Attention Deficit Hyperactive Disorder (ADHD)

The principal characteristics of Attention Deficit Hyperactivity Disorder (ADHD) are inattention, hyperactivity, and impulsivity.  It is hard for a child or adult with ADHD to control their behavior and/or pay attention. The prevalence of AD/HD in adults is thought to be around 4.4%, but many believe it is much higher.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder resulting from problems in the dopamine neurotransmitter systems in the brain. Most cases are genetically inherited. If a parent or close relative has AD/HD there is a 30% chance that a child will have AD/HD. Twin studies show that if an identical twin has AD/HD, there is a 50% chance the other twin will have it also. AD/HD is not caused by poor nutrition, ineffective parenting, drugs, or allergies. Other medical conditions may cause AD/HD-like symptoms (such as severe head trauma, thyroid problems, fetal alcohol syndrome and lead intoxication), however, and for this reason a professional evaluation should be obtained to rule out other medical conditions.

Attention Deficit Hyperactivity Disorder (ADHD) usually becomes apparent in some children in the preschool and early school years.  Those adults with ADHD were probably not recognized with the disorder as children and may have gone undiagnosed or misdiagnosed for years.

People with ADHD typically can focus only on things that interest them, and disregard less interesting things, are often faced with additional problems such as an academic underachievement, lack of social skills, an inability to stay organized, or complete important tasks. These often result in difficulty with personal relationships, staying employed, or completing an education. People may also stimulate themselves by doing reckless or dangerous activities and thus complicate their lives with physical and legal problems.

A child or adult with ADHD faces a difficult, but not insurmountable task in performing everyday functions. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding.

The following information about ADHD, adapted from the National Institutes of Mental Health website offers information on ADHD and its management, including research on medications and behavioral interventions, as well as helpful resources on educational options.

Attention Deficit Hyperactivity Disorder (ADHD) was first described by Dr. Heinrich Hoffman in 1845. A physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. Yet it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing—children who today would be easily recognized as having ADHD.1 Since then, several thousand scientific papers on the disorder have been published, providing information on its nature, course, causes, impairments, and treatments.

The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child's life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.

Symptoms of ADHD will appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. Different symptoms may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD. All children are sometimes restless, sometimes act without thinking, sometimes daydream the time away. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.

According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR),   there are three patterns of behavior that indicate Attention Deficit Hyperactivity Disorder (ADHD). People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. Or they may show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called Attention Deficit Disorder (ADD); and the combined type that displays both inattentive and hyperactive-impulsive symptoms.

Hyperactive children and adults always seem to be "on the go" or constantly in motion. Sitting still can be a difficult task. Impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they're upset. Even as teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.

Is It Really Attention Deficit Hyperactivity Disorder (ADHD)?
Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most people sometimes blurt out things they didn't mean to say, or jump from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

Because everyone shows some of these behaviors at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person's age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person's life such as in the schoolroom, on the playground, at home, in the community, or in social settings. So someone who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.

To assess whether a child or adult has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place? The person's pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the DSM-IV-TR.

Some parents see signs of inattention, hyperactivity, and impulsivity in their toddler long before the child enters school. The child may lose interest in playing a game or watching a TV show, or may run around completely out of control. But because children mature at different rates and are very different in personality, temperament, and energy levels, it's useful to get an expert's opinion of whether the behavior is appropriate for the child's age. Parents can ask their child's pediatrician, or a child psychologist or psychiatrist, to assess whether their toddler has an attention deficit hyperactivity disorder or is, more likely at this age, just immature or unusually exuberant.

In regard to children Attention Deficit Hyperactivity Disorder (ADHD), the ADHD may be suspected by a parent or caretaker or may go unnoticed until the child runs into problems at school. Given that ADHD tends to affect functioning most strongly in school, sometimes the teacher is the first to recognize that a child is hyperactive or inattentive and may point it out to the parents and/or consult with the school psychologist. Because teachers work with many children, they come to know how "average" children behave in learning situations that require attention and self-control. However, teachers sometimes fail to notice the needs of children who may be more inattentive and passive yet who are quiet and cooperative, such as those with the predominantly inattentive form of ADHD.

Professionals Who Make the Diagnosis.

Ideally, the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) should be made by a professional with training in ADHD or in the diagnosis of mental disorders. Psychiatrists and psychologists, developmental pediatricians, or behavioral neurologists are those most often trained in differential diagnosis. Clinical social workers may also have such training.

Within each specialty, individual doctors and mental health professionals differ in their experiences with ADHD. So in selecting a specialist, it's important to find someone with specific training and experience in diagnosing and treating the disorder.

Whatever the specialist's expertise, his or her first task is to gather information that will rule out other possible reasons for the child's or adult's behavior. Next the specialist gathers information on the child's or adult's ongoing behavior in order to compare these behaviors to the symptoms and diagnostic criteria listed in the DSM-IV-TR.

A correct diagnosis often resolves confusion about the reasons for the problems that lets child or adult move forward in their lives with more accurate information on what is wrong and what can be done to help. Once the disorder is diagnosed, the child or adult can begin to receive whatever combination of educational, medical, and emotional help they need.

There is little evidence at this time that Attention Deficit Hyperactivity Disorder (ADHD) can arise purely from social factors or child-rearing methods. As mentioned above, the most substantiated causes appear to fall in the realm of neurobiology and genetics. This is not to say that environmental factors may not influence the severity of the disorder, and especially the degree of impairment and suffering the person may experience, but that such factors do not seem to give rise to the condition by themselves.

Over the last few decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.

Environmental Agents.
Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use.

Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Brain Injury.
One early theory was that attention disorders were caused by brain injury. Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with Attention Deficit Hyperactivity Disorder (ADHD) have been found to have suffered a traumatic brain injury.

Food Additives and Sugar.
It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.3 A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.

In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.

Genetics.
Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population. Many studies of twins now show that a strong genetic influence exists in the disorder.

Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.

Learning Disabilities:

Many children with Attention Deficit Hyperactivity Disorder (ADHD) —approximately 20 to 30 percent—also have a specific learning disability (LD).10 In preschool years, these disabilities include difficulty in understanding certain sounds or words and/or difficulty in expressing oneself in words. In school age children, reading or spelling disabilities, writing disorders, and arithmetic disorders may appear. A type of reading disorder, dyslexia, is quite widespread. Reading disabilities affect up to 8 percent of elementary school children.

Tourette Syndrome:

A very small proportion of people with ADHD have a neurological disorder called Tourette syndrome. People with Tourette syndrome have various nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others may clear their throats frequently, snort, sniff, or bark out words. These behaviors can be controlled with medication. While very few children have this syndrome, many of the cases of Tourette syndrome have associated ADHD. In such cases, both disorders often require treatment that may include medications.

Oppositional Defiant Disorder:

As many as one-third to one-half of all children with ADHD—mostly boys—have another condition, known as oppositional defiant disorder (ODD). These children are often defiant, stubborn, non-compliant, have outbursts of temper, or become belligerent. They argue with adults and refuse to obey.

Conduct Disorder:

About 20 to 40 percent of ADHD children may eventually develop conduct disorder (CD), a more serious pattern of antisocial behavior. These children frequently lie or steal, fight with or bully others, and are at a real risk of getting into trouble at school or with the police. They violate the basic rights of other people, are aggressive toward people and/or animals, destroy property, break into people's homes, commit thefts, carry or use weapons, or engage in vandalism. These children or teens are at greater risk for substance use experimentation, and later dependence and abuse. They need immediate help.

Anxiety and Depression:

Some children with ADHD often have co-occurring anxiety or depression. If the anxiety or depression is recognized and treated, the child will be better able to handle the problems that accompany ADHD. Conversely, effective treatment of ADHD can have a positive impact on anxiety as the child is better able to master academic tasks.

Bipolar Disorder:

There are no accurate statistics on how many children with ADHD also have bipolar disorder. Differentiating between ADHD and bipolar disorder in childhood can be difficult. In its classic form, bipolar disorder is characterized by mood cycling between periods of intense highs and lows. But in children, bipolar disorder often seems to be a rather chronic mood dysregulation with a mixture of elation, depression, and irritability. Furthermore, there are some symptoms that can be present both in ADHD and bipolar disorder, such as a high level of energy and a reduced need for sleep. Of the symptoms differentiating children with ADHD from those with bipolar disorder, elated mood and grandiosity of the bipolar child are distinguishing characteristics.

For children and adults with ADHD, no single treatment is the answer for every person. A person may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. And if the adult or child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best.

For decades, medications have been used to treat the symptoms of ADHD. The medications that seem to be the most effective are a class of drugs known as stimulants.  Some people get better results from one medication, some from another. It is important to work with the prescribing physician to find the right medication and the right dosage. For many people, the stimulants dramatically reduce their hyperactivity and impulsivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as that needed in handwriting and in sports.

The stimulant drugs, when used with medical supervision, are usually considered quite safe. Stimulants do not make the child feel "high," although some children say they feel different or funny. Such changes are usually very minor. Although some parents worry that their child may become addicted to the medication, to date there is no convincing evidence that stimulant medications, when used for treatment of ADHD, cause drug abuse or dependence. A review of all long-term studies on stimulant medication and substance abuse, conducted by researchers at Massachusetts General Hospital and Harvard Medical School, found that teenagers with ADHD who remained on their medication during the teen years had a lower likelihood of substance use or abuse than did ADHD adolescents who were not taking medications.

The stimulant drugs come in long- and short-term forms. The newer sustained-release stimulants can be taken before school and are long-lasting so that the child does not need to go to the school nurse every day for a pill. The doctor can discuss with the parents the child's needs and decide which preparation to use and whether the child needs to take the medicine during school hours only or in the evening and on weekends too.

Psychotherapy works to help people with ADHD.  It helps the person to like and accept themselves despite their disorder. It does not address the symptoms or underlying causes of the disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change or better cope with their disorder.

Behavioral therapy (BT) helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one's own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting.

Social skills training can also help children and adults learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors important in developing and maintaining social relationships.

Life coaching and personal coaching has also been found to be very helpful for ADHD.

Your child with ADHD has successfully navigated the early school years and is beginning his or her journey through middle school and high school. Although your child has been periodically evaluated through the years, this is a good time to have a complete re-evaluation of your child's health.

The teen years are challenging for most children; for the child with ADHD these years are doubly hard. All the adolescent problems—peer pressure, the fear of failure in both school and socially, low self-esteem—are harder for the ADHD child to handle. The desire to be independent, to try new and forbidden things—alcohol, drugs, and sexual activity—can lead to unforeseen consequences. The rules that once were, for the most part, followed, are often now flaunted. Parents may not agree with each other on how the teenager's behavior should be handled.

Now, more than ever, rules should be straightforward and easy to understand. Communication between the adolescent and parents can help the teenager to know the reasons for each rule. When a rule is set, it should be clear why the rule is set. Sometimes it helps to have a chart, posted usually in the kitchen, that lists all household rules and all rules for outside the home (social and school). Another chart could list household chores with space to check off a chore once it is done.

When rules are broken—and they will be—respond to this inappropriate behavior as calmly and matter-of-factly as possible. Use punishment sparingly. Even with teens, a time-out can work. Impulsivity and hot temper often accompany ADHD. A short time alone can help.

As the teenager spends more time away from home, there will be demands for a later curfew and the use of the car. Listen to your child's request, give reasons for your opinion and listen to his or her opinion, and negotiate. Communication, negotiation, and compromise will prove helpful.

Attention deficit hyperactivity disorder is a highly publicized childhood disorder that affects approximately 3 percent to 5 percent of all children. What is much less well known is the probability that, of children who have ADHD, many will still have it as adults. Several studies done in recent years estimate that between 30 percent and 70 percent of children with ADHD continue to exhibit symptoms in the adult years.

The first studies on adults who were never diagnosed as children as having ADHD, but showed symptoms as adults, were done in the late 1970s by Drs. Paul Wender, Frederick Reimherr, and David Wood. These symptomatic adults were retrospectively diagnosed with ADHD after the researchers' interviews with their parents. The researchers developed clinical criteria for the diagnosis of adult ADHD (the Utah Criteria), which combined past history of ADHD with current evidence of ADHD behaviors.17 Other diagnostic assessments are now available; among them are the widely used Conners Rating Scale and the Brown Attention Deficit Disorder Scale.

Typically, adults with Attention Deficit Hyperactivity Disorder (ADHD) are unaware that they have this disorder—they often just feel that it's impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day's work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms.18 The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient's childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for ADHD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

Medications. As with children, if adults take a medication for ADHD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.19

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer "half-life" in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and psychotherapy. Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both "psychoeducation" and individual psychotherapy can be helpful. A professional coach can help the ADHD adult learn how to organize his life by using "props"—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.

Coaching has also been found to be very helpful for ADHD.  A coach for AD/HD can be found through the American Coaches Association. This organization specializes in referrals to coaches who work exclusively with persons with AD/HD.  Please keep in mind that coaching does not have to be done in person, and that most coaching is done over the phone. Because of this fact coaches are able to be helpful and available to you on a regular basis regardless of where you are.

If you suffer from Attention Deficit Hyperactivity Disorder (ADHD) you can be helped.  First, learn as much as you can about AD/HD. Get a good diagnosis from a knowledgeable professional who will rule out other possible causes for the symptoms. Make changes in your lifestyle so that you can experience success and feel good about yourself. Then, if you still need help, contact a professional therapist or counselor.

For more information about Attention Deficit Hyperactive Disorder (ADHD) and Attention Deficit Disorder (ADD) and other mental health problems, please review the Glossary andwebsites listed below.

The ADD, ADHD, learning disabilities, and education fields are so full of acronyms and specialized words that it can be very hard for a non-professional in the field to understand what is being communicated.   Included here are many of the abbreviations and words that are frequently used.

This glossary has been adapted from the LD Online website.

academic English
The English language ability required for academic achievement in context-reduced situations, such as classroom lectures and textbook reading assignments. This is sometimes referred to as Cognitive/Academic Language Proficiency (CALP).

accommodation
Techniques and materials that allow individuals with LD to complete school or work tasks with greater ease and effectiveness. Examples include spell checkers, tape recorders, and expanded time for completing assignments.

accuracy
The ability to recognize words correctly.

adequate yearly progress (AYP)
An individual state's measure of yearly progress toward achieving state academic standards. "Adequate Yearly Progress" is the minimum level of improvement that states, school districts and schools must achieve each year.

affix
Part of word that is "fixed to" either the beginnings of words (prefixes) or the endings of words (suffixes). The word disrespectful has two affixes, a prefix (dis-) and a suffix (-ful).

age equivalent score
In a norm-referenced assessment, individual student's scores are reported relative to those of the norming population. This can be done in a variety of ways, but one way is to report the average age of people who received the same score as the individual child. Thus, an individual child's score is described as being the same as students that are younger, the same age, or older than that student (e.g. a 9 year old student my receive the same score that an average 13 year old student does, suggesting that this student is quite advanced).

alphabetic principle
The basic idea that written language is a code in which letters represent the sounds in spoken words.

alternative education placement (AEP)
An alternative classroom setting used to improve classroom behavior and address needs that cannot be met in a regular classroom setting.

Americans with Disabilities Act (ADA)
A federal law that gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services, and telecommunications.

aphasia
see Developmental Aphasia

assistive technology
Equipment that enhances the ability of students and employees to be more efficient and successful.

Attention Deficit / Hyperactivity Disorder (ADHD)
Developmentally inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity. A person can be predominantly inattentive (often referred to as ADD), predominantly hyperactive-impulsive, or a combination of these two.

Attention Deficit Disorder (ADD)
see ADHD

auditory discrimination
Ability to detect differences in sounds; may be gross ability, such as detecting the differences between the noises made by a cat and dog, or fine ability, such as detecting the differences made by the sounds of letters "m" and "n."

auditory figure-ground
Ability to attend to one sound against a background of sound (e.g., hearing the teacher's voice against classroom noise).

auditory memory
Ability to retain information which has been presented orally; may be short term memory, such as recalling information presented several seconds before; long term memory, such as recalling information presented more than a minute before; or sequential memory, such as recalling a series of information in proper order.

Auditory Processing Disorder (APD)
An inability to accurately process and interpret sound information. Students with APD often do not recognize subtle differences between sounds in words.

automaticity
Automaticity is a general term that refers to any skilled and complex behavior that can be performed rather easily with little attention, effort, or conscious awareness. These skills become automatic after extended periods of training. With practice and good instruction, students become automatic at word recognition, that is, retrieving words from memory, and are able to focus attention on constructing meaning from the text, rather than decoding.

base words
Words from which many other words are formed. For example, many words can be formed from the base word migrate: migration, migrant, immigration, immigrant, migrating, migratory.

Behavior Intervention Plan (BIP)
A plan that includes positive strategies, program modifications, and supplementary aids and supports that address a student's disruptive behaviors and allows the child to be educated in the least restrictive environment (LRE).

bilingual education
An educational program in which two languages are used to provide content matter instruction. Bilingual education programs vary in their length of time, and in the amount each language is used.

blend
A consonant sequence before or after a vowel within a syllable, such as cl, br, or st; it is the written language equivalent of consonant cluster.

Central Auditory Processing Disorder (CAPD)
A disorder that occurs when the ear and the brain do not coordinate fully. A CAPD is a physical hearing impairment, but one which does not show up as a hearing loss on routine screenings or an audiogram. Instead, it affects the hearing system beyond the ear, whose job it is to separate a meaningful message from non-essential background sound and deliver that information with good clarity to the intellectual centers of the brain (the central nervous system).

cognates
Words in different languages related to the same root, e.g. education (English) and education (Spanish).

comprehension strategies
Techniques to teach reading comprehension, including summarization, prediction, and inferring word meanings from context.

comprehension strategy instruction
The explicit teaching of techniques that are particularly effective for comprehending text. The steps of explicit instruction include direct explanation, teacher modeling ("think aloud"), guided practice, and application. Some strategies include direct explanation (the teacher explains to students why the strategy helps comprehension and when to apply the strategy), modeling (the teacher models, or demonstrates, how to apply the strategy, usually by "thinking aloud" while reading the text that the students are using), guided practice (the teacher guides and assists students as they learn how and when to apply the strategy) and application (the teacher helps students practice the strategy until they can apply it independently).

connected instruction
A way of teaching systematically in which the teacher continually shows and discusses with the students the relationship between what has been learned, what is being learned, and what will be learned.

context clues
Sources of information outside of words that readers may use to predict the identities and meanings of unknown words. Context clues may be drawn from the immediate sentence containing the word, from text already read, from pictures accompanying the text, or from definitions, restatements, examples, or descriptions in the text.

continuous assessment
An element of responsive instruction in which the teacher regularly monitors student performance to determine how closely it matches the instructional goal.

cooperative learning
A teaching model involving students working together as partners or in small groups on clearly defined tasks. It has been used successfully to teach comprehension strategies in content-area subjects.

curriculum-based assessment
A type of informal assessment in which the procedures directly assess student performance in learning-targeted content in order to make decisions about how to better address a student's instructional needs.

decoding
The ability to translate a word from print to speech, usually by employing knowledge of sound-symbol correspondences. It is also the act of deciphering a new word by sounding it out.

Developmental Aphasia
A severe language disorder that is presumed to be due to brain injury rather than because of a developmental delay in the normal acquisition of language.

developmental spelling
The use of letter-sound relationship information to attempt to write words (also called invented spelling)

direct instruction
An instructional approach to academic subjects that emphasizes the use of carefully sequenced steps that include demonstration, modeling, guided practice, and independent application.

direct vocabulary learning
Explicit instruction in both the meanings of individual words and word-learning strategies. Direct vocabulary instruction aids reading comprehension.

dyscalculia
A severe difficulty in understanding and using symbols or functions needed for success in mathematics.

dysgraphia
A severe difficulty in producing handwriting that is legible and written at an age-appropriate speed.

dyslexia
A language-based disability that affects both oral and written language. It may also be referred to as reading disability, reading difference, or reading disorder.

dysnomia
A marked difficulty in remembering names or recalling words needed for oral or written language.

dyspraxia
A severe difficulty in performing drawing, writing, buttoning, and other tasks requiring fine motor skill, or in sequencing the necessary movements.

emergent literacy
The view that literacy learning begins at birth and is encouraged through participation with adults in meaningful reading and writing activities.

English as a Second Language (ESL)
English learned in an environment where it is the predominant language of communication.

English Language Learner (ELL)
Students whose first language is not English and who are in the process of learning English.

exceptional students education (ESE)
Refers to special education services to students who qualify.

experimental writing
Efforts by young children to experiment with writing by creating pretend and real letters and by organizing scribbles and marks on paper.

expressive language
The aspect of spoken language that includes speaking and the aspect of written language that includes composing or writing.

Family Educational Right to Privacy Act (FERPA)
A federal law that protects the privacy of student education records.

fluency
The ability to read a text accurately, quickly, and with proper expression and comprehension. Because fluent readers do not have to concentrate on decoding words, they can focus their attention on what the text means.

formal assessment
The process of gathering information using standardized, published tests or instruments in conjunction with specific administration and interpretation procedures, and used to make general instructional decisions.

Free Appropriate Public Education (FAPE)
A requirement of IDEA; all disabled children must receive special education services and related services at no cost.

Functional Behavioral Assessment (FBA)
A problem-solving process for addressing student problem behavior that uses techniques to identify what triggers a given behavior(s) and to select interventions that directly address them.

grade equivalent scores
In a norm-referenced assessment, individual student&capos;s scores are reported relative to those of the nor ming population. This can be done in a variety of ways, but one way is to report the average grade of students who received the same score as the individual child. Thus, an individual child&capos;s score is described as being the same as students that are in higher, the same, or lower grades than that student (e.g. a student in 2nd grade my earn the same score that an average forth grade student does, suggesting that this student is quite advanced).

grapheme
A letter or letter combination that spells a single phoneme. In English, a grapheme may be one, two, three, or four letters, such as e, lei, high, or weigh.

graphic organizers
Text, diagram or other pictorial device that summarizes and illustrates interrelationships among concepts in a text. Graphic organizers are often known as maps, webs, graphs, charts, frames, or clusters.

independent educational evaluation (IEE)
An evaluation conducted by a qualified examiner, who is not employed by the school district at the public&capos;s expense.

independent school district (ISD)
ISD is a common acronym for Independent School District.

indirect vocabulary learning
Vocabulary learning that occurs when students hear or see words used in many different contexts – for example, through conversations with adults, being read to, and reading extensively on their own.

Individualized Education Program (IEP)
A plan outlining special education and related services specifically designed to meet the unique educational needs of a student with a disability.

Individualized Transition Plan (ITP)
A plan developed by the IEP team to help accomplish the student&capos;s goals for the transition from high school into adulthood.

Individuals with Disabilities Education Act of 2004 (IDEA 2004)
The law that guarantees all children with disabilities access to a free and appropriate public education.

informal assessment
The process of collecting information to make specific instructional decisions, using procedures largely designed by teachers and based on the current instructional situation.

Intelligence Quotient (IQ)
A measure of someone&capos;s intelligence as indicated by an intelligence test, where an average score is 100. An IQ score is the ratio of a person&capos;s mental age to his chronological age multiplied by 100.

language learning disability (LLD)
A disorder that may affect the comprehension and use of spoken or written language as well as nonverbal language, such as eye contact and tone of speech, in both adults and children.

learning disability (LD)
A disorder that affects people&capos;s ability to either interpret what they see and hear or to link information from different parts of the brain. It may also be referred to as a learning disorder or a learning difference.

least restrictive environment (LRE)
A learning plan that provides the most possible time in the regular classroom setting.

limited English proficient (LEP)
The term used by the federal government, most states, and local school districts to identify those students who have insufficient English to succeed in English-only classrooms. Increasingly, English language learner (ELL) or English learner (EL) are used in place of LEP.

listening comprehension
Understanding speech. Listening comprehension, as with reading comprehension, can be described in "levels" – lower levels of listening comprehension would include understanding only the facts explicitly stated in a spoken passage that has very simple syntax and uncomplicated vocabulary. Advanced levels of listening comprehension would include implicit understanding and drawing inferences from spoken passages that feature more complicated syntax and more advanced vocabulary.

literacy
Reading, writing, and the creative and analytical acts involved in producing and comprehending texts.

local education agency (LEA)
A public board of education or other public authority within a state that maintains administrative control of public elementary or secondary schools in a city, county, township, school district or other political subdivision of a state.

morpheme
The smallest meaningful unit of language. A morpheme can be one syllable (book) or more than one syllable (seventeen). It can be a whole word or a part of a word such as a prefix or suffix. For example, the word ungrateful contains three morphemes: un, grate, and ful.

morphology
The study of how the aspects of language structure are related to the ways words are formed from prefixes, roots, and suffixes (e.g., mis-spell-ing), and how words are related to each other.

morphophonology
Using a word's letter patterns to help determine, in part, the meaning and pronunciation of a word. For example, the morpheme vis in words such as vision and visible is from the Latin root word that means to see; and the ay in stay is pronounced the same in the words gray and play.

Multiple Intelligences
A theory that suggests that the traditional notion of intelligence, based on IQ testing, is far too limited. Instead, it proposes eight different intelligences to account for a broader range of human potential in children and adults. These intelligences are: linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, naturalist.

multisensory structured language education
An educational approach that uses visual, auditory, and kinesthetic-tactile cues simultaneously to enhance memory and learning. Links are consistently made between the visual (what we see), auditory (what we hear), and kinesthetic-tactile (what we feel) pathways in learning to read and spell.

naming speed
The rate at which a child can recite "overlearned" stimuli such as letters and single-digit numbers.

No Child Left Behind (NCLB)
The No Child Left Behind Act of 2001 is the most recent reauthorization of the Elementary and Secondary Education act of 1965. The act contains President George W. Bush's four basic education reform principles: stronger accountability for results, increased flexibility and local control, expanded options for parents, and an emphasis on teaching methods based on scientifically-based research.

Nonverbal Learning Disability
A neurological disorder which originates in the right hemisphere of the brain. Reception of nonverbal or performance-based information governed by this hemisphere is impaired in varying degrees, causing problems with visual-spatial, intuitive, organizational, evaluative, and holistic processing functions.

norm-referenced assessment
A type of assessment that compares an individual child's score against the scores of other children who have previously taken the same assessment. With a norm-referenced assessment, the child's raw score can be converted into a comparative score such as a percentile rank or a stanine.

occupational therapy (OT)
A rehabilitative service to people with mental, physical, emotional, or developmental impairments. Services can include helping a student with pencil grip, physical exercises that may be used to increase strength and dexterity, or exercises to improve hand-eye coordination.

Office of Special Education Programs (OSEP)
An office of the U.S. Department of Education whose goal is to improve results for children with disabilities (ages birth through 21) by providing leadership and financial support to assist states and local districts.

onset
The initial consonant sound(s) in a monosyllabic word. This unit is smaller than a syllable but may be larger than a phoneme (the onset of bag is b-; of swim is sw-).

orthographic knowledge
The understanding that the sounds in a language are represented by written or printed symbols.

Orton-Gillingham
A multisensory approach to remediating dyslexia created by Dr. Samuel Orton, a neuropsychiatrist and pathologist, and Anna Gillingham, an educator and psychologist.

other health impairments (OHI)
A category of special education services for students with limited strength, vitality or alertness, due to chronic or acute health problems (such as asthma, ADHD, diabetes, or a heart condition).

pervasive developmental disorder (PDD)
The category of special education services for students with delays or deviance in their social/language/motor and/or cognitive development.

phoneme
The smallest unit of speech that serves to distinguish one utterance from another in a language.

phonemic awareness
The ability to notice, think about, and work with the individual sounds in spoken words. An example of how beginning readers show us they have phonemic awareness is combining or blending the separate sounds of a word to say the word (/c/ /a/ /t/ – cat.)

phonics
A form of instruction to cultivate the understanding and use of the alphabetic principle; that there is a predictable relationship between phonemes (the sounds in spoken language) and graphemes, the letters that represent those sounds in written language, and that this information can be used to read or decode words.

phonological awareness
A range of understandings related to the sounds of words and word parts, including identifying and manipulating larger parts of spoken language such as words, syllables, and onset and rime. It also includes phonemic awareness as well as other aspects of spoken language such as rhyming and syllabication.

physical therapy (PT)
Instructional support and treatment of physical disabilities, under a doctor's prescription, that helps a person improve the use of bones, muscles, joints and nerves.

print awareness
Basic knowledge about print and how it is typically organized on a page. For example, print conveys meaning, print is read left to right, and words are separated by spaces.

reading disability
Another term for dyslexia, sometimes referred to as reading disorder or reading difference.

receptive language
The aspect of spoken language that includes listening, and the aspect of written language that includes reading.

Response to Intervention (RTI)
Under IDEA 2004, school districts can use this model (also called the Three-Tiered Model) as an alternative to the discrepancy model to determine whether a student has a learning disability.

responsive instruction
A way of making teaching decisions in which a student's reaction to instruction directly shapes how future instruction is provided.

rime
The vowel and all that follows it in a monosyllabic word (the rime of bag is -ag; of swim is -im).

root word
Words from other languages that are the origin of many English words. About 60 percent of all English words have Latin or Greek origins.

scaffolding
A way of teaching in which the teacher provides support in the form of modeling, prompts, direct explanations, and targeted questions – offering a teacher-guided approach at first. As students begin to acquire mastery of targeted objectives, direct supports are reduced and the learning becomes more student-guided.

self-advocacy
The development of specific skills and understandings that enable children and adults to explain their specific learning disabilities to others and cope positively with the attitudes of peers, parents, teachers, and employers.

self-monitoring
The mental act of knowing when one does and does not understand what one is reading.

semantic organizers
Graphic organizers that look somewhat like a spider web where lines connect a central concept to a variety of related ideas and events.

sight words
Words that a reader recognizes without having to sound them out. Some sight words are "irregular," or have letter-sound relationships that are uncommon. Some examples of sight words are you, are, have and said.

social English
Often referred to as "playground English" or "survival English", this is the basic language ability required for face-to-face communication, often accompanied by gestures and relying on context to aid understanding. Social English is much more easily and quickly acquired than academic English, but is not sufficient to meet the cognitive and linguistic demands of an academic classroom. Also referred to as Basic Interpersonal Communication Skills (BICS).

special education (SPED)
Services offered to children who possess one or more of the following disabilities: specific learning disabilities, speech or language impairments, mental retardation, emotional disturbance, multiple disabilities, hearing impairments, orthopedic impairments, visual impairments, autism, combined deafness and blindness, traumatic brain injury, and other health impairments.

specific learning disability (SLD)
The official term used in federal legislation to refer to difficulty in certain areas of learning, rather than in all areas of learning. Synonymous with learning disabilities.

speech impaired (SI)
A category of special education services for students who have difficulty with speech sounds in their native language.

Speech Language Pathologist (SLP)
An expert who can help children and adolescents who have language disorders to understand and give directions, ask and answer questions, convey ideas, and improve the language skills that lead to better academic performance. An SLP can also counsel individuals and families to understand and deal with speech and language disorders.

supplemental services
Services offered to students from low-income families who are attending schools that have been identified as in need of improvement for two consecutive years. Parents can choose the appropriate services (tutoring, academic assistance, etc.) from a list of approved providers, which are paid for by the school district.

syllabication
The act of breaking words into syllables.

syllable
A part of a word that contains a vowel or, in spoken language, a vowel sound (e-vent, news-pa-per).

text comprehension
The reason for reading: understanding what is read by reading actively (making sense from text) and with purpose (for learning, understanding, or enjoyment).

transition
Commonly used to refer to the change from secondary school to postsecondary programs, work, and independent living typical of young adults. Also used to describe other periods of major change such as from early childhood to school or from more specialized to mainstreamed settings.

vocabulary
Word knowledge. Listening vocabulary refers to the words a person knows when hearing them in oral speech. Speaking vocabulary refers to the words we use when we speak. Reading vocabulary refers to the words a person knows when seeing them in print. Writing vocabulary refers to the words we use in writing.

word attack
An aspect of reading instruction that includes intentional strategies for learning to decode, sight read, and recognize written words.

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