...affect approximately 2 million school-age children (Forness & Kavale, 2002). These children experience difficulties in behaviors crucial to academic success, such as maintaining attention, modulating activity levels, inhibiting impulsive responses, and persisting with academic tasks (DuPaul & Stoner, 2003). Because of their large numbers and refractory behaviors, children with ADHD present a challenge for the school system.

Many children with ADHD qualify for accommodations and/or services under Section 504 of the Vocational Rehabilitation Act or the Individuals With Disabilities Education Act (IDEA; Reid & Katsiyannis, 1995). Estimates are that more than half of children with an ADHD diagnosis are school-identified as eligible for services under IDEA (Barkley, 1998; Reid, Maag, Vasa, & Wright, 1994). Most of these children are served under the categories of learning disability (LD), emotional disturbance (ED), or other health impairment (OHI). Some students with ADHD and a co-occurring cognitive impairment are served under the mental retardation (MR) category (Abikoff, 2002), and those with expressive and/or receptive language limitations are served in the speech-language impairment (SLI) category.

Although ADHD has been the subject of a tremendous amount of research attention (Reid, Maag, & Vasa, 1994), relatively little research has been conducted on ADHD among students receiving special education in the schools. Forness and Kavale (2002) have identified four major questions of interest regarding these students: (1) What is the prevalence of ADHD among students served in special education? (2) Under what categories are students with ADHD served by special education? (3) In what settings are these students served? (4) What services are they provided? The following sections summarize the current literature on these questions as background for presenting new findings related to each of them.

PREVALENCE OF ADHD AND SPECIAL EDUCATION ELIGIBILITY

Many studies have focused on the extent to which children with ADHD theoretically would meet diagnostic criteria for an IDEA disability category; however, this focus does not address the question of the number of children with ADHD who actually are served under IDEA. Further, data on the extent to which children with ADHD are served in various disability categories are sparse (Forness & Kavale, 2002). Gaining a clear picture of the prevalence and category distribution of students with ADHD receiving special education is further complicated by the fact that the diagnostic criteria for ADHD have changed three times since 1980, resulting in the use of slightly different definitions of ADHD over time.

OTHER HEALTH IMPAIRMENT

OHI is the main special education category under which students with ADHD who have no coexisting disabilities may be served. In 1991, the category was opened to children with ADHD based on the "limited alertness" language in the definition (Davila, Williams, & MacDonald, 1991). The intent was to provide a means for serving children with ADHD who would not otherwise qualify for special education services.

Few data have been available on the prevalence of children with ADHD in the OHI category because states do not report the specific disabilities of children in it. Forness and Kavale (2002) noted that the increase in children identified under the OHI category exceeds that for other categories of disability; they estimated that children with ADHD accounted for 68% of new students identified in the OHI category in the 4 years before their study.

LEARNING DISABILITY

Estimates of the prevalence of ADHD among children with LD range from 10% to 92% (DuPaul & Stoner, 2003). When appropriate diagnostic criteria are applied, estimates range from 10% to 25% (Barkley, 1998). Studies that have examined the extent of ADHD among students with LD are consistent with Barkley's estimates, ranging from a low of 16.2% (Bussing, Lima, Belin, & Forness, 1998) to a high of 31.1% (Lopez, Forness, MacMillan, Bocian, & Gresham, 1996), with other studies around 25% (McConaughy, Mattison, & Peterson, 1994). Reid, Maag, Vasa, and Wright (1994) examined the disability categories of students with ADHD, rather than the prevalence of ADHD among students in each category, and found that approximately 28% of them were served under the LD category.

EMOTIONAL DISTURBANCE

ADHD appears to be slightly more prevalent among students with ED than among those with LD. Estimates range from 25% (Duncan, Forness, & Hartsough, 1995) to 44% (Mattison, Lynch, Kales, & Gamble, 1993; Mattison, Morales, & Bauer, 1993; McConaughy et Ill., 1994). Children with ADHD have a high likelihood of receiving special education services under the ED category because of the high rate of co-occurring psychiatric disorders. For example, research suggests that from 43% to 93% of children with ADHD exhibit conduct or oppositional defiant disorders, and estimates of the rate of anxiety or mood disorders range from 13% to 51% (Bird, Gould, & Steghezza-Jamarillo, 1994; Jensen, Martin, & Cantwell, 1997). Reid, Maag, Vasa, and Wright (1994) estimated that 51.9% of students with ADHD were served under the ED category.

MENTAL RETARDATION

Standardized IQ measures of children with ADHD are likely to be 7 to 15 points lower than their peers (Barkley, 1998). However, it is not clear whether these differences reflect real deficits in intellectual functioning or whether they are due to the inattentive and impulsive nature of children with ADHD. Because researchers routinely exclude students with low intelligence scores from studies of ADHD, little is known about ADHD among children with MR. One estimate (Reid, Maag, Vasa, & Wright, 1994) suggested that 9.1% of children with ADHD were served in programs for students with MR.

SPEECH-LANGUAGE IMPAIRMENT

ADHD has been associated with an increased risk for delayed speech development (Hartsough & Lambert, 1985; Szatmari, Offord, & Boyle, 1989) and problems with expressive language (Barkley, DuPaul, & McMurray, 1990; Munir, Biederman, & Knee, 1987). However, relatively few students with ADHD (7.8%) are identified in the SLI category (Reid, Maag, Vasa, & Wright, 1994).

EDUCATIONAL SETTINGS

The settings in which children with ADHD are served have obvious implications for practice. If children with ADHD spend the majority of their time in general education classrooms (as do most children with special needs), then ADHD is both a general education and a special education issue, and teacher training programs should provide general education teachers with information about the characteristics of children with ADHD and effective methods for working with them. Unfortunately, we know relatively little about the instructional settings of children with ADHD. Reid and colleague found that, among children with ADHD in special education programs, 73% were either in general education exclusively or in resource programs; 12% were in part-time self-contained classrooms; and 11% were in full-time, self-contained classrooms (Reid, Maag, Vasa, & Wright, 1994).

SERVICE PROVISION

There are two main treatment approaches for ADHD: (1) behavioral interventions, classroom modifications, and accommodations; and (2) medication.

BEHAVIORAL INTERVENTIONS, MODIFICATIONS, AND ACCOMMODATIONS

There is now good...

NOTE: All illustrations and photos have been removed from this article.



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