The Order of the Public Library

and the Disorder of Attention Deficit

Lynn Akin
Erin OToole

ABSTRACT. While the public library exists to serve a diverse clientele, one group often ignored consists of those with invisible challenges, such as attention deficit disorder (ADD) and attention deficit
disorder with hyperactivity (ADHD), in children and adults. This article
covers background information on ADD/ADHD, diagnostic criteria,
and common characteristics of the disorder. The role of the public
library in serving the ADD user is examined through needs assessment,
training, programming, collection development, and continuing education for librarians. The public library can and should ensure that those
who suffer from disordered attention skills benefit from the ordered
knowledge at their local library. [Article copies available for a fee from The

Haworth Document Delivery Service: 1-800-342-9678. E-mail address:

<getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com>
! 2000 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Public libraries, public librariesprogramming, attention deficit disorder, public librariesspecial populations, attention deficit disorder with hyperactivity
The public library prides itself as a full-service knowledge institution that
exists expressly to serve the information needs of every community member.
As communities become more multi-cultural, the library transforms itself to
respond to requests for foreign language reading materials and special programming needs. Passage of bills, such as the Americans with Disabilities
Lynn Akin is Assistant Professor, School of Library and Information Studies,
Texas Womans University (E-mail: Lakin@TWU.edu).
Erin OToole is Librarian Assistant II, Emily Fowler Central Public Library, 502
Oakland, Denton TX 76201 (E-mail: Erin.otoole@cityofdenton.com).
Public Library Quarterly, Vol. 18(3/4) 2000
! 2000 by The Haworth Press, Inc. All rights reserved.

69

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Act, guarantees that users with disabilities are welcome in all public institutions.
Despite policies of inclusion, some users remain left out. These potential library
patrons, both young and old, suffer from an invisible disability: attention deficit
disorder (ADD) and attention deficit disorder with hyperactivity (ADHD).

ATTENTION DEFICIT DISORDER/HYPERACTIVITY

ADD is the most commonly diagnosed behavioral disorder of childhood
(National Institute of Health 1998). Attention deficit disorder consists of three
primary problems: difficulties with sustained attention, impulse control or inhibition, and excessive activity (Barkley 1995; Hallowell and Ratey 1994). An
individual with ADD sustains these characteristics over time, manifests the
symptoms no later than age seven, and often, as a child, has difficulties in school
(American Psychiatric Association 1997). Total ADD diagnosis percentages
vary widely. While older studies predicted a two to three percent likelihood of an
ADD diagnosis in the entire childhood population, but acknowledged that a
wide range of statistical latitude on incidence exists (Barkley 1981, 7), later
estimates range from three to twenty percent (Armstrong 1997).
CHILDREN WITH ADD
Usually for children, an ADD diagnosis results from a combination of
observations by teachers, parents, and medical personnel. The difference
between a diagnosis of ADD or ADHD involves hyperactivity. A child may
have difficulty paying attention and suppressing impulses but may not fidget
excessively. The more that hyperactivity enters the clinical picture, the more
likely the child emerges with a diagnosis of ADHD.
Any child who has ADD is indeed any child. Attention deficit disorder
occurs without regard to social status, race, religion, economics, or any other
grouping factor save one: physicians diagnose boys with ADD/ADHD far
more often than girls. Out of every ten cases of ADD, approximately seven to
eight will be boys (Armstrong 1997; Barkley 1981). Boys tend to have the
hyperactive component and girls tend to have the inattentive ADD.
Two other characteristics, an altered sense of time and poor social skills,
also mark disordered attention processing. The linear nature of time eludes
the ADD child and in fact, to the ADD individual, time seems to be passing
more slowly than it actually is (Barkley 1995). ADD/ADHD children often
express amazement to discover that the class period has elapsed and they
have accomplished nothing. Because their attention processes wander, their

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71

temporal sense is both elastic and forgiving. ADD students focus on the
present and find it hard to meet future deadlines (Stevens 1997; Barkley
1995). This makes it difficult for such children to succeed at a task unless a
supervising adult provides frequent time reminders or instruction in sequencing.
Poor social skills characterize children with ADD, which can make for
some uncomfortable social interactions. ADD/ADHD children will often
invade body space, talk too loudly when they are already too close, and will
spontaneously offer unedited, tactless observations. Their social immaturity
causes them to have few friends, and in research on peer nominations for best
liked, least liked, causes trouble, and meanest, the ADHD child fares poorly
and frequently places in the three negative categories (Kumpulainen, Rasanen, and Henttonen 1998; McBurnett et al. 1997).
Information about ADD/ADHD into the teen years presents a more depressing picture of a child who has been struggling with learning and behavior issues since as early as age seven. Older children with untreated ADHD
and conduct disorders will abuse drugs, manifest antisocial behavior, and
suffer injuries of all types (National Institute of Health 1998).
ADULTS WITH ADD
Contrary to popular belief, people who suffer from ADD/ADHD do not
grow out of their problems. In fact, fifty to sixty-five percent of children
with ADHD will continue to be symptomatic as adults (Barkley 1995) and a
conservative estimate of adults with ADD ranges from two to five million
redundant (CHADD 1999). All existing diagnostic criteria for ADHD were
designed for young children and have not been adjusted for older children
and adults (National Institute of Health 1998). Hallowell and Ratey (1994)
offer suggested criteria for diagnosis of adult ADD and, in addition to a
childhood history of ADD, other markers include difficulty with organizational skills, constantly multitasking without completion, procrastination,
distractibility and impulsivity. Adults who have struggled lifelong with the
symptoms of ADD often have marked problems. Rates for suicide and accidental death are much higher, educational levels and job status are lower, and
there is an increase in antisocial behaviors and additional psychiatric conditions (Barkley 1995).
THE PUBLIC LIBRARY
Despite such bleak predictions, many people with ADD/ADHD receive
treatment, counseling, and medication. They live in local communities and
are likely to visit their public libraries. The local public schools are sure to
send classes to the public library for instruction or research purposes. High

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school students will come on their own, after school hours, to complete
homework assignments. Based on the earlier statistics, if even one class of 25
students comes for a library tour and instruction, one fifth may have ADD/
ADHD. While adults will be less obvious in terms of inappropriate behaviors,
the public librarian surely serves ADD adults seeking information.
How can the public library better serve this client group? Library literature
does discuss the physically challenged and the learning disabled but it does
not adequately address the role of the library and the ADD library user.
Literature from education, medicine, and psychology is replete with articles
and material on attention deficit disorder. Information directed at parents,
health care professionals, and teachers contains recommendations on how
best to help ADD individuals. Some of the suggestions focus on teaching
organization skills (Rief 1993), technical skills (Stevens 1997; Dornbush and
Pruitt 1995; Graf 1995), social skills (Anhalt, McNeil, and Bahl 1998) or library
skills (Armstrong 1997; Copeland and Love 1995). These areas create major
opportunities for the library to enrich and empower the ADD library user.
NEEDS ASSESSMENT/TRAINING
A comprehensive needs assessment precedes and determines the role of
the library in serving a special needs group and meeting their needs (Holt and
Hole 1995). The ADD population can be identified by contacting local
schools, health associations, and health care professionals who specialize in
treating ADD/ADHD. If there are private schools nearby specifically for
ADD/ADHD children or learning disabled students, the librarian should
contact the school administrators and teachers to determine how to improve
the role of the library. Library users who indicate they have ADD or parent
ADD children can be used as a resource. Simply talking to willing library
clients will help the motivated staff develop an idea of what programming
would be welcomed and helpful.
Training for the librarians emerges as a priority when courting the attentions of a special needs group. In a library survey done for needs assessment
purposes regarding the Phoenix Public Librarys Special Needs Center,
staff, library users, and involved professionals all mentioned training as an
ongoing issue (Holt and Hole 1995). Staff development should cover not
only the essentials of good public relations and programming skills, but also
the unique needs of ADD clients. The librarians should become aware of the
diagnostic criteria for ADD/ADHD (American Psychiatric Association
1997) and the differences between the two types of disabilities. Particularly
with children, ADD behaviors often look and feel like obstinate misbehaving. Awareness training will help a librarian react more positively to ADD
children.

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73

PROGRAMMING AND ADD CHILDREN

A public library can and should make efforts to meet the unique needs of
the young ADD library user. Story times, library skills instruction, and computer activities are all educational components of the public library experience and ADD children require the instruction just as much, if not more so,
than non-ADD children. Collection development supports the efforts of the
library staff in programming for the ADD/ADHD child. When the librarian
identifies strategies designed to make the library meaningful, both the user
and the librarian experience a satisfying interaction.
Story Times
The ADD child at a library story time program may manifest an array of
symptoms, which includes fidgeting, talking, roaming about, touching others,
and asking off-task questions. These behaviors will interfere with numerous
issues: the actual telling of the story, the enjoyment of others, and the librarian
attempting to provide literacy instruction to younger patrons. A number of
strategies can prepare the librarian to minimize these disruptive behaviors
and to positively engage the ADD child in story times.
When a librarian pays attention to the basic characteristics of ADD/ADHD
in planning a story time, the likelihood of a successful program is increased.
Books that contain rhythm, repetition, and invitations to movement are good
choices for story times where ADD children will be present. Children can be
invited to clap hands or stomp feet in time to rhythmic books, and to chant
phrases from books with repetitive text. Some childrens books have built-in
invitations for movement in that they describe different activities, such as
bouncing or twirling. In this case, the librarian can ask the children to imitate
the activities. While all children enjoy these types of books, ADD children
benefit because they can channel their energy into acceptable story time
behavior.
Alternating stories with verse and movement accommodates the childs
short attention span and need for physical release. Songs, songs with actions,
fingerplays, or even simple dances involve the audience. Activities that allow
ADD children to stand and move between stories are best.
ADD children pay better attention when story time involves more than one
sense so adding verbal, visual, tactile, and cognitive cues is effective (Dornbush and Pruitt 1995). Big books, puppets, and physical props work well and
serve as attention anchors. For librarians who are inclined, acting out parts of
a book also serves as a visual aid. Having the children pantomime or roleplay story parts will strengthen focus and interest (Dornbush and Pruitt
1995). Make sure the ADD children sit in the front of the audience to minimize distractions (Stevens 1997).

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Feinberg et al. (1999) offers excellent suggestions for adapting programs

for children with varying abilities. In a section specifically on learning disabilities and emotional and attention disorders (93-95), some of the suggestions include being prepared to redirect the child and to provide physical
components to the lesson, such as allowing the child to turn the pages. Make
sure there are enough materials to go around but also limit choices to reduce
overstimulation. Reduce lighting and provide cozy furniture arrangements to
help the child focus on the story. Carefully arranged furniture can also reduce
wandering by creating boundaries.
Another excellent source book is Teaching the Tiger (Dornbush and Pruitt
1995), written expressly for educators of children with ADD/ADHD. The
book contains ideas for vivid lessons, suggested modifications, and academic
interventions. Any of these ideas could easily be incorporated into a library
skills lesson or a story time.
At the story time conclusion, the ADD child may prefer to browse magazines or check out audio/video tapes rather than books. The linear act of
decoding letters into words is laborious work for a child whose attention
wanders. The aware librarian will have a themed audio/video selection,
linked to the story, available for the interested child. Of course, an obvious
suggestion is to encourage a love of reading but flexibility will be required.
ADD children might like to read while pacing back and forth, or may prefer
odd postures. They may read each word aloud in order to add auditory input,
maintain attention, and increase comprehension. In order to track their place
in the story, ADD readers may follow lines of text with their fingers or
employ a bookmark to isolate lines of words (Rief 1993). The librarian must
keep the end goal in sight, while respecting diverse methods of reading and
seeking information.
Finally, the librarian should encourage close communication with parents
of ADD children as they know their child better than anyone and can offer
valuable insights. A concerned librarian may want to communicate with the
parents of a child who has been acting out during library visits. Tact and
sensitivity must underscore the conversation and guidelines are available for
interested librarians (Feinberg et al. 1999).
Library Skills Instruction
Materials aimed primarily at teachers and parents of ADD/ADHD children
encourage library use and library skills (Copeland and Love 1995, 289).
Whenever possible, include physical movement in library tours and lessons,
thus diverting high energy needs into acceptable outlets. Because people with
ADD take in information on all levels, they often notice small details about
their environment and are keen observers regarding location and changes
(Stevens 1997). Library orientation tours give ADD library users a mental

Lynn Akin and Erin OToole

75

map of the library, and knowing the logic of the library arrangement allows
them to become informed browsers.
Team teaching (Rief 1993) library skills lessons keeps interest high and
allows for users to link to more than one librarian. Actually walking through
a lesson on the Dewey Decimal system allows the ADD child to both relieve
a physical need for movement and internalize the layout of the library. Try
using student buddy pairings (Dornbush and Pruitt 1995) of a non-ADD child
with an ADD child to keep the ADD child on-task. In the same Dewey
lesson, instruct the children to identify what is located in a particular area.
Send the fidgety child to bring back an example book with the help of a
calmer child. This strategy guarantees success of the mission, increases the
self-esteem of the ADD child, and affords the same child another physical
opportunity. Seat the ADD child near the front of the group for a library
lesson (Stevens 1997) in order to minimize distractions. Consider the restless
child a good candidate for small library-related jobs, such as re-shelving
books (Armstrong 1997). Not only does the child learn to decode the classification system (a lifelong skill), but they also perform a needed task, and
discover satisfaction at a job accomplished.
Contingency management is a technique used successfully in both home
and school with ADD children and it involves using a token or reward system
to help children work on self-management skills. A librarian may allow a
child extra computer time as a special privilege for good behavior during
bibliographic instruction. In some schools, recreational computer time acts as
a reward and research supports this practice (Yehle and Wambold 1998;
Dornbush and Pruitt 1995; Ford, Poe, and Cox 1993).
Computer Activities
What ADD children and adults lack in attention control and impulse
inhibition is balanced by the use of computers, and the marriage of technology to ADD users is a sound one (Stevens 1997; Graf 1995; Ford, Poe, and
Cox 1993). The multi-sensory approach of computers catches their attention
on several different levels and the quick screen changes satisfy short attention
spans. Additionally the user is in charge of the technical experience and can
change topics at will. Whenever possible, let the ADD student participate on
the technical aspects of library instruction. If the research unit includes
searching exercises, put the ADD child in the computer searching group.
ADD children will often excel here and can peer coach other children. When
technology is added to the curriculum, research indicates the ADD child will
experience increased attention, persevere longer, and voluntarily try to solve
more problems (Ford, Poe, and Cox 1993; Millman 1984; Kleiman, Humphrey, and Lindsay 1981).

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Public libraries can facilitate computer research by ADD students with

various computer components and accessories. In one survey of learning
disabled students and academic library services, those students with ADD
indicated the least need for additional adaptive technology but they did request adjustable color monitors (Loope 1996). If the library does not already
have privacy screens, consider purchasing them. Besides the obvious reasons
why all library users benefit from privacy, the privacy screens keep ADD
children focused on their own work, minimize off-task conversation and
behaviors, and facilitate more interaction between the student and the information. Additionally, headsets can mask volume levels, particularly with
entertaining educational software. The ADD child can set the volume as loud
as desired and the library, other library users, and the ADD students will
appreciate them. ADD students informally observed at a local public library
were hard on keyboards, hitting the enter key and space bar quite heavily,
almost as if punctuating closure. Industrial strength keyboards are recommended for libraries with ADD users.
The use of study carrels limits distractions for the young ADD researcher
while group work at large tables will probably not be successful. However,
peer coaching may be effective if both students stay on-task. In the research
or study situation, headsets can be provided to students in order to eliminate
noise and maximize concentration.
Collection Development
Collection development librarians will want to pay particular attention to
materials that address the needs of the young ADD/ADHD library user.
Multisensory resources appeal to an ADD child and examples include
puzzles, cloth and toy books, sniff n smell books, toys, audio and video
materials, and CD-ROMs (Feinberg et al. 1999). For older children, well-regarded
story condensations, story-and-tape combinations, or reputable video adaptations help the child with an attention disorder (Stevens 1997).
Good resource books include recommended reading lists and these can be
employed to guide collection efforts (see Feinberg et al. 1999; Dornbush and
Pruitt 1995, for example). ADD specific web sites, such as National Attention
Deficit Disorder Association (www.add.org) also provide recommendations
for suggested reading. The ALA Roads to Learning web site (www.ala.org/
roads/) offers a core collection list. Although this site is directed at learning
disabilities, research indicates that between fifteen to forty-five percent of all
children with reading disabilities also have attention deficit disorder, with or
without hyperactivity (American Library Association 1999), so a short list of
ADD reading materials is included. Because of the link between attention
deficit disorder and poor language skills, reading lists aimed to draw in
reluctant readers should be consulted. Annually, YALSA (Young Adults

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77

Library Services Association) composes a list called Quick Picks, designed

to highlight books for reluctant young adult readers. Several years worth of
lists plus the criteria are available at the YALSA website (www.ala.org/yalsa/).
Any of these suggestions can guide collection development efforts.
PROGRAMMING AND ADD ADULTS
Adult library users with ADD/ADHD will have developed coping strategies
and will be far less obvious than children with ADD. The professional librarian
may even be unable to identify a single ADD adult user. Yet, the statistics of
diagnosis among children indicate that they grow up to become ADD adults.
The library can still play a part in serving this unique community.
Special library programming can focus on attention deficit disorder and
hyperactivity by holding a series of workshops dealing with different aspects
of the condition. Since much of the ADD research focuses on children,
holding sessions on adults with ADD, ADD and the female experience, and
teens with ADD will be unique and informative. Additionally, issues regarding
learning disabilities link well to ADD and enlarge the potential audience.
Local professionals who specialize in treating and diagnosing attention disorders can be invited to speak at library programs. Local support groups can be
encouraged to hold meetings in the library public space and materials advertising their groups can be displayed.
Regarding academic library services, learning disabled and ADD university
students made the strongest negative statements about searching the online
library catalog (Loope 1996). In general, those students disliked the online
catalog and registered complaints regarding not knowing which words to use
and never finding anything they want. Specialized adult bibliographic instruction could be inserted into the ADD workshops, thus helping to ease this
problem. Also, qualified library volunteers who have attended special OPAC
training could serve as online tutors, giving individualized instruction.
Collection development librarians should make sure that the collection
reflects the needs of the ADD/ADHD library client and supports special
programming. Establishing a resource collection (Virginia State Board of
Education 1995) supports the ADD users and postures the library as a responsive institution. The guidelines to good collection development activities
apply. Librarians will need to familiarize themselves with known author
authorities, such as Barkley, currency in research developments as found in
the National Institute of Health consensus statements (1998), and worthwhile
electronic resources. Many ADD specific web pages provide lists of reading
materials. Maintaining information and referral services will aid adults either
in seeking current information about attention deficit disorder or job counseling services.

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PROFESSIONAL DEVELOPMENT
Continuing education is the hallmark of any professional. In addition to
print tools, resources such as webpages, listservs, electronic periodicals, and
online resource collections serve to educate interested and motivated professionals about ADD/ADHD library users.
Several reputable websites contain information and background on ADD/
ADHD. CHADD (Children and Adults with Attention Deficit/hyperactivity
disorder) is a national non-profit organization representing children and
adults with ADD (www.chadd.org). The National Attention Deficit Disorder
Association webpage (www.add.org) supplies a list of books on ADD, arranged by audience, that collection development librarians will welcome.
One ADD Place (www.oneaddplace.com), has a popular page of famous
people with attention deficit and learning disorders. Winston Churchill, Robin Williams, the Wright brothers, and Albert Einstein make the list. The ALA
Public Libraries Learning Disabilities Initiative can be found at www.ala.org/
roads/ and this site offers a list of resources such as listservs. Two applicable
ones are Axslib-L, for librarians concerned about accessibility issues, and
Plld-l, which furnishes information about learning disabilities.
A search performed on any good Internet search engine will result in many
sites dedicated to attention deficit disorder. The Mining Company guide to
ADD (add.miningco.com) provides featured articles, chat rooms, book reviews, and links to other websites.
An online bi-monthly magazine, ADDvance, is written specifically for
women with attention deficit disorder and the magazine contains an online
resource page for women and girls with ADD (www.addvance.com). The
table of contents and selected articles from Attention Magazine, containing
the latest in research, diagnosis, and treatment of ADD, can be located at the
CHADD site.

CONCLUSION
The public library represents information and knowledge in an orderly
arrangement available to all. With help, library users with disordered attention skills will learn to rely on that promise of order and that delivery of
service. Through modifications to programming and collection development,
and attention to continuing education, public libraries and public librarians
can encourage and support users with invisible challenges.

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79

REFERENCES
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Anhalt, Karla, Cheryl McNeil, and Alisa Bahl. 1998. The ADHD classroom: A
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