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ADHD

This unit focuses on attention deficit hyperactivity disorder (ADHD) and its impact on behaviour in individuals.

The unit includes:

  • The clinical definition of ADHD and how it is diagnosed
  • The causes of ADHD
  • The role and effects of medication
  • Difficulties related to ADHD
  • Interventions to support pupils with ADHD

ADHD overview

  • Influenced by...
    • ...bio-medical factors
    • ...psychological factors
    • ...social factors
  • Difficulties with...
    • ...controlling impulses
    • ...inhibiting behaviour
    • ...sustaining attention
  • Linked to...
    • ...concentration
    • ...time awareness
    • ...impulse control
  • Problems at home and in school...
    • ...self-control
    • ...following rules
    • ...organisation

The prevalence of ADHD

ADHD is considered to be the most common childhood-onset behavioural disorder. It affects between four and 10% of children in the UK, with a 2003 mental health survey suggesting that it is approximately four times more common in boys than girls.

UK children with ADHDUK children with ADHD

Executive functions in ADHD

People with ADHD may exhibit signs of reduced executive functions.

Select a circle to find out more about the role of a specific function.

  1. Working memory
  2. Internalised speech
  3. Motivational appraisal
  4. Behavioural synthesis

Working memory

Working memory is a function that enables the brain to retain and manipulate information. It enables people to process items stored in their short-term memory so that they can make use of them in the real world. It is used in tasks such as:

  • Verbal and non-verbal understanding
  • Reasoning
  • Awareness of time
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Internalised speech

Internalised speech is the process of ‘self-talk’ which allows individuals to consider the implications of certain behaviour. It is used for:

  • Description
  • Reflection
  • Problem solving
  • Self-questioning
  • Moral reasoning
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Motivational appraisal

Motivational appraisal provides the individual with information about emotional associations. It allows people to analyse their own behavioural impulses, and make judgements on whether or not a given behaviour will achieve the desired outcome. It is also involved in the implementation of actions aimed towards the achievement of specific goals.

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Behavioural synthesis

Behavioural synthesis enables individuals to analyse past behaviour and integrate that analysis into the planning of their future behaviour. It is essential to an individual’s ability to form behavioural patterns and rules.

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Medicating ADHD

Methylphenidate (trade name Ritalin) is widely prescribed to raise chronically low levels of dopamine activity in people with ADHD.

In studies of its effects, 80% of children were able to improve their:

  • Focus
  • Attention span
  • Impulse control

However, some participants reported side effects such as:

  • Reduced appetite and weight loss
  • Mild sleep disturbance
  • Headaches

Professionals recommend that Ritalin is only used to treat children older than 6 years of age, and that treatment should be halted periodically to assess its impact.

Teaching styles can be adapted to better cater for the needs of children with ADHD. Select each tab to learn more about that adaptation strategy.

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Educational interventions

Understanding

Interventions can employ cognitive approaches to adapt pupils’ thought processes and change subsequent behaviour patterns. By helping pupils to understand the wider impacts of their behaviour, you may be giving them the tools they need to change their behaviour independently. Encourage them to think about:

  • How their behaviour affects others.
  • Whether or not their behaviour achieves the desired goal.
  • How behaviour might be adapted to better suit their needs.
  • How behaviour might be adapted to suit the needs of others.

Adaptation strategies can make specific use of the cognitive strengths of pupils with ADHD. Find out how by selecting each of the tabs.

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Using cognitive strengths

Visual motor tasks

A 1992 study by Sydney Zentall and Yvonne Smith, entitled The learning and behavioral style of hyperactive children (PDF, 1.15MB) , found that pupils with ADHD tend to seek more stimulation and sensation than other pupils. Visual motor tasks, which combine visual information with movement or activity, can make tasks more interesting and engaging for these pupils.

A good example of this approach is the use of completion cards. Pupils can be encouraged to write down their answers to questions on cards, which are then held in the air for review by a teacher. This limits the amount of time a pupil spends waiting for review, and gives them a physical method of engaging with the task.

Perspectives and strategies for ADHD

Ian Hepworth, LEA educational psychologist for Kirklees, and Chris Wilcocks, assistant head teacher for inclusion at the same borough’s Almondbury High School and Language College, talk about working with pupils with ADHD. They give insight into diagnosis, the use of medication, and strategies for teaching these pupils.

This audio clip relates to task 1 in your PDF of unit 15.

Show transcript

Ian Hepworth – Educational Psychologist

My name is Ian Hepworth. I’m Kirklee’s Local Authority Educational Psychologist and was responsible, in part, for the original introduction of Kirklees’s Nurture Group Network.

ADHD is a difficult area for psychologists and for schools. Partly because it’s not as discreet as people tend to think it is. Give something a label and you assume that it’s sort of standard issue condition. You would always prefer to be able to help and manage the ADHD through behavioural approach rather than medication. And to decide to put sometimes quite a young child on medication as powerful as Ritalin and that family of drugs, to do that is a very big decision. What we tend to find is that a proportion of boys in particular who are diagnosed with ADHD or believed to have ADHD, do respond very, very positively to life in the nurture group. It’s the combination of the predictability, it’s a question of feeling safe, it’s a question of trusting that grown up, is leading you somewhere where it is safe and appropriate for you to go. And under those circumstances, children who display ADHD in their classroom settings, very often don’t display any of it in the nurture setting. And the skills that they learn in the nurture setting, they can take back to their classrooms and then they cease to display those behaviours there as well. So, it does really raise the issue of how many of those diagnoses of ADHD are valid diagnoses and how often is it used as a descriptive term for the sort of behaviours that the child is displaying.

Chris Wilcocks – Assistant Head Teacher

My name is Chris Wilcocks. I’m Assistant Head Teacher for Inclusion at Almondbury High School and Language College.

There’s a lot, a lot of difference symptoms and you will see the symptoms in different ways, in different children, and also between boys and girls as well. Girls do tend to internalise their behaviour and just really display the inner tension in lessons, and the day dreaming kind of behaviours. But a lot of the things that you do with, with ADHD, the same as with strategies for teaching people with dyslexia, a lot of it’s founded in good teaching and understanding of the pupil that you’ve got in front of you.

If you have a full appreciation of that child and you can separate, and you know that that behaviour is not deliberately aimed at disrupting your lesson, and you don’t take that personally as a teacher, I think you can start moving forward with the individual child, the children. I think the children have to understand their condition as well, and how that impacts on other people, so there still has to be the consistency of dealing with the behaviour in the classroom, in the same way as you would with any other child. The difficulty is drawing attention to that child for the difficulties that they have, so sometimes what’s found in practice is like a secret signal to that pupil which is negotiated between the teacher and the pupil to actually indicate when they’re displaying those kind of behaviours. Sometimes it can just be a touch on the shoulder, as a secret signal, sometimes it could just a knowing nod or a knowing glance, or a clicking of the fingers, something that’s negotiated between, but it’s got to be something that doesn’t necessarily draw attention to that pupil. It’s just as an indicator, as a marker to them that they’re displaying that kind of behaviour, just so that they can modify their own behaviour in the classroom without the normal kind of routine of a public warning or removal from the classroom which wouldn’t be wholly appropriate for that pupil.

In terms of improving pupil’s behaviour, I think it’s important that staff are aware of the child’s diagnosis, so that they can separate the child from the behaviour, I think that’s got to be at the root of anything that you do in the classroom. So that they don’t see the behaviour as being a deliberate response although sometimes pupils with ADHD do present deliberate behaviours to try and avoid the work that they’re trying to do in the classroom.

In terms of strategies actually in the classroom I think the learning environment has got to be set up in such a way that so it doesn’t play on the individual difficulties that the pupil will have, for example, sitting a pupil next to a window who is prone to day dreaming, or prone to being distracted, wouldn’t be the best possible place for them to sit in the classroom. Sitting them near doors where they could be distractions outside might prove difficult for people to cope with. We have in the past given people things like stress balls to play with so they’ve got something to fiddle with. The problem is with that, some people will get bored with that very, very easily so they need to have a range of things on the desk, and staff just need to be aware of that.

We have one young man who, we’re currently going through a diagnosis for ADHD at the moment, and he has to have something different every lesson, and he selects the item, the staff are made aware of it, and he will look like he’s not paying any attention in the classroom at all, but he can answer any questions that are thrown at him once he’s actually got his focus maintained. So there are simple things that you can do in a classroom as well as more complex things as well.