NASP Position Statement - Students With Attention Problems

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Position Statement on Students With Attention Problems

The National Association of School Psychologists advocates appropriate educational and mental health services for all children and youth. NASP further advocates noncategorical models of service delivery within the least restrictive environment for students with disabilities and students at risk for school failure.

NASP recognizes that some students with academic and adjustment problems exhibit a constellation of behaviors commonly associated with Attention Deficit Hyperactivity Disorder (ADHD). NASP also recognizes that attention problems are not always due to a “disorder” but may reflect emotional or environmental factors such as anxiety or inconsistent discipline practices. NASP believes that these behaviors exist along a continuum from mild to severe and that appropriate interventions will vary depending on the nature and severity of the behaviors of concern.

Longitudinal data suggest that the behaviors associated with ADHD typically present at an early age, may change over time, and may persist into adulthood. Therefore, NASP believes that interventions must be designed within a developmental framework. Furthermore, recognizing that these students are at particular risk for developing social-emotional and learning difficulties, NASP believes problems should be addressed early to reduce the need for long- term special education or placement in more restrictive educational settings. NASP believes that students with severe attention problems can be provided appropriate special education services under current disability categories of the IDEA or with accommodations in regular education through Section 504 of the Rehabilitation Act of 1973.

Diagnosis of ADHD should be done with care and with the understanding that attention problems may reflect normal development or other psychological conditions. Because attention problems can co-exist with other significant disorders or be symptomatic of very different problems, it is essential that a thorough, differential evaluation be conducted prior to diagnosis and treatment, and that this assessment should include direct input from school and home. It should also include a functional analysis of behavior so that interventions are designed with a full understanding of the problem behaviors of concern. NASP strongly believes that assessment of attention problems should be linked to interventions and recommends that intervention assistance to students, teachers and parents is provided early and for as long as such support is necessary to assure optimal performance.

NASP believes that effective interventions should be tailored to the unique strengths and needs of every student. For children with attention problems, such interventions will often include the following:

1) Classroom modifications to enhance attending, work production, and social adjustment;

2) Behavior support systems to reduce problems in areas most likely to be affected (e.g., unstructured settings, large group instruction, independent seatwork, etc.);

3) Direct instruction in study strategies and social skills, with explicit strategies for enhancing generalization to natural environments such as the classroom, playground, etc.;

4) Collaboration and consultation with families to ensure that parents’ expertise in managing their child is fully utilized, to support parents’ behavior support at home, and to facilitate the use of consistent approaches across home, school, and community settings;

5) Monitoring by a case manager to ensure effective implementation of interventions, to provide adequate support for those interventions, and to evaluate the effectiveness of programs in meeting behavioral and academic goals;

6) Education of school staff in characteristics and management of attention problems to enhance appropriate instructional modifications and behavior support;

7) Access to special education services when attention problems significantly impact school performance;

8) Collaboration with community agencies providing medical and related services to students and their families;

9) Interventions to help these students to appreciate their unique abilities and to develop their self esteem.

Research indicates that medication can be a highly effective treatment for many students with attention problems and can enhance the efficacy of other interventions. NASP believes that a decision to use medication rests with parents and is not an appropriate contingency for school placements and interventions. A thorough, differential assessment is essential prior to pharmacological intervention to assure that the most appropriate medication (if any) is prescribed. Furthermore, medication should be considered only as part of a comprehensive treatment program that may include academic, social, behavioral, and/or parent and family intervention. When medication is considered, NASP strongly recommends:

1) That behavioral and academic data be collected before and during blind medication trials to assess baseline conditions and the efficacy of medication; and

2) That communication between school, home, and medical personnel emphasize mutual problem solving and collaborative teamwork; and

3) That the student’s health, behavior and academic progress while on medication are carefully monitored and communicated to appropriate medical providers.

NASP believes school psychologists play a vital role in developing, implementing, and monitoring effective interventions with students with attention problems. As an Association, NASP is committed to publishing current research on ADHD and to providing continuing professional development opportunities to enhance the skills of school psychologists to meet the diverse needs of students with attention problems.

This revision was adopted by the NASP Delegate Assembly, July 2003.

Please note that NASP periodically revises its Position Statements. We encourage you to check the NASP website at www.nasponline.org to ensure that you have the most current version of this Position Statement.