Identification in Schools

In the previous section, we learned about ADHD from an intersectional medical perspective. Now, we turn to the implications for students with ADHD in the school setting. IDEA (the Individuals with Disabilities Education Act) regulations, issued by the U.S. Department of Education in March 1999 and reauthorized in 2004, make it clear that ADHD is included in the list of conditions that could render a child eligible for special education services. However, including ADHD does not automatically mean that all children with ADHD qualify for an Individual Education Plan or other provisions under IDEA. While IDEA does offer help for eligible children with ADHD, not all children with ADHD are eligible. Even a medical diagnosis of ADHD does not necessarily guarantee eligibility for services (IDEA, 2004).

To qualify, ADHD must adversely affect a child’s educational performance. ADHD has various levels of severity. For some students, it is completely debilitating, requiring extensive accommodations and other interventions. Other students are more successful at managing their ADHD and have little trouble in the regular classroom. Decisions about the need for special services and accommodations should be made individually, considering the individual student’s specific needs. For this reason, the law is called the Individuals with Disabilities Education Act – the emphasis is placed on the individual student (IDEA, 2004).

Federal

Thus, when would a child with ADHD qualify for services under IDEA? A 1991 memorandum from the U.S. Department of Education to chief state school officers describes when a student might qualify for special education services under IDEA. According to the memo, children with ADHD may be eligible for services under the following categories, depending on their unique characteristics and identified educational needs:

• Other Health Impairment (OHI). Most children receiving special education services for ADHD alone will likely be classified as “Other Health Impaired” since the regulations implementing IDEA now list ADHD as a condition that can make a child eligible under this category. Children with ADHD may meet eligibility criteria for the “other health impairment” category when their “heightened alertness to environmental stimuli… results in limited alertness concerning the educational environment,” impairing school performance (Additudemag.com, 2023).
• Specific Learning Disability (SLD). Studies using careful diagnostic criteria have found that about half of children with ADHD also have learning disabilities (Hallahan et al., 2019). IDEA defines a learning disability as a disorder in one or more of the basic psychological processes involved in understanding and using language that impairs the ability to listen, think, speak, read, write, spell, or do mathematical calculations. Children with ADHD may be eligible for special education in this category if they have coexisting learning disabilities. However, in some cases, ADHD alone could generate the type of impairment that would cause a child to meet the criteria under this category – especially the Inattentive Type, which has been linked to deficits in mathematics and sensory information processing. Minimal brain dysfunction, a condition listed under this category, was the term for ADHD during most of the 1960s. Recent brain-imaging studies and the current understanding of ADHD’s effect on executive functions (and hence, on information processing) also underscore this category’s continued relevance (Additudemag.com, 2023).
• Emotional Behavioral Disabilities (EBD). Approximately 25% to 50% of children with ADHD also have coexisting emotional and mental needs (Hallahan et al., 2019) such as mood, behavior, or anxiety disorders that can adversely affect educational performance. This sometimes makes them eligible for special education services under Emotional Behavioral Disability (EBD). Refer to Chapter 7 for more information about the characteristics of EBD (Additudemag.com, 2023).

Minnesota

In Minnesota, students with ADHD are most commonly serviced under the special education category of OHI, which is called Other Health Disability (OHD). For a student with ADHD to be considered for special education services under OHD, there must be written and signed documentation of a medical diagnosis by a licensed physician, an advanced practice nurse, or a licensed psychologist. The diagnosis must include documentation that the criteria of the current Diagnostic and Statistical Manual are met (Minn. R. 3525.1335 and Minn. Stat. 125A.02). All other eligibility criteria for OHD apply to the ADHD health condition, which includes (1) in comparison with peers, and (2) the health condition adversely affects the pupil’s ability to complete educational tasks within routine timelines, as documented by three or more of the criteria described in Minnesota Rule 3525.1335. For an initial evaluation, all documentation must be dated within the previous 12 months (Minnesota Revisor, 2015a).

The uneven pattern of medical diagnosis shared in the earlier section becomes a barrier to access: this medical diagnosis is a crucial factor in Minnesota that determines whether a student receives services and, if so, under which category. For instance, if a student has ADHD symptoms that impact behavioral function in school, but for a variety of reasons, does not have a medical diagnosis of ADHD, they might end up getting services under EBD instead, which might be harmful, as the supports are not matched with the student’s needs (overrepresentation of groups in the EBD category is discussed in Chapter 7). This will be counterproductive in developing a child’s genius.

Moreover, the criteria for OHD eligibility are based on objective and subjective interpretations; thus, the potential for interpretations being shaped by implicit biases is of great concern. Misunderstandings and behavior-based conflicts in school can also stem from gaps in cultural awareness due to disproportionate student-teacher racial/ethnic demographics (Prosych.com, 2022). For example, suppose a student is fidgeting excessively, impacting how other peers can relate to the student. In that case, some caregivers may want educators to explain this openly and honestly to their children. Caregivers often want their children to connect with peers without being potentially ostracized. However, if you talk about the abnormal nature of the movement, some cultures may disagree with this, and the line in the sand is drawn immediately. Suppose a clinician is unaware of the cultural interpretation of ADHD, and the model of the family’s culture is not matched appropriately. In such a case, the likelihood of getting support to the family will be pushed to the wayside.

Additional Protections

Children with ADHD who are determined not to be eligible for special education services under IDEA may still be protected and served under two other federal laws: Section 504 of the Rehabilitation Act of 1973 (Section 504) and the Americans with Disabilities Act of 1990 (ADA). The Office for Civil Rights in the U.S. Department of Education enforces the provisions of Section 504 and Title II of the ADA concerning school districts. At the same time, the Department of Education administers IDEA (Additudemag.com, 2023).

The following section is adapted from ADHD and Behavior Disorders in Children by Richard Milich and Walter Roberts.

In the Classroom

Now, consider Miranda and Jake. They are two students being discussed at a child study team meeting. Using the information in this section, are they likely to qualify for special education services under ADHD?

Miranda (she/her), a five-year-old kindergartener, was referred to the child study team by her caregivers, who believed she had ADHD. They reported that Miranda would not comply with their instructions. Specifically, when Miranda’s caregiver asked her to prepare her school lunch, she would leave the kitchen and play with her toys soon after opening her lunch box. They also shared that Miranda would not remain seated during “quality time” with them, which involved sitting quietly for hours watching Netflix. Miranda was reported as complying with their teacher’s request in other settings, such as school, and was no more active than her peers. Earlier in the school year, Miranda’s caregivers pursued a diagnostic assessment with a mental health professional. Their conclusion was that Miranda did not meet any of the diagnostic criteria for ADHD.

Jake (he/him), a 10-year-old fourth grader, was referred to the child study team by his mother. She was concerned because Jake was not getting ready for school on time. Jake also needed help remaining seated during dinner, which interrupted mealtime for the rest of the family. Jake would complete one or two steps of his routine before he became distracted and switched activities, despite his mother’s constant reminders. During dinnertime, Jake would leave his seat between 10 and 15 times throughout the meal. Jake’s teachers were also worried because Jake could only complete 50% of his homework. Further, his classmates would not pick Jake for team sports during recess because he often became distracted and wandered off during the game. His caregivers recently took him to a medical provider for an evaluation, and Jake received a medical diagnosis of ADHD.

In the case of Miranda, her caregivers held unrealistic expectations for a child at Miranda’s developmental level. Instead, the child study team should share information/resources with Miranda’s caregivers about typical child development rather than pursuing an IEP evaluation. Now, turning to Jake, his symptoms would not be considered developmentally appropriate for a 10-year-old child. Further, his symptoms caused him to experience impairment at home and school; thus, he was diagnosed with ADHD. Jake likely qualifies for special education services to support his ADHD symptoms and the impacts on him educationally via OHD.

A way forward for Miranda’s and Jake’s teachers, regardless of their disability label, is to shift away from a deficit lens. Instead, consider Gholdy Muhammad’s advice and consider their strengths. What is their genius?