Student Diversity

Learning Differences

All of us, including our students, have preferred ways of learning. Teachers often refer to these differences as learning styles, though this term may imply that students are more consistent across situations than is really the case. One student may like to make diagrams to help remember a reading assignment, whereas another student may prefer to write a sketchy outline instead. Yet in many cases, the students could in principle reverse the strategies and still learn the material: if coaxed (or perhaps required), the diagram-maker could take notes for a change and the note-taker could draw diagrams. Both would still learn, though neither might feel as comfortable as when using the strategies that they prefer. This reality suggests that a balanced, middle-of-the-road approach may be a teacher’s best response to students’ learning styles. Or put another way, it is good to support students’ preferred learning strategies where possible and appropriate, but neither necessary nor desirable to do so all of the time (Loo, 2004; Stahl, 2002). Most of all, it is neither necessary nor possible to classify or label students according to seemingly fixed learning styles and then allow them to learn only according to those styles. A student may prefer to hear new material rather than see it; he may prefer for you to explain something orally, for example, rather than to see it demonstrated in a video. But he may nonetheless tolerate or sometimes even prefer to see it demonstrated. In the long run, in fact, he may learn it best by encountering the material in both ways, regardless of his habitual preferences.

That said, there is evidence that individuals, including students, do differ in how they habitually think. These differences are more specific than learning styles or preferences, and psychologists sometimes call them cognitive styles, meaning typical ways of perceiving and remembering information, and typical ways of solving problems and making decisions (Zhang & Sternberg, 2006). In a style of thinking called field dependence, for example, individuals perceive patterns as a whole rather than focus on the parts of the pattern separately. In a complementary tendency, called field independence, individuals are more inclined to analyze overall patterns in their parts. Cognitive research from the 1940s to the present has found field dependence/independence differences to be somewhat stable for any given person across situations, though not completely so (Witkin, Moore, Goodenough, & Cox, 1977; Zhang & Sternberg, 2005). Someone who is field-dependent (perceives globally or “wholistically”) in one situation, tends to a modest extent to perceive things globally or holistically in other situations. Field dependence and independence can be important in understanding students because the styles affect students’ behaviors and preferences in school and classrooms. Field-dependent persons tend to work better in groups, it seems, and prefer “open-ended” fields of study like literature and history. Field independent persons, on the other hand, tend to work better alone and prefer highly analytic studies like math and science. The differences are only a tendency, however, and there are a lot of students who contradict the trends. As with the broader notion of learning styles, the cognitive styles of field dependence and independence are useful for tailoring instruction to particular students, but their guidance is only approximate. They neither can nor should be used to “lock” students to particular modes of learning or to replace students’ own expressed preferences and choices about the curriculum.

Another cognitive style is impulsivity as compared to reflectivity. As the names imply, an impulsive cognitive style is one in which a person reacts quickly, but as a result, makes comparatively more errors. A reflective style is the opposite: the person reacts more slowly and therefore makes fewer errors. As you might expect, the reflective style would seem better suited to many academic demands of school. Research has found that this is indeed the case for academic skills that clearly benefit from reflection, such as mathematical problem solving or certain reading tasks (Evans, 2004). Some classroom or school-related skills, however, may actually develop better if a student is relatively impulsive. Being a good partner in a cooperative learning group, for example, may depend partly on responding spontaneously (i.e. just a bit “impulsively”) to others’ suggestions; and being an effective member of an athletic team may depend on not taking time to reflect carefully on every move that you or your teammates make.

There are two major ways to use knowledge of students’ cognitive styles (Pritchard, 2005). The first and the more obvious is to build on students’ existing style strengths and preferences. A student who is field-independent and reflective, for example, can be encouraged to explore tasks and activities that are relatively analytic and that require relatively independent work. One who is field-dependent and impulsive, on the other hand, can be encouraged and supported to try tasks and activities that are more social or spontaneous. But a second, less obvious way to use knowledge of cognitive styles is to encourage more balance in cognitive styles for students who need it. A student who lacks field independence, for example, may need explicit help in organizing and analyzing key academic tasks (like organizing a lab report in a science class). One who is already highly reflective may need encouragement to try ideas spontaneously, as in a creative writing lesson.

Diversity in Learning and Special Education Needs

Beyond the diversity of learning styles, classrooms have become increasingly diverse due to the inclusion of students with disabilities in classrooms with non-disabled peers. In the United States, the trend began in the 1970s, but accelerated with the passage of the Individuals with Disabilities Education Act in 1975, and again when the Act was amended in 2004 (United States Government Printing Office, 2005). The law guarantees free, appropriate education for children with disabilities of any kind—whether the impairment is physical, cognitive, emotional, or behavioral. The laws also recognize that such students need special support in order to learn or function effectively in a classroom with non-disabled peers, so they provide special services (for example, teaching assistants) and procedures for making individualized educational plans for students with disabilities.

Children with Disabilities: Legislation

Since the 1970s, political and social attitudes have moved increasingly toward including people with disabilities in a wide variety of “regular” activities. In the United States, the shift is illustrated clearly in the Federal legislation that was enacted during this time. Three major laws were passed that guaranteed the rights of persons with disabilities, and of children and students with disabilities in particular. The third law has had the biggest impact on education.

Rehabilitation Act of 1973, Section 504: This law, the first of its kind, required that individuals with disabilities be accommodated in any program or activity that receives Federal funding (PL 93-112, 1973). Although this law was not intended specifically for education, in practice, it has protected students’ rights in some extra-curricular activities (for older students) and in some child care or after-school care programs (for younger students). If those programs receive Federal funding of any kind, the programs are not allowed to exclude children or youths with disabilities, and they have to find reasonable ways to accommodate the individuals’ disabilities.

Americans with Disabilities Act of 1990 (or ADA): This legislation also prohibited discrimination on the basis of disability, just as Section 504 of the Rehabilitation Act had done (PL 101-336, 1990). Although the ADA also applies to all people (not just to students), its provisions are more specific and “stronger” than those of Section 504. In particular, ADA extends to all employment and jobs, not just those receiving Federal funding. It also specifically requires accommodations to be made in public facilities such as buses, restrooms, and telephones. ADA legislation is therefore responsible for some of the “minor” renovations in schools that you may have noticed in recent years, like wheelchair-accessible doors, ramps, restrooms, and public telephones with volume controls.

Individuals with Disabilities Education Act (or IDEA): As its name implied, this legislation was more focused on education than either Section 504 or ADA. It was first passed in 1975 and has been amended several times since, including most recently in 2004 (PL 108-446, 2004). To be eligible under IDEA, a student must be adversely affected in oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematics calculation, or mathematics problem-solving. In its current form, the law guarantees the following rights related to education for anyone with a disability from birth to age 21. The first two influence schooling in general, but the last three affect the work of classroom teachers rather directly:

  • Free, appropriate education: An individual or an individual’s family should not have to pay for education simply because the individual has a disability, and the educational program should be truly educational; i.e., not merely care-taking or babysitting the person.
  • Due process: In case of disagreements between an individual with a disability and the schools or other professionals, there must be procedures for resolving the disagreements that are fair and accessible to all parties, including the person himself or herself or the person’s representative.
  • Fair evaluation of performance in spite of disability: Tests or other evaluations should not assume test-taking skills that a person with a disability cannot reasonably be expected to have, such as holding a pencil, hearing or seeing questions, working quickly, or understanding and speaking orally. Evaluation procedures should be modified to allow for these differences. This provision of the law applies both to evaluations made by teachers and to school-wide or “high-stakes” testing programs.
  • Education in the “least restrictive environment”: Education for someone with a disability should provide as many educational opportunities and options for the person as possible, both in the short term and in the long term. In practice, this requirement has meant including students in regular classrooms and school activities as much as possible, though often not totally.
  • An individualized educational program: Given that every disability is unique, instructional planning for a person with a disability should be unique or individualized as well. In practice, this provision has led to classroom teachers planning individualized programs jointly with other professionals (like reading specialists, psychologists, or medical personnel) as part of a team.

Students are eligible for the rights afforded under the IDEA if their academic achievement is being impacted due to a learning disability, autism spectrum disorder, visual or hearing impairment, orthopedic impairment, traumatic brain injury, speech or language impairment, intellectual disability, emotional disturbance, or other health impairment.

Center for Parent Information and Resources

Read more on evaluating children for disability and the categories of disability under IDEA.

Learning Disabilities

A Learning Disability (or LD) is a specific impairment of academic learning that interferes with a specific aspect of schoolwork, and that reduces a student’s academic performance significantly. An LD shows itself as a major discrepancy between a student’s ability and some feature of achievement: The student may be delayed in reading, writing, listening, speaking, or doing mathematics, but not in all of these at once. A learning problem is not considered a learning disability if it stems from physical, sensory, or motor handicaps, or from generalized intellectual impairment. It is also not an LD if the learning problem really reflects the challenges of learning English as a second language. Genuine LDs are the learning problems left over after these other possibilities are accounted for or excluded. Typically, a student with an LD has not been helped by teachers’ ordinary efforts to assist the student when he or she falls behind academically, though what counts as an “ordinary effort,” of course, differs among teachers, schools, and students. Most importantly, though, an LD relates to a fairly specific area of academic learning. A student may be able to read and compute well enough, for example, but not be able to write. LDs are by far the most common form of special educational need, accounting for half of all students with special needs in the United States and anywhere from 5 to 20% of all students, depending on how the numbers are estimated (United States Department of Education, 2005; Ysseldyke & Bielinski, 2002). Students with LDs are so common, in fact, that most teachers regularly encounter at least one per class in any given school year, regardless of the grade level they teach.

These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school), these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.

Video 7.2.1. Common Learning Disabilities defines what makes something a learning disability and explains some of the most common learning disabilities.

Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. Common characteristics are difficulty with phonological processing, which includes the manipulation of sounds, spelling, and rapid visual/verbal processing. Additionally, the child may reverse letters, have difficulty reading from left to right, or may have problems associating letters with sounds. It appears to be rooted in neurological problems involving the parts of the brain active in recognizing letters, verbally responding, and manipulating sounds. Recent studies have identified a number of genes that are linked to developing dyslexia (National Institute of Neurological Disorders and Stroke, 2016). Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.

Dysgraphia, a writing disability, is often associated with dyslexia (Carlson, 2013). There are different types of dysgraphia, including phonological dysgraphia, when the person cannot sound out words and write them phonetically. Orthographic dysgraphia is demonstrated by those individuals who can spell regularly spelled words, but not irregularly spelled ones. Some individuals with dysgraphia experience difficulties in motor control and experience trouble forming letters when using a pen or pencil.

Dyscalculia refers to problems in math. Cowan and Powell (2014) identified several terms used when describing difficulties in mathematics, including dyscalculia, mathematical learning disability, and mathematics disorder. All three terms refer to students with average intelligence who exhibit poor academic performance in mathematics. When evaluating a group of third graders, Cowan and Powell (2014) found that children with dyscalculia demonstrated problems with working memory, reasoning, processing speed, and oral language, all of which are referred to as domain-general factors. Additionally, problems with multi-digit skills, including number system knowledge, were also exhibited.

LDs are by far the most common form of special educational need, accounting for half of all students with special needs in the United States and anywhere from 5 to 20 percent of all students, depending on how the numbers are estimated (United States Department of Education, 2005; Ysseldyke & Bielinski, 2002). Students with LDs are so common, in fact, that most teachers regularly encounter at least one per class in any given school year, regardless of the grade level they teach.

Assisting Students with Learning Disabilities

There are various ways to assist students with learning disabilities, depending not only on the nature of the disability, of course, but also on the concepts or theories of learning to guide you. Let’s take Irma, for example. Irma is a tenth-grader who adds multiple-digit numbers as if they were single-digit numbers stuck together: 42 + 59 equals 911 rather than 101, though 23 + 54 correctly equals 77. Stated more formally, Irma adds two-digit numbers without carrying digits forward from the one’s column to the tens column, or from the tens to the hundreds column. Example 1 shows the effect that her strategy has on one of her homework papers. What is going on here and how could a teacher help Irma?

Example 1: Irma’s math homework about two-digit addition

Look at Irma’s homework below:

Directions: Add the following numbers.

  • 42 + 59 = 911
  • 23 + 54 = 77
  • 11 + 48 = 59
  • 47 + 23 = 610
  • 97 + 64 = 1511
  • 41 + 27 = 68

Three out of the six problems are done correctly, even though Irma seems to use an incorrect strategy systematically on all six problems.

Behaviorism: Reinforcement for Wrong Strategies

One possible approach comes from the behaviorist theory. Irma may persist with the single-digit strategy because it has been reinforced a lot in the past. Maybe she was rewarded so much for adding single-digit numbers (3 + 5, 7 + 8, etc.) correctly that she generalized this skill to two-digit problems—in fact over generalized it. This explanation is plausible because she would still get many two-digit problems right, as you can confirm by looking at it. In behaviorist terms, her incorrect strategy would still be reinforced, but now only on a “partial schedule of reinforcement.” Partial schedules are especially slow to extinguish, so Irma persists seemingly indefinitely with treating two-digit problems as if they were single-digit problems.

From the point of view of behaviorism, changing Irma’s behavior is tricky since the desired behavior (borrowing correctly) rarely happens and therefore cannot be reinforced very often. It might therefore help the teacher to reward behaviors that compete directly with Irma’s inappropriate strategy. The teacher might reduce credit for simply finding the correct answer, for example, and increase credit for a student showing her work—including the work of carrying digits forward correctly. Or the teacher might make a point of discussing Irma’s math work with Irma frequently, so as to create more occasions when she can praise Irma for working problems correctly.

Metacognition and Responding Reflectively

Part of Irma’s problem may be that she is thoughtless about doing her math: the minute she sees numbers on a worksheet, she stuffs them into the first arithmetic procedure that comes to mind. Her learning style, that is, seems too impulsive and not reflective enough. Her style also suggests a failure of metacognition (remember that idea?), which is her self-monitoring of her own thinking and its effectiveness. As a solution, the teacher could encourage Irma to think out loud when she completes two-digit problems—literally get her to “talk her way through” each problem. If participating in these conversations was sometimes impractical, the teacher might also arrange for a skilled classmate to take her place some of the time. Cooperation between Irma and the classmate might help the classmate as well, or even improve overall social relationships in the classroom.

Constructivism, Mentoring, and the Zone of Proximal Development

Perhaps Irma has in fact learned how to carry digits forward, but has not learned the procedure well enough to use it reliably on her own; so she constantly falls back on the earlier, better-learned strategy of single-digit addition. In that case, her problem can be seen in constructivist terms. In essence, Irma has lacked appropriate mentoring from someone more expert than herself, someone who can create a “zone of proximal development” in which she can display and consolidate her skills more successfully. She still needs mentoring or “assisted coaching” more than independent practice. The teacher can arrange some of this in much the way she encourages her to be more reflective, either by working with Irma herself or by arranging for a classmate or even a parent to volunteer to do so. In this case, however, whoever serves as a mentor should not only listen but also actively offer Irma help. The help has to be just enough to ensure that Irma completes two-digit problems correctly—neither more nor less. Too much help may prevent Irma from taking responsibility for learning the new strategy, but too little may cause her to take the responsibility prematurely.

Autism Spectrum Disorder

Autism spectrum disorder is probably the most misunderstood and puzzling of neurodevelopmental disorders. Children with this disorder show signs of significant disturbances in three main areas: (a) deficits in social interaction, (b) deficits in communication, and (c) repetitive patterns of behavior or interests. These disturbances appear early in life and cause serious impairments in functioning (APA, 2013).

The student with autism spectrum disorder might exhibit deficits in social interaction by not initiating conversations with others or turning their heads away when spoken to. They may not make eye contact with others and seem to prefer being alone rather than with others. In a certain sense, it is almost as though these individuals live in a personal and isolated social world others are simply not privy to or able to penetrate.

Communication deficits can range from a complete lack of speech to one-word responses (e.g., saying “Yes” or “No” when replying to questions or statements that require additional elaboration), echoed speech (e.g., parroting what another person says, either immediately or several hours or even days later), to difficulty maintaining a conversation because of an inability to reciprocate others’ comments. These deficits can also include problems in using and understanding nonverbal cues (e.g., facial expressions, gestures, and postures) that facilitate normal communication.

Figure 7.2.1. Dr. Temple Grandin, advocate for individuals with autism.

Repetitive patterns of behavior or interests can be exhibited in a number of ways. The child might engage in stereotyped, repetitive movements (rocking, head-banging, or repeatedly dropping an object and then picking it up), or she might show great distress at small changes in routine or the environment. For example, the child might throw a temper tantrum if an object is not in its proper place or if a regularly- scheduled activity is rescheduled. In some cases, the person with autism spectrum disorder might show highly restricted and fixated interests that appear to be abnormal in their intensity. For instance, the child might learn and memorize every detail about something, even though doing so serves no apparent purpose. Importantly, autism spectrum disorder is not the same thing as intellectual disability, although these two conditions can occur together. The DSM-5 specifies that the symptoms of autism spectrum disorder are not caused or explained by intellectual disability.

The qualifier “spectrum” in autism spectrum disorder is used to indicate that individuals with the disorder can show a range, or spectrum, of symptoms that vary in their magnitude and severity: Some severe, others less severe. The previous edition of the DSM included a diagnosis of Asperger’s disorder, generally recognized as a less severe form of autistic disorder; individuals diagnosed with Asperger’s disorder were described as having average or high intelligence and a strong vocabulary, but exhibiting impairments in social interaction and social communication, such as talking only about their special interests (Wing, Gould, & Gillberg, 2011). However, because research has failed to demonstrate that Asperger’s disorder differs qualitatively from autistic disorder, the DSM-5 does not include it. Some individuals with autism spectrum disorder, particularly those with better language and intellectual skills, can live and work independently as adults. However, most do not because the symptoms remain sufficient to cause serious impairment in many realms of life (APA, 2013).

Video 7.2.2. What is Autism Spectrum Disorder? explains the range of behaviors and symptoms associated with autism spectrum disorder.

Currently, estimates indicate that nearly 1 in 88 children in the United States have autism spectrum disorder; the disorder is 5 times more common in boys (1 out of 54) than girls (1 out of 252) (CDC, 2012). Rates of autistic spectrum disorder have increased dramatically since the 1980s. For example, California saw an increase of 273% in reported cases from 1987 through 1998 (Byrd, 2002); between 2000 and 2008, the rate of autism diagnoses in the United States increased by 78% (CDC, 2012). Although it is difficult to interpret this increase, it is possible that the rise in prevalence is the result of the broadening of the diagnosis, increased efforts to identify cases in the community, and greater awareness and acceptance of the diagnosis. In addition, mental health professionals are now more knowledgeable about autism spectrum disorder and are better equipped to make the diagnosis, even in subtle cases (Novella, 2008).

The exact causes of autism spectrum disorder remain unknown despite massive research efforts over the last two decades (Meek, Lemery-Chalfant, Jahromi, & Valiente, 2013). Autism appears to be strongly influenced by genetics, as identical twins show concordance rates of 60%– 90%, whereas concordance rates for fraternal twins and siblings are 5%–10% (Autism Genome Project Consortium, 2007). Many different genes and gene mutations have been implicated in autism (Meek et al., 2013). Among the genes involved are those important in the formation of synaptic circuits that facilitate communication between different areas of the brain (Gauthier et al., 2011). A number of environmental factors are also thought to be associated with increased risk for autism spectrum disorder, at least in part, because they contribute to new mutations. These factors include exposure to pollutants, such as plant emissions and mercury, urban versus rural residence, and vitamin D deficiency (Kinney, Barch, Chayka, Napoleon, & Munir, 2009).

There is no scientific evidence that a link exists between autism and vaccinations (Hughes, 2007). Indeed, a recent study compared the vaccination histories of 256 children with autism spectrum disorder with that of 752 control children across three time periods during their first two years of life (birth to 3 months, birth to 7 months, and birth to 2 years) (DeStefano, Price, & Weintraub, 2013). At the time of the study, the children were between 6 and 13 years old, and their prior vaccination records were obtained. Because vaccines contain immunogens (substances that fight infections), the investigators examined medical records to see how many immunogens children received to determine if those children who received more immunogens were at greater risk for developing autism spectrum disorder. The results of this study clearly demonstrated that the number of immunogens from vaccines received during the first two years of life was not at all related to the development of autism spectrum disorder.

Other Health Impairment: ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is not a learning disability but can be considered as an ‘other health impairment’ if it is impacting academic performance. Individuals with ADHD show a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning (American Psychological Association (APA), 2013). Some of the signs of inattention include great difficulty with, and avoidance of, tasks that require sustained attention (such as conversations or reading), failure to follow instructions (often resulting in failure to complete schoolwork and other duties), disorganization (difficulty keeping things in order, poor time management, sloppy and messy work), lack of attention to detail, becoming easily distracted, and forgetfulness. Hyperactivity is characterized by excessive movement, and includes fidgeting or squirming, leaving one’s seat in situations when remaining seated is expected, having trouble sitting still (e.g., in a restaurant), running about and climbing on things, blurting out responses before another person’s question or statement has been completed, difficulty waiting one’s turn for something, and interrupting and intruding on others. Frequently, the hyperactive child comes across as noisy and boisterous. The child’s behavior is hasty, impulsive, and seems to occur without much forethought; these characteristics may explain why adolescents and young adults diagnosed with ADHD receive more traffic tickets and have more automobile accidents than do others their age (Thompson, Molina, Pelham, & Gnagy, 2007).

Video 7.2.3. What is ADHD? explains the types and symptoms of ADHD.

ADHD occurs in about 5% of children (APA, 2013). On average, boys are 3 times more likely to have ADHD than girls; however, such findings might reflect the greater propensity of boys to engage in aggressive and antisocial behavior and thus incur a greater likelihood of being referred to psychological clinics (Barkley, 2006). Children with ADHD face severe academic and social challenges. Compared to their non-ADHD counterparts, children with ADHD have lower grades and standardized test scores and higher rates of expulsion, grade retention, and dropping out (Loe & Feldman, 2007). They also are less well-liked and more often rejected by their peers (Hoza et al., 2005).

Differences in Perceptions: ADHD Versus High Activity

It is important to note that classrooms are places that make heavy demands on not showing ADHD-like behaviors: students are often supposed to sit for long periods, avoid interrupting others, finish tasks after beginning them, and keep their minds (and materials) organized. Ironically, therefore, classroom life may sometimes aggravate ADHD without the teacher intending for it to do so. A student with only a mild or occasional tendency to be restless, for example, may fit in well outdoors playing soccer but feel unusually restless indoors during class. It also should not be surprising that teachers sometimes mistake a student who is merely rather active for a student with ADHD, since any tendency to be physically active may contribute to problems with classroom management. The tendency to “over-diagnose” is more likely for boys than for girls (Maniadaki, et al., 2003), presumably because gender role expectations cause teachers to be especially alert to high activity in boys. Over-diagnosis is also especially likely for students who are culturally or linguistically non-Anglo (Chamberlain, 2005), presumably because cultural and language differences may sometimes lead teachers to misinterpret students’ behavior. To avoid making such mistakes, it is important to keep in mind that in true ADHD, restlessness, activity, and distractibility are widespread and sustained. A student who shows such problems at school but never at home, for example, may not have ADHD; he may simply not be getting along with his teacher or classmates.

Is the Prevalence of ADHD Increasing?

Many people believe that the rates of ADHD have increased in recent years, and there is evidence to support this contention. In a recent study, investigators found that the parent-reported prevalence of ADHD among children (4–17 years old) in the United States increased by 22% during a 4-year period, from 7.8% in 2003 to 9.5% in 2007 (CDC, 2010). ADHD may be over-diagnosed by doctors who are too quick to medicate children as behavior treatment. There is also greater awareness of ADHD now than in the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its key symptoms. Thus, parents may be quick to take their children to a doctor if they believe their child possesses these symptoms, or teachers may be more likely now than in the past to notice the symptoms and refer the child for evaluation.

ADHD can persist into adolescence and adulthood (Barkley, Fischer, Smallish, & Fletcher, 2002). A recent study found that 29.3% of adults who had been diagnosed with ADHD decades earlier still showed symptoms (Barbaresi et al., 2013). Somewhat troubling, this study also reported that nearly 81% of those whose ADHD persisted into adulthood had experienced at least one other comorbid disorder, compared to 47% of those whose ADHD did not persist. Additional concerns when an adult has ADHD include worse educational attainment, lower socioeconomic status, less likely to be employed, more likely to be divorced, and more likely to have non-alcohol-related substance abuse problems (Klein et al., 2012).

Family and twin studies indicate that genetics play a significant role in the development of ADHD. Burt (2009), in a review of 26 studies, reported that the median rate of concordance for identical twins was .66, whereas the median concordance rate for fraternal twins was .20. The specific genes involved in ADHD are thought to include at least two that are important in the regulation of the neurotransmitter dopamine (Gizer, Ficks, & Waldman, 2009), suggesting that dopamine may be important in ADHD. Indeed, medications used in the treatment of ADHD, such as methylphenidate (Ritalin) and amphetamine with dextroamphetamine (Adderall), have stimulant qualities and elevate dopamine activity. People with ADHD show less dopamine activity in key regions of the brain, especially those associated with motivation and reward (Volkow et al., 2009), which provides support to the theory that dopamine deficits may be a vital factor in the development this disorder (Swanson et al., 2007).

Brain imaging studies have shown that children with ADHD exhibit abnormalities in their frontal lobes, an area in which dopamine is in abundance. Compared to children without ADHD, those with ADHD appear to have smaller frontal lobe volume, and they show less frontal lobe activation when performing mental tasks. Recall that one of the functions of the frontal lobes is to inhibit our behavior. Thus, abnormalities in this region may go a long way toward explaining the hyperactive, uncontrolled behavior of ADHD.

Many parents attribute their child’s hyperactivity to sugar. A statistical review of 16 studies, however, concluded that sugar consumption has no effect at all on the behavioral and cognitive performance of children (Wolraich, Wilson, & White, 1995). Additionally, although food additives have been shown to increase hyperactivity in non-ADHD children, the effect is rather small (McCann et al., 2007). Numerous studies, however, have shown a significant relationship between exposure to nicotine in cigarette smoke during the prenatal period and ADHD (Linnet et al., 2003). Maternal smoking during pregnancy is associated with the development of more severe symptoms of the disorder (Thakur et al., 2013).

Recommended treatment for ADHD includes behavioral interventions, cognitive behavioral therapy, parent and teacher education, recreational programs, and lifestyle changes, such as getting more sleep (Clay, 2013). For some children, medication is prescribed. Parents are often concerned that stimulant medication may result in their child acquiring a substance use disorder. However, research using longitudinal studies has demonstrated that children diagnosed with ADHD who received pharmacological treatment had a lower risk for substance abuse problems than those children who did not receive medication (Wilens, Fararone, Biederman, & Gunawardene, 2003). The risk of substance abuse problems appears to be even greater for those with ADHD who are un-medicated and also exhibit antisocial tendencies (Marshal & Molina, 2006).

Teaching students with ADHD

Research also shows that ADHD can be reduced for many students if they take certain medications, of which the most common is methylphenidate, commonly known by the name Ritalin (Wilens, 2005; Olfson, 2003). This drug and others like it act by stimulating the nervous system, which reduces symptoms by helping a student pay better attention to the choices he or she makes and to the impact of actions on others. Unfortunately, the medications do not work on all students with ADHD, especially after they reach adolescence, and its long-term effects are uncertain (Breggin, 1999). In any case, Ritalin and similar drugs have certain practical problems. Drugs cost money, for one thing, which is a problem for a family without much money, to begin with, or for a family lacking medical insurance that pays for medications—a particularly common situation in the United States. For another thing, drugs must be taken regularly in order to be effective, including on weekends. Keeping a regular schedule can be difficult if parents’ own schedules are irregular or simply differ from the child’s, for example, because of night shifts at work or because parents are separated and share custody of the child.

In any case, since teachers are not doctors and medications are not under teachers’ control, it may be more important simply to provide an environment where a student with ADHD can organize choices and actions easily and successfully. Clear rules and procedures, for example, can reduce the “noise” or chaotic quality in the child’s classroom life significantly. The rules and procedures can be generated jointly with the child; they do not have to be imposed arbitrarily, as if the student were incapable of thinking about them reasonably. Sometimes a classmate can be enlisted to model slower, more reflective styles of working, but in ways that do not imply undue criticism of the student with ADHD. The more reflective student can complete a set of math problems, for example, while explaining what he or she is thinking about while doing the work. Sometimes the teacher can help by making lists of tasks or of steps in long tasks. Use visual cues to help remind students of what they should be doing. It can help to divide focused work into small, short sessions rather than grouping it into single, longer sessions.  Whatever the strategies that you use, they should be consistent, predictable, and generated by the student as much as possible. Students can also benefit from explicit teaching of self-monitoring skills. By having these qualities, the strategies can strengthen the student’s self-direction and ability to screen out the distractions of classroom life. The goal for teachers, in essence, is to build the student’s metacognitive capacity, while at the same time, of course, treating the student with respect.

How Difficult Can This be–The F.A.T. City Workshop

Video 7.2.4. How Difficult Can This Be–The F.A.T. City Workshop is a simulation provided by Rick Lavoie. While the recording is dated, this award-winning video remains one of the most powerful means for conveying the experience of the learning disabled child to educators and parents. Individuals with learning disabilities often express that this video accurately articulates their schooling experience.



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