ADHD changing academic outcomes for children – the latest research
16th June 2017 Claire OrangeEarly Childhood, Wellbeing - Learning, Wellbeing - Social
The Murdoch Children’s Research Institute released alarming research findings today about the impact of ADHD on the achievement of minimum standards in literacy and numeracy achievement.
“A high number of Australian children with Attention deficit hyperactivity disorder (ADHD) are struggling academically, with an alarming 40% of students failing to meet the literacy and numeracy (NAPLAN) national minimum standards, new research by the Murdoch Children’s Research Institute (MCRI) has found.”
With a diagnosis rate of 6-7% of Australian children with ADHD, this is concerning and most certainly raises important questions about how best to educate children with ADHD for better long term outcomes.
ADHD is a neurobiological condition, with approximately 3 times as many boys as girls diagnosed. It is referred to as a dopamine pathway disorder – dopamine being the neurotransmitter required by the prefrontal cortex to engage in higher level cognitive and problem solving tasks requiring both regulation (Social, emotional and learning) and organisation.
As suggested by the diagnostic title of ADHD – attention deficit is at the core of the diagnosis. Whilst a child may show great ability to sit and engage with something they’re interested in for hours – even days (hyperfocus) – a lack of interest and easy boredom is usually at the very core of being unable to progress academically.
Key facts about ADHD
So, when we’re talking about how to improve these children’s Naplan scores (sigh), literacy and numeracy outcomes, we have to remember some key facts about ADHD. Here they are:
ADHD is a dopamine (neurotransmitter) pathway disorder. Either not enough dopamine is made or enough dopamine is made but the receptors in the prefrontal cortex do not receive the dopamine.
A child’s prefrontal cortex is the gateway to their learning. Without dopamine to stimulate the functioning of the prefrontal cortex, the gate is slammed shut on learning. So no amount of tuition, extra reading or online maths programs are going to work.
Dopamine is made in the gut and moved to the head. Production of dopamine is initiated through movement – so long periods of sitting are most certainly most unhelpful for the child with ADHD. The term ‘fidget to focus’ is exactly right for children with ADHD – they’re self-medicating and helping their dopamine production and dopamine transport.
Planning, organisation, impulse control – can and should be taught. Explicitly and repeatedly to these children – from their early years. These are learning to learn behaviours that are a platform for being able to read. Reading and impulse control – how do they go together? Well, sit with and ADHD child who has read the word ‘and’ 100,000 times and watch them impulsively say ‘cat,’ ‘chair’, ‘seahorse’ – and you’ll get it.
It generally takes a child with ADHD longer to mature emotionally and sometimes cognitively. Usually bright little individuals, the struggle to express their intelligence when the gateway to their learning is slammed shut is akin to torture. And yes, this can lead to great big behavioural issues.
Social and emotional issues
Children diagnosed with ADHD often have day to day social and emotional issues. It’s little wonder when the part of their brain that says ‘slow down’ hasn’t learned how to send that message to the system. So the child bounces and spins – or daydreams and dithers, and doesn’t learn about personal space, turn taking, non-verbal cues from peers and teachers that are the big governors of our social success.
Add to that an almost 100% hit rate of sensory issues – prickly socks can take up 100% of a child’s available brain bandwidth. Or the sound of the fan, the lawnmower out on the school oval or the smell of the candle in the corner. So, what’s left over for spelling, reading and times tables – well, not much really.
Sadly, there’s no magic pill – there’s no single medication, therapeutic approach or behavioural solution for the neuro-diverse children. But there are things that really do work at home and in the classroom that help the prefrontal cortex to start learning the patterns for organisation and regulation.
Stimulant medication seems to garner a whole range of uninformed and fear-based reactions. We don’t expect someone with epilepsy to simply manage their neurological condition and ‘get over it’ – so why do we expect this with ADHD? Medication is not the solution for every child – but it’s also not the devil either. Well-researched, well-prescribed and well-managed schedules of stimulant medication is exactly what some children and their families need to be successful – behaviourally, socially, emotionally and in their learning too.
Environmental modifications. Regular movement helps all children to learn – but it really helps children with ADHD to up their levels of dopamine. It can be as simple as putting a child’s pencil pot at the front of the room and getting the child to get up to change pencils, or having a desk at the front of the room and the back of the room. As long as the child is working they can move between the desks. Elastic bands around chair legs to keep legs bouncing without disrupting others. Fidget toys, wobble cushions – there are multiple options that work if used well. Ask a paediatric Occupational Therapist for heaps of strategies to modify environments successfully to engage a child in their learning environment better.
Teach the ‘how to’s’ of planning and organisation. It is not a natural state for the child with ADHD, so teach a child how to get organised. Have places for particular things – predictable, not too many, not too complex. Teach – in small increments – how to sort out spaces, how to tidy, how to organise resources. Make it simple. Make it obvious. Help a child to plan their time. How to start, what to start with and how long to take.
Move to learn – homework on the scooter, on the trampoline (or even not at all) adds an element of fun. Naturally, the movement is doing its job with dopamine so it’s a win-win. Punctuate learning with trips to get a drink (children will see to this themselves in the classroom if they’re not moving enough by forever going to the toilet). Brain gym activities where the midline is crossed helps the ADHD brain – do more of these – in class and at home.
Focus on the learning to learn skills and not the learning the content skills. Focus in sprints is fantastic for the child with ADHD. What they’re doing has a definite beginning and end – they’re more likely to work hard and fast and get it over if the entire task doesn’t last for anything more than 25 minutes. 7 minute sprints are ideal – and build up from there but no more than 15 minutes at a time. Brain breaks only have to be a couple of minutes – but they are essential. If not, what happens is that the harder the child tries to concentrate the more difficult it becomes. And remember – this isn’t their choice – this is the way their brain works.
Teach self-regulation. If a child knows when they’re feeling overwhelmed – they can pick the signs early, they are more likely to stay in control of their behaviour. Usually, the difficult behaviour associate with ADHD is because the child has topped out on their sensory capacity and they’re in full overwhelm. Weighted objects – like heat packs, door stops, piles of books are sometimes magic in grounding a child. Wrapping – almost like swaddling a baby – gives comfort and brings the child’s body back into itself. A sleeping bag with some sensory toys in it is a great dark place to crawl for a while to get over the sensory heavy world we live in.
Other weird stuff works too. Caffeine works differently in the ADHD brain. For some teens it really helps to get the brain going and focused. Higher levels of protein in the diet help with dopamine getting to the prefrontal cortex. Bacon and eggs for breakfast – probably not too many complaints there. Porridge, protein shakes – they have a place and can quite often be useful to start the day if a child on medication is having difficulty with appetite. And chewing gum – yes, it stimulates the gut – the gut produces the dopamine so it seems to work well. It’s definitely worth a go – especially during times of homework when the moaning is high and the output is low.
The diagnosis of ADHD – whether medicated or unmedicated can cause long term issues for children and their families. Learning confidence drops, social skills can take a big hit, emotional self-regulation can often be difficult. Teaching a child about their unique and beautiful brain helps to normalise their experience of home and classroom life. And as parents and teachers, keep using the wonderful word ‘yet’. Because one day, all those skills that haven’t embedded themselves consistently – yet – will. 22 is a magical for girls with an ADHD diagnosis as estrogen mature their brains and we have while longer to wait for our lads – 29 (eek) and testosterone will do its job to polish all those skills into a shine – for life.