Hello, and thank you for downloading this podcast from Teacher magazine. I'm Rebecca Vukovic.
What are some practical strategies teachers could use in the classroom to assist students with ADHD? That's just one of the questions I ask Dr Emma Sciberras in this episode of The Research Files. Dr Sciberras is a Senior Lecturer and Clinical Psychologist from the School of Psychology at Deakin University. Since 2009, she's been working on the Children's Attention Project, a research study conducted by the Murdoch Children's Research Institute at The Royal Children's Hospital. The project explores the long-term effects that Attention Deficit Hyperactivity Disorder (or ADHD) has on children's behaviour, learning and day-to-day living, and also on their parents' wellbeing. To kick off this episode, here's Dr Sciberras sharing more about the research.
Emma Sciberras: The main project we've been doing is called the Children's Attention Project and we started this project in 2009. We started off with a pilot study in schools and then we moved to a big study where we looked at children across 43 schools in Melbourne to track inattention and hyperactivity symptoms from early primary school, to the end of primary school and into adolescence. So across this project, we screen children across the 43 schools for inattention and hyperactivity symptoms, by both parent and teacher report, and we've now tracked the students from age seven all the way through to age 13. And this project has given us an understanding of what happens with ADHD symptoms over time and what impacts those symptoms have on functioning. So, we look at broad aspects of functioning from language development, to academic functioning, to school engagement, for example.
Rebecca Vukovic: Fantastic, and for listeners who perhaps don't know much about ADHD, how would you explain what it is and how common it is in Australia?
ES: So ADHD is characterised by high levels of inattention and/or hyperactivity and impulsivity symptoms. So the symptoms need to be present by the age of 12 and they need to have occurred for at least six months, and the most important thing is that the symptoms need to have a large impact on functioning. So, they need to make social functioning much harder for kids, or they need to have an impact on academic progress within the classroom. Recent Australian data suggest that around 5-7 per cent of children meet the criteria for ADHD and we know that it's more common in boys than in girls.
RV: And you recently presented at the National Education Summit in Melbourne where you discussed some of the traits of a child with ADHD – including the fact that these students are often curious, creative, energetic and entertaining. Could you share with listeners a bit more about the traits of a student with ADHD?
ES: So I think the main message is that all students with ADHD are different and they all have a profile of strengths and difficulties, really. So there's lots of strengths that children with ADHD have – and some of which you've mentioned – so they can be really curious, they can be really passionate about the things that they're interested in, they can be really funny and make you laugh a lot, but that doesn't mean that the other behaviours aren't challenging.
So I guess the key thing is to recognise what some of those strengths are and think about how we can best utilise those in the classroom or in other contexts. They're similar things that we talk about with parents – how can they make the most of some of those things at home, but how can they also balance it with providing strategies around the things that are tricky for this group. I've always seen different kids with ADHD, there's no one ADHD picture I guess, so you need to do some detective work to best understand what makes them tick and get them interested in things.
RV: Because I also understand that children with ADHD will rarely have ADHD alone but will often experience a whole range of other issues as well. Could you tell me more about that?
ES: So, most children with ADHD (up to 70 per cent) will have an additional area of need. So some of our research is focused on better understanding the areas of need that might not be so obvious to other people like parents and teachers. So one of our studies, for example, found that about 60 per cent of children with ADHD also had high levels of anxiety and those anxiety difficulties made social functioning even harder and made their behaviour even more challenging for parents and teachers. The other area that we've looked at a lot in our research and in the Children's Attention Project is language difficulties. In that research, we found that 40 per cent of children with ADHD have language difficulties and we've identified that using a face-to-face assessment that we do with the children, and we found that's one of the strongest predictors of academic gains over the primary school period.
Other research we're doing looks at sleep and identifies that up to 70 per cent of children with ADHD have sleep problems. We've developed a program to treat sleep problems for kids with ADHD and found that it not only improved sleep but the main symptoms of ADHD. And other people are focused on other things like extreme behavioural difficulties that can go along with ADHD, and also autism can affect about one in five kids with ADHD.
So ADHD is really complex because you have differences in the severity of inattention that they might have and hyperactivity, but then you also have this complexity around other things that go alongside it. So in order to best help kids with ADHD, you need to understand whether or not they're affected by these other conditions too.
RV: And so then for teachers, what would you say some of the challenges a child with ADHD will experience in the classroom?
ES: I think there are lots of challenges for teachers. I think it can be really hard to engage a students with ADHD. Because of the symptoms of ADHD and some of those language and learning difficulties that go alongside with it, it can make it really hard for students to pick up on concepts within the classroom and to remember the material that the teacher is trying to teach them.
We also know that organisation and time management for students with ADHD is really, really difficult and that can be really hard for teachers to manage and can be really frustrating when kids are losing their books and things that are required for class or they're forgetting what they need to do. I think the other really challenging thing is, just coming back to what I was saying before around children with ADHD varying a lot, because there's no ‘one-size-fits-all' ADHD child, it means that an individualised approach is needed and that's really hard for teachers because they've got so many students in their classroom.
Students with ADHD also struggle socially and so that can also be really tricky. [On average], we know that children with ADHD have difficulty both making friends and keeping friends and that can cause conflict if children are getting into disagreements with other kids within the classroom. And another area that can be really tricky for kids with ADHD is transition – so whether its transition between different activities that the teacher might be running within the classroom, or transition from different classes in high school, or transition from classroom to playground – they're times where children with ADHD can get into a little bit of trouble.
RV: And so, given all of that, what are some of the evidence-based programs you've found to improve educational outcomes for children with ADHD?
ES: There really isn't a lot known about how to best improve educational outcomes for kids with ADHD, which is really surprising given it's a condition that affects so many kids and it's a condition that can have a huge impact on the lives of kids. We know that medication can help children with ADHD in the classroom, it can help them to pay attention, it can help them to take in the information, it can help them to behave better in the classroom. And so there is some evidence that medication can help, but we really need more evidence for the benefits of medication in the classroom in particular.
There are a number of international programs that have been shown to be effective in helping kids engage in the classroom. So one is called HOPS (Homework, Organizational, and Planning Skills) intervention and its one that really tries to provide practical strategies to help kids to manage the complex classroom environment. And the research that's been done in the United States has shown that it helps children to manage better in terms of their organisational skills, helps them to plan better within the classroom, and just overall it helps them to engage well within the classroom environment. But we don't have a program like that in Australia and so currently we're working on trying to adapt that US program to best meet the needs of Australian students. So the program is all about helping not only the student but the parents and teachers to support the student with their learning.
So we're trying to get that project together and will be running it hopefully next year as a small pilot first to see how it works in Australia and then we hope to be able to make this a bigger program that could be helpful for this population. But it might also be helpful for other kids that have planning difficulties, like children with autism for example. So I guess it's ‘watch this space' with that, but I think it's an exciting avenue given that we just don't have that kind of program available here in Australia.
RV: Just finally then Emma, for teachers listening, what are some practical things they could do in the classroom to assist students with ADHD?
ES: So I think there are lots of little bits and pieces that teachers can do. So there are lots of different strategies that can be tried and it's one of those things where it can be a bit of trial and error for students and teachers, to work out what's the best fit for these young children.
I think the very first thing is the teacher understanding the profile of that student – so the individual strengths and weaknesses that the student might be experiencing, so that they can individualise their teaching in some way to that student, which of course is very challenging within a large classroom environment. But, understanding what that profile is, so what the severity of their symptoms are, if there are other co-occurring difficulties, can really help the teacher to understand the severity of the presentation but also what that child's unique strengths are so they can use those in the classroom.
I think the other thing is trying, where possible, to level the playing field. So we know that kids with ADHD have difficulties writing, so any opportunities be able to type out work, for example, can just help to facilitate engagement from the student. Whether they can listen to things in an audio fashion, whether they can have notes given to them, as opposed to relying on them having to write them down. So I think some really simple strategies like that, or even taking a photo of material so that they can go away and learn and focus on that particular bit of information rather than struggling to write it down can really help.
And I think another thing is about trying to have some leeway where possible. So, we know kids with ADHD fidget and they move a lot and that can be a bit annoying to other people and it can be distracting to other students, but we know that kids with ADHD, that movement can sometimes help them to learn better and to take in information. So I guess working with the student to see if there are other ways that they might be able to still get some of that movement in, but in a less distracting way for other students – so whether it's about letting them doodle when they're listening or whether it's about having set bathroom breaks so they can get up and have a bit of a burst of physical activity.
Other things are like trying to use engaging materials for assignments for example – so can the student produce a website, or a movie of the thing they're talking about, rather than it always being written? And I guess a lot of these strategies are around trying to enhance the engagement of students in the classroom, because if students are engaged, they're less likely to be disruptive. A few other things … even trying to develop some transition routines, so the children know how to transition between different activities and it can be something that is pasted on their desk. Breaking down assignments into small components that have separate due dates can also help to keep them on track.
And I think the final thing I'd say is about partnering with the parent and having regular communication with the parent. Because the parent will be struggling with a lot of the similar things that the teacher might be struggling with at home, and the parents are likely to have identified some things that can help. And vice versa – the teacher might come up with things that work in the classroom that the parent might not know about. So, if the parent and teacher can team up and share their wisdom together and keep that regular communication going, then the evidence suggests that that results in the best outcome for not only the child, but also for the parents and teachers in terms of reducing their levels of stress too.
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Sciberras E., Mulraney M., Anderson V., Rapee R., Nicholson J., Efron D., Lee K., Markopoulos Z., & Hiscock H. (2018) Managing anxiety in children with ADHD using cognitive-behavioural therapy: a pilot randomized controlled trial. Journal of Attention Disorders, 22(5), 515-520.
What are some of the practical strategies you’ve found to work in your classroom when it comes to teaching children with ADHD? Are they similar to the advice Dr Emma Sciberras has offered in this podcast? How often do you speak to parents and carers to hear their advice and wisdom?