Over 15 million children and adults in the United States have been diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD). According to the DSM-IVÔ , "the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity - impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development."

According to 1990 research published in the New England Journal of Medicine, "adults with ADD utilize glucose – the brain’s main energy source – at a lesser rate than do adults without ADD. This reduced brain metabolism rate was most evident in the portion of the brain that is important for attention, handwriting, motor control and inhibition of responses." From this finding, the researchers concluded that ADD/ADHD is a "neurobiological disorder," not an environmental one.

ADD/ADHD manifests itself as the inability to focus on and/or complete tasks, and occurs often and in more than one setting. It may or may not be combined with a hyperactivity element. Although first seen in childhood, it may not be formally diagnosed until adolescence or adulthood. One- to two-thirds of children with ADD/ADHD continue to have symptoms as adults. ADD/ADHD interferes with major life activities such as learning, completing projects, acquiring and keeping a job, or developing friendships and relationships and displays itself in more than one setting.

Instructors may notice students who frequently exhibit one or more of the following symptoms common to ADHD: impulsivity, restlessness, difficulty sitting still, incessant talking, frequent interruptions, fidgeting, tapping, constant movement, frequent touching. Some students are more subtly distracted by auditory or visual stimuli. They may not listen when spoken to, may have difficulty organizing tasks, may often lose things, may jump from one task to another, may start an assignment but drift off, and may exhibit difficulty completing assignments.

Individuals who have a true diagnosis of ADD/ADHD have symptoms that 1) are frequent and intense; 2) occur in more than one setting; 3) interfere with major life activities; and 4) have occurred since childhood (a history of the condition).

People with ADD/ADHD are often very intelligent and extremely creative individuals with amazing energy. Channeled and focused, using appropriate accommodations and/or reeducation, individuals with this disorder can be highly effective and successful in their lives.

• Seat students who are easily distracted near the front of the room, or away from distractions.
  
  

• Break down directions into small steps.
  
  

• Students may need to take short breaks more frequently to maintain attention.
  
  

• Students may need to take exams in distraction free environments.
  
  

• Maintain structure or routine in the classroom.
  
  

Mood Disorders

A student with a mood disorder may exhibit symptoms that indicate one or both types of episodes. Depressive episodes include such symptoms as: "depressed mood, loss of interest or pleasure in nearly all activities," accompanied by "changes in appetite or weight, sleep, and psychomotor activity (e.g., inability to sit still, pacing, hand-wringing; slowed speech, thinking and body movements; increased pauses before answering); decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans or attempts."

Manic episodes include such symptoms as: "abnormally and persistent elevated (euphoric), expansive (enthusiastic), or irritable mood (also alternating between elevated or expansive mood and irritability)," accompanied by "inflated self-esteem or grandiosity, decreased need for sleep, pressure of speech (loud, rapid, difficult to interrupt), flight of ideas, distractibility, increased involvement in pleasurable activities with a high potential for painful consequences."

Mixed episodes include symptoms from both depressive and manic episodes within the same period of time.

If symptoms are severe enough to merit hospitalization during any given semester, the college may require or request that the instructor give the student the chance to complete the class assignments. Less severe symptoms may require minimal or no accommodations. Students with psychological disabilities, as well as students with other disabilities, should be held to the same academic standards as students without disabilities.

• Students may need extra time for taking exams.
  
  

• Discuss behavioral issues with students in private. Do not bring attention to them in class.
  
  

• Respect the students’ wishes to not discuss the details of their treatment with you.
  
  

Personality Disorders

These disorders fall into three clusters. Individuals who have disorders from cluster A, including Paranoid and Schizoid disorders, often appear odd or eccentric. Those who fall into cluster B, including Antisocial disorders, often appear dramatic, emotional or erratic. Those in cluster C, including Obsessive-Compulsive disorders, often appear anxious or fearful. In general, symptoms of personality disorders include "enduring patterns of inner experience and behavior that deviates markedly from the expectations of the individual’s culture," manifested in "cognition (ways of perceiving and interpreting self, other people and events), affectivity (range and intensity, lability, and appropriateness of emotional response), interpersonal functioning, or impulse control."

Individuals with Paranoid Personality Disorder "assume that other people will exploit, harm or deceive them, even if no evidence exists to support this expectation."

Individuals with Schizoid Personality Disorder "appear to lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not derive much satisfaction from being part of a family or other social group…They are loners."

Individuals with Antisocial Personality Disorder "fail to conform to social norms with respect to lawful behavior. They may repeatedly perform acts that are grounds for arrest, such as destroying property, harassing others, stealing or pursuing illegal occupations." This disorder has historically been referred to as "psychopathy, sociopathy or dyssocial personality disorder." Deceit and manipulation are central features of this disorder. People with this disorder tend to be irresponsible and reckless, with little remorse for their actions.

Individuals with Obsessive-Compulsive Personality Disorder "attempt to maintain a sense of control through painstaking attention to rules, trivial details, procedures, lists, schedules, or forms to the extent that the major point of the activity is lost. They are excessively careful and prone to repetition, paying extraordinary attention to detail and repeatedly checking for possible mistakes." They are usually very rigid and inflexible in their decisions.

• Be clear and concise in your expectations and requirements for classroom behavior.
  
  

• Respect the student’s reality, but do not pretend to share it.
  
  

• Discuss behavioral issues and accommodations privately with the student.
  
  

• If you feel that your safety is threatened, do not hesitate to contact Campus Security.
  
  

Anxiety Disorders

Individuals with Posttraumatic Stress Disorder (PTSD) develop characteristic symptoms after "an extreme stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror." Directly experienced traumatic events can include such things as military combat, violent personal assault, severe automobile accidents, or diagnosis of a life-threatening illness. Witnessed events can include observing injury or death of another due to violent assault or unexpectedly witnessing a dead body or body parts. Events that are learned about can include injury, accident or assault of a friend, or family member, etc.

One of the common symptoms of PTSD is the panic attack. It is characterized by a "discrete period of intense fear or discomfort," accompanied by "palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feeling of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint; derealization (feelings of unreality) or depersonalization (being detached from oneself); fear of losing control or going crazy; fear of dying; parethesias (numbness or tingling sensations); chills or hot flushes."

• If a panic attack occurs while you are with the student, stay calm and speak in quiet tones.
  
  

• Respect the student’s privacy.
  
  

Substance-Related Disorders

This category includes dependence on or abuse of any substance, including alcohol and other legal drugs as well as illegal substances. An individual who is dependent on a substance usually has a high tolerance for the substance and may experience withdrawal symptoms if its use is discontinued. The individual "may take the substance in larger amounts or over a longer period of time than was originally intended; may express a persistent desire to cut down or regulate substance use; may have had many unsuccessful attempts to decrease or discontinue use; may spend a great deal of time obtaining the substance, using the substance or recovering from the use of the substance." Substance abuse, is defined as "recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home; recurrent substance use in situations in which it is physically hazardous; recurrent substance-related legal problems; and continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance." Substance abuse does not require tolerance or withdrawal to be present.

Only students who are not currently using the substance for which they are diagnosed as dependent or abusing are eligible for services through DSPS and are protected under the ADA.

• Substance abuse can sometimes cause neurological deficits similar to acquired brain impairment or attention deficit hyperactivity disorder. Discuss behavioral issues privately with students.

For students with psychological disabilities who are taking prescribed medication, some or all of the symptoms described may be completely eliminated. Other symptoms may be partially alleviated, while some may not be reduced at all.

The presence of a psychological disability usually requires only minimal accommodation in the classroom. As an instructor, you should be aware that some students may have these issues and may need accommodations because of them. Students with psychological disabilities may never reveal their disability to you, or they may reveal it to you, but not want the rest of the class to know that they are "different." Assure them that their privacy is paramount and encourage them to contact DSPS for assistance, if they need it.

1) All references in this section, unless otherwise noted, are from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IVÔ ) published by the American Psychiatric Association, 1994. ADD/ADHD, pp. 78-85. Mood disorders, pp. 317-391. Personality disorders, pp. 629-673. Anxiety disorders, pp. 393-444.

2) CHADD (Children and Adults with Attention Deficit Disorder) fact sheet, 1993.