The "Tug-of-War" over Attention-Deficit Hyperactivity Disorder: Balancing the Interests of Parents and Schools (and Don't Forget the Kids)

By Slater, Amanda; Reeve, Ronald E. | Developments in Mental Health Law, January 2008 | Go to article overview

The "Tug-of-War" over Attention-Deficit Hyperactivity Disorder: Balancing the Interests of Parents and Schools (and Don't Forget the Kids)


Slater, Amanda, Reeve, Ronald E., Developments in Mental Health Law


I. Introduction

The diagnosis of attention-deficit hyperactivity disorder (ADHD) and the prescription of ADHD medications, like Ritalin, Concerta, and Adderall, have reached an all-time high in this country. The increase in the use of these medications among children has fueled an ongoing debate over how to diagnose and treat ADHD in school-age children. At the center of the debate is a controversy over what roles teachers, parents, and school administrators should play in identifying and treating students with an ADHD diagnosis.

This article contends that teachers and school officials should be able to initiate steps that will lead to the implementation of an educational strategy that addresses the treatment needs of these children. Albeit infrequently, when it can be established that treatment is medically appropriate and consistent with the educational best interests of the child, the initiation of these steps may need to occur notwithstanding the objection of the child's parents. However, it will also be asserted that a far better course is to implement measures that will (1) facilitate parent-teacher discussions of and joint agreement on treatment strategies that will best help students with ADHD achieve educational goals, (2) promote the resolution of disputes between parents and school officials about educational strategies, and (3) encourage input from the child on the best strategy to employ.

Part II of this article explains what ADHD is, who it affects, and how it is diagnosed, and examines the different treatment options available to individuals diagnosed with ADHD. Part III outlines the controversy surrounding ADHD medications. Part IV addresses the rights of students and parents to refuse ADHD medication, Part V explains when the state can infringe on those rights, and Part VI explores the school's authority to condition school attendance on the acceptance of a needed and appropriate ADHD treatment program.

II. Attention Deficit / Hyperactivity Disorder

A. What Is ADHD and Who Does It Effect?

There are three diagnostic subtypes of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined (where symptoms of inattention and hyperactivity-impulsivity are both present). (1) The essential feature of an ADHD diagnosis is a persistent pattern of inattention and/or hyperactivity-impulsivity for at least six months that is more frequent and severe than typically observed in individuals at a comparable level of development. (2)

There is no single test for ADHD; instead, psychologists and physicians rely on diagnostic guidelines. (3) The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) lists the widely recognized symptoms of ADHD as well as the criteria for diagnosis. Symptoms include failure to pay close attention to details, a propensity to make careless mistakes, difficulty sustaining attention in tasks or play activities, failure to listen when spoken to directly, failure to follow instructions, avoidance or dislike of tasks that require sustained mental effort, a propensity to be easily distracted by extraneous stimuli, frequent fidgeting or squirming, and frequently interrupting others. (4)

To confirm a diagnosis, these behaviors must occur in more than one setting, such as home, school, and social situations; be markedly more severe than in other children of the same age; start before the child is seven; have been present for more than six months; and make it difficult for the child to function at school, home, or in social situations. (5) Further, when making a diagnosis examiners should conduct a complete physical and psychological exam to rule out other potential causes of the behavior. (6) It is also necessary to gather input from outside sources, such as parents and teachers, to determine the severity and frequency of the symptoms. …

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