Back to School With ADHD

New teachers, new subjects, new routines -- going back to school after the summer break can be taxing on any child, but it's often especially so for kids with ADHD. Parents who are mindful of this can do something to make the transition as smooth as possible.

First, give teachers the information they need to help your child have a good school year. They probably have had kids with ADHD in class before, but don't assume they know what it takes for your child to succeed.

"What may work really well for one ADHD kid may not work well for another, so it's important that parents do more than just say, 'my kid has ADHD,'" says Stephen Brock, PhD, a spokesman for the National Association of School Psychologists and an associate professor of psychology at California State University, Sacramento.

It's also best not to wait until the first day of school to address your child's needs. If you've already drawn up a 504 plan, or if your child has an Individual Education Plan (IEP), that simplifies things somewhat. Otherwise, write a letter to the teacher, and either mail it or deliver it personally before classes begin. Start the process for getting these plans in place for your child. Each is designed to create a program of instructional services to assist students with special needs who are in a regular education setting.

In the letter, detail your child's unique circumstances, including:

• Characteristics of the ADHD
• How he or she is being treated -- behavior plans and medications
• Whether the child will need to leave the classroom to take medications
• Who participates in the treatment (pediatrician, mental health professional)
• Specific strategies that have worked in the past
• What has not worked, and what causes problems
• Whether assignments or test situations need modifications

It helps to let the child write a letter, too, says Stephen Kurtz, PhD, clinical coordinator of the Institute for Attention Deficit Hyperactivity and Behavior Disorders at the New York University Child Study Center. "Kids find it a very empowering experience," he says. "It helps them feel like individuals, not cases that need to be dealt with.

"It also accomplishes the goal of destigmatizing the condition," Kurtz says.

Elementary students typically have one teacher throughout the day, but those in junior high or high school have several, which can complicate the matter. "The parent of the middle or high school-aged student with ADHD should be in contact with the school counselor and/or school psychologist," Brock says. That person will then take your concerns to all the educators your child will be seeing daily.

Expect teachers to be happy to hear your advice. "I've never had a teacher give the impression to the family that it was an encumbrance," Kurtz says.

Back to School, Back on Meds

If your child has been off ADHD medication during the summer break, he or she can go back on it at any time. Stimulant drugs such as Ritalin don't need time to build up in the system over days or weeks; they're effective immediately. "You can go from nothing today to full dosing tomorrow," Kurtz says.

It's hard to say how soon your child should go back on medication before the school bell rings. Again, every child is different, and some doctors might say there's no time like the present. Kurtz, for one, isn't sure that kids should take a vacation from their meds during the summer. He says that children with ADHD should continuously take their medications.

"I think that part of what's important is ensuring that the child has a good summer experience," says Steve Adelsheim, MD, an associate professor of psychiatry at the University of New Mexico Health Sciences Center and co-chair of the schools committee of the American Academy of Child and Adolescent Psychiatry.

If both the parents and the child feel that everything is going well "it's not clear that the medication necessarily has to be part of the equation," he says. "If those things are not happening without medication, then I think it's a different discussion."

At Home and After School

Some simple changes at home can help make the transition from carefree summer days to knuckling down at school less jarring.

If you have allowed your child to stay up and sleep in late, that needs to change when the school bus starts coming at 7 a.m. Kurtz recommends gradually phasing in a new bedtime about two weeks before school starts. "One of the things that ADHD kids are vulnerable to is a poor sleep routine," he says.

You could also reacquaint your child with studying by assigning some daily reading, or by reviewing some of last year's lessons.

"It's the same advice we give to parents of nonimpaired kids, only these kids really need it even more," Kurtz says.

All kids, regardless of ADHD, are encouraged to participate in organized after-school activities, and your child may need the structure even more. But when choosing an activity, consider how ADHD might figure in.

In baseball, for example, "you're sitting out there in right field; you're sitting there [during the entire] game, and all of a sudden one ball comes your way. And if you're not paying attention, it's going to be a bad scene," Brock says. "You don't want to set an ADHD kid up for failure, or put him or her in situations that require them to do things that are hard for them, like pay attention for long periods of time.

"Team sports may not be, for at least some ADHD kids, the best option," he says. "Rather, parents may want to look towards more individual sports, such as swimming, dance, and karate."

Kurtz says parents should not assume that because a child has ADHD, he or she needs to participate in a high-intensity physical activity in order to "blow off steam" after school. "It's kind of a commonly accepted notion that these kids have a lot of energy to burn, but it's really not supported scientifically," he says. "Within a given situation, they're fidgety because they have a hard time persisting at either boring or repetitive tasks. But after that task is over they have no more or less need to run around than the next kid."

Remember that you may need to educate the coach or other supervising adult about your child's ADHD. "In the same way that we encourage a parent to prepare a teacher, we encourage a really active dialog with whoever they're going to be with in after-school and community situations," Kurtz says.

But Adelsheim says parents shouldn't make an issue of it unless they think doing so is warranted. "You might have a child with ADHD whose behavior is totally under control, and no one even knows they have ADHD," he says. In that case, "you may not need to go through any of this."

Adelsheim also cautions parents against developing tunnel vision concerning a child's ADHD. Kids with ADHD can have social problems in school just like any other kid; Kurtz points out social problems are not a primary part of the disorder. Depression, too, can manifest in ways that look like characteristics of ADHD.

"A child with [ADHD] can also have other things going on that may be impacting them," Adelsheim says. "I think it's important to not just make assumptions about what's going on, or say, 'Oh, that's just their ADHD.'"

Getting College Services for ADHD Students

For young adults with ADHD and other learning disabilities college seems like a huge challenge. Getting extra help might seem out of reach. But, that is not truth any more. Now, when you or your child is looking to apply at different colleges, look into each college’s support services. That might help make your mind up on where to attend your formal education. It will be listed and described in college catalogues. You would assume that support services are much the same from one school to the next, but this is far from true. Although several guides that have been developed to assist parents and students in selecting colleges with good learning disability support services, no such guide has yet been developed for ADHD support services. Having the right questions to ask is vital. Here is a list of questions to get you started.
Questions to ask:

1. How many students with ADHD or other learning disabilities are registered with the DSS office? The more the better! A large number of registered students suggest better funding and staffing for support services.
2. Is the director of the Office of Disabled Student Services a clinical specialist in ADHD and/or other learning disabilities? If their answer is "no", the college is less likely to offer good support services.
3. How many ADHD and/or other learning disabilities specialists are employed full-time by disability services? Beware of large universities that employ only few specialists.
4. How long has the current director held the position? The longer the better. The program director is typically the individual who is the heart and soul of disabilities support program.
5. How long has the support program for students with ADHD and other learning disabilities existed on campus? The longer the better. Good support programs take time to build and be reliable.
6. Is there a formal learning disabilities program available for students on campus and do they a separate application? Are there additional costs associated with this program? Many students with ADHD also have learning disabilities and may need support services for learning disabilities as well.
7. Is there an ADHD specialist or ADHD special service for students? Most often the answer is "no." A positive answer, however, is an excellent sign.
8. Is there an ADHD student support group on campus? Finding other students with ADHD and having an organized meeting is a big plus.
9. Is there a faculty education program to familiarize the faculty with the needs of students with ADHD or other learning disabilities? Faculty education about ADHD is very important. Today, many faculty members have little knowledge and even less training about ADHD and may even have a negative, skeptical attitude toward students who ask for accommodations.
10. What kinds of accommodations does the school offer students with special needs? At the bare minimum, a college should provide the possibility of a note-taker in each class, the possibility of extended time on exams, and the possibility of taking exams in a quiet, non-distracting environment.
11. Is specialized tutoring available for students with ADHD or other learning disabilities? Almost all campuses provide peer tutoring, however students with ADHD and other learning disabilities typically need more specialized tutoring from a trained tutor.
12. Does the DSS office facilitate the communication of the student's disability needs to each professor? Disability services should provide official documentation of the student's disability and the accommodations for which he is eligible.
13. How complicated is the procedure a student must follow to obtain alternative testing (extended time or on a computer)? Some schools require such a complex set of steps each time a student with ADHD receives alternative testing that it is difficult.
14. Is there a specialist on campus who teaches planning, organizational and study skills? If "yes", that is positive sign. If "no," ask if they have a list of private professionals in the community that can provide these services.
15. What types of writing supports are? Writing papers is one of the greatest challenges for college students with ADHD. Because they have a particular set of challenges, it is most helpful if writing tutors are available that trained and experienced in working with students with ADHD.
16. Is ADHD coaching available through the student disability office? Some cutting-edge support service offices are beginning to train their staff in ADHD coaching techniques.
17. Does the student disability office have a list of local professionals that provide ongoing treatment such as medication and psychotherapy for ADHD? This list should be made open in all disability offices.
18. Do students with ADHD and other learning disabilities have early registration privileges to allow them to select the courses and professors they need? A very critical accommodation, allowing a student with special needs to hand-pick professors and to customize his or her schedule. It is not a good sign if a college does not provide this accommodation.
19. Does the school offer specialize academic advising through the DSS office for students with ADHD and other learning disabilities? A very strong need! If students with ADHD and other learning disabilities are sent, along with all other students, for academic advising by someone with little or no training in ADHD, the advising is unlikely to be helpful.
20. Is there a way in which a student can identify faculty members who are knowledgeable about and sympathetic toward the needs of students with ADHD and other learning disabilities? Few disability offices will provide an "ADD-friendliness" rating of faculty members, however many office will allow students to make such ratings and will keep a book of such ratings available for other students to peruse.
21. Does the DSS office help to mediate disputes between student and professor regarding rights and accommodations? Many college professors are still not aware of the legal rights of students with a documented disability such as ADHD and some are even hostile to the idea of providing accommodations to these students. Students with ADHD should strongly pursue the choice of a college which has an active ADHD faculty education program and which provides mediation when students encounter resistance from a professor who is asked to provide reasonable accommodations.
22. What is the school's policy toward course substitution when a student's disability prevents him from fulfilling a particular requirement toward graduation such as a math or foreign language course? Are requirements ever waived? Under what circumstances? If a student with ADHD has a particular difficulty with math or foreign language, it is critical that the flexibility of such requirements be carefully considered before applying to a particular college.
23. Are counselors available on an ongoing basis for ADHD? ADHD student guidance, more so than others, counseling from trained staff can make the difference between success and failure during the first year or two of college.
24. Is it necessary for students in the DSS to fail math or foreign language before they qualify for a waiver, and does the failing grade become part of the student's GPA? This is the most important question! Some schools that provide requirement waivers or course substitutions first require a student to take and fail the required course. If this failing grade becomes a permanent part of the undergraduate record it can and will have a permanent negative effect upon your GPA.
At some colleges, in order to be eligible for services and particular accommodation, you might have to produce either an IEP (Individualized Educational Program) or a letter from your physician stating that you do have ADHD; and as a result of having ADHD, you require specific accommodations.
Take the time to carefully research each college you are considering attending. Often many high school children think they will not need these services. So they give little or no consideration of the services available for students. It’s better to have them available than to not know what you could be missing out on to make your college academic career easier. Call the colleges, do your research and be prepared, that is part of being a responsible adult.

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SOURCES: Stephen Brock, PhD, associate professor of psychology, California State University, Sacramento; and spokesman, National Association of School Psychologists. Steven Kurtz, PhD, clinical coordinator, Institute for Attention Deficit Hyperactivity and Behavior Disorders, New York University Child Study Center; and assistant professor of psychiatry, NYU School of Medicine. Steve Adelsheim, MD, associate professor of psychiatry, University of New Mexico Health Sciences Center; and co-chair, schools committee, American Academy of Child and Adolescent Psychiatry. Pediatrics, April 2004. WebMD Medical News: "Effects of ADHD Treatment May Vary Over Time," April 5, 2004. AboutOurKids.org web site.