The Global Search for Education: Health and Higher Achievement Part 2

Posted by: C.M. Rubin, The Global Search for Education

December 4th, 2015

The Global Search for Education (GSE) is a regular contributor to the Edmodo Blog. Authored by C.M. Rubin, GSE brings together distinguished thought leaders in education and innovation from around the world to explore the key learning issues faced by today’s nations. Look for a new post every Friday and join the Global Search for Education Community on Edmodo to share your perspectives with their editorial staff.

Inattention and hyperactivity are some of the most common types of mental and behavioral health problems that affects youth, according to Dr. Charles Basch, author of Healthier Students Are Better Learners. In Basch’s study he notes that approximately 4.6 million (8.4 percent) of American youth aged 6 – 17 have been diagnosed with ADHD (Attention Deficit/Hyperactivity Disorder), and that the problem disproportionately affects urban minority youth from poor families who may not only be more likely to be affected but also less likely to receive accurate diagnosis and treatment.  I asked experts in the field of ADHD, Dr. Gregory Fabiano, Dr. George DuPaul and Dr. Thomas Power, to share their perspectives on how the ADHD problem is impacting our domestic achievement gap and on the ways it is being addressed.

Dr. Thomas Power is the Director for Management of ADHD and Chief Psychologist, Department of Child and Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.  Dr. Power has conducted research on children with ADHD for over 25 years and has published extensively on interventions for ADHD and community-based prevention.  Dr. George DuPaul is Professor of School Psychology and Chair of the Department of Education and Human Services at Lehigh University.  He has published extensively on assessment and treatment of ADHD and is the co-author of ADHD in the Schools: Assessment and Intervention Strategies.  Dr. Gregory Fabiano is Associate Professor of Counseling, School and Educational Psychology in the Graduate School of Education at the University of Buffalo. He is extensively published in the field of ADHD and his particular area of interest is evidence-based assessments and treatments for children with ADHD.2013-03-13-cmrubinworldfamilyfarmed1500_new

Have the consequences of ADHD, treated and untreated, been quantified with regard to academic achievement compared with youth who do not have this disorder?  What is the “gap”?

George: The gap has been quantified and it is somewhere between .75 to 1.0 standard deviations.  This is considered a large difference that means that the average student with ADHD would score at about the 16th percentile relative to his or her non-ADHD peers.

Greg:  In almost every area of functioning within schools, youth with ADHD fare poorer on achievement. Interestingly, children with ADHD are typically comparable on estimates of IQ and cognitive abilities, suggesting that their disorder is what is getting in the way of learning. For instance, some children with ADHD fail classes, not because they are having trouble learning the material, but because homework assignments are missing or incomplete, careless mistakes are made on quizzes, or they forget to turn in long-term projects.

Thomas: It is clear that the presence of ADHD greatly increases the risk of children with ADHD for academic problems, including grade retention, placement into special education, and early school dropout. Behavioral and academic interventions for children with ADHD improve academic performance. Also, medication reduces ADHD symptoms in school and related academic problems, such as poor work productivity and disorganization. In general, research supports the use of combined approaches to treatment (i.e., combination of behavioral and academic interventions with medication) to improve academic performance.

Does the multi-media environment that surrounds youth today foster ADHD symptoms?

Greg: Probably not. ADHD can be thought of as a selective attention deficit disorder and many children do not have difficulty interfacing with multi-media. The problems are apparent in situations where the child needs to sustain and focus mental effort. I would suggest that the current educational system fosters ADHD symptoms – if one wanted to exacerbate the symptoms of ADHD, the best way to do it would be to step up academic demands in an overcrowded classroom with extended academic blocks.  It would also be a good idea to remove natural breaks like recess and be sure to expect the child sit in a seat the whole time.

If the best treatment for ADHD is holistic (pharmacological, behavioral and environmental), it would appear that the disorder is more difficult to treat in low-income urban youth.  Have you seen examples of successful efforts of holistic treatment for this demographic group?  How should such an effort be organized?

Thomas: Treatment in low-income settings is more challenging for many reasons, including the likelihood of the child being repeatedly exposed to stress and trauma, overstressed caregivers who face challenges in consistently using positive parenting strategies, and under resourced schools. The most successful models of treatment use integrated approaches based in schools and primary care practices.  In these contexts, mental health specialists can consult with teachers, provide education to parents, and promote collaborative care with primary care providers.

What progress has been made over the past 5 years in reducing the educational impact of ADHD? What data gives an indication of this progress, if any?

George: Substantial progress has been made in addressing at least the short-term academic achievement of students with ADHD.  My colleagues and I recently published a meta-analysis of school-based interventions for students with ADHD that involved combining analyses from 60 studies conducted between 1996 and 2010.  Many of these studies examined the impact of various methods designed to address academic difficulties (e.g., computer-assisted instruction, changes to teacher instruction).  On average, the use of an educational intervention strategy led students with ADHD to gain 0.5 standard deviations on academic measures.  Stated differently, these strategies made up about half the typical gap in academic achievement between students with and without ADHD. Obviously, students were still behind their peers and we still have a ways to go in addressing academic difficulties, but the results of recent studies are very promising.

Greg: We did a study that showed a simple intervention, a Daily Report Card, significantly reduced children with ADHD’s disruptive behavior in class, increased academic productivity, and also improved teachers’ ratings of IEP (Individualized Education Program) goal attainment.  Interestingly, the comparison group received business as usual and did not improve at all. These results suggest that students with ADHD could substantively benefit from simple approaches like this, and these interventions can move the needle further than current approaches.

What have been the most effective tools for treating ADHD and improving educational outcomes?

George: The strategies that are effective for treating ADHD I mentioned previously (i.e., stimulant medication, behavior modification).  Unfortunately, these two treatments have only small effects (about 0.2 standard deviation change) on educational outcomes.  The most effective way to impact educational outcomes for students with ADHD is the systematic use of academic interventions that have been found effective in other populations for improving performance. Examples include teacher use of systematic direct instruction of specific academic skills, classwide peer tutoring, computer-assisted instruction, and implementation of self-regulation strategies by the students themselves.  Again, the use of one or more of these approaches is likely to increase achievement by about 0.5 standard deviations.

Who should take the lead in the process to identify and treat ADHD?  What examples of well organized approaches have you seen?

Thomas:  School psychologists, guidance counselors, and school nurses are in a good position to orchestrate the efforts of school-based, integrated approaches to care. Pediatric psychologists and nurses are in a good position to orchestrate efforts in primary care.

What teacher training programs are in place for ADHD education and practices to use at schools?  Have you seen any data on the prevalence of these programs?

George: The best example of an organized training program for teachers was developed by the Children and Adults with ADHD (CHADD) organization.  I’m not sure if they have any data on the prevalence of use of this program.

What pedagogical approaches have been developed to focus on academic problems of ADHD youth?  Are there many online programs that have been developed?  Do you believe this will be a significant opportunity for addressing this issue?

George: Some online programs have been developed; however, I have yet to see controlled studies of their impact.  That said, I believe that computer-based training and practice of academic skills has enormous potential to improve the educational outcomes of students with ADHD.  The reason I believe this is that technology allows instruction to be geared to the unique needs of individual students, information can be provided at the student’s desired pace, and students can be provided with immediate feedback about performance.  We know from studying other interventions that these features are especially helpful for students with ADHD.

Continue the conversation in the Global Search for Education Community on Edmodo


C. M. Rubin, Thomas Power, George DuPaul, Gregory Fabiano, Charles Basch


C.M. Rubin is the author of two widely read online series for which she received a 2011 Upton Sinclair award, “The Global Search for Education” and “How Will We Read?” She is also the author of three bestselling books, including The Real Alice in Wonderland, is the publisher of CMRubinWorld, and is a Disruptor Foundation Fellow.


46 responses to “The Global Search for Education: Health and Higher Achievement Part 2”

  1. Amy Sharpe says:

    My son was diagnosed with ADHD and found school extremely difficult even with medication, counseling, behavior modification, etc. It makes me wonder how much better he might have done in school if Edmodo had been available when he was in school.

  2. brad Bielawski says:

    I think that it is important to train teachers so that they are better able to make accommodations for students with ADHD.

  3. I find this blog interesting, informative, and a direct hit home in many of the stated points.

  4. Toh Wee Teck says:

    I think preparing and training teachers on how to interact and teach students with ADHD and other learning difficulties is becoming an increasing importance.

  5. Jason Reagin says:

    I would be very interested to see how the rest of the world handles ADHD. From what I have seen and heard it appears to be worse in the USA as opposed to other countries. This includes developing nations, where in many cases students that do not deal the pressures of school are taken out of school and taught a skill. I am not advocating for this sort of approach just nothing that it might be more difficult to find accurate information.

  6. atik says:

    I can’t wait to know the impact of the online programs that have been developed by Dr. George.

  7. Sarah Eaton says:

    Teaching students with an attention disorder can be challenging. Students may also be failing because their attention span limits the intake of new information. Even in a one on one setting some students can not maintain an attention span or more than a minute without being redirected to the lesson in front of them. Even using online programs (which we do) can not keep all students on task and learning as needed. Younger students have a difficult time learning coping skills and as they mature these will be important to their academic success.

  8. Antoinette Green says:

    Wow, great informative article! I agree wholeheartedly. This is information that all educators need to read. Implementing these strategies in schools could truly make a difference in the academic performance and quality of life for students with ADHD.

  9. Lacey Spencer says:

    I have witnessed first-hand how students with ADHD have a disadvantage in the classroom. Many teachers do not receive training on how to accommodate students with ADHD and they lose patience quickly. While these students are, in most cases, of average or above intelligence, they don’t have the chance to demonstrate this in a classroom.

    I was very interested to learn the statistics. I teach in a low SES area – the Rio Grande Valley, TX – and our students are frequently misdiagnosed for various reasons. The two most common reasons are a lack of adequate care and misdiagnosis/over-diagnosis for the purpose of financial assistance.

    It saddens me that such a common behavioral health condition is so inadequately accommodated for. Our students deserve more from us.

  10. I teach SEN students still 8 years now . My students are excited to use online technologies ( new tools and applications web 2.0 and social media ) . They enjoy edmodo because they like to work online eSafety .

  11. Jennifer Sturge says:

    Interesting article! I hear a lot that ADHD and technology are connected. I enjoyed your point of view.

  12. K Waite says:

    Very interesting read! As a teacher with ADHD I know how frustrating it is!

  13. Rory says:

    I know that this is not a popular stance, but if we could do something for students without medicating them, I am totally behind it. We don’t seek alternatives enough these days.

  14. Oscar says:

    Great information about students with ADHD and how we can help them in the classroom.

  15. Amy Kingsley says:

    I like the idea of a daily report card – some of my students could really benefit from that.

  16. Cheryl Jindeel says:

    This is such an important topic! As educators, we should all be helping students reach their full potential. This includes students diagnosed with ADHD. Great article about what the status of research and types of help for ADHD students.

  17. I think that educational outcomes of students with ADHD could be greatly improved with ICT integration based on authoring tools and rubrics constructed by teachers who apply TPCK to their planning and practices .

  18. Christi Collins says:

    I enjoyed reading the information presented in this article. I have noticed a large increase in the amount of students with ADHD over the past 5 years it seems. I am sure many families do not have the financial means to purchase medicine to help remedy the symptoms, but it was nice to learn about some additional strategies that might work in these situations.

  19. Brenda Osborne says:

    I appreciated the fact that you included that it is more difficult to treat low-income urban youth who have this disorder. These children are typically overlooked when treatment is needed.

  20. Linwood Starling says:

    I have seen an increase in students with ADHD and families that can’t afford the medication or don’t want to put their child on the medication. Great strategies to help these kids.

  21. Cecilia Monserrat says:

    It is sad to hear that students are going under medicine treatment. After long talks to parents, headmasters and other teachers I think a great percentage of the solution is in us, teachers, not only medicine. If we change how we see them and change the way we teach we’ll see incredible results.

  22. Dae Habalo says:

    I’m interested in knowing the remedial program for ADHD. So thankful for this article.

  23. Karol Rivera says:

    It is very interesting that the traditional methods for treating ADHD have very little effect, and that the strategies implemented everyday by classroom teachers to help all learners is what has been found to improve the performance of students with ADHD.

  24. Tom Healy says:

    The daily report card method sounds interesting. I will be sharing this article with our school psychologist and councilor. Here in the Czech Republic, these students are still treated with contempt from teachers who think their inability to focus or sit still is a personal insult and a result of laziness. There are only a couple of us at this school who are trying to help these students, and it’s an uphill battle. Thanks for the ideas in this conversation — they are approachable, manageable, and simple.

  25. Sethi says:

    A very interesting articles. Having ADHD myself and having gone through school with it being untreated I find this article spot on when describing the ‘reasons’ children score less. Losing assignments, making homework and leaving it at home. getting the wrong date of a test, skip over questions only to forget returning to them, etc… We as teachers have a responsibility to hep where possible. I work at a fully inclusive school and seeing how these children are flourishing because the teachers allows them to stand up, move around, work more creatively, etc. make me very happy indeed! Thank you for sharing!

  26. Jenny says:

    I guess I never really thought about the factors that could exacerbate ADHD symptoms. So often it seems as though a district’s answer to money problems is to cut staff which leads to larger class sizes. We already know that overcrowded classes do not help students learn, but I never thought about how much worse it is for children who already cannot concentrate. I was always concerned about classroom management issues instead. Our middle school has something called activity time. It’s 20 minutes before or after lunch (depending on the grade level) where they are not in an academic class. They are in the gym, media center or the commons having free time. It is sort of like a recess for older kids. We had to file a contract waiver in order to restructure our day to include this. A lot of teachers do not like it and want to get rid of it. I think if we get rid of it, we will see an increase in disruptive behaviors in classes after lunch.

  27. Teresa Perles says:

    It is true that students who are getting proper ADHD treatment progress far better in class than those who are not. Also, I find that students with attention deficit are much harder to diagnose in a school environment than students with hyperactivity, as they just sit and do not interfere in class and are often labelled as ‘absent-minded’ or plainly ‘lazy’

  28. Heather Scott says:

    Interesting articles. One part that rings true for me, as a teacher, and obviously for students is: ” if one wanted to exacerbate the symptoms of ADHD, the best way to do it would be to step up academic demands in an overcrowded classroom with extended academic blocks. It would also be a good idea to remove natural breaks like recess and be sure to expect the child sit in a seat the whole time.” Our current structure does NOT support engagement and retention for any student but especially students who are already struggling to maintain focus. Why can’t we think outside of the box in terms of how our day is structured in schools?

  29. Sarah Jacobs says:

    I would love to have training in ADHD best practices! I feel like often it is thrown out there and teachers kind of shrug and that’s it. I would love PD on teacher interventions and how best to accommodate students exhibiting ADHD behavior in classes.

  30. Cristin says:

    Awesome perspective!

  31. Judie says:

    We have used daily report cards in class and these are great for students to help them focus on behaviours and activities. The difficulty becomes when there are numerous students on these in one lesson and the teacher’s attention is divided between them, some things can be overlooked. They need to be carefully thought out before implementation to ensure they give the required information, but do not interfere with the teacher’s learning intentions.

  32. Mr Burke says:

    I appreciate the fact that this article points out teaching & student strategies that can help to “deal” with students with ADHD. Too often, medication is seen as the only option, but this can stifle student creativity & engagement if simply used to calm & focus the student.

  33. Matt Marino says:

    The problem with some of these conditions is that people in my age group were deemed as “boys being boys” when we displayed symptoms, so now it is hard for those of us now as teachers to properly identify. We merely try to keep their attention, rather than examine any issues that may exist.

    Thanks for the great detail and referencing this study.

  34. Carrie Renfro says:

    This is very interesting: “For instance, some children with ADHD fail classes, not because they are having trouble learning the material, but because homework assignments are missing or incomplete, careless mistakes are made on quizzes, or they forget to turn in long-term projects.” I teach inner city students and see this kind of success/failure in their performances. I have to find many many ways to assess student learning and mastery. With a 0.5 improvement it is a challenge to use multiple teaching strategies:”Examples include teacher use of systematic direct instruction of specific academic skills, classwide peer tutoring, computer-assisted instruction, and implementation of self-regulation strategies by the students themselves.” I plan to use these tools to help my students enjoy more success.

  35. Glenda says:

    I thought the article was insightful – we seem to have an ever-increasing number of ADD/ADHD students year after year, and sometimes working with them can be a challenge. This year, in particular, we received a number of students with these behavioral issues, and our team has been working to try and develop strategies to address each unique case, including several of those mentioned in the article. We find that it all depends on the individual student because they all respond differently to different tactics. We also find that parent/family cooperation/consistency is crucial to the success of anything we try to implement. This article was very informative in describing ADD/ADHD and addressing it from many angles. Thank you!

  36. Ed Bonhaus says:

    Very interesting article with some food for thought. I will definitely be sharing this with people in my district.

  37. Mary Jo Heiberger says:

    Thank you for this informative and very important post. Students with ADHD seem to be increasing in number, any help or research on the subject is greatly appreciated!

  38. Sheryl Place says:

    Thanks for the article, very informative. I personally look for ways to assist my students focus. We utilize yoga balls, fidget bars and I do not require students to sit in class. Sometimes a bit chaotic but well worth the effort.

  39. Vanita Vance says:

    Thank you for an interesting and thought-provoking article. As the parent of 2 adult children who were both diagnosed as ADHD during their early school years, I can attest to the benefits of the types of academic interventions described in the article. Those are the exact types of things I used for my own children, and still suggest for my current students who experience the same difficulties.

  40. Alicia says:

    I would love to start using online programs to assist my students with ADHD. I do agree most of our students have low grades because of the lack of assignment completion and because they lose interest in completing tasks. I try to follow up with tutoring, which helps, but it is not enough to reflect on final grades in relation to all subjects.

  41. Amy Sharpe says:

    My son was diagnosed ADHD and I remember being frustrated by people who would state he couldn’t be ADD because he can sit still to watch TV. I know as we try to foster more rigor in the classroom, we tend to put more stress on these students. If by utilizing technology to meet their individual needs we can help improve their outcomes, then we should implement what we can.

  42. Ljiljana Lez-Drnjevic says:

    I like this article. Interesting topic and interesting answers. I would also like to recommend the book Raising Cain: Protecting the Emotional Life of Boys [Dan Kindlon, Michael Thompson].

  43. Julia Ashbaugh says:

    As a teacher myself, I believe it’s imperative that more training be given to educators, so all educators have more information about how to best serve students with ADHD. That really was not addressed in my preparation — I’m sure it is with other disciplines such as special education, but it needs to be more widely addressed.

  44. Cristina Centro Xabier says:

    More and more students with ADHD are enrolling in our school. Most of them take medication, but special strategies are needed in the class as well. We all try to do our best (assigning them special chores so they can move around from time to time and can “scape” the classroom routine, etc…) but we are in need of special training for teachers. Hope we get it soon.

  45. Merri says:

    I completely agree that schools are exasperating the problem by forcing students to focus longer on more challenging tasks in overcrowded rooms not conducive to creative thinking.

  46. Kamela West says:

    The strategies employed at more affluent can be applied at schools that are considered struggling. Effective educator professional development, constant monitoring of strategies by school administrators, gathering & analyzing pertinent data, etc., I believe all students will achieve. Medicating students is temporary ‘banaid’ for a life-long struggle for some. In addition, schools & districts must include all stakeholders (i.e., parents, community members, etc.) in the process.

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