The U.S. Department of Education released a letter to schools last week informing them of their obligations to identify and assist students with ADHD, or Attention Deficit Hyperactivity Disorder. The guidance reminded schools of their obligations toward students with ADHD, since 10 percent of the department’s 16,000 Office of Civil Rights complaints involve allegations of discrimination against students with the disorder.
According to the department, the most common complaint is that students aren’t identified in a timely manner or evaluated properly. Schools often fail to distribute information to staff on how to identify students and provide them with the right interventions and allow financial considerations into decisions about identifying and helping students.
The guidance also challenges pernicious stereotypes and assumptions that set students with ADHD back. Teachers may assume that students who perform well on tests and on homework don’t need to be diagnosed, that girls don’t have ADHD, and that interventions should only allow for things like more time on tests instead of teaching kids skills to manage their time. There are also a lot of misunderstandings about what learning disorders such as ADHD are and how they work. Here are some of the most common assumptions:
We’re identifying kids of all races and ethnicities
A 2013 study found that black children were almost two-thirds less likely to be seen as having ADHD symptoms compared to white children, and Hispanic children, Asian children, and children of other races were about half as likely to have these symptoms noticed compared to white students.
Myles Moody, a Ph.D. student at the University of Kentucky’s Department of Sociology, has studied issues of ADHD diagnosis of black students, the school-to-prison pipeline, and parent-teacher relationships. Research has shown that black students in particular are more likely to receive suspensions and expulsions, that teachers can be racially biased in doling out discipline, and that black children are seen as older than they actually are.
“They’re not getting the help that they need and studies continue to show that there is a huge gap in assessments, and that black children are disproportionately under-diagnosed for the disorder, even though it hasn’t yet been proven that they are less likely to have the disorder,” Moody said. “I believe that this is a cause for concern. Many other scholars have been working in this area, and it certainly warants attention from policymakers, teachers and parents of children with ADHD. It’s a cause for concern for everyone.”
Moody added that there are a number of reasons why this might be the case, such as a tendency to pursue discipline over identifying behavior and offering help when it comes to black students, a lack of connection between parents and teachers in schools in low-income neighborhoods, and the distrust some black people may carry of anything having to do with diagnosis or assessment of behavioral issues.
Moody said that his recent research on relationships between parents and teachers required him to speak to teachers at schools in low-income neighborhoods. He said that distrust of professional medical scrutiny — due to a history of black people being subjected to experiments in the scientific community — doesn’t help either, and may contribute to teachers and family members seeing diagnosis as a “last resort.”
“I asked him, ‘How many referrals for assessment have you made as a teacher?’ and he replied ‘None, I refuse to,’ and the reasoning was he felt as though he wasn’t doing enough as a teacher to improve his classroom management and he wanted to try every option before he resorted to ADHD assessment. He saw ADHD diagnoses and treatment as a last resort and when teachers are looking at it as a last resort, it can be a huge barrier [to diagnosis], even though they may mean well and have good intentions,” Moody said.
Kids with good grades don’t have ADHD
The letter also knocks down the idea that students who are excelling academically wouldn’t have ADHD or need assessment for ADHD. Judith R. Harrison, an assistant professor at the Graduate School of Education at Rutgers University whose research focuses on special education, pointed out that grades are not always the best indication of what a student is learning.
“If a child has support at home with organizing their materials so they get to school and manage to turn all of their assignments in and their grades are good, they still haven’t learned to organize their materials, so it doesn’t really reflect what skills they’re learning,” Harrison said.
Students with ADHD may also have issues with learning certain social skills as well, Harrison said.
“They’re impulsive and they interrupt, not all, but as a group they tend to be loud and hyper. So if you’re working on a group project and someone in your group is demonstrating those behaviors, then it makes group work difficult,” Harrison said.
Girls don’t have ADHD
There is a tendency for educators to identify boys as having ADHD far more than girls because people most associate a hyperactive-impulsive type of ADHD with ADHD. Girls, who are more likely to have Inattentive ADHD, which means they may be easily forgetful, disorganized, and don’t finish their work, may also try to cover up their symptoms because they are expected to perform better at school, experts say. These cultural expectations make it difficult for girls to ask for help or for educators to see them as being in need of help.
Rae Jacobson wrote about her experience with ADHD in New York Magazine last year. She wrote, “Beyond my failures at school and work, not being able to focus made me feel like I’d failed at being a girl. Having ADHD is challenging regardless of gender but in a world predisposed to undermining women, not having your shit together can feel like a dereliction of feminine duty.”
This under-diagnosis of girls is beginning to change, however. Diagnoses for girls have risen 55 percent from 2003 to 2011, according to a study in the Journal of Clinical Psychiatry and prescriptions for medicine for ADHD is increasing for women too. Since girls and women are often identified later, it has been beneficial to girls and women with ADHD that the Diagnostic and Statistical Manual of Mental Disorders was recently revised to show that ADHD symptoms could cause impairment before age 12 and explained how symptoms could appear in adolescence and adulthood.
It will fade over time
One of the challenges of identifying students is that parents may be reluctant to acknowledge the child’s struggles with attention and hyperactivity are more than a phase. According to a 2014 survey from the National Center for Learning Disabilities, parents surveyed said they assumed traits tied to learning disabilities in children ages 3 and 4 would go away and two in three were reluctant to ask about early intervention services.
Harrison said that assumption is becoming less of a problem but it is still there. The child’s symptoms may become less visible over time, but that doesn’t mean they aren’t there and affecting the child’s ability to organize and concentrate on a task.
“That has been a common belief for years, that they grow out of it, and I think it’s worse for kids with ADHD because the hyperactivity tends to get better as they get older so what you physically see — the movement — would turn more into things like doodling instead of running around the room. So maybe it looks like it’s going away but the inattention is still there. I think we’re learning over time that it’s not going away,” Harrison said.
Accommodations are the only solution
Harrison said there is a tendency for schools to think about accommodations as the only way to help kids with ADHD do better in school, but Harrison said it’s just as important for kids to learn the skills to do things they find challenging, such as taking notes or figuring out how to organize a long-term project for example. One of the things that impressed her about the department’s letter was its choice to downplay accommodations.
“For example, if we think a kid can’t take notes we give them notes instead of teaching them to take notes, and there is no research to support that. None. So what I am trying to do is see if there are interventions we can use to teach those skills. It may take longer, it may be a struggle, but we need to teach them and have those accommodations but phase them out,” she said.
Everyone’s needs are the same
As the department makes clear in its guidance, not all children with disabilities and learning disorders benefit from the same interventions, and neither students with ADHD. The interventions should depend on an individual child’s needs, a directive Harrison was happy to see. For example, the department said that one student may need more time on an exam but another child may need a different testing format because they struggle with multiple choice questions. Some children may need behavioral but not academic interventions.
“They talk about not just using a laundry list of strategies. They talk about it being needs-based, which is huge, so what does this child need compared to this child? Because those things could be totally different. Not all strategies work for all students,” Harrison said.