Understanding Attention Deficit Hyperactivity Disorder in the Classroom

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18th May 2020 Education Reference this

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According to the National Institute of Mental Health (2013), Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric developmental mental illness/disorders that affects the way people act and focus. Worldwide, the prevalence of ADHD among children is about 5%, which means that ADHD typically can be found in every 5 children out of 100 (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007).

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 In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), ADHD is defined as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (American Psychiatric Association, 2013). Normally, individuals who frequently have symptoms such as having difficulties in holding attention on tasks, avoiding engaging long duration tasks (e.g. schoolwork or homework), or experiencing difficulties in playing activities quietly, etc. over the past 6 months would be diagnosed with ADHD (American Psychiatric Association, 2013). Although ADHD is typically spotted among school-aged children, its negative impacts such as inattentiveness, impulsiveness, and hyper-activeness (over-activeness) actually can endure through adolescence and into adulthood (American Psychiatric Association, 2013; Nigg, 2013).

Categories of Attention Deficit Hyperactivity Disorder

 Attention Deficit Hyperactivity Disorder (ADHD) can be divided into three subtypes: 1) the inattentive type; 2) the hyperactive-impulsive type; and 3) the combined type, and their distinctions are determined based on the type of behaviours that are most dominant (Fewell & Deutscher, 2002).

 The first subtype is the inattentive type, and the main characteristic of it is having difficulties with attention regulation (American Psychiatric Association, 2013). Children in this subgroup normally encounter circumstances such as easily be distracted by irrelevant sights and sounds, frequently fail to pay attention during class time, or often make careless mistakes. The second subtype is the hyperactive-impulsive type which is characterized by impulsive and hyperactive behaviours (American Psychiatric Association, 2013). A child expressing this type of ADHD commonly will blurt out answers during class time, have difficulty waiting in line or taking turns, and feel restless while seated. The third subtype is the combined type, which is the combination of the previous two subgroups (American Psychiatric Association, 2013). Children who are categorized into this subgroup frequently experience difficulties in both attention regulation and hyperactive behaviours control (Willcutt et al., 2012).

Risk Factors for Attention Deficit Hyperactivity Disorder

 In the past few years, researchers have discovered a couple of risk factors that could potentially contribute to ADHD in children. One of the most prominent factors that have been identified is the inherited genes. Several studies have revealed that the risk of ADHD among children can be elevated if their parents are diagnosed with ADHD (Faraone & Biederman, 2000; Schlarb, Starck, & Grünwald, 2016). Specifically, by analyzing 20 extant twin-studies, Faraone et al. (2005) found there exists strong evidence for a genetic disposition (heritability: 76%) as a basis for ADHD. In other words, ADHD runs in families. A child who is diagnosed with ADHD is more likely to be found having a close relative who is also being diagnosed with ADHD (Schlarb, Starck, & Grünwald, 2016).

 Besides the genetic factor that may contribute to ADHD, environmental factors, such as maternal smoking, alcohol consumption, and stress/anxiety during pregnancy can also lead to the diagnose of ADHD in children (Thapar, Cooper, Jefferies, & Stergiakouli, 2011). The previous study found that smoking during permanency would highly increase the risk of ADHD in the offspring children. The heavier the mother smoke during pregnancy, the greater the risk of ADHD will exist in the child (Huang et al., 2017).

 Another risk factor that might also contribute to ADHD in children is alcohol consumption during pregnancy. Previous studies discovered that there exists a strong positive correlation between maternal alcohol consumption and children’s risk of ADHD (Brown et al., 1991; Streissguth et al., 1989). By making further comparisons among same age children, Streissguth et al. (1989) found that children of heavy drinkers are more likely to display inattentive and impulsive behaviours than their peers whose mothers are infrequent drinkers.

 Additionally, maternal stress/anxiety is another potential risk factor associated with ADHD. One study by analyzing 2140 mother-child pairs proved that if the mothers experienced major stressful events or reported a high level of stress during the pregnancy, their children are about 3.03 times more likely to be diagnosed with ADHD than other children during their early childhood (Okano, Ji, Riley, & Wang, 2018).

Impacts on Academic Outcomes

 Attention Deficit Hyperactivity Disorder (ADHD) can significantly impede children’s academic learning in many ways. Children with ADHD often display poor concentration (e.g. not listening or following teachers’ instructions) or/and high levels of activity and impulsiveness during class which can negatively impact their knowledge perceiving and obtaining and eventually lead to poor academic performance (Barkley, 1997; Hughes, 2009).

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 Mastering mathematics is a complex process, and it requires sustained attention to engage in a lot of practice. Due to the fact that ADHD children often experience difficulties in sustaining their attention, it can be quite struggling for them to practice arithmetic ability regularly for a long duration. As a result, they would not able to acquire adequate skills for arithmetic calculation (Marshall, Schafer, O’Donnell, Elliott, & Handwerk, 1999). The previous study evidenced that during the school year ADHD children tend to spend more time and make more careless mistakes during the mathematics test than other schoolers without ADHD, and as a result, they often have lower test scores than their peers (Zentall, Smith, Less, & Wieczorek, 1994).

 Previous studies also suggested that children with ADHD often experience difficulties in lexical processing (e.g. recognition of words) and word decoding, which are the essential skills needed for reading comprehension (De Jong, Licht, Sergeant, & Oosterlaan, 2012; Willcutt, Pennington, Olson, Chhabildas, & Hulslander, 2005). Without sufficient skills in these aspects, ADHD children would end up having trouble in understanding the meaning of each word or sentence, making reference between paragraphs, or identifying main ideas and topics of the reading materials. As a result, ADHD children’s reading skills will be hindered and eventually lead to lower scores in reading comprehension tests than their peers (Frazier, Youngstrom, Glutting, & Watkins, 2007; Lewandowski, Hendricks & Gordon, 2012; Loe & Feldman, 2007).

Identifying Children with ADHD in Classroom

 On average, children spend about 6 up to 8 hours per day at school, and this makes it extremely important for every teacher to be able to make early accurate identification of ADHD in the classroom (Bhatara, Vogt, Patrick, Doniparthi, & Ellis, 2006). As described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), ADHD can be categorized into three subtypes, and the in-class behaviours of children who fall into different subgroups can be quite different (American Psychiatric Association, 2013).

 Children who are belong to the inattentive subgroup

the inattentive type; 2) the hyperactive-impulsive type; and 3) the combined type

Effective Instructional Interventions and Strategies

4) empirically supported recommendations for teachers on identifying and responding to this disorder in the classroom.

References

According to the National Institute of Mental Health (2013), Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric developmental mental illness/disorders that affects the way people act and focus. Worldwide, the prevalence of ADHD among children is about 5%, which means that ADHD typically can be found in every 5 children out of 100 (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007).

 In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), ADHD is defined as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (American Psychiatric Association, 2013). Normally, individuals who frequently have symptoms such as having difficulties in holding attention on tasks, avoiding engaging long duration tasks (e.g. schoolwork or homework), or experiencing difficulties in playing activities quietly, etc. over the past 6 months would be diagnosed with ADHD (American Psychiatric Association, 2013). Although ADHD is typically spotted among school-aged children, its negative impacts such as inattentiveness, impulsiveness, and hyper-activeness (over-activeness) actually can endure through adolescence and into adulthood (American Psychiatric Association, 2013; Nigg, 2013).

Categories of Attention Deficit Hyperactivity Disorder

 Attention Deficit Hyperactivity Disorder (ADHD) can be divided into three subtypes: 1) the inattentive type; 2) the hyperactive-impulsive type; and 3) the combined type, and their distinctions are determined based on the type of behaviours that are most dominant (Fewell & Deutscher, 2002).

 The first subtype is the inattentive type, and the main characteristic of it is having difficulties with attention regulation (American Psychiatric Association, 2013). Children in this subgroup normally encounter circumstances such as easily be distracted by irrelevant sights and sounds, frequently fail to pay attention during class time, or often make careless mistakes. The second subtype is the hyperactive-impulsive type which is characterized by impulsive and hyperactive behaviours (American Psychiatric Association, 2013). A child expressing this type of ADHD commonly will blurt out answers during class time, have difficulty waiting in line or taking turns, and feel restless while seated. The third subtype is the combined type, which is the combination of the previous two subgroups (American Psychiatric Association, 2013). Children who are categorized into this subgroup frequently experience difficulties in both attention regulation and hyperactive behaviours control (Willcutt et al., 2012).

Risk Factors for Attention Deficit Hyperactivity Disorder

 In the past few years, researchers have discovered a couple of risk factors that could potentially contribute to ADHD in children. One of the most prominent factors that have been identified is the inherited genes. Several studies have revealed that the risk of ADHD among children can be elevated if their parents are diagnosed with ADHD (Faraone & Biederman, 2000; Schlarb, Starck, & Grünwald, 2016). Specifically, by analyzing 20 extant twin-studies, Faraone et al. (2005) found there exists strong evidence for a genetic disposition (heritability: 76%) as a basis for ADHD. In other words, ADHD runs in families. A child who is diagnosed with ADHD is more likely to be found having a close relative who is also being diagnosed with ADHD (Schlarb, Starck, & Grünwald, 2016).

 Besides the genetic factor that may contribute to ADHD, environmental factors, such as maternal smoking, alcohol consumption, and stress/anxiety during pregnancy can also lead to the diagnose of ADHD in children (Thapar, Cooper, Jefferies, & Stergiakouli, 2011). The previous study found that smoking during permanency would highly increase the risk of ADHD in the offspring children. The heavier the mother smoke during pregnancy, the greater the risk of ADHD will exist in the child (Huang et al., 2017).

 Another risk factor that might also contribute to ADHD in children is alcohol consumption during pregnancy. Previous studies discovered that there exists a strong positive correlation between maternal alcohol consumption and children’s risk of ADHD (Brown et al., 1991; Streissguth et al., 1989). By making further comparisons among same age children, Streissguth et al. (1989) found that children of heavy drinkers are more likely to display inattentive and impulsive behaviours than their peers whose mothers are infrequent drinkers.

 Additionally, maternal stress/anxiety is another potential risk factor associated with ADHD. One study by analyzing 2140 mother-child pairs proved that if the mothers experienced major stressful events or reported a high level of stress during the pregnancy, their children are about 3.03 times more likely to be diagnosed with ADHD than other children during their early childhood (Okano, Ji, Riley, & Wang, 2018).

Impacts on Academic Outcomes

 Attention Deficit Hyperactivity Disorder (ADHD) can significantly impede children’s academic learning in many ways. Children with ADHD often display poor concentration (e.g. not listening or following teachers’ instructions) or/and high levels of activity and impulsiveness during class which can negatively impact their knowledge perceiving and obtaining and eventually lead to poor academic performance (Barkley, 1997; Hughes, 2009).

 Mastering mathematics is a complex process, and it requires sustained attention to engage in a lot of practice. Due to the fact that ADHD children often experience difficulties in sustaining their attention, it can be quite struggling for them to practice arithmetic ability regularly for a long duration. As a result, they would not able to acquire adequate skills for arithmetic calculation (Marshall, Schafer, O’Donnell, Elliott, & Handwerk, 1999). The previous study evidenced that during the school year ADHD children tend to spend more time and make more careless mistakes during the mathematics test than other schoolers without ADHD, and as a result, they often have lower test scores than their peers (Zentall, Smith, Less, & Wieczorek, 1994).

 Previous studies also suggested that children with ADHD often experience difficulties in lexical processing (e.g. recognition of words) and word decoding, which are the essential skills needed for reading comprehension (De Jong, Licht, Sergeant, & Oosterlaan, 2012; Willcutt, Pennington, Olson, Chhabildas, & Hulslander, 2005). Without sufficient skills in these aspects, ADHD children would end up having trouble in understanding the meaning of each word or sentence, making reference between paragraphs, or identifying main ideas and topics of the reading materials. As a result, ADHD children’s reading skills will be hindered and eventually lead to lower scores in reading comprehension tests than their peers (Frazier, Youngstrom, Glutting, & Watkins, 2007; Lewandowski, Hendricks & Gordon, 2012; Loe & Feldman, 2007).

Identifying Children with ADHD in Classroom

 On average, children spend about 6 up to 8 hours per day at school, and this makes it extremely important for every teacher to be able to make early accurate identification of ADHD in the classroom (Bhatara, Vogt, Patrick, Doniparthi, & Ellis, 2006). As described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), ADHD can be categorized into three subtypes, and the in-class behaviours of children who fall into different subgroups can be quite different (American Psychiatric Association, 2013).

 Children who are belong to the inattentive subgroup

the inattentive type; 2) the hyperactive-impulsive type; and 3) the combined type

Effective Instructional Interventions and Strategies

4) empirically supported recommendations for teachers on identifying and responding to this disorder in the classroom.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  • Barkley, R. A. (1997). ADHD and the Nature of Self -control. New York: Guilford Press.
  • Brown, R. T., Coles, C. D., Smith. I. E., Platzman, K. A., Silverstein, J., Erickson, S., Falek, A. (1991). Effects of prenatal alcohol exposure at school age, II: attention and behavior. Neurotoxicology and Teratology, 13, 369–376.
  • De Jong, C., Licht, R., Sergeant, J., & Oosterlaan, J. (2012). RD, ADHD, and their comorbidity from a dual route perspective. Child Neuropsychology, 18(5), 467-486.
  • Faraone, S., & Biederman, J. (2000). Nature, Nurture, and Attention Deficit Hyperactivity Disorder. Developmental Review, 20(4), 568-581.
  • Faraone, S., Perlis, R., Doyle, A., Smoller, J., Goralnick, J., Holmgren, M., & Sklar, P. (2005). Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(11), 1313-1323.
  • Fewell, R. R., & Deutscher, B. (2002). Attention deficit hyperactivity disorder in very young children: early signs and interventions. Infants & Young Children. 14(3), 24 –32.
  • Frazier, T., Youngstrom, E., Glutting, J., & Watkins, M. (2007). ADHD and Achievement: Meta-Analysis of the Child, Adolescent, and Adult Literatures and a Concomitant Study with College Students. Journal of Learning Disabilities, 40(1), 49-65.
  • Huang, L., Wang, Y., Zhang, L., Zheng, Z., Zhu, T., Qu, Y., & Mu, D. (2017). Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis. Pediatrics, 141(1), e20172465.
  • Hughes, L. (2009). Engaging students with ADHD in mainstream education: lessons from children, parents and teachers. The international journal of emotional education, 1(1), 108-117.
  • Lewandowski, L., Hendricks, K., & Gordon, M. (2012). Test-Taking Performance of High School Students With ADHD. Journal of Attention Disorders, 19(1), 27-34.
  • Loe, I., & Feldman, H. (2007). Academic and Educational Outcomes of Children With ADHD. Journal of Pediatric Psychology, 32(6), 643-654.
  • Marshall, R., Schafer, V., O’Donnell, L., Elliott, J., & Handwerk, M. (1999). Arithmetic Disabilities and ADD Subtypes. Journal of Learning Disabilities, 32(3), 239-247.
  • National Institute of Mental Health (2013). Attention deficit hyperactivity disorder (ADHD). Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
  • Nigg, J. (2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical Psychology Review, 33(2), 215-228.
  • Okano, L., Ji, Y., Riley, A., & Wang, X. (2018). Maternal psychosocial stress and children’s ADHD diagnosis: a prospective birth cohort study. Journal Of Psychosomatic Obstetrics & Gynecology, 1-9.
  • Schlarb, A., Starck, M., & Grünwald, J. (2016). Occurrence of ADHD in parents of ADHD children in a clinical sample. Neuropsychiatric Disease and Treatment, 12, 581-588.
  • Streissguth, A. P., Sampson, P. D., & Barr, H. M. (1989). Neurobehavioral dose response effects of prenatal alcohol exposure in humans from infancy to adulthood. Annals of the New York Academy of Sciences, 562, 145–158.
  • Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2011). What causes attention deficit hyperactivity disorder?. Archives of Disease in Childhood, 97(3), 260-265.
  • Willcutt, E., Nigg, J., Pennington, B., Solanto, M., Rohde, L., & Tannock, R. et al. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121(4), 991-1010.
  • Willcutt, E., Pennington, B., Olson, R., Chhabildas, N., & Hulslander, J. (2005). Neuropsychological Analyses of Comorbidity Between Reading Disability and Attention Deficit Hyperactivity Disorder: In Search of the Common Deficit. Developmental Neuropsychology, 27(1), 35-78.
  • Zentall, S., Smith, Y., Lee, Y., & Wieczorek, C. (1994). Mathematical Outcomes of Attention-Deficit Hyperactivity Disorder. Journal of Learning Disabilities, 27(8), 510-519.

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