In 2011, the Centers for Disease Control and Prevention (CDC) stated that approximately one out of ten students (ages 4 to 17) in the US were diagnosed with attention deficit-hyperactivity disorder (ADHD). ADHD is the developmental, neurobiological condition defined by the presence of severe and pervasive symptoms of inattention, hyperactivity and impulsivity.
According to the criteria presented in the DSM-5 a child must exhibit a number of inattentive, impulsive and hyperactive behaviors over a period of six months, before the age of seven, that is present in both school and home, and has a significant impairment in regard to daily function.
This individual with ADHD has difficulty taking turns, talks excessively, often appears as if they are not listening when spoken to, and tends to interrupt and intrude on others in games, conversations, and classroom discussion (Daley and Birchwood, 2010). ADHD can have a serious impact on children and young people’s school life and achievement because of their symptoms. These symptoms often make learning difficult and it is therefore important that they are adequately supported in the school environment.
Granted these children are often seen as a challenge for teachers because they generally create discipline problem in the classroom, however they still need support (Ali, 2018).
Children with ADHD have lower grade point average (GPA), do worse on academic tests, have higher retention rates and absenteeism, and have lower high school and college completion rates (Keilow, Holm, and Fallesen, 2018). Recent research have also linked ADHD to delayed maturation of parts of the brain directly related to cognition, indicating a direct biological link between ADHD and low educational achievement.
In addition, medical treatment for ADHD has a significant and sizeable effect on long-term academic performance outcomes (Keilow, Holm, and Fallesen, 2018).
Children diagnosed with ADHD, have reduced volumes in certain areas of the brain that impact behavioral control. Compared to those children without symptoms, children with ADHD symptoms showed a significant reduction in brain volume in multiple areas. Many often experience delayed maturation of the brain, more specifically delayed growth of the pre-frontal cortex. This is the area of the brain associated with the regulation of executive functions, such as complex cognition, decision-making processes, and the moderation of social behavior. In Shaw and colleagues study of 223 children diagnosed with ADHD and 223 typically developing children, They saw substantial a delay in the maturation of the pre-frontal cortex among children with ADHD.
Among children with ADHD, 50 percent of cortical points had reached peak thickness at age 10.5 years, three years later than among the typically developed controls (Keilow, Holm, and Fallesen, 2018). In a more recent study by Sripada, Kessler and Angstadt, they found that children with ADHD also experience delayed maturation within deeper parts of the brain’s architecture and pathways, which are associated with attention, control of impulsivity, disregard of irrelevant stimuli, and other cognitive tasks. It seems there is strong evidence that delayed neurobiological development of areas of the brain that moderate behavior is important for conductive learning-behavior among children with ADHD (Keilow, Holm, and Fallesen, 2018). Thus, the effect of ADHD on educational achievement is likely not only driven directly by delayed maturation of the brain, but also by secondary effects of ADHD on children’s life and learning circumstances (Keilow, Holm, and Fallesen, 2018).
Twenty to thirty percent of ADHD children have an associated learning disorder of reading, spelling, writing and mathematics. School-aged children with ADHD experience an abundance of academic and educational problems. Bauermeister and colleagues (2007) found that children and adolescents with ADHD (aged between 4 and 17) were likely to have educational problems; these individuals were more likely to receive counselling or special education and have a history of suspension or expulsion (Daley and Birchwood, 2010). Children also display lower cognitive achievements, lower test scores, and higher scholastic impairment, especially when it comes to attention problems. This includes predicting poorer math and reading achievement. Thus, research consistently shows that ADHD affects a number of various educational outcomes ranging from performance and achievement measures to school behaviors (Keilow, Holm and Fallesen, 2018). The hyperactive-impulsive symptoms of ADHD appear to be associated with academic failure, however behavioral inattentive symptoms are more strongly related to school performance.
Reading and math abilities exhibit stronger phenotypic and genetic associations with the inattentive dimension than with the hyperactive-impulsive dimension. In fact, the genetic association between hyperactivity-impulsivity and academic performance seems related to shared genetic influences between the hyperactive-impulsive and inattentive traits. In this sense, distractions are likely to be the core source of lower academic performance in ADHD (Costa et al., 2014). With that being said, when children have untreated behavioral problems it will substantially impair their learning and educational achievements. Previous studies have found that children diagnosed with ADHD on average attain 2.2 to 2.5 years less schooling than non-ADHD peers do, and 25 percent of students with ADHD drop out of high school (Keilow, Holm and Fallesen, 2018). When it comes to adolescent research, it shows that individuals with ADHD are likely to perform poorly in school and leave with few or no qualifications.
Heiligenstein and colleagues (1999) compared a small number of students who were classified as having ADHD (n = 26) with non-ADHD students (n = 28). They found that the ADHD group had lower grade averages and were more likely to be on academic probation. As well as see that university students with ADHD encounter problems with tasks and processes that are identical to the requirements of higher education, such as study strategies, note taking, summarizing and outlining, test taking, test strategies, time management, concentration, motivation, information ADHD and academic performance processing and self-testing. It has been noted that the effect and impact of ADHD is mild during physical activities but apparent during academic learning because hyperactive children cannot concentrate and are constantly restless (Daley and Birchwood, 2010).
Students with ADHD often learn differently from their peers without ADHD. In the classroom the ADHD behavior of both girls and boys is more robust as compared outside of the classroom. Similarly, ADHD girls practice more word exchange and then boys whereas ADHD boys practice physical acts and sometimes physically assault their fellows (Ali, 2018). Academic interventions for ADHD individuals should focus on executive function deficits (such as working memory, planning and response inhibition) and inattentive symptoms (Daley and Birchwood, 2010).
Now when it comes to being in a classroom, students with ADHD are more likely to have academic difficulties. A common strategy used for individuals with ADHD is peer tutoring. Peer tutoring is a strategy where an ADHD individual is paired with a peer tutor to work on a certain academic activity. The benefits of having a peer tutor is that the tutor provides one-on one instruction and assistance at the ADHD individual’s own pace. Research has shown that peer tutoring improves classroom behavior and academic performance (Daley and Birchwood, 2010). Task/instructional modifications involve manipulating tasks and instructions to meet the needs of the ADHD individual.
Manipulations include reducing task length, dividing tasks into sub units, giving explicit instructions, and modifying the delivery or modality of instruction according to the pupil’s learning style. When teachers/educators use classroom functional assessment procedures, this involves developing an intervention that is specific to the child, based on the identification and manipulation of environmental variables that initiate, maintain and/or increase the child’s problematic behavior in a particular setting (Ervin et al. 1998). This approach has been used to increase on-task behavior and reduce disruptive behavior in ADHD individuals, but as of yet has not been studied in terms of academic productivity and accuracy (Daley and Birchwood, 2010). Self-monitoring involves individual setting goals for classwork completion and accuracy, monitoring these goals and administering rewards upon successful completion. Research suggests that these strategies help to improve the academic performance of ADHD individuals (particularly older children and adolescents), especially in combination with stimulant medication.
Strategy training involves teaching children a specific skill so they can implement it in an academic situation, to improve their performance. It has been noted that this could be a useful tool for ADHD individuals, where children and adolescents learn useful skills to improve academic performance, while taking responsibility off parents and teachers (Daley and Birchwood, 2010). When implementing the homework-focused intervention, it allows children and adolescents with ADHD experience problems with planning, prioritizing, filtering out distractions, focusing on individual tasks, forgetfulness and lack of organization, it is likely that homework will suffer. Therefore, teaching parents homework strategies based around these problems seems beneficial to ADHD individuals (Daley and Birchwood, 2010).
Another approach to addressing the academic performance of ADHD individuals could be altering teachers’ attitudes towards ADHD behaviors and treatments. In a review, Sherman and colleagues (2008) suggest that teachers’ patience, knowledge of intervention techniques, ability to collaborate with interdisciplinary teams, use of gestures when communicating with students and positive attitude towards ADHD children are key factors in the academic success of ADHD pupils. Stressing these points to teachers could generate a more positive classroom environment, which could prove valuable to both ADHD and non-ADHD individuals (Daley and Birchwood, 2010). When students with ADHD are actively engaged with material, they tend to be more interested in what they are learning, which improves their focus, attention, and retention of the skills learned (Sfrisi et al., 2017).
Often times these students prefer to work in a quiet and warm classroom with traditional furniture. Students prefer to be motivated by others instead of being self-motivated. These students often have a preference to tasks that are broken into multiple steps with specific guidelines and need breaks while completing tasks. These students prefer working in groups/pairs, this explains why they have a strong preference for working with authority figures such as teachers and para-educators (Sfrisi et al., 2017). It seems that children and young people with ADHD are at a high risk of school exclusion, particularly when ADHD has not yet been diagnosed (The National Attention Deficit Disorder Information and Support Service, 2004). This can further affect academic achievement and have a substantial impact on self-esteem. It is therefore important that professionals working in schools are able to identify the symptoms of ADHD, and for strategies to be in place to limit school exclusion (Voogd, 2014).
The most common ADHD treatments include stimulant medication and behavioral interventions, which are used to target (and improve) off task and disruptive behavior (Daley and Birchwood, 2010). During the past 50 years, a worldwide increase in prevalence rates of mental disorders in children and adolescents was found in studies using data from health insurance providers, national registers of health services, and special education programs. In regard to, attention-deficit/hyperactivity disorder (ADHD), the rate of psychostimulant use in children and adolescents in some studies exceeds earlier prevalence rates of ADHD (8–10% of students in grades 2 through 5 in two cities received medication for ADHD).
Research shows that children who do not fulfill ADHD criteria are treated with psychostimulants. These findings have raised concerns regarding overdiagnosis of ADHD in daily practice, especially as a recent study reported prevalence rates up to 20% (Merten et al., 2017). The short-term medical treatment does have positive effects on academic achievement, whereas long-term studies of the effects on education are scarce and effects are generally more diverse, smaller, or less significant than short-term effects. In their recent review, Baweja et al. conclude that the evidence for a positive effect of medical ADHD treatment on school performance remains more substantial for acute than long-term indicators of academic performance (Keilow, Holm and Fallesen, 2018). Pelham, Wheeler, and Chronis (1998) noted that 70% to 80% of students with ADHD respond positively to stimulant medication. These positive effects are related more to calming students’ impulsivity and inattention and not in fostering academic achievement (Sfrisi et al., 2017).
Generally speaking, these studies support different reasons to believe that poor academic performance is a result of misdiagnosing a child with ADHD. It seems that we are aware of some the reasons as to why children struggle. It’s important that we remember that ADHD symptoms persist into adulthood, with between 11 and 40% of childhood cases continuing to meet criteria for the disorder in adulthood (Daley and Birchwood, 2010). With that being said this issue needs to be addressed while they’re young, so we can avoid misdiagnosing a child with ADHD.
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