Articles

New findings suggest that ADHD is a learning disorder rather than a behavioral disorder.

The following article is a summary of a full article with references. The full article is published in Educational Leadership in the November 2001 / Volume 59 / Number 3 issue. It can also be accessed through the following URL. http://www.ascd.org/publications/ed_lead/200111/tannock.html

ADHD is prevalent in 2-5 percent of all school age children. Another way of looking at ADHD is that at least one or two students in every classroom have ADHD. According to Tannock and Martinussen, students with ADHD may appear with different profiles. Though many present in class as inattentive and hyperactive or impulsive, some may present as slow moving, quiet, dreamy and inattentive. Others may appear as loud, constantly in motion and impulsive. As well, these behavioral patterns may vary in different situations and learning contexts. To make matters more complicated, many students with ADHD also have specific learning disabilities and may also have associated mental health problems which are often incorrectly seen as ADHD behaviors.

This complex picture of ADHD has implications for the classroom teacher. School and classroom interventions are usually behavioral in nature. Success is limited or short-lived. And academic performance continues to be poor.

The authors suggest that one reason for the frustration in the classroom may be the gap between current scientific research and classroom practice. The direct causes of ADHD are not yet known, but research has identified certain facts. ADHD is usually not caused by environmental factors such as food allergies, excess sugar, television, poor parenting, poverty or poor schooling. ADHD is related to one's neurobiology.

Research has shown that ADHD is an inherited brain based disorder. Scientists have identified some of the genes linked to ADHD. These genes are associated with regulating the transport of the chemical dopamine. Dopamine is a one of the brain's neurotransmitters that conveys signals from one neuron to another. It appears that dopamine imbalances are related to ADHD. Researchers have also shown that taking stimulant medications increases the levels of dopamine in the brain. Much of this knowledge has been further corroborated through brain-imaging research from The National Institute of Mental Health in the USA. Researchers at the NIMH have identified that several areas in the brain are different in people with ADHD. The areas identified include the right prefrontal cortex, the basal ganglia and the cerebellum. These areas are rich in dopamine. They are also known to regulate attention, working memory, impulsiveness and motor control.

What this new research has shown is that the primary problem with ADHD is not behavior, but rather cognition. That is, the underlying deficit in ADHD is a cognitive control problem that effects both cognitive functioning and behavior. One of the primary cognitive control mechanisms is working memory. Working memory plays a major role in helping the mind focus on task while screening out distractions. Working memory functions as temporary storage of knowledge that is applied to tasks of comprehension, computation and planning. As a result, researchers have shown that poor working memory is related to poor academic achievement, especially in subjects associated with language arts and mathematics.

Research has also shown that current treatment practices have had limited benefit on the cognitive problems associated with ADHD. The two most common treatments are pharmacological and behavioral interventions. The NIMH's Multimodal Treatment Study of pharmacological and behavioral interventions for ADHD has shown that though medications benefit classroom behavior and academic productivity, this does not translate into academic improvement. There is little credible evidence that pharmacological or behavioral approaches have any sustained effects on the cognitive features of ADHD as they apply to literacy and math skills.

Tannock and Martinussen put forward the proposal the ADHD should be viewed as a cognitive disorder. This has implications for the classroom. Current practices target the overt behavioral systems of ADHD. The authors suggest that an alternative approach might be to try to moderate behavioral symptoms by using instructional practices that reflect an understanding of the cognitive weaknesses associated with ADHD.

For the past five years Dr. Tannock's research group has been studying ADHD and reading difficulties. They have been doing this work in a laboratory classroom situated in a regular school. Based on their experience, they have found three questions that guide their thinking when developing programs for ADHD students.

They are:

1. Does the student have the preskills necessary to acquire the knowledge or concepts that you are teaching? For example, students with ADHD often have difficulty understanding instructional language. As a result, tasks are either misunderstood or not done.
2. Does the lesson content and the delivery match the needs of the student? Often, if the content gap is too great between what an ADHD student knows and what they are expected to learn, they are unable to initiate the process of learning. Also, because of difficulties associated with language skills, ADHD students may require linguistic re-framing of classroom instruction.
3. How can I help my students become self-regulated strategic learners? ADHD students often lack good metacognitive strategies that allow for efficient and reflective learning.

The authors offer many suggestions and available resources for addressing the problems identified through the three key questions. The important concept for teachers to keep in mind when working with ADHD students is teaching strategies that address cognitive weaknesses, will benefit students both behaviorally and academically.