Questions and Answers-cont.

A:   The various special education programs are graded according to the severity and type of the child's learning and/or behavior disorder, from mild to severe, as follows:

• Regular classroom plus part-time tutoring
• Regular classroom plus part-time resource room, 1/2-2 hours daily
• Part-time learning disability class plus resource room and mainstreaming or integration into regular class for certain subjects
• Full-time learning disability (LD) or behavior disorder (BD) class
• Full-time "educable mentally handicapped" class (intended for children with an IQ of 60-80 and not classified as ADHD or LD).

      The advantages of the resource room and the learning disability class are the small size, which allows for more individual attention, and staffing by teachers with special qualifications in the field of learning disorders.   The disadvantage of such classes is the stigma of labeling and segregating the child from peers at an early age.   However, if the purpose is explained to the child individually and to the class and the parents, the special education is soon accepted when academic successes result.

A:   Specialized support services made available to children with ADHD attending public schools include the following:

• School psychologist.  The psychologist is called upon to perform individual intelligence, perception, and reading tests if a child is thought to have a learning problem, and to evaluate social-emotional factors underlying behavior disorders.   The psychological evaluation administered individually is different from the achievements tests (Iowa, Stanford, or California) which are administered to a group by the classroom or learning disability teacher at more frequent intervals.   Parents are often confused about the functions and tests performed by the psychologist and the LD teacher.
• Social Worker.  The school social worker may provide counseling services for children with behavioral problems, and emotional support and reassurance for those dealing with issues such as divorce or peer pressures.
• School nurse.  The school nurse often takes the responsibility for handing out medications at lunchtime, for reporting any side effects, and supervises records for required immunizations, and vision and hearing tests.
• Remedial reading teacher.  Children with dyslexia or lesser degrees of reading difficulty can be referred to the reading specialist for individual or group instruction and training.
• Speech pathologist.  Speech and language evaluations are performed by the school if a child's understanding and/or expressive language abilities are delayed.   The speech pathologist also provides therapy individually or in groups.
• School guidance counselor.  Guidance counselors are available particularly in high schools.   They assist students with selection of classes, careers, and colleges.   In lower grades a guidance counselor may help with tutors and decisions regarding grade placement or special schools.
• Occupational therapist.  Occupational therapy (OT) sessions are sometimes advised for children with ADHD who have incoordination of motor movement and are described as clumsy.   OT will often help in facilitating gross coordination, permitting children to participate in group physical activities.

A:   Medical opinion has changed regarding the outcome of childhood ADHD.   Formerly, most pediatricians reassured parents by predicting that hyperactivity would resolve after 12 years of age.   Currently, most experts favor a more guarded prognosis, with symptoms persisting to some degree in approximately 50% of ADHD children as they approach adulthood (Barkley RA, 1990).   The majority make adjustments for their symptoms, but some experience continuing difficulties requiring treatment, especially those with comorbid psychiatric disorders.   Even among psychiatrists, however, opinions vary regarding outcome, a recent study finding that children with uncomplicated ADHD may "outgrow" the disorder.