Adolescence

Adolescents are faced with many challenges inclusive but not limited to; cognitive, emotional, behavioural and environmental changes; all of which have the potential to cause significant impact upon healthy and stable transition to adulthood.  Risk and protective factors that occur within this developmental stage additionally have the potential to cause either positive or negative (or a combination of the two) upon the life of an adolescent. Teenage years are notably difficult to navigate. When an adolescent has the added challenges and complexities of a diagnosed mental health condition, this can be detrimental to their academic and social achievement, if not managed and supported in the correct manner with the appropriate strategies and support teams.

Attention Deficit Hyperactivity Disorder

Attention Deficit and Hyperactivity Disorder (ADHD) is a complex neuro-developmental disorder (ADHD Australia, 2019) which is typically diagnosed in childhood, however, it affects children, adolescents and adults alike.  It is estimated that, in Australia, ADHD affects 281,200 children and adolescents (aged 0-19) and 533,300 adults, aged 20.  ADHD is recognised as a diagnostic category within the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA 2013b).  There are three different sub-type categories of ADHD – predominantly inattentive type, hyperactive-impulsive type and combined type which is a combination of the two aforementioned types of ADHD (Better Health, 2019).  This case study will aim to provide an in-depth description of the disorder, discuss the assessment and diagnosis process for ADHD, and describe and analyse interventions and support based strategies within an educational context.

Evidence of Symptoms 

As aforementioned, ADHD is neuro-developmental disorder and as such, has significant impact on a person’s executive functioning and this can be detrimental in all aspects of a person’s life, if not treated accordingly. Each different sub-type of the disorder can be characterised differently, however much of the research available suggests that ADHD can potentially lead to adverse life outcomes. Some of the following maladaptive behaviours have been recognised in people with ADHD; poor peer relationships, strained parental relationships, impaired academic performance, substance misuse, reduced job performance and increased emotional difficulties (Caye et al, 2018.)  The inattentive sub-type of ADHD is characterised by forgetfulness, disorganisation, and an inability to focus for extended periods – particularly if the focus is an unpreferred task. The hyperactive sub-type is defined by running, climbing or leaving a seat at inappropriate times during teaching, interrupting during conversations and additionally includes difficulties with sleeping.  The combined type is the most prevalent form of the disorder and people diagnosed experience a variety of symptoms from both aforementioned sub-types of ADHD (ADHD Australia, 2019).

In order to receive a diagnosis, children must present with six symptoms from either or both categories and adolescents and adults over 17 are required to present with 5 symptoms.  Experiencing such a multitude of symptoms has the potential to cause significant deficits in both personal and academic (or professional) environments and as such can have a detrimental effect on development and functioning.  ADHD is considered to be one of the most prevalent developmental and behaviour disorders amongst children and adolescents.  As such, it is therefore notable that there is no current medical test that contributes to the diagnosis of ADHD.  The disorder is diagnosed based on data provided from trusted adults and professionals that have a thorough knowledge and understanding of the presenting behaviours and limitations of the symptomatic person. There are suggestions that these diagnostic criteria lack diagnostic utility owing to the fact that the diagnostic tests are considered checklists to be completed. (Biermann et al., 2014.)  Additionally, it has been identified that clinical assessment relies profoundly on accounts of behaviour in multiple settings as indicators for the disorder (Alloway et al., 2010).  The DSM-5 (APA, 2013b) is the manual used by clinicians to diagnose and classify mental disorders. ADHD is now listed as a category within ‘Neuro-developmental Disorders’ and is characterised by inattention, hyperactivity, and impulsivity that are pervasive and affect social, academic and occupational parts of an individual’s life.

Impact on the Individual and Interactions

ADHD can potentially cause a lifelong negative impact, it is imperative that children are correctly and intensively tested to ensure that they receive the correct course of treatment in order to become successful members of society in the future.  Undiagnosed or untreated ADHD has the potential to cause significant ramifications in both the life of the person with ADHD and those around them.  ADHD is a developmental disorder that typically begins in childhood and therefore, if not treated appropriately or with the best individualised supports and strategies implemented during the correct time periods, the disorder could result in maladaptive, dangerous and reckless behaviours. Impaired executive functioning has the potential to adversely affect a child with ADHD within an educational setting.  The inability to self-regulate emotions, the limited capacity to focus and organise (both internally and externally) would cause a person with ADHD to seem careless, forgetful and disinterested in the classroom.  In fact, the aforementioned symptoms of the disorder would impede the students’ ability to successfully engage with the learning program without intervention-based support.  Academic impairment has been identified as one of the most difficult domains of impairment for adolescents with ADHD (Campez et al., 2016.), this would in turn cause undue stress upon a person and potentially damage relationships and future educational or employment opportunities.

Suggested Interventions

Within an educational context, classroom rules and expectations, social cues and norms and the structure of the school day are all factors that a student with ADHD could find difficult to navigate, owing to the fact that the symptoms of the disorder are misaligned with these factors and their executive functioning is limited. Difficulties with attention span, impulse control and capacity to remain in a designated space would significantly impact with curriculum delivery and learning of others. (Barkley et al., 2008; DuPaul & Stoner, 2003)  It is imperative that Guidance Officers and caregivers work collaboratively to ensure that consistency of approach is executed to support the assessment and diagnosis of a child with ADHD.  In the aforementioned information, it is identified that the assessment process for ADHD defines that the behaviours of concern are required to be observed in multiple settings.  Therefore, it is paramount that caregivers and Guidance Officers that are present within these settings can work on a collaborative level to provide a holistic and valid interpretation of the behaviours, in order to gain an accurate diagnosis and treatment can begin.

From a classroom-based perspective, there is a level of expected professional practice from teachers, which includes knowing their students and how they learn (AITSL, 2018). There are a number of evidence-based practices and teacher mediated instruction strategies, that can be facilitated by a Guidance Officer, including; strengths-based approaches to learning, chunking of work, adjustment of tasks, scaffolding, explicit teaching of the use of graphic organisers and visual schedules, checking for understanding and importantly, environmental manipulations.  These strategies can be applied as whole-classroom strategies and supplement the learning of all students, however it is acknowledged that teachers may not have the capability or the capacity to deliver individualised content for students with ADHD who require behavioural consultation intervention. As such, some school staff members may possess insufficient time to deliver the interventions (Campez et al., 2016).  It has been noted by some that cognitive treatment studies have not demonstrated any treatment advancements (Abikoff, 1991). However, a multimodal treatment approach combined with a collaborative, holistic team facilitated by the Guidance Officer, would seem to provide the most beneficial outcomes for students with ADHD, particularly when implemented during early intervention.