We are all created equal, albeit unique; and yet, some of us are different from “everybody else.” Adults and children come in all shapes and sizes, with many different characteristics and traits, different abilities and inclinations. Some are smarter than others, some are quick, some are slow, some are left behind. At the age of 5 or 6 children begin their long journey in the world of education. They are taught how to read and write, how to AD/HD, subtract and multiply, some history, grammar, literature and geography and many other things. Children are required to sit still in class, be quiet and attentive, do all their homework, succeed. Most children go to first grade, not all of them graduate from high school.
Some find school a reasonably easy task to tackle, some struggle and sweat throughout school, failing or barely making it. The failure of some children in school is sometimes the outcome of a learning disorder: a ‘dysfunction in one or more neuropsychological systems that affect school performance.’ (Pennington, 1991, p. xii). Pennington makes a distinction between “school problems” that are entirely due to emotional, motivational, or cultural factors and “learning disabilities”[1] that are a subset of learning disorders and include problems such as dyslexia, developmental language disorders and attention deficit disorder. Attention deficit disorder with or without hyperactivity (AD/HD) [2] is the centre of this discussion.
AD/HD is an inherited developmental disorder characterised by impulsivity, inattention and often motor restlessness or hyperactivity (Mould, 1993). People with AD/HD have difficulties in staying on a task, following through, paying attention, sitting still, controlling impulses, dealing with frustrating situations and remembering details. They tend to procrastinate, fidget, get side-tracked, be late and be forgetful. Like blindness, deafness, Down’s syndrome and other impairments, AD/HD has a physiological source, yet, it is often perceived as a psychological problem or as a character deficiency rather than a neurological disability. AD/HD cannot be “cured” but with the help of educational assistance, therapy, behaviour management and medication the individual can learn to cope with AD/HD and to overcome some of its disabling aspects.
The limitations of people who have AD/HD are hard to perceive and understand. Their behaviour is often mistaken for stupidity, bad education or a character deficiency such as lack of motivation, laziness or malignancy. In recent years awareness of AD/HD has increased, but it is still not widely known or understood by professionals or by laymen. Although AD/HD is labelled as a disability, it also carries some advantageous aspects.
AD/HD often appears in highly, even exceptionally intelligent individuals, it is positively correlated with creativity, ability to see the bigger picture, intense curiosity, flexibility of thought and sensitivity (Hallowell, 1994; Kelly & Ramundo, 1993; Weiss, 1992). People with AD/HD often compensate for their difficulties by finding original alternatives for achieving their goals. Thomas Edison, Albert Einstein, Benjamin Franklin, Edgar Allan Poe, George Bernard Shaw, Salvador Dali and Abraham Lincoln are some of the best known examples of successful, highly intelligent and creative people who undoubtedly made a positive and significant mark on society. All were very likely AD/HD as well as dyslexic and their “AD/HD traits” play a central role in their unique life work (Hallowell, 1994). Nevertheless, AD/HD is best known for its negative effects and people with AD/HD are often treated with suspicion, hostility and recurring attempts of normalisation. Usually, the child with AD/HD first meets these attitudes in school.
The school problems of children with AD/HD, the attitude of educators towards them and possible explanations for these attitudes will be discussed. An attempt will be made to suggest strategies that might be helpful in eliminating some of the problematic aspects in the school experience of the child with AD/HD. Problems at school and the diagnosis of AD/HD The possibility of an existing learning problem is usually first considered when a child with average or above average intelligence experiences difficulties with what is academically and behaviorally expected of children of his age group. The child with AD/HD might be unable to pay attention and sit still in class, have difficulties in getting organised, submitting work on time, keeping up with the curriculum or socialising with his peers. If hyperactivity is present the child might be disruptive and aggressive, when hyperactivity is absent the child is often “dreamy” and mentally absent from the classroom. When a teacher notices a child that has difficulties in mastering basic reading and writing skills and lags behind his peers, or a child that exhibits an exceptionally restless or disruptive behaviour he would normally initiate an investigation into the nature and sources of the problems.
The UK Department of Education devised specific guidelines for the investigation procedure. First, the teacher will talk to the parents about the child’s school problems, will ask about his health, developmental history and behaviour patterns at home and will enquire about possible causes for the problems. Then, the teacher responsible for special education needs will talk to the child, the parents and the child’s teachers and, if appropriate, will design an individual education plan. The third stage, if needed, is a referral to a specialist such as an educational psychologist outside the school. The fourth stage is a statutory assessment by the Local Education Authority (Department of Education, 1994). At any time, the parent can decide to send the child to an educational and psychological evaluation by a specialist.
An educational and psychological evaluation can result in a diagnosis of emotional problems, dyslexia, AD/HD or other difficulties. Sometimes no diagnosis is made or the child is not even referred to evaluation, sometimes an incorrect diagnosis is made. When AD/HD is present, it is essential to have a correct diagnosis, but whether a diagnosis, correct or incorrect, is or is not made, things can still go wrong: ‘In school, it was hard for me to stay on the subject or to finish anything. When I did not finish my school work, I’d get spankings at home. Teachers would be on my back.
They said I was such a good child – they couldn’t understand it’ (Weiss, 1992, p. 13). ‘In the fourth grade there was a girl named Karla. She was so sweet. She could be quiet and she could sit still, and all her teachers loved her… My dream was to be like Karla.
But I never even made it into the classroom. I was always acting up, getting into a fight with someone, not paying attention, and doing things that would take me off the task… .’ (Weiss, 1992, p. 17). ‘You just can’t know how much I hated going to school… It was all a blur.
My main idea was just to get through the day without getting hurt… I actually loved to read and to make up stories, but all the teachers saw was the slow reader, the late papers, the messy handwriting, the bad spelling. One teacher actually said to me “Your handwriting looks like a moron’s.” She wasn’t even a mean teacher. She just thought she was motivating me to try harder…
.’ (Hallowell, 1994, p. 168). These are excerpts from case studies of individuals diagnosed with AD/HD. They all share a common pattern — a child has difficulties with his studies or exhibits problematic behaviour, a conflict with the teachers, a diagnosis of AD/HD.
The diagnosis provides an explanation for the difficulties and behaviours, yet, the relationship with the teachers does not change significantly. The child is left responsible to fight for accommodations for his disability and continues being scolded for behaviour and difficulties resulting from his neurological condition and that he cannot control. Sometimes the teacher is willing to help but is unable to fully understand what having AD/HD means and the consequences on behaviour and abilities, sometimes the teacher has a good understanding but the school environment is disabling for the child, often there are no resources in the school to help the child. This pattern appears repeatedly in the cases treated and described by experts on AD/HD such as Dr. Edward Hallowell and Dr. Lynn Weiss.
This pattern is present in the childhood memories of many other adults with AD/HD whose stories I have heard. This is not a universal pattern, but even today, when AD/HD is becoming more widely recognised than in the past, it is still very common. Explaining the problematic relationship of children with AD/HD with their teachers Teachers do not scold, punish, treat with hostility and discriminate against children with AD/HD out of cruelty or dislike for the child himself, at least that is usually not the case. There are several factors that contribute to the situation where a child with AD/HD is wrongly perceived and treated as a lazy, stupid or bad child or when his special needs are not provided.
Sketchy information about AD/HD, difficult diagnosis, difficulties in perceiving the nature of AD/HD, economical factors and unwillingness to accommodate and change the existing environment are some of these factors. AD/HD has been discovered, researched and addressed only relatively recently. Knowledge about AD/HD is still not widespread, and the training of teachers does not include much information about it (Weiss, 1992). Teachers are not specifically trained to detect AD/HD or to deal with it. When a teacher meets a pupil with average or above average cognitive ability who nevertheless fails in his studies, or who exhibits disruptive behaviours, he can refer the child to a school counsellor, child psychologist or other suitable professional. The professional is better informed than the teacher about the possible problems that the child might have.
Ideally all professionals should have enough knowledge and training to be able to recognise, diagnose and suggest treatment for children with AD/HD, but this is not always the case. The first obstacle to the proper treatment of the child with AD/HD is in the very first step of recognising the existence of a problem. AD/HD with hyperactivity is more prevalent among boys while girls tend to have AD/HD without hyperactivity (Hallowell 1994, Weiss, 1992). Traditional expectations for boys to be active and energetic and girls to be quiet and still, can mask to a certain extent the existence of AD/HD. Hyperactive behaviour can be interpreted as liveliness, high energy and curiosity or just “being a boy” while quiet and dreamy girls often go unnoticed or are perceived as “good” or “little angels.” The mere presence of the symptoms of AD/HD is not unusual, what is unusual about AD/HD is the severity and duration of the symptoms (Hallowell, 1994), the distinction between “being a boy” and hyperactivity is not always clear.
Once it has been recognised that a child’s behaviour or difficulties in school are outside the range of “normal”, another obstacle is met in the form of the diagnosis itself. AD/HD is very difficult to diagnose. Firstly, there are no scientifically reliable tests — physical or psychological — that can determine with certainty that a child has AD/HD. DSM-IV provides a list of symptoms, inconsistent results of subtests of the Wechsler test are indications for possible dyslexia or AD/HD, there are symptom checklists for AD/HD, family and developmental histories contain typical elements when AD/HD is present.
But none of these is a definite indication for the existence of AD/HD. Secondly, AD/HD is very often accompanied by other disorders that might mask the AD/HD symptoms or offer other interpretations to them. A high comorbidity between AD/HD and dyslexia [3] makes it hard to distinguish between the effects of the two on behaviour and performance in the school environment (Pennington, 1991; Hallowell, 1994). Secondary emotional problems resulting from difficult life experience of the undiagnosed AD/HD sufferer are very common and often they are wrongly mistaken for the primary problem and cause of difficulties, thus masking the AD/HD and preventing proper diagnosis and treatment (Silver, 1984). The line that separates “normal” and AD/HD is not clear, there is no one specific point in which the symptoms become frequent enough or severe enough to indicate definite AD/HD.
The diagnosis of AD/HD is more than anything a matter of intuition and experience. Regardless of the difficulties, correct diagnoses of AD/HD are made and treatment plans are devised. The child diagnosed with AD/HD would be referred to a professional who is supposed to be informed about AD/HD and familiar with the treatment options. But in most parts of the world there is a severe lack of well informed professionals.
Other factors effecting the problematic school experience of the child with AD/HD are inherent to the nature of this condition and closely related to the lacking knowledge about it. It is never easy to perceive the experience of having an impairment that we do not have, but some things are easier to perceive than others. While it would seem ridiculous to expect a visually impaired individual to drive or a paraplegic to run, we cannot really grasp how a person is simply unable to listen to what we say, sit still for a few minutes or arrive to a meeting on time. We all have difficulties in paying attention sometimes, most of us are occasionally (or often) late, everyone has moments of restlessness when he feels unable to sit still. But most of the time we can pay attention, we do remember, we do sit still, so why is the individual with AD/HD unable to do the same? Somehow there is a feeling that trying harder is the solution and that failure in paying attention or meeting a deadline is our fault and not something that is beyond our control. The prevalent belief in contemporary western culture is that “when there is a will there is way”, anything can be done if we want and try hard enough.
Chances are that when our AD/HD child leaves his dirty socks on the floor by the bed, we will scold him for being messy and lazy and will not be able to accept that he is unable to remember the simple task of putting the socks in the dirty laundry basket. He is an intelligent child, he can learn something that simple, after all, if we could, why can’t he? He probably does not care enough to remember. Adding to the difficulty in understanding the limitations of AD/HD is the common inconsistency in performance. ‘These kids puzzle us as they flounder one day and shine the next day, read to beat the band one day and stare out the window the next, solve complex math problems in their spare time but find themselves unable to do any of the math on the test.’ (Hallowell, 1994, p.
162). When performance is inconsistent it is very hard to tell what can be expected from the child with AD/HD and the teacher can grow quite suspicious of a child who cannot do today what seemed easy for him to tackle last week. The structure of the education system is laden with potential problems for the child with AD/HD. Education is geared for the average student, thus adhering to an egalitarian and inclusive policy but not allowing for the out of the ordinary situations and needs. The standard duration of 45-50 minutes for a class is reasonable for the average child not for the child with AD/HD who cannot sit still and pay attention for so long.
The format of study in which the teacher talks and the students sit still, listen and take notes is also very difficult for the child with AD/HD. So are long written exams, evaluation methods requiring memory for details, learning by heart and many other characteristics of the education system in western society. Schools and teachers are bound to a curriculum and to certain achievement standards, their success depends on their ability to be up to these standards. Children with learning problems might hold the class back and teachers might react with hostility.
Moreover, the behaviours associated with AD/HD can be quite irritating even to the most understanding, caring and knowledgeable teacher and might again result in hostile feelings towards the child, even though the teacher might recognise that the behaviours is beyond the child’s control. Economical issues influence many areas of life, and the school experience of the child with AD/HD is no exception. Lack of funds can account in part for the lacking education on AD/HD in the training of teachers but school budgets and the ways they are distributed have an obvious and direct influence on the child with AD/HD. Public education systems tend to suffer from chronic lack of funds.
Classes range from 20 children per class in the best of cases to 40 or more children per class [4]. A single teacher in charge of a large number of children is unable to accommodate the special needs of one or a few children with AD/HD without neglecting the other children in the class. Building more classrooms; employing more teachers. tutors and special needs professionals; and buying educational aids such as computers equipped with specialised software all require funds which are very rarely available to the school.
When funds are available, they are often used for purposes considered more pressing or important than those of children with AD/HD or other problems. Even when a correct diagnosis is made, knowledgeable professionals are available and funds allow for a smaller class, tutoring or other forms of help, not always are the teachers or the people responsible for the curriculum willing and able to make allowances and changes needed by the child with AD/HD. Some teachers still regard AD/HD with suspicion while others are too set in their ways to consider changing their educational approach. Changing one’s perception of his job and work habits is a difficult process even when there is a strong will to change and sadly, not enough teachers are even willing to try. ‘The solutions preferred by teachers… were centred on smaller classes, tougher sanctions and counselling for difficult youngsters.
Changing teaching styles, curriculum and school climate were favoured by only two in ten’ (Lane, 1990, p. 3). Because of the factors described here, the school experience of the child with AD/HD is very often one of discrimination, struggle, stigmatization, and abuse. Whether intentional or accidental, this negative experience can have a lifelong emotional toll.
Consequences of the school experience of the child with AD/HD It is difficult to distinguish between the direct consequences of AD/HD and the consequences of how child with AD/HD is treated by others in response to his AD/HD induced behaviours. For example, lack of impulse control can cause the child to behave in a disruptive manner in class: this is a direct consequence of AD/HD. The teacher will react to the disruptive behaviour by scolding the child, who will develop a negative self image. The negative self image is a consequence of the experience of life with AD/HD. School children are constantly required to learn new information, memorise, spell, calculate, pay attention, focus and behave properly. The child with AD/HD is bound to fail in many of these tasks.
Dropping out of school is perhaps the most direct consequence of recurring failure in school, and indeed, the dropout rate of children with AD/HD is higher than that of “normal” children (Weiss, 1992). In contemporary western society, where education is highly rated, low grades and incomplete education are disadvantageous starting points in life. AD/HD young adults find themselves facing many closed doors both in higher education and in the career world, but these are not the only consequences of a bad school experience. Much, perhaps most, of the damage is emotional and psychological. Possibly the most common reaction of a child who is constantly told that he is stupid, lazy, not trying hard enough, bad, disruptive, immature, etc.
is to believe these evaluations and develop a low self-esteem and a negative self image. ‘Throughout childhood, at home and at school they are told they are defective. They are called dumb, stupid, lazy stubborn, wilful, or obnoxious. They hear terms like “space-shot”, or “daydreamer” or “out in left field” all the time… Month after month, year after year, the tapes of negativity play over and over again until they become the voice the child knows best… This voice puts the child’s self esteem down and down, out of the reach of the helping hands that might be extended, into the private world of adolescent self-reproach.’ .
(Hallowell, 1994, p. 17). ‘By high school they almost had me convinced I has just plain stupid… I would try. Believe me, I would try. I got lectures all the time on how I didn’t try, but I did try.
It’s just that the biggest sledge-hammer didn’t work… They’d tell me to try harder. Over and over again. Try harder. And I’d try harder and it wouldn’t work. After a while I figured I didn’t have the brain to do it.
And at the same time I knew I did. But it just didn’t work out.’ (Hallowell, 1994, p. 17). Self esteem can be damaged even when the child is occasionally told he is smart and can do well (when he tries) or when different people convey different messages. An inconsistent and contradicting message can as harmful a consistently negative one.
Often the AD/HD child tries very hard to please and do well, in many cases without the desired result. When effort is rarely rewarded, frustration builds up, to the point that frustration is almost constantly present and can be triggered by the smallest incident. Low self esteem and a low frustration threshold probably contribute to the high prevalence of depression among individuals who suffer from AD/HD. ‘… ADD and depression frequently coexist. This is not hard to understand when one considers the typical life experience of someone with ADD.
Since childhood, the person with ADD has felt a sense of chronic frustration and failure. Underachieving all along, accused of being stupid or lazy or stubborn, finding the demands of everyday life extraordinarily difficult to keep up with, tuning out instead of tuning in, missing the mark time and again, living with an overflow of energy but an under supply of self-esteem, the individual with ADD can feel that it is just not worth it to try anymore, that life is too hard, too much of a struggle, that perhaps it would be better if life were to end than go on.’ (Hallowell, 1994, p. 157) ‘Adults with ADD feel angry, frustrated, confused, and out of control. They can be chronically depressed — stuck in their grief, but grief over what they don’t know. Their fear of failure…
is enormous and repressive. And no wonder, when we consider how their lives have been filled with failure. Why would anyone so used to failure want to undertake new experiences or enter new situations that seem to set them up for more failure?’ (Weiss, 1992, p. 41). Life with AD/HD can also be experienced as a perpetual trauma and result in a loss of the sense of identity and self: ‘Cynthia was the over-controlled, passive type of ADD adult. She had crawled far inside herself, away from the world around her.
It was the only way she could cope with the pain of ADD… Her way of coping with ADD had shaped her personality, if not robbed her of it, for she had, in fact. sacrificed her personality at the altar of ADD.’ (Weiss, 1992, p. 40-41) Hallowell (1994) mentions other disorders and behaviours that often accompany AD/HD but are not necessarily a result of the AD/HD experience.
He refers to different 13 “subtypes” of AD/HD such as AD/HD with anxiety, AD/HD with dissociative states, AD/HD with borderline personality features and AD/HD with obsessive compulsive disorders. Often these accompanying disorders mask the existence of AD/HD that has many similar symptoms, preventing a correct diagnosis and treatment. This can be particularly harmful when the treatment for the secondary disorder conflicts with the proper treatment for AD/HD. In order to defend himself from the difficulties caused by AD/HD, effective but problematic defence mechanisms could be developed. Kelly & Ramundo (1993) describe some common coping mechanisms: delinquent behaviours that replace the image of “stupid” with an image of “bad”, perfectionism, blaming every failure on others, apathy, denial, manipulation of others, withdrawal, anger, learned helplessness and controlling behaviour. While the nature of AD/HD in itself possibly makes some aspects of life inevitably problematic, proper diagnosis, treatment and positive attitude of others can reduce the risk of the development of emotional problems.
Changes in school environment that could benefit the child with AD/HD The causes for the difficult school experience of the child with AD/HD that were discussed above, are themselves indications to some changes in the school environment that might make the experience for the child with AD/HD less difficult. Informed teachers and professionals are a key factor without which not much can change. Teacher’s training programmes should be more informative on AD/HD and the needs of children with AD/HD. Knowledge is the first step towards allowing the teacher to perceive a little better the experience of AD/HD. Understanding can be also promoted by especially designed workshops and tools, such as the video “Fat City” that attempts to convey the experience of being dyslexic.
Smaller classes, educational aids such as computers equipped with teaching software, individual tutoring, diverse and interactive teaching styles, alternative organisational and filing methods, quiet rooms for exams and permission to leave the class when feeling restless are just some examples of changes in the school that could be beneficial for the child with AD/HD. Because of the difficulty in diagnosis, estimates of the prevalence of AD/HD vary immensely and range between 1-20% of the population (Kelly & Ramundo, 1993). Whichever estimate is right, this is by no means an insignificant minority. But the prevalence of AD/HD in the population and arguments in favour of equal opportunities for the disabled are not the only reasons why changes in the education system should be made. Another argument in favour of change is that small classes, a large variety of teaching methods, more educational aids, one on one instruction and other proposed changes are very likely to be beneficial to all children.
Yet, few changes, if any, are made in education and the accommodations for children with AD/HD are still too few. If changes in school could indeed benefit most children, why is it that these changes are not made? Would it not seem natural to strive towards the improvement of an imperfect system? The most obvious answers to these questions are financial and political ones. Reforms in schools will be extremely expensive, even if in the long run they will prove cost-effective by saving future expenses on remedial education and therapy. Funds for making reforms can be allocated only if there is enough political pressure for doing so. Saving children with AD/HD from a future of low self-esteem, depression and unfulfilled potential is not a strong enough political incentive. The possible benefit for all children is yet to be proved and even then it might not be enough.
Resistance to change is inherent to human nature. Throughout history, change was encouraged on one hand and rejected on the other. Scientific discoveries are resisted and met with suspicion, and a struggle is often needed for innovations to be accepted. The existing environment is not always comfortable but it is familiar and therefore secure and although change can be very beneficial, it also constitutes a risk. People need to be convinced of the advantages of a change before they are willing to take risks and make efforts. People are also not thrilled to make a personal effort.
These factors, together with the conviction of many education professionals of the adequacy of the existing system, carry much influence on the possibility of change in the education system. Another partial explanation to the resistance from change lies in the threatening aspects of AD/HD. AD/HD is a continuum disability in the sense that every person has some of the symptoms some of the time. The presence of the AD/HD symptoms makes everyone somewhat AD/HD, and therefore somewhat disabled. Undoubtedly this is a quite threatening notion that promotes the tendency to distance ourselves from AD/HD and its symptoms.
Ignorance about AD/HD makes it a foreign and therefore a threatening condition. Ambiguity is threatening and people like to have clear notions about “right” and “wrong.” Current conventions are that 50 minutes is the “right” duration for a class, linear thinking is “right”, chaotic thinking is “wrong”, stacks of papers are “right”, a cluttered table is “wrong”, etc. Within these conventions people with AD/HD who do things differently, are “wrong.” The creativity and original nature of these people are a constant reminder that there are many ways of doing things and that what we know and what we are used to do is not necessarily “right.” Acceptance of the “AD/HD way” would create a threatening ambiguity in the conventions of right and wrong, and for AD/HD to less threatening it has to be labelled as “disability” and not just as “difference.” Some of the proposed changes are threatening because they promote a diverse approach to education that blurs the boundaries between the current notions of “right” and “wrong.” Better information and understanding of AD/HD are the first steps towards the solution of problems individuals with AD/HD currently face. The next step is perhaps the acceptance of AD/HD not necessarily as a disability but as an expression of the diverse nature of human kind. The significance of this attitude raises many interesting questions about the social construction of disability and the acceptance of diversity. References: Copeland, Edna D.
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Lyon, Jenny (1995) ‘A British Perspective on the Psychological Assessment of Childhood AD/HD’ ADD-vice 2 (4): 1-3. Mould, Stan (1993) ‘Chaos on the Classroom’ LADDER Article Series Pennington, Bruce F. (1991) Diagnosing Learning Disorders: A Neuropsychological Approach. New York: The Guilford Press. Silver, Larry B. (1984) The Misunderstood Child.
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