April 17, 2015

Helping Learners with ADD/ADHD to be Successful

by Sarah Jaffery, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

Most educators will agree that ensuring each student has an effective learning experience is no easy task.  This becomes all the more daunting when teaching students with learning difficulties. A well-known disorder that may act as a barrier in the learning process for students is Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). ADD/ADHD is commonly thought of as a pediatric disorder, but up to 65% of children diagnosed with this disorder continue to have symptoms into adulthood.1 More than 4% of adults are estimated to have ADHD.2  Although ADD/ADHD is not considered a learning disability, it can certainly have detrimental effects on daily functioning including impairments in educational performance.1 To be an effective teacher to a student with ADD/ADHD, it is necessary to have an awareness of the medical components of this disorder, a solid foundation in behavioral management, and proficiency in instructional design.3

According to the diagnostic criteria for ADD/ADHD, adults who are not diagnosed during
childhood need to exhibit five or more inattentive and/or hyperactive-impulsive symptoms for at least six months.  These symptoms need to be severe enough to interfere with social, academic, or occupational functioning. Inattention symptoms might include difficulty remaining focused during lectures; beginning tasks but quickly losing focus and getting sidetracked; difficulty keeping materials in order; poor time management; failure to meet deadlines; and losing belongings such as school materials, wallets, keys, and paperwork. Hyperactive-impulsive symptoms include leaving one’s seat during a class; feeling restless; inability to stay still for a long period of time; talking excessively; and interrupting or taking over what others are doing.5 Not only do these behaviors make it more difficult for the adult with ADD/ADHD to be successful in school, but they can be disruptive to other learners too.

Several strategies can be employed to foster a more conducive learning environment for students with ADD/ADHD. These strategies require the educator to spend extra time with students to ensure everyone is on the same page and working towards the same goal. An educator may suggest the following strategies to students with ADD/ADHD at the start of a class or learning experience:3
    • Sit near the front with your back to the class to keep other students out of view and thus minimize distractions
    • Participate in peer tutoring and cooperative/collaborative learning
    • Study in an area with minimal stimuli
    • Take extra time to complete tasks and assignments
    • Set specific times and routines for studying
    • Report to a mentor or study buddy who encourages assignment completion and organization
      Educators’ views and beliefs regarding their learners influence how they approach teaching. These views guide instructors’ ideas about which methods of teaching best suit the learner’s needs. A research report developed by the Learning & Skills Research Centre of the UK aimed to propose an alternative way for educators to think about learning and suggests a more person-centered and well-informed approach to teaching students with learning difficulties. First, a variety of teaching strategies / methods should be used - not just one. Next, there should be a focus on the purpose of learning rather than the outcome, as this takes into account the emotional and psychological aspects of learning and promotes participation. In addition, the learner’s fundamental values, stage of development, inclinations, and capabilities should be explored and should guide the teaching. Finally, to teach effectively, learning activities should take place in controlled settings (e.g. in the classroom and labs) as well as real-life (e.g. at home and on the job). This will help students test and apply the knowledge learned in a controlled setting in situations meaningful to them. Moreover, it provides opportunities for interactions with and to learn from people other than the teacher.4

      Another strategy to help students with ADD/ADHD improve their learning capacity is teaching metacognition, or thinking about learning. Studies have shown that students who utilize metacognitive strategies tend to be better learners. Given that students with ADD/ADHD do not typically thrive in academic settings, they may benefit from training in metacognitive thinking. A study conducted in children and adults with ADD/ADHD demonstrated that training students to adopt metacognitive strategies is helpful.6 Students were coached to think about and monitor their learning. They were taught active reading strategies, listening skills, and organization skills, among others. There was an emphasis on being attentive when listening and studying as well as organizing and creating material to help with recall. This work resulted in positive outcomes including decreased inattention symptoms and improved academic/intellectual functioning.4 A more recent study explored the efficacy of a 12-week metacognitive therapy group intervention, focused on time management and organization, in adults with ADHD.7 Strategies used to promote metacognition in this study included teaching practical skills like using a daily planner, along with time management skills to help them organize and complete complicated projects. There were significant improvements in ADHD symptoms of those participants in the metacognitive therapy group when compared to the symptoms of participants in a control therapy group. It seems intuitive that training the brain to reflect on one’s learning, something that individuals with ADD/ADHD have difficulty doing, would be a beneficial behavioral technique.

      It is clear that teaching is less effective using a one-size-fits-all approach. Creating an effective learning environment requires effort from both the educator and the student. For the educator, it is important to understand the medical aspects of ADD/ADHD as well as to be skillful in behavioral management and instructional design. If the educator has an in-depth knowledge regarding a variety of teaching approaches that can be used to meet the individual student needs, the likelihood of success is greater.

      References:
      1. Adler LA. Epidemiology, impairments, and differential diagnosis in adult ADHD:introduction. CNS Spectr. 2008;13:8(Suppl 12):4-5.
      2. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the UnitedStates: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006. 163(4):716-732.
      3. TeacherVision: Teaching Children with ADHD. [online] 1998 Sept. ERIC Clearinghouse on Disabilities and Gifted Education. (Accessed 2015 Mar 24)
      4. Dee L, Devecchi C, Florian L, et al. Being, having and doing: theories of learning and adultswith learning difficulties. LSRC Research Report.
      5. Rabiner D. New Diagnostic Criteria for ADHD. Attention Deficit Disorder Association. (Accessed 2015 Apr 1)
      6. Thompson L and Thompson M. Neurofeedback combined with training in metacognitive strategies:effectiveness in students with ADD. Appl Psychophys Biof. 1998. 23(4):243-263.
      7. Solanto MV, Marks DJ, Wassersein J, et al. Efficacy of meta-cognitive etherapy for adult ADHD. Am J Psychiatry. 2010;167(8):958-68.

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