Book Review: 1000 Best Tips for ADHD

1000 Best Tips for ADHD, by Susan Ashley, PhD, a psychologist specializing in behavioral disorders in children, is a practical book that has helpful tips for improving various aspects of life for parents of kids with ADHD.

The book has an introduction on how to use the book, followed by a list of tips categorized by the issue at hand.  The introduction is crucial to using the book, otherwise, the book is a reference style manual meant to help parents with specific common problems faced by children with ADHD.  The book avoids being trite and it acknowledges the hard work that sometimes comes with implementing behavioral strategies, so in a sense, while this is a book of tips, it is not a book of hacks.  Some of the suggestions given are easier to implement than others, and some of them will not work for a given child's situation.

The book has many strengths.  It is very practical and is not a long treatise on a certain approach or philosophy.  The main philosophy in this book seems to be, "Do what works."  Many parents with ADHD willl appreciate that fact that this book is reference style, so you don't have to read the whole book to understand or get to the part that you want, which is a fix for your child's problems.   The book offers a wide variety of tips in a wide variety of areas such as medication, behavioral issues, school, diet, and social issues.

There are several downsides to this book.   I was looking for a book about managing behavioral issues specific to older children and teens with ADHD, things like hygiene, organizational skills, and driving.   Those issues are not specifically addressed in this book.   I  would love to see the author write a similar book about teens with ADHD.  Another omission was that the book only talked about children having difficulty in brick and mortar school situations and did not address how to alter home schooling to help a child with ADHD.  It does refer the reader to a website and there are some tips on homework and specific subjects which could be helpful, however. 

Overall, though, the book offers many useful behavioral strategies you can try to help your child with ADHD.  While it is not the only book you will ever need, and not really a "complete reference for parenting a child with ADHD" as it is advertised to be, it certainly is a solid starter book for parents new to dealing with ADHD in a younger child.

Which is Better, a 504 plan or an IEP?

One of the first decisions a parent has to make once their child is diagnosed with ADHD is what kind of educational accommodations they should ask the school for.  This article discusses the differences between a 504 plan and an IEP, to help you decide which is best for your child.

First of all, 504 plans and IEPs only apply to public schools in the United States.  If your child is in a private school, you must discuss with your child's school whether and how they can accommodate your child.

504 plans
A 504 plan is usually best if your child is doing ok academically, but is having behavioral issues in the classroom that may affect their learning or the learning environment for other children.   Generally the types of accommodations provided are things that do not require a special education teacher to implement.  They would usually be changes a general education teacher could provide in a classroom while attending to a full class of children.  Examples include allowing the child some kind of fidget item/weighted lap pad/wobble cushion/standup desk, giving the child breaks upon request, preferential seating, redirection, verbal and written instructions, not withholding gym or recess, emailing homework assignments, and incentive charting.  At times, if a child has significant behavioral issues, a one on one aide might be provided under a 504 plan, but if your child definitely requires a one on one aide to function, you will probably want to go for an IEP.

A qualifying diagnosis, such as developmental delay or ADHD, is all that is needed for a child to qualify for a 504 plan.  No school testing or response to intervention is required by law for a child to get a 504 plan, so the process should be relatively quick, although the parent is responsible for holding the school accountable to adhering to the plan.

IEP
An IEP is usually what is needed if your child is struggling with academics, either because of an identified learning disability or because of ADHD alone.  Signs that your child is struggling academically include poor grades or having the teacher suggest that your child will not be ready to advance to the next grade.  Other common signs of academic trouble include not reading at grade level or frequently being unable to complete homework because of a lack of understanding of what was taught.

An IEP will label your child as a special education student, but will not necessarily result in a placement in a special education classroom.  What it can provide is a plan with specific goals and a timeline for improving academics, which usually includes access to a special education teacher and/or an instructional aide, curriculum, and other types of academic support.  If your child also has behavioral issues, the IEP usually also includes accommodations provided under a 504 plan, so you do not need both.

To qualify for an IEP, a child has to show that they have a learning problem.  In some districts, the teacher's word is all that is needed, but other districts have complex requirements for testing and response to intervention in order to come up with their plan.  If you switch districts, the new district will almost always require copies of academic records and testing, which is one reason why you should keep detailed records of your IEP journey.  Because of the need for evaluation, the process for getting an IEP is usually longer than that for getting a 504, so some families opt to get the 504 first while waiting for the IEP.

As you can see, 504 plans and IEP's are different, but no one is necessarily better than the other.  It just depends on what your child's needs are.    Generally speaking, an IEP is better for children who are having trouble with learning, while a 504 would be better for a child who can learn if their behavior can be better managed.

ADHD and Too Much Homework: The Early Elementary Years

 Many parents of kids with ADHD wish that they didn’t have to deal with tantrums over homework.  And interestingly, some schools are banning homework.  So what’s the deal?  Will ADHD kids stand to benefit from homework bans?  Should no homework be written into your child’s educational plan?

Many parents feel that more homework will help their child learn faster.  However, for younger students, academic achievement isn’t boosted by homework, and may actually be decreased by it.   However, some educators argue that homework in grades K-3 is mainly training for upper grades namely:

1)      to develop good habits, such as a homework routine and learning to keep track of assignments until they are turned in.

2)      to develop good attitudes towards learning outside of school

3)      to keep parents appraised of the student’s progress

In other words, the point of the assignment isn’t learning the topic of the assignment, but learning how to do homework and be a good student outside of class.

So, if your child is in the lower grades and you are having frequent homework battles, you may want to ask the teacher to adjust the homework so that your child can achieve the goals they are looking for.  Some adjustments you may ask for include:

1)      decreasing the length of assignments

2)      changing the assignments to something more hands on, especially if all you get is seat work

3)      allowing assignments to be limited to a certain time length.

4)      having assignments emailed or posted on the school’s website

You can also help your child at home by:

1)      setting up a homework routine

2)      teaching your child to clean out their backpack and use an accordion file (to help them keep track of the papers they actually still need)

3)      checking in with the teacher about homework assignments, and teaching your child how to check their assignments electronically.

References:

Marzano, Robert J., and Debra Pickering J. "Special Topic / The Case For and Against Homework." Educational Leadership:Responding to Changing Demographics:The Case For and Against Homework. ASCD, Mar. 2007. Web. 26 Sept. 2016.

Shire Offers Scholarship for College Students With ADHD

THIS SCHOLARSHIP COMPETITION IS NOW CLOSED.  STAY TUNED FOR MORE ON THE 2017 SCHOLARSHIP.

Shire, a pharmaceutical company that makes ADHD medication, is offering a scholarship of $2000 and one year of ADHD coaching to 50 students this year!
You have to be a legal resident of the United States, be enrolled in a 2 or 4 year degree program at an accredited institution, and be under the care of a licensed professional for ADHD.  You do not have to use any particular type of treatment for ADHD, such as medication.
The application will be judged according to a personal essay, recommendation, an essay about ADHD coaching, and extracurricular activities.  They are looking for a person who embodies " Shire values of BRAVE—Bold, Resilient, Accountable, Visionary, and Ethical".

If you are interested in this scholarship, or know someone who should be, more information may be found at the Shire website.

Residents of Canada also are eligible for a scholarship of $1500 and a year of ADHD coaching.  Please follow the link to Shire Canada for more information.

What to Do When Your Child With ADHD Struggles with Writing

Writing is torture for many children with ADHD.  This is because handwriting issues combine with a confusion of ideas, poor working memory, and difficulty planning to give a blank paper.   In a previous article, I discussed handwriting in depth.  This article focuses on composition.

Tips for remediating writing difficulties.
Point out how writing is typically structured.  For example, paragraphs have an indent and are about a topic.  A plot summary has the setting, the characters, the problem and solution.  A news article or report on a historical event or figure has the 5 W's and how.  A helpful exercise is to have the student take notes on a passage, then write a paragraph based on the notes.  If your student needs more structure, you could even pose direct questions such as, "Where does this story take place?  Whom is it about?  What is the main problem?  How do they solve it? "  Then have them write a summary.

Provide organizational support.
There are many ways to help your child organize his or her thoughts in order to get them down on to paper.

• Write out a list of possible topics and their pros and cons.
• Have the child dictate their thoughts.
• Write the student's ideas on post its.  Practice categorizing ideas into topics by having the student place them into piles like "things the animal eats", "where the animal lives", "animal family". Then have the student organize them into paragraphs or toss them if they are not relevant.
• Experiment with graphic organizers and concept diagrams.  There are a lot of different types depending on the type of composition.  Often you can find them for free on the internet, or you can also buy software that can assist with organizing writing.

Take baby steps.  While some neurotypical children can write pages of stories from the time when they are able to form letters on paper, children with ADHD often need to take baby steps.   They may find it especially difficult to come up with and organize ideas for writing.

Here is a sample progression of writing skills:

1)  Copywork.  Start with a sentence, go up to a paragraph.
2)  Dictation.   
3)  Lists--first dictated lists, then written ones.
4)  Fill in the blank--closed ended question.  For example, "(blank) was the first person to be President of the United States." If done as a dictation exercise, write the full sentence.
5)  Answering a direct, factual question with a full sentence, first dictated then written.
6)  Answer a series of direct, factual questions, then recounting/reporting/summarizing with fixed template response.
7)  Take notes, then recount/report/summarize with a fixed template response.
8)   Fill in the blank--open ended question.  For example, "If you like (blank), you should live in a suburb, not a city."
9)   Taking notes, then recounting/reporting/summarizing without a template response.
10)  Open ended writing prompt.

Accomodating problems with composition.
Accept that creative writing is difficult for your student and come up with an alternative plan to help your child learn to write relevant prose.  Writing pure fiction is not a life skill.  Even writing sentences using vocabulary/spelling words isn't really a life skill, though it is important for students to use the words they learn.  Ask the teacher to allow your student to have a choice between a creative topic or a more concrete or real life topic.  For example, instead of writing about what he would do if he were a bird, he could write about what he sees birds doing, or how to build a birdhouse.   Instead of coming up with sentences, perhaps he could take dictation or answer questions using spelling words.

Other real life writing assignments include:
shopping lists and to do lists
menus
instructions
letters, reviews, or emails of complaint or commendation
invitations or descriptions of social events
persuasive essays, letters to the editor, letters to legislators
reports on topics

Unbundle the exercise.  If the exercise is really meant to teach grammar, have the child practice the grammar in a different way, such as sentence diagramming or editing, without the demand for composition.  If the exercise is meant to teach facts about a topic, perhaps use a fill in the blank worksheet.

Finally, keep trying, and listen to your student.  Composition is a necessary skill for almost all people, but it can take time and patience to learn it.

The Child With ADHD and Parent Teacher Conferences

Many parents with children with ADHD dread parent teacher conferences, and yet, this is a great tool for helping your child do the best they can at school.  Here are some tips for a successful parent teacher conference.

1) Stay focused on the goal of the conference:  Your goal is to build the parent-teacher team so that the child can do their best in school.  Although the child with ADHD may cause the teacher to present many problems during the conference, its important to realize that the teacher is not the enemy and to try whatever you can to face this as a team effort, not a war against each other.

Also, though some schools form an adversarial relationship with parents and make them fight for help for their child, typically the teacher is on the side of your child.  So, even if you've had a hard time with other members of the educational team, try to keep an open mind for the teacher.

2)  Be prepared:  The teacher's time is limited, and while you may have a lot of stories to tell about your child, to get the most out of your meeting with the teacher, keep to the point.
-Review the material you already have from the teacher, so that you do not have to go over it again, such as:
grades, report cards, progress reports
emails or notes home
how your child says things are going at school

- Have a list of questions prepared, such as:
What will my child be expected to learn this year?
What kinds of tests or evaluations should we expect?
Is he turning in his homework on time?
What do you see as my child's strengths/weaknesses?
How are my child's social skills?
Which accommodations are you already using in the classroom?
What accommodations do you see are the most helpful in managing my son's ADHD?

-Make a list of other things that may need to be brought to the teacher's attention such as:
changes to your child's accommodations, if not already discussed
med changes
upcoming doctor's appointments
questionnaires for the doctor
family upheaval (death in the family, divorce, new baby, recent move, etc)
other needed evaluations (learning disabilities, gifted)

-Research accommodations and interventions such as:
accommodations and interventions specific to problem subjects
accommodations and interventions specific to problem behaviors (organization, losing things, meltdowns during homework, blurting in the classroom, etc.)
what works and doesn't work for your child at home

3)  Ask for suggestions on how you can help.    The suggestions will become the backbone of your action plan for helping your child do their best at school.  It is smart to write these down.  If the teacher seems like they have no suggestions for how to help your struggling child, ask for the special education team to come do an assessment (child study) for further accommodations.  Doing this in writing will usually ensure that this occurs in a fairly timely fashion.

4)  Voice your disagreement with a plan if you don't like it.  The teacher may assume you agree if you don't disagree.  If you can work out your differences openly, the result will likely be better for your child in the long run.

5)  Watch your time.  If your child is not doing well, you may not cover everything at this meeting.  An important tip is to discuss your most important concerns first.   You may need to write a list of what you want to cover in order of priority.   Be considerate of your meeting time and schedule a followup visit to discuss outstanding issues if needed.

6)  Make sure you know how to stay in communication.  Ask your child's teacher what the best mode of communication is, and what time of day is convenient.  If you have been having problems with getting a response, ask how long you should wait before following up to make sure the teacher got your message.  Remember, a face to face meeting is the most private mode of communication, but written records of communication are needed if accommodations become a legal issue.

7)  Thank the teacher for their time and for their special efforts for your child.   As a parent, it is easy to lose sight of the extra effort it takes to teach a child with ADHD.   Many teachers have more than one child with ADHD in the class.   Not all teachers know what to do or want to try.  So if you have one who does either, thank them.

What to Share With Your Child's School About Your Child's ADHD

A common question parents have at the beginning of the school year is:  What should I share with the school/teacher about my child's ADHD?  This may come up as part of discussions you have with the child's teacher, or with their IEP team.   Some questions may be well meaning, but overly intrusive.   Your child's diagnosis and treatment information are privileged medical information.  It is your job as a parent to protect that information.  However, since school is a place where your child spends the majority of his or her waking hours, the school may need certain information to keep your child safe and help with treatment.

Your child's teacher probably should know your child's diagnosis.  A teacher who is aware can be a valuable help in securing and suggesting appropriate accommodations.   Their feedback is vital in making an accurate diagnosis and in adjusting your child's treatment plan.    If you make a change in your child's medication regimen, notify the teacher and ask for their feedback.   If the psychologist or therapist is working on certain areas which impact school, definitely tell the teacher.   Many times behavioral therapies will not work as well if they are not consistently applied at both school and home.

However, do not discuss your child's diagnosis or medical treatment in public areas.  Its best not to mention the name or dose of your child's medicine at all to teaching or administrative staff.   This is important because children with ADHD can be preyed upon by drug seekers and dealers.   No one should know your child has access to a controlled substance but you and those providing medical treatment.  If a teacher asks for this information, politely tell them that for the sake of your child's safety, you cannot release this information.  Medication names and doses are not necessary.   It is inappropriate for teachers to pressure you to treat your child with medication or certain medications as they are not licensed medical professionals.

Sometimes parents wish to reassure school officials that they are doing their part in addressing their child's ADHD.  Sometimes this is necessary if there has been no progress, in order to avert suspicion of medical neglect.   In this case, you may mention that you are bringing the child to the doctor/specialist regularly and that you have tried a certain number of different medications and doses, or different behavioral techniques, without necessarily bringing in unnecessary specifics.  If they press you for more, you may wish to point out that discussing unnecessary details is a hazard to your child's safety.

Busy teachers may wish to discuss matters with you in front of other children or parents. It is important to respect and encourage the teacher's desire to communicate.   In this case, you might want to say something like, "I agree that we really should talk about this, but its important to me to keep my child's medical information private.  Can I set up a conference with you, email you, etc?"   Be aware that a child with ADHD may or may not be a reliable messenger and phone conversations cannot be considered private.

Your school nurse or clinic may need to know all or only some of the details of the treatment plan.  Even if your child is not receiving medication in school if there is an emergency, the medication they are taking may become very important information for the treating doctor.  It is best for the nurse's office to have this information on record should you not be available.  If your child is receiving treatment for ADHD or other behavioral issues through school, then other treatment details may become important and should be released to the persons doing the treatment only.

Most of the time, unnecessarily intrusive questioning from the school is either innocent curiousity or a desire to be helpful, but in an inappropriate way.  Always do your best to keep your teacher and school on your side, but protect what you can of your child's medical information as it is a safety issue.

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Homeschool Accommodations for ADHD: Hyperactivity

The beauty of home schooling a child with ADHD is that you can try as many accommodations as you like for your student.  However, the challenge is that many parents do not know exactly where to begin.

Accommodations are changes we make to the environment or learning process that allow a student to function and learn despite their disability, but they do not attempt to correct the disability.  Before we make accommodations, some general principles:

Keep your goals in mind.  Your goal is NOT to replicate the public school setting.  Your child does NOT have to sit in their seat and work on worksheet after worksheet from 8 until 3 every day.  

Some reasonable and important goals include:

Your child learns necessary academic material.

Your child enjoys learning.

Your child learns coping strategies for ADHD symptoms.

Your child learns character.

Do not hesitate to get a professional evaluation by a specialist.    ADHD often occurs with other problems affecting learning, such as autism spectrum disorders, dyslexia, dysgraphia, dyscalculia, anxiety, and various sensory processing disorders.   Hyperactivity is often a byproduct of these disorders and not necessarily due to ADHD alone.  Be aware, however, that the best professional to see may depend on the type of learning problem.  Many physicians, for example, do not even believe that sensory processing disorders are real disease entities.  For more on the different types of specialists, please see my article Doctor, Psychologist, Psychiatrist--Who's Best for ADHD?

Ask your child for input.  ADHD is a chronic problem.  Some children grow out of it, but many do not.  So your child is embarking on a journey where they must learn coping skills.  The very first skill to learn is to know the questions to ask to know if something is working or not working.  Your child may not always be correct, and may not always be aware of what is happening, but its a good practice to encourage them to understand what is being done and why.

Now for the accommodations.  Not every accommodation will work for every child, but these are some to try.

Schedule in exercise.   Many home schooling families do sports.  However, this is not enough for a child with ADHD.  To help a child with ADHD who must sit for some part of the day, it is important to schedule some form of physical activity every day, even if it is just going outside for a walk, or weeding the garden.  Exercise is also  an important habit to get into as a lifetime coping skill.    So, invest in some good outdoor play equipment, buy rainy weather gear, and kick your kids outside to play every day.

Know when to take a break.  If your child is getting restless, ask them if they need help, or if they need to take a break.   With younger children especially, pushing for that "one more thing" often leads to a meltdown.  So stop if your child needs to.  Set a timer for 5 minutes, so that they know when they need to come back.  

Sit with them.  This can be boring for the parent unless they have something they can do quietly (like paying bills or answering emails).  You may also need something you can put down quickly (like folding laundry or crocheting) if your child or children are not able to wait for you to finish what you were doing when they need help.   But it does help.

Allow movement.  You might teach your child how to fidget quietly or do isometric exercises to be able to endure seated tasks.  However, your child does not need to sit to learn, so be patient and allow them to move as long as they are still learning.  You might have them listen to recordings or DVDs while seated on a wobble cushion, bouncing on an exercise ball, or running on a trampoline or treadmill.  Some children do well with standing to do written work, at a standing desk or counter, for example.  Other children do best if movement is incorporated into the lesson.

Provide quieting sensory input.  Some children find a weighted vest or lap pad calming.  Others may quiet with music or white noise.   Others may need something to touch (but not play with).   Still others may find sensory input overwhelming, so be sensitive to your child's feedback.

Address distractability and inattention.  Many times  one symptom of ADHD may be the product of another.  For example if a child is working hard to pay attention, he may fidget more.

As always, its important to periodically take stock of the situation and see what is working and what isn't.   If things aren't going well despite accommodations, it may be in the best interests of everyone to pursue further treatment.

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How to Help Your Child with ADHD With Reading Comprehension

When your child with ADHD struggles with reading comprehension it is important to intervene quickly and effectively.  Problems with understanding what is read can eventually translate into problems with learning many other subjects. 

Most children who struggle with reading comprehension due to ADHD do so because they spend so much brain energy decoding what they read that they do not have much left to understand what is being communicated.  Children who have this issue have problems sounding out unfamiliar words.  Their reading is slow and they make many pauses.  I have written about decoding difficulties in a different article.

This article is about children who struggle with reading comprehension despite apparently being able to decode words fluently and efficiently. 

Make sure your child can decode words well.   Some children with ADHD compensate for decoding difficulties by memorizing a large number of words.  These children get to a point where they cannot memorize any more words.  Then they start to guess words based on context, instead of reading them. 

If your child seems to decode words well, then usually the problem lies in one or both of two areas:  working memory and suppressing irrelevant details.

Working memory describes the ability to remember, process, and store information simultaneously.   When it comes to reading, working memory enables a person to do tasks such as understanding what a sentence is saying and relating it to the rest of what has already been said.    Difficulties may arise when a child is asked to recount a story or summarize what they have read.  A child may be unable to recall key events, or to sequence important events.

Possible approaches are:

• brain training games to improve working memory or a broader range of executive functions.  This approach is controversial.  The research is difficult to interpret because of problems with appropriate blinding and a lack of evidence that increased working memory on psychological testing improves reading comprehension.
• explicit instruction in techniques of reading comprehension.  This includes looking for key words, asking specific questions about the passage, identifying the main idea and suppporting ideas, usage of headings/subheadings, etc.  If a child struggles on a sentence level with understanding what is being read, they may also benefit from a technique like "visualizing and verbalizing" (Lindamood Bell).
• note taking strategies.  This might include things like using a graphic organizer or outline, or different colored highlighters to indicate main ideas and important facts.  For patients with dysgraphia, use of a tape recorder may help with working memory issues.
• pauses.  Learn to take time out after each paragraph or so to ask yourself what you just read and how it relates to what you have already read.

Suppression of irrelevant details means the ability to focus on what is important in the text, and to move on from one idea to the next without being stuck on what was said before.   

Possible approaches include:

• teach students how to categorize or sort into related groups, or sets.  Starting first with words, then moving to sentences, students can learn what goes together, and what does not.
• block out the unneeded.  Using an index card or sticky notes over parts of the page that are not being read at the time can help a reader focus on what they need to read at the time.
• mark up the page.  Students may start with marking key (repeated) words, in order to determine what the passage is mostly about.  Then they should mark phrases that talk about the main idea (supporting details).  Then, they should make sure (and mark off with a check) that the phrases they marked are about the main idea.
• use a graphic organizer.  Insert key words and ideas into a graphic organizer such as a concept map to give a visual idea of how the ideas fit together.

Reading comprehension is a complex task involving many other skills and many brain processes.  Some trial and error may be involved, as well as hard work, in helping your child learn to understand and process what they read.  Many children with comprehension difficulties continue to struggle with reading comprehension for the rest of their lives, but certainly many eventually learn to read well using some of the techniques listed above.

References:

http://education.jhu.edu/PD/newhorizons/Journals/Winter2011/Mahone

https://www.nmu.edu/education/sites/DrupalEducation/files/UserFiles/Hovie_Dawn_MP.pdf#

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Homeschooling ADHD: What is the Ideal Schedule?

Every child with ADHD is different, just like every homeschooling family is different, so the ideal schedule for one family is probably not the same as it is for another family.  There are many factors at play, such as the ages of your children, how many children there are, how many children you have with ADHD, how many "littles" you have to manage, and so forth.  However, there are definitely some things about ADHD that you can factor into your schedule to make it work better for your child with ADHD and for you.

 Try to finish your hardest subjects in the morning.  The brain works best when it is well rested and adequately fed by a good breakfast.  In the afternoon, fatigue sets in and medication, if any, begins to wear off.

Factor in physical activity.  Exercise, even if brief, say fifteen minutes, improves focus.   Going outside is ideal, because nature seems to be calming for many people, but if it isn't practical, at least do jumping jacks for 15 minutes before you sit down to do your most difficult academic work.  Ideally, you also want to work in an hour or so of physical activity during the day for optimum health benefits, but 15 minutes is great for the brain.

Allow for short breaks between subjects.  In general, you want to keep things rolling along so you can finish your work before brain fatigue sets in.  However, after difficult  subjects or assignments, your child may truly need a break.  If you let him stop school for a long time, say more than 15 minutes, it may be difficult to get him back on track, but a short break can help future focus.  You can also do a short pseudo break by taking time to sing a song (think memory work), listen to a short piece of music (music appreciation, history or Bible), do a short chore, or maybe practice some physical exercises (calisthenics, stretching, or martial arts moves).

Keep lessons on difficult subjects short.  It gives you a chance to regroup if it isn't going well, and gives your child a sense that the lesson has an end, so that they will be more easily motivated.  If you have to get through a lot of material in a day and your child isn't tolerating a longer lesson, consider splitting it up into two shorter lessons within the same day.

Have a routine, but not a schedule.  A routine tells you and your child what is on deck for the day and helps everyone know what to expect next.  This way, its harder for your child to argue about whether they will or will not move on to the next subject.  However, one of the rules of ADHD is that every day is different.  There are good days and bad days.  So build in some flexibility if you can.

Build in time for supervised social interaction.  Many kids with ADHD struggle with social interactions.  Homeschooling provides the perfect opportunity for you to be the coach, but to do the best job, you have to be present, not just drop your child off.   If your child is already aware of their struggles, they may feel shy among a large group of children and may feel safer if they have play dates at home to begin with.  

What to Do When Your Child With ADHD Struggles with Reading

Children with ADHD often struggle to learn how to read, and with reading comprehension once they have learned to read.  This article deals with difficulties in learning how to read. I will deal with reading comprehension in a later post.

Difficulty with reading is not a core symptom of ADHD.  Many children with ADHD are above average readers.   However,  children diagnosed with ADHD are more likely than neurotypical children to have difficulty with reading.  

Children with ADHD have difficulty with reading due to core symptoms of ADHD.

Usually children with ADHD who are having difficulty with reading due to ADHD alone will struggle with all subjects that require attention to detail, listening, staying on task, and sitting still in a classroom.  Treatment of the core symptoms with medication, diet and adequate exercise will usually help the problem.  Strong consideration should be given to medication, as being unable to read will set a child up for difficulties in many subject areas.

Children with ADHD have difficulty with reading due to dyslexia.

Dyslexia is a brain disorder where the patient sees letter and number reversals, or has difficulty connecting letters/letter combinations with sounds.  Reading, spelling and handwriting are typically affected.  Children with the auditory form of the disorder may exhibit difficulty with rhyming and segmenting words into their separate sounds, as well as understanding letter blends.

There are many interventions which are helpful, including:
1) multisensory techniques
2) integrating reading with handwriting and spelling to reinforce learning
3) structured reading curriculum which systematically teaches reading skills
4) reinforcement and review
5) re-reading to improve fluency

Children with ADHD have difficulty with reading due to visual tracking problems.

Children with this disorder will often see letters and numbers blurring, blending, moving, and jumping on the page.  They will not know that this is not normal, and so will not bring it up unless you question them about it.  In school, these children may show difficulty with paying attention because their eyes will not follow the teacher very easily.  These children are usually not hyperactive and their symptoms are often much worse in school than at home, where visual tracking is much less necessary.  An optometrist can diagnose visual tracking problems and may prescribe vision therapy.  At times vision therapy is not covered by insurance.

Other ways to help a child with visual tracking disorders include using special fonts (usually sans serif) and wider spacing.  On demand publishers sometimes will print books specially designed for readers with developmental vision problems.

All children who are having difficulty learning to read benefit from accommodations until they are able to read fluently.  Accommodations do not allow the child to learn to read, but enable progress in other subject areas.  Such accommodations include:
allowing oral or dictated work
allowing recording of assignments
allowing more time for tests
using audio books, and
using adequate spacing and font size.

References:
"Dyslexia Interventions." Wikipedia. Wikimedia Foundation, 24 Nov. 2014. Web. 07 Mar. 2015.


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What to Do When Your Child With ADHD Struggles with Math

While not all children with ADHD struggle with math, many do, either due to core symptoms of ADHD or due to underlying dyscalculia.

Core symptoms of ADHD can also cause problems for children learning math.  For example, difficulties with focus can cause children to become distracted by illustrations on a page, or to lose track of complex calculations or multi-step problems.  Or a child can become overwhelmed by a paper containing several math problems.

 ADHD can cause problems with learning math due to difficulties with certain executive skills crucial for doing math easily.  For example, working memory deficits can make it difficult for a child to readily recall math facts, even when they have learned, understood, and memorized them in the past.

Thankfully, there are some strategies that can be used to help a child who is having difficulty with math due to ADHD.

1)  Keep the page simple.  Teach your child to cover up all but the problem they are working on.  Sticky notes or index cards work well for this purpose.

2)  Take it one step at a time.  Review the steps to solving the problem.  Then, coach your child through multistep problems and calculations with questions like, "Ok, so what's the next step?"

3)  Allow the use of memory aids if the situation is not specifically learning/reviewing math facts.  Memory aids may include tables or a calculator.  If your child needs extra help learning their math facts, consider songs, flash cards, drill games, or computer games to drill the facts on a daily or nearly daily basis until they know them well.

4)  Use manipulatives to illustrate math concepts.  Children with ADHD often do better if they can concretely see what is going on in a math problem.  Unifix cubes, Cuisinaire rods, an AL  abacus, or ordinary countable objects such as coins, beans, or bottle caps can help your child visualize a calculation and also remind them that they are supposed to be doing math when their mind wanders.  Number lines can also be helpful.  Using real life situations to measure can also help a child grasp difficult things such as distance and time.

5)  Use graph paper to keep numbers lined up.  Particularly for problems involving place value, graph paper can help your student to focus in on the right numbers at the right time.  If a problem is written horizontally at first, encourage them to rewrite or at least visualize it vertically.

However, sometimes even when a student's ADHD core symptoms are well controlled, he or she may continue to struggle with math.  About 20% of students with ADHD also have a math  learning disorder, dyscalculia.  Unlike ADHD, dyscalculia does not respond to medication and is addressed solely with educational therapy.  Some additional strategies that can help students with dyscalculia include:

1)  Allowing use of manipulatives and fingers for counting for longer than normal.
2)  Using diagrams to illustrate math concepts and word problems.
3)  Using mnemonics for the steps of different kinds of math problems, or other concepts, like the order of calculations.


Reference:
"Dyscalculia." Learning Disabilities Association of America. Learning Disabilities Association of America, 2015. Web. 25 Feb. 2015.

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What to Do When Your Child With ADHD Struggles with Handwriting.

 Dysgraphia, handwriting difficulty, is a very common complication of ADHD.  Handwriting requires not only fine motor strength and coordination, but also attention to detail, sequencing of writing steps, planning, and memory of letter shapes and formation steps.  It is also a skill which is essential for academic progress.  So, what to do when your child with ADHD struggles with handwriting?

Prevent Handwriting Hatred

Use other activities to promote fine motor coordination and strength.     Any activity that uses a lot of squeezing and finger work is a candidate here:  scissors activities, play dough (not with toys), silly putty, etc.

Work on handwriting during handwriting assignments only.  When your child is working on other subjects, such as spelling or social studies, keep comments about their handwriting to yourself.  You may wish to allow the use of adaptive methods such as keyboarding or dictation during non-handwriting subjects.   Having skeleton/fill-in-the-blank notes can help a child learn notetaking skills while not being overly burdened by their handwriting.  Alternatively, allowing the child to use someone else's notes, a scribe, a small tape recorder, or even a camera (usually best for short, time limited notes like assignments, not lectures) can be helpful.

If you are home schooling or remediating handwriting at home, you may wish to use a structured handwriting curriculum such as Handwriting Without Tears.  Keeping handwriting to itself allows the child to achieve confidence in other subjects instead of allowing all subjects to be infected by the frustration of not being able to write well. 

Encourage Proper Grip

If your child complains of hand pain, or seems to have a death grip on their pencil, their grip may be incorrect.  Correcting a poor grip may be as easy as using a gripper, or using a larger writing implement (such as a large marker, or kindergarten pencil).  However, if the grip isn't remedied by these strategies, consider having an occupational therapist intervene.

Other methods for encouraging a proper grip include having your child write with stubs of broken crayons or small bits of chalk (on a slate).

Make Writing Physically Easier

Sometimes its easy to forget that things like chair height (and foot placement), a good supportive surface (not a soft pile of papers or a thick blotter),  and a smooth surface (like dry erase markers on white board instead of pencil on grey dollar store paper) can make a world of difference for making writing physically easier.

Memory aids

Children with ADHD often struggle with writing because a deficit in working memory makes it difficult to recall how to form letters or when to put in spaces.

Some methods to help with memory problems include posting a letter strip on the child's desk or work area, having the child write in a sensory way (such as with clay letters, with fingers in a sand/salt/shaving cream/pudding tray, with fingers on sand paper or bumpy foam letters, or using a spacer (fingers or a decorated craft stick) for spacing between words.

Medication

Many teachers notice an immediate improvement in handwriting when effective medication is started, which testifies to the direct impact ADHD has on the handwriting process.  While medication isn't the best fit for every patient, if a child is struggling with a key academic skill like handwriting, it probably should be a consideration.

Vision Therapy

Some patients with ADHD have difficulty with visual tracking.  They cannot focus on, or see letters correctly without vision therapy, which is typically provided by a specialized optometrist.  These children uniformly also have difficulty with reading. Since they cannot see the letters correctly to identify them, they also can have difficulty writing.

Your child with ADHD will likely not need to use all the strategies listed above.  The best approach is to keep trying until one or more of them work.

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What To Do When Your Child With ADHD Struggles With Homework

There are many reasons why a child with ADHD may struggle with homework.  These reasons include:

1)  Not understanding the work when it was taught in the classroom.

2)  Feeling overwhelmed by the quantity of work/motivation issues.

3)  Acting out due to unrecognized fatigue or hunger

4)  Learning disabilities outside of ADHD, such as dysgraphia, dyslexia, or dyscalculia.

5)  Coming down off of medication

Each of these issues are addressed in a different way, so it is worth your while to try to understand what the issue is to best help your child.  You will need to know whether the teacher feels there is any particular problems during class, and whether these issues occur mostly in the morning or later in the day.  Also, you will need to have some idea about whether your child is eating well before they come home to do homework.

Not understanding work when it is first taught in the classroom.

Your child's teacher will note poor performance during the school day.  Typically classroom accommodations and medication adjustments should be tried to help your child to understand the work before they get home.  If understanding during the day is still a problem, consider learning disabilities and possibly a tutor.

Feeling overwhelmed by the quantity of work/motivation issues.

Typically this child will do ok in the classroom, but will not want to start, or quickly gives up on homework.  They might complain it is too hard, but do fine once they get started.  For this situation, it helps to help them break the assignment down into chunks and mini goals.  For a difficult math problem, for example, you might walk them through step by step.  For a writing assignment, you might first brainstorm ideas, then organize them, then write a draft, then revise it.

Motivation may be helped by using external rewards.  It is better if these are normal privileges, such as a 5 minute break, going outside to play, getting to choose dinner, or video/TV time.  A timer (either to beat the timer, or to work on an assignment for a certain time before a break) is helpful for some children, but not for others.

A third strategy to help with motivation is to have a strict routine of when you start homework every school day.  This gives your child fewer chances to argue about when they will start.  In general, as soon as possible after finishing school is best, but some children need a snack or a short break before they can start work again.

Unrecognized fatigue or hunger.

A tired child will usually do worse and worse as the day progresses.  You will usually know that your child is not getting enough sleep.  If this is the case, you may want to look into sleep hygiene and possibly schedule an appointment with your child's doctor about a sleep disorder.  Sleep difficulties very commonly occur in patients who have ADHD.

A hungry child often is hungry because they haven't eaten well at school.  This may be a side effect of medication or may be a product of their schedule.   Most children need a snack in the afternoon.  If your child is having difficulty with homework, make sure they get a decent snack before they start working.  If they aren't eating well at school and won't eat a snack either, you may need to address their lack of appetite with their doctor.

Coming down off medication.

Usually a child coming down off medication is on a stimulant.  Even long acting stimulants can have this problem.  Usually the child has other symptoms such as hyperactivity or emotional outbursts during the same period of time every day they take their medication.  This problem can be remedied by doing homework earlier in the day (before they come home from school), or by adjusting the medication by adding a booster dose or changing to a longer acting formulation of the same medication.

Learning disabilities.

Specific learning disabilites will cause problems with certain types of assignments, but not others.  For example a child with dysgraphia will often refuse written work, but will do fine if the work is oral or if an adult is allowed to scribe for them.  A child with dyslexia will have difficulty with reading and writing, but not with math or with assignments that require neither reading nor writing.  An special education specialist can  evaluate your child and give you suggestions for helping with homework.

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Homeschooling ADHD: How to Start

Once you have made the decision to homeschool your child with ADHD there are a few things you need to know before you start.

1)  You should be aware of the laws governing homeschooling in your state.  These are ever changing, so the best thing to do is check out the Homeschool Legal Defense Association's website.  Some states require testing or other means of demonstrating adequate progress through the year.  If your state is one of these it is worth your while to get an understanding of what kinds of provisions are made for children with learning disabilities, and what kind of documentation you will need of said disability.  You'll also want to know what will happen if your child does not make adequate progress. 

If you have any questions about the laws in your state, contact HSLDA directly.  They are usually very happy to help.

2) You should make preliminary plans for school (i.e. choose curriculum).  As tempting as it is to use the most rigorous curriculum out there, remember that children with ADHD are motivated by success and extremely demoralized by failure.  Chances are your child is already turned off by school.  It may take a few weeks or months of success before they begin to see that learning can be fun and they are willing to try something more challenging. 

Keep in mind that all children are different.  So these recommendations are general and may not apply to your child.  They are merely a starting point.

Teaching Method.  Children with ADHD may struggle with methods requiring a lot of seatwork or workbooks.  Also, they may have problems with large amounts of copywork if they also have dysgraphia.  Shorter lessons are to be preferred.

Math.  Children with ADHD tend to have a concrete learning style.  They often understand math in context (for example, oral word problems) rather than in abstract (for example, sheets of sums) and they usually do better if they can see a concept demonstrated with manipulatives.   However, colorful worksheets are often distracting.  For these reasons, Right Start Math and Math U See are good places to start.

Handwriting.  Children with ADHD often struggle with dysgraphia, or difficulty with handwriting.  It is not a good idea to just plop your child down with a ton of copy work, though, because kids with ADHD find copying extremely boring, unhelpful, and downright painful for both parent and child.  A formal curriculum such as Handwriting without Tears or A Reason for Handwriting is probably best.  If your child continues to struggle, consider bringing in an occupational therapist to help with the problem early on.

                                                   

Reading.  Many children with ADHD also have dyslexia.  If this is the case, a strong phonics background is a must, as is high interest material.  There are many strong programs.   The key is patience and trying different approaches while continuing to read age appropriate materials aloud to continue to build vocabulary.  The parent should count on reading a lot aloud, or purchasing books on CD. 

Composition.  Composition can be a tough subject to teach because it requires handwriting, coming up with ideas, organization, planning, careful attention to details, and a decent working memory, all of which are areas that ADHD affects.  You should probably use a curriculum that not only involves practicing these skills, but also has specific strategies for addressing these issues, such as using a graphic organizer, and proofreading.

Physical Education.  This isn't one of the core subjects, but you should make a plan for your child to have some physical activity for at least a hour a day.  This applies to winter as well as summer.  If you are unable to participate (for example if you are disabled, infirm, or pregnant)  and keep your child on track you may need to consider an outside class or classes.

5)  You should set up your space and your schedule.  While you can homeschool off of the dining room table, having a dedicated space for your child with ADHD to work at least some of the time can be helpful.  This helps especially if there are other siblings who need to use the dining room table for school or other things (like eating).   Having a dedicated space  also helps to keep the space used for schooling free of distracting nonschool items.   Posting rules can also help your child to know what you expect in the classroom.

While many homeschooling families can get by with a very relaxed routine, children with ADHD  usually do better with a fairly strict routine, which aids with transitions and with self-discipline.  Posting a daily agenda, or organizational strategies such as workboxing also may help with these same things.  Notice that a routine is not the same as a schedule.  You will find that some days will take longer than others, depending on your child's motivation (and yours).

Be sure to include some time for breaks.   Alternate easy and hard subjects, or just get the hard ones out of the way first, for starters.

6)  You should know your child's areas of struggle and investigate accommodations.

Not all children with ADHD struggle with the exact same issues when it comes to school.  Hopefully you have some idea from teachers' reports or from your own observations.  You'll want to have a plan entering into schooling, of what kinds of things you'll want to try to address your child's areas of weakness.  Curriculum and scheduling are part of this, but not the whole for some children.  For example, a child who has dysgraphia may need a special pencil grip or ongoing help from a physical therapist.  A child who struggles with defiant behavior needs a plan for what happens when they refuse to do schoolwork.

7)  You should identify a support system.  Did I mention that schooling a child with ADHD is difficult?  You'll want to look for a support system, preferrably one where there are other children with ADHD or other learning issues.  In this day of Facebook forums and online groups, there is really no excuse for not getting help with a problem when you face it.  There are academic co-ops, enrichment co-ops, support groups, and informal gatherings of moms on playgrounds, at church, and at various home school classes.  HSLDA and some other national groups offer consultation as well.  

8)  You should accept that things will change.  For one thing, most of us don't get it right the first time.  For another, kids with ADHD crave novelty, so it helps their enthusiasm to shake things up a little once in a while.  Really big changes can be disturbing, but tweaking things now and again is usually appreciated.  You should still plan ahead.  A child with ADHD who faces the day without a plan will run around and accomplish little.  However, re-evaluate frequently and if things aren't working, be open to change.

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Homeschooling ADHD: Is It For Our Family?

Homeschooling seems like a great idea for kids with ADHD.  The benefits of the homeschool environment for children with ADHD are many and include:

1) an individualized learning environment, so that your child doesn't get lumped in with children of low IQ or severe behavioral problems, who also require special educational intervention, and also so that your child can spend more time in pursuits that interest him.

2)  flexibility of the learning environment, so that your child can move or take a break as needed and not be penalized.

3)  dedicated (hopefully) parent-teachers who will follow the educational plan and not need to be scolded and browbeaten constantly to treat your child fairly.

4)  better control over your child's social environment, so that they may avoid negative peer influences and being a target for name calling and bullying.

5)  avoiding ineffective and detrimental disciplinary tactics such as taking away recess or physical education class time, punishment for issues directly related to ADHD, public humiliation and others.

6)  avoiding the need to deal with ignorant, overburdened, or financially motivated teachers and administrators.

7)  avoiding the anxiety of changing teachers every year.
8)  less expensive than private schools.

However, homeschooling is not for everyone.  In addition to issues that pertain to everyone who home schools, people who home school a child with ADHD should also consider:

1)  Homeschooling a child with ADHD is difficult.  You need extra patience, not a short temper.  If you do have issues with patience, take heart, though.  Sometimes you love your child more than you realize and you are able to grow in this area.  However, if you do have severe anger issues, this is not for you.

2)  If you have other children, your child with ADHD may take a disproportionate share of your time.  They may work independently later on than you expect and they may require more frequent check ins or direct supervision depending on the subject.  You may spend a lot of time sitting with your ADHD child keeping them on track and this can take a toll on the other children if you aren't careful to give them attention as well.  This can be especially difficult with little ones.

3)  Your child may require more expensive curriculum than the average child.

4)  Your child will require regular opportunities for physical activity, at least daily.  This means you need a place nearby that is safe to play in year round--whether a large back yard, an indoor trampoline or treadmill, a park, a gym or a pool.  Keep in mind that it should be something fairly appealing or they may not do it.  Sometimes these types of activities can be expensive.

5)  Your child may not do well in the traditional home school co-op setting as the teachers are generally all volunteers and few have training in handling children with special needs.  On the other hand, co-ops sometimes have very small class sizes, which can be helpful in differentiating instruction to fit the needs of the student.  Co-ops have differing degrees of academic rigor and social expectations, so parents need to be aware of what they are getting into.   Of note, not all home school families participate in co-ops.  Some find socialization opportunities through scouts, church, sports, other types of paid classes (art, martial arts), play dates, etc.
6)  While you can always access services such as OT, speech therapy, and special educational services privately, you may have to pay for them out of pocket.  Some states/districts allow home schooled children to access special services through the public schools.  Some do not.   Some health insurance policies will not cover services that can be accessed through public schools or which are considered "educational".

If you are having a hard time deciding whether you can handle homeschooling your child with ADHD, there are a number of people out there who could be a resource to you.  First, you may want to check with your local homeschool support group for a "struggling learners" or "special needs" group.  Second, you may want to consult your local chapter of CHADD.

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ADHD and Alcohol Do Not Mix For College Students

Alcohol often can seem like a tempting way to self medicate for ADHD, but in fact, it may do more harm than good, at least for college students.  College students with ADHD have their own share of academic struggles, but a new study done by Langberg, et al. suggests that alcohol plays a major role in who adjusts well to college life and who doesn't.  What's even more interesting is that alcohol played such an important role that it outperformed baseline ADHD symptoms and baseline measures of executive function as a predictor of successful adjustment by the end of the year.

How does alcohol do it, when it can often seem to calm the ADHD mind?  The researchers found the connection was that alcohol, as many depressants, seems to decrease motivation.

So, what's a college student to do?
Don't drink.  Real friends won't think less of you if you abstain, especially if it's for your future.  You can always blame your doctor ("doctor's orders!"), say it messes with your medication, or just say you prefer orange juice.

Pursue other means for learning to calm your mind, if that's an issue for you.

-Exercise is healthful and increases blood flow to the brain.  In elementary schools, exercise programs are being used to help promote concentration and better learning.

-Mindfulness is a less strenuous method that may work if you already are having difficulty getting motivated.

-If you're constantly anxious or can't get your mind to slow down on your own, seek medical help.   A therapist may be able to provide you with techniques and accountability to help you out in a healthier way than alcohol, or a doctor may suggest medication.

If you find you are not able to stay away from alcohol, get help.  If it hasn't affected your academic career, it is likely to do so in the future.  Your student health center may be a good place to start, but if you're not comfortable with that, you can look for a local chapter of Alcoholics Anonymous to point you in the right direction.

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School Accommodations for ADHD: Specific Ideas for Focus and Inattention

Inattentiveness can wreak havoc on a child's ability to learn at school.  The following accommodations may help your child to stay on task at school, or even at home.

• Student to be paired with a "buddy" student, or an aide.
• Student to be seated near the teacher, or apart from other students.  This is also known as "preferential seating".
• Student to be allowed to test in a separate, quiet room with no other students.  Student to be given extra time for tests.
• Student to be given instructions in written format, or to be given instructions one step at a time with frequent check ins for redirection as necessary.
• Teacher/aide to check child's bag before and after school.  (Before for homework, after for materials needed for homework.)
• Teacher to write assignments in an assignment book, or to email assignments to parent.
• Student to be allowed an extra set of books at home.
• Student to be allowed less homework.

Inattentive students may also be helped by appropriately addressing their hyperactivity by allowing nondistracting movement or fidgeting.    This is because instead of focusing their attention on keeping still, the students are able to focus on the teacher and the lesson instead.

If you know of any accommodations that have helped your inattentive child which I have not included here, please leave a comment!

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School Accommodations for ADHD: Specific Ideas for Hyperactivity

To get accommodations at school, you first must have a formal diagnosis of some kind by a doctor.  Some districts also allow a mental health professional to make a diagnosis as well.  During a special education meeting, the parents will work with the teacher and special education staff on accommodations.    Any child with ADHD should be able to get some accommodations in a 504 plan.  Some children will qualify for more intervention through an IEP.

Homeschooled children do not need a diagnosis, but can also use some of the ideas here.

There are many possible accommodations for hyperactivity.  Not all of them will be effective for every child.  

1)  Allow student to get up and move around during class time.  Student may be sent to do errands for the teacher, or may be allowed to go to a secluded area of the class (like the back) to stretch.

2)  Student may sit on an exercise ball or special seat cushion that allows motion.  Student may use a standing desk.  Student may use mini trampoline between parts of lesson to help expend energy.

3)  Student may be allowed the use of a weighted lap pad or weighted vest (usually prescribed by an OT), if they seem to need sensory input to calm them.

4)  Student may fidget with special quiet fidget toys, fold paper (such as origami), or chew gum in class.

5)  Teacher may not deprive student of recess or gym as a form of discipline.

6)  Recess may be scheduled at a time that works best for the student's needs (i.e. not at the very beginning or end of the day).

7)  Teacher to use reward charting as a means for encouraging good behavior.

8)  Student to use "code words" to ask teacher for a break to get up and move.  For example:  "May I have a bathroom break?" (request for movement break) instead of "May I go to the bathroom?" (request to go to bathroom)

If you have any accommodations for hyperactivity that have worked well for your student and that I have left out, leave a comment!

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School Accomodations for ADHD: The Basics of IEP vs. 504

When requesting school accommodations for ADHD, one is typically looking for either a 504 plan or an IEP (Individualized Education Plan) or both.    I am not a teacher nor an education law specialist.  But in my travels I've learned a little bit, so I'll give you the basics and you can link elsewhere when you've passed School Accommodations 101.  Please note that this article refers to practices under United States law.  If you live elsewhere, these laws do not apply.

Section 504 and the IEP only apply to public schools.  

If your child goes to a private school, you may still request accommodations, but the school is not under any obligation to provide them unless your contract specifically states that these services will be provided (for example, if your child attends a school specializing in children with ADHD or special needs students).

How to make a request for accommodations.

You should submit your request for an evaluation for accommodations in writing to the appropriate authorities.   In writing because it begins a paper trail.  If you ever have problems with the school providing accommodations or dragging their feet, you must create and keep records to show that you have done your part.  Legally speaking, it is up to the parents to prove that the school has not done their job if problems arise.

Also, when a request is submitted in writing, it begins a clock.  The school usually has a certain period of time during which it is required to respond to your request.

The appropriate authorities differ from school to school and from district to district, so the best thing to do is to contact various possibilities until you get an answer.  Potential candidates include the child's teacher, the special education coordinator, or the principal.  If you speak to someone on the phone, always get their name.  Write down that you spoke to (name) and (date) about (topic) in a binder or notebook devoted to the purpose of school accommodations.

Once the proper authorities have been notified, the school should set up an evaluation.  Typically they will include the parents.  You should bring relevant medical records, report cards (or other evidence of academic struggles and/or failure), and records of other testing such as psychological testing or IQ testing.  The school may request more testing.  Sometimes if the school is not forthcoming, you should request your own testing (especially if you want an IEP and the school does not want to give you one).

Every child with ADHD should qualify for a 504 plan

Then the school will come up with a plan.  All students with an ADHD diagnosis are eligible for a 504 plan, unless the school disputes the diagnosis.  They cannot deny you a 504 plan based on lack of failing grades or any other academic criteria.  The 504 plan protects your child's rights as a person with disabilities, whether or not they affect their learning.  For example, this law allows a child with ADHD to request an accommodation such as being able to get up and walk around in a nondisruptive way, without being subject to teacher reprimand.

A 504 plan does not have to include the parents in planning (although most schools do, anyway), does not have to include a specific plan with a specific timeline or specific goals.   Nor does it have to be reviewed annually.   It is simply a list of accommodations.  Just because you have a 504 plan does not mean it will be followed.  Parents must be proactive in making sure that proposed accommodations are being implemented in the classroom.

An IEP is for a child who needs special educational accommodations.

An IEP requires more of the school and is typically more difficult to get.  To get an IEP, some school districts require that the child show evidence of being unable to function in a regular classroom.  This usually requires some evidence that the child is not making good grades without significant accommodations.  Having an IEP means that you can ask the school to name specific goals, propose a specific timeline,  and name specific strategies to meet those goals.  The school is required to involve the parent and to periodically review the child's progress in meeting the educational goals spelled out in the plan.  This is at least annually but may be more frequent.  Although an IEP falls under special educational law, having an IEP does not automatically mean your child will be placed in a special education classroom. 

The public school may not stipulate that you must medicate your child for your child to receive accommodations.  

Teachers may strongly and repetitively voice their opinions regarding medications, but this is a decision you must make with your child's doctor.   The school cannot force you to medicate.  A private school, however, may request that your child be under treatment in order to stay enrolled.  This type of request may be an indication that the school is unable to handle a child with ADHD (since treatment may or may not work), but it is not illegal.