ADHD for Educators

This resource was developed in collaboration with health care professionals and educators to provide critical information and resources for school personnel working with children who have, or who are suspected as having attention deficit/hyperactivity disorder (ADHD).

Identification of ADHD

Overview
ADHD is a chronic neurobehavioral disorder that affects all aspects of a child’s life, including school, home, social relations, and extra-curricular activities. A child can be diagnosed with ADHD with hyperactive subtype, inattentive subtype, or combined-type (both hyperactive and inattentive). What many people refer to as attention-deficit disorder (ADD) is actually just the inattentive subtype of ADHD; ADD is an outdated term and was formally changed to ADHD in 1994.
Prevalence
ADHD is one of the most common chronic disorders of childhood. In a classroom of 30 children, it would not be unreasonable to expect 3 kids to have ADHD. [U.S.: 2014] Boys are more than twice as likely as girls to receive this diagnosis. [Visser: 2014] Prevalence of ADHD is rising in the United States; it is unclear if a greater number of children have the condition, or if there is better recognition of it - or both.
child sitting backwards on chair looking at camera while other children do table work in a classroom setting
Christopher Futcher/Istock Photo
Behaviors that School Personnel May See
Teachers are often the first to see behaviors that may be suggestive of ADHD:
  • Problems waiting for his or her turn, interrupting other kids, acts without thinking
  • Cannot hold still, fidgety, can’t stay in seat, runs around, may show aggression, cannot play quietly, talks excessively
  • Distracted easily, daydreams, doesn’t finish tasks, forgetful, makes careless mistakes, doesn’t seem to listen
In addition to the challenging behavior, teachers may see positive traits:
  • Creativity, brings new ideas to the classroom, artistic talent
  • Ability to identify what others do not see, has a fresh perspective
  • Enthusiasm and spontaneity
  • Mental flexibility, intelligence
The colorful 2-page printable resource, Recognizing ADHD in the Classroom (CHADD) (PDF Document 232 KB), provides a quick summary of red flags and strategies and tips for the classroom.
Working with Parents and Physicians: Before a Diagnosis
School personnel should never say, in any way, “I think your child has ADHD,” or tell a parent that his or her child should see a pediatrician. Instead, when a student is suspected of having ADHD, it is wise to have regular discussions with the family about the child’s observed strengths and challenging behaviors in the school setting:
  • Ask parents if there are similar challenges at home or in other settings, but do not assume that the child acts the same way outside of school.
  • Share with the family any testing and interventions that the school team has already implemented to support the child, and the child’s response to those interventions. Encourage families to share your documentation with the child’s primary healthcare provider.
  • It can be helpful to explain that you are concerned that ADHD or another untreated medical condition may be keeping the child from achieving his or her full potential, but it is not appropriate for a teacher to tell a parent that their child has ADHD. (This is making a diagnosis.)
If it is difficult finding the right words to communicate your concerns with families, consider statements such as: “We/I’ve noticed that Johnny sometimes demonstrates __________[the following behaviors] in class. Have you had similar concerns at home? Have you ever talked about these behaviors/concerns with your pediatrician?”
It can take time for a family to agree that their child should get a medical evaluation, and it is the parents' choice on whether to follow up with medical help or not. In the meantime, school staff should work as a team to support the child, the other students, and the teachers who interact with the child.

Diagnosis of ADHD

The child’s primary care clinician often is the person who makes the diagnosis of ADHD; however, supporting information from the parents and educators plays an integral role. School staff should provide the family with relevant behavioral observations, test results, and supporting documentation. Specific screening forms, such as the Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) (PDF Document 1.1 MB), can be shared with the family, who then may discuss the ratings with their child’s clinician. Talking directly with the clinician can be helpful, too; if there is a mental health specialist familiar with the child, this person should also be consulted. Discussing a student with subspecialists external to the educational system requires written consent from the parent on school forms. See Communicating with the Medical Provider, below.
Barriers to Diagnosis and Treatment
  • It can take time to make a diagnosis of ADHD because the diagnosis requires impaired function in 2 or more of the child’s regular settings (home and school being the most common).
  • Teachers may have multiple students with ADHD or other behavioral, developmental, medical, or learning problems.
  • Recognition of students with the inattentive subtype can be relatively slow because these students may present with quiet school failure or not achieving their potential, but are not necessarily disruptive to others.
  • Parents often lack the perspective to know that their child has a medical problem, and can feel embarrassed or angry that their child is struggling in school.
  • Parents may perceive a poor fit between the student and teacher, and may wait to see if the issues resolve with next year’s teacher.
  • Children with ADHD and high cognitive function may not struggle with academics until the material becomes increasingly complex.
  • The school may have limited access to a psychologist who can help in this process.
  • The child may not have a primary care provider (a medical home) or may lack insurance to cover medical visits or medications.
  • Parents also may have symptoms of ADHD, and this can make it difficult for them to follow through on medical and school appointments.
  • Many people worry about using medications to treat ADHD in children.
  • Minorities and uninsured children are less likely to get a diagnosis (and therefore treatment) of ADHD.
Working with Parents and Clinicians: After a Diagnosis
  • When children are trialing medications, frequent feedback helps ensure appropriate therapy; let the family know about improvements or side effects that you may observe.
  • When a child divides time between different households, taking medication regularly can be challenging; families can arrange for medication to be given at school if needed.
  • Continue working on behavioral and academic supports in the school setting. Medication can be very helpful in managing symptoms, but it does not cure ADHD. Teach children how to structure and organize their learning environment so that they can learn to manage ADHD on their own, with or without medications.

Interventions in the School Setting

Visual schedules. Post them and stick to them. If children have difficulty following the class schedule, they can have their own visual schedule at their desk.

Consistent behavioral plan. Use it among all school staff (teachers, librarians, therapists, coaches, etc.). When kids know what to expect, they are more successful. See Supporting and Responding to Behavior: Evidence-Based Classroom Strategies for Teachers.

ABC’s of behavior (antecedents, behaviors, and consequences). Be aware of what the child is getting out of the maladaptive behavior. Is there a better way to meet this need? Documenting can help in recognizing behavior patterns and in developing individualized interventions. The ABCs of Behavior provides more details.

Response to Intervention (RTI). Use RTI, a tiered behavioral intervention model, to develop meaningful interventions and to determine the need for additional behavioral supports RTI Action Network: Behavior Supports (NCLD).

Brain breaks. Use of short breaks throughout the day for children to move around and have fun improves attention spans. See Brain Breaks (Go Noodle).

Exercise. Encourage kids with ADHD to get exercise before school (e.g., walking or riding a bike to school) and to be active during recess. Exercise increases blood flow to the brain and helps kids improve their academic performance. It is counter-productive to penalize children with ADHD by taking away recess time.

Nutrition. Ensure that the child with ADHD is getting a nutritious breakfast and lunch. Stimulant medications may suppress appetite, and a noisy lunchroom can also be very distracting. Consider recess before lunch, instead of after lunch, so that children are not skipping lunch to play.

Support. Be supportive and patient. Many children with ADHD feel bad about being considered disruptive, lazy, or stupid. Messages they get from educators and school staff can help them understand that they are not bad kids. Be sure to reinforce positive behaviors and notice small steps in the right direction.

Be an ally. Kids with ADHD may appreciate special passwords or signals to indicate that they need to get up and move around. Consider asking these kids to pass out papers, sharpen pencils, take things to the office, etc. Children who take medications at school may feel embarrassed if other students know that they are leaving class to take their medicine, so develop a strategy to help protect the student’s privacy.

Team approach. Document responses to interventions and share successful (and unsuccessful) strategies with other school staff who work with the same child.
  • Psychologists can perform testing to understand if the child has learning disabilities or an autism spectrum disorder that affect their participation and success in the educational setting. They may also help with evaluating the child and accessing resources such as anger management or social skills groups.
  • Occupational therapists often have tools that can help children with ADHD, such as wiggly seats or balls to sit on, time-on-task buzzers/reminders, headphones, etc.
  • Special educators can assist in behavioral observation and interventions.
  • Nurses can provide additional information about the child’s medical condition and possible side effects of medications.
  • Physical therapists are good resources for children with both coordination disorder and ADHD.
  • Speech therapists are helpful when there is a concurrent language disorder.
  • Administrators can help with coordinating a school-wide (or district-wide) behavioral plan to ensure consistency in all the child’s school settings.
  • Other teachers and aides may have insights and experiences to share as well, and can be an excellent source of support.
  • Parents can be great resources for how best to work with their child, and what to do when things are not going well. If you have useful strategies that work at school for a child, share these with interested parents to promote consistency across settings.

Information about ADHD Treatments

Medication and behavioral supports are the main evidence-based treatments of ADHD.

Stimulant Medications
Compared to other medications, stimulant medications have the strongest likelihood of improving ADHD symptoms. Stimulants can decrease symptoms including hyperactivity, impulsivity, inattentiveness, and trouble getting along with others. Stimulants are recommended as first-line treatment for children 6 years old and older by the American Academy of Pediatrics. [Wolraich: 2019] Stimulant medications work on certain neuroreceptors in the brain. Approximately 75% of children with ADHD will respond to stimulant treatment if dosing is correct. Stimulant medications fall into two classes: (1) methylphenidates (includes Ritalin, Metadate, Concerta, Daytrana, Focalin, Methylin, Quillivant, Quillichew, Aptensio, Relexxi, Adhansia, Cotempla, Jornay) and (2) amphetamines (includes Adderall, Vyvanse, Dexedrine, ProCentra, Zenzedi, Evekeo, Adzenys, Dyanavel, Mydayis). Both classes have shorter- and longer-acting release formulas to make them effective for 2-12+hours.

Common side effects can include mild bellyaches and headaches, depressed appetite and weight loss, difficulty sleeping, increased blood pressure and heart rate, irritability, and anxiety. Risks for stimulant misuse include sharing or selling to other students or having medications stolen.

Non-stimulant Medications
Non-stimulants can be considered when side effects, lack of effect, or other concerns interfere with the use of stimulant medications. These medications take longer to reach full effect, so it can take a while to see if they work.
  • Atomoxetine (Strattera) regulates norepinephrine in the brain. Side effects include upset stomach, decreased appetite, dizziness, mood swings, and fatigue.
  • Guanfacine (Intuniv, Tenex) and clonidine (Kapvay, Catapres) lower blood pressure and can help with attention. Side effects include dry mouth, sleepiness, mood changes, stomach discomfort, constipation, low blood pressure, and dizziness.
  • Some antidepressants can be used to help with ADHD; however, little data for use in children exists, and they can have other side effects.
Natural Treatments
Mind-Body Approaches to help with attention and self-regulation
  • Yoga
  • Exercise (such as martial arts)
  • EEG neurofeedback (Although there is some support for use of neurofeedback for ADHD, this therapy is often not covered by insurance and has significant out of pocket expenses for the family. Effects are not maintained once treatment has been discontinued.)
Dietary Approaches
  • Omegas. Although treatment with stimulants are more effective, some evidence supports use of high dose Omega 3 and 6 fatty acids for treatment of ADHD.
  • Diet. A healthy diet with whole grains, fruits, vegetables, and lean protein sources, and maintaining even blood sugar and insulin levels by eating frequent, smaller meals, are reasonable approaches to aiding in the management of ADHD. Not a lot of evidence supports a particular diet; however, analysis of the 2011 Impact of Nutrition on Children with ADHD (INCA) study suggests that a medically supervised food elimination trial may be an approach to consider. [Pelsser: 2011] In contrast, European guidelines indicate no evidence for elimination diets unless there are GI symptoms. There is lack of evidence for exclusively organic diets to help ADHD symptoms.
  • Food dyes. There is some evidence for avoiding food dyes to reduce some ADHD symptoms in some children.
  • Further information. For a more in-depth review of dietary approaches to managing ADHD, see The Diet Factor in ADHD (AAP) and Complementary Medicine and ADHD (Medscape), which is available with a free account.
Other Approaches
Popular alternative practices for managing ADHD symptoms also include herbal supplements, homeopathic treatments, vision therapy, chiropractic adjustments, yeast infection treatments, anti–motion-sickness medication, metronome training, auditory stimulation, and applied kinesiology (realigning bones in the skull). Many of these approaches are not proven effective, or are detrimental to the child's health.

Overdiagnosis or Misdiagnosis

Many people worry that normal childhood “disruptive” behaviors are misdiagnosed as ADHD, particularly among active little boys. While making the diagnosis can facilitate helpful interventions, labelling and medicating active children without ADHD can be harmful. This is why the diagnosis should be made cautiously and with input from people who are familiar with the child in different settings.
Look-alike Conditions
Several other conditions can result in inattentive or hyperactive symptoms that may be mistaken for ADHD, but do not respond to traditional ADHD treatments:
• Substance abuse • Sleep problems
• Hunger or poor nutrition • Anxiety
• Depression or bipolar disorder • Autism spectrum disorder
• Traumatic stress through home or
community violence, homelessness or
displacement, loss or imprisonment
of a parent, etc.
• Learning problems caused by other factors (e.g., moving and changing schools often, frequent absences, learning English as a second language)
Related Conditions
Children with ADHD can have other conditions, complicating diagnosis and treatment: (Conditions that have a link lead to Portal diagnosis and management information.)

Communicating with the Medical Provider

Contacting the prescribing clinician can be helpful if you have specific questions or concerns about the child’s medical treatment. The family’s permission is necessary for you to have direct communication with the medical provider. Obtain written consent from the parent or guardian to authorize transfer of records, verbal and/or e-mail communications, etc., as appropriate. Sample forms to enhance communication between medical provider and schools can be found at Forms for Education, including a Schools Information Release Form (PDF Document 49 KB) to authorize two-way communication. For more information about privacy rights see the Portal's section about Forms for Education.
Faxes, phone calls, e-mails, and (less frequently) in-person or online meetings are all methods to communicate with the medical provider; however, like educators, clinicians are often difficult to reach directly while they are working. If direct communication is challenging, see if the physician has a care manager who can help facilitate the process. This is typically a person such as a nurse, medical assistant, or social worker in the clinic who is familiar with more complex patients in the practice, but is not a prescriber.

Resources

Information & Support

Teaching Students with ADHD

Understanding ADHD: For Educators (CHADD)
This website offers additional training and resources on ADHD to help educators improve the classroom experience for their students. Specific sections include: classroom accommodations, instructional process, assignment accommodations, teacher training and video, webinars on preschoolers, educational rights, and teacher to teacher training; Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).


ADHD in the Classroom - Tips and Strategies for Educators (PDF Document 7.2 MB)
An experienced occupational therapist provides lots of visual examples of useful interventions, strategies and tools for helping children with ADHD stay focused in the classroom. Powerpoint developed by Marilyn Schneider, MOT, OTR/L. Sept 2018.


Teaching Children With Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices (DOE)
Instructional strategies and practices for academic instruction, behavioral interventions, and classroom accommodations for children with ADHD; U.S. Department of Education.

For Teachers (ADDitude)
ADDitude.org provides information and support for educators of students with ADHD and learning disabilities. Resources include specialized classroom strategies for addressing academic difficulties, encouraging focus, and ensuring appropriate school behavior.


10 Common Challenges and Best Practices for Teaching Students with ADHD (Scholastic)
Very readable resource about successful strategies to teach students with ADHD.


General Student Engagement and Classroom Management Tools

Supporting and Responding to Behavior: Evidence-Based Classroom Strategies for Teachers
This downloadable document includes an interactive map of classroom PBIS strategies, a self-assessment, examples of critical practices in elementary and secondary settings, non-examples of critical practices, descriptions of supporting evidence, links to resources, scenarios that illustrate implementation, and other guidelines for implementation; PBIS.org, a website developed under a grant from the US Department of Education.


RTI Action Network: Behavior Supports (NCLD)
Discusses how to maximize student learning and the impact of effective interventions by preventing the development, and lessening the intensity, of problem behaviors; National Center for Learning Disabilities.


Edutopia
Edutopia is a trusted source shining a spotlight on what works in education, including best practices and stories of innovation and continuous learning in the real world. Resources on Assessment, Integrated Studies, Problem-Based Learning, Teacher Development, Technology Innovation, and many other useful topics; George Lucas Educational Foundation.


Brain Breaks (Go Noodle)
Ideas for brain breaks in the classrooms to help get the wiggles out; free sign up.


PK-12 Education (APA)
This resource helps teachers manage behavior problems, motivate students, assist struggling learners, handle stress, support gifted and talented youth, and more. APA also supports the teaching of high school psychology.; American Psychological Association.


LD Online (WETA)
On-line resources for teaching students with learning disabilities and ADHD. Includes many useful articles as well as a link to an on-line learning store; WETA, an educational service of public television station in Washington, D.C.


Imagine Learning
A paid-subscription program helping students acquire, develop, and strengthen the language skills necessary to fully participate in academic settings and prepare for college and careers. This site provides a suite of adaptive digital curriculum in literacy, math, and assessment solutions for PreK–8. Includes resources for distance learning and English as second language learners.




Getting More Information (for School Personnel, Families, and Students)

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
A national non-profit organization, with numerous local chapters, that provides education, advocacy, and support for ADHD; includes ADHD-focused e-learning trainings for parents and teachers, information, advocacy, and support, podcasts, newsletters, and more.


Understood for Learning & Attention Issues
An organization providing resources to young adults, parents, and teachers of children with different learning styles and attention disorders. Focusses on an initiative to create inclusive workplaces by developing and implementing best-in-class disability inclusion programs so they can hire, advance, and retain people with disabilities.


ADHD Parenting (ADDitude)
This comprehensive guide to parenting a child with ADHD won’t waste your time with run-of-the-mill advice. You need ADD-tested strategies, and here they are — everything you need to know about oppositional defiance, positive parenting, school and learning challenges, health and wellbeing, social skills, executive functions, treatment & more; ADDitude.org.


Family Resources (AACAP)
Family education for disorders that include anxiety, autism, depression, conduct disorder, oppositional defiant disorder, and more, Includes facts, videos, and a psychiatrist finder tool; American Academy of Child & Adolescent Psychiatry.


National Alliance of Mental Illness (NAMI)
A national organization that provides information and resources for families and professionals, including helpline, local chapter resources, and advocacy.


Healthy Children (AAP)
Offers information and advice about child development, health topics, safety and injury prevention, various medical conditions and educational issues, and parenting; American Academy of Pediatrics.


Child Development Institute
Information, products, and services related to child development, psychology, health, parenting, media, entertainment, and family activities. Helps families to connect with other parents, professionals, and organizations.


ADHD 3rd Edition: What Every Parent Needs to Know
Reliable information about how ADHD is defined and diagnosed and the most current behavioral, developmental, educational, and medical therapies. Topics covered align with the DSM-5 updates. Paperback and eBook versions available for purchase; American Academy of Pediatrics.


For Professionals

National Resource Center - ADHD Weekly For Teachers (CDC)
Weekly articles with topics for educators; funded by the Centers for Disease Control and National Center on Birth Defects and Developmental Disabilities.

Tools

ADHD Rating Scale-5 for Children and Adolescents
Child and adolescent versions with parent and teacher questionnaires, ages 5-17, the scales take <5 minutes to complete. Scoring is linked directly to DSM-5 diagnostic criteria for ADHD. Available for purchase.

Medical Home to School Summary Form (PDF Document 40 KB)
Sample form for communication between health care providers and schools about health concerns that impact a student's education.

School Health Care Plans - Fact Sheet (Utah Family Voices) (PDF Document 48 KB)
Information, tips, and resources.

Schools Information Release Form (PDF Document 49 KB)
Sample form for a child's parent/guardian to authorize two-way communication between the health care provider and school teams, as it relates to the diagnosis/condition listed.

Screening & Surveillance Tools and Family Educational Handouts (DB Peds)
Information and checklists for a variety of developmental and behavioral disorders and related medical conditions; University of Washington Developmental & Behavioral Pediatrics.

Vanderbilt Assessment Scales - Parent and Teacher Initial and Follow-Up Scales with Scoring Instructions (NICHQ) (PDF Document 1.1 MB)
Helps to diagnose ADHD in children between the ages of 6 and 12; also screens for anxiety, depression, oppositional-defiant, and conduct disorders. Includes questionnaires for the initial and follow-up assessments for teachers and parents - and scoring instructions. No fee is required.

Authors & Reviewers

Initial publication: October 2015; last update/revision: October 2020
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewer: Sean Cunningham, Ph.D.
Funding: Funding and support for this project was provided in part by the American Academy of Pediatrics Council on School Health, the University of Utah, and the Salt Lake City School District.
Authoring history
2015: first version: Jennifer Goldman-Luthy, MD, MRP, FAAPA; Laura MillerR; Judi Yaworsky, RNR; Megan Wanzek, Ph.D.R; Tom LuthyR
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, Haagen TA, Rommelse NN, Buitelaar JK.
Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial.
Lancet. 2011;377(9764):494-503. PubMed abstract

U.S. Department of Health and Human Services.
Key Findings: Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD: United States, 2003—2011.
Centers for Disease Control and Prevention; (2014) http://www.cdc.gov/ncbddd/adhd/features/key-findings-adhd72013.html. Accessed on July 2015.
Study findings.

Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ.
Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011.
J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46.e2. PubMed abstract

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text
This guideline revision provides incremental updates to the 2011 guideline on ADHD, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations; American Academy of Pediatrics (AAP).