difficult to isolate its 

effectiveness. The multiplicity of interventions and outcome measures makes careful analysis of

the effects of behavior therapy alone, or in association with medications, very difficult (AAP, 

2001). A review conducted by McInerney, Reeve, and Kane (1995) confirms that the effective 

education of children with ADHD requires modifications to academic instruction, behavior 

management, and classroom environment. Although some research suggests that behavioral 

methods offer the opportunity for children to work on their strengths and learn self-management, 

other research indicates that behavioral interventions are effective but to a lower degree than 

treatment with psychostimulants (Jadad, Boyle, & Cunningham, 1999; Pelham, et al., 1998). 

Behavior therapy has been found to be effective only when it is implemented and maintained 

(AAP, 2001). Indeed, behavioral strategies can be difficult to implement consistently across all 

of the settings necessary for it to be maximally effective. Although behavioral management 

programs have been shown to enhance the academic performance and behavior of children with 

ADHD, followup and maintenance of the treatment is often lacking (Rapport, Stoner, & Jones, 

1986). 

In fact, some research has shown that behavioral techniques may fail to reduce ADHD’s core 

characteristics of hyperactivity, impulsivity, and inattention (AAP, 2001; U.S. Department of 

Health and Human Services [DHHS], 1999). Conversely, one must consider that the problems of 

children with ADHD are seldom limited to the core symptoms themselves (Barkley, 1990a). 

Children frequently demonstrate other types of psychosocial difficulties, such as aggression, 

oppositional defiant behavior, academic underachievement, and depression (Barkley, 1990a). 

Because many of these other difficulties cannot be managed through psychostimulants, 

behavioral interventions may be useful in addressing ADHD and other problems a child may be 

exhibiting. 

Pharmacological Approaches 

Pharmacological treatment remains one of the most common, yet most controversial, forms of 

ADHD treatment. It is important to note that the decision to prescribe any medicine is the 

responsibility of medical—not educational—professionals, after consultation with the family and 

agreement on the most appropriate treatment plan. Pharmacological treatment includes the use of

psychostimulants, antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers 

(NIMH, 2000). Stimulants predominate in clinical use and have been found to be effective with 

75 to 90 percent of children with ADHD (DHHS, 1999). Stimulants include Methylphenidate 

(Ritalin), Dextroamphetamine (Dexedrine), and Pemoline (Cylert). Other types of medication 

(antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers) are used 

primarily for those who do not respond to stimulants, or those who have coexisting disorders. 

The results of the Multimodal Treatment Study (MTA), which are discussed in further detail in 

the next section, confirm research findings on the use of pharmacological treatment for patients 

10
with ADHD. Specifically, the study found that the use of medication was almost as effective as 

the multimodal treatment of medication and behavioral interventions (Edwards, 2002). 

Administering Medication at School 

• 

• 

• 

Develop a plan to ensure that medication is administered in accordance with doctor’s 

recommendation

Include this plan in the child’s IEP

Maintain child and parent rights to medical confidentiality

Researchers believe that psychostimulants affect the portion of the brain that is responsible for 

producing neurotransmitters. Neurotransmitters are chemical agents at nerve endings that help 

electrical impulses travel among nerve cells. Neurotransmitters are responsible for helping 

people attend to important aspects of their environment. The appropriate medication stimulates 

these underfunctioning chemicals to produce extra neurotransmitters, thus increasing the child’s 

capacity to pay attention, control impulses, and reduce hyperactivity. Medication necessary to 

achieve this typically requires multiple doses throughout the day, as an individual dose of the 

medication lasts for a short time (1 to 4 hours). However, slow- or timed-release forms of the 

medication (for example, Concerta) may allow a child with ADHD to continue to benefit from

medication over a longer period of time. Doctors, teachers, and parents should communicate 

openly about the child’s behavior and disposition in order to get the dosage and schedule to a 

point where the child can perform optimally in both academic and social settings, while keeping 

side effects to a minimum. If it is determined that the child should receive medication during the 

school day, it is important to develop a plan to ensure that medication is administered in 

accordance with the plan. Such a plan would be an appropriate component of the child’s IEP. In 

addition, schools must ensure that the child’s and parent’s rights to medical confidentiality are 

maintained. 

Although the positive effects of the stimulant medication are immediate, all medications have 

side effects. Adjusting the dosage of the medicine can diminish some of these side effects. Some

of the more common side effects include insomnia, nervousness, headaches, and weight loss. In 

fewer cases, subjects have reported slowed growth, tic disorders, and problems with thinking or 

with social interaction (Gadow, Sverd, Sprafkin, Nolan, & Ezor, 1995). Medication also can be 

expensive, depending upon the medicine prescribed, the frequency of administration, and the 

subsequent frequency of refills. Stimulant medicines do not “normalize” the entire range of 

behavior problems, and children under treatment may still manifest higher levels of behavioral 

problems than their peers (DHHS, 1999). Nonetheless, the American Academy of Pediatrics 

(AAP) finds that at least 80 percent of children will respond to one of the stimulants if they are 

administered in a systematic way. Under medical care, children who fail to show positive effects

or who experience intolerable side effects on one type of medication may find another 

medication helpful. The AAP reports that children who do not respond to one medication may 

have a positive response to an alternative medication, and concludes that stimulants may be a 

safe and effective way to treat ADHD in children (AAP, 2001). 

In January 2003, a new type of nonstimulant medication for the treatment of children and adults 

with ADHD was approved by the FDA. Atomoxetine, also known as Straterra, may be 

prescribed by physicians in some cases. 

11
Multimodal Approaches 

Research indicates that for many children the best way to mitigate symptoms of ADHD is the use 

of a combined approach. A recent study by the NIMH—the Multimodal Treatment Study of 

Children with ADHD (MTA)—is the longest and most thorough study of the effects of ADHD 

interventions (MTA Cooperative Group, 1999a, 1999b). The study followed 579 children 

between the ages of 7 and 10 at six sites nationwide and in Canada. The researchers compared 

the effects of four interventions: medication provided by the researchers, behavioral intervention, 

a combination of medication and behavioral intervention, and no-intervention community care 

(i.e., typical medical care provided in the community). 

Multimodal intervention improves . . . 

• 

• 

• 

• 

• 

Academic performance 

Parent-child interaction 

School-related behavior 

and reduces . . . 

Child anxiety 

Oppositional behavior

Of the four interventions investigated, the researchers found that the combined 

medication/behavior treatment and the medication treatment work significantly better than 

behavioral therapy alone or community care alone at reducing the symptoms of ADHD. 

Multimodal treatments were especially effective in improving social skills for students coming 

from high-stress environments and children with ADHD in combination with symptoms of

anxiety or depression. The study revealed that a lower medication dosage is effective in 

multimodal treatments, whereas higher doses were needed to achieve similar results in the 

medication-only treatment. 

Researchers found improvement in the following areas after using a multimodal intervention: 

child anxiety, academic performance, oppositional behavior, and parent-child interaction. 

Positive results also were found in school-related behavior when multimodal treatment is 

coupled with improved parenting skills, including more effective disciplinary responses, and 

appropriate reinforcements (Hinshaw, et al., 2000). These findings were replicated across all six 

research sites, despite substantial differences among sites in their samples’ sociodemographic 

characteristics. The study’s overall results appear to apply to a wide range of children and 

families identified as in need of treatment services for ADHD (NIMH, 2000). Other studies 

demonstrate that multimodal treatments hold value for those children for whom treatment with 

medication alone is not sufficient (Klein, Abikoff, Klass, Ganeles, Seese, & Pollack, 1997). 

In October 2001, the AAP released evidence-based recommendations for the treatment of 

children diagnosed with ADHD. Their guidelines state that: 

Primary care clinicians should establish a treatment program that recognizes ADHD as a 

chronic condition; 

• 

• 

• 

The treating clinician, parents, and the child, in collaboration with school personnel, 

should specify appropriate target outcomes to guide management; 

The clinician should recommend stimulant mediation and/or behavioral therapy as 

appropriate to improve target outcomes in children with ADHD; 

12
When the selected management for a child with ADHD has not met target outcomes, 

clinicians should evaluate the original diagnosis, use of all appropriate treatments, 

adherence to the treatment plan, and the presence of coexisting conditions; and 

• 

• The clinician should periodically provide a systematic followup for the child with 

ADHD. Monitoring should be directed to target outcomes and adverse effects, with 

information gathered from parents, teachers, and the child. 

The AAP report stressed that the treatment of ADHD (whether behavioral, pharmacological, or 

multimodal) requires the development of child-specific treatment plans that describe not only the 

methods and goals of treatment, but also include means of monitoring over time and specific 

plans for followup. The process of developing target outcomes requires careful input from

parents, children, and teachers as well as other school personnel where available and appropriate. 

The AAP concluded that parents, children, and educators should agree on at least three to six key 

targets and desired changes as requisites for constructing the treatment plan. The goals should be 

realistic, attainable, and measurable. The AAP report found that, for most children, stimulant 

medication is highly effective in the management of the core symptoms of ADHD. For many 

children, behavioral interventions are valuable as primary treatment or as an adjunct in the 

management of ADHD, based on the nature of coexisting conditions, specific target outcomes, 

and family circumstances (AAP, 2001). 

HOW DOES ADHD AFFECT SCHOOL PERFORMANCE? 

The school experience can be challenging for students with ADHD. Students usually are 

identified only after consistently demonstrating a failure to understand or follow rules or to 

complete required tasks. Other common reasons for referral include frequent classroom

disruptions and poor academic performance. 

Studies found that students with ADHD, compared to students without ADHD, had persistent 

academic difficulties that resulted in the following: lower average marks, more failed grades, 

more expulsions, increased dropout rates, and a lower rate of college undergraduate completion 

(Weiss & Hechtman as cited in Johnston, 2002; Ingersoll, 1988). The disruptive behavior 

sometimes associated with the disorder may make students with ADHD more susceptible to 

suspensions and expulsions. A study by Barkley and colleagues (1990b) found that 46 percent of 

their student study group with ADHD had been suspended and 11 percent had been expelled. 

ADHD’s core symptoms—inattention, hyperactivity, and impulsivity—make meeting the daily 

rigors of school challenging (Zentall, 1993). Difficulty sustaining attention to a task may 

contribute to missing important details in assignments, daydreaming during lectures and other 

activities, and difficulty organizing assignments. Hyperactivity may be expressed in either verbal 

or physical disruptions in class. Impulsivity may lead to careless errors, responding to questions 

without fully formulating the best answers, and only attending to activities that are entertaining 

or novel. Overall, students with ADHD may experience more problems with school performance 

than their nondisabled peers. 

Helpful Hints 

This section highlights a few evidence-based hints for addressing the specific learning needs of 

children with ADHD. More detailed information about the effective strategies can be found in a 

13
companion guide, Teaching Children with Attention Deficit Hyperactivity Disorder: 

Instructional Strategies and Practices. Information regarding the complete set of materials is 

available on page 21. 

Numerous studies have found that positive results occur when the major stakeholders in a 

student’s education collaborate to address a child’s ADHD (Blazer, 1999; Bos, 1999; Bos, 

Nahmias, & Urban, 1999; Nahmias, 1995; Williams & Carteledge, 1997). Effective collaboration 

and communication between home and school provide structure across the two major settings in 

the child’s life. Common rewards, reinforcement strategies, and language help to promote 

consistency across settings. 

Bos et al. (1999) reported that collaborative partnerships between home and school were 

especially important during the initial assessment of the child’s disability and educational needs, 

the development of behavior modification plans, the evaluations of medication, and the 

coordination of assignments. Parents and teachers can share information with one another if they 

work together to plan behavioral and academic strategies for the student. Parents can offer 

information about the child—including the child’s medical history, hobbies and interests, 

effective reinforcers, and behavior in other settings—that may inform the decisions made by the 

teacher and other members of the IEP team. The teacher can keep parents informed about their 

child’s progress, performance, and behavior in school. If the child is taking medication, the 

teacher can offer feedback to parents regarding how the medication affects the student’s 

performance and the duration of the medicine’s effectiveness. This information also can be used 

to help medical professionals make more informed decisions about the child with ADHD. 

If a child exhibits patterns of disruptive or aggressive behavior, best practice research indicates 

that the child may benefit from a positive behavioral intervention plan that clearly delineates 

expectations and includes positive supports. The process to develop an effective plan should be 

collaborative and involve the parents and those other individuals who are most familiar with the 

child. 

Students also can take some of the responsibility for their educational and behavioral 

adaptations. Blazer (1999) reported that students as young as 5 years old can communicate ways 

to make their school experience more pleasurable and learning easier. Student input also helps to 

promote a sense of ownership and responsibility for the new strategies and adaptations. 

The following are some suggestions for practices that may be helpful for parents and teachers 

working with a child with ADHD. 

Tips for Home 

Caring for children with ADHD may be challenging, but it is important to remember that these 

children can learn successfully. It is critical that parents remember that some of their child’s 

disruptive behavior is a manifestation of the disability and that the challenge is finding ways to 

help their child change the inappropriate behavior. Key to this is remembering to focus on the 

need for structure and routine for your child’s daily schedule and thereby reinforcing the 

importance of learning self-control and self-regulation. The following are suggestions for 

parents: 

• Focus on discrete rewards and consequences for appropriate and inappropriate behavior: 

 Tangible rewards and treats; 

 Movie night for a good week at school; 

14
 Removal of privileges; and 

 Time-out from reinforcing activities: the child is essentially removed from situations 

that foster inappropriate behavior. 

Set a daily routine and stick to it. Bedtime and preparation for school are much easier if 

there is a structure already in place. 

• 

• 

• 

• 

• 

• 

• 

Have tangible reminders: 

 A big clock in the bedroom;

 Charts for chores; 

 Assignment pad to record homework and a specific folder to put work in upon 

completion; and 

 Gain the child’s attention before speaking to him or her. Have the child repeat back 

directions for things that are really important. 

Avoid the following: 

 Repeating patterns of inappropriate behavior followed by ineffective punishment; 

 Administering consequences without prior warning or without the child 

understanding why he or she is receiving them; and 

 Responding inconsistently to inappropriate behaviors. 

Tips for School 

A student with ADHD can present unique challenges in the classroom. Inattention, hyperactivity, 

or impulsivity can be the source of frustration, but there are ways teachers can help students with 

ADHD to improve the educational experience and control the symptoms of the disorder. It is 

important for teachers to be aware of coexisting conditions such as learning disabilities, as well 

as reinforcing the importance of classroom and instructional structure. 

The following are tips for teachers: 

Work on the most difficult concepts early in the day; 

Give directions to one assignment at a time instead of directions to multiple tasks all at 

once; 

Vary the pace and type of activity to maximize the student’s attention; and 

Structure the student’s environment to accommodate his or her special needs. For 

example, the student can be seated away from potentially distracting areas (such as doors, 

windows, and computers) or seated near another student who is working on a shared 

assignment. 

This guide is the first in a series of three publications that address issues related to the instruction 

of children with ADHD. The two additional guides are A Resource Directory for ADHD and 

Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and 

Practices. Teachers and others are encouraged to consult these publications and to use them in 

conjunction with Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource 

for School and Home. As the documents become available, they will be listed on the Office of

Special Education and Rehabilitative Services/Office of Special Education Programs Web site 

(www.ed.gov/offices/OSERS/OSEP). 

15
REFERENCES 

Abramowitz, A. J., Eckstrand, D., O’Leary, S. G., & Dulcan, M. K. (1992). ADHD 

children’s responses to stimulant medication and two intensities of a behavioral intervention. 

Behavior Modification, 16, 193-203. 

American Academy of Pediatrics (2000). Clinical practice guideline: Diagnosis and 

evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105: 5, 1158-

1170. 

American Academy of Pediatrics. (2001). Clinical practice guideline: Treatment of the 

school-aged child with attention deficit/hyperactivity disorder. Pediatrics, 108, 1033-1044. 

Retrieved from www.aap.org/policy/s0120.html. 

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental 

Disorders (4th ed.). Washington, DC: American Psychiatric Association. 

Anderson, J. C., Williams, S. C., McGee, R., & Silva, P. A. (1987). DSM-III disorders in 

preadolescent children: Prevalence in a large sample from the general population. Archives of

General Psychiatry, 44, 69-76. 

Barkley, R. A. (1990a). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis 

and Treatment. New York: Guilford Press. 

Barkley, R. A. (1990b). Comprehensive evaluation of attention deficit disorder with and 

without hyperactivity as defined by research criteria. Journal of Consulting and Clinical 

Psychology, 58, 775-789. 

Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: 

constructing a unifying theory of ADHD. Psychological Bulletin, 121:1, 65-94. 

Barkley, R. A. (September, 1998a). Attention-deficit hyperactivity disorder. Scientific 

American, 279: 3. 

Barkley, R. A. (1998b). Handbook of Attention Deficit Hyperactivity Disorder (2nd ed.). 

New York: Guilford Press. 

Bird, H. R., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., et al. 

(1988). Estimates of the prevalence of childhood maladjustment in a community survey in 

Puerto Rico. The use of combined measures. Archives of General Psychiatry, 45, 1120-1126. 

Blazer, B. (1999). Developing 504 classroom accommodation plans: A collaborative 

systematic parent-student-teacher approach. Teaching Exceptional Children, 32, 28-33. 

Bos, C. S. (1999). Home school communication. In C. Jones, H. R. Searight, & M. A. Urban 

(Eds.), Parent Articles for ADHD. San Antonio, TX: Communication Skill Builders. 

Bos, C. S., Nahmias, M. L., & Urban, M. A. (1999). Targeting home-school collaboration for 

students with ADHD. Teaching Exceptional Children, 31, 4-11. 

16
Cantwell, D. P., & Baker, L. (1991). Association between attention deficit-hyperactivity 

disorder and learning disorders. Journal of Learning Disabilities, 24, 88-95. 

Carlson, C. L., Pelham, W. E., Jr., Milich, R., & Dixon, J. (1992). Single and combined 

effects of methylphenidate and behavior therapy on the classroom performance of children 

with attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 20, 

213-232. 

Dykman, R. A., Akerman, P. T., & Raney, T. J. (1994). Assessment and Characteristics of 

Children with Attention Deficit Disorder. Prepared for the Office of Special Education 

Programs, Office of Special Education and Rehabilitative Services, U.S. Department of 

Education. 

Edwards, J. H. (2002). Evidenced-based treatment for child ADHD: “Real world” practice 

implications. Journal of Mental Health Counseling, 24:2, 126-139. 

Esser, G., Schmidt, M. H., & Woemer, W. (1990). Epidemiology and course of psychiatric 

disorders in school-age children: Results of a longitudinal study. Journal of Child 

Psychology and Psychiatry, 31, 243-263. 

Gadow, K. D., Sverd, J., Sprafkin, J., Nolan, E. E., & Ezor, S. N. (1995). Efficacy of 

methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. 

Archives of General Psychiatry, 52, 444-455. 

Hinshaw, S. P., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H. B., Arnold, L. E., et 

al. (2000). Family processes and treatment outcome in the MTA: Negative/ineffective 

parenting practices in relation to multimodal treatment. Journal of Abnormal Child 

Psychology, 28(6), 555-568. 

Ingersoll, B. (1988). Your Hyperactive Child. New York: Doubleday. 

Jadad, A. R., Boyle M., & Cunningham, C. (1999). Treatment of Attention 

Deficit/Hyperactivity Disorder. Evidence Report/Technology Assessment No. 11. Rockville, 

MD: Agency for Healthcare Research and Quality (AHRQ); 1999. AHRQ Publ. No. 00-E005 

Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., et 

al. (2001). ADHD Comorbidity findings from the MTA Study: Comparing Comorbid 

Subgroups. Journal of the American Academy of Child Adolescent Psychiatry, 40(2), 147-

158. 

Jensen, P. S., Martin, D., & Cantwell, D. (1997). Comorbidity in ADHD: Implications for 

research, practice, and DSM-IV. Journal of the American Academy of Child Adolescent 

Psychiatry, 36(8), 1065-1079. 

Johnston, C. (2002). The impact of attention deficit hyperactivity disorder on social and 

vocational functioning in adults. In P.S. Jensen and J.R. Cooper (Eds.), Attention Deficit 

Hyperactivity Disorder: State of the Science, Best Practices. (Chapter 6, pp 1-21). Kingston, 

NJ: Civic Research Institute. 

17
Klein, R.G., Abikoff, H., Klass, E., Ganeles, D., Seese, L.M., & Pollack, S. (1997). Clinical 

efficacy of methylphenidate in conduct disorder with and without attention deficit 

hyperactivity disorder. Archives of General Psychiatry, 54, 1073-1080. 

McInerney, M., Reeve, A., & Kane, M. B. (1995). Synthesizing and Verifying Effective 

Practices For Children and Youth With Attention Deficit Disorder. Washington, DC: 

Chesapeake Institute. 

MTA Cooperative Group. (1999a). Fourteen-month randomized clinical trial of treatment 

strategies for attention-deficit hyperactivity disorder. Archives of General Psychiatry, 56, 

1073-1086. 

MTA Cooperative Group. (1999b). Effects of comorbid anxiety, poverty, session attendance, 

and community medication on treatment outcome in children with attention 

deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088-1096. 

Nahmias, M. L. (1995). Communication and collaboration between home and school for 

students with ADHD. Intervention in School and Clinic, 30, 241-247. 

National Institute of Mental Health (NIMH). (1999). Questions and answers. NIMH 

Multimodal Treatment Study of Children With ADHD. Bethesda, MD: NIMH. 

National Institute of Mental Health. (2000). NIMH Research on Treatment for Attention 

Deficit Hyperactivity Disorder (ADHD): The Multimodal Treatment Study—Questions and 

Answers. [Online]. Available: www.nimh.nih.gov/events/mtaqa.cfm. 

Neuwirth, S. (1994). Attention deficit hyperactivity disorder. Bethesda, MD: National 

Institutes of Health (NIH). NIH Publication No. 96-3572. 

OSEP Letter to Michel Williams, March 14, 1994, 21 Individuals with Disabilities Education 

Law Report 73. 

Pastor, P. N., & Reuben, C. A. (2002). Attention deficit disorder and learning disability: 

United States, 1997-98. National Center for Health Statistics. Vital Health Stat, 10(206). 

Pelham W. E., & Fabiano, G. (2001). Behavior modification. Child and Adolescent 

Psychiatry Clinics of North America, 9(3), 671-688. 

Pelham, W. E., Jr., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of 

DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American 

Academy of Child and Adolescent Psychiatry, 31, 210-218. 

Pelham, W. E., & Hoza, B. (1996). Intensive treatment: A summer treatment program for 

children with ADHD. In E. Hibbs & H. Jensen (Eds.) Psychosocial Treatment for Child and 

Adolescent Disorders: Empirically Based Strategies for Clinical Practice. New York: 

American Psychological Association Press, 311-340. 

18
19

Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial 

treatments for attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 

27, 190-205. 

Rapport, M. D., Stoner, G., & Jones, J. T. (1986). Comparing classroom and clinic measures 

of attention deficit disorder: Differential, idiosyncratic, and dose-response effects of 

methylphenidate. Journal of Counseling and Clinical Psychology, 54, 334-341. 

Ross, D. M., & Ross, S. A. (1982). Hyperactivity: Current Issues, Research, and Theory. 

New York: Wiley. 

Shaffer, D., Gould, M. S., Fisher, P., Trautment, P., Moreau, D., Kleinman, M., et al. (1996). 

Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 

339-348. 

Swanson, J. M. (1992). School-Based Assessments and Interventions for ADHD Students. 

Irvine, CA: K. C. Publishing. 

U.S. Department of Health and Human Services (DHHS). (1999). Mental Health: A Report 

of the Surgeon General. Washington, DC: DHHS. 

Waslick, B., & Greenhill, L. (1997). Attention-deficit/hyperactivity disorder. In J. M. Weiner 

(Ed.), Textbook of child and adolescent psychiatry (2nd ed.). Washington, DC: American 

Academy of Child and Adolescent Psychiatry, American Psychiatric Press, 389-410. 

Williams, V. I., & Cartledge, G. (1997). Passing notes to parents. Teaching Exceptional 

Children, 30, 30-34. 

Wolraich, M. L., Hannah, J. N., Pinock, T. Y., Baumgaertel, A., & Brown, J. (1996). 

Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide 

sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 319-324. 

Zentall, S. S. (1993). Research on the educational implications of attention deficit 

hyperactivity disorder. Exceptional Children, 60, 143-153.