Part One: At-Risk Preschoolers and ADHD
At-Risk Preschoolers and Early Developmental Delays

Because early intervention can be critical for optimizing student outcomes, identifying at-risk students in preschool has become built into the Individuals with Disabilities Education Act (IDEA). In fact, IDEA also offers guidelines for identifying possible developmental delays in infants and toddlers who are under age three and who would be “likely to experience a substantial developmental delay if early intervention services are not provided,” (Taylor, Smiley & Richards, 2009, p. 413). For preschoolers, the terminology used in IDEA changes from “at risk,” to more straightforward terminology based on exhibited developmental delays in terms of cognitive, social, emotional, physical, or other constructs of development. However, this is not to say that special education teachers and administrators do not use the term “at risk” when it comes to identifying those preschoolers who are exhibiting developmental delays and also have environmental triggers that could exacerbate the problems such as trauma or adverse socioeconomic conditions (Taylor, Smiley & Richards, 2009). Special educators are therefore legally and ethically obliged to provide all at risk preschoolers with the programs and services they need, including those based on instructional strategy and design. Being at risk can include children who have already been diagnosed with any type of disability but have yet to exhibit any externalizing or internalizing behaviors. Defining and identifying at risk preschoolers is going to be a collaborative effort involving interactions with members of the medical team, counselors, social workers, and parents.

Characteristics of at risk preschoolers vary too much to generalize. Special educators may notice possible signs of physical, emotional, sexual or psychological abuse: all of which are risk factors. Other risk factors the special educator may use to characterize students as being at risk include instability in the home, extreme poverty or homelessness, substance abuse in the home, or exposure to violence in the community (Taylor, Smiley & Richards, 2009). In addition to these characteristics, a preschooler who is at risk may also have been considered at risk in infancy or as a toddler according to the IDEA definitions, thereby warranting additional assessments and interventions (Taylor, Smiley & Richards, 2009). When students fall behind their peers in terms of language or literacy development, or exhibit externalizing behaviors like aggressions, the special educator may characterize the preschool student as being at risk for early developmental or cognitive delays.

The key to working with at risk preschoolers is early intervention. However, special educators also have the opportunity to identify the structural supports and other protective factors that can promote resilience in the child and mitigate risk (Taylor, Smiley & Richards, 2009). In terms of best practice instructional practices, content should be adapted to suit the needs of the child. Children who are at risk or who exhibit early developmental delays will be steered in the direction of the general curriculum, albeit with special education supports in subjects like mathematics, literacy, or social skills (Taylor, Smiley & Richards, 2009). Reaching out to at risk students in preschool, or those with early developmental delays, can reduce risk factors and even lead to the child no longer needing special literacy instruction by kindergarten (Taylor, Smiley & Richards, 2009). Although many of the factors that precipitate early developmental delays due to environmental triggers like trauma are due to an unstable or unhealthy home environment, research does show that family support in early intervention instructional strategies promotes successful student outcomes (Taylor, Smiley & Richards, 2009). In fact, engaging the parents of an at risk preschool student might reduce the risk factors by providing the parents with opportunities to access community resources they need. Research also shows that parent training can be an efficacious means of helping preschool at risk students or students with early developmental delays (Rimestead, Lambek & Christiansen, 2016).

Attention Deficit/Hyperactivity Disorder (ADHD)

Although special education teachers will invariably address the needs of students with ADHD in their classrooms, ADHD is not one of the conditions covered under IDEA. Therefore, there is no legal definition of ADHD (Taylor, Smiley & Richards, 2009). Definitions are based on psychiatric descriptions of the symptoms associated with the diagnosis. Psychologists have, therefore, operationalized a definition of ADHD based on empirical research. The definition of ADHD is based on symptoms and symptom persistence, with characteristics like inattentiveness and poor impulse control that interfere with the student’s performance in the classroom (Taylor, Smiley & Richards, 2009). To be diagnosed with ADHD, the symptoms need to be present for at least six months and also be “persistent, frequent, and severe,” in order to avoid erroneous diagnoses (Taylor, Smiley & Richards, 2009, p. 444).

The characteristics of students with ADHD follow from the psychiatric definition, with inattentiveness or inability to concentrate or focus a major feature. Other characteristics of students with ADHD include being...…(Taylor, Smiley & Richards, 2009). Direct instruction, cognitive-behavioral modification strategies, behavioral intervention, and precision teaching are also best practices instructional strategies that can be used, even without IDEA support (Taylor, Smiley & Richards, 2009). Finally, teachers may consider modifying the environment to minimize distractions or to promote prosocial behaviors. For example, students with ADHD may perform better in a “highly structured environment,” and one that lacks order or routine (Taylor, Smiley & Richards, 2009, p. 463). Students with ADHD may not perform well on group exercises, which means that teachers may want to focus more on instructional strategies using independent learning. Teachers are also advised to keep their lectures focused, while offering students with ADHD recordings or digital copies they can review later in their own time in case their concentration waned (Taylor, Smiley & Richards, 2009). This way, teachers support the unique cognitive needs of students with ADHD while still maintaining their inclusion in the general education classroom. Technology can also help students with ADHD process course content in ways that are meaningful to them. In some cases, peer mediated instruction may be an instructional strategy that helps students with ADHD (Taylor, Smiley & Richards, 2009).

Some students with ADHD may have comorbid conditions such as developmental or intellectual disabilities that do warrant their coverage under IDEA and the use of an IEP. In cases like these, instructional strategies will vary depending on the comorbidity and the assessment of the student. For example, research on students with ADHD comorbid with reading disorders benefitted from an intensive reading instruction intervention—whether or not the children were on medications (Tannock, Frijters & Martinussen, 2016). Evidence-based instructional strategies like intensive reading instruction and precision teaching can be taught to general education teachers or implemented by special education teachers in the collaborative teaching environment to ensure inclusivity.

As with at risk preschool students, students with ADHD benefit from additional supports and not only instructional strategies applied in the classroom. Involving the family, and techniques like parent training, help to provide the ongoing support the student needs. Parents who are engaged in their student’s education can learn how to apply the instructional strategies at home to promote student academic success and overcome the challenges associated with memory and content mastery that some students with ADHD experience. When special educators focus on early intervention, they have a much greater chance of helping students with special needs.