Thursday, October 10, 2024
Addressing the Attention Deficit: ADHD and literacy
As a late-diagnosed ADHD woman, I am always intrigued by my disorder and the impact it has on my daily life.
During my time as a primary school teacher, I could easily recognise those students whom I suspected had underlying, possibly undiagnosed, neurodivergence. I saw, through observing them, my own symptoms and childhood experiences playing out in the classroom.
Curiously, as a child myself, I never struggled particularly with literacy and actually excelled within the school environment.
Why then, were some of my own pupils struggling with literacy? More importantly, how could I begin to help them?
What is ADHD?
Most educational practitioners will already be well-versed in what ADHD is, but understanding how symptoms can manifest in classrooms and, in turn, understanding how this can assist in supporting pupils, is key.
ADHD stands for Attention Deficit Hyperactivity Disorder.
The brain of a person with ADHD is behaving differently. ADHD is defined by having a lower amount of two neurotransmitters: dopamine and norepinephrine (noradrenaline).
Dopamine is a chemical in the brain responsible for experiencing happiness and pleasure, while norepinephrine is part of our stress-management system.
In those with ADHD, a decreased level of norepinephrine means individuals are not as aroused by stimulus in the same way as others, and cannot easily gather their thoughts or act.
Another key part of ADHD is executive dysfunction.
There are three main areas of executive function – working memory (active when completing tasks in the present), cognitive flexibility (ability to adapt to their environment and move from one topic/thought/task to another) and inhibition control (controlling your impulses).
Executive dysfunction then, if we morphemically analyse the word, affects your ability to control your thoughts, emotions and behaviours. Due to the effects of executive dysfunction, ADHD is often comorbid with other mental health disorders, including but not limited to ASD, OCD, GAD and depression.
ADHD in the Classroom
We know ADHD is associated with a lack of dopamine, which can be demonstrated by ‘hyperfocus’. When those with ADHD dedicate cognitive resources on a task that is particularly interesting, it provides that rush of dopamine that they are lacking and therefore crave.
This is when those with ADHD are most passionate and creative, where they are able to focus and be productive – like a hidden superpower – but can also lead to not taking appropriate breaks to drink water, eat and even go to the toilet.
Conversely, due to that lack of norepinephrine and stimulation, and just like with any ‘drug’, there is a crash! This may be when those with ADHD really struggle to concentrate, may appear tired, more fidgety or evenirritated as they desperately search for more stimulation (yes, even arguing/confrontation increases dopamine levels, though this is not to say that they enjoy/seek arguments).
Feeding into that attention deficit, this is when there are no more cognitive resources to provide attention to a task, no matter its importance.
It may be at this point students begin acting out, getting out of seats or appear generally disinterested, even if they were before.
The fundamental impact of executive dysfunction can look like general forgetfulness and disorganisation, like those students who always seem to forget their stationery.
Relating to that lack of inhibition control and inability to be cognitively flexible, those with ADHD may tend to interrupt more so than others or seemingly derail the conversation using personal anecdotes. Considering the overlap with ASD and other neurodivergences, masking and impaired social skills are also common – particularly in girls with ADHD – and you may find there are those who are hyper-organised in an effort to counteract their executive dysfunction.
What does the research say?
Despite the clickbait headlines claiming ADHD diagnoses are soaring, the actual picture is drastically different.
5% of children in the UK have ADHD according to NHS data.
3-4% of adults in the UK are diagnosed with ADHD according to NHS data.
Interestingly, this is actually lower than the global picture, possibly due to the use of the ICD in the UK rather than the DSM-V for diagnosing the condition, which utilises stricter diagnostic criteria.
Despite these figures, one study found that fewer than 1 in 3 children diagnosed with ADHD access specialist care.
As teachers, we may be ‘manning the frontline’ in terms of providing support for these children.
Mayes and Calhoun (2000) claimed that more than half of ADHD children struggled with written expression and approximately 25-40% of patients with ADHD have major reading and writing difficulties.
It was no surprise then, that I discovered that ADHD is commonly comorbid with other learning difficulties; ADHD and dyslexia frequently co-occur, with up to 40-50% of those with one diagnosis meeting criteria for the other.
Miller et al (2013) reported that individuals with ADHD often displayed word decoding deficits, which led to poor comprehension, unable to discern central ideas from peripheral information when reading texts. One explanation for what may hinder those with ADHD from forming these connections is that their attention deficit requires them to devote more cognitive resources to sustaining attention than typical readers. Despite these somewhat-bleak statements, there has been no evidence linking ADHD with innate reading impairments suggesting that there is something we can do to set our students up for success.
How can we help students?
If you were stranded on a desert island and only had enough wood for a fire or a shelter, you would need to prioritise and choose where you could best use these resources. This is what it is like for those with ADHD each and every day, cognitively speaking.
Addressing the attention deficit is going to have the greatest impact on these learners.
Chan et al (2023) stated that ADHD children are off-task during academic instruction about one-quarter of the time and demonstrate frequent shifts between attentive and inattentive behaviours. We need to get them engaged and crucially, keep them engaged.
In terms of boosting literacy, phonics has been shown to activate multiple regions of the brain versus whole-word memorisation including the visual and language processing centres (McCandliss, 2015).
In other words, to develop reading skills, teaching students to sound out “C-A-T" sparks more optimal brain circuitry than instructing them to memorise the word "cat." This is an excellent example of how literacy facilitates dual-processing – an effective way to create multiple pathways to ‘file’ information and better retain it – as it utilises both visual and auditory inputs for learning.
The implications of this may be that students with ADHD could have particular difficulty in memorising high-frequency words or common exception words/homophones as this would require whole-word memorisation, which does not induce dual-processing.
Nevertheless, simple repetition can be helpful if the task is engaging and they are excited by what they are reading to allow those with ADHD to devote more attention to memorisation. If you’re not already, incorporating visual, physical, spoken and auditory elements concurrently into your planning and teaching practice (dual-processing) is absolutely something I recommend to benefit all students (SEND, EAL and neurotypical alike).
Additional Support and a Place for Intervention
What about those students who need additional support?
Chan et al (2023) found that students with ADHD may benefit from reading interventions as much, if not greater, than their neurotypical peers, albeit gains not being at the same rate.
While these learners may need longer in interventions, research has shown that reading interventions are equally effective with ADHD students, regardless of whether they were taking medications for their symptoms or were unmedicated.
Sessions need to be structured with the students’ needs in mind to address the attention deficit and keep students engaged, so it’s really a question of the quality of these interventions.
Interventions targeting phonemic awareness and decoding has yielded significantly larger benefits in those with ADHD than just targeting reading comprehension and interventions for ADHD learners delivered by teaching assistants were just as effective as those delivered by teachers.
Combining oracy tasks into intervention activities is a great way to help with poor written expression, build metacognition, and support those with ADHD and dyslexia.
There are also behavioural implications to consider to improve ADHD outcomes.
Primarily, having an unencumbered space to conduct interventions is crucial to direct focus and reduce distractions – particularly important in those with ADHD.
Additionally, immediate feedback, individualised attention and frequent reinforcement during interventions have been associated with better academic achievement broadly in those with ADHD.
Adding Lexonik to your Support Toolbox
The Lexonik programmes already integrate all of these evidence-backed techniques to best support vulnerable learners.
If you are interested in getting started with teaching your students in a fast, focused and fun way in an effort to close the literacy gap at your school, get in touch with us today.
As a professional and on a personal level, I know only too well how vital it is that we support those who may need a little more intervention in their literacy journey.
Please reach out at alex.hill@lexonik.co.uk. I’d love to share my experience and insight.
Al Dahhan, N.Z., Halverson, K., Peek, C.P., Wilmot, D., D’Mello, A., Romeo, R.R., Meegoda, O., Imhof, A., Wade, K., Sridhar, A., Falke, E., Centanni, T.M., Gabrieli, J.D.E. and Christodoulou, J.A. (2022). Dissociating Executive Function and ADHD Influences on Reading Ability in Children with Dyslexia. Cortex, 153. doi:https://doi.org/10.1016/j.cort....
Miller, A.C., Keenan, J.M., Betjemann, R.S., Willcutt, E.G., Pennington, B.F. and Olson, R.K. (2012). Reading Comprehension in Children with ADHD: Cognitive Underpinnings of the Centrality Deficit. Journal of Abnormal Child Psychology, [online] 41(3), pp.473–483. doi:https://doi.org/10.1007/s10802....
Chan, E.S.M., Shero, J.A., Hand, E.D., Cole, A.M., Gaye, F., Spiegel, J.A. and Kofler, M.J. (2022). Are Reading Interventions Effective for At-Risk Readers with ADHD? A Meta-Analysis. Journal of Attention Disorders, 27(2), p.108705472211301. doi:https://doi.org/10.1177/108705....
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