Massia Bailey | ADHD: Traits, types, and treatment – a special education perspective

Talk to any teacher, parent, or employer and they will tell you that they have noticed an increase in children and adults with symptoms of attention deficit hyperactivity disorder (ADHD) in recent years.

Educators, employers, and households are encountering these individuals far more frequently than they did 10 to 15 years ago. In fact, the rising prevalence of ADHD—like that of other disabilities — has significantly shifted the dynamics in classrooms, homes, workplaces, and society at large.

Population-based surveys, where parents report ADHD diagnoses among children in their households, indicate an increase in prevalence among children aged three to 17 from 6.1 per cent in 1997 to 10.2 per cent in 2016. Recent studies suggest that this rate has stabilised at around 10 per cent for the same age group. While the causes of this increase are still being debated, it is evident that ADHD is not going away.

MISCONCEPTIONS AND LIFELONG IMPACT

Coexisting with this verifiable upward statistical trend is misinformation about the causes and optimal treatment for ADHD. These misconceptions permeate schools, homes, workplaces, and other societal spaces despite an abundance of factual information on the condition. This leads to problematic circumstances for these unique individuals as they are sometimes perceived negatively and treated in ways that undermine their academic progress, social-emotional state, and well-being particularly when their behaviours are misinterpreted and treated as inappropriate and deliberate.

As a result of these misconceptions, students with ADHD disproportionately experience discipline, including reprimands, detentions, suspensions, and expulsions, compared to their peers without ADHD. It is crucial then, to address these misconceptions, deepen our understanding of ADHD, and intervene early especially as current research indicate that children with ADHD often grow up to face significant challenges in adulthood.

Compared to their neurotypical peers, adults with ADHD are more likely to drop out of post-secondary schools, earn lower incomes, struggle to maintain steady employment, rely on parents or others for financial support, and experience isolation and depression.

DEFINITION AND ETIOLOGY

ADHD is a neurodevelopmental difference. This means the condition is brain-based with symptoms that will likely persist throughout a person’s lifetime. Because of its etiology, ADHD cannot be “cured” in the medical sense, with appropriate intervention, the lives of individuals with ADHD can be improved.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Among other diagnostic criteria, symptoms must be present before the age of 12. It is also well established that ADHD is largely genetic, with some contribution from biological and environmental factors. A child is more likely to be diagnosed with ADHD if a parent or sibling has been diagnosed.

Studies have also shown that children with ADHD often have low levels of the brain chemical dopamine, which plays a key role in regulating the sleep-wake cycle, motor control, motivation, cognition, working memory, mood, and the brain’s reward system.

Low dopamine levels in children with ADHD means they may struggle with reduced motivation, difficulty concentrating, mood swings, and potential sleep problems. This in turn can impact their ability to initiate tasks, sustain interest to completion, motivation, as well as control their impulses. Brain imagery also indicates that children with ADHD exhibit underdevelopment in the brain regions responsible for attention, social judgment, and movement.

ADHD TYPES

In the past, ADHD was distinguished from attention deficit disorder (ADD), but today, the diagnosis given is ADHD, with one of three main types specified: inattentive, hyperactive-impulsive, or combined.

• Inattentive ADHD is marked by difficulties with focus, organisation, and task completion.

• Hyperactive-Impulsive ADHD is characterised by excessive activity, restlessness, and impulsivity.

• Combined ADHD involves symptoms of both inattention and hyperactivity-impulsivity.

All three types involve significant challenges with executive functioning skills. Since executive functioning is a broad and critical topic on its own, it will be explored in a subsequent article.

INTERVENTION AND TREATMENT IN SCHOOLS

Managing ADHD requires an individualised approach based on the child’s specific symptoms and the beliefs and values of their family. There is no one-size-fits-all solution. While prescribed stimulants have been proven to improve focus and task completion, recent studies show that these improvements do not always translate to increased overall academic achievement. It is often recommended that medication be considered only after other treatment options have been explored. Other options include behaviour therapy, parent training, and classroom-based interventions such as the use of planners, checklists, and accommodations.

SEQUENCE TREATMENT MATTERS

Research shows that not only does treatment type matter, but the timing and order in which interventions are introduced also plays a critical role in achieving favourable outcomes. Behavioural therapy and family training, also known as behavioural parent training (BPT), are recommended for children under six years old.

Young children can experience more side effects from medication, making BPT a valuable alternative to prescribed stimulants. BPT helps parents create routines and structures that can help children stay organised, manage time, and reduce impulsivity. Additionally, BPT, helps parents develop other skills to manage their child’s behaviour and improves the parent-child relationship. In fact, BPT can be as effective as medication for younger children in reducing the impact of behaviours associated with ADHD as it supports the development of self-regulation and executive functioning.

ADHD is a lifelong, brain-based condition that requires an individualised approach and research-informed interventions. By addressing misinformation, prioritising early behavioural supports, and approaching treatment in the right sequence, educators and families can help students with ADHD thrive academically and socially, in their youth and into adulthood.

Massia Bailey, EdD is an applied learning scientist, special educator, and adjunct professor of education in Florida. Send feedback to learninganddevelopmentdoctor@gmail.com