Literature Review Of Attention Deficit Hyperactive Disorder
The literature review attempts to define the impairment attention deficit hyperactive disorder (ADHD) and provide information relating to the identification and available support for children with this condition. A brief overview of research conducted by Cast and Burke (2002) Barber, Grubbs and Cottrell (2005) and Mujiyati and Adiputra (2018) will examine possible links between ADHD and self-esteem. They will also analyse the importance of ADHD in relation to education and learning for children with this impairment. Finally, the review will reflect upon the challenges practitioners face when teaching children with ADHD.
Literature Review
Abibullaev (2012) explains that ADHD is a complex brain disorder, which exists in children’s lives if their practical diagnostic criteria is not supported. ADHD is a common neurological disorder which affects 3-7(%) percent of children in school. Children with ADHD experience an inappropriate level of inattention, impulsivity and/or hyperactivity. The underlying brain differences that can cause ADHD can also cause problems with learning disabilities, depression, anxiety and conduct disorder. This may only happen with learning disabilities and conduct disorder, but others may experience difficulty with their self-esteem: confidence, anxiety and avoiding challenging situations in order to feel safe.
According to the ADHD Foundation (2020) an ADHD diagnosis is determined by the presence of behavioural symptoms, which causes difficulties in an individual’s functioning. The ADHD foundation (2020) further suggest that ADHD is a prevalent childhood illness, which may continue into adolescence and adulthood. Children who have this disorder can experience difficulties focusing, maintaining their attention and controlling their behaviour. Accompanying weaknesses may be identified in areas of impulsivity, level of intelligence, spoken language and mental health difficulties. (ADHD Foundation, 2020)
Loughborough University (2020) propose that ADHD is related to the way the brain processes information. This can be understood as a combination of strengths and weaknesses that do not limit the opportunities available if reasonable changes are made subject to an individual’s ability. Loughborough University (2020) further suggest that neurodiversity is not related to intelligence. Therefore, the university portray the strengths and skills that an individual with ADHD may have, including creativity, good communication and a holistic approach to problem-solving.
The Parliamentary Office of Science and Technology (POST, 2004) state that “All educational institutions and Local Educational Authorities (LEAs) must comply with the Disability Discrimination Act 1995 (as amended by the Special Educational Needs and Discrimination Act 2001) in providing equal access to the curriculum for students with disabilities.”
Open Society Foundations (2019) advise that inclusive education means different and diverse students learning within the same classroom. Each student’s contribution and diversity are appreciated in an inclusive setting, where every child feels safe and has a sense of belonging. Furthermore, inclusive systems allow quality education for all students and are essential in order to change discriminatory attitudes within schools. Education that excludes and segregates discrimination against marginalised groups can potentially be minimalised as a result of inclusive education.
The Alliance for Inclusion Education (Allfie, 2010) state: “inclusive education is education that includes everyone, with non-disabled and disabled people (including those with ‘special educational needs’) learning together in mainstream schools, colleges and universities.” Allfie (2010) have a commitment to eradicate all barriers to participation of every child as a valued, unique individual. However, Wedell (2008) argues that the mainstream schooling foundation has been identified as a potential impediment to allowing inclusion for children with learning difficulties.
Although ADHD is not considered a learning disability, research from Learning Disabilities Association (LDS) indicates that 30-50(%) percent of children with ADHD also have a specific learning difficulty, and that these two condition interact, making learning extremely problematic. Wedell (2008) further suggests that successful inclusion can be compromised by class grouping and rigid timetabling, which can make it challenging for practitioners to give their full attention to students with behavioural disorders. Furthermore, Fox (2003) has shown inclusive education to be effective in relation to family involvement, teamwork and effective use of support staff.
According to the British Broadcasting Cooperation, (BBC News, 2020) there have been numerous cases where individual’s with ADHD have sued local authorities due to a lack of support in teaching, including Debbie Bendall. She said that her son was treated like a truant and the family had faced threats of fines over his non-attendance. Debbie filed for the accountability of schools and local education authorities (LEA) to be improved. The BBC News (2020) further state that several organisations agree and suggest the government needs to recognise the challenges many parents face and have called for an overhaul of the attendance system with more help for children who are struggling. However, Lord Justice Morritt from the British Broadcasting Corporation (1999) rule that the LEA does not have to care for children with special educational needs. The responsibility for ensuring specialist targeted support for vulnerable learners has been passed directly to the school. However, Dr Tony Lloyd (CEO of the ADHD Foundation) suggests that many schools have yet to embrace external agencies to raise attainment levels. This particularly applies in the provision of mental health services to children experiencing emotional distress. Consequently, children’s achievements are undermined, which may have a negative effect on their self-esteem (SecEd, 2020).
Cast and Burke (2002) believe that self-esteem is “an outcome of, and necessary ingredient in, the self-verification process that occurs within groups… self-esteem built by self-verification buffers the negative emotions, thus stabilises the group because it motivates individuals to form and maintain relationships that verify identities.” Drawing from several theoretical perspectives, research conducted by Booth and Gerard (2011) found that self-esteem is associated with educational achievement.
Humphries (2002) in Burden and Burdett (2005) also identifies the correlation between self-esteem and academic achievement. Humphries (2002) further highlights the importance for self-esteem and self-enhancement programmes for children with behavioural and learning difficulties. However, their research suggests that these programmes alone are not likely to overcome children’s deep feelings of failure. In contrast, the relatively limited research from Burden (2008) has produced ambiguous results, which reveal that a child’s self-esteem may not necessarily suffer due to school difficulties. However, state that “early recognition, intervention and emotional support are all significant factors in building resilience.”
The Education World (2012) state that self-esteem problems may present education and learning implications. Additionally, they suggest that low self-esteem can have a significant effect on children’s academic performance due to the fact that it lessons an individual’s desire to learn, impacts their focus and reduces their willingness to take risks. This notion concurs with Hernández et al (2017) who suggests that positive self-esteem enhances academic success and is associated with increases in school belonging.
Kuo and Yang (2019) display growing evidence to suggest that positive self-esteem mediates the relationship between academic self-efficacy and social self-efficacy. Their findings also indicate that positive self-esteem has a significant impact on children’s mood and their sense of self-worth. Moreover, Special Education Needs (2012) believe that children’s self-worth may be associated to how well they are managing their school-based academic tasks.
Although there have been vast amounts of evidence from practitioners throughout the past two decades, research has yet to address the self-perceptions of children with ADHD. To date, only a handful of researchers have recognised this issue (E.g. Dumas & Pelletier, 1999; Barber, Grubbs & Cottrell, 2005; Kitta & Inoue, 2017). Additionally, the research has involved small scaled projects, where children with an ADHD diagnosis have been interviewed. However, researchers have yet to fully acknowledge the perspectives of teaching practitioners. One of the first researchers to look at self-esteem in relation to ADHD was conducted by Dumas and Pelletier (1999). This study aimed to present findings of children’s self-esteem among hyperactive children and compare the results with a general population of children of the same age. Results revealed that all dimensions of self-perception and self-esteem were lower among children with ADHD than among children in the control group.
Barber, Grubbs and Cottrell (2005) conducted research through means of semi-structured interviews, with seventy-seven children aged 8 – 12 years in one mainstream primary school. The findings were: (1) The ADHD group had a lower score on social acceptance, physical appearance and global self-worth. (2) Teachers have an influence on the development of self-esteem among children with an ADHD diagnosis. (3) Children with ADHD often compared themselves to their peers, enhancing a feeling of isolation and loneliness. Barber, Grubbs and Cottrell (2005) commented on the significance that self-esteem scores varied most when children with ADHD experienced symptoms of depression or anxiety.
The results from research by Barber, Grubbs and Cottrell (2005) suggest that after a positive diagnosis, children experience increased self-esteem because the label offers an opportunity to explain their problems to their peers. Moreover, the term ‘Attention Deficit Hyperactive Disorder’ provided children with reassurance and offered an explanation regarding the difficulties they face at home and school. Barber, Grubbs and Cottrell (2005) further suggest that students in their study recognised the diagnosis of ADHD as the turning point for accepting their genuine specific difficulty, opposed to a general behavioural difficulty.
Biederman (2003) supports the findings of Barber, Grubbs and Cottrell (2005) and believes that early intervention after a diagnosis may address self-esteem issues and help children acknowledge their personal strengths, which is fundamental in children’s development. ADHD Research (2020) suggests that without early intervention and teaching children to manage their ADHD, there is a significant risk of educational failure, mental health challenges and difficulties accessing further education or employment. Brady’s findings (Brady, 2014) provide additional evidence, which suggests that children value their diagnosis because they begin to understand any underlying issues, they have previously experienced.
Barber, Grubbs and Cottrell (2005) explain that social isolation is devastating for children to experience during school because pupils undergo changes in the development of their self-worth. Unfortunately, isolation was a consistent theme within this study, which can lead to feelings of negativity, depression and dropping out of school. Moreover, some students highlighted that teachers often had the same expectations of them as their peers, like deadlines and time constraints. However, Gentschel and McLaughlin (2000) believe that it is paramount for primary teachers to have a full understanding of self-esteem and academic capabilities that students with ADHD lack, thus enable children to adopt healthy mental states. According to Zendarski, Sciberras and Mensah (2018) children with ADHD in mainstream school do not receive optimum educational support, which is consequently associated with increased academic risk and difficulties keeping up with non-ADHD peers.
Research by Mujiyati and Adiputra (2018) confirms that children often compare themselves with more able children. Individuals who have high self-esteem respect and consider themselves as valuable. On the other hand, individual with low self-esteem cannot accept themselves and often experience a feeling of worthlessness. Burn (1993) further states that every child should have high self-esteem in order to fully acknowledge their personal strengths and qualities. The results from this study concluded that peers have a significant effect on children’s self-esteem.
According to Coopersmith (1967), if a child experiences rejection by his/her peers, they will feel lonely, arise hostility and feel disappointed with themselves. One student revealed that he felt frequent disappointment when making comparisons between himself and his peers, which resulted in him giving up. Special Educational Needs (2012) concurs these findings and highlight the confusion related to ADHD, as it enhances children’s emotional reactions. These may appear in the form of withdrawal and anxiety due to schoolwork or misbehaving in class.
According to Educational advice (2020), the ‘National Institute for Clinical Excellence’ (NICE) guidance states that “The department for children, schools and families should consider providing more education to trainee teachers about ADHD by working with the Training and Development Agency for Schools and relevant health service organisations to produce training programmes for supporting children with ADHD.” They further suggest that schools who employ the ‘Social and Emotional Aspects of Learning’ (SEAL) initiative contribute to children’s emotional development, which underpins intellectual development. This initiative is driven by positive nurturing relationships with parents, siblings, peers and teachers.
According to the ADHD Foundation (2020) all practitioners should create a structured environment in order for children to complete tasks, make transitions, work with others, follow directions and maintain their attention. Children with ADHD prefer a learning environment that enhances predictability, structure, short work periods and positive reinforcement in order to be academically successful. Similarly, Anderson et al (2012) suggest that teachers are central to supporting children with ADHD to achieve academically and socially. They further argue that teachers’ knowledge and attitudes towards ADHD influence the subsequent behavioural and learning outcomes for children. Throughout the study, good initial teacher training was emphasised and it was agreed that teacher-training institutes need to provide accurate information about ADHD and its treatment.
Desimone (2009) supports these findings and suggests that training should be conducted collaboratively, occur over an extended time and include opportunities for teachers to receive coaching and feedback. Furthermore, research by Murray et al (2008) in Martinussen et al (2011) revealed that additional training is essential in order to enhance practitioners knowledge of ADHD and use more individualised instructional supports and behaviour management approaches to enable success for students with ADHD. However, some researchers believe that ADHD is used as a label to excuse poor behaviour and therefore do not believe in the disorder. Erdman (1998) states “ADHD is frequently misdiagnosed, even overdiagnosed, and provides an alternative way of viewing such problem behaviours in children.”
A number of researchers have examined the possible long-term implications for learners with ADHD. According to ADHD Foundation (2020) “As a child moves through adolescence into adulthood, they take on responsibilities, which can affect their emotions and self-confidence…with ADHD, everything can seem more intense and harder to handle as the difficulties become more acute.” Research by Eugene Arnold et al (2015) revealed that long-term academic results are consequently affected by ADHD, including achievement test scores and academic performance.
Katzman et al (2017) suggest that ADHD is a prevalent disorder in the adult population, yet it is frequently unrecognised, under-diagnosed and under-treated. Many adults within this study described having recollections of feeling different to peers, stupid, and embarrassed in their early school experiences. Katzman et al (2017) further believes that the origins of internalising problems, such as depression and anxiety may also be linked to these traumatic school experiences. Special Educational Needs (2012) confirm that individuals who academically underachieve are more likely to experience several unbefitting jobs, and in extreme circumstances, engage in crime.
