School Success for Kids With ADHD

Stephan M. Silverman, Jacqueline S. Iseman, Sue Jeweler

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000495928
• Edition: 1
• Topic: Didattica
• Subtopic: Didattica generale

School Success for Kids With ADHD offers parents and teachers the support they need to ensure that children with attention deficits build on their strengths, circumvent their weaknesses, and achieve to their fullest potential. With the growing number of children diagnosed with attention problems, parents and teachers need practical advice for helping these children succeed in school. Topics covered include recognizing the causes and types of attention deficits and how they appear in the school context, requesting school evaluations and diagnoses, understanding the laws regarding students with special needs, advocating for these students in the school environment, and coaching students with attention deficits to success. The authors also include a brief overview of research and medical perspectives on attention deficits, strategies used by teachers of children with ADHD, and helpful tools for parents and teachers to employ.

Chapter 1

The Importance and Impact of Attention

DOI: 10.4324/9781003237815-2

“If I put my mind to it I can do just about anything.”

Michael Phelps, Olympic champion and record holder

NOTHING of value can be accomplished without focus and concentration. The power of concentration characterizes those who truly excel in any field. Achievement requires the ability to sustain attention, to sacrifice other impulses, to resist distraction, to postpone pleasures, and to act with timing and judgment. These qualities separate those who are great in any field from others.

As the authors created this book, an unprecedented event took place in Beijing, China. Michael Phelps, the phenomenal young swimmer, shattered the record number of gold medals earned in a single sport at an Olympic games. According to the media, his was the “greatest individual triumph in Olympic history” (Jenkins, 2008). Michael’s inspirational story reflects the athlete’s commitment to achieving his personal best and also his deep understanding of the meaning of sportsmanship and humility. The impact of his accomplishment is heightened by the fact that he has ADHD and frequently was in trouble for disruptive behavior in the pool and at school.

His mom, a teacher, school administrator, and his greatest advocate, explained that he never sat still, never stopped talking, never stopped asking questions, and had difficulty staying on task. One of Michael’s elementary school teachers said to her that Michael was unable to focus on anything. However, Mrs. Phelps knew that her son had exceptional focus when swimming. His ability to “hyperfocus” on his goals contributed to his success as a swimmer. In his own words, Michael said, “If I put my mind to it I can do just about anything” (Low, 2008).

Michael’s story is repeated daily by children, adolescents, and adults with ADHD. They may not be Olympic stars, but with appropriate and effective support, guidance, and treatment by parents, educators, and other professionals working together as a team, these individuals with attention deficits can find resounding success and make exceptional contributions to the world.

Michael does not stand alone in his ability to “hyperfocus” on his goals. It is said that Sir Isaac Newton once worked on some theories sitting under a tree. A brass band went by him while he worked. A passerby interrupted Newton’s studies and asked in which direction the band was traveling. Newton could not answer the question, because he didn’t notice the band, let alone what direction it was going in. He was too absorbed in his studies. With practice, great meditators can continue to concentrate in loud environments, even when construction is going on, for example. Disciples of spiritual masters are known to sit in silence for hours with single-pointed attention.

Being poised “at the ready” to focus is a prelude to many activities, whether it is practicing martial arts, standing at attention in military exercises, waiting for a pitch in baseball, holding a linebacker’s lunge in football, preparing for the first note of a symphony, or awaiting a cue to go on stage. In some cultures, such as in parts of India, for example, children are taught to sit with their legs crossed in a straight posture while awaiting the arrival of their teacher in the classroom for the day’s lessons. They are “primed” to attend. This is not to say that there are no children who have trouble with such discipline in India. Children with difficulties in attention and restraint are born into every culture. In every culture, however, most productive activities require the ability to maintain focus. Schooling is a universal experience in human development where attention is required to access its content and skills. These abilities, the aggregate of skills that make up sustained attention and restraint, are of great importance in life in and out of school.

The goal of every life is crowned by self-knowledge and the discovery of strengths. When these strengths are combined with passion, a personal mission, then the power of attention can be focused and enabled. It is our hope that every child, especially those with challenges in attending and restraining action, can be recognized for their strengths and that the power of self-knowledge and passion can be harnessed and focused for their own fulfillment.

The more information we know and understand about ADHD and its impact on individuals, the better able we are to create a thoughtful, collaborative, and effective approach that successfully addresses the strengths and needs of those who deal with attention challenges every day.

What is Attention Deficit Hyperactivity Disorder and why must we be concerned about its impact on children?

Attention Deficit Hyperactivity Disorder (ADHD) is a mental disorder of childhood characterized by symptoms of inattention, hyperactivity, and impulsivity. In order to be diagnosed, these symptoms must occur more frequently and be more serious than those normally observed in individuals with a similar level of development. Additionally, in order to accurately clinically distinguish ADHD from other diagnoses, the symptoms must be present in two or more contexts, must appear before the age of 7, and must cause a clinically significant deterioration of social, academic, or work-related activities.

Despite the amount of press ADHD has received, individuals with ADHD only constitute approximately 3%–5% of the school-aged population (American Psychiatric Association, 2000). According to a Client/Patient Sample Survey collected by the Center for Mental Health Services in 1997, which provided detailed information about the status of youth and adults in mental health care, individuals with ADHD represent the largest group referred for services (Milazzo-Sayre et al., 2001). Clinical experience bears this out in daily practice. These individuals comprised 14% of the total youth population admitted for services each year (Milazzo-Sayre et al., 2001). Due to the high prevalence rate of ADHD among youth, as well as the frequent utilization of health services by this population, ADHD is a considerable public health issue (Scahill et al., 1999).

Causes of ADHD

Although no one is exactly sure what factors cause ADHD, research suggests that there is a combination of causes, including genetics and environmental influences. Although several factors could increase an individual’s likelihood of having ADHD, physical differences in the brain seem to be involved (see Chapter 3 for an in-depth discussion).

Family History

Although the precise causes of ADHD have yet to be identified, there is little question that biological contributions are the largest factor in the expression of this disorder (Barkley & Murphy, 2006). It is estimated that the likelihood of inheriting ADHD is about 80%, which means that genetic factors account for approximately 80% of the differences among individuals with this set of behavioral symptoms. According to the American Academy of Child & Adolescent Psychiatry (AACAP; 2008), more than one-third of fathers who had ADHD during their own childhood had a child who met the criteria for ADHD.

Prenatal and Perinatal Risks

In instances where heredity does not seem to play a role, difficulties during pregnancy, as well as prenatal exposure to alcohol and tobacco, appear to contribute to the risk for this disorder. Additionally, premature delivery, significantly low birth weights, and postnatal injury to the prefrontal regions of the brain all contribute to the risk for ADHD in varying degrees (Barkley & Murphy, 2006). We also cannot disregard many of the abnormalities of delivery and early development including a wrapped cord, a “blue baby,” a seizure, high temperatures, or any cause of oxygen loss or chemical insult to the developing brain.

Environmental Toxins

It has been found that children who are exposed to very high levels of lead before 6 years of age also might be at a higher risk for ADHD. Young children may become exposed to lead when they spend time in older buildings with a build-up of dust from chipped paint that contains lead or from drinking water that was delivered through lead pipes (AACAP, 2008).

The Subtypes of ADHD

The text revision of the DSM-IV-TR (APA, 2000) identifies three types of ADHD including the predominantly inattentive type, the predominantly hyperactive/impulsive type, and the combined type, in which an individual displays both inattentive and hyperactive/impulsive symptoms. A reprinting of the DSM criteria for ADHD is included in Figure 1.

Figure 1. DSM-IV-TR criteria.

The Inattentive Child

Children diagnosed with the predominantly inattentive type of ADHD may get bored with an activity quickly, particularly if the task is not one that they enjoy. They struggle with organization and planning a task in order to be able to complete it or to learn something new. As students, children with the inattentive type of ADHD frequently have difficulty remembering to copy down school assignments and to bring home books and other school materials. Additionally, completing homework can be a very large challenge. Often they are thought to have a memory problem, when, in fact, they missed “registering” information in the first place.

Throughout life, individuals with the inattentive type of ADHD are easily distracted and may make many careless mistakes in their academics, work, or personal lives. They frequently are forgetful, have difficulty following instructions, and skip from one activity to another without finishing the first activity.

It is extremely important to note that an inattentive child with ADHD often may be able to sit quietly in class and appear to be working. However, frequently this student is not really focusing on the assignment. Therefore, it is common for teachers and parents to overlook the problem.

The Hyperactive/Impulsive Child

Children with the predominantly hyperactive/impulsive type of ADHD always seem to be in motion. They may move around, touch or play with whatever is nearby, or talk unremittingly. In school, during story time or instruction, these children may squirm around in their seats, fidget, or get up and move about the classroom. These children frequently wiggle or tap their feet and fingers. They may blurt out comments or answers without thinking first. Frequently, they also may display their emotions without restraint or forget to consider the consequences of their actions. Hyperactive/impulsive children typically find it difficult to wait in line or take turns.

A teenager or adult who is hyperactive/impulsive may describe feeling restless or a need to stay busy all of the time. These teenagers and adults tend to make choices based on their small immediate payoff rather than persistently working toward a larger delayed reward. In general, children with these symptoms come across as being impatient. They may only get part of a communication because they stop listening before the speaker is finished.

Coexisting Disorders and Their Frequencies in Childhood

ADHD, in and of itself, is a challenge, but what often separates straightforward instances from those that are very challenging to manage are those with ADHD who also suffer from a variety of frequently associated neuropsychiatric disorders. The frequently occurring additional diagnoses are described as comorbidities. According to the National Institute of Mental Health (NIMH; 2008c), there are several disorders that sometimes accompany childhood ADHD. The following disorders are most frequently found as coexisting disorders with ADHD in childhood.

Learning Disabilities, Language Difficulties, and Areas of Cognitive Weakness

Learning disabilities are the most common comorbidity seen with ADHD. Between 24% and 70% of all individuals with ADHD are believed to suffer from some type of learning problem (Barkley, 2006; however, it must be kept in mind that studies differ, as do the ways learning disabilities are defined). According to NIMH (2008c), approximately 20%–30% of children with ADHD also have a diagnosable, specific learning disability (LD). During the preschool years, these disabilities can appear as difficulties in understanding certain sounds or words, as well as difficulty in expressing oneself verbally. During the school age years, reading or spelling disabilities, writing disorders, and arithmetic disorders are common among children with ADHD. Reading disabilities (dyslexia) are seen in 8%–39% of individuals with ADHD, while spelling difficulties are seen in 12%–30% of cases. Dyscalculia (a mathematics learning difficulty) is observed 12%–27% of the time, and handwriting difficulties (dysgraphia) are present in more than 60% of children with ADHD (Barkley, 2006). Thus, any child with ADHD should be carefully screened for associated learning problems.

Another complex aspect of ADHD is that even without a formal reading or language disorder, reading and listening comprehension deficits still are observed frequently, due to the limitations seen in working memory that frequently accompanies ADHD. (Working memory is explained simply by how much you can hold in your mind at one time, like the RAM on a computer; see p. 26.)

Language disorders, often associated with other learning problems, are diagnosed often. Expressive language deficits are seen in 10%–54% of individuals, and “pragmatic language” problems are noted 60% of the time (language pragmatics are loosely defined as language usage for the purpose of social interaction/dialogue; Barkley, 2006). Children with ADHD and associated language problems often display excessive speech, reduced fluency, and overall speech that is less logical, coherent, and organized.

The difficulty with working memory noted above, and other associated issues with language processing, often results in children with ADHD demonstrating a delayed internalization of language or internal self-talk. This is linked to what often is described as a reduced capacity for rule-governed behavior in individuals with ADHD. It’s more difficult for them to “talk themselves through” any given experience; thus they can be less self-observing and less mindful of themselves.

Lower Average Intelligence (7–10 point deficit) in IQ testing is generally seen in children with ADHD as a group. This discrepancy is felt to be due to an apparent failure to keep pace with peers academically because of the overall impact of ADHD, but also could result from poor executive functioning (see p. 23) that partly affects IQ testing results.

Motor and Other Physical Symptoms

Motor symptoms are another common accompanying issue in children with ADHD. These symptoms have been described as dyspraxia (motor planning), where a significant population of children with ADHD will have difficulty executing both fine and/or gross motor tasks such as writing, buttoning buttons or snapping snaps, tying shoelaces, or throwing and catching a ball. Occupational therapists and psychologists measure many of these same capacities and describe them as visual-motor integration abilities. In addition to having many of the motor planning issues above, children with visual-motor integration difficulties also have trouble copying complex designs and representing what they are thinking and seeing on the page. Formal diagnoses of these visual-motor and fine motor problems are termed a developmental coordination disorder. More than 50% of children with ADHD qualify for this diagnosis (Barkley, 2006). As a group, and linked to many of the motor issues noted above, children with ADHD show reduced physical fitness, strength, and stamina.

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