Attention deficit hyperactivity disorder, frequently referred to as hyperactivity
or attention deficit disorder (ADHD), is a severe and usually chronic disorder
estimated to affect 3% to 5% of school-age children (American Psychiatric Association).
ADHD is more prevalent in males, with boys outnumbering girls by a mean ratio
of six to one in clinic samples (Barkley). Phelan notes that on average, one
child in an elementary school classroom has ADHD. Moreover, he reports that
approximately 40% of students manifesting problems are likely to be students
with ADHD. Children with ADHD experience behavioral difficulties, which most
often manifest in distractibility, inattention, impulsivity, or hyperactivity.
In fact, ADHD children are most commonly characterized as having difficulty
completing tasks or persisting at a play activity, difficulty concentrating
on tasks requiring sustained attention, distractibility, and not paying attention
(Hoza & Pelham). As a result, children with ADHD may develop emotional,
social, developmental, academic, and/or family problems because of the frustrations
and difficulties they commonly experience due to the disorder. In addition,
the families of children with ADHD may experience pressures and stresses beyond
those produced by normal developmental problems (Schwiebert, Sealander, & Tollerud;
Sealanderetal). Although most children with ADHD exhibit the first signs of
difficulty before the age of 4, most often ADHD is first diagnosed when the
child is in elementary school. Moreover, the behaviors of ADHD children and
the problems which result put the ADHD child at risk for the following: completing
their education, substance abuse, poor vocational achievement, social rejection
by peers, oppositional behaviors, and delinquency. However, with proper intervention
and treatment, children with ADHD can learn how to cope with daily demands
in the classroom, in social situations, in family situations, and with life
in general. Therefore, it is essential that identification of children with
ADHD occur early. This allows teachers, parents, healthcare professionals,
and school therapists to work with these students to assist them with strategies
and intervention techniques designed to facilitate adjustment to school and
vocational situations, social situations, family situations, and life in general.
It is important to note that while definite criteria exist for the diagnosis
of ADHD, the experiences of children and families affected by ADHD may differ
depending on the cultural lens through which ADHD is experienced. Expressions
of ADHD by the child as well as familial recognition of and/or response to
these behaviors may differ depending upon cultural and ethnic influences. To
date, there is no research that attempts to define differences in the experience
of ADHD by children with the condition and their families from a cultural perspective,
it is, however, important for therapists to consider the effects of ADHD and
the development of treatment interventions within the cultural context of the
affected child and family. It is beyond the scope of this paper to address
this topic. However, a discussion of the accepted criteria for recognizing
and diagnosing ADHD are included below.
Characteristics of Children and Adolescents with ADHD
According to the Diagnostic and Statistical Manual of Mental Disorders (American
Psychiatric Association) definition, ADHD consists of one of three subtypes--predominantly
inattentive type, predominantly hyperactive-impulsive type, or combined type--although
most individuals will have symptoms of both inattention and hyperactivity-impulsivity.
To be diagnosed with ADHD, the individual must exhibit the following symptoms:
A. Either 1 or 2: 1. At least six (or more)
of the following symptoms of inattention have persisted for at least 6 months
and to a degree that is maladaptive and inconsistent with developmental level: • Often
fails to give close attention to details or makes careless mistakes in schoolwork,
work, or other activities • Often has difficulty sustaining attention
to tasks and play activities • Often does not seem to listen when spoken
to directly • 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) • Often has difficulties
organizing tasks and activities • Often avoids, dislikes, or is reluctant
to engage in tasks that require sustained mental effort (such as schoolwork
or homework) • Often loses things necessary for tasks or activities (e.g.,
toys, school assignments, pencils, books, or tools) • Often is easily
distracted by extraneous stimuli • Often forgetful in daily activities 2. At
least six (or more) of the following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months and to a degree that is maladaptive and
inconsistent with developmental level: • Hyperactivity: often fidgets
with hands or feet and squirms in seat, often leaves seat in classroom or in
other situations in which remaining seated is expected, often runs about or
climbs excessively in situations where it is inappropriate (in adolescents
or adults, may be limited to subjective feelings or restlessness), often has
difficulty playing or engaging in leisure activities quietly, is often on the
go or acts as if driven by a motor, often talks excessively • Impulsivity:
often blurts out answers to questions before questions have been completed,
often has difficulty awaiting turn, often interrupts or intrudes on others
(e.g., butts into others conversation or games)
B. Some hyperactive-impulsive or inattentive symptoms that
caused impairment were present before the age of 7 years.
C. Some impairment from the symptoms is present in two or
more settings (e.g., at school 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, Dissociative Disorder, or a Personality Disorder).
Although the DSM (American Psychiatric Association) specifies that diagnostic
criteria must be present before age 7, difficulties associated with ADHD may
persist well beyond the childhood years. Although their classroom behavior
typically becomes less disruptive as they get older, children diagnosed with
ADHD have problems that persist into adolescence. With respect to performance
in the classroom, they remain impulsive, easily distracted, and have problems
with tasks requiring attention and concentration (Fischer, Barkley, Edeibrock, & Smallish;
Currently, from. a legal perspective, ADHD alone is not a handicapping condition
that qualifies children for special education services. Those students receiving
special education services do so on the basis of a coexisting condition such
as a learning disability (Teeter), or services may be provided in the regular
classroom under Section 504, which requires accommodations and services be
provided for children diagnosed with ADHD. The latter is less favorable for
the school system as schools do not receive funding for these services. Because
coexisting conditions have implications for service provision and the formulation
of effective interventions, they are discussed below.
Academic underachievement is one of the most commonly reported correlates of
attention deficit hyperactivity disorder. Learning problems are estimated
to occur in from 9% to 48% of children with ADHD (Frick et al.). Teeter reports
that up to 80% of children with learning disabilities also have hyperactive-attentional
problems, are below expected levels academically, and are at higher risk
for school failure. A learning disability can be classified as a disorder
in areas such as oral expression, listening comprehension, written expression,
basic reading skills, and reading comprehension. Success in these areas is
related to advances in language. Co-existence of ADHD and language disabilities
has been well documented (Cantwell, Baker, & Mattison; Wodrich). Cantwell
and Baker conducted a follow-up study of 600 children with early speech and
language delays. They found that there was an increased prevalence of learning
disabilities and ADHD in this population.
Difficulties in oral expression and listening comprehension
in language/learning disabled students includes the inability to maintain an
overall organization of verbal information, process verbal information, and
make evaluations or judgments regarding the information. Additionally, the
inability to organize information with complex syntax and structure can impact
the written expression as well as reading comprehension of students with language/learning
difficulties (Shankweiler & Liberman). These deficit areas can be intensified
when coupled with characteristics of attention deficit disorder. According
to Hallowell and Ratey, characteristics of young adults with ADHD include difficulty
getting organized, the tendency to say what comes to mind without regard to
timing and appropriateness, and drifting in the middle of conversation. These
characteristics affect the organization of spoken and written information,
social interactions, academic functioning, and general daily functioning. Examples
of other co-existing conditions include a diagnosis of Conduct Disorder (CD),
delinquent behaviors (Frick et al.), general learning disabilities (Robins),
reading deficits, and externalized behavioral problems (Hinshaw). Of 115 boys
with ADHD referred to a university outpatient clinic, 39% also had a specific
reading disability (Sealander, Schwiebert, Eigenberger, Little, & Ross).
On a battery of cognitive and attentional measures, both ADHD groups (with
and without a reading disability) performed at a lower level than a control
group (August & Garlinkel). Other areas in which ADHD children are more
likely to have difficulties are problem-solving strategies and organizational
skills; problems associated with sleeping; and emotional disorders of various
- Schwiebert, Valerie A, Karen A Sealander, and Monica L Bradshaw; Preparing
students with attention deficit disorders for entry into the workplace and
post-secondary education; Professional School Counseling; Oct98, Vol.
2 Issue 1, p26
Reflection Exercise Explanation
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 250 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities.
Reflection Exercise #1
The preceding section contained information
about characteristics of ADHD children. Write
three case study examples regarding how you might use the content of this section
in your practice.
Peer-Reviewed Journal Article References:
Burns, G. L., Becker, S. P., Servera, M., Bernad, M. d. M., & García-Banda, G. (2017). Sluggish cognitive tempo and attention-deficit/hyperactivity disorder (ADHD) inattention in the home and school contexts: Parent and teacher invariance and cross-setting validity. Psychological Assessment, 29(2), 209–220.
Overgaard, K. R., Oerbeck, B., Friis, S., Biele, G., Pripp, A. H., Aase, H., & Zeiner, P. (2019). Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4. Psychological Assessment, 31(8), 985–994.
Patros, C. H. G., Tarle, S. J., Alderson, R. M., Lea, S. E., & Arrington, E. F. (Mar 2019). Planning deficits in children with attention-deficit/hyperactivity disorder (ADHD): A meta-analytic review of tower task performance. Neuropsychology, 33
Smith, Z. R., Eadeh, H.-M., Breaux, R. P., & Langberg, J. M. (2019). Sleepy, sluggish, worried, or down? The distinction between self-reported sluggish cognitive tempo, daytime sleepiness, and internalizing symptoms in youth with attention-deficit/hyperactivity disorder. Psychological Assessment, 31(3), 365–375.
According to the DSM, what are the three subtypes of ADHD? Record the letter of the correct answer