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Health Issues

School can be particularly challenging for children with attention-deficit/hyperactivity disorder (ADHD), who often experience poor academic performance, behavior problems, and difficulties with social interaction. Coexisting conditions, such as a learning disability, an anxiety disorder, or disruptive behavior problems, can make it even more difficult for a child to succeed. The situation can be further complicated by the fact that there is no typical, predictable classroom style common to all children with ADHD—some parents of children with ADHD may receive reports that their child is “not trying hard enough” academically, while others may be told that their child turns in acceptable work but frequently violates classroom rules. It can be hard for you as a parent to tell how much of any problem identified by a teacher falls into the normal range of child development, how much is due to ADHD, and how much is due to a coexisting problem. Add to this the fact that the focus of your child’s problems may change from year to year—from largely behavioral to academic, from academic to social, and so on. It is small wonder that children with ADHD and their families often find school issues so central to their overall concerns.

The better informed you are as a family about the many ways in which ADHD may affect your child’s school experience, the better prepared you will be to anticipate and deal with problems before they become insurmountable. You can use the information provided in this chapter to help foster your child’s academic and social success in school. In the following pages, you will learn

  • What types of school-related challenges children with ADHD face most often
  • How to identify your own child’s particular areas of concern
  • Which classroom structures, school policies, teaching styles, and accommodations can best support your child’s learning
  • What an Individualized Education Program (IEP) is and how to work with your child, his teachers, and the school team to create one
  • How to promote school success at home and elsewhere

What Types of Challenges Do Children With ADHD Typically Face at School?

Because ADHD can limit a child’s ability to pay attention and control impulses and behavior, it is easy to imagine how problems in these areas can affect many aspects of school life, and how such problems can increase if not addressed effectively early on. In general, children with ADHD experience their greatest challenges in the areas of behavior management, academic progress, and social interaction. Due to changing school demands and changes in your child’s symptoms, she may face greater problems in one area at a particular age and in another as she grows older. It is important to continue observing your child’s functioning in each of these areas, and to encourage her to gain skills in monitoring her own functioning, to address any emerging problems as soon as possible.

Behavior Issues

Disruptive behavior is a common expression of hyperactive-impulsive– and combined-type ADHD, and can begin to create real problems as a child enters kindergarten or elementary school. Because so many of the demands in the early school years involve following rules and settling down, the inability to meet these demands is what frequently leads to questions about whether a child might have ADHD. A teacher may report that such a child “talks too much,” “acts out constantly,” or “doesn’t seem to recognize limits.” Teachers may suggest that the child’s impulsive behavior is alienating the other children or making it difficult to maintain order in the classroom and on the playground. As a child with hyperactive-impulsive– or combined-type ADHD grows, the ADHD symptoms may begin to be expressed less in physical terms and more verbally. The child may interrupt frequently or speak out of turn, and perhaps even “mouth off” to authority figures or his classmates.

Other factors not directly attributable to ADHD may increase your child’s behavior problems at school. Parents’ or teachers’ lack of knowledge about how to support or work with a child with ADHD, or a child’s past negative preschool or child care experiences, can damage his self-esteem or attitude. This can cause him to give up trying to follow rules or please authority figures, at least temporarily. Coexisting conditions, such as depression, can also intensify a child’s difficulties.

Even the normal developmental stages of childhood, such as a sixth-grader’s testing of boundaries (refusing to do homework) or an adolescent’s desire not to seem different from his classmates (avoiding taking medication), can have a negative effect on his functioning. Stresses in the home environment—marital conflict, financial difficulties, discipline problems, or other issues—can also affect your child’s behavior at school. Finally, it is important to remember the role that general health plays in your child’s behavior. Every child, including children with ADHD, should receive routine medical care and have his vision and hearing tested.

Academic Concerns

While behavior management issues are often the first school-related problems that children with ADHD experience, academic progress often becomes an area of increasing concern. Regardless of your child’s intellectual abilities, she may find it hard to meet academic expectations as her symptoms interfere with her ability to learn, or she fails to receive some of the academic supports that she needs. Because it is difficult for many children with ADHD to stay on task and work independently for long periods, they often complete less work and thus have fewer chances to respond appropriately during the teacher’s instruction. Problems with work production (incomplete work, sloppiness, failure to follow instructions) and inconsistency (satisfactory work one day and poor output the next) can become major barriers to school success. This may partially account for the estimates that 60% to 80% of children with ADHD underachieve academically and are identified by their teachers with some school performance problems. About 20% of children with ADHD have specific learning disabilities, such as a reading disorder, mathematics disorder, or expressive language disorder, that are separate from their ADHD symptoms.

It is easy to see how many ADHD-type behaviors can interfere with successful learning in a typical classroom. Your child’s distractibility and lack of persistence may prevent her from retaining material taught in class. Her impulsivity may cause her to rush through schoolwork and respond spontaneously to questions instead of thinking ideas through. A poor sense of time, characteristic of many children with ADHD, can make long homework assignments, time-limited tasks, and test-taking extremely difficult. Organizing, planning, and sequencing problems lead to incomplete work, poor note-taking skills, or an inability to follow a work schedule or finish a long assignment. Poor fine motor planning can make the actual writing process difficult—limiting your child’s ability to take notes, complete tests, and write effortlessly. Short-term memory problems can make it difficult to memorize facts. Inconsistencies and fluctuations in performance are common. Children with ADHD can also do well in any of these areas one day and poorly the next.

Around the fourth grade, as more academic focus and work production is required (as students move from “learning to read” to “reading to learn”), children with inattentive- or combined-type ADHD often begin to fall behind academically. Failure to pay attention to classroom lectures and turn in homework are typical symptoms that alert teachers to a child’s difficulties.

As children with ADHD enter middle school and high school, they may encounter new challenges due to poor organizational skills, incomplete work, or a failure to turn work in. Because many of these behaviors are also experienced by children who do not have ADHD, your child’s teacher may suggest that these problems are due to lack of motivation, low selfesteem, or other psychological causes. However, as you will read, when children with ADHD have these problems, they may qualify for extra support in school to help with overcoming or bypassing these obstacles. By middle school academic performance can also decline if medication schedules are not adjusted to cover lengthening homework time (in situations where medication is indicated and has been helpful), or if a child’s treatment plan fails to meet her changing needs in other ways.

When a child is far behind in learning, a learning disability should be suspected. Children with coexisting learning disabilities may experience more long-lasting and serious academic difficulties than those struggling academically on the basis of ADHD alone. Learning disabilities are diagnosed when a child has not developed specific academic skills at the expected level in spite of adequate intelligence and education. The category of learning disabilities is designated by schools. Schools do not medically diagnose conditions, but rather determine if a child’s apparent need, such as a learning problem, will qualify that child for special education services under a disability category, such as a specific learning disability. Federal legislation requires each state to develop its own criteria for determining a specific learning disability. The criteria must allow use of a process based on the child’s response to scientific, research-based educational interventions. This is often called response to intervention or RTI. The category of specific learning disabilities is defined by federal definition as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that can result in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations.”

A student with a learning disability in one area may excel in others. Some children with learning disabilities may have excellent verbal and reading skills, for example, but do poorly in math, while others may have the opposite profile. Keep in mind, however, that ADHD is not itself a learning disorder, that it does not necessarily lead to academic difficulties at school, and that neither ADHD nor learning disabilities are signs of low intelligence. In fact, children with ADHD display the same range of intelligence as their classmates. Learning disabilities are recognized in reading, mathematics, and written expression.

Social Concerns

For many children with ADHD, interactions with classmates tend to become difficult at one time or another. Children with ADHD can be disliked, ignored, or rejected by their peers. Some children with ADHD can be impulsive and intrusive in social relationships, physically or verbally overwhelming others. Others may not initiate interactions with their classmates, or miss the social cues necessary to establish positive relationships, and thus become socially isolated. Inattentiveness or impulsivity may decrease a child’s success in games, sports, or other group activities that would otherwise enhance popularity. Younger children with hyperactive-impulsive– or combined-type ADHD may frequently experience physical conflicts with their peers, pushing their way into lines, or being “in their face.” By middle childhood, a child’s hyperactive-impulsive–type behaviors, discipline problems, perceived “spaciness,” or social awkwardness may lead to social rejection. Some adolescents with ADHD may be 1 to 2 years less mature than their classmates, further complicating their social relationships at a time when they are taking on great importance.

Later you will find suggested ways for you and your child’s teacher to provide opportunities for your child to improve her social standing and interact more successfully with her peers. Meanwhile, social concerns should be discussed at any meeting aimed at evaluating your child’s progress and needs.

 

Last Updated
5/11/2013
Source
ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.