Summary: Daley, D. & Birchwood, J. (2010). ADHD and academic performance: why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom? Child: Care, Health and Development, 36, 455–464.

Abstract

This paper is about the relationship between ADHD and academic performance and covers the relationship at different developmental stages (pre-school, children, adolescents, adults) and the factors underpinning the relationship between ADHD and underperformance.

Intro

Attention deficit hyperactivity disorder (ADHD) is a developmental, neurobiological condition defined by the presence of severe aand pervasive symptoms of inattention, hyperactivity and impulsivity [American Psychiatric Association (APA) 1994]. The concerned child must exhibit a number of inattentive, impulsive and hyperactive behaviours over a period of 6 months, before the age of 7, which should be present in school and at home, and which significantly impair daily functioning (DSM-IV criteria). The child has difficulties in taking turns, he talks excessively and often appears not to be listening when being spoken to. He also tends to interrupt and intrude on others in games, conversations and classroom discussions. ADHD exists in pre-school children, school-age children, adolescence and adulthood.

The co-occurence in ADHD is that 30-50% of ADHD children also have oppositional defiant disorder (ODD) and/or conduct disorder (CD). 20-30% of them experience anxiety and 11-22% also have bipolar disorder. 20-30% of the ADHD children additionally experience a learning disorder of reading, spelling, writing and arithmetic. ADHD children do have a decreased size of the prefrontal cortex and, therefore, experience for example deficits in response inhibition and working memory. ADHD is a disorder of dysregulation of thought and action associated with poor inhibitory control. It also is the manifestation of a motivational style associated with altered reward mechanisms. These two are independent coexisting characteristics of ADHD.

The academic disadvantage of ADHD individuals. A developmental perspective, from pre-school to university

The pre-school years are a key period for the ADHD children, because social, behavioural and  academic skills are developed for the success in academic performance. 2% of the pre-school children may experience difficulties in developing those skills as they are  identified  with ADHD. They may experience difficulties with memory, reasoning, academic skills, conceptual development, general cognitive ability and acquiring basic pre-reading and mathematics skills. Not all individuals who show early signs of ADHD go on to express fully the disorder and experience the associated academic impairments. A proactive, firm limit-setting at home and appropriately structured classrooms can help. However, once at school, children with ADHD will struggle with academic work. ADHD is associated with poor grades, poor reading and mathematics standardized test scores, and an increased likelihood of repeating a school year. The academic performance of adolescents with ADHD has faced less empirical scrutiny. However, it is suggested that they, too, are likely to struggle at school. Childhood hyperactivity has been shown to predict adolescent behavioural problems and adolescent academic problems, which tend to culminate in leaving school with no qualifications. Research shows that ADHD symptoms persist into adulthood, with between 11 and 40% of childhood cases continuing to meet criteria for the disorder in adulthood. Adolescent research shows that individuals with ADHD are likely to perform poorly at school, and leave with few or no qualifications, therefore university prospects seem bleak and are controversery. From a developmental prospective the negative impact of ADHD symptoms on academic attainment can be seen across the lifespan of children, adolescents and young adults.

Why do ADHD individuals experience academic problems?

As ADHD individuals often are ikely to experience many other associated problems, such as a CD diagnosis, they are likely to experience future academic problems and offending problems. Also, research has shown that negative associations exist between ADHD and intelligence. 

Cognitive deficits and academic performance

The cognitive deficits – or executive function (EF) deficits – experienced by ADHD individuals include response inhibition and working memory. EF deficits are not common to all ADHD children. However, the implication of EFs in research suggests that deficits in executive functioning could be at the heart of ADHD-related academic underperformance.

Academic intervention

Inattentive symptoms and executive function (EF) deficitis, such as working memory , planning, and response inhibition, are associated with academic problems. Therefore, academic interventions should focus on these. The most common ADHD treatments include medication and behavioural interventions, from which the impact of academic performance is smaller and less studied. 

Peer and parent tutoring

Being placed in a large class may increase the ADHD childs' academic difficulties. In contrast, research on peer tutoring (a strategy whereby an ADHD individual is paired with a peer tutor to work on a certain academic activity, with the peer tutor providing one-on-one instruction and assistance at the ADHD individual’s own pace) has shown that it improves classroom behaviour and academic performance. Also parent-tutoring (through one-in-one instruction, feedback and active responding) may help to increase the reading performance at school and home. 

Task/Instructional modifications

Manipulating tasks through reducing the task length, dividing tasks into sub-units, giving explicit instruc-
tions, and modifying the delivery or modality of instruction according to the ADHD  pupil’s learning style may help in improving, for example, mathematics performance. 

Classroom functional assessment procedures

Developing an intervention, specific to the child, through manipulating environmental variables that initiate, maintain and/or increase the child’s problematic behaviour in a particular setting, could be used  to reduce disruptive behaviour in ADHD individuals.

Self-monitoring

Setting goals for classwork completion and accuracy, monitoring these goals and administering rewards upon successful completion may help the ADHD individual to improve academic performance, especially in combination with stimulant medication.

Strategy training

Teaching ADHD individuals a specific skill to implement in academic situations may help to improve their performance.

Homework-focused interventions

As homework is the best predictor of student grades and achievement, it may help to teach parents homework strategies based around the problems of ADHD individuals. However, parental ADHD levels should be taken into account. Altering teachers' attitudes towards ADHD behaviours may also help in generating a more positive classroom environment. 

Conclusion

ADHD is associated with academic underachievement from pre-schoolers to adults. Inattentive symptoms and executive function (EF) are associated with academic problems. Hyperactivity/impulsivity and
co-morbid conduct problems are not. Future research should focus on the neuropsychological underpinnings of the relationship between ADHD and acadmic underperformance across the ADHD developmental spectrum.

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Summaries & Study Note of Helena Tegeler
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