Review
Systematic Review: Educational Accommodations for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

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Objective

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often receive instruction and take tests using educational accommodations. This review aims to summarize and integrate the research literature on accommodations for this specific population.

Method

Electronic databases in medicine (MEDLINE), psychology (PsycINFO), and education (ERIC) were systematically searched (last update January 13, 2020), with inclusion criteria selecting any document with a focus on accommodations in educational settings or on academic tasks for children or adolescents with ADHD. The search yielded 497 unique documents. Additional searches yielded 13 more documents. Of the 510 total potentially useful documents, 68 met criteria for topical relevance and age range, to be discussed in the narrative review. The wide range of document types led to a qualitative synthesis.

Results

Accommodations are by far the most common response to ADHD in educational settings, with testing accommodations such as extended time being particularly prevalent. However, most accommodations fail to show evidence of benefits that are specific to students with ADHD, and many of the more common accommodations have few or no experimental studies supporting them. An exception is read-aloud accommodations, which have two randomized experiments finding specific benefits for younger students with ADHD. Students and those who work with them often express ambivalence and dissatisfaction over the accommodations process.

Conclusion

More empirical research is needed to examine the effects of these extremely common supports. In the absence of supportive evidence, health professionals should be hesitant to recommend accommodations immediately after a diagnosis. Even when such evidence exists, educational accommodations should only be provided along with evidence-based interventions, or after interventions have failed, as suggested by the “life course” model of managing ADHD.

Section snippets

Method

We followed PRISMA guidelines for our review. Our PRISMA checklist is provided as Figure S1, available online.

Results

A total of 68 documents met full inclusion criteria (see Figure 1 for the PRISMA flow chart and Tables S1 and S2, available online, for summaries and classifications of all documents). Consistent with our broad search, we found documents providing relevant information about the following topics: the current legal framework supporting students’ rights to educational accommodations; the prevalence of accommodations; the effectiveness of various accommodations; perceptions of the accommodations

Discussion

Child and adolescent psychiatrists and related health care professionals, while not based in school settings, often provide diagnostic documentation and management recommendations for students with ADHD that are presented to school staff as authoritative, and so it is critical for such professionals to understand educational accommodations well. It is difficult to summarize such a broad and diverse body of documents on the topic, but 4 key conclusions were evident. First, educational

References (81)

  • B.J. Lovett et al.

    Testing Accommodations for Students with Disabilities: Research-Based Practice

    (2015)
  • L.R. Ketterlin-Geller et al.

    Instructional adaptations: accommodations and modifications that support accessible instruction

  • X. Ng et al.

    A latent class analysis to identify variation in caregivers’ preferences for their child’s attention-deficit/hyperactivity disorder treatment: do stated preferences match current treatment?

    Patient Patient-Centered Outcomes Res

    (2017)
  • C. Schnoes et al.

    ADHD among students receiving special education services: a national survey

    Except Child

    (2006)
  • D.L. Wodrich et al.

    The other health impairment category and health-based classroom accommodations: school psychologists’ perceptions and practices

    J Appl Sch Psychol

    (2007)

  • Provision of Services to Students with Attention Deficit Hyperactivity Disorder. A Vision for Education

    (1991)
  • M. Gordon et al.

    Assessment and management of ADHD in educational and workplace settings in the context of ADA accommodations

  • J. Konecky et al.

    Through the maze: legal issues and disability rights

    Learn Disabil Multidiscip J

    (2000)
  • M.D. Cohen

    Educational rights of children and adolescents with attention-deficit/hyperactivity disorder

    Adolesc Med State Art Rev

    (2008)
  • P.A. Zirkel et al.

    K–12 students eligible solely under section 504: updated national incidence data

    J Disabil Policy Stud

    (2016)
  • A.E. Pritchard et al.

    Academic testing accommodations for ADHD: do they help?

    Learn Disabil Multidiscip J

    (2016)
  • D.W. Murray et al.

    Prevalence and characteristics of school services for high school students with attention-deficit/hyperactivity disorder

    Sch Ment Health Multidiscip Res Pract J

    (2014)
  • M.E. Pariseau

    Individualized education programs for students with ADHD: analysis of special education services provided and cost of intervention

    (2012)
  • C.F. Spiel et al.

    Evaluating the content of individualized education programs and 504 plans of young adolescents with attention deficit/hyperactivity disorder

    Sch Psychol Q

    (2014)
  • E.W. Beale

    Identification of culturally diverse children with attention deficit/hyperactivity disorder: a school-based survey

    (1998)
  • S.S. Zentall et al.

    Educator preferences of accommodations for students with attention deficit hyperactivity disorder

    Teach Educ Spec Educ

    (1995)
  • S. Vinciguerra

    Lived experiences of secondary instrumental music teachers who teach students with learning disabilities

    (2016)
  • K.A. Melago

    Strategies for successfully teaching students with ADD or ADHD in instrumental lessons

    Music Educ J

    (2014)
  • T. Liontou

    Foreign language learning for children with ADHD: evidence from a technology-enhanced learning environment

    Eur J Spec Needs Educ

    (2019)
  • G.F. Gaastra et al.

    Unknown, unloved? Teachers’ reported use and effectiveness of classroom management strategies for students with symptoms of ADHD

    Child Youth Care Forum

    (2019)
  • D.W. Murray et al.

    Teacher management practices for first graders with attention problems

    J Atten Disord

    (2011)
  • M.R. Capriotti et al.

    Patterns and predictors of service utilization among youth with ADHD-predominantly inattentive presentation

    J Atten Disord

    (2019)
  • C.M. Rogers et al.

    A summary of the research on effects of test accommodations: 2015-2016. NCEO Report 412, Minneapolis, MN

    Natl Cent Educ Outcomes

    (2019)
  • P.H. Latham et al.

    Attention deficit disorder in school: teachers, students and parents

    Partners Educ

    (1998)

  • Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home

    (2008)

  • Special Education Section. Technical Assistance Resource Guide for Teachers Educating Students with Attention Deficit Hyperactivity Disorder

    (1996)

  • 101 Ways To Help Children with ADD Learn: Tips from Successful Teachers

    (1994)
  • R. Reid

    Attention deficit hyperactivity disorder: effective methods for the classroom

    Focus Except Child

    (1999)

  • Students with Attention Deficit Disorders ADD/ADHD: Eligibility Issues and Service Options under the Individuals with Disabilities Education

    Act (IDEA) and Section

    (1998)

  • Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices

    (2008)

    • Cited by (0)

    The authors have reported no funding for this work.

    This article is part of a special series devoted to the subject of child and adolescent attention-deficit/hyperactivity disorder (ADHD). The series covers a range of topics in the area including genetics, neuroimaging, treatment, and others. The series was edited by Guest Editor Jonathan Posner, MD, along with Deputy Editor Samuele Cortese, MD, PhD.

    Author Contributions

    Conceptualization: Lovett, Nelson

    Data curation: Lovett, Nelson

    Formal analysis: Lovett, Nelson

    Writing – original draft: Lovett

    Writing – review and editing: Lovett, Nelson

    ORCID

    Benjamin J. Lovett, PhD: https://orcid.org/0000-0003-4785-3070

    Jason M. Nelson, PhD: https://orcid.org/0000-0002-6170-2394

    The authors wish to thank Tina Wang, BA, of Teachers College, Columbia University, for her help with managing documents and references for the review.

    Disclosure: Drs. Lovett and Nelson have reported no biomedical financial interests or potential conflicts of interest.

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