ADHD and At-Risk Preschoolers: Identification and Instruction

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 under age three 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 shifts from "at risk" to more straightforward language based on exhibited developmental delays in cognitive, social, emotional, physical, or other developmental constructs. However, this is not to say that special education teachers and administrators do not use the term "at risk" when 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 a collaborative effort involving interactions with members of the medical team, counselors, social workers, and parents.

Characteristics and Legal Framework

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, a preschooler who is at risk may have been considered at risk in infancy or as a toddler under IDEA definitions, thereby warranting additional assessments and interventions (Taylor, Smiley & Richards, 2009). When students fall behind their peers in language or literacy development, or exhibit externalizing behaviors such as aggression, 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. Special educators also have the opportunity to identify structural supports and other protective factors that can promote resilience and mitigate risk (Taylor, Smiley & Richards, 2009). In terms of best practice, 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 toward the general curriculum, albeit with special education supports in subjects such as mathematics, literacy, or social skills (Taylor, Smiley & Richards, 2009). Reaching out to at-risk students in preschool 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 are due to an unstable or unhealthy home environment, research shows that family support in early intervention instructional strategies promotes successful student outcomes (Taylor, Smiley & Richards, 2009). Engaging the parents of an at-risk preschool student may reduce risk factors by providing parents with opportunities to access needed community resources. Research also shows that parent training can be an efficacious means of helping at-risk preschool 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 operationalized a definition of ADHD based on empirical research. The definition rests 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, symptoms must be present for at least six months and must 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 the inability to concentrate or focus — being a major feature. Other characteristics include impulsivity or hyperactivity: acting without thinking in ways that are developmentally inappropriate. Special education teachers need to realize that not all children will exhibit the same symptoms. Some will be characterized more by the inability to concentrate with few signs of impulse control problems or hyperactivity, while others may be the opposite (Taylor, Smiley & Richards, 2009). Older students and adolescents might exhibit more inattentive characteristics, while younger students may present more hyperactive ones (Taylor, Smiley & Richards, 2009). Hyperactive or impulsive characteristics include excessive talking, inability to play quietly, inappropriate running or other physical activities, and impatience when waiting in line or for one's turn in class (Taylor, Smiley & Richards, 2009). Characteristics may also be age- and gender-dependent, as well as influenced by sociocultural factors (Kvande, Belsky & Wichstrom, 2017). Regardless of how symptoms cluster and manifest, ADHD does impact social and academic performance. Special education teachers and administrators therefore need to be aware of best practice instructional strategies that support students with ADHD.

Best practices when working with students with ADHD will be individualized. Some students may require pharmacological interventions and counseling services in addition to instructional strategies, and teachers may need to be aware of these interventions. Direct instructional strategies such as mnemonics may help students with ADHD master the core curriculum, even though they are not entitled to an individualized education plan under IDEA. Special education teachers are nevertheless ethically obliged to provide students with ADHD with the least restrictive environment that suits their unique needs, while embracing diversity and the principles of inclusion in the classroom (Freedman, 2016). Special education teachers may therefore work in a collaborative teaching environment to support the general education teacher with direct instruction or to promote student self-regulation and classroom management (Taylor, Smiley & Richards, 2009). Self-monitoring techniques and self-reinforcement strategies can provide students with the cognitive tools they need to cultivate desirable behaviors (Taylor, Smiley & Richards, 2009). Research on parent training for students with ADHD has also been promising, encouraging special education teachers to suggest parent training as an additional intervention (Rimestead, Lambek & Christiansen, 2016). Other effective methods include precision teaching, a systematic means of adapting instructional strategies (Taylor, Smiley & Richards, 2009). The special education instructor can become familiar with multiple tools and techniques and apply them according to the individual student's needs.

References

Blotnicky-Gallant, P., Martin, C. & McGonnel, M. (2014). Nova Scotia teachers' ADHD knowledge, belief, and classroom management practices. Canadian Journal of School Psychology, 30(1): 3–21.

Freedman, J.E. (2014). An analysis of the discourses on attention deficit hyperactivity disorder (ADHD) in US special education textbooks, with implications for inclusive education. International Journal of Inclusive Education, 20(1): 32–51.

Hancock, T.B., Ledbetter-Cho, K., Howell, A. & Lang, R. (2016). Enhanced milieu teaching. In Early Intervention for Young Children with Autism Spectrum Disorder. Springer.

Kvande, M.N., Belsky, J. & Wichstrom, L. (2017). Selection for special education services. European Journal of Special Needs Education, 33(4): 510–524.

Morrill, M.S. (2018). Special education financing and ADHD medications. Journal of Policy Analysis and Management, 37(2): 384–402.

Rimestead, M.L., Lambek, R. & Christiansen, H.Z. (2016). Short- and long-term effects of parent training for preschool children with or at risk of ADHD. Journal of Attention Disorders. https://doi.org/10.1177/1087054716648775

Tannock, R., Frijters, J.C. & Martinussen, R. (2016). Combined modality intervention for ADHD with comorbid reading disorders. Journal of Learning Disabilities, 51(1): 55–72.

Taylor, R.L., Smiley, L.R. & Richards, S. (2009). Exceptional Students. New York: McGraw-Hill.