Part I: The Extent of the Problem

Attention Deficit/Hyperactivity Disorder (ADHD) is classified as a behavior disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.  Three types of the disorder are delineated by the degree to which hyperactivity and impulsivity are present.  ADHD, especially when unrecognized or untreated, can have a negative effect in many aspects of a child's life, including cognitive, social, and emotional development (Bowley & Walther, 1992).  As a result, children with ADHD may experience academic frustration and failure, rejection by peers, and low self-esteem (Erk, 1995), which may lead to future anti-social behavior, alcohol and drug abuse, dropouts, and suicide (Bowley & Walther, 1992).

The acknowledgment of and interest in ADHD has skyrocketed over the last decade, as evidenced by the increased amount of literature available.  The incidence of ADHD in American school children is estimated to be between 3% and 5% (Schwiebert, Sealander & Bradshaw, 1998).  Also, research has indicated a link between ADHD and learning disabilities, effecting between 20% and 50% of children with ADHD (Maynard, Tyler & Arnold, 1999).  Further statistics point out that an estimated 25% to 30% of students with ADHD do not complete high school (Schwiebert, Sealander & Bradshaw, 1998).  This information is of great importance to school counselors who are in a position to help these students gain more positive and successful feelings in several areas of their lives.

Part II: Behavioral Characteristics

The following are the criteria for Attention Deficit/Hyperactivity Disorder from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

A. Either (1) or (2):
 

1. six (or more) of the following symptoms of inattention have persisted for at least 6 months 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 in tasks or 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 difficulty 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)
• is often easily distracted by extraneous stimuli
• is often forgetful in daily activities

1. six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• often fidgets with hands or feet or 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 in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• often has difficulty playing or engaging in leisure activities quietly
• is often "on the go" or often acts as if "driven by a motor"
• often talks excessively

• often blurts out answers before questions have been completed
• often has difficulty awaiting turn
• often interrupts or intrudes on others (e.g., butts into conversations or games)

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] 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).

Types:

Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months.

Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months.

Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months.
 

ADHD shares symptoms with other disorders , so it is important that each student is carefully evaluated before a diagnoses is made.

Part III: Different Counseling Strategies

The school counselor can intervene in several ways, and at several levels, to help students with ADHD.  Here are a few examples:

1. Resource Coordinator/Consultant
 

• Communication between school and home is very important for consistency and carry over of plans and interventions (Nahmias, 1995).  Communication between the two locations can improve the student's understanding of expectations and can increase chances for success.  The school counselor can help facilitate communication between parents, teachers, other professionals involved, and the student.

• Providing information to parents and staff regarding students'educational rights  may also be necessary.

• It may be appropriate for the school counselor to share information with parents and staff regarding accommodations in the classroom.

• The school counselor may also have the opportunity to provide school staff with inservices about ADHD.

• Individual and small group counseling may be indicated to address the following areas:

                   Social Skills:  Children are likely to have an idea of how they are negatively perceived by others and may actually inadvertently elicit negative behaviors and responses from others (Wheeler & Carlson, 1994).  Students may benefit from opportunities to observe appropriate behavior being modeled by others, and from role-playing problematic situations.  A free lesson plan addressing interpersonal skills is available at lifeskills4kids.

                    Self Concept:  There may be gender differences in the issues faced by adolescents with ADHD.  For example, girls may experience feelings of inadequacy, while boys may struggle with anger and defiance.  Additionally, adolescents may have a hard time separating themselves from their diagnoses and may have a negative self concept (Kreuger & Kendall, 2001).  With older children and adolescents, the counselor's role may be to help them develop self advocacy and reliance (Schwiebert, Sealander & Bradshaw, 1998).

                   Organizational Skills/Study Skills:  It is often challenging for students with ADHD to organize  their supplies, thoughts, and behaviors.  A contractor reward/behavioral system may be effective.  Examples of rewards could include verbal praise, awards, and recognition (Nahmias, 1995).
 
 
 

Part IV: Conclusions and Recommendations

The biggest thing that struck me after researching this information was the extent to which ADHD effects all areas of children's lives- not just academic work, but their ability to play with others and make friends, their ability to complete daily routines, their sleeping and eating patterns, their emotional health.  Now that awareness of attentional disorders is increasing, it is likely that schools are going to be dealing with larger numbers of students who may need extra support for success.  I think that school counselors are in a great position to coordinate services for students with ADHD including parent training, gathering information from outside sources, relaying information between students, teachers, and other professionals, and providing consultative and direct services to students.  It may be extremely helpful to design some type of protocol for counseling intervention for students with ADHD, while recognizing each student's individuality and uniqueness.  Most importantly, from personal experience working with children with ADHD, I think that a comprehensive approach involving several disciplines is the best way to obtain the full picture of how a child is developing and functioning.
 
 

Part V: References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Bowley, B.A., Walther, E. (1992). Attention deficit disorders and the role of the elementary school counselor. Elementary School Guidance & Counseling, 27, 39-47. Retrieved January 26, 2002, from EBSCOHost Web database.

Erk, R. R. (1995). A diagnosis of attention deficit disorder: what does it mean for school counselors. School Counselor, 42, 292-300.Retrieved January 26, 2002, from EBSCOHost Web database.

*Kelly, P.C., Cohen, M.L., Walker, W.O., Caskey, O.L., & Atkinson, A.W. (1989). Self-esteem in children medically managed for attention deficit disorder. Pediatrics, 83, 211-217. Retrieved January 26, 2002, from EBSCOHost Web database.

Krueger, M., & Kendall, J. (2001). Descriptions of self: an exploratory study of adolescents with ADHD. Journal of Child and Adolescent Psychiatric Nursing, 14, 61-72. Retrieved January 26, 2002, from EBSCOHost Web database.

Maynard, J., Tyler, J.L., & Arnold, M. (1999). Co-occurence of attention deficit disorder and learning disability: an overview of research. Journal of Instructional Psychology, 26, 183-188.  Retrieved January 26, 2002, from EBSCOHost Web database.

Nahmias, M.L (1995). Communication and collaboration between home and school for students with ADD. Intervention in School & Clinic, 30, 241-248. Retrieved January 26, 2002, from EBSCOHost Web database.

Schwiebert, V. L., Sealander, K.A., & Bradshaw, M. L. (1998). Preparing students with attention deficit disorders for entry into the workplace and postsecondary education. Professional School Counseling, 2, 26-33. Retrieved January 26, 2002, from EBSCOHost Web database.

Wheeler, J., & Carlson, C.L. (1994). The social functioning of children with ADD with hyperactivity and ADD without hyperactivity. Journal of Emotional and Behavioral Disorders, 2, 2-13. Retrieved January 26, 2002 from EBSCOHost Web database.

Websites

 www.chadd.org

 www.add.org

 www.lifeskills4kids.com

 www.ldonline.org

 www.ashland.com

 www.add-adhd.org

 www.teis.virginia.edu