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In the second part of the interview on ADHD & teachers with Dr Fernández, we are focusing on

How ADHD affects these students’ learning process & their behaviour in class

If you or somebody you know want to read this post in Spanish this is the link to the post on Dr Fernández’s blog elneuropediatra

Q. 1: It appears that these disorders affect some areas of the brain, but not others. Is that so?

Yes, that’s right. Some areas are affected, but not the whole brain. As a matter of fact, this is how I always explain it for those parents who come to my practice to understand that this is not a question of being intelligent or not.

Frontal Cortex

Several areas or regions of the brain are affected. The most important one is the frontal region or frontal cortex. This is the area which is just above the eyes. It may be the right or the left hemisphere. There is no correct maturation.

In this area is where the main control centres for our brain’s executive functions are located. The executive functions allow us to self-regulate our capacities. There are cool and hot functions.

• • Cool (or cold) executive functions deal with purely cognitive issues.
  • Hot executive functions are in charge of the issues concerning emotions.

They both work in a coordinated fashion.

From this, it can be easily inferred that intelligence is not necessarily affected.

ADHD is not a question of IQ

The problem lies in how to manage the mechanisms required to develop those capacities.

ADHD & Gifted Children

This is so much so that in 30% of the cases, kids suffering from ADHD have High Intellectual Capacities. There are certain advantages but also drawbacks when ADHD and High Intellectual Capacities come together.

Advantages

•  High IQ helps to make up for attention problems.
• Just by paying a little attention the kid can assimilate enough information
• Reaction to treatment usually is more favourable and faster.
• Prognosis is better, and the doses and length of the medication are lower.

Drawbacks

• A High IQ may hide attention problems when doing the Tests
• It often takes longer to diagnose.
• There may be emotional problems caused by the feeling of academic impotence.
• There may be behavioural problems increased by the high intellectual capacity.
• When it comes associated with hyperactivity and/or impulsivity it can cause serious problems.

If you wish to find out more about this, check this article in Spanish: TDAH y las altas capacidades.

Brilliant in Primary Education

I often come across this situation in my practice. There are kids who in Primary education were brilliant. They had very good results with very little effort.

Often fail in Secondary Education

Suddenly, the family starts seeing how gradually both their performance and their behaviour get worse.  Bad moods become more frequent and, in a short while, the kid gets extremely bad results and huge behavioural problems.

Kids then give in. They always had excellent results with very little effort. Little by little, the academic courses become more difficult. They are more demanding, require more time, and their concentration span is short.

The kids do not understand what is happening to them. They feel frustration. At first, they try, but then, they give in and look for excuses, deceptions, etc. Any strategy to justify themselves to the rest.

Q. 2:  And in this case, are some of these areas not exclusively related to attention but to language acquisition or production?

They may be. Depending on the specific areas which are affected and the maturity level of each one of them. The “immaturity” area of influence may be larger or smaller. It may affect more or fewer areas in its vicinity.

In any case, it is important to distinguish between specific learning disorders and the consequences of ADHD.

ADHD affects learning in general

The ADHD itself is going to affect learning in general. Consequently, it may hinder the onset of language learning and other types of learning. In any case, there may also be comorbidities. These are added disorders which may appear with ADHD but they are not directly caused by this disorder.

ADHD & Dyslexia

For instance, ADHD may hinder language development. But it may also be that kid suffering from ADHD also has some language disorder.  If possible, this complicates matters even more.

It is not always easy to distinguish between the different issues.

It is important to make the right diagnosis

This may lead to gross errors in the diagnosis and, of course, in the appropriate treatment. Let’s consider the two possibilities:

• It will be utterly useless to treat an “alleged” dyslexia if the kid suffers from untreated ADHD. Indeed, it may not be dyslexia but some problem derived from the ADHD symptoms. It only requires for ADHD to be treated. It does not need a dyslexia-specific educational treatment.
• On the other hand, if the child has both conditions and the ADHD has not been treated, dyslexia therapy will not be very effective. If the kids cannot focus or cannot control themselves, they won’t take full advantage of the therapy. They will give in when they see that it doesn’t work.

On many occasions in my consultancy, I have met small kids with this type of problems due to lack of information on the part of the parents or teachers.

It is important to know about the language problems among ADHD sufferers (see Los problemas de lenguaje en el TDAH) because they are frequent and significant.

Hyperactivity in little kids

It is also important that parents learn to identify the data since their kids are little, to detect hyperactivity (see detectar la hiperactividad) and to know about how to treat ADHD in little kids (see el Tratamiento del TDAH en los Niños Pequeños)

ADHD & Autism

The same mistakes can be made with other disorders. When they are little, children suffering from ADHD may seem to show autistic signs. They don’t speak, do not communicate properly, are very nervous, do not look you in the eye, etc.

It is very important not to make a gross error. Indeed, it would not be the first time I have seen it happen. I recommend you to read this article on ADHD and Autism: La realidad del TDAH y el Autismo.

Q. 3: Can reading comprehension skills, for example, be affected as well?

Of course, they can. Following the reasoning expressed above, there may be reading and writing problems, in mathematics, etc., all caused by ADHD.

To illustrate:

Not long ago I came across a report from a reputed centre in Madrid where a patient was given a lot of diagnoses.

The report said that there was a high risk of ADHD. Among the diagnoses, there was: language disorder, dyslexia, social relationship disorder, mental maths disorder…it was almost endless.

It took them 3 mornings to do all those tests. I did not want to ask them how much they were charged. Based on the test results, they were given a report with the recommendations to set up the psychological and educational treatment at a centre in their town.

The funny thing was that, after telling them all this and at the end of the session, they were told: “In any case, the neuro-paediatricians at our centre usually recommend these children to have some kind of medication. So, go to your paediatrician and ask him to prescribe…”

My comments:

• The kid had not been seen by a Neuro-paediatrician.
• The medication cannot be prescribed by a psychologist. Only a doctor can.
• The recommendations they were given were based on the results of the tests, without medication.
• If the kid is treated, the test results are no longer valid.
• Some of these tests cannot be repeated until 6-12 months later.

What shall we do now?

The family came to me because they did not understand why their daughter should need so much therapy. Particularly since she had started taking medication. It wasn’t the best, but it had some effect.

We need to use some common sense in all this. There are many teaching and health professionals who have lost their marbles and do not know what they are doing. Either this or worse, they act in bad faith for purely economic reasons.

Q. 4: Is there anything that prevents them from learning to mastery?

None whatsoever. The essential factor to bear in mind if we want these kids to learn is motivation. Indeed, motivation is the brain mechanism that regulates the control of attention, movement and impulsiveness.

Motivation is the key

The abnormal maturation of the frontal region of the brain is what causes the malfunction of that mechanism. This prevents the normal stimuli from being enough to make the kid control those elements.

Consequently, a kid suffering from ADHD needs more intense and frequent stimuli to feel the same motivation. If you do not provide them, you do not stimulate the kid and fail to attract the kid’s attention. In most cases, it is something involuntary on their part.

Electronic devices

This means that when there is something the kids like, it is also highly stimulating for them. They can then concentrate normally, even excessively sometimes. These kids’ brains are not used to receiving gratifying stimuli, so when they get one they really respond to it.

In fact, many kids have problems with electronic devices and they never want to get off the mobile phone or video game (see nunca quieren dejar el móvil o la consola).

You can check how these kids’ brains work in this article Entender el TDAH.

In short, we can say that they suffer from demotivation.  The effort required by kids with ADHD to get over their daily obligations is much greater than that required by the rest.

When motivated, they concentrate

However, there are situations or issues which attract them a lot. They love these issues and they feel motivated by them. In this case, they manage to achieve a balance in the mechanism so that it works properly. Consequently, they concentrate and work on these issues with no problem. Sometimes they are even hooked on them until they get saturated or have had enough.

It seems quite common for attention disorders to appear together with hyperactivity. Some of these students suffer from impulsive and sometimes aggressive behaviour, especially teenagers.

Q.5: Is there a link on the way these teenagers are treated regarding daily routines or formal education and the probability to develop aggressive attitudes?

Yes, there is.  The “nuclear” symptoms of ADHD are 3: Lack of attention, Hyperactivity and Impulsiveness. Depending on the region of the brain which is affected and the degree in which it is affected, the symptoms will be more of one kind than other.

Moreover, there are the already mentioned comorbidities. These are more than the ones mentioned above: anxiety, depression, sleep problems, tics, coordination problems, behavioural disorders, etc.

ADHD & teachers

When a teacher sees a kid with ADHD in class, what the teacher sees is what the kid does. Whether the kids pay attention, move or behave properly. When they don’t, it may be due to any combination of the 3 main ADHD symptoms.

3 main ADHD symptoms

• If a kid does not pay attention in class, he’s not going to do well in his studies. Besides, he’ll get easily bored, will tend to move, interrupt, disturb the rest…even if he does not suffer from hyperactivity or impulsiveness.
• On the other hand, if kids are hyperactive they’ll move a lot in class. This may disturb or interrupt the class development, but it will also prevent them from keeping their eyes on the board.
• Finally, if kids are impulsive, they’ll have behavioural problems in class, but not just that. They will also respond excessively to any stimulus from the environment; they’ll get up, talk… and very likely will not be able to keep up with the pace in the class.

How can we tell which the problem is in each case?

Besides, they can combine in different proportions. What can we do?

It is important to be able to measure the different symptoms. We can see the consequences of each one of them. There are learning (school), behavioural or social relationship problems.

• Attention deficit is the main cause of learning (school) problems
• Hyperactivity is responsible for most social relationship problems.
• Impulsiveness is responsible for most behavioural problems.

With the help of technological advances

The truth is that technological advances are making our task easier. Currently we have devices which can assess all these issues.

The AULA Test is based on virtual reality and it allows us to independently measure each of the symptoms using a kind of computer game and a set of 3D glasses. This is currently the most reliable test to assess those symptoms. This link will tell you more about it AULA

Besides, we have recently incorporated a new technology called BrainGaze. This device serves to assess whether there is or not ADHD by assessing a series of activities the kid performs directly on the computer and analysing eye movement patterns. This test helps to make a definite ADHD diagnosis definitivo diagnóstico del TDAH

These two tests are the best example that the ADHD is not a matter of opinion but a scientific issue.

You may also be interested:

If you haven’t read the first part this is the link: ADHD & teachers: How to deal with ADHD as a teacher. 1st of 4 parts

In  4 weeks’ time, you will have the 3rd part of this interview.

• How can teachers identify a case of ADHD?
• How to act with them in class and how to manage tasks and activities

You can’t miss it! It will be very helpful for your teaching practice and  your syllabus design if you are preparing for the Competitive Exam (Oposición)

And if you wish to find out more about Mastery learning:

Vuelco a las aulas: Repensando la Educación I.

Lots & Hots or Learning to Mastery

Finally, as usual, if you like it, share it, and if you have any questions or comments, we’d love to deal with them!