Entrepreneur Richard Branson, actors Emma Watson and Will Smith, comedians Rory Bremner and Russell Howard, Olympians Michael Phelps and Lewis Smith, chef Jamie Oliver, Formula 1 champion Lewis Hamilton – all have one thing in common: they have ADHD.
If school reports are anything to go by, so too did Winston Churchill, John Lennon and Albert Einstein.
ADHD affects five per cent of the school population – one in 20 children – so it is very likely you will have at least one and possibly two children in your class with ADHD. The number of children diagnosed in the UK is approximately two per cent – so there are three per cent of children with ADHD who are never diagnosed.
The undiagnosed children are most likely to be labelled lazy, naughty or underachievers. This is especially true of young girls, who are less hyperactive and generally more compliant. ADHD in girls more often presents as mental health problems such as depression, especially in secondary school.
Taking a "strength-based approach" to ADHD learners, that is, focusing on what they can do well, will help them to grow as confident learners. The myth that children with ADHD are all badly behaved is finally beginning to change as research has provided greater understanding of how a learner with ADHD learns and achieves. The challenge for many teachers is that ADHD does not correlate with low intelligence, yet these children consistently underachieve, particularly in exams.
It is important to remember that as well as poor concentration, poor memory, impulsivity and hyperactivity, children with ADHD are at significant risk of anxiety and depression. This further impairs their cognitive functioning. Reducing "learner" anxiety is vital to improving attainment for children with ADHD.
Teaching children with ADHD can be a wonderful experience. They are intelligent, quick-witted, enthusiastic and very creative. Channelling those strengths is the key strategy to successful integration into classroom learning. Here are some strategies to ensure your learners with ADHD achieve.
Get to know the child
If the pupil has an individualised education plan or Education, Health and Care Plan, familiarise yourself with it. Only 30 per cent of those with ADHD have pure ADHD – most will have a secondary diagnosis such as dyslexia, dyscalculia, Erlin syndrome, nervous ticks, Asperger's Syndrome, speech and language difficulties, sensory processing disorder and autism. Is there any indication of a learning difficulty? Neurodisabilities are more often heritable so family history will give you an indication of any likely learning difficulty. If you have any concerns, speak with the SENCO.
Mental health
Are there any underlying mental health problems? Children with ADHD are predisposed to anxiety which has a negative impact on thinking, problem-solving, memory and sensory processing. The first law of teaching and learning for children with ADHD is teach them how to get into a "learning state". Stress management techniques, including deep breathing, progressive muscle relaxation and brain gym, can be effective ways to achieve this learning state.
The main barrier for children with ADHD and overlapping symptoms of neurodisability is a biological one – so teach these children to master their biology to reduce learner anxiety and frustration. Active learning strategies such as brain gym and music are great ways to start a lesson.
Self-regulation
Children with ADHD must learn to understand how their ADHD affects them in particular and be taught strategies to self-regulate their impulsivity and hyperactivity. Involve the family so that the strategies you are employing are also being used at home.
More and more schools are directly commissioning skills-based training for parents to support behaviour agreements and to support homework and attainment. Good use of Pupil Premium often means contracting in specialist agencies, such as the ADHD Foundation or the National Autistic Society.
Memory posters
Employ the use of learning and memory posters. Get the child to design and create posters for their bedroom walls and even for the fridge door at home. The posters can contain the school timetable – reminders on which days to bring PE kit to school or what days homework is due. Laminated pocket cards for each day of the week can also be a great way of helping to reduce the anxiety of "forgetting".
Limit distraction
Distraction is a challenge for children with ADHD. Sit them near the front of the class, near to the teacher and away from windows. When they wander off task, employ strategies such as hand signals or small cards that can be placed in front of them. This reduces the number of times you need to challenge them and avoids drawing negative attention from other pupils.
Tackle stigma
Destigmatise ADHD by explaining to other class members about different learning styles and learning difficulties. Display posters of famous high achievers with learning difficulties in the classroom and if possible design themed assemblies and class projects that explore differences and disabilities.
Instructions
When giving instructions, remember that poor memory and poor auditory processing in children with ADHD requires that we give one instruction at a time. When possible reinforce this with written instructions and ask the pupil to repeat back to you what you have asked of them.
Exercise and sleep
Encourage pupils with ADHD to engage in daily exercise, which is proven to help reduce the impact of the neurochemical deficits of ADHD learners. Also, work with families to encourage children to have regular sleep patterns, even during school holidays and weekends. Bedrooms should be kept as organised and tidy as possible with no television or computer games for at least one hour before bedtime.
Medication?
Medication is for some children absolutely necessary if they are to cope with classroom-based learning and independent learning such as homework. Teachers should advise the SENCO and parents if they have concerns about whether the medication is effective or not.
Deciding which type of ADHD medication and what dosage is very much a trial and error process and clinicians need schools' feedback to help get this right. Children on medication must take them with a meal. A biscuit or a drink will not suffice. In the school's discussions with parents, it may be useful to talk about the child's diet. For example, a low carbohydrate, high protein diet which is devoid of energy drinks or drinks high in sugar can reduce hyperactivity.
Time
Children with ADHD have a poor sense of time. Explore with the child how they need help with this – for example, breaking tasks up into smaller chunks with clearly defined time limits. Egg timers or clocks are also helpful visual reminders to encourage ADHD learners not to rush tasks and thus avoiding careless mistakes
Behaviour
Behaviour is a major concern for teachers when it comes to ADHD. Remember that ADHD is not the cause of bad behaviour. Rather untreated, unsupported ADHD results in learner anxiety and behaviour that is inappropriate for the classroom.
ADHD should not be an excuse for poor behaviour – for the child, the parent or the teacher. Children must learn that choices have consequences – it is a necessary part of the socialisation process. However, draw a distinction between ADHD behaviours (fidgeting, lack of concentration, forgetting and impulsively shouting out) and other "chosen" behaviours. Children do not have a great deal of self-awareness, they need to have the consequences of their behaviour explained to them. Explaining consequences rather than "punishment" ensures they learn to recognise that they are responsible for their behaviour and its outcomes.
If you have concerns about a child's behaviour, try using a positive report card so that something positive is written after each lesson which reinforces the types of behaviour you want to see.
- Dr Tony Lloyd is CEO of the ADHD Foundation.
Further information
For more information about managing behaviour and learning, visit www.adhdfoundation.org.uk or email info@adhdfoundation.org.uk