Accommodations are a primary evidenced based intervention for students with ADHD in the school setting. Accommodations are powerful agents of lasting change when provided with fidelity. Moreover, accommodations will immediately impact the development of self-efficacy and the prevention of dangerous lifelong secondary complications for students with ADHD .

Why are there so many issues surrounding providing accommodations for students with ADHD? If they are so effective, why do parents report that teachers are not using them? Why are teachers reporting that students are refusing them?

Most school based professionals have never received adequate training on how to teach students with ADHD. Therefore, most schools are inadequately prepared to design or implement IEP or 504 accommodations from an understanding of ADHD.

Without adequate knowledge surrounding ADHD, accommodations are viewed with significant prejudice and provided without clear, explicit explanation and implementation guidance. 

Whether you’re a school-based OT , administrator, special education teacher, general education teacher, or parent, this post will prepare you to design and implement individualized accommodations from an improved understanding of ADHD. 

Accommodations Are Viewed with Prejudice 

Every day I encounter the not so discrete eye rolls when I suggest ways to accommodate students with ADHD in the classroom. This is not surprising.

When not explicitly aware of the importance and impact of accommodations, educators and caregivers can easily view them with prejudice. The word “accommodate” evokes a privilege-like stigma, whereas accommodation is considered an excuse or an easy way out of challenges. Without understanding the chronic nature of ADHD, teachers and caregivers misinterpret accommodations for excuses. Especially for invisible disabilities with large spectrums of inconsistent performance like ADHD.  

Every caregiver must understand that most children with ADHD will have chronic deficits in working memory, response inhibition, and time awareness throughout their school years. These natural to neurotypical skills will not develop to an age-appropriate level that will support independent performance during their academic years. ADHD is a chronic developmental disorder of executive function and self-regulation that you MANAGE, not treat or cure. The adults in this child’s life need to teach them different skills and not force them to try harder to develop a skill that won’t develop in time. 

ADHD is a disorder you MANAGE, not treat or cure. The adults in this child’s life need to teach them different skills and not force them to try harder to develop a skill that won’t develop in time. 

When we accommodate the child by building systems and environments to support performance, we are modeling the methods they need to learn to grow up and mitigate the impact of their ADHD on their own. 

Would you spend your time trying to teach a paralyzed child to walk, or would you teach them how to navigate using a wheelchair?  

Would you try to teach a blind child to read, or would you teach them to use braille to read? 

We do not try to teach a child with ADHD to hold things in mind. Instead, we teach them to make the things they need to hold in mind external.

We do not try to teach a child with ADHD to control their impulses. Instead, we teach them ways to engineer their environment to decrease distraction and nudge them toward their goals. 

When we develop accommodations to improve a child’s ability to show us what they know, it does not excuse them. It is a valuable teaching tool to empower them to design and honor the systems that will work for them long after they leave your home, classroom, or office. 

“ Preferential Seating” What does that even mean? 

Every September, general education teachers are handed a piece of paper listing accommodations for multiple students they don’t know, usually without ample time to prepare for these kids. Most general educators are provided the 504 or IEP document without a clear, explicit understanding of the accommodation or implementation guidance. What they receive is typically vague and subject to interpretation.

Below is an example of an accommodation plan from a parent’s ADHD group.

Legally, this child requires a visual schedule, preferential seating, and extended time to complete assignments as needed by all teachers across all subjects.

What is the likelihood that all teachers can implement this plan with fidelity?

Zero.

As Needed? Extended time? How long? What kind of visual schedule?

IEP and 504 teams require a clear understanding of the specific child’s ADHD in context to design and implement accommodations to minimize the impact of ADHD on the educational access. Unfortunately, most schools lack training on ADHD and are inadequately prepared to design or implement IEP or 504 accommodations from an understanding of ADHD.

Below is an example of a 504 plan that provides clarity, purpose, and implementation guidance. When a teacher understands WHY the student needs the accommodation to learn and is supplied with implementation guidance for the accommodation, it will make a significant difference in fidelity. 

Accommodations are Not Suggestions.

It is very important to understand that accommodations are not suggestions. Accommodations are a federally protected right of a student with a 504 plan or an Individualized Education Plan(IEP). Accommodations that are necessary for the student to access instruction and participate in educational and school-sponsored extracurricular activities are protected under the Section 504 of the Rehabilitation Act of 1973, a civil rights law, and the Individuals with Disabilities Education Act (IDEA).

The U.S.Department of Education’s Office for Civil Rights (OCR) enforces both federal laws protecting the rights of students facing discrimination on the bases of disability. The OCR provides substantial guidance to school districts specifically for students with ADHD in their  Resource Guide on Students with ADHD and Section 504 , also linked below.

ADHD is a Disorder of Performance

ADHD is a neurodevelopmental disorder that impacts performance, executive function, and self-regulation. The student knows what to do but has chronic difficulty doing what they need to do at the time required. ADHD is a disorder of performance, not skill, not knowledge. And there is no possible way to separate performance from context. So when talking about a performance disorder, the environment and occupation (task) are equally as important as the child. The performance exists in the middle of the interaction between a person, the task, and the environment. The performance, or lack thereof, is about the interaction or goodness of fit between the three. 

To facilitate performance, you can intervene in 3 ways:

• Change the task /occupation
• Change the context (setting, environment) 
• Change the person

An accommodation aims to “minimize the impact of a disability, facilitate learning and demonstrate the student’s knowledge in the least restrictive environment. Accommodations immediately improve the goodness of fit between the child, the task, and the environment. 

The most common accommodation used in any school setting is prescription lenses. This accommodation works so well that these children do not require a 504 or IEP to protect them from discrimination.

As long as the student wears their accommodative lenses, they can visually function 100% on par with their 20/20 peers. The child did not change, the task is the same, but the accommodating lenses bend and distort the light from the environment to the child’s eyes in a way that improves the goodness of fit between the child’s eyes and the environment. Powerful stuff! A bent piece of glass is changing lives.

Providing accommodations to minimize a neurodevelopmental disorder’s impact is the same as providing accommodative lenses to a “visually disordered” child—equally as powerful, important, and necessary. 

No one would ever tell a child to remove their glasses because it is not fair to the rest of the class that he should have such a privilege of magnification and clarity?

Types of Accommodations

Accommodations do not change the content or curriculum, they change the method in which it is provided. 

According to the IRIS Center Website, there are four categories of accommodations.

• Presentation Accommodations change the method in which instruction, information, and directions are given.
• Response Accommodations allow students with disabilities to demonstrate their learning by completing instructional assignments or assessments in ways other than typical verbal or written responses.
• Setting Accommodations Identify and remove barriers in the school environment or structure.
• Timing and Scheduling Accommodations allow changes to when and how long students must complete assignments or assessments. 

Below we will review each type of accommodation and describe why each may be needed to mitigate barriers in the classroom from an understanding of ADHD.

Many of the accommodations described below are excellent teaching strategies for your learners with ADHD. My hope is that all teachers use them. However the difference between an accommodation and an instructional strategy is in the purpose. An accommodation is used to remove a barrier caused by a disability so the student can access their education in par with peers without disabilities. While many students will “BENEFIT” from all of the below instructional strategies, your student with ADHD must “REQUIRE” it to learn for it be considered a reasonable accommodation.

Designing Presentation Accommodations From an Understanding of ADHD 

Presentation accommodations change the method in which instruction, information, and directions are given. With a presentation accommodation, you’re changing your manner of presenting the same exact material you would give to the entire class. You’re not changing or modifying the material.  

Students with ADHD often require presentation accommodations to manage and mitigate developmental delay in executive function, self-regulation, and inattentive or impulsive symptoms. ADHD commonly impacts the child’s ability to regulate and sustain attention to presented instructions, information, and directions. When designing presentation accommodations, teams must ask and answer the following five questions?

Does ADHD Impact Their Ability to Comprehend Text Used to Access Instruction, Information and Directions? 

ADHD (separate from comorbid learning disabilities) does not impact students’ intelligence or ability to read or decode text. However, ADHD will affect their ability to access the instruction and materials commonly used to teach reading, decoding, and comprehension.

Due to working memory difficulties, students with ADHD often forget what they are reading as they read it, impairing comprehension of the material presented in purely visual form. Many adults still report having to go back and reread a paragraph or page multiple times to comprehend it. In addition, students with ADHD often make “careless errors” which are directly related to ADHD, not carelessness. For example, they will miss small details, like mathematical operation signs and keywords in word problems.

To mitigate the impact ADHD has on the students ability to access and comprehend text used for Instruction, Information and Directions , students with ADHD may require:

• Visual Cues to make critical information more salient.
  • color coding mathematical operations
  • bold print keywords
  • highlighting key information

• Reduction of visual distractions
  • Reduce clutter
  • Less information on a page
  • Enlarged font ( 18-20 pt font)
  • One problem per page  

• Audio formats paired with the visual format
  • Provide sound-blocking headphones
  • Permit quiet time to comprehend visual information 
  • Text-to-speech software 

Does ADHD Impact Their Ability to Hear or Understand Instructions, Information, and Directions Presented Orally?

ADHD (separate from comorbid auditory processing or hearing deficits) does not impact the student’s ability to hear but affects the student’s ability to regulate, prioritize and sustain attention to auditory information. A student with ADHD will attend to all the auditory distractions in the learning environment and then have difficulty getting back on task ( sustained attention, task initiation, and working memory). This difficulty explains why students tend to miss directions, not hear you when speaking to them, and often need clarification.

Students with ADHD who have difficulty processing auditory information may require: 

• Reduction of auditory distractions (e.g., provide headphones, permit quiet time)
• Clear and explicit directions
• Cue the student before giving direction
• Visual or auditory signals or prompts 
• Use physical proximity and touch. 
• Provide supportive eye contact
• Visual cues (e.g., color coding, highlighting key information)
• Auditory cues (e.g., “This is important”)
• Alternate formats (e.g., written text, diagrams, graphic organizers)

Does ADHD Impact Their Ability to Remember and Identify Key Information in Instruction, Information, and Directions? 

Due to working memory difficulties, students with ADHD struggle to follow multistep directions and remember key information. They often forget the next step while completing the first step. They may be easily distracted and miss contextual clues and implicit rules or meanings. The student may have challenges learning, storing, and retrieving new information.

Presentation accommodations that mitigate working memory weakness include strategies to make what the student is expected to hold in mind externally represented. 

• Require explicit instruction and explicit directions – leave nothing up to assumption. Every step is laid out.
• Provide a Visual Schedule- provide the student with a visual schedule or checklist of the instructions for the task or day.
• Provide Multi Step Directions One at a Time 
• Highlight and identify key information in instruction, information, directions
• Externalized Rules and Directions (visual) – student can not hold multiple things in mind while working ,provide rules and expectations in an area that is at eye level and noticeable to the student.
• Provide Written Materials to support verbal classroom instruction (course outlines, chapter summaries, etc.)
• Change Test Formats to assess recognition, rather than recall, in the form of multiple choice instead of open-ended questions.
• Require Student to Repeat it Back:  Provide the student with the opportunity to repeat information just learned to ensure comprehension.

Does ADHD Impact their Ability to Maintain Attention to Presented Instruction, Information, and Directions? 

Um, yes. These students are focused, just not on what you want them to be at the present moment.

Focusing is a vague construct. Many describe it as the spotlight of your attention. It requires the executing functions of task initiation (get started), response inhibition ( ignore distractions), working memory ( keep in mind various parts of the task as you complete the task), and sustained attention ( remain focused until completion). Therefore, accommodations that explicitly support the underlying executive functions required to stay focused and maintain attention to the material and directions presented in class will mitigate the impact of ADHD upon the learner. 

“Refocusing and Redirection”– is the most commonly seen accommodation on 504’s and IEPs” but what does that look like? Without an explicit understanding of ADHD, it is often subjectively implemented as a teacher reminding the student to “focus” multiple times a day. No judgement, I am guilty. 

Refocusing and Redirection” is a form of presentation accommodation to maintain the learners’ engagement and redirects their engagement back to the task.

To refocus a student you can:

• Cue student before giving direction
• Provide supportive eye contact
• Use physical proximity and touch. 
• Attempt to involve the student in the lesson actively 
• Dramatize information, and change teaching style frequently to capture the student’s attention. 
• Use frequent positive feedback with “I notice” for attention 
• Using visual cues (e.g., color coding, highlighting key information)
• Using Auditory cues (e.g., “This is important, Pattern Interrupts)
• Using Alternate formats (e.g., diagrams, pictures, hands-on activities)
• Use a flashlight or a laser pointer to illuminate objects or words to pay attention to

Due to inattention and poor working memory, the student with ADHD may have difficulty following and remembering directions. 

Redirection is more than just repeating yourself. The student may: 

• Need paraphrased instructions
• Need written instructions paired with verbal instructions 
• Need directions repeated one at a time
• Need to repeat instructions to confirm comprehension.
• Need visual redirection supports (e.g., color coding, highlighting key information)
• Need auditory redirection cues (e.g., “This is important…”)
• Need frequent checks for understanding and immediate feedback

10:2 Chunking

Students with ADHD will have difficulty processing ” un-chunked ” instruction. Difficulty with sustained attention and working memory will impede access to learning when presented one way for the entire lesson. To keep students engaged (actually beneficial to all students), teachers need to provide a break from the presentation method every 10 minutes.

Chunking instruction is intentionally pacing instruction with a 2-minute “reset” in between. The reset doesn’t have to be a complete break; it can be a turn and talk, stop and jot or getting up to move to hand in a piece of paper. Popular teaching methods such as “Chunk, Chew and Check” work well for students with ADHD because before moving on to the next chunk of information, you would ‘check’ understanding by assessing or probing. The break is vital for absorbing, processing, and comprehending information.

Does ADHD Impact Their Ability to Manage Materials Required for Instruction, Information, and Directions?

Organization and time management are later developing executive functions that depend on response inhibition, , temporal awareness and working memory. Students with ADHD typically lose things A LOT! Many completed homework assignments do not make it back to school. They lose worksheets, folders, and supplies.

To mitigate the impact of poor organization and temporal discounting, students may require the following: 

• Assistance with organization of materials, homework, book checks, pack up checks 
• A separate set of materials at the desk to decrease distraction 
• A separate set of materials at home
• Provide students with an assignment book
• Check that homework assignments are written in full detail
• Supervise students in writing in the assignment book or provide written instructions
• Provide a written checklist for getting organized
• Provide notebook with dividers and folders for work
• Check desk/notebook for neatness: reward it
• Establish object placement routines
• Use color and physical/spatial organizers

Designing Response Accommodations from an Understanding of ADHD 

Response accommodations allow students with ADHD to demonstrate their learning by completing assignments or assessments in ways other than verbal or written responses. Difficulty with response inhibition, task initiation, sustained attention, working memory, and temporal processing is often a barrier for students with ADHD to complete assignments and demonstrate their knowledge.

Does ADHD Impact the Use of Written Expression to Demonstrate Knowledge? 

Written Expression is the most common area of impact in students with ADHD. Written expression is a complex task with high demands on working memory and executive function. Writing demands more executive functioning skills than most other academic tasks. Students must manage word retrieval, language/vocabulary, planning, organizing, transcription, and self-monitoring as they try to edit.

In addition, significant barriers exist for these students in the underlying transcription skills of spelling and handwriting. Editing skills, including spelling and punctuation, are impeded by working memory, and sustained attention to small details.

Many students with ADHD exhibit a significant discrepancy between their ability to verbally express knowledge and the ability to put their thoughts on paper. Read more about ADHD’s impact on written expression here. Response accommodations for written expression are often required to minimize the limitations ADHD has on their ability to demonstrate knowledge,

Accommodations for written expression include: 

• Reduction of the amount of written work required to demonstrate knowledge
  • Accept alternatives to written reports (oral, tape-recorded, display, projects)
  • Reduce or eliminate copying from board or book 
  • Adapt assignments requiring less writing (e.g., provide a photocopy, enlarge, circle, cross out, write above/below the line, etc.)
  • Use of graphic organizers and visual organizers with step-by-step processes 
  • Provide Templates (e.g., for outlines, paragraphs, essays)
  • Provide Prewriting Checklists

• Use of technology to replace writing by hand
  • Use of a word processor (if keyboarding is functional)
  • Use of Speech-to-text software (student and teacher must be trained on how to use it)

Spelling and Grammar

• Word prediction and spell check
• Editing checklist 
• Computer/word-processing program with grammar-checking feature
• Limit or eliminate the need for exact spelling in assessments of content
• Provide a Word Bank

Does ADHD Impact a Student’s Ability to Demonstrate Mathematical Computation?

Mathematics is heavily dependent on working memory. Students with ADHD commonly have difficulties rapidly recalling math facts and noticing operational signs, including decimal points. They have difficulty computing multistep problems, keeping their place in a math problems, and sustaining attention to complete them. They require support in checking work, finding errors, and self-correcting.

Response accommodations to support students with ADHD include: 

• Provide concrete objects or manipulatives
• Provide multiplication tables/ Sheet of basic math facts
• Permit the use of a calculator
• Provide graph paper to align numbers 
• Provide enlarged print problems and larger work areas

Does ADHD Impact Task Completion? 

Students with ADHD have developmental delays in task initiation, poor time awareness, difficulty with sustained attention, working memory, and difficulty with planning and prioritizing, making multistep tasks extremely difficult. Despite their best intention, students with ADHD are notorious for “never” finishing anything.

Response Accommodations to mitigate barriers to task completion include: 

• Teacher check-in before starting a task – Starting tasks can be complicated for students with ADHD. They might not know where to start or have missed some key directions. Students often won’t admit or even know what is holding them back. A teacher check-in can be just the trick to get the engine started.

• Chunking – Reduce the barriers by chunking or breaking down tasks into smaller manageable parts. When chunking for students with ADHD, we need to support substantial differences in motivation and task initiation. The first step has to be tiny, so tiny they can’t help but complete it. This builds behavioral momentum. Give the student a specific task to finish. Check it when done. Then give them a break to move or engage in a preferred activity when the job is complete. You can use this strategy with challenging tasks of any length. 

• Time-bound Check In’s: Set a timer for 10-minute intervals and have the student get up and show the teacher the work.

• Increase Accountability and Short-Term Deadlines for Projects: Large tasks such as completing a research paper or project may seem impossible to a student with ADHD. Break down the large project and have the small part due each day. If it is not “Due”, then we will not “do”.

Designing Setting Accommodations From an Understanding of ADHD 

The setting includes the context of the learning environment. ADHD symptom severity is highly dependent upon the demands of the context including the physical, social, and attitudinal environment). Therapists with the same students on their caseloads witness drastic discrepancies in their ability to function from year to year.

Environmental supports are crucial to influencing function. Students with ADHD require structured environments with distractions minimized . Accommodations plans that can ensure that the student is educated in an environment that facilitates function often include:

• Student Requires a Structured Learning Environment with Explicit Expectations

• Student requires distraction minimized
  • Student needs study carrels to block visual stimuli
  • Reduction of visual clutter
  • The student has access to noise-reducing headphones

• Student needs seating that allows for movement
  • access to a wiggle cushion, standing desk, or flexible seating 

• Student requires visual support for organization 
  • (e.g., labeled storage containers, color-coded binders)
  • Student needs clear boundaries and concrete visual reminders of the time.  

• Preferential seating- Preferential seating is a common accommodation on IEPs and 504s that is usually interpreted as “front row” seating; instead, it should be interpreted as “strategic seating.”Preferential seating means that a student’s seat is in a location that is most beneficial for learning in the classroom. Preferential seating means you seat the student in an area where they are most likely to stay focused on what you teach. Of course, the ideal seating location for any particular student will vary, depending on the unique qualities of the target student and of your classroom. Some students need to be seated near the teacher, some away from distractions, and others in the part of the room where the teacher tends to focus most of their instruction. Some kids with ADHD get distracted visually and need to be in the front. While others are more distracted by sound, the kids, always looking behind them, will need to sit in the back of the class. Seating should be away from distractions, like high-traffic areas, windows, heating/air conditioning vents, speakers, and disruptive peers. Don’t hesitate to rearrange as needed. 

Designing Timing /Scheduling Accommodations from an Understanding of ADHD 

Timing and scheduling accommodations allow changes to when and how long students must complete assignments or assessments.

Students with ADHD have significant difficulty with temporal awareness. They are often described as “time blind” meaning that these students do not feel the passing of time. Time is either now or not now. Students with ADHD can focus and attend to items in the now, but if there is a timing element, a gap, or a delay in time, that causes difficulty. Students with ADHD may exhibit difficulty sustaining attention over long periods. The student may be unable to attend to two tasks simultaneously, such as listening to the teacher and taking notes. ADHD will impair the length or amount of time required to process information, remain focused or maintain attention, exhibit required stamina (i.e., medication timing), complete learning without frustration and anxiety, and manage time. 

4:1 Ratio of Positive Reinforcement: Responses are best when they are consistent, immediate, salient, and specific. Attempt to balance a ratio of 4:1 ratio positive: negative corrective statements. 

Chunking: Allow assignments to be broken down into smaller sections. This accommodation can also be timed strategically to help break apart long work sessions, as students tend to work better in smaller bursts of time. 

Frequent Breaks One of the most commonly seen and least implemented accommodations seen on 504 and IEPs is frequent breaks. Frequent breaks are as subjective as preferential seating. Teams must define the frequency and purpose of a break in the context of the students’ ADHD. Providing a break can be counterproductive to a student who has finally begun a task or to students who need help with transitions.  

Preemptive breaks will be helpful prior to periods of prolonged inactivity. ADHD brains need movement to maintain focus ( all children need much more activity than is available in today’s school setting). If students spend all their energy trying to sit still and counteract movement, they will have the little mental capacity to focus on the learning part.

Movement breaks  ADHD children need regular opportunities to move around. They need frequent physical and brain breaks to alleviate restlessness or anxiety. Breaks should be functional and allow movement, such as classroom “tasks” (i.e., handing out papers to the class or delivering a message to the office). 

Extra Time: This is one of the biggest misunderstood accommodations out there. Students with ADHD need additional time to complete assignments, but it is NOT because they work slowly.For example, if you take a child with ADHD and give them an assessment that takes 10 minutes, for 9 minutes, the student will be off task and not complete the assessment. If they receive “time and a half” accommodations, they have 25 minutes to complete the assessment; the student will spend 24 minutes off task and still will not complete the assessment. The extra time is needed so the student can receive cues, prompts, frequent checks for understanding, chunking, and reset breaks. Giving a child who is essentially time-blind more time is not the purpose of this accommodation for students with ADHD. 

Isn’t That Just Good Teaching

Many of the accommodations described above are excellent teaching strategies for your learners with ADHD. My hope is that all teachers try them. 😉

However the difference between an accommodation and an instructional strategy is in the purpose. An accommodation is used to remove a barrier caused by a disability so the student can access their education in par with peers without disabilities. While many students will “BENEFIT” from all of the above instructional strategies, your student with ADHD must “REQUIRE” it to learn for it be considered a reasonable accommodation.

Summary

Accommodations are a primary intervention for students with ADHD because they immediately improve the goodness of fit between the child, the task, and the environment. Accommodations are not suggestions. They are never less important than goals or curriculum.  

ADHD is a chronic neurodevelopmental disorder you MANAGE, not treat or cure. The adults in this child’s life need to be teaching them a different set of skills. 

When we accommodate the child by building systems and environments to support performance, we are modeling the methods they actually need to learn to grow up and mitigate the impact of their ADHD on their own. 

When we develop accommodations to improve a child’s ability to show us what they know, it does not excuse them. Instead, it is a valuable teaching tool to empower them to design and honor the systems that will work for them long after they leave your home, classroom, or office.

IEP and 504 teams need to design accommodations from an understanding of ADHD. Accommodations must be documented in plans with clarity, explanation, and purpose. 

School-based occupational therapists and special education teachers can collaborate with general education teachers to ensure that they implement student accommodations in feasible and effective ways. When accommodations are clearly defined for the general education teacher in charge of implementing them, fidelity improves, prejudice is reduced, and our students thrive.

Resources

Barkley, R. (2016). Managing ADHD in School The Best Evidence-Based Methods for Teachers. Eau Claire, WI: PESI Publishing & Media.

The U.S.Department of Education’s Office for Civil Rights (OCR) guidance to school districts specifically for students with ADHD Resource Guide on Students with ADHD and Section 504

Barkley, R. (2008). Classroom Accommodations for Children with ADHD. ADHD Report.

Accommodations: Instructional and Testing Supports for Students with DisabilitiesThe IRIS Center Peabody College Vanderbilt University Nashville, TN 37203 iris@vanderbilt.edu. The IRIS Center is funded through a cooperative agreement with the U.S. Department of Education, Office of Special Education Programs (OSEP) Grant #H325E170001. Project Officer, Sarah AllenIRIS | – Vanderbilt University.