By E. Mark Mahone, Lisa Carey, Erin Jones & Alison Pritchard
October 6, 2015
We asked the faculty of Kennedy Krieger Institute’s Department of Neuropsychology to share common misconceptions about students with Attention Deficit Hyperactivity Disorder (ADHD)/ADD). Students with ADHD are more likely to experience learning problems, miss school, develop troublesome relationships with teachers, family, and peers, and become injured as a result of hyperactivity and inattention. The first step in ensuring that educators are prepared to support students with ADHD is to clarify some common misconceptions about the disorder.
MYTH: “My students with ADHD just need stricter parents.”
FACT: While appropriate parenting techniques can help manage symptoms of ADHD, research has shown that genetics play a larger role in the development of ADHD than environmental factors1. Brain imaging studies have demonstrated that the brains of children with ADHD look different from the brains of their same-aged, same-sex, non-disabled peers, demonstrating that ADHD is a disorder with neuro-biological and genetic markers2,3. Blaming parents for their child’s ADHD will not help build the strong parent-teacher relationship needed to benefit students with ADHD.
MYTH: “It’s not ADHD; they just eat too much sugar!”
FACT: Sugar has not been found to contribute to hyperactive behavior or negatively impact cognition. (Though, there are many other reasons to monitor sugar intake!)4. While a well-balanced diet will contribute to overall improved health, diet should not be blamed for the symptoms experienced by students with ADHD.
MYTH: “Michael doesn’t have ADHD; he just needs to try harder.”
FACT: Executive dysfunction symptoms related to ADHD can make initiating tasks, planning and organizing information, and maintaining focus very difficult for students with the disorder. Behaviors that appear to be laziness (e.g., failure to complete assignments), may, in fact, be unaddressed ADHD symptoms. Many students with ADHD respond well to scaffolded supports within the classroom, such as task lists, assistance with organization, and cues and reminders to help refocus attention5.
MYTH: “I don’t believe that Mia has ADHD. She’s not hyper, and all of my other students with ADHD are boys.”
FACT: There is a misconception that ADHD is a boys-only disorder. While it is true that boys tend to be diagnosed more often, girls may be overlooked as they often display ADHD symptoms differently than boys. For instance, girls are more likely to be inattentive and have less disruptive behavior6, which may explain why their symptoms are less noticed. The name Attention Deficit Hyperactivity Disorder may also contribute to the confusion, as a diagnosis of ADHD does not necessitate the presence of hyperactivity. There are different subtypes of ADHD: hyperactive type, inattentive type, and combined type2.
Students with inattentive type ADHD may exhibit the following symptoms:
- fail to pay attention to detail or make careless mistakes in school work
- difficulty sustaining attention in tasks or play activities
- does not follow through on instructions and fails to finish work
- has difficulty organizing tasks and activities
- avoids tasks such as school work and homework that require sustained mental effort
- loses supplies and items necessary for tasks or activities
- is easily distracted
- is forgetful in daily activities
Students with hyperactive/impulsivity type ADHD may exhibit the following symptoms:
- fidgets with hands or feet or squirms in seat
- leaves seat in classroom when remaining seated is expected at a duration that is developmentally appropriate
- Runs or climbs excessively in situations where it is inappropriate
- Is “on the go” and acts as if “driven by a motor”
- Talks excessively
- Blurts out answers before questions have been completed
- Has difficulty awaiting their turn
- Interrupts or intrudes on others
Students with combined type ADHD have at least 6 symptoms of inattention AND at least six symptoms of hyperactivity/impulsivity.
MYTH: “They’re in 10th grade, so they should just be able to get it together and focus.”
FACT: Most students do not outgrow ADHD; however, symptoms have been shown to change over the lifespan. A recent longitudinal study of children with ADHD published in the Journal of Attention Disorders showed that while hyperactive symptoms tend to decline as students enter adolescence, other symptoms of ADHD (particularly inattention) persist well into adolescence and adulthood7.
ADHD is a neurodevelopmental disorder that negatively impacts the development of executive function and other skills related to academic success. Thus, even when other students in your class have demonstrated growth in the areas of attention, organization, and planning, students with ADHD, by virtue of the nature of their disorder, may continue to struggle. Helping older students with ADHD develop and maintain systems for staying organized and on-task can support the development of skills and assist them in transitioning those skills into adulthood.
MYTH: “I should call Mrs. Jones about getting her kid on meds.”
FACT: Teachers should not be advising parents regarding medications. Concerns about behavior should be shared with parents and documented in order to assist parents in having treatment conversations with outside medical providers. It is also important to note that medication is not the only option for treatment of ADHD. Behavioral treatments have been shown to be effective in reducing ADHD symptoms. Additionally, interventions targeted at improving executive function will benefit students with ADHD.
References:
- Goodman R, Stevenson J. (1989). A twin study of hyperactivity— II. The aetiological role of genes, family relationships, and perinatal adversity. Journal of Child Psychology and Psychiatry, 30(5), 691-709.
- Pritchard AE, Nigro CA, Jacobson LA, Mahone EM. (2012). The role of neuropsychological assessment in the functional outcomes of children with ADHD. Neuropsychologial Review, 22(1), 54-68.
- Qiu A, Crocetti D, Adler M, Mahone EM, Denckla MB, Miller MI, Mostofsky SH. (2009). Basal ganglia volume and shape in children with attention deficit hyperactivity disorder. American Journal of Psychiatry, 166(1), 74-82.
- Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. The New England Journal of Medicine, 330(5), 301-307.
- Meltzer L, Pollica LS, Barzillai M. (2007). Executive function in education (pp. 165-193), In Executive function in the classroom: Embedding strategy instruction into daily teaching practices, L. Meltzer (Ed.). New York, NY: The Guilford Press.
- Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. (2005). Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(11), 1313-1323.
- Holbrook JR, Cuffe SP, Cai B, Visser SN, Forthofer MS, Bottai M, Ortaglia A, McKeown RE. (2014). Persistence of parent-reported ADHD symptoms from childhood through adolescence in a community sample. Journal of Attention Disorders, 1-10.
