Running Head: Educational Opportunities and Children with ADHD

APSY 651 Final Exam: Are Educational Opportunities Supportive for Children with ADHD Shawna Sjoquist University of Calgary

Educational Opportunities and Children with ADHD The American Psychiatric Association (2000) offers that ADHD is a neuropsychiatric

disorder characterized by an enduring pattern of inattention and or hyperactivity-impulsivity that presents in excess of the norm prior to the age of seven (DSM-IV-TR). Children diagnosed with ADHD enter the educational system and are often met with a plethora of difficulties that have been argued to relate the inherent characteristics of their disorder. Whether or not these children are supported and provided every opportunity to promote successful opportunities for learning is a critical issue germane to the area of childhood ADHD. Mash and Barkley (2003) identify that it is commonplace for children (especially preschoolers) to be active, energetic, and exuberant; to flit from one activity to another as they explore their environment and its novelties; and to act without much forethought, responding on impulse to events that occur around them, often with their emotional reactions readily apparent (p. 75). While the attributes described by Mash and Barkley may be used generally to describe childhood in its natural form, children that demonstrate these attributes in excess of what is considered the norm to the detriment of their own ability to sustain attention when warranted, successfully selfregulate and maintain age-appropriate gains in development have come to been identified as demonstrating something more than simple child-like nature (Mash and Barkley, 2003). Appropriate support for children diagnosed with ADHD with the educational system begins with an understanding of the disorder itself. We must be able to conceptualize ADHD, be cognizant of empirical literature, account for personal and professional biases and consider societal seasons before we can ever hope to effectively support children with ADHD in our educational systems. Culture has relevance to the identification and support of children with ADHD in the educational environment. Children are challenged to adhere to cultural expectations that are

Educational Opportunities and Children with ADHD readily apparent in the educational environments they attend. The way in which educational teams, professionals and families interpret ADHD symptomology is, to some extent, culturally influenced. Cultural influence may be a contributing factor to variance in prevalence rates that can be seen in research when compared from country to country (Mash and Barkley, 2003). Interpretation of ADHD symptomology can also be challenged by the invisible nature of the disorder itself. Support may be more readily and appropriately applied to a child with a visibly deficit than one where the deficit is less apparent. For instance, a child with a broken dominant arm will not likely be asked to write their name without support yet a child with ADHD, also presenting with a deficit that may inhibit their ability to succeed, may be asked to do so. Both may be hindered in their ability to complete the task yet I wonder if the way in which they are supported in the educational system at times reflects the extent to which characteristics of the disorder are visible to the naked or untrained eye. Support for children with ADHD is best initiated by an individual with a trained understanding of ADHD in children. Sheer lack of understanding of the diagnosis itself that is comprehensive in nature challenges the ability to effectively support a child with ADHD. In my experiences there doesnt seem to be a widely recognized public awareness of what ADHD actually means for the child. Support for this challenge comes from the literature, it comes from my own professional experience to date and also from academic dialogue Ive been privy to in this course. Mash and Barkley (2003) recognize the argument that children diagnosed with ADHD are simply regular kids become victim of poor, boring or restrictive educational

environments. This contrasts with the argument that ADHD is a valid diagnosis. This divergence in conceptualization is also present in varying opinions presented throughout this course. Some have argued the validity of an ADHD diagnosis and others have expressed a mixed opinion that

Educational Opportunities and Children with ADHD incorporate elements of both a diagnostically relevant and environmentally produced view of ADHD. In my professional experiences to date I have worked with a variety of disciplines that also seem to view and approach ADHD in different ways. I have seen occupational therapists approach ADHD from a sensory integration stand point, supporting with active sitting cushions

that allow for movement and weighted seating aids such as weighted vests or lap weights. I have seen emotional behavioural therapists approach ADHD with strategies strongly centered on standard emotional regulation techniques that involve introspection and calming tactics. I have also seen educational teams that conceptualize ADHD with the assumption that inattention is equivalent to defiance, thus attempting to curb the defiance with standard behaviour modification techniques. Conceptualization of ADHD and support of the diagnosis in the educational environment has both interested and challenged me as I admittedly did not have a strong conceptual standpoint prior to this course. Current literature, research and theoretical conceptualization of ADHD point to two main behavioural components that are seen to prompt the characteristic difficulties of children with ADHD (Mash and Barkley, 2003). Difficulties associated with the inattention domain can manifest as an inability to sustain attention, persist through tasks, focus in play, remain cognizant of classroom rules, follow through on instruction and endure the busyness that is school (Mash and Barkley, 2003). Research indicates that although ADHD has been associated with comorbid disorders, difficulties with inattention do not seem to be the effect of comorbidity (Mash and Barkley, 2003). Difficulties associated with the hyperactive-impulsive domain have been shown by research to include increased general activity, noteworthy struggles with stopping and continuing behaviour, increased talkativeness, conversational disruption, delayed gratification and the ability to withhold or refrain responses (Mash and Barkley, 2003). Research indicates

Educational Opportunities and Children with ADHD that difficulties associated with inhibition tend to present before difficulties associated with attention at three to four and five to seven years of age respectively (Hart, Lahey, Loeber, Applegate and Frick; Loeber, Green, Lahey, Christ and Frick; Milich et al. as cited in Mash and Barkley, 2003). Difficulties with inhibition are thought to involve voluntary or executive inhibition of prepotent responses, rather than impulsiveness that may be more motivationally controlled, as in a heightened sensitivity to available reward (Nigg as cited in Mash and Barkley, p. 79, 2003). Current research has also indicated that level of performances is influenced by time of day, task complexity, level of necessary restraint, level of stimulation, immediacy of consequence and reinforcement and presence of adult supervision (Mash and Barkley, 2003). Given that research has identified problems with inhibition and factors that influence level of performance, appropriate educational support for children with ADHD would seemingly do well to incorporate knowledge from these research findings. Several theoretical conceptualization of ADHD exist including Barkleys theory of inhibitory dysfunction which attempts to account for the difficulties experienced by children

diagnosed with ADHD (Macdonald, 2010). Essentially this theory proposes that primary deficits in inhibitory functioning trickle down and affect four other main areas of executive function thereby helping to explain pronounced difficulties associated with ADHD (Mash and Barkley, 2003). Specifically Barkley proposes that behavioural disinhibition affects nonverbal working memory, the internalization of speech, internalization of play, self-regulation of affect, motivation and arousal which then influence motor control, fluency and syntax (Barkley as cited in Mash and Barkley, 2003). It is theorized that deficits in inhibitory control influence executive functioning significantly contributing to the individuals level of adaptive functioning later social self-sufficiency and concurrent experiences (Mash and Barkley, 2003). According to this theory,

Educational Opportunities and Children with ADHD it is predicted that children with ADHD will present with difficulties definitively connected to the four identified areas of executive functioning. For instance, it is theorized that children with ADHD will demonstrate delay in referencing and sensing time (Mash and Barkley, 2003). Children with ADHD are also theorized to have decreased capacity for privatization of speech, verbal reflection that precedes action, influential self-directed speech designed to control their own behaviour, following rules and instruction (Barkley as cited in Mash and Barkley, 2003). According to this model children are predicted to respond to events with large emotional expression, demonstrate moderated social perspective taking and decreased motivational drive (Mash and Barkley, 2003). Further, children with ADHD are projected to exhibit difficulty with the development of motor coordination that includes planning and carrying out goal-directed responses (Mash and Barkley, 2003). Review of literature presented and prompted throughout this course indicates that research into the above predicted areas of difficulty, as presented by

Barkleys theory of inhibitory dysfunction, have both been supportive of several predictions and suggested the need for further study. The current literature, research and theoretical conceptualizations of ADHD described above have greatly influenced my understanding of this topic area. I openly acknowledged that I did not have strong conceptualization of ADHD nor would I say that I have an exceedingly strong conceptualization of it now. What I can say is that I now have a greater appreciation for the study that has gone into this area and am on my way to developing a more thorough understanding of what constitutes ADHD, how to support the incurred deficits of children diagnosed with ADHD and how to collaborate with professionals and primary caregivers to promote successful learning opportunities for these children. My rationalization for interest into this area was formed from my current role within the educational systems and an observed

Educational Opportunities and Children with ADHD

disconnect between discipline specific practice and approach to supporting children with ADHD. In critical analysis of my own understanding of children with ADHD and the educational system I must acknowledge that I was somewhat ignorant to the presence and source of contributing factors that fuel matters of discordance between primary caregivers, educational teams and professionals. When I work with children I tend to look at what appears to be working, what may need to be changed and what has been identified as an area of difficulty. I now consider this to be a bit of a professional bias that may have been hindering me as a professional. I had not considered that identified areas of difficulty may reflect variation in method of identification and individual situational characteristics. Further to this, I now have a new found awareness for the presence and potential influence of comorbidity in children diagnosed with ADHD. To support children with ADHD is not only necessitated by an understanding of ADHD itself but also the co-occurring disorders that may be associated with it. Reflection on my understanding of the inattention and the hyperactive-impulsive domains has deepened my consciousness of the amount of sources of difficulty present in the standard educational classroom that are inherently challenging for children diagnosed with ADHD. If the understanding is that children diagnosed with ADHD have inherent difficulties with the ability to sustain attention, persist through tasks, focus in play, remain cognizant of classroom rules (Mash and Barkley, 2003) then I cant help but feel that the very list of difficulties associated with children with ADHD also constitute the main cornerstones or ability classrooms are founded upon. Children are required to sustain attention for long periods of time when in school and opportunities for breaks from sustained attention are not always readily provided. I have to admit that I sometimes wonder if the way the dominant norm would have things done is the only way things can be done. My understanding is that it comes down to functionality which leads

Educational Opportunities and Children with ADHD into the next personal bias I would like to identify. I adopt an opinion that believes in a flexible approach to teaching that would modify learning to create a successful learning environment for all children where possible. If a child needs to move while working and can functionally

complete tasks while doing so, I would be inclined to see this as an acceptable adaptive approach potentially developed in response to difficulties associated with a diagnosis of ADHD. Academic dialogue and literature has, in several ways, contributed to the development of my understanding of ADHD as it applies to the educational system. Information provided in lecture format has succeeded in bringing experimental, biological, social and cultural influences relevant to children with ADHD to the foreground of thought consideration. The idea that society goes through developmental phases (MacDonald, 2010) applies to children with ADHD in our educational system as the way we choose to educate children reflects the societal views and culture we are immersed in. Academic dialogue poses the question has technology created the new ADHD generation (Debby Lee Kenna, November 18, 2010)? While it is true that increases in technology have created an instantaneously gratifying environment rich with immediate reinforcement, it is my understanding that research demonstrating cognitive, neurological, genetic, behavioural and social differences between children with ADHD and typically developing children would seem to indicate that ADHD is not simply a symptom of environmental influence. It could stand to reason that technological gains may one day lead to educational changes that bring an element of instant gratification into the classrooms in an attempt to support children with ADHD. Support for children with ADHD should further include the reconciliation that children present with individual strengths and weaknesses (MacDonald, 2010). The fact that children with ADHD present with a variety of difficulties does not negate the presence of a multitude of strengths that also need to be emphasized. The educational system

Educational Opportunities and Children with ADHD may call attention to weakness of children with ADHD however I truly believe there is merit in cataloguing data relevant to individual strengths as well. Supporting children with ADHD in the classroom may begin with an identification of relative weakness but should not end there. Success of children with ADHD in the educational system reflects the educational

approach the system itself adopts. For instance, the opinion exists that the public school way of sitting in a desk for a large majority of the day was designed in a time that has long passed (Bonnie Heath, November 13, 2010). Further, It is almost as if it is too easy to blame ADHD for behaviours instead of digging deeper and focusing upon solutions (Kimberly Louise Matheson Lyseng, November 15, 2010). I think that these comments identify salient challenges that have the potential to hinder effective support for children with ADHD in the classroom environment. Behaviours characteristic of ADHD historically have persisted for quite some time yet the conceptualization of ADHD has and continues to be challenged. It is difficult to support a condition that seems to be stalled out, especially in the public education system, at the conceptualization phase. With the development of a sound conceptualization of ADHD, I would hope that an understanding of ADHD would begin to become instilled within the educational system itself. As society changes so too does the educational system, however it may be suggested that while the need for change may be apparent, the direction change should take is a little less distinct. The development of a current and comprehensive conceptualization of ADHD and its application to the educational system is a process that should never end. In order to better consult with parents, professionals and educators a professional plan should include continued education, professional dialogue, reflection and analysis. Barkleys theory of inhibitory dysfunction for explaining difficulties associated with ADHD itself is a work in progress. Research has only

Educational Opportunities and Children with ADHD 10 begun to identify supportive longitudinal research that corroborates theoretical conceptualizations of ADHD. The fact that support for this theory exists does not stand to indicate that this current conceptualization is not without fault or the necessity for modification. With continued effort toward strengthening my own conceptualization of ADHD I believe that a professional plan should include the shared presentation of knowledge and mentorship. Support for children with ADHD in the educational system should not end nor potentially even begin with the child. Research has indicated strong evidence that would suggests parents of children with ADHD may in many cases share the same diagnosis (Mash and Barkley, 2003). Therefore, in order to support children with ADHD in the educational system knowledge of ADHD conceptualization would benefit parents of children with ADHD. Additionally, I believe that a professional plan should also incorporate continued professional dialogue to ensure that classroom support for children with ADHD is provided for and supported by a consistent conceptualization of the disorder. My understanding of ADHD in children and its presence in the educational system has been enhanced by the opportunities presented throughout this course. Knowing that children with ADHD are likely to exude energy and have difficulty focussing is not enough. Better understanding can lead to better intervention (MacDonald, 2010). Being able to conceptualize ADHD allows for better prediction and understanding of how to support children in healthier ways. Knowing that parents of children with ADHD might also have a diagnosis of ADHD has merit to the way a school psychologist collaborate with and support families of children with ADHD. Being readily aware of the underlying difficulties with inhibitory control and secondary executive functioning increases the school psychologists capacity to comprehend child difficulties and collaborate with educational teams. Awareness of underlying difficulties allows

Educational Opportunities and Children with ADHD 11 for educated dialogue with teachers that move past a discussion of deficits or difficulties to include an element of why certain difficulties may occur and what can be done to likely support children in the face of inherent deficits. Understanding the impact of potentially present comorbidity will help the school psychologist perceive contributing factors that may hinder the classroom success of a child with ADHD. Recognition that ADHD likely presents associated cognitive, emotional and social deficiencies and being able to explain why they exist enhances professional dialogue and collaboration between disciplines creating a comprehensive learning environment that supports the whole child. A school psychologist empowered with an educated appreciation of the developmental nature of ADHD is more likely able to support children with ADHD as they progress through the educational system and throughout life.

Educational Opportunities and Children with ADHD 12 References American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition: Text Revision. Washington, DC. Mash, E. J. & Barkley, R. A. (2003). Child psychopathology, 2nd edition. New York: Guilford Press