ADHD & education

It is all about the accommodations and adjustments

Introduction

I spent my childhood in school with undiagnosed ADHD, and thus my entire school career was hell for me, struggling with attention, loneliness - because of my inability to understand social interaction, emotional dysregulation, procrastination, depression, anxiety, stress, and so much more. In short, it broke me. At age 9, I was subjected to emotional and psychological abuse by a teacher who caused incredible trauma, all because I had undiagnosed ADHD, and I still remember how repulsed I was by this particular teacher on my first day of class with her as my new year teacher. School for children with ADHD is not a pleasant experience, particularly when a child is undiagnosed, which is so common in girls, due to misconceptions about what ADHD looks like in girls. Studies reflect that the statistics for suspension and expulsion of children with ADHD are far higher than “neurotypical” children, which I believe requires a rethink about how to educate children that have ADHD. The big problem with children that have ADHD is the lack of diagnosis and treatment, something that is hugely problematic in the UK.

Why are children struggling in schools that have ADHD?

One of my son’s psychiatrists told me that he absolutely hated schools and state education because of the amount of administration that he was required to do to support his patients, writing letter after letter to schools, only to find that schools and teachers ignored his letters and advice, which left his patients traumatised and refusing to attend school, which is more common than people will realise.

So why are ADHD children struggling in school? Quite simple really, education is not designed for them! Most curricula are standardised and inflexible, with very little thought given to educating children that have additional needs. Teachers are under pressure to deliver the set curriculum in a set period, and they don’t have enough support to meet needs of children - all children, and of course, class sizes are too big, with limited time to complete one period, which means that teachers have to deliver a lesson under pressure. Teachers cannot cope with children who are simply not managing the demands placed upon them, which means that any form of negative behaviour is pounced upon, and children tend to be removed when they are disruptive. In short, education is designed upon a production line, and any delay in production is dealt with harshly.

So lets look at why ADHD children are struggling in some detail.

• Early diagnosis is key. Most children don’t get a diagnosis before starting school and they probably don’t get a diagnosis in first few years. This means that children are prejudiced because of imperfections in the identification and assessment regime of both education and the medical profession. The sooner a child gets diagnosed and treated with medication, the better.

• Undiagnosed ADHD is devastating, and is common in both parents and children in the UK. This means that needs are not clearly defined, children are left adrift of any support. Parenting children that have ADHD is particularly frustrating and challenging, with many children developing Oppositional Defiance Disorder because of disruptive parenting, something not clearly understood. What defines adults that have ADHD who achieve success in life is the amount of support they received as children, and even as adults.

• Developmental lag is a feature of ADHD, which is a neurological developmental disorder. Yes, it is a developmental disorder. Children are all developing neurologically whilst at school - something lost on education as a whole, because children are not viewed the way that they should be. Development lag can be up to a third, that is a third of biological age - which means, a child of 9, will have a cognitive developmental age of 6, which does present significant problems for education. What does developmental lag look like? Emotional responses are one of the biggest clues, with children that have ADHD unable to cope with the cognitive demands placed upon them, which results in emotional dysregulation - behaviour that is often seen as “negative behaviour”, an implication that a child is being wilfully “naughty”. Developmental lag will also affect focus and attention, impulsivity, and managing tasks. In short you cannot expect a 10 year old to manage tasks set for a child of 13 or 14.

• Executive Function is impaired. This is something that most teachers do not understand about children, unless of course they have been trained about Executive Function! Executive Function is top-down cognitive processes, unlike the autonomic functions of the nervous system, or the brain being dominated by the Statro-Limbic system - which are all bottom up brain communication. Children can be considered to be impaired in their executive function, in most respects, as the Prefrontal Cortex is under development and only stops development and growth at age 25 or so. This is not to say children cannot engage in executive function, but rather, the younger children are, the less capable they are in using executive function, and it does improve as they get older. ADHD children are executive function impaired, and will be for the rest of their lives. This is something important to understand.

• Children that have ADHD are sensitive to criticism, which does cause difficulties with emotional regulation. The idea that a child with ADHD will have received over 20000 negative comments by age 12, is important to understand why children with ADHD will struggle with social interaction, and this deteriorates significant the older a child is, because of Rejection Senstive Dysphoria. A teacher will ignite the limbic system with the wrong comment because of RSD, which will cause explosive responses. Teachers who cold call ADHD children and then reprimand them because the response has been unsatisfactory will cause a very angry response, one which will interpreted the wrong way.

• Social interaction is very hard for children with ADHD, and they are susceptible to bullying. Bullying is traumatic, and when children lash out at bullies, invariably the child that lashes out is blamed and punished. It is hard to fit into social groups for children with ADHD, and many are extremely lonely at school.

• Masking is a massive problem for children with ADHD as they attempt to navigate social interaction, demand for standardised behaviour, and this takes an enormous mental toll on children who mask their ADHD traits. Masking is an entire level of cognitive processing on top of what ever else is demanded from schools and teachers. It usually results in emotional dysregulation at school and at home. This is applicable for autistics and to be honest, all of this applies to autistic children.

• Comorbidities with ADHD are common and this is what makes ADHD so complex, because in reality, ADHD is a treatable disorder, the traits and complications can be successfully mitigated, but only if proper support is in place, but comorbodities make ADHD a challenge for an individual adult (never mind a child) to manage. Oppositional Defiance Disorder is the single most common comorbid disorder amongst children - around 50% of children will struggle with ODD. ADHD and autism are common, although ADHD is usually identified in autistics who have clear diagnosis. In adults with Bipolar Disorder, up to 25% of individuals will have comorbid ADHD. It is estimated that 75% people who have ADHD will have at least one comorbid disorder, and around 50% of people will have two comorbidities.

It should be apparent that ADHD is an extremely complex disorder, but when people are still arguing over whether ADHD is a real neurological developmental disorder, when people are claiming that ADHD (autism) are over diagnosed, you begin to understand why ADHD children are struggling in education!

Executive Function and Self Regulation are key

We need to see and understand what is executive function. Dr Russell Barkley has identified 7 executive function skills:

1. Self-awareness: Simply put, this is self-directed attention.

2. Inhibition: Also known as self-restraint.

3. Non-Verbal Working Memory: The ability to hold things in your mind. Essentially, visual imagery — how well you can picture things mentally.

4. Verbal Working Memory: Self-speech, or internal speech. Most people think of this as their “inner monologue.”

5. Emotional Self-Regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. This means learning to use words, images, and your own self-awareness to process and alter how we feel about things.

6. Self-motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence.

7. Planning and Problem Solving: Experts sometimes like to think of this as “self-play” — how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we’re planning solutions to our problems.[What Is Executive Function? 7 Deficits Tied to ADHD]

These seven executive function skills play a massive role when children are in school, and this is part of the problem behind education’s approach to learning, even for the most neurotypical child!

The Neurology of ADHD

Executive Function and the ADHD Brain

• The “What” Circuit: Goes from the frontal lobe — especially the outer surface — back into an area of the brain called the basal ganglia, particularly a structure called the striatum. The “What” Circuit is linked to working memory, so it’s in this circuit that what we think starts to guide what we do. This is particularly true when it comes to plans, goals, and the future.

• The “When” Circuit: This second circuit goes from the same prefrontal area back into a very ancient part of the brain called the cerebellum, at the very backmost part of your head. The “When” Circuit is the timing circuit of the brain — it coordinates not just how smooth behavior will be and the sequence of behavior, but also the timeliness of your actions and when you do certain things. An improperly functioning “When” Circuit in a person with ADHD explains why we often have problems with time management.

• The “Why” Circuit: The third circuit also originates from the frontal lobe, going through the central part of the brain (known as the anterior cingulate) to the amygdala — the gateway to the limbic system. It’s often referred to as the “hot” circuit because it’s linked to our emotions — it’s where what we think controls how we feel, and vice versa. It’s the final decision maker in all our plans. When thinking about multiple things we could be doing, this is the circuit that eventually chooses among the options based on how we feel about them and their emotional and motivational properties.

• The “Who” Circuit: This final circuit goes from the frontal lobe to the very back of the hemisphere. It’s where self-awareness takes place — it’s where we’re aware of what we do, how we feel (both internally and externally), and what’s happening to us.

By viewing ADHD in relation to these four circuits, you can understand where symptoms originate. Depending upon which circuits are most impaired and least impaired, you can see variation in the kinds of symptoms that any individual is going to have. Some people have more working memory deficit. Some people have more emotion regulation problems. Some people have more difficulties with timing, but less difficulties with all the others. But they all involve these circuits.[What Is Executive Function? 7 Deficits Tied to ADHD]

Behaviour science and psychology is not appropriate for education

This is something that is not being acknowledged in UK education, with attitudes in the Department for Education being downright Victorian in nature, education is failing all children, but it is prejudicing and discriminating against children who are disabled, neurologically developing on a different time line, and this is causing significant trauma for many children, and is a safeguarding issue for all children. Behaviour science and behavioural psychology are intellectually bankrupt approaches to education, as children require a great deal more room to learn and develop at their own place. Schools should be places where children can and will make mistakes. We need a better approach to education.

Collaborative Learning

Dr Ross Greene is a clinical psychologist who realised that behavioural approaches don’t work in education, developed a system called Collaborative Proactive Solutions, a program that has worked in some of the most challenging education environments in the USA, mainly in inner city schools, many that had a school to prison pipeline for children, who were written off by education boards and teachers alike. CPS requires a different approach, one based on relationships with children, nurturing trust and safety in the environment. Children who are challenging are identified on the basis of needs and not a diagnosis, their needs being of importance. Lagging skills needed to be identified to assist children in overcoming their challenges, and it needs to be done proactively - not retroactively - which is too late. Behaviours are symptomatically of need - regardless of what uneducated fools like Tom Bennett think! Relationship education should be the direction that children’s education should be headed in.

The symptom is an indication of the need

Children with SEND needs are overwhelming more likely to suspended or excluded from schools, and this is also an indication of how poorly needs are being defined by schools and Local Authorities! The reality is that ADHD is really under-diagnosed in the UK - substantially under-diagnosed, regardless of Wes Streeting’s views, or that of the hatchet job he has set up to confirm said over-diagnosis. This will have major repercussions for education and society alike. Inmates with ADHD in prisons are over represented in prison populations, particularly those who have undiagnosed ADHD - and I believe it is cheaper to diagnose and treat ADHD, than it is put individuals through the criminal justice system and then incarcerate them for however long their sentences are. Children diagnosed at an early age, treated and supported stand every chance of succeeding in life. What I will say is that ADHD diagnosis is very much an indication of social class and income group. This of course gets ignored by the Department for Education. Inclusion of SEND learners in mainstream will not address needs.

Mental Illness and ADHD

What is not discussed about ADHD is mental illnesses. Children with ADHD will struggle in school, driving anxiety, fear and depression, as they face a hostile environment, one which is not fit for even adults to work in! Challenges with age inappropriate behaviour, impulsivity, lack of engagement, and being labeled as persistently disruptive in class will destroy the well being of a child with ADHD, place them at risk, and yes they are vulnerable, leaving these children unable to achieve success in education and damaging future prospects. It gets harder in further education, and ultimately in employment - many adults that have ADHD will struggle to comply with demands of employers who also don’t provide accommodations for ADHD.

Conclusion

This blog has been very difficult for me to write, as I could probably write pages on the topic! I have tried to be concise. I hope that this gives an idea about ADHD and children’s challenges to cope in education

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