An Exploratory Study conducted by Sharyn Travers
Attention Deficit Hyperactivity Disorder (ADHD) affects between 3% and 9% of school aged children in the UK. It is characterised by the core symptoms of ‘hyperactivity, impulsivity and inattention.’ The symptoms of ADHD are described as both chronic and pervasive; resulting in profound impairments to educational and social functioning: across multiple settings, causing adverse effects for the sufferer, their families, peers and teachers. Due to a growing body of scientific evidence that supports the brain development correlations, ADHD was moved from the category of ‘Behavioural Disorders’ in the DSM-5 (2013) and instead placed within the new category of Neurodevelopmental Disorders: affecting the way in which the brain grows and develops. As a result, brain functioning is disrupted and the ADHD brain struggles to process information. By definition, ADHD is therefore classified as a Specific Learning Difficulty – according to the British Dyslexia Association.
International research into the nature of ADHD continues to focus on areas such as; cognition, neurobiology and genetics. However, evidence suggests that ADHD is not the result of a single cause but rather an interplay between ‘… genetics, the brain and psychosocial factors that influence behaviours.’ Therefore, children who are biologically predisposed to developing ADHD as a result of family genetics, will experience hyperactive, impulsive and inattentive symptoms that are intensified by environments that are ‘rigid and unresponsive’ to their needs. The way in which a child (with ADHD) interacts with his/her environment will ultimately determine the extent to which their development and functioning (ADHD symptoms) is impacted. Studies show that practitioners who possess ‘low level knowledge’ or ‘insufficient understanding’ of ADHD, are highly likely to exacerbate the problems associated with the condition. Therefore, the knowledge and attitudes of practitioners in relation to ADHD is significantly important in determining the future outcomes for children with ADHD, either positively or negatively so.
Background to the Research
Sharyn is a qualified Child & Youth Practitioner – Specialising in Behavioural Analysis & Intervention. Over a 20 year span, she has worked across Primary and Secondary Education, also within Outreach Response Teams, Pupil Referral Units and Youth Work Provisions. Sharyn’s personal interest in ADHD began as a result of a close family member being diagnosed with the condition back in 2001, which subsequently provided her with lots of first-hand experience.
Professionally, her role involves working directly with children and young people who demonstrate challenging behaviour, many of whom are diagnosed with ADHD. Much of her work is focused around self-regulation in response to behavioural problems that are regularly reported through schools. In her experience, Sharyn has found that many schools have invested in some ADHD training and here practitioners seem to have acquired knowledge and skills which are geared towards disruptive behaviours particularly.
However, Sharyn comments “I have observed many children with ADHD who appear to have sufficient levels of intelligence but who struggle to access learning through the curriculum. I have also witnessed high levels of frustration in these children, as a direct result of those difficulties.” Through research, Sharyn believes that a lack of knowledge in relation to ADHD as a Neurodevelopmental Disorder – involving both behavioural and cognitive dysfunction, exists and that learning opportunities for children with ADHD are potentially affected as a result.
In 2016, Sharyn conducted a small scale Action Research project as part of an undergraduate dissertation – BA Hons in Childhood Studies at Manchester Metropolitan University.
The Research Aims:
- To explore knowledge and understanding of practitioners in relation to ADHD.
- To examine current approaches used by practitioners to manage ADHD in schools.
- To explore the biopsychosocial paradigm as an alternative approach towards ADHD.
The study consisted of 28 participants who work within education to support children with ADHD. It began with a systemic literature review that was supported by anonymous questionnaires and separate 1:1 interviews. Sharyn designed and delivered a training workshop on ADHD: as a Neurodevelopmental Disorder in accordance with the DSM 5: bringing up to date the cognitive deficits concerning executive functioning and emotional regulation. A more sophisticated ‘Bio-psycho-social’ model of ADHD was also introduced. Sharyn then interviewed a selection of participants and got them to follow up with a questionnaire about the training they had received and how it compared to the knowledge of ADHD that they already had.
- The knowledge and understanding of practitioners in relation to ADHD.
The study showed that the overall knowledge of ADHD as a Neurodevelopmental Disorder was poor, with only 10% of the group correctly identifying this. The majority consensus demonstrated that ADHD was either perceived as a Mental Health Condition or a Behavioural Disorder, with 89% of the participants believing that disruptive behaviour was a central component to an ADHD diagnoses. Many participants stated that they were somewhat aware of the cognitive deficits, with 75% agreeing that ADHD appeared to affect learning. However, only 46% of the participants considered ADHD as a Specific Learning Difficulty (SpLD), which suggests that impaired learning is perhaps understood as a consequence to problematic behaviour.
The concern here is that practitioners may be at risk of wrongly labelling children who are disruptive: as ADHD, whilst completely overlooking children who are less or non-disruptive: ADHD Inattentive types, both of which could impact negatively upon growth and development, and potentially result in mental health difficulties.
Of the group sample, 64% agreed that children with ADHD are considerably disadvantaged compared to their peers in schools. The study showed that children with ADHD experience higher levels of increased failure – 79% agreed response, and negative treatment – 71% agreed response. Only 28% of participants felt that children with ADHD receive appropriate levels of learning/behavioural support in schools.
The Education Act (1996), states that schools must make special educational provision for pupils whose behaviour related learning difficulties (ADHD) calls for such. The Children and Families Act (2014) also states that Local Authorities have a duty to identify learning difficulties through formal educational assessments. In addition, schools are required to make appropriate reasonable adjustments for children with ADHD, in accordance with disability guidelines.
The study therefore highlights that children with ADHD may not be receiving their full entitlement, in accordance with the Special Educational Needs and Disability (SEND) Code of Practice, due a potential lack of ADHD knowledge, on the part of practitioners.
- The current approach used to manage children with ADHD in the school environment.
Data findings suggest that previous ADHD training had likely stemmed from a medical background, as the knowledge of participants focused predominantly around behaviours. The overall view of the group sample was that training had previously been poor and misleading. 100% of participants felt that such training; under the medical model, was restricting to their practice as it failed to offer them scope for learning or development.
“We need training that will help us to better understand the effects of ADHD and strategies that we can actually work with” (Participants, 2016).
Although current ADHD training in schools is sufficient – in accordance with National Health Guidelines, the study found that it was of poor quality to ‘practitioners in education.’ Previous ADHD training had failed to provide them with key information concerning the neurological and socio-cultural aspects, which subsequently denied them of opportunities to exploit the educational potential and improve upon current approaches for ADHD across schools.
Therefore, ADHD training – in relation to the study, was deemed as ineffective, given that it fails to meet the holistic needs of children with ADHD.
- The Biopsychosocial Paradigm: as an alternate approach towards ADHD in Education.
This approach uses a holistic perspective that focuses upon a range of biological, psychological, and sociological/cultural influences and subsequent interactions, that impact upon human development and functioning. The biopsychosocial model of ADHD works on the premise that genetic inheritance (nature) and environmental factors (nurture) are continuously interacting as part of a dynamic and fluid process.
- Nature – Children born with ADHD will undoubtedly impact upon their surroundings – resulting in additional stress factors for family members, teachers, etc.
- Nurture – Children with ADHD regularly experience high levels of negativity from adults, where they often attract labels that are unfavourable and which can impact affect self-esteem and subsequent development.
- Outcome – Children who experience persistent levels of low self-esteem tend to develop a negative perception of self: believing that they are ‘not good at things’ or that ‘situations will work out badly for them.’
Children who fail to have their self-esteem needs met are ultimately denied the opportunity to achieve in line with their real potential. It is therefore vital that practitioners understand the biological and psychological correlations of ADHD in order to improve upon teacher-student relationships, educational engagement and social functioning.
Of the sample group, 100% agreed that the training workshop had made them more aware of their own practice in terms of meeting the needs of children with ADHD. All of the participants involved, each stated that learning about ADHD through: (a) Biological, (b) Psychological and (c) Sociological/Cultural perspectives, had helped to improve their overall understanding of ADHD. The general consensus was that this approach could offer new ways of working such as ‘curriculum implementation and organisational arrangements’ to accommodate learning difference by enabling children to participate in ways that best suit their [innate] needs.
The study identified a 57% increase in practitioner knowledge of ADHD.
Other key findings:
- The importance of viewing ADHD as a Neurodevelopmental Disorder: where cognitive deficits concerning executive functioning and emotional regulation are recognised.
- The importance of Cognitive Assessments to determine the extent of deficits upon diagnoses and assist in the development of support systems for improved learning.
- The importance of improving practitioner knowledge of ADHD as a Neurodevelopmental Disorder to aid identification of ADHD in school children – in view of ADHD Inattentive Types.
- The importance of placing ADHD in the category of ‘cognition and learning’ alongside other SpLD’s as part of the SEND document that informs school practice.
‘Our school years shape the rest of our lives – negatively so for children whose ADHD is unrecognised and/or ignored. But paradoxically – although school is the place here the most damage is done – it is also the place where we can make the most difference to these children’s lives with the right interventions’ (ADDISS, 2005).
Author: Sharyn Travers (February, 2018)