ADHD and Accommodations

11/22/2021 | Eileen C. Bolton, MD

The quarter’s grades are in. Your elementary schooler is “not meeting expectations”. They are having trouble focusing in class and are distracting the other children. At home, getting them to put down the video games and do their homework is a daily battle, as is bedtime and getting them off to school every morning. You are worried that they are not learning the essentials, and since your sister’s son has ADHD, could that be the problem? How should you find out? What should the school be doing, and how can you best help your child get the help they need? This brief guide to help you get started is by no means a complete set of instructions but should help you find resources and start asking questions.


Diagnosis

Start by meeting with their teacher. By this point in the year, they should have a fair understanding of how your child is functioning in school, both academically and socially, compared to the other children in the class. They should also be the primary person to ask if any learning differences might be impacting your child’s behaviors and what evaluation might be undertaken to determine that. 

The next professional to consult would be your pediatrician. Many primary care providers offer services for ADHD, and even if yours does not they should have a list of folks who can help make an initial diagnosis. Both parents and teachers (at your request) will fill out standardized rating scales such as the Vanderbilt or Connors to help figure out if this is ADHD or if there is another reason for their lack of focus. To make a diagnosis of ADHD, symptoms must be present for at least 6 months, have started before the age of 12, and include symptoms from either the inattentive area, the hyperactive area or both.

Inattentive presentation
Hyperactive-impulsive presentation
Avoiding tasks of sustained attention
Interrupting or intruding on others
Difficulty sustaining attention
Running about/climbing excessively
Difficulty following through/finishing things   
On the go as if “driven by a motor”
Not seeming to be listening
Fidgeting/squirming
Easily distracted
Difficulty remaining seated
Inattention to details/making careless mistakes
Difficulty quieting oneself
Absent minded or forgetful
Talking excessively
Losing things
Blurting out answers
Disorganization
Difficulty waiting their turn


Symptoms must 1) be present in more than one situation (both home and school) and 2) not be better explained by another diagnosis.


Next Steps

Once the forms are completed, the pediatrician will want to meet with both you and your child to discuss the results and help you formulate a comprehensive treatment plan. While medication management may be an important component of that plan, the intent of this guide is to focus on accommodations that your child may need and how to ask for them. It is always best to request an evaluation to see if your student may benefit from academic accommodation in writing and address it to the person who oversees Special Education services, with copies to the guidance counselor, homeroom teacher, and any other interested parties. Send it by both email and regular mail and keep a copy for your file. Sample letters can be found at www.healthychildren.org, the American Academy of Pediatrics website, and at www.nationwidechildrens.org.

For most children, accommodations can be made in their regular classroom setting under the guidance of a trained teacher experienced in behavior management. Based on the Federal laws that cover special education services, the Individuals with Disabilities Education Act, or IDEA guarantees the provision of special services for children whose disabilities severely affect their academic performance. Your child may qualify if they have been diagnosed with ADHD and the condition has been shown to affect performance severely and adversely.


IEP vs 504

There are many categories for disabilities that can affect learning and ADHD is considered under “other health impairment”. If the school determines your child qualifies under the IDEA, the school’s Intervention Team will develop an IEP or Individualized Education Plan. The IEP needs to meet your child’s specific learning needs in academic, behavioral, and social areas and you will meet with the team to review all the accommodations and supports recommended. The goals should be measurable and there should be a detailed description of how, when, where, and how often services will be provided. 

If your student does not qualify for services under IDEA, they may still qualify under Section 504 of the Rehabilitation Act which applies to all public and private schools that receive federal financial assistance. It is aimed at preventing discrimination against students with disabilities and emphasizes accommodating those students in regular classrooms whenever possible. This may include a reduced class size, preferential seating, modifications in homework and assignments, extended time for testing, note taking, and written instructions to reinforce the teacher’s verbal instructions as well as behavior management strategies. 


Resources

As your child’s primary teacher and advocate, your efforts will be key in obtaining an evaluation and helping formulate a plan that takes their individual needs into account. Parent support associations and local groups can help as well. You can link to your local chapter of CHADD at www.chadd.org. Our local advocacy resource www.cap4kids.org has an excellent search engine for resources of every kind, and www.nationwidechildrens.org has parent resources and even parent classes at the ADHD academy. Last but not least the American Academy of Pediatrics has a wide range of offerings from www.healthychildren.org as well as many well written books including “ADHD What every parent needs to know”, now in its 3rd edition and which served as a reference for this article.

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