“It is both a pleasure and a privilege to provide this strong and unequivocalendorsement of so informative and consumer-friendly a book as this one.Grounded in the latest science of ADHD, filled with exceptionally detailed advice. . . parents and educators will find this book to be exceptionally useful in raisinga successful ADHD child.”

—Russell A. Barkley, Ph.D., professor of psychiatry, Medical University of SouthCarolina, and author of Taking Charge of ADHD

“For over a decade, Sandra Rief ’s How to Reach and Teach Children withADD/ADHD has been the most definitive and user-friendly ‘go-to’ guide forteachers and parents eager to help children with ADHD succeed in school, home,and life overall. Now updated with the latest research findings from the last tenyears, this book outstrips even the original. Unlike so many other volumes, thisbook is hands-on, well-organized, extremely readable, and full of the kind of wise,practical advice that only comes from someone who has been there (and contin-ues to be there!) helping teachers, parents, children, and youth struggling withADHD. I especially like the focus on different ages, school settings, and subjects.My highest recommendation for this book, and my greatest praise for Sandramaking this invaluable resource available!”

—Peter S. Jensen, M.D., director, Center for the Advancement of Children’s Men-tal Health and Ruane Professor of Child Psychiatry at Columbia University

“Sandra Rief is one of the most astute as well as compassionate voices in theworld about ADHD. She really gets it, and this book will give you what she gets.A wonderful contribution and valuable, practical resource for all teachers, par-ents, and clinicians.”

—Edward Hallowell, M.D., author of When You Worry About the Child You Loveand coauthor of Driven by Distraction

“This valuable resource should be at every teacher’s fingertips! Sandra Rief offerscurrent research-based strategies and information on ADHD that are a mustread for every educator.”

—Ellen Stantus, special education director, Davis School District, Farmington,Utah

“This book not only addresses the latest research on this neuro-biological differ-ence, but goes further by offering creative strategies for home and school in orderto help these students reach their full potential. As always, Sandra Rief fills herbook with what to do about it.”

—Jill Murphy, special educator, ADHD life skills and academic coach, ADDResources Parent Support, and mother of two children with ADD/ADHD,Bonney Lake, Washington

Jossey-Bass TeacherJossey-Bass Teacher provides K–12 teachers with essential knowledge and tools tocreate a positive and lifelong impact on student learning. Trusted and experiencededucational mentors offer practical classroom-tested and theory-based teachingresources for improving teaching practice in a broad range of grade levels and sub-ject areas. From one educator to another, we want to be your first source to makeevery day your best day in teaching. Jossey-Bass Teacher resources serve two typesof informational needs—essential knowledge and essential tools.

Essential knowledge resources provide the foundation, strategies, and meth-ods from which teachers may design curriculum and instruction to challenge andexcite their students. Connecting theory to practice, essential knowledge books relyon a solid research base and time-tested methods, offering the best ideas and guid-ance from many of the most experienced and well-respected experts in the field.

Essential tools save teachers time and effort by offering proven, ready-to-usematerials for in-class use. Our publications include activities, assessments, exer-cises, instruments, games, ready reference, and more. They enhance an entirecourse of study, a weekly lesson, or a daily plan. These essential tools provideinsightful, practical, and comprehensive materials on topics that matter most toK–12 teachers.

HOW TO REACH AND TEACH CHILDREN WITH

ADD/ADHDPractical Techniques, Strategies, and Interventions

SECOND EDITIONSANDRA F. RIEF

Copyright © 2005 by Sandra F. Rief. All rights reserved.

Published by Jossey-BassA Wiley Imprint989 Market Street, San Francisco, CA 94103-1741 www.josseybass.com

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or byany means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permittedunder Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written per-mission of the Publisher, or authorization through payment of the appropriate per-copy fee to the CopyrightClearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on theweb at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permis-sions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, e-mail: permcoordinator@wiley.com.

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ISBN 0-7879-7295-9

Printed in the United States of AmericaSECOND EDITION

PB Printing 10 9 8 7 6 5 4 3 2 1

About the AuthorSandra F. Rief, M.A., is a leading educational consultant, author, and speaker oneffective strategies and interventions for helping students with learning, attention,and behavioral challenges. Sandra presents seminars, workshops, and keynotesnationally and internationally on this topic. She received her B.A. and M.A. degreesfrom the University of Illinois. Sandra was formerly an award-winning teacher(1995 California Resource Specialist of the Year) with over twenty-three years’experience teaching in public schools.

Sandra is the author of several books and publications, including the follow-ing published by John Wiley & Sons: The ADHD Book of Lists; How to Reach andTeach All Students in the Inclusive Classroom (co-authored with Julie Heimburge);The ADD/ADHD Checklist: An Easy Reference for Parents & Teachers; and AlphabetLearning Center Activities Kit (co-authored with Nancy Fetzer).

Sandra also developed and presented the acclaimed educational videos ADHD& LD: Powerful Teaching Strategies and Accommodations; How to Help Your ChildSucceed in School: Strategies and Guidance for Parents of Children with ADHDand/or Learning Disabilities; ADHD: Inclusive Instruction & Collaborative Practices,and together with Linda Fisher and Nancy Fetzer, the videos Successful Classrooms:Effective Teaching Strategies for Raising Achievement in Reading and Writing andSuccessful Schools: How to Raise Achievement & Support “At-Risk” Students.

Sandra is a past member of the CHADD National Professional Advisory Boardand was on the faculty of NICHQ (National Initiative for Children’s HealthcareQuality—Collaborative on ADHD). For more information, visit her website atwww.sandrarief.com.

vv

About This BookThis book offers comprehensive guidance to everyone engaged in the positive edu-cation of children who have been diagnosed with ADD/ADHD. Whether you are aclassroom teacher or a parent; a special education teacher, counselor, or psycholo-gist; or a school or district administrator, this book will be a valuable resource.You’ll find information, techniques, and strategies to help these students succeed.While the book addresses the specific needs of students with ADD/ ADHD, thestrategies are also appropriate and recommended for all students who appear tohave attention problems, learning disabilities, or are underachieving for any rea-son, including gifted children.

This second edition includes enhanced content in the following areas: med-ications, case studies, documentation, placement, model programs, and references,among others. For easy use, the information is organized into thirty-five sectionsthat provide comprehensive, practical guidance on such topics as:

* Preventing behavioral problems in a classroom* Learning styles: elements and interventions* Cooperative learning techniques* Q&A with a school nurse regarding medication and its management* Techniques for relaxation and visualization* Challenges and specific interventions for students of all ages* Tips on communicating effectively with parents, physicians, and agencies

DedicationThis book is dedicated to the memory of my beloved son, Benjamin, and to all of thechildren who face obstacles in their young lives each day with loving, trustinghearts, determination, and extraordinary courage. I also wish to dedicate this bookin loving memory of Levana Estline—dear friend, exceptional teacher, and a bless-ing to all who knew her.

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ContentsIntroduction * xvi

PART 1: KEY INFORMATION FOR UNDERSTANDING AND MANAGING ADHD

Section 1.1: Understanding Attention-Deficit/Hyperactivity Disorder * 3

Definitions and Descriptions of ADHD * 3

Behavioral Characteristics of ADHD * 4

The Predominantly Inattentive Type of ADHD * 4

The Predominantly Hyperactive-Impulsive Type of ADHD * 6

Positive Traits and Characteristics Common in Many Children, Teens, and Adultswith ADHD * 9

Girls with Attention-Deficit Disorders * 9

ADHD and the “Executive Functions” * 10

ADHD “Look Alikes” * 11

ADHD and Co-Existing (or Associated) Disorders * 12

Statistics and Risk Factors * 13

What Is Currently Known About ADHD * 14

What May Be the Causes of ADHD * 17

What Is Not Known About ADHD * 20

ADHD and the Impact on the Family * 20

Section 1.2: Making the Diagnosis: A Comprehensive Evaluation for ADHD * 23

The Components of a Comprehensive Evaluation for ADHD * 24

Who Is Qualified to Evaluate a Child for ADHD? * 26

Section 1.3: Multimodal Treatments for ADHD * 29

Management Strategies * 29

AAP Guidelines and Additional Points * 32

A Word About Alternative and Unproven Treatments * 33

Section 1.4: Medication Treatment and Management * 35

Psychostimulant (Stimulant) Medications * 35

Antidepressants * 38

Atomoxetine (Strattera™) * 39

Other Medical Treatments * 39

What Teachers and Parents Need to Know If a Child/Teen Is on Medication * 39

vii

viii * Contents

Advice for Parents * 41

Interview with Mike * 42

Section 1.5: Do’s and Don’ts for Teachers and Parents * 43

Advice for Teachers * 43

Advice for Parents * 44

Interview with Spencer’s Mother * 47

Interview with Steve * 47

Section 1.6: Critical Factors in the Success of Students with ADHD * 49

Interview with Joe * 54

Section 1.7: ADHD and Social Skills Interventions * 55

Skill Deficits Versus Performance Deficits * 55

Interventions for Social Skills Problems * 56

School Interventions * 57

Child Social Skills Interventions * 59

Parent Interventions * 61

Summer Treatment Programs * 62

Section 1.8: ADHD in Preschool and Kindergarten * 63

Parent Concerns and Recommendations * 64

Preschool and Kindergarten Classroom Strategies for Success * 65

Creating the Climate for Success * 66

Management Techniques in Kindergarten * 68

What Else Is Important? * 70

What to Do About . . . * 72

Section 1.9: ADHD in Middle School and High School * 75

What All Adolescents Need * 76

The Value of Mentorship * 76

Dan’s Story * 77

The Core Symptoms of ADHD During Adolescence * 78

How Parents Can Help * 79

Why Can’t They “Act Their Age”? * 79

School Supports * 80

Exemplary Model Program for Students with ADHD (The ADHD Zero Point Program) * 81

Looping in Middle School * 83

Student Support Teams * 84

Warning Signs of Trouble in Middle School and High School * 84

Warning Signs of Learning Disabilities in Secondary School Children * 85

Interview with Joe * 85

Contents * ix

Part 1: General References * 87

Part 1: Recommended Resources * 93

PART 2: MANAGING THE CHALLENGE OF ADHD BEHAVIORS

Section 2.1: Classroom Management and Positive Discipline Practices * 97

Common Triggers or Antecedents to Misbehavior * 98

Classroom Management Tips * 99

Addressing Student Misbehavior * 109

Possible Corrective Consequences * 110

Interview with Brad * 113

Section 2.2: Preventing or Minimizing Behavior Problems During Transitionsand Less Structured Times * 115

Some Ways to Help * 115

Section 2.3: Individualized Behavior Management, Interventions,and Supports * 119

Understanding the ABCs of Behavior * 119

Target Behaviors * 120

Goal Sheets * 121

Home Notes and Daily Report Cards * 121

Chart Moves * 126

Contracts * 126

Token Economy or Token Programs * 127

Response Costs * 127

Self-Monitoring * 129

Rewards * 130

Strategies to Aid Calming and Avoid Escalation of Problems * 130

Tips for Dealing with “Challenging” or “Difficult” Kids * 132

What Is an FBA? * 133

What Is a BIP? * 135

Guiding Questions for Behavioral Issues * 136

Section 2.4: Strategies to Increase Listening, Following Directions,and Compliance * 139

Tips for Teachers and Parents * 139

Compliance Training * 143

Section 2.5: Attention!! Strategies for Engaging, Maintaining, and RegulatingStudents’ Attention * 145

Getting and Focusing Students’ Attention * 145

Maintaining Students’ Attention Through Active Participation * 147

Questioning Techniques to Increase Student Response Opportunities * 149

x * Contents

Keeping Students On-Task During Seatwork * 153

Tips for Helping Inattentive, Distractible Students * 154

Self-Monitoring Attention and Listening Levels (Self-Regulatory Techniques) * 155

Part 2: General References * 159

Part 2: Recommended Resources * 161

PART 3: INSTRUCTIONAL AND ACADEMIC STRATEGIES AND SUPPORTS

Section 3.1: Reaching Students Through Differentiated Instruction * 165

What Differentiation Means * 165

What Can Be Differentiated? * 167

Flexible Grouping * 167

Multiple Intelligences * 167

Layered Curriculum * 169

Interview with Bob * 169

Section 3.2: Multisensory Instruction * 171

Multisensory Strategies for Learning Multiplication Tables * 172

Multisensory Spelling Strategies and Activities * 175

Instructional Suggestions for Teachers * 177

Accommodations and Modifications * 178

Interview with Brita * 179

Section 3.3: Reaching Students Through Their Learning Styles and MultipleIntelligences * 181

Learning Styles * 182

Environmental Adaptations and Accommodations * 186

Multiple Intelligences * 190

Student Learning Style/Interest Interview * 191

Interview with Amy * 193

Section 3.4: The Advantages of Cooperative Learning for Studentswith ADHD * 195

The Five Elements of Cooperative Learning * 196

Getting Started with Group Work * 197

Structuring to Achieve Positive Interdependence * 197

Teaching Social Skills Through Cooperative Learning * 198

Section 3.5: Organization, Time Management, and Study Skills * 207

What Teachers and Parents Can Do to Help Build Organization Skills * 208

What Teachers and Parents Can Do to Help with Time Management * 212

Contents * xi

Section 3.6: Learning Strategies and Study Skills * 223

Learning Strategies * 223

Study Skills * 227

Interview with Susan * 231

Section 3.7: Writing and Reading Challenges for Students with ADHD * 233

Why Writing Is Such a Struggle for Students with ADHD * 233

Common Reading Difficulties in Children and Teens with Attention-Deficit Disorders * 235

Reading Disabilities/Dyslexia * 237

What Research Tells Us About Learning to Read and Reading Difficulties * 237

What Is Known About Effective Intervention for Struggling Readers * 239

Section 3.8: Written Language Strategies, Accommodations, and Interventions:Pre-Planning/Organizing, Handwriting, Assistive Technology * 241

Strategies to Help with Planning/Organizing (Pre-Writing) * 241

Strategies for Improving Fine Motor, Handwriting, Written Organization,and Legibility * 245

Strategies for Bypassing and Accommodating Writing Difficulties * 248

Section 3.9: Strategies for Building Written Expression and Editing Skills * 253

Written Expression—Strategies and Support * 253

More Instructional Recommendations * 256

Help with Editing Strategies and Other Tips * 257

Section 3.10: Reading Strategies and Interventions: Building Decoding Skills,Vocabulary, and Fluency * 261

The Reading Process: What Good Readers Do * 261

Strategies for Building Word Recognition, Reading Vocabulary, and Fluency * 262

Independent Reading * 266

Oral Reading Strategies * 266

Vocabulary Enhancement * 267

Reading Tips and Strategies for Parents * 268

Research-Based Reading Intervention Programs * 269

Interview with Malinda * 271

Section 3.11: Reading Comprehension Strategies and Interventions * 273

Pre-Reading Strategies * 273

During-the Reading Strategies * 274

After-Reading Strategies * 275

Graphic Organizers (Graphic Outlines or Graphic Aids) * 275

Other Reading Comprehension/Meaning-Making Strategies * 276

xii * Contents

Other Active Reading/Discussion Formats * 279

Book Projects/Activities * 282

Interview with John * 283

Section 3.12: Mathematics: Challenges and Strategies * 285

Math Difficulties Associated with ADHD * 285

Math Strategies and Interventions * 287

National Council of Teachers of Mathematics (NCTM) Standards * 292

Part 3: General References * 299

Part 3: Recommended Resources * 309

PART 4: PERSONAL STORIES AND CASE STUDIES

Section 4.1: A Parent’s Story: What Every Teacher and Clinician Needs to Hear * 313

A Parent’s Story * 313

Section 4.2: Case Studies and Interventions (Adam and Vincent) * 327

Adam (Twelve Years Old, Seventh-Grade Student) * 328

Vincent (Seventeen Years Old, High School Senior) * 338

PART 5: COLLABORATIVE EFFORTS AND SCHOOL RESPONSIBILITIES IN HELPING CHILDREN WITH ADHD

Section 5.1: Teaming for Success: Communication, Collaboration, and MutualSupport * 361

The Necessity of a Team Approach * 361

The Parents’ Role in the Collaborative Team Process * 362

The Educators’ Role in the Collaborative Team Process * 367

The Clinicians’ Role in the Collaborative Team Process * 370

Cultural Sensitivity and Its Impact on Effective Communication and Collaboration * 370

Final Thoughts on Home/School Collaboration * 371

Section 5.2: The Role of the School’s Multidisciplinary Team * 373

The Student Support Team (SST) Process * 373

If You Suspect a Student Has ADHD * 378

The School’s Role and Responsibilities in the Diagnosis of ADHD * 380

School-Based Assessment for ADHD * 381

Section 5.3: School Documentation and Communication with Medical Providersand Others * 385

Communication with Physicians * 385

Communication Between Schools * 389

Communication with Community Health Providers/Organizations * 391

Teacher Documentation * 394

Contents * xiii

Section 5.4: Educational Laws and Rights of Students with ADHD * 395

Individuals with Disabilities Act (IDEA) * 395

Section 504 * 398

Which One May Be Better for a Student with ADHD—A 504 Plan or an IEP? * 400

Disciplining Students with Disabilities Under Special Education Law * 400

The Reauthorization of IDEA * 403

IDEA 2004 * 404

No Child Left Behind (NCLB) * 404

Section 5.5: Innovative Collaborative Programs for Helping Children with ADHD * 407

The Utah Model—Intermountain Health Care’s (IHC’s) Care Management Systemfor ADHD * 408

Project for Attention Related Disorder (PARD) of San Diego, California * 411

OU Pediatrics/Kendall Whittier Elementary—Collaborative Model of Care in Tulsa, Oklahoma * 414

Insights from Dr. Donald Hamilton, OU Pediatrics * 416

More Innovative Programs and Projects for Improving the Lives of Those withADHD * 417

Part 5: General References * 419

Part 5: Recommended Resources * 421

PART 6: ADDITIONAL SUPPORTS AND STRATEGIES

Section 6.1: Stress Reduction, Relaxation Strategies, Leisure Activities,and Exercise * 425

Fun and Laughter * 425

Breathing Techniques * 425

Yoga and Slow Movement Exercises * 426

Visualization and Guided Imagery * 427

Music * 428

Leisure Activities, Recreation, and Hobbies * 429

Exercise and Sports * 429

Section 6.2: Music for Relaxation, Transitions, Energizing, and Visualization * 431

Music for a Calming Effect * 432

Music for Moving from Here to There * 433

Music for Transitional Times * 433

Effect of Music on Mood * 434

Interview with Bruce * 435

Part 6: General References * 437

Part 6: Recommended Resources * 439

AcknowledgmentsMy deepest thanks and appreciation to

* Itzik, Ariel, Jackie, Gil, Sharon, Jason, Mom, and Ben—for the joy you bringme, and your constant, loving support, encouragement, and good humor

* My girls (Jackie and Sharon), the new generation of teachers in the family—I am so proud of you and the enthusiasm, talent, and fresh ideas you bring tothe profession

* All of the children who have touched my heart and inspired me throughoutthe years. It is because of you that I love what I do

* The special families who have shared with me their struggles and triumphsand allowed me to be part of their lives

* Mrs. Linda Haughey and the wonderful Haughey family, for courageouslysharing their personal, powerful story in Section 4.1

* My dear friends, Lynda and Diana, for so generously sharing their precioussons’ case studies, school histories, and intervention plans (last names omit-ted at their request to protect their privacy)

* All of the wonderful, dedicated educators I have had the great fortune to workwith and meet over the years, thank you for sharing with me your creativestrategies, ideas, and insights

* The extraordinary parents (especially the wonderful volunteers in CHADD andother organizations worldwide) whose tireless efforts have raised awarenessabout ADHD, and as a result, improved the care and education of our children

* All of the researchers and practitioners in the different fields dedicated to help-ing children and families with ADHD, LD, and other disabilities, from whomI have learned so much

* Steve Thompson, Ph.D., my editor at Jossey-Bass in San Francisco, for all ofyour help and guidance, and for making it such a pleasure to write this book

* Sandra Wright and Susie Horn, exceptional school nurses in the San DiegoCity Schools—my friends and role models—for all you have done to help chil-dren with ADHD and their families

* Karen Easter, one of the wonderful mothers I have been privileged to meet andbefriend at one of my workshops, for sharing your original poems in this book

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Acknowledgments * xv

* My illustrators—Decker Forrest, an incredibly talented former student ofmine, who was in the eighth grade at the time he drew these illustrations (firstpublished in the 1993 edition), and Ariel Rief, my darling son, who providedsome of the other illustrations in this book (as well as those in The ADHDBook of Lists)

* Joe, Spencer, Steve, Susan, Mike, Bruce, Amy, Joseph, John, Brita, Malinda,Bob, and Brad (teens and adults with ADHD), and the group of early childhoodeducators, who allowed me to interview them and share their insights inexcerpts throughout this book

IntroductionWhen I first wrote How to Reach and Teach ADD/ADHD Children back in 1993,awareness of attention-deficit/hyperactivity disorder and information/resourcesavailable were minimal at best. Since that time, a tremendous amount of scientificresearch and education efforts have taken place. It would be rare to find anyonewho has not heard of ADD or ADHD.

Reliable information is now easily accessible, and far more resources than everbefore are available to parents/caregivers, educators, and those who work with andtreat children with attention deficit disorders. However, there is still a great dealof misinformation, controversy, and myths surrounding this disorder. There are stillcountless children and teens who have ADHD and who have been suffering andexperiencing school failure due to their lack of identification or treatment and mis-interpretation of their behaviors by teachers and others, who don’t understand oraccept the reality of their disorder and its impact on school performance.

According to a Surgeon General’s report, attention-deficit/hyperactivity disor-der is the most common neurobehavioral disorder of childhood, affecting approxi-mately 3 to 7 percent of school-aged children. Every teacher has at least onestudent with ADHD in his or her classroom. Educators need to be aware and knowl-edgeable about the nature of the disorder, as well as the strategies effective inreaching and teaching these students. Parents of children with ADHD also need tobe well-informed and equipped with the skills and strategies that help in manag-ing and coping with inattentive, hyperactive, and impulsive behaviors. It is oftennot easy to live with a child who has ADHD (either at home or at school). Knowl-edge about the disorder is very important, because when we understand whatADHD is and how it affects the child’s behavior and performance, it helps usbecome more tolerant and empathetic.

Attention deficit/hyperactivity disorder is not something that we can “cure”;nor does a child with ADHD “outgrow” it in most cases (although behaviors aremanifested differently as the child matures and symptoms may be less or moreimpairing at different times in their lives). We, the significant adults in their lives,play a major role in how well these children and teens succeed and how they feelabout themselves. We are the ones who can help them manage with the challengesthey face, cope with frustrations, and compensate for weaknesses. We are also theones who can help them see and utilize their many strengths and value theiruniqueness.

Many children with ADHD have grown up to be very successful adults. Theyhave drawn on their strengths, creativity, and “survival skills” to their advantage.

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Introduction * xvii

On the other hand, there are many who have not fared well. There is a high corre-lation between ADHD and a number of negative outcomes. A significant percent-age of individuals who drop out of school, are unable to keep a job, are stuck in workpositions to which they have defaulted rather than aspired, fail in their interper-sonal relationships, pack our prison system, have “self-medicated” with drugs andalcohol, and so on, had this disorder without the benefit of identification, interven-tion, and treatment. Many adolescents and adults with ADHD have painful mem-ories of their childhoods, particularly of their experiences and frustrations in school.Many experienced years of failure and serious depression.

It is our responsibility in the schools to pull together as a team, doing every-thing we can to meet these students’ needs effectively. This includes providing eachchild with the environment, engaging instruction, skills, tools, and confidence tolearn and achieve. We need to be patient, positive, and understanding—and try tosee past the behaviors to the whole child—as we provide support and remove theobstacles in their paths.

Much can be done to help those with ADHD. Most of this book focuses on spe-cific strategies, supports, and interventions that have been found to be effective inminimizing the typical problems associated with ADHD and on helping thesechildren/teens achieve success. I am very fortunate to have spent most of mytwenty-three-year teaching career working at a school that was a model in “inclu-sive education.” Our staff was firmly committed to reaching and teaching all stu-dents; and we were very successful in doing so. A number of strategies orrecommendations in this book come from what I have learned from my many stu-dents with ADHD and/or learning disabilities, their families, and my colleagues.

In addition, I have had the privilege these past few years of observing hun-dreds of classrooms and working with scores of educators across the United Statesand internationally. I am grateful for the openness of these wonderful teachers (andparents), who so willingly shared their ideas, strategies, struggles, and successes.Their stories and insights have inspired and taught me so much.

For easy use, this resource is organized into six parts that provide compre-hensive, practical guidance divided into sections. In essence, the content in muchof this book comes from (1) a lot of “hands-on” experience working with studentswho have ADHD and (2) from many experts I have learned from—particularly inthe fields of education and psychology. Although the book is designed and writtento address the specific needs of students with ADHD, the suggested strategies aregenerally “good teaching practices” for all students (or “positive parenting prac-tices” for any child). The techniques and suggestions are, however, of particular ben-efit for those who are experiencing behavior, attention, or learning difficulties. Beaware that many gifted, intelligent children fall within this category.

I urge all readers to read Section 4.1, A Parent’s Story, the poignant accountby the mother of six children, four of whom have been diagnosed with ADD/ADHD.The original story from the first edition is included, along with a follow-up aboutthe family a decade later. In addition, be sure to read Section 4.2, the highlyinformative and insightful case studies of Adam and Vincent. One of the rewards Ihave gained in writing this book comes from the wonderful opportunity I had to

xviii * Introduction

interview teenagers and adults from across the country who have grown up withADHD. Excerpts of these interviews are included throughout this book. By theiropenly sharing their experiences and insights, the parents’ stories, the case stud-ies, and the personal interviews reveal an important message about what makes adifference and the power we have as teachers.

It is always preferable to be able to identify children with ADHD or any spe-cial needs early and then initiate interventions and supports at a young age inorder to avoid some of the frustration, failure, and subsequent loss of self-esteem.However, it is never too late to help a child. In many cases, the kind of help thatmakes a difference does not take a huge effort on our part. Sometimes even smallchanges (such as in the way we respond to our child or teen) can lead to significantimprovements. If I am able to convey any single message with this book, I wish forit to be one of hope and optimism. When we work together—providing the neces-sary structure, guidance, encouragement, and support—each and every one of ourchildren can succeed!

Sandra F. Rief

A Note from the AuthorThe most official term for the disorder at this time is Attention-Deficit/Hyperac-tivity Disorder (AD/HD). You may see it in print with or without the slash. In thepast, the term ADD was commonly used. Many people still prefer to use ADD if theindividual does not have the hyperactive characteristics. However, ADHD (with orwithout the slash) is the most current term or abbreviation, and it is inclusive ofall types of the disorder:

* The predominantly inattentive type (those without hyperactivity)* The predominantly hyperactive/impulsive type* The combined type

I want to make clear to readers that, although I am maintaining the use ofADD/ADHD in the title (as in the first edition of 1993), I have chosen throughoutthis new book to refer to this disorder as ADHD. Please be aware that all referencesto ADHD also include those individuals who do not have the hyperactive behaviors.

xix

1

Section 1.1: Understanding Attention-Deficit/Hyperactivity Disorder

Section 1.2: Making the Diagnosis: A Comprehensive Evaluation for ADHD

Section 1.3: Multimodal Treatments for ADHD

Section 1.4: Medication Treatment and Management

Section 1.5: Do’s and Don’ts for Teachers and Parents

Section 1.6: Critical Factors in the Success of Students with ADHD

Section 1.7: ADHD and Social Skills Interventions

Section 1.8: ADHD in Preschool and Kindergarten

Section 1.9: ADHD in Middle School and High School

p a r t

1Key Information

for Understanding and Managing ADHD

3

s e c t i o n

1.1

As mentioned in this book’s introduction aswell, many people continue to use the two dis-tinct terms of ADD (Attention-Deficit Disorder)and ADHD (Attention-Deficit/Hyperactivity Dis-order). Some use the two terms interchangeably,and others specifically use ADD when referringto those who do not have the symptoms ofhyperactivity. However, the most current andofficial term or acronym is ADHD (with or with-out the slash). This is the umbrella term oracronym under which all three types of the dis-order are included:

* The predominantly inattentive type ofADHD (those without hyperactivity)

* The predominantly hyperactive/impulsivetype of ADHD (those without a significantnumber of the inattentive symptoms)

* The combined type (the most common type ofADHD—those with a significant amount of symptoms in all three core areas—inattention, impulsivity, and hyperactivity)

In the first edition of this book (1993) I hadused ADD/ADHD, and it remains as such in thetitle of this new edition. However, throughoutthe remainder of this text I choose to use themost current terminology of ADHD; and thiswill include all three types of attention-deficitdisorders.

Definitions and Descriptions of ADHD

There are several descriptions or definitions ofADHD based on the most widely held belief ofthe scientific community at this time. The fol-lowing are some of those provided by leadingresearchers and specialists in the field:

* ADHD is a neurobiological behavioral disorder characterized by chronic and devel-opmentally inappropriate degrees of inat-tention, impulsivity, and, in some cases,hyperactivity (CHADD, 2001c).

* ADHD is a brain-based disorder that arisesout of differences in the central nervoussystem (CNS)—both in structural and neu-rochemical areas.

* ADHD is a dimensional disorder of humanbehaviors that all people exhibit at times tocertain degrees. Those with ADHD displaythe symptoms to a significant degree thatis maladaptive and developmentally inap-propriate compared to others that age.

* ADHD is a developmental disorder of self-control, consisting of problems with atten-tion span, impulse control, and activitylevel (Barkley, 2000b).

* ADHD is a chronic physiological disorderthat interferes with a person’s capacity to

Understanding Attention-Deficit/Hyperactivity Disorder

4 * How to Reach and Teach Children with ADD/ADHD, 2nd Edition

regulate and inhibit behavior and sustainattention to tasks in developmentally appro-priate ways.

* ADHD is a neurobiological behavioral disorder causing a high degree of variabil-ity and inconsistency in performance, out-put, and production.

* ADHD refers to a family of related chronicneurobiological disorders that interferewith an individual’s capacity to regulateactivity level (hyperactivity), inhibit behav-ior (impulsivity), and attend to tasks (inat-tention) in developmentally appropriateways (National Institute of Mental Health,2000; National Resource Center on AD/HD,2003a).

* Attention-deficit/hyperactivity disorder(ADHD) is the most common neurobehav-ioral disorder of childhood. ADHD is alsoamong the most prevalent chronic healthconditions affecting school-aged children(American Academy of Pediatrics, 2000).

* ADHD is a neurobehavioral disorder char-acterized by differences in brain structureand function that affect behavior, thoughts,and emotions (CHADD, 2001c).

* ADHD is characterized by a constellation ofproblems with inattention, hyperactivity,and impulsivity. These problems are devel-opmentally inappropriate and cause diffi-culty in daily life (Goldstein, 1999).

Behavioral Characteristics of ADHDThe fourth edition of the Diagnostic and Statis-tical Manual (DSM-IV), published by the Amer-ican Psychiatric Association [APA] in 1994, isthe source of the official criteria for diagnosingattention-deficit/hyperactivity disorder. TheDSM-IV and more recently the DSM-IV-TR (textrevised) lists nine specific symptoms under thecategory of inattention and nine specific symp-toms under the hyperactive/impulsive category.Part of the diagnostic criteria is that the child or

teen often displays at least six of the nine symp-toms of either the inattentive or the hyperactive/impulsive categories. The lists below containthose symptoms or behaviors found in the DSM-IV (1994) and DSM-IV-TR (2000). Below are thesymptoms specifically listed in the DSM (whichare indicated in italics), as well as additionalcommon and related behaviors (Rief, 2003).

The Predominantly InattentiveType of ADHDThis type of ADHD (what many still call ADD),refers to those with a significant number of inat-tentive symptoms that occur frequently. Theymay have some, but not a significant number ofthe hyperactive/impulsive symptoms. Since theydo not exhibit the disruptive behaviors that getour attention, it is easy to overlook these stu-dents and misinterpret their behaviors andsymptoms (for example, as “not trying” or “beinglazy”).

It is common to display any of the followingbehaviors at times, in different situations, to acertain degree. Those who truly have an attention-deficit disorder have a history of showing manyof these characteristics—far above the “normal”range developmentally—causing impairment intheir functioning (at school, home, social situa-tions, work). The nature of these inattentivesymptoms tends to heavily impact academic per-formance and achievement. Those written initalics are the behaviors that are listed in theDSM-IV and DSM-IV-TR.

Characteristics and Symptoms ofInattention (That Occur Often)

* Easily distracted by extraneous stimuli (sights,sounds, movement in the environment)

* Does not seem to listen when spoken todirectly

* Difficulty remembering and following directions

* Difficulty sustaining attention in tasks andplay activities

Understanding Attention-Deficit/Hyperactivity Disorder * 5

* Difficulty sustaining level of alertness totasks that are tedious, perceived as boring,or not of one’s choosing

* Forgetful in daily activities* Does not follow through on instructions and

fails to finish schoolwork, chores, or duties inthe workplace (not due to oppositional behav-ior or failure to understand instructions)

* Tunes out—may appear “spacey”* Daydreams (thoughts are elsewhere)* Appears confused* Easily overwhelmed* Difficulty initiating or getting started on

tasks* Does not complete work, resulting in many

incomplete assignments* Avoids, dislikes, or is reluctant to engage in

tasks requiring sustained mental effort(such as schoolwork or homework)

* Difficulty working independently—needshigh degree of refocusing attention to task

* Gets bored easily* Sluggish or lethargic (may fall asleep eas-

ily in class)* Fails to pay attention to details and makes

many careless mistakes (with math com-putation, spelling, written mechanics—capitalization, punctuation)

* Poor study skills* Inconsistent performance—one day is able

to perform a task, the next day cannot; thestudent is “consistently inconsistent”

* Loses things necessary for tasks or activities(toys, school assignments, pencils, books, ortools)

* Disorganized—misplaces or loses belong-ings; desks, backpacks, lockers, and roomsmay be total disaster areas

6 * How to Reach and Teach Children with ADD/ADHD, 2nd Edition

* Difficulty organizing tasks and activities(planning, scheduling, preparing)

* Little or no awareness of time—oftenunderestimates length of time a task willrequire to complete

* Procrastinates* Displays weak executive functions as

described below in this section

Academic Difficulties Related toInattentionReading:

* Loses his or her place when reading* Cannot stay focused on what he or she is

reading (especially if text is difficult, lengthy,boring, not choice reading material), result-ing in missing words, details, and spottycomprehension

* Forgets what he or she is reading (limitedrecall) and needs to reread frequently

Writing:

* Difficulty planning and organizing for thewriting assignment

* Off topic as result of losing train of thought* Minimal written output and production

* Slow speed of output/production—takingtwo or three times longer to execute onpaper what is typical for the average child/teen that age or grade

* Poor spelling, use of capitalization/punctuation, and other mechanics, abilityto edit written work (as a result of inatten-tion to these boring details)

Math:

* Numerous computational errors because ofinattention to operational signs (+,–,×, ÷),decimal points, and so forth

* Poor problem solving due to inability tosustain the focus to complete all steps ofthe problem with accuracy

The Predominantly Hyperactive-Impulsive Type of ADHDThose individuals with this type of ADHD havea significant number of hyperactive/impulsivesymptoms; they may have some, but not a sig-nificant number of inattentive symptoms. Chil-dren and teens with ADHD may exhibit many ofthe following characteristics (not all of them).

Understanding Attention-Deficit/Hyperactivity Disorder * 7

Even though each of these behaviors is normalin children at different ages to a certain degree,in those with ADHD, the behaviors far exceedthat which is normal developmentally (in fre-quency, level, and intensity). Again, those writ-ten in italics are the behaviors that are listed inthe DSM-IV and DSM-IV-TR.

Characteristics and Symptoms ofHyperactivity (That Occur Often)

* “On the go” or acts as if “driven by a motor”* Leaves seat in classroom or in other situa-

tions in which remaining seated is expected* Cannot sit still (jumping up and out of

chair, falling out of chair, sitting on kneesor standing by desk)

* Highly energetic—almost nonstop motion

* Runs about or climbs excessively in situa-tions in which it is inappropriate (in adoles-cents or adults, may be limited to subjectivefeelings of restlessness)

* A high degree of unnecessary movement(pacing, tapping feet, drumming fingers)

* Restlessness* Seems to need something in hands. Finds/

reaches for nearby objects to play withand/or put in mouth

* Fidgets with hands or feet or squirms in seat* Roams around the classroom—is not where

he or she is supposed to be* Difficulty playing or engaging in leisure

activities quietly* Intrudes in other people’s space; difficulty

staying within own boundaries* Difficulty “settling down” or calming self

8 * How to Reach and Teach Children with ADD/ADHD, 2nd Edition

Characteristics and Symptoms ofImpulsivity (That Occur Often)

* Much difficulty in situations requiring hav-ing to wait patiently

* Talks excessively* Difficulty with raising hand and waiting to

be called on* Interrupts or intrudes on others (butts into

conversations or games)* Blurts out answers before questions have

been completed* Has difficulty waiting for his or her turn in

games and activities* Cannot keep hands/feet to self* Cannot wait or delay gratification—wants

things NOW* Knows the rules and consequences, but

repeatedly makes the same errors/infractions of rules

* Gets in trouble because he or she cannot“stop and think” before acting (respondsfirst/thinks later)

* Difficulty standing in lines* Makes inappropriate or odd noises* Does not think or worry about conse-

quences, so tends to be fearless or gravitateto “high risk” behavior

* Engages in physically dangerous activitieswithout considering the consequences(jumping from heights, riding bike intostreet without looking); hence, a high fre-quency of injuries

* Accident prone—breaks things* Difficulty inhibiting what he or she says,

making tactless comments—says whateverpops into head and talks back to authorityfigures

* Begins tasks without waiting for directions(before listening to the full direction or tak-ing the time to read written directions)

* Hurries through tasks (particularly boringones) to get finished—making numerouscareless errors

* Gets easily bored and impatient* Does not take time to correct/edit work* Disrupts, bothers others

* Constantly drawn to something more inter-esting or stimulating in the environment

* Hits when upset or grabs things away fromothers (not inhibiting responses or thinkingof consequences)

Other Common Characteristics inChildren and Teens with ADHD

* A high degree of emotionality (temper out-bursts, quick to anger, get upset, irritable,moody)

* Easily frustrated* Overly reactive* Difficulty with transitions and changes in

routine/activity* Displays aggressive behavior* Difficult to discipline* Cannot work for long-term goals or payoffs* Low self-esteem