ADHD: Appropriate
Determination of Eligibility
Under the Category of Other
Health Impairment
Developed by the Kentucky Special
Education Cooperative Network
Definition: Other Health Impairment
Other health impairment (OHI) means having limited strength,
vitality, or alertness, including a heightened alertness to
environmental stimuli, that results in limited alertness with
respect to the educational environment, that:
a) is due to a chronic or acute health problem e.g., as acquired
immune deficiency syndrome, asthma, attention deficit
disorder or attention deficit hyperactivity disorder, diabetes,
epilepsy, a heart condition, hemophilia, lead poisoning,
leukemia, nephritis, rheumatic fever, sickle cell anemia,
Tourette syndrome, or tuberculosis; and
b) adversely affects a child’s educational performance.
34 CFR 300.8 (c) (9)
707 KAR 1:280 Section 1 (42)
KRS 157.200 (1) (b)
Definition: A Chronic or Acute Health Problem
includes a non-exhaustive list that covers health problems
such as acquired immune deficiency disease, asthma,
attention deficit disorder, attention deficit hyperactivity
disorder, diabetes, epilepsy, heart condition,
hemophilia, lead poisoning, leukemia, nephritis,
rheumatic fever, sickle cell anemia, Tourette syndrome
and tuberculosis.
34 C.F.R. 300.8 (a) (9)
707 KAR 1:280 Section 1 (42)
OHI means having limited:
STRENGTH
VITALITY
ALERTNESS
Definition: Limited Strength
includes the endurance of fine and gross motor
skills and activities including trunk control,
slouching, and the maintenance of posture. It
may also include how the student’s emotional
stamina and how the student deals with stress
or pain.
Definition: Limited Vitality
includes physical and mental endurance
(duration, intensity, and frequency over time)
in an activity as measured by work
completion; time on task; and the number of
times the student took a break.
Definition: Limited Alertness
including a heightened alertness to
environmental stimuli, in the focus on tasks,
activities, and responses, as measured by
whether the student has a short attention
span (i.e., pays attention to nothing) or is
highly distractible (i.e., pays attention to
everything).
Types of ADHD
• Primarily Inattentive
• Primarily Hyperactive-Impulsive
• Combined Type
Look For:
Primarily Inattentive:
• Makes careless mistakes
• Has trouble sustaining
attention
• Seems not to listen
• Has difficulty following
directions
• Disorganized
• Losses things
• Forgetful
Primarily Hyperactive-Impulsive:
• Fidgets or squirms frequently
• Often runs, climbs and is
restless
• Has difficulty working or
playing quietly
• Always seems on the go
• Talks excessively
• Blurts out answers before
question is finished
• Difficulty waiting turn
• Interrupts others
Eligibility Determination
Who Can Make The Diagnosis?
Specialty
Can Diagnose
ADHD?
Can Prescribe
Medication if
needed?
Provides counseling
or training?
Psychiatrists
Yes
Yes
Yes
Psychologists
Yes
No
Yes
Pediatrician or
family physician
Yes
Yes
Usually, no
Neurologists
Yes
Yes
No
This chart from the National Institute of Mental Health
lists the types of doctors who are qualified to
diagnose and supervise treatment for ADHD,
although not all may have specific training in this
disorder.
The affect of the health problem resulting in
limited strength, vitality, or alertness:
How does the health problem limit the student’s strength?
• What is the expectation for similar age peers for strength?
• How does the student differ in this area from peers?
How does the health problem limit the student’s vitality?
• What is the expectation for similar age peers for vitality?
• How does the student differ in this area from peers?
How does the health problem limit the student’s alertness?
• What is the expectation for similar age peers for alertness?
• How does the student differ in this area from peers?
Possible Data Sources:
Behavior Observations, Data Logs
• Determine how and when the child is
inattentive, impulsive and/or hyperactive
• Carefully examine the environment to
determine WHY (rule the following out):
– Is the task too hard, too easy?
– Were the expectations made explicit?
– Is there a pattern of events that allows for
prediction of the inattentive, impulsive and/or
hyperactive behavior
Possible Data Sources:
Rating Scales
• Will tell you whether the child’s behavior is
significantly different from peers
• Will NOT tell you WHY
• Ratings should be gathered across settings
– If the problem doesn’t occur in most/all settings,
it is an environmental problem rather than a
“within the child” problem
• Possibilities: Conner’s Rating Scales- Revised,
Brown Attention Deficit Disorder Scales
Possible Data Sources:
Curriculum Based Assessment
• Assessment based on the grade level
curriculum
• Given to ALL students
• Assessed three (3) times per year
• Possibilities: PAS, Diebels, GMADE, GRADE
Possible Data Sources:
Direct Assessment
• Conner’s Continuous Performance Test
– Computer based assessment
– Measures ability to attend to a boring task
– Measure impulsivity
Definition: Adverse Affect
the progress of the child is impeded by the
disability to the extent that the educational
performance is significantly and consistently
below the level of similar age peers.
34 CFR 300.8
707 KAR 1:280 Section 1 (2)
Eligibility Determination:
Adverse Affect
• Review all student assessment results
• Compare student performance to peers
• The ARC determines “Adverse Affect”
when:
Eligibility Determination:
Adverse Affect
1. The disability related to the health
problem impedes progress to the extent
that educational performance is
significantly and consistently below the
level of similar age peers.
Eligibility Determination:
Adverse Affect
2. The disability related to the health
problem interferes with acquiring,
developing, understanding, or applying
knowledge or skills needed to be
included in and progress in the general
curriculum
Eligibility Determination:
Adverse Affect
3. The disability related to the health
problem affects the student to such a
degree that special education and
related services are needed in order to
benefit from education.
Exclusionary Clause
The student is not eligible for services if
the ARC determines:
• A lack of instruction in reading
• A lack of instruction in math
• The student is limited English proficient
• The student child does not meet
eligibility criteria
IEP Development
The ARC determines specific areas of need
for the student that result from the
ADHD.
The ARC considers the areas specifically
related to the student’s:
–Limited strength
–Limited vitality
–Limited alertness
Example: Larry
Larry: 10 years; medical diagnosis of ADHD
Limitations from ADHD:
– Distractible
– Peers are expected to stay on task for 20 minutes
without distractions or interruptions. When given
a 20 minute period of time and a 10 question
handout to complete, he writes his name and the
date, and works on the first question; he is on task
a total of 5 minutes.
– Accommodations the teacher has used include
setting a timer to complete his work, working in a
study carrel, and assigning completion of 2/3 of
his assignments
Additional data on Larry
• Curriculum based measures indicate that Larry is
performing well below the average of the class in
reading and math. Due to his lack of attention, he is
failing to acquire and understand the curriculum
content. The ADHD (his health problem) causes his
distractibility and off task behavior; he needs to learn
specific strategies and generalize to other settings, so
that he may begin learning the content he has
missed (i.e., specially designed instruction)
• A review of his grades, the curriculum, and his
performance indicate that he has been provided
appropriate instructional opportunities in reading
and math, and the ARC ruled out a learning disability
or another disability.
Other Data Needed
• What reading, writing, and math skills has this
student gained? (Remove the impact of the
distractibility when assessing)
• What are the specific skills that this student
has missed? (Remove the impact of the
distractibility when assessing)
Needs Related to the Disability
• Decrease Distractibility
• Increase on-task behavior
• Increase work completion
What are NOT areas of need
for this student?
• This student’s needs are NOT in reading and math. The
ADHD causes the distractibility, causing the off task
behavior and lack of work completion. If a student is
not on task, the student can not and will not learn the
skill being taught.
• The IEP should address the needs of the student that
result from the disability, which is distractibility.
• Once the student is taught (through specially designed
instruction) specific strategies that will help him
develop, understand, and apply the strategies to
decrease his distractibility, his on task behavior and his
work completion will improve
?
?
?
If the student doesn’t need
goals in reading or math, what
kind of goals are needed?
?
?
?
Possible IEP Goals from
Academic Expectation 2:
• AE 2: develop abilities to apply core concepts…..to
what they will encounter throughout life
• AE 2.32: Demonstrate strategies for becoming and
remaining mentally and emotionally healthy
• AE 2.37: demonstrate skills and work habits that
lead to success in future schooling and work
Possible IEP Goals from
Academic Expectation 3:
• AE 3: Develop their abilities to become selfsufficient individuals
• AE 3.5: Demonstrate self-control and selfdiscipline
• AE. 3.7: Demonstrate the ability to learn on
one’s own
Possible IEP Goals from
Academic Expectation 5:
• AE 5: Develop their abilities to think and solve
problems in school situations and in a variety of
situations they will encounter in life
• AE 5.1: Use critical thinking skills such as analyzing,
prioritizing, categorizing, evaluating, and comparing
to solve problems in a variety of real-life situations
• AE 5.3: Students organize information to develop or
change their understanding of a concept
Possible IEP Goals from
Academic Expectation 6:
• AE 6: Develop their abilities to connect and integrate
experiences and new knowledge from all subject
matter fields which what they have previously
learning…….
• AE 6.2: Use what they already know to acquire new
knowledge, develop new skills, or interpret new
experiences
• AE 6.3: Expand their understanding of existing
knowledge by making connections with new
knowledge, skills and experiences
Example Benchmarks:
On-task behavior
GOAL: Demonstrate self-control and self-discipline
BENCHMARKS:
• Complete 80% of work at 80% accuracy rate
• Begin working on assignment within 2 minutes of
directions begin given
• Follows directions with less than 2 personal prompts
• Works on class assignments for 10 minutes before
taking break (baseline data provides the target
number of minutes)
Specially Designed Instruction
• Direct teaching of what “on-task”
behavior looks like through role-playing
• Direct teaching of self-monitoring strategies
with reinforcement for close approximations
of the benchmark
• Direct teaching of listening strategies
Supplementary Aids and Services
• Use of a visual cue to get back on task
• Break tasks into parts and frequently check
on- task progression
• Reinforce for correct on-task behavior when it is
displayed –even if it is displayed for only a short
period of time
• Allow for movement breaks that involve heavy
lifting or fast movements such as taking a note to
the office
What Accommodations, if
any, would be needed for
instruction and assessment?
• Review what the student gets
regularly for SDI
• Review what the student gets
regularly for SAS
Example Benchmarks:
Overall Organization
GOAL: Organize information to develop or change
understanding of a concept
BENCHMARKS:
• Maintain a notebook according to system taught with at
least 85% of papers in the correct section of the
notebook during weekly teacher student conferences
• Come to class with required materials 4/5 days for each
class
• Complete and turn in 85% of homework in each class
• Come to class on time at a rate of 95%
Specially Designed Instruction
• Directly teach a notebook organization
system with re-teaching and monitoring
of the system each week during case
manager-student conference
• Reinforce the student for increasing the
level of compliance with the notebook
system
– Note: to do this appropriately, you must
assess what is reinforcing to the student in a
systematic way
Supplementary Aids and Services
• Provide a consistent area in the classroom for work
to be left
• Check with the child frequently and look at the notebook to
help him/her learn the system
• If assignments are not turned in, the general education
teacher will notify the case-manager and discuss whether
extra time is needed to find or re-do the assignment. While
the student is learning this skill, points will not be removed for
late work. This is a temporary accommodation while the skill
is being learned. The decision on when or whether to count
off for late work should be a joint decision between the
content teacher and the case manager.
What Accommodations, if
any, would be needed for
instruction and assessment?
• Review what the student gets
regularly for SDI
• Review what the student gets
regularly for SAS
Sample Benchmarks:
Organization for academic tasks
• Written paragraphs have a topic sentence
• Written paragraphs have 3 or more supporting
details
• All items on work sheets are completed with
none left out
Specially Designed Instruction
• Directly teach the student to use a graphic
organizer to complete writing assignments
• Directly teach the student to divide worksheets
into sections and scan work for missed items before
turning it in
• Directly teach a system of self assessment:
–
–
–
–
Did I complete all items?
Did I answer all parts of the question?
Read the work to make sure words are not omitted
Did I do my best work?
Supplementary Aids and Supports
• Frequently check with the student to ensure
understanding of the graphic organizer
• Require the student to complete work left blank.
While the student is learning this skill, points will
not be removed for work completed after originally
turned in. This is a temporary accommodation while
the skill is being learned. The decision on when or
whether to count off for late work should be a joint
decision between the content teacher and the case
manager.
What Accommodations, if
any, would be needed for
instruction and assessment?
• Review what the student gets
regularly for SDI
• Review what the student gets
regularly for SAS
When the Health Impairment Impacts
Reading Skills: Sample Present Level
According to curriculum based assessments, Johnny’s
basic reading is commensurate with peers. When
reading for comprehension, Johnny reads too fast
and cannot identify the main idea and supporting
details that help him understand the concepts and
content. Johnny’s lack of attention to what he reads
impacts his ability to read and understand for
meaning.
Sample Benchmarks: When Attention Deficits
Significantly Impact Reading Skills
• Johnny will identify the main idea of a grade
level reading passage
• Johnny will give 3 supporting details from a
grade level reading passage
Specially Designed Instruction
• Direct instruction in pre-reading strategies to
set the stage for identification of the main
concept
• Direct instruction in text cues
which point to the main idea
• Direct instruction in the use of a graphic
organizer to take short notes when reading.
Specifically, the graphic organizer will provide
a spot to note important supporting details
Supplementary Aids and Services
• When reading is expected in the classroom, the teacher
will give Johnny a cue designed to help identify the main
idea
• As a part of reading assignment instructions, the teacher
will review the organization of the reading passage. The
purpose of this is to cue the student as to ways of
identifying the main idea as well as the supporting details
that are most critical
• Teachers will provide a graphic organizer for Johnny when
reading for detail is part of the classroom activity. Johnny
will earn bonus points for use of this graphic organizer in
order to reinforce his use of the strategy
What Accommodations, if
any, would be needed for
instruction and assessment?
• Review what the student gets
regularly for SDI
• Review what the student gets
regularly for SAS
When The Health Impairment Impacts
Math Skills: Sample Present Level
Johnny does not understand the concept of regrouping
within any mathematical concept (addition,
subtraction, multiplication, division). His inability to
maintain focus has prevented his understanding of
this concept. Within the general education
environment, Johnny has received both Level II (30 ½
hour sessions within 45 school days) and Level III
interventions (2 30 min sessions on 40 of 60 school
days) which have not been successful in helping him
master this skill.
Sample Benchmarks: When Attending
Deficits Significantly Impacts Math Skills
• Johnny will utilize strategies to determine
whether regrouping is needed within a given
math problem with 95% accuracy
• Johnny will correctly utilize regrouping in 80 %
of math problems presented
Specially Designed Instruction
• Direct teaching of strategies to assess math
problems to determine whether regrouping is
needed
• Direct instruction (with a visual cueing system)
in the steps for regrouping in a variety of
problems
• Instruction in a self-monitoring strategy to
check work and determine whether
regrouping was appropriate
Supplementary Aids and Services
• Visual cueing system will be present on Johnny’s desk to help
determine whether regrouping is needed
• When errors are made, Johnny will correct the work with the
assistance of his case-manger who will utilize cognitive strategies to
help him understand the error and why he made it.
• Additional time may be needed to get this process complete. The
case-manager and teacher will negotiate how much time is needed
to complete this process.
• The grade earned after the correction phase will be his recorded
grade. This is a temporary accommodation and will be faded as
Johnny learns the skill. It should be noted, however, that Johnny
has had considerable intervention in this area so the skill may take
time to learn.
What Accommodations, if
any, would be needed for
instruction and assessment?
• Review what the student gets
regularly for SDI
• Review what the student gets
regularly for SAS
Tying it all together: Addressing Needs that Relate to the Disability
Present
Levels
Identified Need
Annual Goal
Benchmarks/
Methods of
Measurement
Curriculum based measures indicate that Larry is performing
well below the average of the class in reading and math. Due
to his lack of attention, he is failing to acquire and understand
the curriculum content. The ADHD (his health problem)
causes his distractibility and off task behavior; he needs to
learn specific strategies and generalize to other settings, so
that he may begin learning the content he has missed (i.e.,
specially designed instruction).
Increase on-task behavior
Develop his ability to become a self-sufficient individual
As measured by performance based on criteria
established within rubrics to assess on task behaviors:
Complete 80% of work at 80% accuracy rate
Begin working on assignment within 2 minutes of directions
begin given
Follows directions with less than 2 personal prompts
Works on class assignments for 10 minutes before taking a
break
The ARC should articulate the following:
How does the health problem limit the student’s strength?
• What is the expectation for similar age peers for strength?
• How does the student differ in this area from peers?
How does the health problem limit the student’s vitality?
• What is the expectation for similar age peers for vitality?
• How does the student differ in this area from peers?
How does the health problem limit the student’s alertness?
• What is the expectation for similar age peers for alertness?
• How does the student differ in this area from peers?
If the ARC cannot articulate the
information from the previous slide, there
is not a clear understanding of the child’s
issues.
The ARC should always consider the
possibility that the child may have a disability
which DOES NOT require specially designed
instruction. This child would not be
considered a child with a disability under
IDEA.
While ADHD can certainly be a
DISability with a negative impact
ADHD does have a
positive side