Supporting an ADHD Child in the Classroom

Written by Peter Withnall, Educational Psychologist

Detailed information on ADHD children in the classroom: How ADHD affects a child's learning ability, ADHD medication during school, and helpful school accommodations for children with ADHD.

What is ADHD?

Attention Deficit Hyperactivity Disorder is a neuro-developmental disorder, the symptoms of which evolve over time. It is considered to have three core factors, involving inattention, hyperactivity and impulsivity. In order to have a diagnosis of ADHD the child would need to show significant problems relating to these three factors which would then constitute an impairment in at least two different settings, usually home and school.

The child with ADHD is easily distracted, forgets instruction and tends to flit from task to task. At other times they may by fully focused on an activity, usually of their choice. Such a child may also be over-active, always on the go physically. They are often out of their seat and even when seated are restless, fidgety or shuffling. The phrase "rump hyperactivity" has been coined to describe this wriggling restlessness often seen in children with ADHD when they are required to sit in one place for a length of time. Often children with ADHD will speak or act without thinking about possible consequences. They act without forethought or planning, but also with an absence of malice. A child with ADHD will shout out in order to be attended to, or will butt into conversation and show an inability to wait their turn.

In addition, to the three core factors there are a number of additional features which may be present. Most children with ADHD need to have what they want when they want it. They are unable to show gratification, being unable to put off the receipt, of something that they want, for even a short period. Linked to this they also show "temporary myopia", where they have a lack of awareness or disregard for time - they live for the present, where what has gone before or what might be to come is of little consequence.

They may show insatiability, going on and on about a particular topic or activity, not letting the matter drop, with constant interrogation until they receive what is an acceptable response to them. Frequently they have a social clumsiness where they are over-demanding, bossy, over-the-top and loud. They misread facial expression and other social cues. Consequently even when they are trying to be friendly their peers can isolate them.

Sometimes there is also a physical clumsiness, occasionally because of their impulsivity, but also perhaps because of poor co-ordination. Some of these problems may be related to developmental dyspraxia, which is a specific learning difficulty sometime seen alongside ADHD. These children will also be dis-organised and experience problems with planning, tidiness and have the right equipment for a task.

As well as the developmental dyspraxia, many other difficulties can be present in children with ADHD. These include other specific learning difficulties e.g. dyslexia, Autistic Spectrum Disorders, Oppositional Defiant Disorder, Conduct Disorder, etc.

At Primary School age up to 50% of children with ADHD will have additional problems of oppositional defiant behaviour. About 50% of children with ADHD will experience specific learning difficulties. Many will have developed low self-esteem in relation to school and their social skills. By late childhood children with ADHD who have not developed some co-morbid psychiatric, academic or social disorder will be in the minority. Those who remain as having purely ADHD are likely to have the best outcome in relation to future adjustment.

Additionally some professionals suggest that any primary age child who has developed Oppositional Defiant Disorder or Conduct Disorder will have ADHD as the primary problem, even if this is not immediately evident from their behaviour. At present, a diagnosis of ADHD is usually determined through referral to DSM IV criteria. (Appendix 1) There are three types of ADHD recognised: - ADHD predominantly hyperactive/impulsive; ADHD predominantly inattentive; ADHD combined. The ADHD predominantly inattentive is what used to be referred to as ADD (Attention Deficit Disorder without the hyperactivity).

Generally, it is considered that there are five times as many boys than girls who show ADHD (HI), compared with twice as many boys to girls who show ADHD (I). It is recognised that around 5% of children are affected by ADHD, with perhaps about 2% experiencing severe problems. It should also be noted that some children will show aspects of an attentional deficit, which, although significant from their point of view, would not trigger a diagnosis of ADHD. There is a continuum of severity of problems in such a way that some children will have an attentional deficit but will not be ADHD. Yet others will show attention problems but for other reasons, for example, daydreaming/inattention because of something on their mind e.g. family bereavement.

ADHD - Probable Causes

It is generally agreed that there is a biological predisposition to the development of ADHD, with hereditary factors playing the most significant part. It is likely to be the genetic transmission which results in dopamine depletion or under-activity in the prefrontal - striatal - limbic regions of the brain which are known to be involved in behavioural disinhibition, which is considered to be most significant in ADHD, sensitivity to behavioural consequences and differential reward. Dopamine is a neurotransmitter, which facilitates the action of neurones by allowing passage of messages across the synaptic gaps between neurones. The condition is made worse by perinatal complications, toxins, neurological disease or injury, and dysfunctional child rearing. Poor parenting doesn't itself cause ADHD.

In looking at potential predictors of ADHD there are several factors, which are found to be predicative of ADHD. These include: -

• a family history of ADHD
• maternal smoking and alcohol consumption during pregnancy
• single parenthood and low educational attainment
• poor infant health and developmental delay
• early emergence of high activity and demanding behaviour in infancy
• critical/directive maternal behaviour in early infancy

As baby's children with ADHD tend to be colicky, difficult to settle, failing to sleep through the night and show delayed development. Parents will make comments, which reflect aspects of the ADHD - "He never walks, he runs", "I can't turn my back for a minute", "The terrible two's just seemed to go on forever". Parents often feel embarrassed about taking their child anywhere. The young child with ADHD is more accident-prone, probably because of the high speed of movement, lack of caution, over-activity and inquisitiveness. Often they have relatively more files at the Accident and Emergency Unit. Toilet training is often difficult which many children not bowel-trained until after three years and they continue to have accidents long after their peers do not. There is also found a strong association between ADHD and enuresis. There is the suggestion that ADHD should not be diagnosed in a child under the age of three years, perhaps the term 'at risk of ADHD' is more appropriate.

Diagnosis is usually made once the child is at school, where sitting appropriately, attending to directed activities and turn taking are expected of all children.