Teachers & ADHD: In the 3rd part of the interview to neuro-pediatrician Dr. Fernandez on ADHD, he talks about

How teachers can identify a case of ADHD

Some of these disorders are detected in schools and then diagnosed and treated by experts. However, teachers deal every day with students who suffer from a complete lack of motivation as regards formal education.

Q. How is it possible to tell these students from the ones who really suffer from attention disorders?

This is not an easy question to answer, particularly with teenagers. Nor are there any magic wands which allow us to distinguish between one situation and another at face value.

The essential issue to bear in mind when you ask me that question is the need for early detection. I lay a lot of emphasis on how important it is to inform and train primary and secondary teachers because they perform a significant role in our kids’ learning processes and education.

Nature is wise. What I mean by this is that a child tends to develop following a regular path from birth to adulthood. Thus, a kid with no significant problems will develop within standards. They will behave properly, study, learn, interact with others with nothing particularly striking in their development.

Children are naturally interested in learning

When there’s a problem, though, altering, hindering or limiting the kid’s capacities, he or she responds by developing abnormally. In principle, no child is demotivated, negative, uninterested either in his studies or other aspects of life.

Normally children are interested in learning, in gaining skills, competences, knowledge. They want to grow into adults and to do so they need to gradually acquire all these learning processes with some reasonable, progressive and increasing but not disproportionate effort as a trade-off.

Students with ADHD need to make more effort to achieve results

But kids suffering from ADHD, despite being quite smart and even some of them having above average intelligence, need to make a much greater effort than other same age kids to achieve the same objectives.

Brain maturation occurs at a slower pace

ADHD kids’ brain maturation evolves at a pace between 3 and 5 years more slowly in the regions regulating attention, movement, and impulses. This means that an 8-10-year-old kid suffering from ADHD will tend to behave like a 5-year-old in this regard.

Moreover, in his/her attempt to behave and perform like a child of his age, (s)he has to make a special effort which, sometimes, is well beyond him/her. When this happens on a daily basis and in all areas of life expected from the child, there comes a moment when, after unsuccessfully trying so many times, (s)he just gives up. Furthermore, throughout the process, (s)he suffers from anxiety, insecurity, and low self-esteem.

Learning, attitudinal or demotivation problems may indicate ADHD

This is why I insist so much on how important it is for teachers, at whatever level they may be teaching, when they come across a kid with learning, attitudinal or demotivation problems, to consider that possibility. This is particularly significant in the first years of primary and even infant education.

In Infant Education

There are many times when infant school teachers have problems to manage some kids’ behaviour. They claim that they do what they like, do not pay attention and it is impossible to keep them sitting still and taking part in the “class assembly.”

This alone is a significant sign to warn the parents. At least to be on the look out. Indeed, many kids suffering from ADHD already show those symptoms at such an early age. This hinders their relationship with their peers but also such basic learning as letters, numbers, etc. Many of these kids already start primary education at a disadvantage.

In extreme cases, I feel myself in the need to start giving pre-school kids pharmacological treatment due to high-intensity hyperactivity and impulsiveness. Sometimes they are a risk to themselves because they are not aware of the danger, while other times they are a risk to their classmates because they behave aggressively. (You can check what Dr Fernández has written about Young kids & ADHD here -in Spanish)

In Primary Education

I have found the same in Primary education. Here we need to take into account that there are other factors that have an impact on a kid suffering from ADHD’s final performance at school. It is not the same when attention deficit is predominant or when it is hyperactivity or impulsiveness. Likewise, IQ is a significant factor.

IQ &  ADHD

Depending on the balance between the kid’s capacities (intelligence quotient) and the difficulties he faces (ADHD), problems with his school performance may start at an early or late stage.

A kid with mild ADHD and a high IQ may not have any performance issues at school while the effort required from the courses is medium to low.

• Indeed, for as long as the effort required is not greater than what his/her attention span can reach, school performance will be good or even very good.
• Besides, not much effort or time will be required.
• Thus, (s)he gets used to obtaining good results with very little effort.
• This, which can be good at first, presents a problem. When the effort required is greater and his/her attention span cannot reach the level required, that’s when the breakdown occurs.

Planning, organisation & study techniques: key elements to help kids with ADHD

And it is a sudden breakdown because, during all that time, appropriate learning has not occurred nor have basic functions such as planning, organisation, study techniques been developed. Suddenly the kid finds that the effort he/she has to make to perform well is far too great. What is more, the outcomes are not as good as before, as (s)he had come to expect. Indeed, (s)he may even fail some subjects. What happens then is that many of those kids assume they are not able to carry on with their studies because “it’s very difficult.” If that case had been diagnosed at the right time, the situation described above would have been avoided with appropriate treatment. Once it has taken place, the kid loses motivation and looks forward to ending school. I’m afraid at that point, there’s not much to do.

The most common case is that of a kid with mild ADHD and an average IQ. Their development is more predictable in these cases.

• As the school subjects become more demanding performance is gradually decreasing.
• The need for support is greater.
• There are kids more willing to work than others, depending on their ADHD profile but, overall, these cases come to the consultancy at a more or less early stage and they can be successfully dealt with.

In Secondary  Education

Something similar takes place in Secondary education, and we come across extreme cases.

• There are kids who are truly hard-working and, despite average or even poor performance, they do not give in and go on working.
• Teachers do not usually understand them.
• The kids and their parents work hard but, to the teacher, they come across as not working much, as weak.

On the other hand, there are those pre-adolescents who simply give up, and they just want to drop out. They are constantly disrupting the class, annoying teachers, and do not work at all. Very little if anything can be done for them at that stage.

After Compulsory education, there comes higher secondary, vocational training, university. The situation here is the same as before.

Teachers are often unaware

On top of that, teachers at the higher levels know nothing about and are not aware of this issue. If it is complex for teachers at infant or primary education to know about it and “believe it happens,” you can well imagine how teachers at Compulsory and Higher Secondary Education or University feel when they are told that one of their students is failing the subject due to a problem of attention deficit. Or that (s)he forgets to hand in assignments or similar things.

In a nutshell: lack of motivation means there is a problem

To answer your question in a nutshell, when you come across a child who lacks motivation, has given up and has no inclination to work, there may be a case of ADHD or some other problem. What is sure is that there is a problem. Had it been detected or treated at the right time, it would very likely have been prevented. And, concerning ADHD, detection ensures that we are on the right path to solve the problem.

We need to carry on working to inform, train and raise awareness among teachers at all levels so that they are vigilant of any suspicious signs and can inform the parents as early as possible.

Q. Is there any age when these disorders can be diagnosed with more reliability?

It is important to bear in mind, as I mentioned above that this is a genetic disorder which is inherited. This means that the symptoms may already appear in infancy.

The problem is that the younger the kid, the more difficult it is to distinguish it from normal behaviour or from other disorders. Indeed, the symptoms showing during the first years of life, i.e. before the child is 6, may be mistaken for those characterising the autism spectrum.

Telling ADHD from ASD

ADHD prevents kids from focusing on a task, which itself makes them not look at you, take no notice of you, or give the impression that they are not listening. They have problems with language development and are very much on edge. This limits their social learning capacities. Before kids are 6, the symptoms for ADHD and ASD (Autism Spectrum Disorder) overlap in 30% of the cases. In these situations, one has to be extremely careful when giving a diagnosis. The repercussions of having a child with ASD are far more serious than having one with ADHD, so we must tread extremely carefully when assessing a case. (You can check out this post on ADHD & Autism, in Spanish, by Dr Fernández)

The best age range to diagnose ADHD is school age (6-14)

Also essential to bear in mind is that time complicates matters for a child suffering from it. During adolescence or adulthood, there may be so many intertwined situations that render it difficult or even almost impossible to identify or diagnose the disorder.

Thus, the age range when we can most easily detect and diagnose ADHD is the schooling period, i.e. between 6 and 14 years of age. This is when the symptoms are most evident because of school or social problems, but they have not yet developed long-term comorbidities or complications.

Easier to detect if the predominant symptoms are those of hyperactivity

Even within that age range, it is much easier to diagnose or at least to suspect its existence when the predominant symptoms are those of hyperactivity or impulsiveness. This type of child is disruptive from the very beginning, and the teacher can detect it more easily.

On the contrary, when the predominant factor is attention deficit, we may have a delay in the diagnosis of 6-7 years.  In which case, the kid may be 13, 14 or 17 years old before he’s diagnosed.

Q. We understand that there are different types of ADHD.

Q. Is there a connection between ADHD and dysgraphia? 

Absolutely. Kids with ADHD very often have problems with their writing skills.

Q. How can we distinguish between kids who really have ADHD from those who just have bad handwriting, or make spelling mistakes? Or is the latter an indication of the former?

The truth of the matter is that it may be very difficult to tell a kid with a specific writing disorder from one with ADHD. Perhaps the easiest way is by checking whether there are any problems other than writing. A kid suffering from ADHD will normally have other problems as well.

Very often families will come to the consultancy saying that their kid is dyslexic. (S)He has reading problems, makes spelling mistakes, etc. Well, most of the times, at the end of the session, the tests show that there is a significant attention deficit.

When I speak to the parents I always ask them the same:

If your kid does not pay attention when reading or writing, how can we know if the mistakes are due to ADHD or dyslexia?

We can only find out once we see how the child is after being treated, and the ADHD symptoms have disappeared.

Mega-assessments are a waste of time & money

That is exactly why I am totally against psycho-pedagogic mega-assessments to study kids with learning problems.

• First, find out whether they suffer from ADHD or not.
• Then you will know how to act.

Any other way is a waste of time and money. But I suspect we’ll need to change a lot of mindsets at schools and educational psychology consultancies.

It should be one of the first things to discard in any kind of learning disorder. Like an eyesight or a hearing test.

In this regard what I have said concerning writing  is equally valid for reading and maths.

(see Dr. Fernandez’s posts in Spanish)

This is not the end of the interview

In the last part, Dr. Fernández will tell us how we can help them in class. You cannot afford to miss it. Register on the blog and you will be notified when is ready.

And if you have found the post interesting, share it on Facebook and on the Facebook groups for teachers. You may help other teachers understand and know how to deal with ADHD.

You may also like to read

Teachers & ADHD. Part 1.

Teachers & ADHD. Part 2

And if you or somebody you know prefers to read the Spanish version of these posts, Dr Fernández has published his version El neuropediatra: Todo lo que los profesores necesitan saber sobre el TDAD-3