Attention Deficit/Hyperactivity Disorder (ADHD) is frequently misunderstood and misdiagnosed, especially in females. It is a pattern of behaviour that begins in early childhood and throughout the lifespan. However, as an individual with ADHD grows and matures, their symptoms can become more manageable. Key features of ADHD include inattention, distractibility, hyperactivity and impulsivity. ADHD and Autism are commonly comorbid, meaning that they often co-occur with each other (i.e., many people on the autism spectrum also have a diagnosis of ADHD).
The diagnostic criteria for ADHD, as stated in the DSM-5 (2013), can be found below:
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterised by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily side-tracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
Specify whether:
Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity/impulsivity) is met but Criterion A1 (inattention) is not met over the past 6 months.
Specify if: In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.
Specify current severity:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in only minor functional impairments.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.
In the Classroom
Depending on the type of presentation, and the severity of their ADHD, a child’s behaviour can be extremely different at home and at school. Although many children with ADHD show signs of the disorder before they reach school age, a large number of children are not diagnosed until they begin school, when they start to have trouble meeting the behavioural, social, and academic expectations that formal schooling requests.
Typical ADHD behaviour within the classroom can involve a child:
- Demanding attention by talking out of turn or moving around the room.
- Having trouble following instructions, especially instructions that are more than one step long
- Forgetting to write down homework assignments, do them, or bring completed work to school.
- Lacking fine motor control, which makes handwriting and cutting difficult
- Struggling to participate in group projects and may even keep a group from accomplishing its task.
ADHD is one of the first diagnoses that is suspected when a child 'misbehaves' in class, has trouble sitting still, or is not keeping up with their schoolwork. If we break down what a formal school setting requires children to do, we can essentially summarise these expectations into five categories:
- Sit still
- Listen quietly
- Pay attention
- Follow instructions
- Concentrate
These are the exact areas in which children with ADHD struggle; not because they are not willing, but because they cannot cognitively engage. As a consequence, grades may be lower than expected, they may be isolated from their peers (children don’t want to be friends with the ‘naughty’ child), and self-esteem may struggle, as children with ADHD are often in trouble for their behaviour.
How Can Teachers Help?
In summary: patience, creativity, consistency, leniency.
A teacher’s role is to evaluate each child’s individual needs and strengths, and then develop strategies that will help that child. For a child with ADHD, this would involve developing strategies that will help them stay focused, stay on task, and reach their potential. You would not believe how many children with ADHD have been referred to me for a cognitive assessment because they are failing their academic work, to only come out with an above average IQ!
The most important thing a teacher can do for a child with ADHD is to always engage them with a positive attitude. Often these children, both at home and school, are all too familiar with being told they are doing something wrong, to stop doing something, that they have been naughty/bad/inappropriate, or are being reminded that their choices are poor. Instead, try making the student your partner by saying, “Let’s figure out ways together to help you get your work done.” Assure the student that you’ll be looking for good behaviour and quality work and when you see it, reinforce it with immediate and sincere praise.
Finally, look for ways to motivate a student with ADHD by offering rewards on a point or token system. You may have to reward students with ADHD much more frequently than your other students, and that is OK. On the same note, you may have to ignore ‘mild’ behaviours’ that you perhaps would not ignore in your typically developing students, and that too is ok! If you do have to discuss these scenarios, it is really important to do so in a private setting, away from the other students.
Undoubtedly, at times, the student’s behaviour will escalate. However, more often than not, there will be warning signs that an escalation is about to occur. It is important to understand the child’s escalation pattern, and to put calming measures in place for every aspect of this pattern! However, with the right teaching approach and reinforcement system in place, large, uncontrollable escalations should be minimal.
Specific Recommendations
The following recommendations have been taken from HelpGuide.org (https://www.helpguide.org/articles/add-adhd/teaching-students-with-adhd-attention-deficit-disorder.htm?pdf=12362)
Seating
Seat the student with ADHD away from windows and away from the door.
Seat the student with ADHD right in front of your desk unless that would be a distraction for the student.
Seats in rows, with focus on the teacher, usually work better than having students seated around tables or facing one another in other arrangements.
Create a quiet area free of distractions for test-taking and quiet study.
Information delivery
Give instructions one at a time and repeat as necessary; visual instructions paired with verbal instructions often work best.
If possible, work on the most difficult material early in the day.
Use visuals: charts, pictures, colour coding.
Create outlines for note-taking that organise the information as you deliver it.
Student work
Create worksheets and tests with fewer items, give frequent short quizzes rather than long tests, and reduce the number of timed tests.
Test students with ADHD in the way they do best, such as orally or filling in blanks.
Divide long-term projects into segments and assign a completion goal for each segment.
Accept late work and give partial credit for partial work.
Organisation
Have the student keep a master binder with a separate section for each subject, and make sure everything that goes into the notebook is put in the correct section. Colour-code materials for each subject.
Provide a three-pocket notebook insert for homework assignments, completed homework, and “mail” to parents (permission slips, PTA flyers).
Make sure the student has a system for writing down assignments and important dates and uses it.
Allow time for the student to organise materials and assignments for home. Post steps for getting ready to go home.
Starting a lesson
Signal the start of a lesson with an aural cue, such as an egg timer, a cowbell or a horn. (You can use subsequent cues to show how much time remains in a lesson.)
Establish eye contact with any student who has ADHD.
List the activities of the lesson on the board.
In opening the lesson, tell students what they’re going to learn and what your expectations are. Tell students exactly what materials they’ll need.
Conducting the lesson
Keep instructions simple and structured. Use props, charts, and other visual aids.
Vary the pace and include different kinds of activities. Many students with ADHD do well with competitive games or other activities that are rapid and intense.
Have an unobtrusive cue set up with the student who has ADHD, such as a touch on the shoulder or placing a sticky note on the student’s desk, to remind the student to stay on task.
Allow a student with ADHD frequent breaks and let him or her squeeze a rubber ball or tap something that doesn’t make noise as a physical outlet.
Try not to ask a student with ADHD perform a task or answer a question publicly that might be too difficult.
Ending the lesson
Summarise key points.
If you give an assignment, have three different students repeat it, then have the class say it in unison, and put it on the board.
Be specific about what to take home.
Summary
ADHD-related behaviours can be extremely challenging for teachers to manage within the classroom. It is important however, to manage these behaviours appropriately, as if handled poorly, students with ADHD can develop anxiety, depression, and an extremely poor self-concept.
ADHD Resources: Free Workbooks and Other Resources
Here are some free resources to help you better understand ADHD in the classroom:
101 Ways to Teach Children Social Skills: A Ready-To-use Reproducible Activity Book
This is one of my all-time favourite resources! Those who have been following me from the beginning, probably already have this resource, as I have shared it with you guys before. This book is divided into nine different sections that cover the major categories of social development. Most of the worksheets can be printed and used as part of a social skills group, or lesson plan within the classroom. It can be used as an educational resource or as a therapeutic resource, to address specific social skill concerns. Furthermore, each activity comes with an explanation for the teacher/therapist on how to use the resource and explain the concepts to the children they are working with.
To Download for Free: https://healthiersfexcel.org/wp-content/uploads/2018/07/101-Ways-to-Teach-Children-Social-Skills.pdf
ADHD: Teacher’s Pack
This is a free, PDF download that I stumbled across while researching another resource for this manual. It was created to provide guidance to teachers who may have a child with ADHD in their class. It includes relevant background information and promotes the use of behavioural and psychological interventions as alternatives to, or to be used alongside, medical treatment of ADHD. I think this is a great resource for teachers to be able to easily download and read and provides clearly worded psychoeducation on all aspects of ADHD.
To Download for Free: https://www.dronfield.derbyshire.sch.uk/site_content/unsecure/sen/SEND-teachers_booklet_for_ADHD.pdf
ADHD: A Resource for Educators
This booklet examines how ADHD can influence learning and provides strategies teachers can use in the classroom. It examines key areas where students with ADHD may need support and features some whole class strategies that may benefit all students, particularly those with ADHD.
To Download for Free:https://www.inclusive.tki.org.nz/assets/inclusive-education/MOE-publications/MOESE0040-ADHD-booklet.pdf
ADHD: Understanding and Learning About Student’s Health
This is a great resource to learn more about ADHD and the impact of ADHD on a number of areas. It also provides some ideas for managing ADHD in the classroom while also supporting the student with ADHD.
To Download for Free: http://www.columbia.edu/itc/hs/medical/residency/peds/new_compeds_site/pdfs_new/school_based_health/ADHD.pdf
Teaching Children with ADHD: Instructional Strategies and Practices (2008)
This is an interesting resource from the US which explores strategies for assisting children with ADHD, and how to put in place these strategies. While 2008 was 11 (OMG) yes ago, many of these strategies remain relevant.
To Download for Free: https://www2.ed.gov/rschstat/research/pubs/adhd/adhd-teaching-2008.pdf
Classroom Interventions for Attention Deficit/ Hyperactivity Disorder Considerations Packet
This packet focuses on classroom intervention strategies to enhance the learning environment for students with attention deficit/hyperactivity disorder (ADHD). An overview of ADHD is presented along with a brief description of the challenges students with ADHD typically demonstrate in the classroom. Strategies for academic interventions, behaviour management, and home-school collaboration and communication are also included.
To Download for Free: https://education.wm.edu/centers/ttac/documents/packets/adhd.pdf
