psychology

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Emotional and Behavioural Difficulties

The article that I have chosen to critique and evaluate, was written Professor John Visser and Zenib Jehan (2009) and was published in the journal ‘Emotional and Behavioural Difficulties’ in June 2009. This journal is the official publication of the Social, Emotional and Behavioural Difficulties Association (SEBDA). John Visser is a professor in the University of Birmingham’s school of education and is also an associate editor of the journal that his article appears. He has published many books in the field of Social, Emotional and Behavioural Difficulties (SEBD) such as ‘Effective Schooling for Pupils with EBD’ (Cole et al., 1998) and ‘Emotional and Behavioural Difficulties in Mainstream Schools’ (Visser et al., 2001). The article critically questions the current scientific evidence, espoused by doctors, psychiatrists and pharmaceutical companies, that ADHD is essentially a wholly a biomedical condition. It is argued that the medical research evidence contains uncertainties and discrepancies and further, that the use of psycho-stimulant medication to control behaviour is flawed. The authors believe that this medicalised approach to ADHD leads to a simplistic ‘cure’ in the form of pharmaceutical intervention and consideration of the psychosocial or environmental nature of the condition is consequently overlooked. Visser and Jehan do not deny the bio-medical paradigm of ADHD, but suggest that it is a bio-psychosocial condition. The article essentially offers no empirical data, nor does not constitute new research; it appears to have been written to focus attention on revisiting the debate surrounding the issues regarding the causes and treatment of ADHD.

The Emotional and Behavioural Difficulties journal places a limit of 8,000 words on article submissions and Visser and Jehan’s article falls well below this limit at 5,056 words. I was surprised however that this article was included in this journal and had not been published in the Journal of Attention Disorders – an academic publication dedicated to the study of ADHD. The readership of SEBDA’s journals is predominantly teachers, learning support assistants, educational psychologists and other professionals who work with children categorised as having SEBD. I feel that it has been assumed that any reader of this article would need to have a fairly adequate scientific understanding and knowledge base.

The aetiology (the study of the causes and origins of a disorder) of Attention-deficit hyperactivity disorder is a particularly relevant topic to me as I have worked in a special school categorized as catering for pupils with Social, Emotional and Behavioural Difficulties for the last 12 years. 40% for the students at the school, who are aged between 11 and 16, have been diagnosed, by either a paediatrician or educational psychologists as having ADHD. Students generally have a further co-existing diagnosis (co-morbidity) of conditions such as CD – compliance disorder, ODD – Oppositional Defiant Disorder or bipolar disorder.

I chose this article as I am particularly interested in understanding the framework of ADHD diagnosis and investigating whether different behavioural strategies are required to those used in dealing with a wider BESD population. Having worked for a considerable period of time with children who can display difficult to manage behaviours, I know very little about ADHD and have never had any specific training or information on the issues regarding effective engagement of ADHD pupils. This lack of knowledge is another reason for choosing this article. I believe however, that the 40% of pupils that have been diagnosed as having ADHD within the school, are not a visual or an identifiable group that could be discerned from the general SEBD population. The intensity and number of challenging incidents appear to be no different from ADHD pupils than that from the general SEBD population of the school.

The Notion of ADHD

The American Psychiatric Association (2000) define ADHD as:

In order to diagnose ADHD, the symptoms of ADHD must be present for a minimum 6 months and be observed in at least two different environments e.g. school and home; there must also be un-refutable evidence that the symptoms of ADHD interfere with academic and/or social functioning.

In their article, Visser and Jehan define ADHD to be “a broad category” of behaviours and treat ADHD as a unitary condition, taking a vague definition of ADHD, formulated back in 2005. Currently however, ADHD is divided into three distinct sub-types (McBurnett et al., 2000). The first sub-type is “Inattentive” - this is where the child appears to have great difficulty in concentrating on what they are doing or to stay focused on a particular task; unless however, it is something they have an interest in. The second ADHD sub-type is “Hyperactivity” which is characterised by the inability to slow down, appearing to have endless energy and seem not to be able to sit still. The final sub-type is termed “Combined” this is where characteristics of both inattentiveness and hyperactivity are displayed behaviours.

Although the Education Act 1996 only offers a definition of Special Educational Need and not specifically SEBD, the Code of Practice for the Identification and Assessment of Special Educational Needs (DfES, 2001) however provides guidance on how social, emotional and behavioural difficulties may be a special educational need. There are certain similarities between APA’s statement of ADHD and that of the UK government’s definition of the SEBD population. SEBD is defined as:

It is estimated that between 0.2% to 1.07% of pupils in the English school system have a statement for SEBD (Cole et al., 2003). However, this categorisation of SEBD pupils differs to that of a diagnosis of ADHD, as paragraph 58 of the Education Act 1996 clearly states:

Although there is a multitude of academic papers on ADHD in the research domain, parents and educationalists are possibly more likely to access information regarding ADHD through newspaper articles and television programmes. As Norris and Lloyd (2000) state:

In the past, it was common for the media to suggest that the growth in ADHD diagnosis was an attempt to medicalise anti-social and inappropriate human behaviours. The idea that ADHD is not a true medical condition is further supported by Dr Fred Baughman, an American paediatric neurologist. Through his web-site and published book ‘The ADHD Fraud’ (2006) he describes the symptoms of ADHD as ‘the behaviours that normal children do that irritate adults’.

Whether ADHD is seen as a valid medical condition or not, the labelling of a set of behaviours, makes it possible to focus discussion and research around this phenomena. It would be difficult to refute however, that around 5% of children demonstrate the characteristics described as ADHD on a daily basis, even if this disorder is not believed to be true.

Epidemiology of ADHD

In the United States, it is estimated that between 7-8% of children (aged 4 – 17) have been diagnosed with ADHD; it is the most commonly diagnosed behavioural disorder in children with approximately 4,400,000 diagnoses with over 2,500,000 of these being prescribed medication (Visser and Lesesne, 2005). In the UK however, estimates of ADHD diagnosis ranges between 3-5% (NICE, 2006a) In a mental health survey of carried out in 1999 of 10,438 UK children (aged of 5 -15), it was noted that 3.6% of boys and 0.9% of girls had ADHD (Tamsin et al., 2003). Generally, boys are often diagnosed as hyperactive type ADHD, with girl’s diagnosis being the inattentive form of ADHD and are thought to be currently significantly under-diagnosed.

Government statistics showing the number of pupils who are statemented by each type of special educational need does not include a separate category for ADHD. However research carried out by Holowenko and Pashute (2000) found that more than half of all children with ADHD are not statemented for SEN, this suggests that ADHD is not necessarily a special need. Similarly, in a more recent study by Wheeler et al (2008) they found that 70% of pupils with ADHD were not statemented. In contrast, within the American school system, children with ADHD are 5 times more likely to be placed in a special school than non-ADHD children (Peter S et al., 2004).

Estimates of worldwide diagnosis of ADHD is 5.29% (Polanczyk et al., 2007). However in their analysis, Polanczyk et al. found that the rate of diagnosis in Africa and the Middle East was significantly lower than that in North America and Europe. It could be suggested that this variation in diagnosis could be due to the social, life style and cultural issues of these continents. It should be noted however that they reported on the diagnosis rates and not the prevalence of the ADHD.

Identification of ADHD

There is no single medical, physical or other test for diagnosing ADHD. As a parent, I have always believed that if your child was diagnosed as having a medical condition such as diabetes or epilepsy, you would expect that the doctor would provide results of a test to confirm the prognosis. However it seems to be the case that parent’s of ADHD sufferers are not offered such assurances before placing their child on potentially dangerous and highly addictive drugs, such as Ritalin. There are no outward chemical or physical indicators of this disorder as the condition is “within the child”. It is difficult therefore to dispute the statement from Peter Jensen (1998) of the National Institute of Mental Health who states:

It is conceptually difficult to ascertain, qualify or identify ADHD, as there are no clear objective indicators of the disorder, as Reid and Maag (1997) state:

The most commonly used and widely accepted procedure for the diagnosis of ADHD, in both America and the UK is the use of the ICD-10 -International Classification of Mental and Behavioural Disorders 10th revision (World Health Organisation, 1993) and the DSM-IV -Diagnostic and Statistical Manual of Mental Disorders, 4th Edition  (American Psychiatric Association, 2000). In the UK, ADHD can only be formally diagnosed by a child psychiatrist or child psychologist, a paediatrician, a psychiatric social worker, an educational psychologist or GP.

For the DSM-IV to diagnose ADHD, six out a possible nine symptoms must be present. Items to determine inattention are –“Often makes careless mistakes”, “Is often easily distracted”, and “Often does not seem to listen when spoken to directly. “(American Psychiatric Association, 2000) To accurately identify hyperactivity statements such as “Often fidgets with hands or feet or squirms in seat”, ” Often interrupts others”, “Often talks excessively”, and “is impatient” are use as diagnostic criteria. Advocates of the social construct theory of ADHD would argue that these criteria are extremely subjective, and drawing a line between what is normal and what is not, is decided by society and is not an absolute.

It is interesting to note though, that in 47% of ADHD cases, it is a teacher who is responsible for initially identifying ADHD in children; a further 30% of cases are identified by the child’s parents (Sax and Kautz, 2003). It is through the use of a questionnaires such as the Conner’s Teacher's Rating Scale (Conners and Multi-Health System, 1997) that parents and teachers identify the behaviours of ADHD. It could be argued however that the use of questionnaires to identify what is essentially a neurological impairment, by parents and teachers, who have no clinical training, could lead to inappropriate judgements being made. It is difficult to know if this procedure of identification is not flawed. Carey (1999) argues that this use of questionnaires in the diagnostic process by non medical professionals could possibly:

The Conner’s Teacher's Rating Scale takes under 10 minutes to complete and comprises 28 items. Responses to each item are in the form of a 4 point Likert-scale, ranging from “never” to “very often” (Reynolds and Fletcher-Janzen, 2000). Likert scales are used to measure attitude, providing ranges of responses to a given question or statement. Typically, there are five categories of response, from 1 = strongly disagree to 5 = strongly agree. As Cohen et al. (2000) point out though, ‘the response categories have a rank order, but the intervals between values cannot be presumed to be equal.’ Cohen contends that it is illegitimate to infer that the frequency of occurrence between “often” and “very often” is equivalent to the frequency of occurrence between other consecutive categories.

In their discussion of the epidemiology of ADHD Visser and Jehan (2009) comment that:

This finding is similar to research carried out by Jick et al. (2004) where they found that drug treatment for ADHD was comparatively rare in the United Kingdom up until the mid-1990s, as opposed to North America, where such treatment has been administered for many decades. According to the American Centre for Disease Control and Prevention, the number of children diagnosed with ADHD has increased by an average of 3% a year between 1997 and 2006 (Pastor and Reuben, 2008).

Visser and Jehan further comment that:

They insinuate that the dramatic rise in the diagnosis of ADHD makes it’s aetiology a contentious issue, however there could be many reasons that explain this rise. Firstly, global awareness of ADHD has increased and as a consequence sufferers of ADHD, that may not have realised they had a disorder, are more likely to seek treatment. In the past, the ADHD label has been predominately assigned to hyperactivity in boys, however a further sub-type of inattentive ADHD was generally not included before in the definition of ADHD. The inclusion of this sub-category has led to an expansion of symptoms and a rise in diagnosis, especially amongst girls. Advances in pre-natal medicine have also led to a decrease in mortality rates attributable to low birth weights and prematurity. Both of these factors however, can place children at three times the risk of ADHD (Mick et al., 2002). It may be the case that ADHD symptoms have become more visible as schools and places of the work increasingly require more sustained focus in activities such as working with computers for prolonged periods of time. This change, from less physically demanding activities may cause people to be more aware or could exacerbate the symptoms of ADHD. Another possible reason for the growth in the diagnosis rates could be that ADHD is no longer considered to be exclusively a childhood disorder, with symptoms of ADHD continuing through teenage years and later life. Research by Castle et al. (2007) on demographic trends in the use of ADHD medication between 2000 and 2005 reported that:

Dominance of Biomedical Discourse

It is not surprising that a biomedical discourse has such prevalence in the aetiology of ADHD. For many parents or carers, the recognition that difficult or inappropriate behaviour is not the result of poor parenting or due to any other social or environmental factors, but is a result of the child suffering from a medical condition, must be a more palatable option. In his book, “Taking Charge of ADHD - The Complete, Authoritative Guide for Parents”, Barkley (2000) states that:

In today’s society, psychiatrists and medical practitioners are held in an authoritative and trusted position; it is therefore difficult to imagine a parent refuting firstly the diagnosis and then the subsequent need for medication. Foucault (1973) argues that the power of knowledge held by doctors has the greatest influence over the public. According to Foucault the medical profession achieves influence through a three stage procedure. Firstly using ‘scientific discourse’ to label human behaviour as either ‘insane’ or ‘deviant’, then secondly power is extorted through ‘divided practises’, in other words ADHD sufferers are perceived as being different. The final influence is how an individual identifies and internalises with the given label. The medical label of ADHD determines who they are and how they will be treated by others.

The medical profession have gone to great lengths to ensure that ADHD is seen as a bio-medical condition. In January 2002 The International Consensus on ADHD (Barkley et al., 2002) was published and signed by 36 well renowned researchers, listing in excess of 300 research papers that support the position that ADHD is a real medical condition. It is hard to believe that so many and such eminent professionals could be wrong, bearing in mind as well the colossal sums of money that pharmaceutical companies have already spent on researching effective medications.

In their article, Visser and Jehan (2009) state:

However, research by Castellanos et al. (1994) involving MRI scans of 50 ADHD males and 48 non-ADHD males found that the average right brain volume was slightly smaller in ADHD males than that of the comparison subjects. It is the right hemi-sphere which is believed to control the inhibition responses in human behaviour (Hale et al., 2009). However, it is not clear how these differences in brain volumes could be responsible for causing the symptoms of ADHD or whether in fact the difference is caused by ADHD medication.

Visser and Jehan (2009) argue that:

This situation however is not unique to ADHD. Many other brain disorders such as schizophrenia, autism, psychosis or bipolar disorder are similar to ADHD in that they have no medical evidence, pathology of brain impairment or disease to verify their existence. Perhaps it is the fact that this disorder is frequently treated by amphetamine based medication that singles it out as controversial.

Visser and Jehan give a detailed account of both the genetic and dopamine dysfunction research that has been carried out over the last ten years, which now forms the back-bone of the medical aetiology of ADHD. They comment that the inconsistencies in identifying the specific gene responsible for ADHD, brings the bio-medical paradigm into question. This criticism is confirmed by research by Acosta et al. (2004) who state that:

In essence, there can be no absolute scientific proof that ADHD is truly a bio-medical condition as there are no “absolute truths” in science - evidence in collated which either supports or negate a hypothesis. An opinion of truth can only be based on the available information.

A Social Discourse

The Department for Education and Skills (2006) reported in July 2006 that:

Schools require students to conform to a set of defined behaviours in order to maintain discipline and good order. Each school however could be viewed as a small community that broadly decides what behaviours are deemed worthy of exclusion from their society. How ADHD behaviour manifests itself in schools may highlight a lack of behaviour management training for students with ADHD. It could further be argued that, inattentiveness, hyperactivity and impulsivity could be a reaction to the regulations, constraints and expectations of a school environment.

The approach of simply medicating ADHD sufferers is not the panacea in regulating ADHD behaviours. As Professor Roselise Wilkinson (2010) Medical Director Emeritus states on her web-site:’

It has long been established that that ADHD is more prevalent where social depravation is greater. Psychosocial factors such as single parent and low income households, paternal criminality and large family size contribute to the increased likelihood of childhood mental disorders (Rutter et al., 1975). In a further study Biederman et al. (1995) reported that parental divorce and low social class also affected psychopathology in children. It is not suggested that that these social problems cause ADHD but that the prevalence of ADHD is higher where these factors exist. This cause and effect relationship between psychosocial issues and ADHD however could be the reverse, as Kepley and Ostrander note (2007) :

There are a number of alternative theories that view ADHD as part of the normal spectrum of behaviour instead of a disorder. The Hunter / Farmer theory is a slightly farfetched concept which was proposed by Thom Hartmann. He suggests that hyperactivity is a beneficial trait or gift, which has evolved in the human genome. The theory essentially states that for several millennia, humans were nomadic “hunter” gatherers – an occupation that was suited to hyperactivity; however over time populations became agriculturally based “the farmer”. Most homo sapiens modified their behaviours to a nurturing farming culture, but people with ADHD retained the genes responsible for the hunter trait.

Another sociological theory to explain the causation of ADHD is that of Neuro-diversity. The theory attests that, every person is an individual in that they have a different body, shape and personality. It is therefore possible that each individual will have different neurological development; a supporter of the Neuro-diversity theory would argue that it is wrong to label a human difference as a disorder.

ADHD and Environmental Influences.

Much research has been carried out on whether diet plays a contributory factor in creating ADHD behaviours (Breakey, 1997, Schnoll et al., 2003). There is currently no evidence to support a link between diet and ADHD. However, in 2007 the British government’s Food Standards Agency has called for the ban of six artificial colourings, known as the “Southampton Six” following research from the University of Southampton that demonstrated that additives can cause hyperactivity in children (Stevenson, 2009) but not cause or exacerbate the symptoms of ADHD.

Banerjee et al. (2007) found that ‘exposure to substances, such as lead and mercury, cigarette smoke and alcohol, can increase the severity of ADHD symptoms, but there is no evidence to suggest that any environmental factors can cause ADHD by themselves.

ADHD Treatments

The acceptance of the bio-medical discourse has led to a dramatic increase in prescription of psycho-pharmaceuticals to children. There are currently three different categories of medication currently licensed for use in the UK; methylphenidate which is usually immediate-release tablets such as Ritalin, Equasym and Concerta; atomoxetine, an inhibitor based medication such as Strattera and finally Dexamphetamine, an amphetamine based drug group, with Dexedrine being the most commonly prescribed for children under 6. The National Institute of Clinical Excellence (2006b) conclude that these medications are effective treatments ADHD compared to no treatment at all.

Studies have shown that children taking stimulant medication may have a decreased appetite, insomnia, anxiousness, irritability or proneness to crying (Ialongo et al., 1994). ADHD sufferers often complain of stomach aches and headaches and in rare cases, can develop motor tics (Benjamin L et al., 1991). Research attempting to identify cases of sudden deaths cases due to ADHD medication by McCarthy (2009) found that there is no evidence to support the myth that the use of Ritalin increases morality rates. McCarthy’s report however highlighted that teenage ADHD patients were at an increased risk of suicide.

Visser and Jehan’s article offers evidence from a large long-term multimodal treatment study (Jensen et al., 1999) and suggest that medication is the best option for the treatment of ADHD . Jensen’s study comprised 579 children with ADHD, split into four groups – the first received medication only, the second group had intensive behavioural support from a therapist, the third group had both medication and behavioural support and the final group received none of these treatments. The article by Visser and Jehan concludes that medication alone “is a sufficient treatment” for children with ADHD (Visser and Jehan, 2009 p. 130). This view is supported by research carried out by Abikoff et al (2004), Klein et al. (1997) and the National Institute of Clinical and Health Excellence (NICE, 2009) who conclude:

Visser and Jehan’s paper also comments that this fact therefore ”justifies the dominance of the bio-medical perspective within the ADHD debate.” (2009 p. 131). However, NICE (2006a) guidelines recommend that medication should not be the first line of treatment, Visser and Jehan comment that pharmacological intervention is very frequently prescribed as the first treatment option. In contrast to this, NICE (2009, ) guidelines state that, except in the most severe cases, medication should only be used in conjunction with social, behavioural and psychological treatments.

Education and ADHD

Visser and Jehan (2009) introduce their article with the comment:

It would seem strange, if not contradictory then, that the article was published in a journal which is an educational journal. The statement also insinuates that educationists should accept that the condition exists within the bio-medical domain. With ADHD being diagnosed in 1 in every 20 children in the UK, it is surprising that the UK government’s education website does not provide any information on ADHD. Their website - education.gov.uk (Department for Education, 2010) contains no information whatsoever on which teaching strategies are considered effective in the management of ADHD behaviours; a search using the words “Attention Deficit Hyperactivity Disorder” or “ADHD” yields results for Autism Spectrum disorder!

Research indicates that diagnosed ADHD sufferers underachieve academically across the all educational phases - during primary schooling (Marshall et al., 1999), within the secondary education system (Loe and Feldman, 2007) at even at university graduate level (Frazier et al., 2007). This could be a result of the lack of information given to educators on how best to manage ADHD students. Although there is a plethora of “parenting guides” available for parents of ADHD children, there is currently no advice or guidelines available specifically for teachers. Research on whether schools feel that they have sufficient knowledge and information on ADHD by Holowenko and Pashute (2000) found that only 24% of teachers said that they felt that they had enough information on ADHD. Similar research by Bekle (2004 p. 156) into teacher’s perceptions of ADHD reported that only 10% of practising teachers have received training in ADHD. It is not surprising then that when Couture et al. (2003) researched teacher’s beliefs of the causes of ADHD, the majority believed that ADHD is a wholly biological issue. Using a questionnaire to elicit basic teacher knowledge of ADHD and its management, Couture rated teacher knowledge as poor (Couture et al., 2003 p. 427).

In considering my own professional practice, I would like to develop effective teaching strategies for teaching pupils with ADHD; it is interesting to note that Professor Paul Copper (2005) suggests that:

He suggests that positive attributes of ADHD include divergence in thinking; a willingness to take risks; being highly creative and curious and incredible energy levels. There are fundamentally two interventional approaches in which the school environment can be adapted to more closely meet the needs of ADHD pupils, either by altering curriculum delivery or by classroom behavioural management strategies.

In a small scale investigation with children aged 6 – 14, Shaw et al. (2005) found that ADHD pupil’s attention improved and was sustained for longer periods of time with the use of ICT equipment such as computers. Similar findings from research by Wheeler (2010) show that watching videos or television programmes can also increase attention in ADHD pupils. Children with ADHD often have poor social skills and find initiating and sustaining friendships difficult. These activities of using a computer and watching television involve no peer social interaction, and as a consequence reduce ADHD behaviours. In case studies of ADHD pupils, Daniel and Cooper (1999) found that creative subjects such as art, ceramics, food and design technology elicited a reduction of ADHD behaviours compared to more traditional curriculum areas.

Hughes and Cooper (2007) state that a structured learning environment, with clear boundaries and guidance are essential classroom management skills required to support ADHD pupils effectively. They cite good discipline and adherence to routine as well as letting the child work at their own pace with adult support as essential prerequisites. Wheeler (2010) recommends maintaining eye contact; reducing the length of tasks by breaking them down in to smaller manageable pieces; working in pairs as opposed to groups and offering frequent and immediate feedback to pupils. It is also believed that listening to restful background music can improve attention levels.

Conclusion

To be able to fully understand the disorder of ADHD, it is essential to combine knowledge of both the neurological workings of brain function with an understanding of a child’s emotional and social development. This approach of considering the biological, psychological and social perspectives of ADHD is advocated by Visser and Jehan when they quote Professor Paul Cooper in their paper:

ADHD is a complex disorder that cannot be simply understood by considering just the medical perspective; NICE guidelines (2009) accept that this is the case.

If it is believed that ADHD is a purely biological disorder, then education has no part to play in the treatment or solution of this condition. Acceptance of the bio-psychosocial paradigm however, would demand the development and evaluation of effective educational practices for children with ADHD. The bio-psychosocial discourse argues that ADHD sufferers have a biologically inherited gene responsible for ADHD (the biological part), then by being placed in social constructs (the psychosocial part) such as school, some children are then considered ‘disordered’. ADHD is a combination of both biological and social factors, that is, the condition is caused by the interaction of neuropathy and psychosocial factors.

Visser and Jehan talk in their article of the marginalisation of completing discourses for ADHD, a possible reason why this may be the case is the fact that the bio-psychosocial model would require educational, health and social care professionals to work together to provide a multi-modal intervention plan. But as Hughes and Cooper (2007) point out:

Even with documents promoting multi-agency working, such as the Every Child Matters Agenda (DfES, 2003) and the British Psychology Society (2000) guidelines on collaborative working practices, there is limited evidence of this professional “team work” taking place.

Whilst medication is often seen as the best way to treat the symptoms of ADHD, tablets are unable to improve social interactions with peers or to tackle underachievement in reading and mathematics skills.

With a UK prevalence rate of ADHD estimated at 5%, this would indicate that in an average class of 30 students, there will be at least one pupil with ADHD. As there is currently no national guidance from the Department for Education on how to meet the needs of pupils with ADHD, combined with a lack of resources and training for teaching staff, it is difficult to see how the situation will improve.

For a bio-psychosocial discourse to dominate or influence current thinking around the issues of ADHD, multi-modal invention methods need to be better resourced, publicised and funded to gain any credence.

Support for the bio-psychosocial model, comes from a meta-analysis of 174 behavioural programmes for ADHD, conducted by American researchers Fabiano et al. (2009). They found that there is consistent and strong evidence that behavioural interventions are highly effective in treating ADHD. Similar meta-analytical studies of school based interventions by DuPaul and Eckert (1997) and Power et al. (2009) found that these were clearly effective in reducing ADHD related behaviours.

A diagnosis of ADHD is not an excuse for poor or inappropriate behaviour, but rather an explanation of that behaviour. It is essential that educational professionals have a good understanding of the facts and reality of ADHD, rather than relying on myths and misinformation. Rather than being given a “label”, an ADHD child and their family need help, support and understanding. Essentially, children with ADHD are not problem children, but children with a genuine problem.


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