- Front Matter
- Back Matter
- Subject Index
- Section 1: Background to ADHD
- Chapter 1: The Concept of ADHD
- Chapter 2: Use of Medication
- Chapter 3: Multi-Professional Involvements
- Section 2: The School Setting
- Chapter 4: Systematic Classroom Observation
- Chapter 5: Effective Teaching for Students with ADHD
- Chapter 6: Classroom and Behaviour Management Strategies
- Chapter 7: Associated and Coexisting Difficulties
- Section 3: The Wider Context
- Chapter 8: Working with Parents
- Chapter 9: Conclusions and Recommendations
Education at SAGE[Page ii]
SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets.
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© Linda Wheeler 2010
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
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Key to Icons[Page vii]
- Chapter objectives
- Case study
- Points to remember
- Questions for reflection and discussion
- Electronic resource available from website
List of Electronic Resource Materials[Page ix]
Wherever you see the icon, downloadable material can be found at http://www.sagepub.co.uk/wheeler for use in your setting. A full list of materials follows.Appendices
- A Section 1: Background to ADHD – PowerPoint presentation 113
- B Section 2: The school setting – PowerPoint presentation 114
- C Section 3: The wider context – PowerPoint presentation 116
- D ADHD information for parents – PowerPoint presentation 117
- E Blank ITS analysis table 119
- F Blank FIS analysis table 120 [Page x]
The schools involved in the case studies remain anonymous, but a special thank you must go to the head teachers, staff and students who provided a warm welcome and offered every assistance with the research.
I should like to acknowledge the assistance given by Wendy Quill and her colleagues in the undertaking of the school ADHD survey and the organisation of two ADHD study days.
In supervising the research, the overwhelming support and encouragement received over six years from Peter Wakefield and Professor Peter Pumfrey have been invaluable.
Many thanks to Jude Bowen and Amy Jarrold at Sage for all their help and encouragement.
Finally, neither the completion of the research nor the writing of this book would have been possible without my husband, David, who has had faith in me over the years and supported me every step of the way.[Page xii]
About the Author[Page xiii]Linda Wheeler
Linda Wheeler is an ex-teacher in mainstream primary and special schools who has developed an interest in exploring and understanding more about the nature of ADHD from an educational perspective. She has recently completed a PhD at the University of Worcester in association with Coventry University UK. So far two articles based on her research findings have been published in the journal Emotional and Behavioural Difficulties. Linda is a part-time lecturer in the Institute of Education, University of Worcester, Worcester, UK. She can be contacted at linda email@example.com for further details of her research or advice on INSET training in schools.[Page xiv]
How to Use This Book[Page xv]
This book is primarily based on the research undertaken for the author's PhD thesis and offers discussion of the theoretical issues surrounding the concept of ADHD as well as practical applications of the findings. The research was in two parts which ran concurrently. One part was based on detailed analyses of data from a questionnaire survey on ADHD in all schools in a local authority together with analyses of responses from delegates attending two ADHD study days at a university. The other part adopted a case study approach to gather in-depth data on situational and temporal variability in ADHD behaviour in school settings, enabling the identification of approaches and strategies for minimising such behaviour.
Where appropriate, extracts from the PhD research data are used to illustrate particular features. Anonymity has been ensured by the use of pseudonyms throughout the research and the book. From the inclusion of the details and views of real students and real-life situations in schools in addition to theoretical considerations, readers will be able to relate some of their own experiences to the research findings and strategies presented here in order to gain a clearer understanding of the issues raised. The book may be read as a whole, but would also suit individual readers or school groups wishing to focus on particular chapters or sections. A glossary provides a list of ADHD-related terms, acronyms and abbreviations used in the book. PowerPoint presentations (Appendix A, B and C) offer a brief explanation of the contents of each section of the book and may be used to facilitate staff training, for example on school INSET days. A further PowerPoint presentation (Appendix D) is included for use with parents. All four presentations are available as downloadable materials.
Throughout the book, and in Section 2 in particular, to avoid confusion, ‘he’ is used to describe a student with ADHD and ‘she’ for a teacher. This is obviously not always the case, but it reflects the higher number of boys with a diagnosis and the higher proportion of female teachers, particularly in early years and primary settings.[Page xvi]
At the time of writing it is approximately 16 years since the current version of the ADHD diagnosis was published. This version is of course only the most recent of a series of criteria published by the American Psychiatric Association dating back to the middle of the 20th century It is also important to note that the American Psychiatric Association diagnosis of ADHD has many close similarities (and is identical in some respects) with the World Health Organization diagnosis of Hyperkinetic Syndromes which has a similar lengthy history There are also claims that something very similar to these modern diagnoses can be traced back much further to the work of the appropriately named English physician George Still in the early 1900s (Barkley 1997), and the Scottish physician Alexander Crichton, who was working at the overlap between the 18th and 19th centuries (Palmer and Finger, 2001). Furthermore, the nature of ADHD and related conditions, and interventions for them have been the subject of more scientific research than any other biopsychosocial disorder which is highly prevalent among children and young people (Barkley, 2005).
Given these uncontroversial facts, it is surprising that ADHD has been the subject of a sometimes heated debate, stimulated by individuals who question its legitimacy. A recent example of such a negative, anti-ADHD view is provided by Skidmore (2004), who writes:
Given its long historical roots, and the undoubted existence of such psychological and medical conditions [as Down's syndrome and autism], it is likely that research into learning difficulties in the psycho-medical paradigm will continue to be conducted, that it will continue to exert an influence on the wider field, and that some of its findings will be found to be of use in the education of pupils who are affected by conditions which are generally recognised to have an organic basis. The difficulty arises when illicit attempts are made to apply this framework to an infinitely extensible set of putative syndromes or disorders for which reliable evidence of a neurological or organic base is lacking, and where ‘diagnosis’ rests on value laden, culturally-specific judgements about behavioural or cognitive norms. In the case of ADD [sic] it is arguable that the scientistic discourse of positivism and the rhetorical stance of authoritative objectivity which it engenders have been deployed to disseminate a biological determinist hypothesis for which empirical evidence is wanting, and to legitimise the practice of drugging defiant children into docility, using stimulants whose long-term side effects are unknown, in the service of a tacit project of social control.(Skidmore,2004, pp.3–4).
Skidmore's distaste for ADHD is not unique, Slee (1995) wrote something similar almost ten years earlier, and twenty years before him Schrag and Divoky (1975) wrote a book entitled: The Myth of the Hyperactive Child, and Other Means of Child Control. For the reader who has engaged with the educational and psycho-medical literature on ADHD these negative views are baffling. To portray ADHD as a biological determinist construct which not only lacks scientific credibility, but acts as a tool for inflicting harm on children and young people, is, to put it politely, at odds with what the research and theoretical literature relating to ADHD actually says. Writers who promote these views have either not understood the literature which seeks to [Page xviii]illuminate ADHD, or they have failed to engage with it in the first place. If they did they would realise that the most negative life outcomes associated with ADHD (such as educational failure, relationship difficulties, delinquency and mental health problems) are associated with a failure to identify and intervene with ADHD early in a person's life. Further, they would realise that far from being a ‘biological determinist hypothesis’ ADHD is best understood as a biopsychosocial condition (Barkley, 2005); that is, a phenomenon that is the product of the dynamic interaction between inherited (genetic) characteristics and the social environment.
Fortunately, Linda Wheeler, whose book you are reading, has not only engaged with the literature on ADHD and understood it, she has contributed to it, both as an academic researcher and as a pedagogue. The ADHD Toolkit offers an extremely well researched guide to understanding and supporting students with ADHD in schools. One thing that any reader will be able to take from this text is that ADHD, far from being a bogus construct, is very real, both at the conceptual level and in terms of the day to day experience of the people who bear the diagnosis and those with whom they interact. This book will help the reader to understand the difference between the child who is disaffected, defiant and oppositional, and the child whose core difficulties reside in chronic problems of self regulation and concentration (ie. ADHD). It will also help the reader to understand how to translate these insights into practical strategies that will promote the positive social and educational engagement of students with ADHD. This is not to say that students with ADHD are not sometimes capable of being disaffected, defiant and oppositional. They can develop these characteristics when the core features of ADHD are ignored. Linda Wheeler's book will help the reader to realise that to adopt the view that ADHD is merely an excuse for mistreating ‘defiant children’ is not only ignorant, it is positively dangerous. Such an approach will promote defiance and disaffection, because it ignores the central cause of the initial difficulties.
I hope you will enjoy reading Linda Wheeler's book as much as I have. More importantly, I hope you will take from it its central message of compassion for students who experience ADHD and their need for understanding and informed intervention.References1997) ADHD and the Nature of Self Control. New York: Guilford.(2005) ADHD: A Handbook for Diagnosis and Treatment,(3rd Edition. New York: Guilford.2001) ‘An early description of AD/HD: Dr. Alexander Crichton and “mental restlessness”’, Child Psychology and Psychiatry Review, 6 (2): 66–73. http://dx.doi.org/10.1017/S1360641701002507and (1975) The Myth of the Hyperactive Child, and Other Means of Child Control. London: Pantheon.and (2004) Inclusion. Milton Keynes: Open University Press.(1995) Changing Theories and Practices of Discipline. London: Falmer.(
Appendix A: Section 1: Background to ADHD[Page 113]
Appendix B: Section 2: The School Setting[Page 114][Page 115]
Appendix C: Section 3: The Wider Context[Page 116]
Appendix D: ADHD Information for Parents[Page 117][Page 118]
Appendix E: Instantaneous Time Sampling Observation Analysis[Page 119]
Appendix F: Fixed Interval Sampling Observation Analysis[Page 120]
Glossary and Abbreviations[Page 121]
ABC Antecedents, behaviour and consequences approach ADD Attention deficit disorder ADDISS Attention Deficit Disorder Information and Support Service ADHD Attention deficit hyperactivity disorder Amphetamine Type of stimulant drug APA American Psychiatric Association ASD Autistic spectrum disorders Atomoxetine A non-stimulant drug (Strattera) BESD Behavioural, Emotional and Social Difficulty BID Behavioural inhibition disorder Bio-psycho-social Influenced by biological, psychological and social factors BPS British Psychological Society CAMHS Child and Adolescent Mental Health Services CD Conduct disorder Concerta Once-daily sustained release version of methylphenidate DAMP Deficits in Attention, Motor Control and Perception DCD Development coordination disorder DCSF Department for Children, Schools and Families Dexamphetamine Type of stimulant drug (for example, Dexedrine, Adderall) DfES Department for Education and Skills DLA Disability Living Allowance Dopamine A neurotransmitter; a chemical compound occurring in the brain that aids selective attention [Page 122] DSM-IV (TR) Diagnostic and Statistical Manual of Mental Disorders (4th edn) text revision (APA, 2000) DT Design and Technology Dyscalculia A condition associated with specific learning difficulties in mathematics EBD Emotional and behavioural difficulties FIS Fixed interval sampling – systematic observation in which behaviour is recorded over fixed intervals of time Hyperactivity Excessive levels of activity HKD Hyperkinetic disorder – persistent impaired attention and hyperactivity ICD-10 International Classification of Diseases (10th edn) (WHO, 1990) ICT Information and communication technology Impulsivity impulsiveness Suddenly saying or doing things without thinking, having little sense of danger Inattention Difficulty in concentrating, paying attention IEP Individual Education Plan – a document which sets out what a student needs to achieve and how he will be helped to do so INSET In-service education and training ITS Instantaneous time sampling – systematic observation in which behaviour is recorded at pre-determined moments in time LBSS Learning and Behaviour Support Service Methylphenidate Stimulant drug (Ritalin is the most common form) Neurotransmitter A chemical messenger in the brain that carries information between nerve cells NHS National Health Service NICE National Institute for Health and Clinical Excellence Noradrenaline A neurotransmitter that prompts ‘fight or flight’ reactions (also known as norepinephrine) OCD Obsessive compulsive disorder ODD Oppositional defiant disorder PE Physical Education [Page 123] PGCE Postgraduate Certificate in Education PRU Pupil referral unit PSHE Personal, Social and Health Education SAT Standard Assessment Task SEAL Social and Emotional Aspects of Learning SEN Special Educational Needs SENCO Special Educational Needs Coordinator SIGN Scottish Intercollegiate Guidelines Network SSA Special support assistant Statement A document produced by the local authority outlining a student's needs and the support and additional provision necessary to meet those needs (known as a Record of Need in Scotland) TA Teaching assistant TCA Tricyclic antidepressant medication TOAD Talking out, Out of seat, Attention problems and Disruption [Page 124] WHO World Health Organisation
Suggestions for Further Reading[Page 125]
The following suggestions for further reading are in addition to the sources included in the References section.
Parents2008) All Dogs Have ADHD. London: Jessica Kingsley.(1999) The AD/HD Handbook: A Guide for Parents and Professionals on Attention Deficit/Hyperactivity Disorder. London: Jessica Kingsley.and (National Institute for Health and Clinical Excellence (NICE) (2008) Understanding NICE Guidance. London: NICE.2000) Parenting the ADD Child: Can't Do? Won't Do?London: Jessica Kingsley.(
Books for children and adolescents2006) Hurricane Wills. London: Bloomsbury Publishing (also available as an audio book).(1998) Hunter of the Past (downloaded from http://www.adders.org).and (2005) Zak has ADHD: A Doctor Spot Book. London: Red Kite.(2008) Need to Know ADHD. Oxford: Heinemann Library.(2001) What Does It Mean to Have Attention Deficit Hyperactivity Disorder?Oxford: Heinemann Library.(
Self-esteem2002) Because I'm Special: A Take-home Programme to Enhance Self-Esteem in Children Aged 6–9. Bristol: Lucky Duck Publishing.and (1996) Enhancing Self-Esteem in the Classroom,(2nd edn. London: Paul Chapman Publishing.2007) Helping Children to Build Self-Esteem: A Photocopiable Activities Book,(2nd edn. London: Jessica Kingsley.
[Page 126]Alternative/complementary interventions2005) ‘Homeopathy for attention deficit/hyperactivity disorder: a pilot randomised controlled trial’, Journal of Alternative and Complementary Medicine, 11 (5): 799–806. http://dx.doi.org/10.1089/acm.2005.11.799, , , and (2004) ‘The effects of yoga on the attention and behaviour of boys with attention deficit/hyperactivity disorder’, Journal of Attention Disorders, 7 (4): 205–16. http://dx.doi.org/10.1177/108705470400700403and (1999a) ‘ADHD — a different viewpoint I: dietary factors’, in P.Cooper and K.Bilton (eds), Attention Deficit Hyperactivity Disorder (ADHD): Research, Practice and Opinion. London: Whurr Publishers, pp. 76–110.(1999b) ‘ADHD — a different viewpoint II: holistic and other approaches’, in P.Cooper and K.Bilton (eds), Attention Deficit Hyperactivity Disorder (ADHD): Research, Practice and Opinion. London: Whurr Publishers, pp. 111–37.(2005) ‘Complementary and alternative medicine use in children with attention deficit hyperactivity disorder’, Journal of Paediatrics and Child Health, 41 (1–2): 23–6. http://dx.doi.org/10.1111/j.1440-1754.2005.00530.xand (
List of Useful Organisations and Websites[Page 127]
http://www.adders.org An ADD/ADHD non-profit-making support group based in Thanet, Kent, UK http://www.addiss.co.uk National Attention Deficit Disorder Information and Support Service (UK) http://www.behaviour4learning.ac.uk Website supported by the Training and Development Agency includes research in behaviour management http://www.nasen.org.uk UK organisation for special educational needs http://www.ni.add.org/uk Northern Ireland ADHD Support Centre http://www.SEBDA.org Multi-professional social, emotional and behavioural difficulties association http://www.sign.ac.uk Scottish Intercollegiate Guidelines Network http://www.sqa.org.uk Scottish Qualifications Authority http://www.teachernet.gov.uk Developed by the Department for Children, Schools and Families (UK) as a resource to support the education profession http://www.teachers.tv Provides education programmes on TV and online, resources and support materials http://www.tda.gov.uk Training and Development Agency for schools [Page 128] http://www.youngminds.org.uk UK charity which promotes child and adolescent mental health services
References[Page 129]ADDISS (2003) ADHD: Parents, Provision and Policy: A Consultation with Parents. London: ADDISS.2001) Managing Attention Deficit/Hyperactivity Disorder in the Inclusive Classroom: Practical Strategies for Teachers. London: David Fulton.and (American Psychiatric Association (APA) (2000) Diagnostic and Statistical Manual of Mental Disorders,4th edn, text revision. Washington, DC: APA.2006) ‘Methylphenidate transdermal system: in attention deficit hyperactivity disorder in children’, Drugs, 66 (8): 1117–26. http://dx.doi.org/10.2165/00003495-200666080-00007and (2005) ‘Social skills training reconsidered: what role should peers play?’, The ADHD Report, 13 (1): 1–5. http://dx.doi.org/10.1521/adhd.126.96.36.199562(1996) Assessing Individual Needs: A Practical Approach,, and (Support for Learning Service, London Borough of Tower Hamlets Children's Service) (2nd edn. London: David Fulton.2006) Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment,(3rd edn. New York: Guilford Press.2002) ‘International Consensus Statement on ADHD’, European Child and Adolescent Psychiatry, 11 (2): 96–8. http://dx.doi.org/10.1007/s007870200017and 74 co-endorsers (2000) Effective Intervention in Primary Schools: Nurture Groups,and (2nd edn. London: David Fulton.2007) ‘Pupils' little helper at 50p a fix’, Times Educational Supplement, 8 June.(British Psychological Society (BPS) (1996) Attention Deficit Hyperactivity Disorder: A Psychological Response to an Evolving Concept. Leicester: British Psychological Society.British Psychological Society (BPS) (2000) Attention Deficit Hyperactivity Disorder (ADHD): Guidelines and Principles for Successful Multi-agency Working. Leicester: British Psychological Society.CAMHS (2008) Children and Young People in Mind: The Final Report of the National CAMHS Review. Downloaded from http://www.dcsf.gov.uk/CAMHSreview.2006) ‘Attention Deficit Hyperactivity Disorder has serious and immediate implications’, Educational Journal, 94 (4): 35–7.and (2005) ‘Attention deficit hyperactivity disorder: should we believe the mass media or peer-reviewed literature?’, Psychiatric Bulletin, 29: 288–91. http://dx.doi.org/10.1192/pb.29.8.288(2008) ‘Teachers' responses to the emotional needs of children and young people. Results from the Scottish Needs Assessment Programme’, Emotional and Behavioural Difficulties, 13(1): 8–19. http://dx.doi.org/10.1080/13632750701814633, , , , , and (2004) Nurturing Pupils with ADHD. Paper presented at the 5th World Congress on Dyslexia, Thessaloniki, Greece, August.(2005) ‘AD/HD’, in A.Lewis and B.Norwich (eds), Special Teaching for Special Children? Pedagogies for Inclusion. Maidenhead: Open University Press, pp. 123–37.(2006) ‘Assessing the social and educational value of AD/HD’, in M.Hunter-Carsh, Y.Tiknaz, P.Cooper and R.Sage (eds), The Handbook of Social, Emotional and Behavioural Difficulties. London: Continuum, pp. 248–63.([Page 130]2002) Attention Deficit/Hyperactivity Disorder: A Practical Guide for Teachers,and (2nd edn. London: David Fulton.2001) Educating Children with AD/HD: A Teacher's Manual. Abingdon: RoutledgeFalmer.and (1999) ‘ADHD from the inside: an empirical study of young people's perceptions of the experience of ADHD’, in P.Cooper and K.Bilton (eds), Attention Deficit Hyperactivity Disorder (ADHD): Research, Practice and Opinion. London: Whurr Publishers, pp. 223–45.and (1999) ‘Teachers' classroom strategies for dealing with students with ADHD: an empirical study’, in P.Cooper and K.Bilton (eds), ADHD: Research, Practice and Opinion. 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