ADHD impedes academic achievement
One of the most critical findings from recent cross-sectional and
longitudinal research is that children with ADHD are at high risk for
academic failure, grade repetition, placement in special education, and
high-school drop-out (see Table 4-1, below).1-4
Additional research suggests that the association between ADHD and
poor academic achievement starts early in a child's school career (that
is, kindergarten for many students).5-9
Table 4-1: Educational Attainment in ADHD
Educational Outcome |
ADHD vs. Non-ADHD Peer Group |
Low achievement at school:1-3
Grade repetition
Low academic grades (Cs and Ds)
Achievement scores (reading, math)
Placement in special education
|
two-fold risk
two- to four-fold risk
8% to 10% lower
two- to four-fold risk
|
Early school leaving:2-3
Highest level completed
High school dropout
|
one to two years lower
three-fold risk
|
Tertiary level attainment (college):4
College grade point average (GPA)
|
0.7 lower GPA
|
Language functioning in children with ADHD
Deficits in language functioning associated with ADHD can be classified into three areas:
- pragmatic language
- higher-level language comprehension and expression
- basic language abilities
Weaknesses in pragmatic language
Children with ADHD are often described as poor communicators, even
though they seem on the surface to have normal verbal expression and
basic language skills. Specifically, their communication problems arise
due to weaknesses in the "pragmatics of language."10-11
Pragmatic language refers to how language is used in everyday
interactions with others. It requires the ability to self-regulate one's
own communication (planning what to say, when to say it, and how to get
the message across, while respecting the rules of turn-taking in
conversations). Communication breakdowns in ADHD children may be
explained by poor self-regulation of language use.
The pragmatic language difficulties, which can often be identified as behaviour problems by parents and teachers, include:
- blurting out answers in class
- interrupting others
- talking excessively when it is inappropriate
- problems in modulating voice volume
Problems with voice modulation
Children with ADHD often speak much louder than social norms for a given situation and fail to modulate their voice volume.12
From the listener's perspective, it may appear that these children are
being rude or "in your face." However, these problems likely reflect
their immature motor system, which is involved in the fine muscle
adjustments involved in voice modulation, as well as in other fine motor
control activities such as handwriting.
Also, children with ADHD are often highly verbose in that they speak
for much longer at a stretch, and with many brief pauses. Speakers often
pause briefly during their utterances in order to re-think,
re-formulate, and re-organize the information and language to be used in
forthcoming utterances. However, the within-turn pauses in the speech
of children with ADHD appear to be too short to permit thought,
organization of information, or speech planning. Moreover, they are too
short to permit others interceding or being able to take a turn.
Weaknesses in higher-level language
Children with ADHD also exhibit weaknesses in the "higher-level"
language functions. These functions are necessary for comprehending and
producing lengthy and complex spoken and written language. They involve
learning complex language strategies used to construct cohesive and
coherent units of information. Not surprisingly, processing tasks
associated with higher-level language are most difficult for children
with ADHD because of the high demands on working memory skills. Research
has found that children with ADHD display weak performance in the
following types of tasks:
Language comprehension:
- comprehending inferences13
- identifying errors in instructions13
- making judgments about comprehension efficiency14
- comprehending information in science textbooks14
- comprehending cause-effect relationships and goal-directed actions of characters in stories15-18
Language expression:
- retelling a narrative in an organized and coherent manner19
- elaborating verbally on their ideas20
- making clear explanations on request20,21
- answering questions concisely using specific vocabulary20
Weaknesses in basic language skills
Many children with ADHD will have deficits in basic language skills.22,23
These basic language skills involve the development of age-appropriate
vocabulary, grammar, and syntax, which in turn will affect their
classroom work.22,23 Specifically, these children will struggle with oral language and reading skills.
Educational Implications of Language Weaknesses
- Children with ADHD may have communication breakdowns that
negatively affect their social interactions (for example, working in a
cooperative group, participating in a whole-class discussion).
- Children with ADHD may have considerable difficulty
communicating their ideas in an organized and coherent manner (for
example, justifying a solution for a math problem, explaining or
retelling a story).
- Students may need external organizers or support systems to
help them understand the text structure and to help them construct
coherent written texts.
|
ADHD and reading
Studies have shown that behaviour problems in kindergarten,
particularly those involving symptoms of inattention, are predictive of
later academic underachievement in reading, even after accounting for
other co-existing behaviour problems (for example, hyperactivity), early
reading skills, and intellectual ability.6,24
Children who exhibit behavioural difficulties in kindergarten and who
have initial reading difficulties are also less likely to make
improvements in the primary grades in reading achievement compared to
children who exhibit only initial reading problems. This finding
strongly suggests that early intervention efforts need to address both
behaviour-related concerns and early literacy weaknesses.9,24
Children with ADHD may exhibit a range of reading profiles.
Approximately 15% to 40% of children with ADHD exhibit a co-existing
specific reading disability.22
ADHD children with a co-existing reading disorder display the cognitive
weaknesses associated with both of the individual disorders.25,26
These students exhibit:
- core linguistic weaknesses associated with reading disorder (for
example, poor phonological skills and word attack skills, slow
letter/digit naming speed)
- executive function deficits associated with ADHD (for example, poor working memory and inhibitory control)
Some children with ADHD, particularly those with attention problems,
have also been found to exhibit poor orthographic processing.25,27
Orthographic processing refers to the ability to represent the visual
properties of the words. A typical task assessing orthographic
processing asks children which letter string is a correctly spelled word
(for example, blame/blaim or streat/street). Orthographic processing is
important to the development of both reading and writing outcomes, and
thus it is important for children to be able to create a precise
orthographic word form in working memory.27
Text recall and comprehension in children with ADHD
Children with ADHD may also exhibit mild to more severe impairments
in text recall and comprehension, depending upon their decoding skills,
oral reading fluency, and knowledge of reading strategies. For example,
students with ADHD have been found to:
- have slow reading of single words and nonwords28
- have difficulty recalling information from stories19
- be less sensitive to story structure15
- have difficulty organizing events and identifying causal events in narratives15
- have difficulty retelling stories in a well organized and cohesive manner19
- have difficulty monitoring comprehension of orally presented information13
- have difficulty making inferences13
Adolescents with ADHD without co-existing reading disorder have been
found to exhibit subtle weaknesses in text reading rate and text
accuracy and have performed slightly more poorly than non-ADHD peers on
silent reading comprehension.28
Educational Implications of Research on Children with ADHD and Reading Difficulties
- Inattentive children in kindergarten and Grade 1 should be
considered at risk for later reading problems, even when their
reading-related foundation skills may be in the typical range.24
Frequent progress monitoring will help to ensure that these students
demonstrate appropriate levels of growth in core reading skills.
- Children with reading, attention, and behaviour
problems require instructional interventions of sufficient intensity and
duration that address both types of difficulties. For example,
instructional programs that are highly structured, systematic, explicit,
and promote high levels of engagement have been shown to be beneficial
for children with reading and behavioural difficulties.29,30
In particular, children with ADHD and reading difficulties would likely benefit from:
- intensive instruction that promotes high levels of
engagement and participation (for example, using small group instruction
or structured peer-assisted learning programs)30,31
- instruction that provides students with multiple
opportunities to respond and receive explicit and systematic feedback
(for example, error corrections and feedback statements regarding
performance)29,30
- instruction that incorporates systematic direct
instruction in pivotal reading-related skills and provides students with
specific strategies to use to become independent readers30
- instruction that helps students attend to the orthographic units in written words
|
ADHD and written expression
Children with ADHD often exhibit significant weaknesses in written expression.32
Anecdotally, problems with written expression are one of the most
common and impairing problems at school for children with ADHD.
Problems with written expression in children with ADHD are often characterized by:
- low productivity, poor fluency
- slow and effortful and/or fast and careless approach
- poor written spelling
- untidy, uneven, illegible handwriting
- poor planning and disorganization
- poor written sentence construction
- poor story composition (missing story elements, missing reasons or conclusion)
Figure 4-1: Neuropsychological Model of Written Expression33
As described in Figure 4-1, many of the difficulties that
characterize children with ADHD (for example, poor orthographic coding,
poor fine motor skills, weaknesses in executive functions and working
memory) are considered to be core components of neuropsychological
models of written expression and thus it is not surprising that children
with ADHD may find the process of text generation (composition) to be
daunting.
The model in Figure 4-1 illustrates the extent to which the process
of text generation carries a significant cognitive load. Specifically,
text generation requires high levels of advanced planning and
organization, and the ability to concurrently store and manipulate
multiple elements of information at the same time (for example, text
structure and sequence, topic knowledge, ideas, spelling).
Educational Implications of Research on Children with ADHD and Written Expression
- To increase output, the teacher may need to give the student
support for both the transcription aspects of writing and the
composition process.
- To help with the transcription process, the student may
benefit from assistive technology (for example, speech-to-text software,
word processing).
- To help the student with composition, the teacher may provide:
- highly explicit strategy instruction regarding the writing
process (planning, understanding text structures, use of transition
words, thesis statements) (see Chapter 6, "Facilitating the Academic Success of Students with ADHD: Student Learning Strategies")
- software to facilitate the planning process (for example, outlining and graphic organizer software)
- concrete reminders of key action steps in the text
generation process (for example, think sheets, cue cards). These
supports are gradually phased out as the student becomes familiar with
the steps
|
back to top ^
Numeracy skills in children with ADHD are often significantly below
those of their peers. Data from a recent national longitudinal study
reported that the mathematics achievement scores of students with
symptoms of ADHD were 8% to 10% lower than that of their non-ADHD peers.1
Academic underachievement in numeracy is not solely due to the
behavioural symptoms that students with ADHD exhibit in the classroom.
Rather, children with ADHD are often perceived by their classroom
teachers to exhibit skill deficiencies in numeracy.34
This strongly suggests that in order to optimize academic achievement,
children with ADHD need academic instruction that targets their skill
deficiencies and takes advantage of their potential strengths.
Research has shown that children with ADHD tend to exhibit the following types of math weaknesses:35-38
- procedural errors (for example, subtracting larger number from smaller number, failing to carry a number)
- tendency to rely on finger counting rather than direct retrieval of facts
- more overt (out-loud) self-talk to guide actions (rather than using inner speech)
- slow computation speed
- difficulty retrieving number facts fluently and accurately
- difficulty ignoring irrelevant information in word problems
- difficulty solving math problems with multiple procedures or steps
Students with ADHD may have difficulty approaching a problem-solving
situation in a systematic manner and also may have difficulty evaluating
the success of specific strategies. For example, they may have a
limited number of strategies in their repertoire and these strategies
may be less sophisticated or inefficient. Students with ADHD often need
to be able to learn how to be active and strategic learners.
In addition, learning mathematics requires students be able to access
prior knowledge in order to apply this knowledge to a new, more
advanced mathematical concept.39
Children with ADHD may have difficulty with using prior knowledge for
several reasons. They may lack important pre-skills and/or may have the
requisite prior knowledge but may have difficulty retrieving this
information in an efficient and organized manner. Children with ADHD may
also struggle with the language and processing demands of word
problems. For example, Table 4-2 illustrates how subtle changes to the
language of a word problem can alter both the problem type and the type
of computation needed to solve the problem.
Table 4-2: Characteristics of Word Problems: Linguistic, Situational, and Mathematical Features
Word Problem |
Problem Type |
Required Arithmetical Operation |
1. |
John had three marbles. Then Nina gave him six more marbles. How many marbles does Jim have now? |
|
change |
addition |
2. |
John
had some marbles. The he gave six marbles to Nina. Now John has three
marbles. How many marbles did John have in the beginning? |
|
change |
addition |
3. |
John has three marbles. Nina has six marbles. How many marbles did they have altogether? |
|
combine |
addition |
4. |
John and Nina have nine marbles altogether. John has three marbles. How many marbles does Nina have? |
|
combine |
subtraction |
5. |
John has nine marbles. Nina has six marbles. How many marbles does John have more than Nina? |
|
compare |
subtraction |
6. |
John has nine marbles. He has six more marbles than Nina. How many marbles does Nina have? |
|
compare |
subtraction |
Educational Implications of Research on Numeracy and ADHD
- Teachers may wish to use several useful strategies that support students who are experiencing math difficulties.40 These include:
- rewriting problems in a simpler language
- pointing out key words and key concepts
- minimizing copying from boards by providing students with hand-outs
- using multiple representations and providing links to "real-world" situations
- Students may need:
- explicit instruction in problem-solving strategies (for example, counting on, how to use a table, drawing a picture)
- more instructional supports to learn a strategy (for
example, more guided practice, opportunities for review, feedback, and
help with monitoring strategy use and application) (see Chapter 6, "Facilitating Academic Success in Students with ADHD: Instructional Supports")
- Math problems requiring multiple procedures and/or
multiple operations may be quite challenging for a student with ADHD and
additional instructional supports and guidance may be required to
facilitate success (for example, cue cards, mnemonics, guided practice,
and frequent progress monitoring).
- To help students gain understanding of key math concepts,
vocabulary and facts, more intensive instruction and/or increased
opportunities for engagement (for example, peer tutoring, small group
instruction) may be needed.
- Assessment of mathematical understanding often requires a
student to explain his or her ideas either orally or in written language
(for example, asking the student to explain the problem in their own
words or explain processes and results and justify solutions). As
students with ADHD may have difficulty organizing their oral or written
output and explaining relationships among concepts, they may need more
guided questioning and supportive dialogue to demonstrate their level of
understanding of mathematical concepts.
|
Children with ADHD often experience more social and emotional problems than their non-ADHD peers.41-44
Although ADHD is often viewed in the classroom as a behaviour
management issue, interpersonal deficits are common to all subtypes of
ADHD and occur in both boys and girls.43-44
These deficits are often the consequence of poor social skills
acquisition, limited insight into social interactions, and/or poor
control and regulation of behaviour.45
Children who exhibit hyperactive-impulsive symptoms often experience peer rejection.46
This is often the result of their aggressive behaviour, lack of
insight, and failure to develop social problem-solving skills. As well,
the use of language for social engagement may be impaired. This
impairment may appear as either poorly learned conversational skills or,
when the skills are evident, limited ability to perform the skills in a
social context.
Social and emotional problems also appear in children who are
predominantly inattentive, without the hyperactivity and impulsivity.46
Again, social problems are associated with the failure to develop
appropriate social skills and in some cases are also associated with
anxiety or depression. Because these children are usually quiet and
withdrawn, teachers may not recognize social problems. Yet, these
children are often shunned or even bullied by their peers.
It is important to recognize that these maladaptive classroom
behaviours and poor peer interactions by ADHD children are not
intentional behaviours, but rather the consequence of neurocognitive
weaknesses, specifically in executive functions. These weaknesses may
manifest themselves in the classroom as:
- blurting out answers
- acting without thinking
- getting up or moving around in the middle of a lesson
- difficulty remembering the classroom rules
- misunderstanding instructions
Poor peer interactions may include:
- aggressive play
- interrupting conversations
- failing to take turns
- overly loud speech
Comorbid psychiatric disorders
Social and emotional skills in ADHD may also be affected by the
presence of one or more comorbid disorders. Children with ADHD often
present a complex diagnostic picture, with approximately 50% to 80% of
children diagnosed with ADHD meeting criteria for other co-existing
psychiatric diagnoses (see Chapter 1 for more detailed information).47,48
Co-existing Diagnosis |
Rate among Children with ADHD |
Anxiety disorder |
38% |
Conduct disorder |
14% |
Oppositional defiant disorder |
40% |
There are many programs available to teachers to help children
develop social skills, though the success of these programs is limited.
However, research shows that the most effective programs need to be
embedded in the environment in which the child is having difficulty,
such as the classroom.
For teachers who are unable to bring in a full curriculum, there are
classroom practices that can make a big difference. Researchers have
pointed out that children who feel connected to their school and
classroom are more likely to engage in pro-social behaviour and to
achieve academically. Teachers can make children feel connected by
creating positive learning environments. (See Chapter 7, "Behaviour Support Strategies," for more information.)
Educational Implications of Social Skills Weaknesses in ADHD
It is important to:
- Teach, model, and scaffold the child's ability to exhibit
pro-social behaviours to increase the occurrence of appropriate
behaviours: teach a behaviour you want to replace the one you do not
want.
- Provide high levels of positive feedback to reinforce pro-social behaviours (for example, "Thank you for raising your hand").
- Be proactive by being aware of which students are at risk
and gathering information to develop a good assessment. Recognize and
support the student's competencies and promote protective factors that
the children may have difficulty achieving on their own.
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back to top ^
There is a triad of related difficulties that children with ADHD
often exhibit. As illustrated in the diagram below, attention problems
are related to weaknesses in both working memory and academic
achievement. In turn, these two variables relate to each other. For
instance, studies indicate that children with working memory deficits —
regardless of whether or not they have ADHD — tend to perform worse on
tests of academic achievement than those students without such
impairments.50
Figure 4-2: Triad of Problems in ADHD
In the classroom, two common characteristics of students with ADHD
are their struggle to achieve and their low productivity (that is, they
often have difficulty completing tasks or assignments). As indicated in
the preceding sections, children with ADHD often experience significant
weaknesses in many academic domains. Hence, the academic problems
experienced by children with ADHD are not just due to their behavioural
symptoms, but are also associated with their difficulty developing
academic skills (for example, reading) and supportive academic enablers
(for example, study skills, level of engagement).34
For example, researchers have demonstrated that academic grades in
reading for children with ADHD are predicted both by academic skills and
by teachers' ratings of students' academic enablers (for example, level
of engagement, study skills). This finding suggests that academic
achievement in children with ADHD may be enhanced by increasing the
student's engagement in the task (for example, using instructional
techniques that enhance engagement) and by using various instructional
strategies to boost academic skills (for example, peer-assisted learning
strategies, instructional supports, study strategies, and
organizational techniques).
A second group of factors influencing academic success for students with ADHD is weakness in memory and executive functions.51,52
It has generally been found that children with ADHD who have poor
working memory and executive function capabilities often underachieve
academically51,52 (see also Chapter 3, "Rethinking ADHD from a Cognitive Perspective").
These findings are important because they suggest that interventions
to support learning and academic success for children with ADHD need to
address both potential cognitive and academic skill weaknesses and not
just focus on the reduction of the behavioural symptoms.
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