Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by severe and persistent inattention, hyperactivity and/or impulsivity. It’s thought to affect about 5% of children and young people worldwide, though estimates vary (a UK study reported a prevalence of 1.6% in 5–19 year olds). It’s known that young people with ADHD tend to have poorer educational and social outcomes than their peers. In fact, difficulties such as low academic attainment, antisocial behaviour, low self-esteem, poor physical health, increased risk of accidents and poor occupational outcomes can all persist into adulthood.

Young people with ADHD have higher rates of school absence and are more vulnerable to risk factors for low school attendance, including bullying, social isolation, low attainment and disciplinary exclusion. Previous studies have found that whilst young people with ADHD often understand their teachers’ expectations for schoolwork and behaviour, they tend to struggle to meet them and many report negative experiences of education. Interventions can help and we know that effective parent-teacher interactions and a good understanding of ADHD (by both school staff and parents) can help to enable access to appropriate and effective support.

Recognising the challenges that these young people face at school is vital. Greater knowledge will allow researchers and commissioners to understand what changes could be made to benefit children and young people with ADHD. Along with her colleagues, our Researcher of the Month, Dr Abby Russell has recently published a paper which aims to explore these children’s educational experiences and suggest actionable recommendations for government, schools and families.

Summary

The study provides qualitative insights from 64 young people with ADHD (20 female and 44 male), alongside interviews with 28 parents. This generated two main experiential themes. The first was labelled the ‘problematic provision loop’; a negative cycle of experiences during children’s early education, often within the mainstream sector. The second focused on positive developments and a progression out of this loop, often after a change in school.

Young people and their parents frequently described negative experiences of school. Mainly, these were felt to occur due to a mismatch between the young people’s needs and the structures and support offered in mainstream provision. Interviews showed that negative interpersonal experiences and frustrations seemed to stem from a lack of understanding of ADHD amongst school staff and a lack of appreciation of the support needed to alleviate these children’s difficulties. The children reported feeling misunderstood, being labelled as ‘naughty’ and that teaching staff did not understand that they do not have full volitional control of their behaviour, or reactions to others or their surroundings.

The paper notes that the process of ADHD diagnosis led to the most substantive and positive changes in young people’s educational experiences. Diagnosis was associated with the ability to transfer out of mainstream school and access to additional support for learning. Progression out of the ‘problematic provision loop’ often coincided with a change of school (frequently movement to a special school or other alternative provision), when children found themselves in a setting that could adapt to support their needs.

Young people’s experiences of education seemed to be enhanced in settings which leveraged their strengths through learning that engaged them personally, often related to their interests and hobbies. Flexibility around their difficulties was found to be key. This included delivering lessons that were not overly-demanding of sustained attention, giving the young people agency and choice over what they studied or how they engaged with school and having the ability and permission to exert physical energy. Where ADHD was well-managed or supported, young people reported staying on a more positive path.

To ensure that school staff better understand ADHD and other neurodevelopmental conditions, Dr Russell recommends that policy makers and local authorities should consider delivering neurodevelopmental and mental health training to educational practitioners and should provide schools with sufficient resources to implement support for children with ADHD. Assessment and diagnosis processes need to be refined to enable children to access appropriate learning and support more quickly. She also advised that schools should be provided with resources to help children awaiting a formal diagnosis. The paper also notes the benefits of a range of suitable education provisions for children with ADHD or other special educational needs and of allowing schools to offer a more flexible curriculum.

Implications

“Engagement with education is associated with long-term positive outcomes, so finding methods to better support young people with ADHD in school is critical.”

Dr Russell’s study provides six key recommendations for school staff:

1. Promote inclusion and celebrate individual differences.

The report notes that young people with ADHD are negatively affected by their initial understanding that they are different from the majority of their peers. “A school culture that promotes inclusion, and celebrates individual differences, could help to remedy some of these negative impacts, reduce victimisation, and improve young people’s experiences of education.” Staff should be wary of interventions which make children feel distanced from their peers and implement individual adaptations sensitively.

2. Offer genuine individual accommodations and tailor learning to interests and needs.

It’s important to talk to young people themselves about potential adaptations. Find out what is most likely to help each individual. A range of options could be discussed with the child and their parents before being trialled. Get to know individual children and their likes and interests. Use their strengths!

3. Support children and families awaiting a formal diagnosis.

Recognise that this is a stressful time for families. Talk to parents and ask how you can support their child during the process of assessment.

4. Be aware of stressful periods for the child and family.

Common stress points include times of transition and the time lag between the recognition of problems and obtaining support. Schools should aim to provide an understanding, supportive environment and facilitate the development of positive peer and teacher-student relationships.

5. Minimise or eliminate use of exclusion and suspension for children with ADHD, and avoid isolating children.

When schools make every effort to work with young people to resolve issues, they are less likely to become trapped in the problematic provision loop.

6. Work on trusted relationships with new students with ADHD.

Bear in mind the young person’s prior experiences of education and strive to develop positive relationships.

Dr Russell’s Tools for Schools flex toolkit is an extremely useful resource for primary settings.