SPECIAL TOPIC
ADHD
From Stereotype to Science
Forget Dennis the Menace and other outdated stereotypes
about kids with ADHD. New research reveals the breadth
and complexity of the disorder.
Thomas E. Brown disorder, now referred to as ADHD, efficiently; managing emotions; using
I
has been considered essentially a short-term working memory; and
n almost every classroom, at least behavioral problem. For a long time, monitoring one’s actions to fit the
one or two students are identified it was seen as just a problem of setting and avoid excessive impulsivity
as having attention deficit hyper hyperactive little boys who couldn’t (see fig. 1 on p. 55).
activity disorder (ADHD). Some sit still, wouldn’t stop talking, and n All of us experience character
times the parents mention at the frustrated their parents and teachers istics of ADHD from time to time;
start of the term that their child has with chronic misbehavior. The term those with ADHD simply have more
been diagnosed with ADHD; some attention deficit wasn’t added to the chronic and impairing difficulty with
times word comes from a 504 plan name until 1980. Since then, there these problems. ADHD isn’t an all-
or a teacher who previously had that have been substantial changes in our or-nothing situation like pregnancy,
student in class. Usually the ADHD scientific understanding of ADHD that where one either is or isn’t pregnant.
label is taken as a warning that the are important for educators to know. ADHD is more like depression—it
student is likely to be difficult to teach comes in small, medium, and large
and manage, that he or she will be An Update on the Basic Facts levels of severity. Everyone feels down
more restless and disruptive than most These facts are now well-established in sometimes, but being unhappy for
other students in the class. the scientific research. a couple of days doesn’t warrant a
However, this image of the student n ADHD is a developmental diagnosis of clinical depression. The
with ADHD as Dennis the Menace is impairment of the brain’s self- diagnosis is reserved for those who are
an outdated stereotype. Some students management system that includes significantly and persistently impaired
with ADHD are restless and disruptive, problems with getting motivated, by their symptoms.
but many others with this disorder are organized, and started on necessary n Although some children and
quieter, more distracted and passive, tasks; focusing on what needs to be adults with ADHD have significant
and not very productive or consistent attended to and shifting focus when problems with hyperactive and exces
in their work. needed; managing alertness and sleep; sively impulsive behavior, many
Ever since it was first described in sustaining effort to complete tasks; with the disorder don’t display such
the medical literature in 1902, the processing and outputting information behavior. The majority of those who
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© ANNA & ELENA BALBUSSO/THEiSPOT
were “hyper” as children outgrow variability in developing ADHD is
most of their hyperactivity in early accounted for not by family envi-
adolescence but continue to have ronment but by inherited vulnerabil-
chronic difficulty with inattention and ities (Faraone et al., 2005). Subsequent
related problems. ADHD is found studies have demonstrated that this
n ADHD is highly heritable; it runs
in families. Twenty-five percent of
in people across vulnerability isn’t caused by any one
gene; it’s caused by a large number of
children with ADHD have a parent the full range of genes in combination.
with ADHD, and 30 percent have n Longitudinal and other imaging
a brother or sister with ADHD. intellectual abilities. research has demonstrated significant
Twenty studies comparing identical differences in brain development
twins yielded a heritability index of and connectivity of children with
0.75, which means that most of the ADHD compared with typically devel-
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oping children of similar age (Shaw n ADHD is not just one or two spe- struggle with chronic ADHD problems
et al., 2007). Although much brain cific symptoms. It’s a complex syn- may have none of those problems
development is similar in the two drome, a cluster of impairments that when they engage in a particular
groups, some areas of the brain that often appear together, although some activity or task.
are important for self-management aspects of the disorder may be more Although they struggle to focus
tend to mature about three to five or less prominent in any particular on their schoolwork, students with
years later in those with ADHD. person. There are many differences ADHD may demonstrate a remarkable
n It was once thought that a child among those with ADHD, even among ability to focus and work effectively
with ADHD would outgrow the dis- those of similar age; people with the when they’re playing a sport, creating
order before reaching the age of about disorder are not all alike in either their art or music, doing mechanical tasks,
14. However, longitudinal studies have strengths or their difficulties. or playing a favorite video game.
shown that approximately 70 percent
of those who have ADHD in childhood
will continue to have some ADHD
impairments at least into late adoles-
cence (Biederman, Petty, Evans, Small, Some students with ADHD are restless and
& Faraone, 2010; Biederman, Petty,
Monuteaux, et al., 2010.) For many disruptive, but many others who suffer from
but not all, the impairments of ADHD
continue throughout life.
this disorder are quieter and more distracted.
n ADHD is sometimes apparent
during the preschool years, but it’s
often not noticeable until the child
enters elementary school or advances n Most people with ADHD also Although they may not be able to keep
into middle school, where there’s no have difficulties resulting from one or directions for assignments in mind
longer just one teacher who provides more co-occurring disorders. The inci- or retain basic facts learned in social
structure and control for most of the dence of learning disorders, anxiety studies or math, they may have an
day. Some children don’t demonstrate and mood disorders, sleep disorders, incredible ability to recall the statistics
significant ADHD impairments until obsessive-compulsive disorders, about their favorite baseball team or
they enter high school or move away substance use disorders, and autism the lyrics of popular songs.
from home and must deal with chal- spectrum disorders is considerably When asked why they can focus
lenges of more independent life in higher among those with ADHD than so well when it comes to these few
college or employment. Those with in the general population. Sometimes activities, students with ADHD often
later onset of ADHD can be fully as the co-occurring disorder is recog- reply that it depends on whether the
impaired as those with earlier onset. nized, whereas the ADHD is not. task is interesting—that if it’s not,
n ADHD has nothing to do with how n Medication doesn’t cure the dis- they just can’t stay tuned. Although
intelligent a person is. ADHD is found order, but for about 8 of 10 people this may be true for everyone—that
in people across the full range of intel- with ADHD, carefully managed we focus better on things that interest
lectual abilities. medication significantly improves the us—there’s an important difference
n Emotions play two important roles symptoms. These medications aren’t here. Most of us can make ourselves
in ADHD, neither of which is reflected like an antibiotic that may cure an focus on something we recognize as
in current diagnostic criteria. First, infection; they’re more like eyeglasses important, even though it’s pretty
conscious and unconscious emotions that improve vision while they’re boring. For those with ADHD, doing
play a crucial role in the problems of worn. so is much more difficult.
motivation and self-regulation that A patient once remarked to me that
are pervasive in ADHD. Second, many The Central Mystery of ADHD having ADHD “is like having erectile
people with ADHD have chronic dif- There’s one fact about ADHD that’s dysfunction of the mind. If the task
ficulty recognizing and managing the most puzzling: The symptoms are situ- you’re trying to do is something that
expression of their emotions. ationally variable. That is, people who really interests you, you can perform.
54 Educational Leadership / October 2015
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But if the task you are trying
to do is not intrinsically FIGURE 1. Executive Functions Impaired in ADHD
interesting, you can’t make
it happen.” Although ADHD
often appears to be a problem Executive Functions
with willpower, it’s not. It’s a (work together in various combinations)
problem with the dynamics of
the chemistry of the brain.
When people are faced
with a task that really Organizing, Focusing,
Regulating
Managing Utilizing
interests them—because it alertness, Monitoring
prioritizing, sustaining, frustration working
sustaining and self-
appears to offer pleasure to and and shifting and memory
effort, and regulating
activating attention to modulating and accessing
them at that moment or seems to work tasks
processing
emotions recall
action
speed
to ward off some imminent
unpleasantness they want
to avoid—that perception,
1. 2. 3. 4. 5. 6.
conscious or unconscious, Activation Focus Effort Emotion Memory Action
instantly changes the chem-
istry of the brain. This moti-
Source: From Attention Deficit Disorder: The Unfocused Mind in Children and Adults (p. 22), by Thomas E. Brown,
vation process is not under
2005, New Haven: Yale University Press. Copyright © 2005 by Thomas E. Brown.
our voluntary control.
ADHD and Reading
The motivation problem is often or explain in detail the storyline of a need it for the test, but a few hours
apparent in reading. Students with movie they saw years ago. Yet they or days later, something jogs their
ADHD often report that they may may have great difficulty keeping in memory and the information is back
understand a text as they read it—they mind the directions the teacher just again.
can decode all the words and under- gave for an assignment. During class It’s not that the students hadn’t
stand what’s being said. Yet just a few discussions, students with ADHD may learned it; they simply weren’t able to
minutes later, they don’t have the raise their hands to answer a question retrieve the information from memory
foggiest idea what they just read. To the teacher has posed and then forget when they needed it. Working
extract the meaning of the text and what they intended to say if the memory is the search engine of the
retain it, they often have to reread it teacher calls on someone else first. brain. Those with ADHD often suffer
several times. One student with ADHD Their problem isn’t with long-term from chronic difficulties with their
reported, storage memory; the memory problem working memory even though their
When I’m reading something that’s in ADHD is more with short-term longer-term storage memory works
not really interesting to me, it’s like working memory, the ability to keep very well.
I’m licking the words and not chewing one bit of information in mind while
them. I know what all the words mean thinking about or doing something ADHD and Writing
as I’m reading them, but they just don’t else. Of all the primary academic tasks,
stick inside my head. I don’t really
digest them. That’s why I have to write Students with ADHD will sometimes typically the most difficult one for
notes while I’m reading or use a high- study for a test the night before the students with ADHD is written
lighter or else just read the same page test is given. A parent may quiz them expression. In the earliest grades, the
over several different times. until they have all the material clearly student with ADHD may be excep-
in mind. They walk into class the next tionally slow in doing any written
ADHD and Memory day expecting to get a really good work. In the time it takes most other
Many students with ADHD have grade, only to find that a big chunk students to put the heading on their
adequate or even exceptionally good of what they knew so well the night paper and copy the first three sen-
long-term storage memory. They may before has suddenly evaporated. They tences from the board, the student
be able to recite extended song lyrics can’t recall the information when they with ADHD may still be working on
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getting his or her name and date in the sequence, and elaborate their thoughts be struggling with this disorder. When
heading. When writing tasks get more in a structure they need to create. Slow a student demonstrates impairments
lengthy and complex in the higher processing speed is often characteristic that may be related to ADHD, the
grades, students with ADHD often of students with ADHD. teacher can describe the student’s diffi-
report that they have many good ideas culties in detail and encourage the
for what to write, but it takes them What Can Educators Do? family to present this information to
forever to put their thoughts into orga- Assessment and diagnosis of ADHD their pediatrician or other specialist.
nized sentences and paragraphs. usually require a licensed physician, Such early identification can prevent
Written expression makes more psychologist, or other medical spe- students with ADHD from becoming
demands on the executive functions cialist who has been trained to demoralized by repeated experiences
that are often impaired in ADHD than recognize the disorder and design of frustration and failure and can
do reading and writing. The words appropriate treatment. But classroom ensure that they receive the assessment
and numbers found in texts and math teachers and school administrators and support they need to succeed. EL
problems provide a structure and have an important role to play.
an organization to assist the reader, Educators who are aware of our new Copyright © 2015 Thomas E. Brown
whereas written expression requires understandings about ADHD are better
students to organize, prioritize, equipped to identify students who may References
Biederman, J., Petty, C. R., Evans, M.,
Small, J., & Faraone, S. V. (2010).
How persistent is ADHD? A controlled
10 year follow-up study of boys with
Resources for Educators About ADHD ADHD. Psychiatry Research 177, 299–
304.
Websites Biederman, J., Petty, C. R., Monuteaux,
M. C., Fried, R., Byrne, D., Mirto, T.,
Understood ([Link] This website, created by 15 nonprofit Spencer, T., et al. (2010). Adult psychi-
organizations, offers parents and teachers extensive and easily accessible atric outcomes of girls with attention-
information about attention and learning problems. deficit hyperactivity disorder: 11-year
follow-up in a longitudinal case-control
The National Resource Center on ADHD ([Link]), a clearing- study. American Journal of Psychiatry.
house for the latest evidence-based information on ADHD, is funded by the 167(4), 409–417.
U.S. Centers for Disease Control and Prevention. Faraone, S., Perlis, R. H., Doyle, A. E.,
Smoller, J. W., Goralnick, J. J.,
Books Homgren, M. A. & Sklar, P. (2005).
Molecular genetics of attention deficit/
Bright Kids Who Can’t Keep Up by Ellen Braaten and Brian Willoughby hyperactivity disorder. Biological Psy-
(Guilford Press, 2014). chiatry, 57(11), 1313–1323.
Shaw, P., Eckstrand, K., Sharp, W., Blu-
Attention Deficit Disorder: The Unfocused Mind in Children and Adults by menthal, J., Lerch, J. P., Greenstein,
Thomas E. Brown (Yale University Press, 2005). D., Clasen, L., et al. (2007). Attention-
A New Understanding of ADHD in Children and Adults: Executive Function deficit/hyperactivity disorder is charac-
terized by a delay in cortical maturation.
Impairments by Thomas E. Brown (Routledge, 2013).
Proceedings of the National Academy of
Smart but Stuck: Emotions in Teens and Adults with ADHD by Thomas E. Sciences, 104(49), 19649–19654.
Brown (Jossey-Bass/Wiley, 2014).
How to Reach and Teach Children with ADD/ADHD: Practical Techniques,
Thomas E. Brown ([Link]
Strategies, and Interventions (2nd ed.) by Sandra F. Reif (Jossey-Bass/Wiley,
brown.com) is a clinical psychologist and
2005). associate director of the Yale Clinic for
Teaching Teens with ADD, ADHD, and Executive Function Deficits: A Quick Attention and Related Disorders in New
Reference Guide for Teachers and Parents (2nd ed.) by Chris A. Ziegler Dendy Haven, Connecticut. His most recent
(Woodbine, 2011). book is Smart but Stuck: Emotions in
Teens and Adults with ADHD (Jossey-
Bass/Wiley, 2014).
56 Educational Leadership / October 2015
[Link] 56 8/27/15 4:46 PM
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