At Beacon we are passionate about ADHD. Many clinicians are reluctant to give this diagnosis because of the negative connotations associated with it.
However, we see many of our students present with strong characteristics of ADHD. They may never have considered that they have this particular SpLD because of the media myth of ADHD which paints an inaccurate picture of children who are out of control. Our experience is that many of our students who present with ADHD are perfectly capable of controlling their behaviour.
We continue to carry out research into ADHD at Beacon and we hope you find the first of our series on ADHD written by our Head of Services of interest and use.
ADHD is forgetfulness and impulsiveness that gets you fired. ADHD is forgetting why you entered a room, forgetting what you wanted to say, putting the milk away with the teacups, talking over everybody before you forget what you wanted to say, and then getting distracted by your phone when they respond — all within 15 minutes or so. Each day. All day. It’s absentmindedness weaponized.
(Cootey, 2016, in Tartakovsky, 2016)
Attention Deficit Hyperactivity Disorder (ADHD) is a commonly misconceived condition which can result in chronic difficulties for learners, both diagnosed and undiagnosed, within the education system (Meehan et al., 2008).
The International Classification of Mental and Behavioural Disorders 10th Revision (ICD-10) is a medical classification system, developed by the World Health Organization (WHO) which describes ADHD as hyperkinetic disorder (HKD), a label that is commonly used across Europe. The ICD-10 defines HKD as a severe impairment of psychological development that is persistent and present from a young age (WHO, 2017). The ICD-10 is designed to complement the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) which was published in 2013 as an update to the American Psychiatric Association’s (APA) classification and diagnostic tool.
The most frequently assessed and diagnosed Specific Learning Difficulties (SpLDs) are dyslexia, found within ten percent of the populace (BDA, 2017); dyspraxia, found within five to ten percent of the populace (Dyspraxia Foundation, 2017) and dyscalculia, found within four to six percent of the populace (Badian, 1999). Whilst ADHD is often recognised to be present as a co-morbid condition, it can also present as a singular disorder.
There is no global consensus on the prevalence of ADHD. However, meta-regression analyses estimate the worldwide prevalence at between 5.29%and 7.1% in children and adolescents and at 3.4% (range 1.2–7.3%) in adults; the two populations that have been most often researched. A meta-analysis of studies (n=102) of children and adolescents (<18) found variance between countries, with the European prevalence of ADHD to be just under 5% (ADHD Institute, 2016). Maucieri (2014) comments that ADHD may be undiagnosed, which is an important concern of any prevalence statistics, as is the concern that it may be overdiagnosed, which is the more widely held view (Thomas, Mitchell and Batstra, 2013). Due to the way in which ADHD is diagnosed, prevalence will vary significantly between countries according to cultural bias, awareness and diagnostic guidance.
ADHD is a relatively newly recognised condition, despite being the most common neurodevelopment disorder of childhood (Shaw et al., 2007). The first description of the condition was in 1902, where it was classified as a defect of moral control. By 1937 the medication Benzedrine was introduced for children with behavioural problems. By 1980 the DSM-III included the label Attention Deficit Disorder (ADD) and its 3 subtypes: hyperactive, non-hyperactive, and residual. It referred to the condition as a disruptive behaviour disorder of childhood (Brown, 2013). In 1987 the DSM-III referred to the condition as ADHD. It then took twenty six years for the APA (2013) to publish new guidance on ADHD in the DSM-5, which is now included in the neurodevelopmental disorders section, as opposed to its previous classification under disruptive behaviour disorders.
Despite the new paradigm of ADHD, as reflected in its recent reclassification, the enduring myth that it is a behavioural disorder continues (Brown, 2013). For instance, an impairment that is commonly associated with ADHD is delinquent behaviour. Whilst ADHD is often characterised by behavioural difficulties such as frustration and impulsive negative reactions, clinical behavioural difficulties such as Oppositional Defiant Disorder are reported in as few as 40% of individuals with ADHD (Brown 2013).
Brown (2013) summarises other key misunderstandings of ADHD, including the misconception that individuals cannot concentrate and the polar belief that individuals with ADHD can concentrate when they wish to do so. Evidence shows that whilst individuals with ADHD can concentrate, they have no control over this (Kahneman, 2011). Another popular myth is that ADHD is a condition that will be eventually ‘outgrown’, which is not the case for all individuals (Shaw, et al., 2007) as symptoms can continue into adulthood in more than 50% of cases, with some studies finding that eighty percent of children that have been diagnosed in childhood will retain their diagnosis as adults (Barkley, 2006).
It is the author’s experience that ADHD is complex in terms of assessment and support. In relation to diagnostic assessment, a specialist teacher can make a case for the student to be awarded Disabled Students’ Allowances (DSA), where sufficient evidence can be presented of ADHD, whilst being unqualified to make a formal diagnosis (SASC, 2016). However, the adult student will face numerous barriers to securing a formal diagnosis, not in the least because there are no standardised diagnostic tools in existence. This is due to the fact that there is no standard cognitive profile of ADHD as there is no ‘one size fits all’ (Nigg, 2009). Diagnosis is instead based on observed behaviour, self-report and the collection of qualitative information.
Student retention among higher education students is one of the biggest challenges for universities, with figures published by the Higher Education Statistics Agency revealing that over 32,000 students dropped out of university in their first year of study in 2012/13 (Gurney-Read, 2015). Whilst 7,420 transferred to another university, 24,745 were no longer in higher education. Students with ADHD are more likely to drop out of higher education than their peers, with nearly one-third of students diagnosed with ADHD in the USA abandoning their studies prior to completion (Preidt, 2010). This establishes an early pattern of failure and has serious implications for future success in life, physical, social, and emotional health (Preidt, 2010).
Our starting point to supporting our ADHD students at Beacon is to adhere to the social model of disability. This is a progressive concept that is anti-medical and makes a distinction between ‘impairment’ and ‘disability’, with disability being defined as the lack of consideration given by the organisation of society to the physical or psychological impairments of the individual who is disabled (Shakespeare and Watson, 2001). This is a social constructionist distinction which highlights the limitations brought about by the environment and social discourse, and which recognises that whilst some individuals have physical or psychological differences which can affect their ability to effectively function within society, it is society itself which causes these differences to become disabling. The barriers raised by factors external to the individual result in a difficulty or inability to move, function or communicate as effectively as people without impairments.
Disabled people are more than twice as likely as non-disabled people to have no qualifications; furthermore, approximately fifty percent of impaired people of working age who can work are in work, compared with 80% of non disabled people of working age (Shaw Trust, 2005). From a cultural perspective, society disables certain individuals because of the pervasive culture of prejudice against anyone perceived to be ‘different’, and unfortunately, such attitudes are often perpetuated by the media (Shakespeare and Watson, 2001). Therefore, at Beacon, we promote the new paradigm of ADHD so we can begin to introduce effective support within a Higher Education environment.
References
ADHD Institute (2016) Epidemiology [Online] Available at: http://www.adhd-institute.com/ burden-of-adhd/epidemiology/ (Accessed: 12/12/16)
Badian, N. A. (1999). ‘Persistent arithmetic, reading, or arithmetic and reading disability’. Annals of Dyslexia, 49, pp. 45-70.
Brown, T. E. (2013) A New Understanding of ADHD in Children and Adults. London: Routledge
Kahneman, D. (2011) Thinking, fast and slow, New York: Farrar, Straus and Giroux.
Maucieri, L. (2014) Adult ADHD: Overdiagnosed? Underdiagnosed? Or Both? [Online] Available at: https://www.psychologytoday.com/blog/the-distracted-couple/201403/adult-adhd-overdiagnosed-underdiagnosed-or-both (Accessed: 14 December 2016).
Meehan, K., Ueng-Mchale, J., Reynoso, J. Harris, B., Wolfson, V., Gomes, H. & Tuber, S. (2008) ‘Self-regulation and internal resources in school-aged children with ADHD symptomatology: An investigation using the Rorschach inkblot method,’ Bulletin of the Menninger Clinic, 72(4), pp.259-282
Nigg, J. T. (2005) ‘Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade,’ Biological Psychiatry, 57, pp. 1424–1435.
SASC (2016) ADHD Guidance [Online] Available: http://www.sasc.org.uk/SASCDocuments/ ADHD%20 Guidance-September%202013.pdf (Accessed: 12th March 2017).
Shakespeare, T. & Watson, N. (2001) ‘The social model of disability: an outdated ideology?’ Research in Social Science and Disability, 2, pp. 9-28.
Shaw, P., Gornick, M., Lerch, J., Addington, A., Seal, J., Greenstein, D. Sharp, W., Evans, A., Giedd, J. N., Castellanos, F. X. & Rapoport, J.L. (2007) ‘Polymorphisms of the Dopamine D4 Receptor, Clinical Outcome, and Cortical Structure in Attention-Deficit/Hyperactivity Disorder,’ Archives General Psychiatry, 64 (8) pp. 921-931.
Tartakovsky, M. (2014) Why ADHD is Misunderstood. [Onine] Available:https://psychcentral .com /blog/archives/2014/11/27/why-adhd-is-misunderstood/ (Accessed: 5th January 2017).
Thomas, Mitchell & Batstra (2013) ‘Attention Deficit Hyperactivity Disorder. Are we Helping or Harming?’ British Medical Journal, 347.
