What do we know about ADHD in our learners

By Dr Loh Pek Ru
Psychology and Child & Human Development, NIE, NTU
Published: 1 August 2022

Working with students with ADHD can be challenging for teachers. The more a teacher understand about ADHD, the better the teacher can support the student with ADHD in the classroom.

Facts about ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by a persistent pattern of inattention and/or hyperactivity and impulsivity that interferes with normal functioning and development in a child (APA, 2013).

There are three presentations:

• • Predominantly Inattentive: Having difficulty in focusing or sustaining attention.

  • Predominantly Hyperactive-Impulsive: Overly active and having difficulty with controlling impulsivity.

  • Combined Presentation: Having both above presentations.

ADHD is one of the most common childhood condition (APA, 2013) occurring in different cultures and countries (Biederman, 2005; Rhode et al., 2005). It has a worldwide prevalence estimate of 5. 29% (Polanczyk, de Lima, Horta & Biederman, 2007) and an estimate of 3% to 7% in school-age children (Faraone, Sergeant, Gillberg, & Biederman, 2003). The symptoms can change over time, and the presentation may evolve, usually to combined presentation as the child grows older. About 30% to 60% of these children continue to have ADHD as adults (Biederman, 1998; Biederman, Mick, & Faraone, 2000). The exact cause of ADHD is unknown, but the condition has been shown to run in families and genetics play an important role in its development (Faraone et al., 2021).

Cognitive profile of ADHD

The IQ distribution in children with ADHD is similar to their neurotypical peers (APA, 2000). In other words, you will find a range of high to low IQ among children with ADHD. Research found that high IQ in a child with ADHD may serve to mediate the poor academic outcome commonly seen in these children without intervention (Katusic et al., 2011).

ADHD is not a learning disorder, but it can result in learning difficulty. Having ADHD means that the child has an impairment in the executive functions (EFs), the core issue in ADHD. This impairment in EFs results in the child having difficulty in the following: impulse control, focusing and sustaining attention, paying attention to details, holding and retaining information in mind, organizing and planning (Barkley, 2001; Brown, 2006). These are the symptoms of ADHD.

Research has also suggested that children with ADHD may process information slower than their neurotypical peers. However, such findings are inconsistent in the literature (Mayes & Calhoun, 2004). Interestingly, there is support for slower processing speed seen in children with ADHD only if they have a comorbid developmental coordination disorder (DCD). DCD is a childhood condition where impairment is seen in motor coordination unexplained by the child’s age, intellect and any other diagnosable conditions (APA, 2013). Further, visuo-spatial processing ability was found to be poorer in children with comorbid ADHD and DCD but not in children with a single diagnosis of ADHD (Loh, Piek & Barrett, 2011). It is important to take note because the comorbidity rate between ADHD and DCD is as high as 50% (Pitcher, Piek & Hay, 2003). This has implication for classroom learning as poor motor coordination (such as writing, copying, manipulating objects, performing task during lesson) can inhibit or slow down learning in students with comorbid ADHD and DCD. Besides learning, the impairment in EFs can lead to social difficulties in children with ADHD. Successful social communication and interaction involves the ability to inhibit socially inappropriate behaviours, detect social cues, hold information in mind to continue a conversation, but these abilities are lacking in students with ADHD. Research examining teacher-rated reports on difficulties seen in students with ADHD found that hyperactive-impulsive symptom is a predictor for social problems in these students (Goulardins et al., 2015).

Common behaviours in ADHD

As a result of the impairment in EFs, we commonly see students with ADHD exhibiting the following behaviours in school:

• • Squirm or fidget in seat

  • talk excessively

  • frequently interrupting others

  • act impulsively

  • have difficulty taking turns

  • daydreaming in class

  • often forget or lose things

  • make careless mistakes on worksheets

  • have difficulty making friends or maintaining friendship

Local context

Local research was found that our students with ADHD exhibited symptoms of hyperactivity, impulsivity, inattention/distractibility and anger issue. Such symptoms led to academic difficulties, poor relationship with teachers and peers, negative self-concept and mental health issues. Importantly, hyperactivity plays an important role in academic outcome (Choi, 2016).

In Practice

Teachers play a pivotal role in the learning of students with ADHD. No two students with ADHD are alike and symptoms of ADHD varies from student to student. Hence, teachers need to clearly identify the symptoms and understand what is driving the behaviour seen students with ADHD. For example, is out-of-seat behaviour a manifestation of inattention or hyperactivity-impulsivity? In this case, the strategy to address inattention and hyperactivity-impulsivity will be different.

There are three areas that teachers can consider when working with a student with ADHD:

• • Use of instruction: Understand the profile, interest, strengths, and difficulties of your students with ADHD to help you select the most effective instruction that works for them. Teachers can consider using differentiated instruction with students with ADHD.

  • Early intervention: Remove distraction in the environment; equip students with ADHD with learning and coping skills. Research found that self-management skills and prompting are most effective in managing behaviours and classroom engagement in students with ADHD (Harrison et al., 2022).

  • Accommodation: To make learning easier, teachers need to consider how to allow acquiring of information and demonstrating of knowledge by students with ADHD easier in the classroom.

Resources

Teachers may find teaching resources in the following sites useful:

https://www.adhdfoundation.org.uk/

https://www.adcet.edu.au/inclusive-teaching/specific-disabilities/adhd

https://www.cdc.gov/ncbddd/adhd/school-success.html

https://childmind.org/guide/teachers-guide-to-adhd-in-the-classroom/#block_17a6d2c1-1df3-4cd1-a807-76568335ea4e

http://www.spark.org.sg/resources

Take home message

• Utilise the interests and strengths of the students with ADHD in designing pedagogy and classroom intervention.

• Strategies adopted must specifically target the ADHD symptoms.

• Early intervention and support from teachers are necessary.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Text Revision (4th ed.). Washington: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Barkley, R. A. (2001). Executive functions and self-regulation: An evolutionary neuropsychological perspective. Neuropsychology Review, 11, 1–29.

Biederman, J. (1998). Attention-deficit/hyperactivity disorder: A life span perspective. Journal of Clinical Psychiatry, 59, 4-16.

Biederman, J. (2005). Atention-Deficit/Hyperactivity Disorder: A selective overview. Biological Psychiatry, 57, 1215-1220.

Biederman, J., Mick, E., & Faraone, S. V. (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type. American Journal of Psychiatry, 157, 816-818.

Brown., T. E. (2006). Executive Functions and Attention Deficit Hyperactivity Disorder: Implications of two conflicting views. International Journal of Disability, Development and Education, 53 (1), 35–46.

Choi, P., M. (2016). Identifying common areas of difficulty experienced by individuals with attention deficit/hyperactivity disorder (ADHD) in Singapore mainstream schools. [Doctoral dissertation, National Institute of Education, Nanyang Technological University] NIE eBooks Collection (NIESG).

Coghill, D. R., Banaschewski, T., Bliss, C., Robertson, B., & Zuddas, A. (2018). Cognitive Function of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder in a 2-Year Open-Label Study of Lisdexamfetamine Dimesylate. CNS drugs, 32(1), 85–95. https://doi.org/10.1007/s40263-017-0487-z

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., . . . Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.01.022

Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: Is it an American condition? World Psychiatry, 2, 104-113.

Harrison, J. R., Evans, S. W., Zatz, J., Mehta, P., Patel, A., Syed, M., Soares, D. A., Swistack, N., Griffith, M., & Custer, B. A. (2022). Comparison of Four Classroom-Based Strategies for Middle School Students With ADHD: A Pilot Randomized Controlled Trial. Journal of Attention Disorders. https://doi.org/10.1177/10870547221081108

Goulardins, B., Daniela Rigoli, D., Loh, P. R., Robert Kane, R., Licari, M., Hands, B., Oliveira, J. A. & Piek, J. P. (2015). The relationship between motor skills, social problems, and ADHD symptomatology: Does it vary according to parent and teacher report? Journal of Attention Disorders. DOI: 10.1177/1087054715580394

Katusic, M. Z., Voigt, R. G., Colligan, R. C., Weaver, A. L., Homan, K. J., & Barbaresi, W. J. (2011). Attention-deficit hyperactivity disorder in children with high intelligence quotient: results from a population-based study. Journal of developmental and behavioral pediatrics: JDBP, 32(2), 103–109. https://doi.org/10.1097/DBP.0b013e318206d700

Loh, P. R., Piek, J. P., & Barrett, N. C. (2011). Comorbid ADHD and DCD: examining cognitive functions using the WISC-IV. Research in developmental disabilities, 32(4), 1260–1269. https://doi.org/10.1016/j.ridd.2011.02.008

Mayes, S. D., & Calhoun, S. L. (2004). Similarities and differences in Wechsler Intelligence Scale for Children-Third Edition (WISC-III) profiles: Support for subtest analysis in clinical referrals. The Clinical Neuropsychologist, 18, 559–572.

Pitcher, T. M., Piek, J. P., & Hay, D. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine and Child Neurology, 45, 525–535.

Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. The American journal of psychiatry, 164(6), 942–948.  https://doi.org/10.1176/ajp.2007.164.6.942

Rhode, L. A., Szobot, C., Polanzyk, G., Schmitz, M., Martins, S., & Tramontina, S. (2005). Attention-deficit/hyperactivity disorder in a diverse culture: Do research and clinical findings support the notion of a cultural construct for the disorder? Biological Psychiatry, 57, 1436-1441.

Citation

Loh, P.R. (2022, August 1). What do we know about ADHD in our learners. Child and Human Development, Life@NIE SG®. https://nie.edu.sg/chd/topics/special-education/adhd-in-our-learners