essay on adhd in the classroom

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Data and Statistics on ADHD
• Free Materials on ADHD
• Attention-Deficit / Hyperactivity Disorder Articles
• Clinical Care and Treatment
• View All Home

ADHD in the Classroom: Helping Children Succeed in School

At a glance.

Children with attention-deficit/hyperactivity disorder (ADHD) experience more obstacles in their path to success than the average student. The symptoms of ADHD, such as inability to pay attention, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to do well in school.

What to know

To meet the needs of children with ADHD, schools may offer

• ADHD treatments, such as behavioral classroom management or organizational training;
• Special education services; or
• Accommodations to lessen the effect of ADHD on their learning.

Explore resources available for parents and teachers to help children with ADHD adjust to changes in school.

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child. Learn more about their services.

How schools can help children with ADHD‎

The American Academy of Pediatrics (AAP) recommends that the school environment, program, or placement is a part of any ADHD treatment plan.

AAP also recommends teacher-administered behavior therapy as a treatment for school-aged children with ADHD. You can talk to your child's healthcare provider and teachers about working together to support your child.

Classroom treatment strategies for ADHD students

There are some school-based management strategies shown to be effective for ADHD students: 1

• Behavioral classroom management 1 2

Organizational training

Did you know ‎, behavioral classroom management.

The behavioral classroom management approach encourages a student's positive behaviors in the classroom, through a reward system or a daily report card, and discourages their negative behaviors. This teacher-led approach has been shown to influence student behavior in a constructive manner, increasing academic engagement. Although tested mostly in elementary schools, behavioral classroom management has been shown to work for students of all ages.

Organizational training teaches children time management, planning skills, and ways to keep school materials organized in order to optimize student learning and reduce distractions. This management strategy has been tested with children and adolescents.

Teaching and supporting positive behavior‎

Special education services and accommodations.

Most children with ADHD receive some school services, such as special education services and accommodations. There are two laws that govern special services and accommodations for children with disabilities:

• The Individuals with Disabilities Education Act (IDEA)
• Section 504 of the Rehabilitation Act of 1973

Learn more about IDEA vs Section 504

The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504:

• An Individualized Education Program (IEP) , or a

What are the main differences between an IEP and a 504 Plan?‎

• 504 Plan: Provides services and changes to the learning environment to meet the needs of the child as adequately as other students and is part of Section 504 of the Rehabilitation Act.

Accommodations

IEPs and 504 Plans can offer accommodations for students to help them manage their ADHD, including the following:

• Extra time on tests
• Instruction and assignments tailored to the child
• Positive reinforcement and feedback
• Using technology to assist with tasks
• Allowing breaks or time to move around
• Changes to the environment to limit distraction
• Extra help with staying organized

Did you know?‎

There is limited information about which types of accommodations are effective for children with ADHD. 3 However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help. 4

What teachers can do to help

For teachers, helping children manage their ADHD symptoms can present a challenge. Most children with ADHD are not enrolled in special education classes but do need extra assistance on a daily basis.

Helping students with ADHD‎

CHADD's National Resource Center on ADHD provides information for teachers from experts on how to help students with ADHD.

Close collaboration between the school, parents, and healthcare providers will help ensure the child gets the right support. Here are some tips for classroom success:

Communication

• Give frequent feedback and attention to positive behavior.
• Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings.
• Provide extra warnings before transitions and changes in routines.
• Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.

Assignments and tasks

• Make assignments clear—check with the student to see if they understand what they need to do.
• Provide choices to show mastery (for example, let the student choose among written essay, oral report, online quiz, or hands-on project.
• Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard may work well.
• Allow breaks—for children with ADHD, paying attention takes extra effort and can be very tiring.
• Allow time to move and exercise.
• Minimize distractions in the classroom.
• Use organizational tools, such as a homework folder, to limit the number of things the child has to track.

Develop a plan that fits the child

• Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting, depending on the child).
• Communicate with parents on a regular basis.
• Involve the school counselor or psychologist.

Parent education and support

How to best advocate for your child‎.

What every parent should know

• School support and services are regulated by laws. The U.S. Department of Education has developed a "Know your rights" letter for parents and a resource guide for educators to help educators, families, students, and other interested groups better understand how these laws apply to students with ADHD so that they can get the services and education they need to be successful.
• Healthcare providers also play an important part in collaborating with schools to help children get the special services they need. 5

More information

• CHADD's ADHD Toolkits for Parents and Educators
• Health and Supportive School Environments | CDC
• Society of Clinical Child & Adolescent Psychology - Effective child therapy: ADHD
• Evans SW, Owens JS, Wymbs BT, Ray AR. Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder. J Clin Child Adolesc Psychol. 2018 Mar-Apr;47(2):157-198.
• DuPaul GJ, Chronis-Tuscano A, Danielson ML, Visser SN. Predictors of Receipt of School Services in a National Sample of Youth With ADHD. J Atten Disord. 2019 Sep;23(11):1303-1319.
• Harrison JR, Bunford N, Evans SW, Owens JS. Educational accommodations for students with behavioral challenges: A systematic review of the literature. Review of Educational Research. 2013 Dec;83(4):551-97.
• Moore DA, Russell AE, Matthews J, Ford TJ, Rogers M, Ukoumunne OC, Kneale D, Thompson-Coon J, Sutcliffe K, Nunns M, Shaw L. School-based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods. Review of Education. 2018 Oct;6(3):209-63.
• Lipkin PH, Okamoto J; Council on Children with Disabilities; Council on School Health. The Individuals With Disabilities Education Act (IDEA) for Children With Special Educational Needs. Pediatrics. 2015 Dec;136(6):e1650-62.
• The American Academy of Pediatrics. How Schools Can Help Children with ADHD. Available at: https://www.healthychildren.org/English/health-issues/conditions/adhd/pages/Your-Child-At-School.aspx . Accessed on November 17, 2023
• CHADD. Education. Available at: https://chadd.org/for-parents/education/ . Accessed on November 17, 2023
• CHADD. Overview. Available at: https://chadd.org/for-educators/overview/ . Accessed on November 17, 2023
• CHADD. About the National Resource Center. Available at: https://chadd.org/about/about-nrc/ . Accessed on November 17, 2023
• CHADD. Individuals with Disabilities Education Act. Available at: https://chadd.org/for-parents/individuals-with-disabilities-education-act/#:~:text=What%20are%20my%20responsibilities%20as%20a%20parent%3F . Accessed on November 17, 2023
• U.S. Department of Education. Know Your Rights: Students with ADHD. Available at: https://www2.ed.gov/about/offices/list/ocr/docs/dcl-know-rights-201607-504.pdf . Accessed on November 17, 2023
• U.S. Department of Education. Dear Colleague Letter and Resource Guide on Students with ADHD. Available at: https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201607-504-adhd.pdf . Accessed on November 17, 2023

Attention-Deficit / Hyperactivity Disorder (ADHD)

CDC's Attention-Deficit / Hyperactivity Disorder (ADHD) site includes information on symptoms, diagnosis, treatment, data, research, and free resources.

For Everyone

Health care providers.

ADHD in the Classroom: How to Support Students with Attention-Deficit/Hyperactivity Disorder

By andy minshew.

• September 2, 2021

A survey of educators found that most feel they don’t have enough information and classroom management strategies for students with attention-deficit/hyperactivity disorder (ADHD).[2] Because children with ADHD need the right resources to thrive in the classroom, this can seriously inhibit their ability to reach their academic potential.

As a teacher, you know how important it is to provide support and guidance to these students. The more familiar you are with recognizing and helping students with ADHD, the more likely they are to reach their academic potential and exhibit positive classroom behavior.

In this article, we will define ADHD and list a few symptoms to watch for in your students. Then we’ll discuss helpful classroom management strategies.

What is ADHD and How Does It Affect Students?

Of course, definitions can only go so far. Talking to someone with ADHD is the best way to learn what it is and how it feels to live with it. If you don’t have anyone to ask in real life, this video from the How to ADHD channel is a great primer for educators on what ADHD is and how it affects academics.

Is ADHD a Disability? What Educators Need to Know

As a teacher, you may not feel qualified to help children with ADHD in the classroom—especially if you don’t have much experience with it. But classroom interventions can be as simple as slight modifications your instruction or providing small accommodations for your ADHD students.[2] You could, for example, give them extra time to complete homework or give them a folder to organize all of their assignments.[13]

For issues that are beyond your expertise, you can always refer the student to your school counselor or an in-school ADHD specialist, depending on the resources available. Get to know your school counselors or psychologists so if you have a student with ADHD, you know who can help them.[5] If you don’t have an ADHD specialist at your school, you could also discuss your concerns with a school administrator. They may be able to get in touch with a specialist within your district or provide accommodations in another form.

If school accommodations are sparse, and the family has not yet looked into professional treatment (such as therapy) for their child, it can be helpful to refer parents to ADHD specialists outside of your school.[8] Additionally, try to involve parents in the process of helping or disciplining a child with ADHD in school.[10] Parents will be more familiar with their child’s symptoms and may be able to suggest tactics to help their child focus in class.

Signs of ADHD: What Teachers Should Look For

Remember that as a teacher, you are not qualified to officially diagnose a student, but you can advise a specialist as needed. If you suspect that a child might have ADHD, it is best to discuss this concern with their family and with your school administrators. After speaking to the child’s family, and if the child has not been diagnosed with ADHD, you may want to encourage that family to visit a pediatrician or other specialist.

Symptoms of ADHD may vary depending on the child’s age and how much support they’ve received. For elementary school teachers, here are a few early signs of ADHD to look for:[14]

• Low self-control
• Difficulty staying focused on lessons
• Hyperactivity that interferes with a child’s ability to pay attention
• Trouble organizing assignments and belongings
• Excessive talking with peers and difficulty staying quiet while working

To learn more about ADHD signs and how these might present in the classroom—along with common misconceptions—use this video from ADDitude Magazine as a guide.

7 Teaching Tips and Classroom Accommodations for Students with ADHD

While students who have ADHD may have additional needs, these students are just as capable of succeeding in school as are their peers. Classroom strategies designed to help students with ADHD are the best way to reduce disruptive behavior and help students reach their academic potential.[7]

These seven tips for teaching students with ADHD can help them stay focused and feel comfortable in class:

• Try to follow a regular classroom routine every day; this helps students with a range of learning disorders by limiting confusion or distraction.[12]
• Provide students with organization tools, such as a three-pocket notebook or binder, to help them keep their assignments together.[11]
• Because children with ADHD often have trouble staying focused, schedule in short breaks for students to recharge throughout the day.[19]
• Offer positive feedback regularly so they trust you and know that you have their best interests in mind.[12]
• Check out this list of children’s books about ADHD from Verywell Mind, and add a few to your classroom library to normalize discussions about ADHD.
• Students with ADHD often struggle in test-taking environments. Give these students extra time and help them find a space that is distraction free (like the school library) to take tests.[18]
• Remember, a student’s needs may exceed what you’re able to provide. In this case, refer the child to a counselor or ADHD specialist.
• Scahill, L., and Schwab-Stone, M. Epidemiology of Adhd in School-Age Children . Child & Adolescent Psychiatric Clinics of North America, July 2000, 9(3), pp. 541-555.
• Pfiffner, L., DuPall, G.J., and Barkley. R. Treatment of ADHD in School Settings . retrieved from semanticscholar.org: https://pdfs.semanticscholar.org/63ea/daa464079cdb6ffc661f1d8e3f3c6f35a7b1.pdf.
• Evans, W.N., Morrill, M.S., and Parente, S.T. Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children . Journal of Health Economics, September 2010, 29(5), pp. 657-673.
• Kent, K.M., Pelham, W.E., Molina, B.S., Sibley, M.H., Waschbusch, D.A., Yu, J., Gnagy, E.M., Biswas, A., Babinski, D.E., and Karch, K.M. The Academic Experience of Male High School Students with ADHD . Journal of Abnormal Child Psychology, 2011, 39(3), pp. 451-462.
• DuPaul, G.J., Weyandt, L.L., and Janusis, G.M. ADHD in the Classroom: Effective Intervention Strategies . Theory Into Practice, 2011, 50(1), pp. 35-42.
• Greene, R.W., Beszterczey, S.K., Katzenstein, T., Park. K., and Goring, J. Are Students with ADHD More Stressful to Teach?: Patterns of Teacher Stress in an Elementary School Sample . Journal of Emotional and Behavioral Disorders, 2002, 10(2), pp. 79-89.
• Miranda, A., Jarque, S., and Tarraga, R. Interventions in School Settings for Students With ADHD . Exceptionality: A Special Education Journal, 2006, 14(1), pp. 35-52.
• Loe, I.M., and Feldman, H.M. Academic and Educational Outcomes of Children With ADHD . Journal of Pediatric Psychology, July 2007, 32(6), pp. 643-654.
• Sciutto, M.J., Nolfi, C.J., and Bluhm, C. Effects of Child Gender and Symptom Type on Referrals for ADHD by Elementary School Teachers . Journal of Emotional and Behavioral Disorders, October 2004, 12(4), 247-253.
• Power, T.J., Mautone, J.A., Soffer, S.L., Clarke, A.T., Marshall, S.A., Sharman, J., Blum, N.J., Glanzman, M., Elia, J., and Jawad, A.F. A family–school intervention for children with ADHD: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, August 2012, 80(4), pp. 611-623.
• Segal, J., and Smith, M. Teaching Students with ADHD. Retrieved from helpguide.org: https://www.helpguide.org/articles/add-adhd/teaching-students-with-adhd-attention-deficit-disorder.htm.
• Dendy, C.Z. Teaching Students with ADHD: Strategies That Help Every Child Shine . Retrieved from additudemag.com: https://www.additudemag.com/teaching-strategies-for-students-with-adhd/.
• Seay, B. 20 Classroom Accommodations That Target Common ADHD Challenges . Retrieved from additudemag.com: https://www.additudemag.com/20-adhd-accommodations-that-work/.
• HealthyChildren Staff. Early Warning Signs of ADHD . Retrieved from healthychildren.org: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Early-Warning-Signs-of-ADHD.aspx.
• Perlstein, D., and Shiel, W.C. Attention Deficit Hyperactivity Disorder (ADHD) in Teens . Retrieved from emedicinehealth.com: https://www.emedicinehealth.com/adhd_in_teens/article_em.htm#attention_deficit_hyperactivity_disorder_adhd_in_teens.
• HealthyChildren Staff. Causes of ADHD: What We Know Today . Retrieved from healthychildren.org: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Causes-of-ADHD.aspx.
• Mayo Clinic Staff. Attention-deficit/hyperactivity disorder (ADHD) in children. Retrieved from mayoclinic.org: https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889.
• Morin, A., and Oswalt, G. Classroom accommodations for ADHD. Understood. https://www.understood.org/articles/en/classroom-accommodations-for-adhd.
• Ditzell, J. What School Accommodations Can You Get for a Child with ADHD? Psych Central. August 10, 2021. https://psychcentral.com/adhd/adhd-accommodations.

More education articles

Celebrating Juneteenth 2024: Children’s Books and Activities for Families and Educators

MacKenzie Scott’s Yield Giving Awards Waterford.org a $10 Million Grant

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Wiley Open Access Collection

How interactions between ADHD and schools affect educational achievement: a family‐based genetically sensitive study

Rosa cheesman.

1 PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo Norway

Espen M. Eilertsen

2 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo Norway

Ziada Ayorech

Nicolai t. borgen.

3 Department of Special Needs Education, University of Oslo, Oslo Norway

Ole A. Andreassen

4 NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo Norway

5 Institute of Clinical Medicine, University of Oslo, Oslo Norway

Henrik Larsson

6 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm Sweden

7 School of Medical Sciences, Örebro University, Örebro Sweden

Henrik Zachrisson

Fartein a. torvik, eivind ystrom.

8 Department of Mental Disorders, Norwegian Institute of Public Health, Oslo Norway

Associated Data

Appendix S2. Mobagenetics quality control.

Appendix S3. Analysis of special educational support data.

Figures S1–S3 . Distributions of achievement by decile of average school performance.

Figure S4. Correlations between raw standardised test scores and item response theory‐derived scores.

Figure S5. Distributions of ADHD effects on achievement in individual subjects across Norwegian schools.

Figure S6. Slope intercept correlations ( y ‐axis) vary by ADHD levels ( x ‐axis).

Table S2. Phenotypic descriptive statistics for analysis variables within the MoBa genetics cohort.

Table S3. Fit statistics for main models (1–6).

Table S4. Results for main models (1–6).

Table S5. Results for maths, reading and english separately.

Table S6. Results for boys and girls separately.

Table S7. Results for special educational support analyses.

Children with ADHD tend to achieve less than their peers in school. It is unknown whether schools moderate this association. Nonrandom selection of children into schools related to variations in their ADHD risk poses a methodological problem.

We linked data on ADHD symptoms of inattention and hyperactivity and parent–child ADHD polygenic scores (PGS) from the Norwegian Mother, Father, and Child Cohort Study (MoBa) to achievement in standardised tests and school identifiers. We estimated interactions of schools with individual differences between students in inattention, hyperactivity, and ADHD‐PGS using multilevel models with random slopes for ADHD effects on achievement over schools. In our PGS analyses, we adjust for parental selection of schools by adjusting for parental ADHD‐PGS (a within‐family PGS design). We then tested whether five school sociodemographic measures explained any interactions.

Analysis of up to 23,598 students attending 2,579 schools revealed interactions between school and ADHD effects on achievement. The variability between schools in the effects of inattention, hyperactivity and within‐family ADHD‐PGS on achievement was 0.08, 0.07 and 0.05 SDs, respectively. For example, the average effect of inattention on achievement was β = −0.23 ( SE  = 0.009), but in 2.5% of schools with the weakest effects, the value was −0.07 or less. ADHD has a weaker effect on achievement in higher‐performing schools. Schools make more of a difference to the achievements of students with higher levels of ADHD, explaining over four times as much variance in achievement for those with high versus average inattention symptoms. School sociodemographic measures could not explain the ADHD‐by‐school interactions.

Conclusions

Although ADHD symptoms and genetic risk tend to hinder achievement, schools where their effects are weaker do exist. Differences between schools in support for children with ADHD should be evened out.

Introduction

Complex outcomes such as educational achievement result from exchanges between individual characteristics and environmental contexts such as families, schools and neighbourhoods, over time (Bronfenbrenner & Ceci,  1994 ). Schools are essential for cognitive and social development and have been proposed to affect student achievement in multiple ways, including through social processes (e.g. quality of instruction, disciplinary practices) and physical and institutional features (e.g. school resources, class sizes, ability tracking) (Rutter,  1982 ; Wang & Degol,  2016 ). However, it is not well understood how school environments interact with individual differences between children in their cognitive and behavioural difficulties. Research in this area could eventually inform policymakers and teachers on which school environments best support children at risk of low achievement.

Attention‐deficit/hyperactivity disorder (ADHD) is of particular interest in this context. Its characteristic symptoms of hyperactivity and inattention loom large at school. ADHD symptoms are common, typically appear in early childhood and are associated with profound impairments in achievement (DuPaul et al.,  2004 ; Massetti et al.,  2008 ; Polderman, Boomsma, Bartels, Verhulst, & Huizink,  2010 ; Thapar & Rutter,  2015 ). Academic impairments are especially severe for inattention symptoms (Pingault et al.,  2011 ; Salla et al.,  2016 ) and may be partly due to general effects on everyday learning, such as spending more time off‐task than peers (Kofler, Rapport, & Alderson,  2008 ). However, the role of schools in the relationship between ADHD and academic difficulties has received relatively little attention. School‐based behavioural interventions (e.g. environmental modifications, reinforcement systems, computer‐assisted instruction and peer tutoring) improve behaviour but have modest effects on achievement (DuPaul, Weyandt, & Janusis,  2011 ; Jangmo et al.,  2019 ). More research is required on school factors that directly address academic skills in ADHD (DuPaul et al.,  2011 ). Identifying which school environments aid the achievements of students with ADHD could help to design policies and interventions.

Quantifying how much the association between ADHD and achievement varies between schools is a valuable first step towards understanding how schools influence the academic consequences of ADHD. Addressing this question using a latent approach opens the possibility of capturing effects of all school‐level factors driving differences in how much ADHD symptoms affect achievement, including unknown and unmeasured ones. This has the advantage of remaining agnostic to specific environments, which are challenging to identify and measure and, if measured, may represent mere proxies for the ‘true’ interactive school factors (Boardman, Daw, & Freese,  2013 ; Trejo et al.,  2018 ). After clarifying whether school environments moderate ADHD effects on achievement (i.e. increase or decrease the effect compared with the average across schools), researchers may then identify what these environments are. If available measured school factors cannot account for the latent moderation effects, this would justify hypothesising about other specific school characteristics.

ADHD‐by‐school interactions are challenging to study because non‐random selection into schools can create spurious interactions. For example, if parents with elevated ADHD symptoms choose certain schools for their offspring, then the interaction between student ADHD symptoms and schools may actually reflect an interplay between student and parent symptoms. This endogeneity problem can be tackled through within‐family analysis of children's ADHD polygenic scores (PGS) adjusted for parents' ADHD‐PGS. ADHD is strongly genetically influenced (70–80% in twin studies) (Faraone & Larsson,  2019 ), and PGS allow genetic propensity for ADHD to be indexed on the individual level. Parents' selection of schools partly reflects heritable characteristics such as ADHD liability, which are inherited by children. This mechanism, known as passive gene–environment correlation (Plomin, DeFries, & Loehlin,  1977 ), leads to a correlation between child genetic variation and the school they attend. Importantly, school selection by parents confounds typical PGS analyses, but not within‐family analyses where the child PGS is conditioned on parental PGS (Schmitz & Conley,  2017 ). Within‐family PGS effects reflect the random segregation of alleles at conception and are uncorrelated with the social environments that parents select. However, in situations where children can select schools themselves, the within‐family PGS may still be correlated with school (i.e. active gene–environment correlation is not adjusted for). Previous work has demonstrated negative effects of the ADHD‐PGS on achievement (Greven, Kovas, Willcutt, Petrill, & Plomin,  2014 ; Stergiakouli et al.,  2017 ), including within families (Jangmo et al.,  2021 ), but no research has examined between‐school differences in this association.

Between‐school variation in the effect of ADHD genetic risk on educational achievement would constitute a gene–environment interaction; that is, genes and social environments moderate one another (Plomin et al.,  1977 ). In both the educational achievement and ADHD literatures, empirical findings on gene–environment interactions have been mixed, with genetic influences being stronger, weaker or invariable between environments. Studies have focused on interactions with specific measured home environments, such as family socioeconomic status (Figlio, Freese, Karbownik, & Roth,  2017 ; Gould, Coventry, Olson, & Byrne,  2018 ; Pennington et al.,  2009 ; Tucker‐Drob & Bates,  2016 ), family chaos (Gould et al.,  2018 ; Z. Wang, Deater‐Deckard, Petrill, & Thompson,  2012 ), parental conflict and involvement (M. A. Nikolas, Klump, & Burt,  2015 ; M. Nikolas, Klump, & Burt,  2012 ). A few studies have examined gene–environment interactions involving schools, finding that genetic effects on oral reading fluency in second grade increased as teacher quality increased (Taylor, Roehrig, Soden Hensler, Connor, & Schatschneider,  2010 ), but that associations between the educational attainment PGS and adult educational and socioeconomic attainments generally do not meaningfully vary between schools (Trejo et al.,  2018 ). However, these have been United States‐based and have not considered the role of ADHD or its genetic risk.

Here, we explore how educational achievement is shaped by interactions between individual differences in ADHD and school environments. Our primary aim was to estimate total latent between‐school variation in the effects of inattention, hyperactivity and within‐family ADHD‐PGS on achievement. Using multilevel models, we remain agnostic to the relevant aspects of school environments. Moreover, our within‐family PGS analyses control for selection into schools. Our data set includes >25,000 Norwegian children's national test results, school identifiers, ADHD symptoms and parent–offspring PGS for ADHD, from a novel linkage between genetic trio data in the Norwegian Mother, Father and Child Cohort Study (Magnus et al.,  2016 ) and the Norwegian National Educational Database. Norway is a useful context because the education system is highly standardised, and register data are almost complete. In sum, these data uniquely position us to investigate how genetic propensity interacts with schools in explaining the negative association between ADHD and achievement.

The Norwegian context

Relative to other Western nations, Norway is a wealthy welfare state with low unemployment and low economic inequality (Eurofound,  2017 ). Nonetheless, income inequality and child poverty are substantial, and exacerbating over time (Barth, Moene, & Pedersen,  2021 ). The public sector provides various welfare services, including free compulsory education and universal health care. Education is comprehensive with a common curriculum for all students, and there is no tracking/streaming before upper secondary schooling. In elementary school, children primarily attend local schools, defined by their home address. Fewer than 4% of students attend private schools, which are schools with alternative pedagogical traditions, religious schools, or international schools. Special needs schools are extremely rare: in 2018, only 0.65% of children attended such schools. Child mental health services are almost exclusively public, and children with suspected ADHD or other mental health problems are referred by general practitioners. National guidelines for treatment of ADHD refer to adapted and special needs education as a key intervention, either prioritised before, or supplementary to psychopharmacological treatment. Local school psychology services design individual pedagogical plans based on symptoms and child functioning, not on diagnoses (Helsedirektoratet,  2021 ).

The Norwegian Mother, Father, and Child Cohort Study (MoBa; Magnus et al.,  2016 ) is a prospective population‐based pregnancy cohort study conducted by the Norwegian Institute of Public Health. Pregnant women were recruited from across Norway from 1999 to 2009. The women consented to initial participation in 41% of the pregnancies. The total cohort includes 114,500 children, 95,200 mothers and 75,200 fathers. All initial MoBa participants are currently being genotyped, and the sample of 98,110 genotyped individuals available to date should not be systematically different to MoBa overall. The current study is based on version 12 of the quality‐assured phenotype data files.

The present analyses were performed on a subsample of ~23,000 MoBa children with genome‐wide genotype data, parental genotype data, plus administrative records of educational achievement and school membership linked to MoBa through the Norwegian national ID number system. The administrative data are of high quality and do not suffer from attrition (Hovde Lyngstad & Skardhamar,  2011 ; Røed & Raaum,  2003 ). Analyses were restricted to one child per family, by choosing one sibling at random. Phenotypic‐only analyses were additionally limited to ~11,000 MoBa children with data for mother‐rated ADHD symptoms at age 8. This lower sample size is mainly due to attrition as the symptom data were collected when children were 8 years of age, whereas the genotype data were collected at birth. See Appendix  S1 for a sample size flow chart.

The establishment of MoBa and initial data collection was based on a licence from the Norwegian Data Protection Agency and approval from the Regional Committees for Medical and Health Research Ethics. The MoBa cohort is now based on regulations related to the Norwegian Health Registry Act. The current study was approved by the Regional Committees for Medical and Health Research Ethics (project #2017/2205).

School achievement

Standardised national test results for maths and reading at grades 5, 8 and 9 (ages 10, 13 and 14), and English at grades 5 and 8 were obtained through linkage to Norway's National Education Database. Introduced in 2007, these tests are mainly used to monitor school development over time. Tests are compulsory, with 96% of all students in Norway taking them; students with special needs and those following introductory language courses may be exempt. Results are conveyed to teachers and parents but have no direct consequence for students. We residualised students' test scores for sex, current age (to capture birth cohort effects) and the exact age when they took the tests. We created ‘core achievement’ measures as mean scores at each grade across available subjects (Rimfeld et al.,  2018 ), and centred these to have mean zero and standard deviation 1. Results are presented for overall mean achievement in the main text.

Interactions can arise spuriously due to features of outcome distributions (Domingue, Trejo, Armstrong‐Carter, & Tucker‐Drob,  2020 ), for example a truncated distribution of educational attainment (Trejo et al.,  2018 ). To guard against this, we assessed the mean, variance and skewness of test outcome distributions (overall and stratified by school performance deciles) and investigated their correlations with item response theory (IRT) scores. The IRT scores, which measure latent ability, are more normally distributed but less contextually meaningful than the main standardised test outcomes returned to teachers.

School codes

We matched children's achievement results to the schools they attended when they took each test. School identifiers were obtained from the National Education Database.

School sociodemographics

To complement the latent analyses, we tested whether specific school‐level sociodemographic measures could explain interactions identified through multilevel modelling. We created sociodemographic measures by aggregating administrative data from all parents of students at each school with register data, not only MoBa participants. Measures were intended to capture both the average sociodemographic background among students within each school and the variability of sociodemographic backgrounds of students within each school. For each school, we included five measures. The first measure was the average years of completed education of parents, converted from Norwegian Standard Classification of Education (NUS2000) categories and measured when students were 16. The second sociodemographic indicator was the average parental pretax annual income from gainful employment including self‐employment but not capital income or social welfare transfers. We averaged the income of both parents across the years that children were aged 11–15, and ranked their income compared with other parents in the same birth cohort. Third and fourth, we measured socioeconomic inequality by calculating Gini coefficients in reported levels of parental education and income, respectively. Gini is a widely used single measure of inequality and ranges from 0 to 1, with 0 indicating absolute equality and 1 indicating absolute inequality. Fifth, we calculated the proportion of children who are non‐Western immigrants and/or who are the children of non‐Western immigrants. We created these broad measures in the absence of more detailed school data. Notably, the measures could capture effects intrinsic to specific schools (e.g. peer effects) or broader social stratification (e.g. composition of the school catchment area). If the latter is true, then these variables could be considered additional controls for selection into schools and neighbourhoods.

We used the same measures of parental educational attainment and earned income as individual‐level control variables to ensure that interactions are not confounded by differences in family socioeconomic background.

ADHD symptoms

The Parent Rating Scale for Disruptive Behaviour Disorders (RS‐DBD) (Silva et al.,  2005 ) was used to measure inattention and hyperactivity symptoms when children were aged 8. Items were rated by mothers on a 4‐point scale (1 = never/rarely, 2 = sometimes, 3 = often and 4 = very often). Inattention items (9 in total) included ‘Fails to give close attention to details or makes careless mistakes in schoolwork’ and ‘Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)’. Hyperactivity items (9 in total) included ‘Leaves seat in classroom or in other situations in which remaining seated is expected’ and ‘Talks excessively’. Item alphas ranged from 0.78 to 0.96 ( https://www.fhi.no/en/studies/moba/for‐forskere‐artikler/questionnaires‐from‐moba/ ). We summed the items for the inattention and hyperactivity subscales. For individuals with less than 50% missing data on either scale, missing item values were imputed by the sample mean. The remaining individuals were excluded from analyses. We then centred sum scores to have mean zero and standard deviation 1. Inattention and hyperactivity subscales were analysed separately, due to differences in their aetiologies (Nikolas & Burt,  2010 ) and associations with achievement (Salla et al.,  2016 ). These symptom measures are intended to capture population variation in ADHD as a dimensional trait, of which clinical ADHD is the extreme (Faraone & Larsson,  2019 ). Findings based on symptoms rather than diagnoses are more generalisable and robust to variability in diagnostic practices.

Genotype quality control

The current MoBa genomic data set comprises imputed genetic data for 98,110 individuals (~32,000 parent–offspring trios; before quality control), derived from nine batches of participants, who make up four study cohorts. Within each batch, parent and offspring genetic data were quality‐controlled separately. Preimputation quality control criteria have been described in previous publications and are detailed in the Appendix  S2 . We conducted postimputation quality control, retaining SNPs meeting the following criteria: imputation quality score ≥0.8 in all batches, nonduplicated (by position or name), call rate > 98%, minor allele frequency >1%, Hardy–Weinberg equilibrium p  < .001, not associated with genotyping batch at the genome‐wide level and not causing a Mendelian error. We removed individuals with the following criteria: heterozygosity outliers (F‐het ±0.2), call rate < 98%, reported sex mismatching SNP‐based sex, duplicates (identified using PLINK's (Chang et al.,  2015 ) ‐genome command as having pihat > = 0.98, and distinguished from monozygotic twins through linkage to unique IDs in the population register, plus age, sex and kinship information within MoBa), individuals with excessive numbers of close relatives (cryptic relatedness) and Mendelian errors. To minimise environmental confounding, we identified a subsample of individuals with European ancestries via principal component analysis using the 1,000 Genomes reference; thresholds for exclusion of outliers were based on visual inspection of a plot of principal components 1 and 2. The final numbers of individuals and SNPs passing quality control were 93,582 and 6,797,215, respectively. Principal components of genetic ancestry were computed for all participants using PLINK's ‐within and ‐pca‐clusters commands, based on an LD‐pruned version of the final quality‐controlled genotype data.

ADHD polygenic scores ( PGS )

We generated ADHD‐PGS for all individuals in MoBa who passed quality control, based on the latest genome‐wide association study of 20,183 individuals of European‐associated ancestry diagnosed with ADHD and 35,191 controls (Demontis et al.,  2019 ). We used the PRSice software to calculate scores using all SNPs (i.e. p ‐value threshold of 1), with clumping parameters kb = 500, p  = 1, r 2  = .25 (Choi Shing Wan,  n.d. ). We excluded 175 MoBa participants who were also included in the BUPGEN and TOP cohorts contributing to the ADHD‐GWAS prior to analyses. We computed mid‐parental PGS by taking the average maternal and paternal PGS. ADHD‐PGS for one child per family ( N  = 27,582; one sibling selected randomly) and mid‐parental PGS ( N  = 25,169, hereafter ‘parental PGS’) were then centred to have mean zero and standard deviation 1. In all PGS analyses, we included parental PGS as controls, such that effects of offspring PGS are within‐family direct genetic effects . These within‐family PGS effects reflect random genetic segregation, holding any parental and wider ancestral differences constant, including population stratification, assortative mating and general social background effects. Notably, within‐family designs based on siblings or adoptees rather than parent–offspring trios can also be used to distinguish direct genetic effects from parental genetic effects (Demange et al.,  2020 ). We also included principal components (5 based on maternal data and 5 based on paternal data) to control for population stratification in the parental ADHD‐PGS effects.

The main advantage of the within‐family ADHD‐PGS over the symptom measures is that it effectively accounts for differential selection of schools by parents. We checked the clustering of children in schools according to ADHD symptoms and PGS. For inattention and hyperactivity symptoms, and individual child and parental ADHD‐PGS, 1–2% of the variance is at the school level, which indicates selection into schools (Table  S1 ). However, once parental ADHD‐PGS is accounted for, 0% of the variance in child ADHD‐PGS is explained by schools. The absence of clustering of child ADHD at the school level in a within‐family ADHD‐PGS model implies that we can consider the sorting of students into schools according to within‐family ADHD‐PGS in this model as random and interpret the variation between schools in PGS effects causally. Note that the degree of clustering of genetic risk for ADHD in schools is likely to be larger than estimated here using child and parent PGS, which only explain 1.4% and 0.6% of the variance in child ADHD symptoms, respectively (effects were equal for inattention and hyperactivity subscales).

Statistical analyses

Table  1 summarises our approach to investigating ADHD‐by‐school interactions. In short, we estimated the effects of ADHD on achievement in standardised tests and examined whether these associations varied between schools. We performed analyses for three indices of ADHD (inattention, hyperactivity and within‐family ADHD‐PGS) separately. To ensure that any between‐school variability was not simply produced by chance, we formally compared fit statistics for a series of increasingly complex multilevel models (see below).

Model‐fitting approach

The dependent variable was educational achievement (standardised national test results); ADHD refers to inattention symptoms, hyperactivity symptoms or the within‐family ADHD‐PGS – we performed the model comparison procedure separately for these three ADHD indicators; ADHD|School refers to the random slope for the ADHD effect between schools (consistent with the lme4 R package notation).

The base model (Model 1) estimated the association between achievement and ADHD (symptoms or within‐family PGS). We pooled data across grades by including individual identification number as a random intercept, and time point as a fixed effect to account for mean differences in scores across time. Time point was coded as a continuous variable centred with 0 for grade 9, −1 for grade 8 and − 4 for grade 5. Note that the grade 9 composite only includes maths and reading, whereas achievement composites for grades 5 and 8 include all three subjects.

In Model 2, we tested the degree to which achievement varied between schools, by adding a random intercept for schools.

In Model 3, we tested for ADHD‐by‐school interactions by adding random slopes for the effects of ADHD on achievement across schools. Improved fit relative to Model 2 is evidence that there is more variation around the average effect of ADHD (or slope) between schools than expected by chance. Since random intercepts were already included in Model 2, improved fit of Model 3 must only reflect schools interacting with ADHD, and not mean differences between schools.

In Model 4, we aimed to correct the school‐specific intercepts for potential selection into schools by adding fixed effects for individual‐level parental educational attainment and income. Intercepts thus reflect school effects on achievement rather than differences between students in family socioeconomic background.

We also tested whether school‐level sociodemographic characteristics could explain any observed school effects and ADHD‐by‐school interactions. We first added fixed effects for school environmental measures (Model 5). These fixed effects are meant to account for intercept variance, that is average differences between schools in student achievement. We then added environment‐by‐ADHD interaction terms (Model 6) to see whether the covariates could explain ADHD–school interactions, beyond any main effects that they have on achievement (already accounted for in Model 5). The five school sociodemographic measures were tested jointly. If covariates account for interactions between ADHD and schools, then the fit of Model 6 would be improved relative to Model 5, and the standard deviation of slopes for ADHD measures between schools would be reduced.

Since we used maximum‐likelihood estimation, we could compare fit of models before and after the inclusion of fixed effects, not only of models that differ in their random‐effects structure. Specifically, this allowed us to test whether model fit improved upon inclusion of random slopes for ADHD effects across schools (i.e. an ADHD–school interaction) and upon inclusion of specific school variables as fixed effects (e.g. school‐average parental income) that could explain any interactions.

Multilevel models allow the inclusion of all schools in analyses, even those only attended by one individual. Although having larger numbers of individuals per group increases power (Austin & Leckie,  2018 ), small/singleton groups do not lead to bias, because the models borrow information from other groups (Bell, Ferron, & Kromrey,  2008 ). By including the single‐student schools, our results become more population‐representative. In any case, the single‐student schools generally have not one but three outcome observations (for grades 5, 8 and 9), and the number of schools (of which we have many: ~2,500) is more important for statistical power than the number of children per school.

We performed two supplementary analyses. First, we tested for gender differences in any ADHD‐by‐school interactions by refitting the best model for boys and girls separately. Second, we explored whether results could be partly due to between‐school differences in special education services. We used parent‐reported information from MoBa (at child age 8) on whether a formal administrative decision had been made about their child being eligible for special education. By comparing the fit of further multilevel models, we tested whether the effect of ADHD on achievement depended on receiving special educational support, and whether this interaction varied between schools (see Appendix  S3 for full details).

Model fitting and comparisons

Analyses were conducted in R with the lme4 package (Bates, Mächler, Bolker, & Walker,  2015 ). Model comparisons are made using the anova() command to assess AIC fit statistics. AIC calculates the trade‐off between model fit and model complexity with a penalty for the number of parameters. If the model with, for instance, the random slopes (ADHD effects) across schools has a lower AIC value than that of a simpler model, this is evidence that ADHD‐by‐school interactions should be included for an optimal approximation of the underlying data generating processes.

Descriptive statistics

Achievement outcomes (standardised national test scores) were approximately normally distributed, with no indication of skewness of <−1 or >1 or of ceiling effects (no students gained the maximum number of points; Table  S2 ). This held across deciles of school quality (Figures  S1 – S3 ). Additionally, achievement outcomes were strongly correlated with item response theory‐derived scores reflecting the latent ability distribution, from the Norwegian Education database (Figure  S4 ). The ADHD symptom measures were correlated at 0.62, and the within‐family ADHD‐PGS was equally correlated with inattention and hyperactivity (0.03 and 0.04, respectively).

Multilevel models included up to 23,598 children with complete data for achievement, ADHD‐PGS, parental ADHD‐PGS, and school membership (2,579 unique schools). The average number of students participating in MoBagenetics per school at grade 5 was 11, with a minimum of 1 (in 221 schools) and a maximum of 65 (in one school). For the analyses with ADHD symptoms, the sample included 11,737 individuals, from 2,383 schools. Table  S2 shows descriptive statistics for all variables.

ADHD ‐by‐school interactions influence educational achievement

To explore between‐school differences in the effects of ADHD on achievement, we compared models as outlined in Table  1 . Model‐fitting results showed that the best model for all three ADHD indicators (inattention symptoms, hyperactivity symptoms and within‐family ADHD‐PGS) was Model 4. Table  2 shows that AIC values were lowest for this model, in which ADHD effects on achievement were allowed to vary between schools (i.e. an ADHD‐by‐school interaction), and parental education and income were controlled for. In all cases, the change in AIC indicated substantial improvement in fit upon inclusion of the ADHD–school interaction (change in AIC between Models 2 and 3 was 74, 59 and 11 for inattention, hyperactivity and within‐family ADHD‐PGS, respectively). Table  S3 shows full model fit statistics (chi‐squared, BIC, log‐likelihood, etc., as well as AIC). For Model 3 compared to Model 2, chi‐squared p ‐values were <2e−16 for inattention and hyperactivity, and 0.001 for the within‐family ADHD‐PGS. For Model 4 compared with Model 3 (i.e. the addition of controls for parental socioeconomic status), chi‐squared p ‐values were <2e−16 for all three ADHD indicators. We now describe the estimates for the best‐fitting model (Model 4). Full results for all tested models are in Table  S4 .

AIC fit statistics for tested models, with the best‐fitting models in bold

Note that model fitting was performed in two stages, first to test for the presence of ADHD‐by‐school interaction, and second to account for any interaction using school‐level variables.

Figure  1 displays results from the best‐fitting model for each ADHD indicator (Model 4), showing that the effects of all three on achievement ( x ‐axis) vary considerably between schools. On average (dashed lines), the association between inattention and achievement is β = .23 ( SE  = 0.009), while the association between hyperactivity and achievement is β = .09 ( SE  = 0.009). For children's within‐family ADHD‐PGS, the association with achievement is β = .07 ( SE  = 0.013). These effects varied between schools (indicated by the distribution of effects around the dashed averages in Figure  1 ), with standard deviations of effects between schools of 0.08, 0.07 and 0.05 for inattention, hyperactivity and within‐family ADHD‐PGS, respectively. This means that students' inattention symptoms have an effect between β = −.39 and β = −.07 in 95% of schools, but effects are more extreme than this in 5% of schools (calculated as −0.23 −/+ (1.96 × 0.08), since effects are normally distributed across schools).

School‐level variation in the effect of ADHD measures on achievement. Dashed lines show the average effects of ADHD measures on achievement (β = −.23, −.09 and −.07 for inattention, hyperactivity and within‐family ADHD‐PGS, respectively). Normal curves show that there is variation in these associations between schools, with SDs of the distributions of effects across schools of 0.08, 0.07, and 0.05 for inattention, hyperactivity and within‐family ADHD‐PGS, respectively. Results for the three ADHD variables were obtained from three separate models [Colour figure can be viewed at wileyonlinelibrary.com ]

The effect of the within‐family ADHD‐PGS (the child ADHD‐PGS effect adjusted for the parent ADHD‐PGS effect) on achievement is more extreme than double the school‐average effect (i.e. β = −.16) in 2.5% of the schools with the most strongly negative slopes, while negligible for schools in the opposite tail of the distribution of effects. Between‐school differences in within‐family ADHD‐PGS effects reflect gene–environment interaction, controlling for selection into schools. The parent ADHD‐PGS has an effect of only β = −.002, reduced from −.037 without controlling for parents' education and income (Model 3). This suggests that the indirect genetic effect of parental ADHD‐PGS on offspring achievement is mediated by family socioeconomic status. Here, parental education has a stronger association with student achievement than parental income (0.25 vs. 0.09, respectively).

Note that results were similar for maths, reading and English outcomes (Table  S5 ; Figure  S5 ), and for boys and girls (Table  S6 ).

The ADHD–school interaction that we identified implies that not only do ADHD effects vary between schools but that school effects vary according to student ADHD levels. Figure  2 , based on results from Model 4, shows the fraction of variance in achievement that is explained by school differences across ADHD levels. Schools are more important for students with higher compared to average ADHD symptoms and genetic risk. At average levels of ADHD inattention symptoms (i.e. x ‐axis = 0 in Figure  2 ), differences between schools explain less than 2% of the variance in achievement. However, differences between schools become of greater importance when comparing students with increasingly high inattention symptoms; for those with the highest levels of symptoms, schools explain 10% of the variation in achievement. Nearly, the same estimates are found for hyperactivity symptoms. The pattern for ADHD‐PGS is similar; only the differences are smaller. Since parental income and education were controlled for, school effects reflect school ‘value added’, beyond the contribution of family background.

Variation in the effects of schools on achievement by student ADHD measures. On the x ‐axis, 0 = mean level of each ADHD indicator, and values either side represent SDs from the mean, with lines covering only the range of observed variation. Y ‐axis indicates the % variance explained in achievement by school, controlling for family background [Colour figure can be viewed at wileyonlinelibrary.com ]

The correlation between the ADHD effect and the school effect on achievement, known as the slope–intercept correlation, was positive for all ADHD indicators ( r  = .36, .38 and .10 for inattention, hyperactivity and within‐family ADHD‐PGS, respectively). This positive correlation means that ADHD has less of an impact on achievement in higher‐achieving schools. Indeed, as ADHD effects increase between schools from strongly to weakly negative, overall achievement increases. As with the school intercept, the intercept–slope correlation is interpreted for average values of ADHD variables. We found that the correlation becomes more strongly positive with increasing values of student ADHD symptoms and PGS (Figure  S6 ).

The roles of school sociodemographic measures and special educational support

Our five direct measures of school sociodemographics contributed modestly to the between‐school differences in achievement. Model 5 showed improved fit relative to Model 4 (Table  2 ), but the school intraclass correlation – a latent school effect on achievement – reduced merely from 2.8% to 2.4% when including the school covariates. Effect sizes were β = 0.01 for school‐average parental education, 0.04 for inequality in parental education, 0.05 for average parental income, −0.05 for inequality in parental income and 0.06 for the proportion of non‐Western immigrants.

None of the five school‐level sociodemographic measures could explain ADHD‐by‐school interactions. This was reflected by the reduced fit of Model 6, which included ADHD‐by‐covariate interactions, relative to Model 5.

Supplementary analyses revealed tentative evidence that the relationship between ADHD and achievement depends on whether a student special educational support and that this dependency varies between schools (at least for inattention symptoms). This suggests that differential quality of special support between schools may explain our interaction results (see Supporting Information and Table  S7 ).

Using a unique sample of ~23,000 Norwegian children with data on standardised national test results, school identifiers, ADHD symptoms and parent–offspring ADHD polygenic scores (PGS), we provide new insights into how achievement in this sample is shaped by the interplay between school contexts, and individuals' ADHD symptoms and genetic risk. The availability of parent–offspring ADHD‐PGS allowed us to take advantage of the ‘natural experiment’ of random segregation of parental genetic variation at conception. Using such a within‐family ADHD‐PGS design is equivalent to randomising children to schools, meaning that the genetic analyses (but not the symptom analyses) are unlikely to be confounded by selection into schools.

We detected an interaction between schools and ADHD, whether ADHD was measured by symptoms of inattention, hyperactivity or within‐family ADHD‐PGS. This indicates that the educational consequence of ADHD depends on which school ADHD is expressed in. For example, the average effect of inattention on achievement is β = −.23, but in the 2.5% of schools where inattention matters the least for achievement, the effect is β = −.07 or less. Our estimates of ADHD‐PGS associations with achievement (β = −.11 crude and −.07 within‐family) were similar to those from a prior study, although the proportion of the ADHD‐PGS association due to direct child‐led genetic effects was weaker for their Swedish GPA outcome (β = −.12 crude and −0.04 within‐family) (Jangmo et al.,  2021 ). We build on this by showing that the within‐family ADHD‐PGS effect depends on the school, with effects greater than β = −.16 in the 2.5% of the schools with the most strongly negative slopes. The interaction also indicates that school effects on achievement vary according to students' levels of ADHD symptoms or genetic risk, with larger achievement differences between schools for higher ADHD students. For example, schools explain 2% of the variance in achievement for those with average inattention levels, versus 8% for students more than two standard deviations above average in inattention. Sociodemographic differences between schools cannot explain the latent ADHD‐by‐school interaction.

We found that in some schools, student achievement is strongly differentiated by ADHD, and in others, not at all. Our formal model comparisons indicated that the between‐school variation in ADHD effects is greater than expected by chance. For individual differences researchers, these school differences imply that associations between ADHD and achievement should be contextualised. For policymakers and teachers, this suggests that the link between ADHD and low achievement is malleable. On average, ADHD symptoms and genetic risk have large negative effects on achievement – with the strongest negative effects in the lower performing schools. However, this does not need to be the case. Further studies with richer data are needed to describe school contexts in which the ADHD penalty is reduced. Nevertheless, the finding of latent between‐school variation provides optimism by showing that schools where ADHD effects are small do exist.

The ADHD‐by‐school interaction also implies that school effects vary according to individual differences in ADHD symptoms and genetic risk. For those interested in education policy, this means that effects of school contexts must be interpreted with reference to individual psychological differences. The small impact of the school on national test scores on average (<3% of the variance) corresponds well with prior evidence from Norway and the United Kingdom (Hermansen, Borgen, & Mastekaasa,  2020 ; von Stumm et al.,  2020 ). However, our results suggest that average estimates of school effects conceal larger impacts for certain children at risk of poor achievement. Students with high‐ADHD symptoms and genetic risk may achieve differently at different schools, even taking family background into account.

The greater impact of school differences on achievement differences among students with higher ADHD symptoms and genetic risk could reflect variability between schools in support for higher needs students. Special needs education has been shown to affect marginal participants' educational outcomes (Ballis & Heath,  2021 ), so variation in such practices could contribute to between‐school differences in ADHD effects. Norwegian national regulations emphasise inclusive education, with 92% of special needs students remaining in mainstream settings (Nes,  2017 ). However, schools differ in whether/how funds are allocated to higher needs students, and in how ‘inclusivity’ is interpreted and implemented. School psychology services are locally organised and may vary in the level of engagement and type of pedagogical interventions. Moreover, schools vary in how actively the principal facilitates adaptations of classroom practices and collaboration with school psychologists. Research suggests that many Norwegian schools do not follow the national policy of providing support as early as possible for learning difficulties, but instead require children to wait for an ADHD diagnosis (Haug,  2014 ). Our supplementary analyses provide initial evidence that schools vary in how much special educational support weakens the negative association between inattention and achievement. The role of special education in the ADHD–school interaction will be clarified upon the availability of richer school‐level data, or ideally data from experiments where children are randomised to receive special support. Future work should identify school environments that support high‐ADHD‐risk students to perform well. If a policy goal is to reduce school‐driven inequalities in achievement, efforts should focus on evening out differences in opportunities for students with high‐ADHD symptoms and genetic risk between schools.

We also tested whether available measures of school sociodemographics could account for the latent interactions between schools and students' ADHD symptoms and PGS. None of these factors (school‐average parental education, income, inequality in education, inequality in income, and proportion of non‐Western immigrants) appeared to be involved. These measures are likely too broad to capture how schools moderate the effect of ADHD on achievement. Future work should use the framework introduced here to identify the total latent moderation effect by schools, and then see what fraction of this can be captured by more detailed school environmental measures. Candidate school measures should include institutional, practical, social and community domains, for example, not only the qualifications of teachers and psychologists to cater to children with cognitive and behavioural difficulties (Taylor et al.,  2010 ), but also time spent outdoors (potentially beneficial to students with tendencies for hyperactivity). Difficulties with measuring school indicators accurately (worse for measures such as school goals and leadership than for teacher qualifications and class size (Mayer, Mullens, & Moore,  2000 )) add to the issue that we lack concrete statistical evidence on school factors that aid student achievement. Yet, it will be valuable to identify salient school features that aid the achievements of students with ADHD, since these may provide useful intervention targets. Future research should aim not only to explain the interaction identified within the current methodological framework but also to validate the finding through triangulation with other methods, such as regression discontinuity designs based on policy changes (Barcellos, Carvalho, & Turley,  2018 ).

This study has several limitations. First, the generalisability of the findings is limited. Analyses included a subsample of MoBa participants with European ancestries, as defined by principal component analysis of the genetic data. The findings cannot be uncritically generalised to children with non‐European ancestries, and replication of our findings in more diverse samples is essential. Generalisability issues also may stem from selection into the MoBa sample, and attrition linked to ADHD. However, the school identifiers and standardised national test results cover the Norwegian population and are not affected by these issues.

Second, while we control for passive gene–environment correlation using parental ADHD‐PGS, children's own genetic propensities could theoretically still influence their school attendance. However, this is unlikely for two reasons. First, the within‐family ADHD‐PGS shows no clustering in schools. Second, there are no selective elementary schools in Norway, with almost all children simply attending their local school. We note that self‐selection will be much more important in other educational settings (e.g. the United Kingdom), and will be difficult to account for even in within‐family gene–environment interaction studies. However, selection into schools is an interesting phenomenon that can be understood better using multilevel genetically sensitive methods.

Third, our analyses underestimate the main and interactive effects of ADHD genetic risk. The latest ADHD‐PGS explains only 5.5% of the variance in case–control ADHD (Demontis et al.,  2017 ), despite the high twin heritability of 70–80% (M. A. Nikolas & Burt,  2010 ). Moreover, the PGS is based on mean effects of SNPs on ADHD case‐status across international education systems. These might not be the SNPs with effects that are sensitive to school context in Norwegian young people. However, the within‐family ADHD‐PGS had a strikingly similar average effect to hyperactivity symptoms (−0.07 and −0.09, respectively) and have the key advantage of providing a stricter test for gene–environment interaction. Indeed, compared with the measured ADHD symptoms, the ADHD‐PGS is less prone to the issue of selection into schools, more normally distributed and not subject to attrition. The interaction between genetic risk for ADHD and schools is likely to be larger than estimated here. We anticipate that future ADHD‐GWAS (ideally within‐family GWAS (Howe et al.,  2021 ), capturing SNP effects on ADHD and variability in ADHD (Al Kawam, Alshawaqfeh, Cai, Serpedin, & Datta,  2018 )) will facilitate more powerful PGS to be used in gene–environment interaction studies.

In sum, we found evidence of an interaction between students' ADHD symptoms and PGS, and their schools. This means that the performance gap associated with ADHD differs between schools, and the impact of school on achievement varies according to individual differences in ADHD. Children with elevated ADHD symptoms and PGS perform better in some schools than others. Knowing the characteristics of these environments requires future research, but this study indicates that one can expect to find them. Given the high individual and societal costs of ADHD and low educational achievement (Du Rietz et al.,  2020 ), the potential profitability of identifying these school qualities is great.

Supporting information

Appendix S1. Sample size flowchart.

Table S1. Intraclass correlations indicating variance in ADHD measures due to variation between schools.

Acknowledgements

R.C., E.M.E and E.Y. are supported by the Research Council of Norway (288083) and the European Research Council project GeoGen (101045526). H.Z., E.Y. and N.T.B. are supported by the ERC consolidator grant EQOP ‘Socioeconomic gaps in language development and school achievement: Mechanisms of inequality and opportunity’ (818425). Z.A. is supported by a Marie Skłodowska Curie Action Individual Fellowship from the European Union (894675). F.A.T. is supported by the Research Council of Norway (300668 and 273659). This work was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700. The Norwegian Mother, Father and Child Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research. The authors are grateful to all the participating families in Norway who take part in this ongoing cohort study. The authors thank the Norwegian Institute of Public Health (NIPH) for generating high‐quality genomic data. This research is part of the HARVEST collaboration, supported by the Research Council of Norway (#229624). The authors also thank the NORMENT Centre for providing genotype data, funded by the Research Council of Norway (#223273), South East Norway Health Authority and KG Jebsen Stiftelsen. The authors further thank the Center for Diabetes Research, the University of Bergen, for providing genotype data and performing quality control and imputation of the data funded by the ERC AdG project SELECTionPREDISPOSED, Stiftelsen Kristian Gerhard Jebsen, Trond Mohn Foundation, the Research Council of Norway, the Novo Nordisk Foundation, the University of Bergen, and the Western Norway health Authorities (Helse Vest). H.L. reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention‐deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. The remaining authors have declared that they have no competing or potential conflicts of interest.

Analysis code can be found at https://github.com/rosacheesman/ADHD_schools/ .

• ADHD impairs educational achievement, but it is unknown whether schools can influence this (and how).
• We found that schools moderate the effects of ADHD on achievement. We demonstrated this not only using ADHD symptoms but also using within‐family ADHD‐PGS, where selection into schools is controlled for.
• Schools alter the impact of ADHD and create particularly strong differences in achievement among high‐ADHD risk students.
• We have developed a robust framework to investigate gene–environment interactions based on multilevel modelling of within‐family data that could be used in future studies.

Conflict of interest statement: See Acknowledgements for full disclosures.

• Al Kawam, A. , Alshawaqfeh, M. , Cai, J.J. , Serpedin, E. , & Datta, A. (2018). Simulating variance heterogeneity in quantitative genome wide association studies . BMC Bioinformatics , 19 ( Suppl 3 ), 72. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Austin, P.C. , & Leckie, G. (2018). The effect of number of clusters and cluster size on statistical power and Type I error rates when testing random effects variance components in multilevel linear and logistic regression models . Journal of Statistical Computation and Simulation , 88 , 3151–3163. [ Google Scholar ]
• Ballis, B. , & Heath, K. (2021). The long‐run impacts of special education . American Economic Journal: Economic Policy , 13 , 72–111. [ Google Scholar ]
• Barcellos, S.H. , Carvalho, L.S. , & Turley, P. (2018). Education can reduce health differences related to genetic risk of obesity . Proceedings of the National Academy of Sciences of the United States of America , 115 , E9765–E9772. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Barth, E. , Moene, K. , & Pedersen, A.W. (2021). Rising inequality in the egalitarian nordics. In Europe's income, wealth, consumption, and inequality (pp. 218–245). Oxford, England: Oxford University Press. https://oxford.universitypressscholarship.com/view/10.1093/oso/9780197545706.001.0001/oso‐9780197545706‐chapter‐6 [ Google Scholar ]
• Bates, D. , Mächler, M. , Bolker, B. , & Walker, S. (2015). Fitting linear mixed‐effects models using lme4 . Journal of Statistical Software , 67 , 1–48. [ Google Scholar ]
• Bell, B. , Ferron, J. , & Kromrey, J. (2008). Cluster size in multilevel models: The impact of sparse data structures on point and interval estimates in two‐level models . Undefined.
• Boardman, J.D. , Daw, J. , & Freese, J. (2013). Defining the environment in gene‐environment research: lessons from social epidemiology . American Journal of Public Health , 103 ( Suppl 1 ), S64–S72. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bronfenbrenner, U. , & Ceci, S.J. (1994). Nature‐nurture reconceptualized in developmental perspective: A bioecological model . Psychological Review , 101 , 568–586. [ PubMed ] [ Google Scholar ]
• Chang, C.C. , Chow, C.C. , Tellier, L.C. , Vattikuti, S. , Purcell, S.M. , & Lee, J.J. (2015). Second‐generation PLINK: Rising to the challenge of larger and richer datasets . GigaScience , 4 , 7. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Choi Shing Wan . (n.d.). PRSice 2 Wiki GitHub . Retrieved January 31, 2018 from: https://github.com/choishingwan/PRSice/wiki
• Demange, P. A. , Hottenga, J. J. , Abdellaoui, A. , Malanchini, M. , Domingue, B. W. , de Zeeuw, E. L. , … & Cheesman, R. (2020). Parental influences on offspring education: Indirect genetic effects of non‐cognitive skills . BioRxiv . 10.1101/2020.09.15.296236 [ PMC free article ] [ PubMed ] [ CrossRef ]
• Demontis, D. , Walters, R. K. , Martin, J. , Mattheisen, M. , Als, T. D. , Agerbo, E. , … & Neale, B. M. (2017). Discovery Of The First Genome‐Wide Significant Risk Loci For ADHD . BioRxiv . 10.1101/145581 [ PMC free article ] [ PubMed ] [ CrossRef ]
• Demontis, D. , Walters, R.K. , Martin, J. , Mattheisen, M. , Als, T.D. , Agerbo, E. , … & Neale, B.M. (2019). Discovery of the first genome‐wide significant risk loci for attention deficit/hyperactivity disorder . Nature Genetics , 51 , 63–75. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Domingue, B. , Trejo, S. , Armstrong‐Carter, E. , & Tucker‐Drob, E. (2020). Interactions between polygenic scores and environments: Methodological and conceptual challenges . Sociological Science , 7 , 365–386. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Du Rietz, E. , Jangmo, A. , Kuja‐Halkola, R. , Chang, Z. , D'Onofrio, B.M. , Ahnemark, E. , … & Larsson, H. (2020). Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register‐based study . Journal of Child Psychology and Psychiatry , 61 , 959–968. [ PubMed ] [ Google Scholar ]
• DuPaul, G.J. , Volpe, R.J. , Jitendra, A.K. , Lutz, J.G. , Lorah, K.S. , & Gruber, R. (2004). Elementary school students with AD/HD: predictors of academic achievement . Journal of School Psychology , 42 , 285–301. [ Google Scholar ]
• DuPaul, G.J. , Weyandt, L.L. , & Janusis, G.M. (2011). ADHD in the classroom: Effective intervention strategies . Theory Into Practice , 50 , 35–42. [ Google Scholar ]
• Eurofound . (2017). Annual review of working life . Retrieved June 24, 2021 from: https://www.eurofound.europa.eu/publications/report/2018/annual‐review‐of‐working‐life‐2017
• Faraone, S.V. , & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder . Molecular Psychiatry , 24 , 562–575. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Figlio, D.N. , Freese, J. , Karbownik, K. , & Roth, J. (2017). Socioeconomic status and genetic influences on cognitive development . Proceedings of the National Academy of Sciences of the United States of America , 114 , 13441–13446. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Gould, K.L. , Coventry, W.L. , Olson, R.K. , & Byrne, B. (2018). Gene–Environment Interactions in ADHD: The roles of SES and chaos . Journal of Abnormal Child Psychology , 46 , 251–263. [ PubMed ] [ Google Scholar ]
• Greven, C.U. , Kovas, Y. , Willcutt, E.G. , Petrill, S.A. , & Plomin, R. (2014). Evidence for shared genetic risk between ADHD symptoms and reduced mathematics ability: A twin study . Journal of Child Psychology and Psychiatry , 55 , 39–48. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haug, P. (2014). The practices of dealing with children with special needs in school: A Norwegian perspective . Emotional and Behavioural Difficulties , 19 , 296–310. [ Google Scholar ]
• Helsedirektoratet . (2021). Hjelp i barnehage/skole/arbeid ved ADHD/Hyperkinetisk forstyrrelse – Helsedirektoratet . Retrieved November 23, 2021 from: https://www.helsedirektoratet.no/retningslinjer/adhd/behandling‐og‐oppfolging‐av‐adhd‐hyperkinetisk‐forstyrrelse/hjelp‐i‐barnehageskolearbeid‐ved‐adhdhyperkinetisk‐forstyrrelse
• Hermansen, A.S. , Borgen, N.T. , & Mastekaasa, A. (2020). Long‐term trends in adult socio‐economic resemblance between former schoolmates and neighbouring children . European Sociological Review , 36 , 366–380. [ Google Scholar ]
• Hovde Lyngstad, T. , & Skardhamar, T. (2011). Nordic register data and their untapped potential for criminological knowledge . Crime and Justice , 40 , 613–645. [ Google Scholar ]
• Howe, L. J. , Nivard, M. G. , Morris, T. T. , Hansen, A. F. , Rasheed, H. , Cho, Y. , … & Davies, N. M. (2021). Within‐sibship GWAS improve estimates of direct genetic effects . BioRxiv. 10.1101/2021.03.05.433935 [ PMC free article ] [ PubMed ] [ CrossRef ]
• Jangmo, A. , Brikell, I. , Kuja‐Halkola, R. , Feldman, I. , Lundström, S. , Almqvist, C. , … & Larsson, H. (2021). The association between polygenic scores for attention‐deficit/hyperactivity disorder and school performance: The role of attention‐deficit/hyperactivity disorder symptoms, polygenic scores for educational attainment, and shared familial factors . JCPP Advances , 1 , 12030. [ Google Scholar ]
• Jangmo, A. , Stålhandske, A. , Chang, Z. , Chen, Q. , Almqvist, C. , Feldman, I. , … & Larsson, H. (2019). Attention‐deficit/hyperactivity disorder, school performance, and effect of medication . Journal of the American Academy of Child and Adolescent Psychiatry , 58 , 423–432. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kofler, M.J. , Rapport, M.D. , & Alderson, R.M. (2008). Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta‐analytic review . Journal of Child Psychology and Psychiatry , 49 , 59–69. [ PubMed ] [ Google Scholar ]
• Magnus, P. , Birke, C. , Vejrup, K. , Haugan, A. , Alsaker, E. , Daltveit, A.K. , … & Stoltenberg, C. (2016). Cohort profile update: the Norwegian mother and child cohort study (moba) . International Journal of Epidemiology , 45 , 382–388. [ PubMed ] [ Google Scholar ]
• Massetti, G.M. , Lahey, B.B. , Pelham, W.E. , Loney, J. , Ehrhardt, A. , Lee, S.S. , & Kipp, H. (2008). Academic achievement over 8 years among children who met modified criteria for attention‐deficit/hyperactivity disorder at 4–6 years of age . Journal of Abnormal Child Psychology , 36 , 399–410. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mayer, D.P. , Mullens, J.E. , & Moore, M.T. (2000). Monitoring school quality: An indicators report . Washington, D.C.: National Center for Education Statistics. [ Google Scholar ]
• Nes, K. (2017). Inclusive education and exclusionary practices in Norwegian schools. In Dovigo F. (Ed.), Special educational needs and inclusive practices (pp. 63–78). Rotterdam: SensePublishers. [ Google Scholar ]
• Nikolas, M. , Klump, K.L. , & Burt, S.A. (2012). Youth appraisals of inter‐parental conflict and genetic and environmental contributions to attention‐deficit hyperactivity disorder: examination of GxE effects in a twin sample . Journal of Abnormal Child Psychology , 40 , 543–554. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nikolas, M.A. , & Burt, S.A. (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: A meta‐analysis . Journal of Abnormal Psychology , 119 , 1–17. [ PubMed ] [ Google Scholar ]
• Nikolas, M.A. , Klump, K.L. , & Burt, S.A. (2015). Parental involvement moderates etiological influences on attention deficit hyperactivity disorder behaviors in child twins . Child Development , 86 , 224–240. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pennington, B.F. , McGrath, L.M. , Rosenberg, J. , Barnard, H. , Smith, S.D. , Willcutt, E.G. , … & Olson, R.K. (2009). Gene X environment interactions in reading disability and attention‐deficit/hyperactivity disorder . Developmental Psychology , 45 , 77–89. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pingault, J.‐B. , Tremblay, R.E. , Vitaro, F. , Carbonneau, R. , Genolini, C. , Falissard, B. , & Côté, S.M. (2011). Childhood trajectories of inattention and hyperactivity and prediction of educational attainment in early adulthood: A 16‐year longitudinal population‐based study . The American Journal of Psychiatry , 168 , 1164–1170. [ PubMed ] [ Google Scholar ]
• Plomin, R. , DeFries, J.C. , & Loehlin, J.C. (1977). Genotype‐environment interaction and correlation in the analysis of human behavior . Psychological Bulletin , 84 , 309–322. [ PubMed ] [ Google Scholar ]
• Polderman, T.J.C. , Boomsma, D.I. , Bartels, M. , Verhulst, F.C. , & Huizink, A.C. (2010). A systematic review of prospective studies on attention problems and academic achievement . Acta Psychiatrica Scandinavica , 122 , 271–284. [ PubMed ] [ Google Scholar ]
• Rimfeld, K. , Malanchini, M. , Krapohl, E. , Hannigan, L.J. , Dale, P.S. , & Plomin, R. (2018). The stability of educational achievement across school years is largely explained by genetic factors . NPJ Science of Learning , 3 , 16. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Røed, K. , & Raaum, O. (2003). Administrative registers – Unexplored reservoirs of Scientific Knowledge? The Economic Journal , 113 , F258–F281. [ Google Scholar ]
• Rutter, M. (1982). Fifteen thousand hours . Cambridge, MA: Harvard University Press. [ Google Scholar ]
• Salla, J. , Michel, G. , Pingault, J.B. , Lacourse, E. , Paquin, S. , Galéra, C. , … & Côté, S.M. (2016). Childhood trajectories of inattention‐hyperactivity and academic achievement at 12 years . European Child & Adolescent Psychiatry , 25 , 1195–1206. [ PubMed ] [ Google Scholar ]
• Schmitz, L. , & Conley, D. (2017). Modeling gene–environment interactions with quasi‐natural experiments . Journal of Personality , 85 , 10–21. [ PubMed ] [ Google Scholar ]
• Silva, R.R. , Alpert, M. , Pouget, E. , Silva, V. , Trosper, S. , Reyes, K. , & Dummit, S. (2005). A rating scale for disruptive behavior disorders, based on the DSM‐IV item pool . The Psychiatric Quarterly , 76 , 327–339. [ PubMed ] [ Google Scholar ]
• Stergiakouli, E. , Martin, J. , Hamshere, M.L. , Heron, J. , St Pourcain, B. , Timpson, N.J. , … & Davey Smith, G. (2017). Association between polygenic risk scores for attention‐deficit hyperactivity disorder and educational and cognitive outcomes in the general population . International Journal of Epidemiology , 46 , 421–428. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Taylor, J. , Roehrig, A.D. , Soden Hensler, B. , Connor, C.M. , & Schatschneider, C. (2010). Teacher quality moderates the genetic effects on early reading . Science , 328 , 512–514. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Thapar, A. , & Rutter, M. (2015). Neurodevelopmental disorders. In Thapar A., Pine D.S., Leckman J.F., Scott S., Snowling M.J., & Taylor E. (Eds.), Rutter's child and adolescent psychiatry (pp. 31–40). Chichester, UK: John Wiley & Sons. [ Google Scholar ]
• Trejo, S. , Belsky, D.W. , Boardman, J.D. , Freese, J. , Harris, K.M. , Herd, P. , … & Domingue, B.W. (2018). Schools as moderators of genetic associations with life course attainments: Evidence from the WLS and add health . Sociological Science , 5 , 513–540. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Tucker‐Drob, E.M. , & Bates, T.C. (2016). Large cross‐national differences in gene × socioeconomic status interaction on intelligence . Psychological Science , 27 , 138–149. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• von Stumm, S. , Smith‐Woolley, E. , Cheesman, R. , Pingault, J.‐B. , Asbury, K. , Dale, P.S. , … & Plomin, R. (2020). School quality ratings are weak predictors of students' achievement and well‐being . Journal of Child Psychology and Psychiatry , 62 , 339–348. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Wang, M.‐T. , & Degol, J.L. (2016). School climate: A review of the construct, measurement, and impact on student outcomes . Educational Psychology Review , 28 , 315–352. [ Google Scholar ]
• Wang, Z. , Deater‐Deckard, K. , Petrill, S.A. , & Thompson, L.A. (2012). Externalizing problems, attention regulation, and household chaos: a longitudinal behavioral genetic study . Development and Psychopathology , 24 , 755–769. [ PMC free article ] [ PubMed ] [ Google Scholar ]

• Search Menu
• Sign in through your institution
• Advance articles
• Virtual Issues
• Author Guidelines
• Open Access
• Self-Archiving Policy
• Why publish with this journal?
• About Journal of Pediatric Psychology
• About the Society of Pediatric Psychology
• Editorial Board
• Student Resources
• Advertising and Corporate Services
• Dispatch Dates
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Conceptual framework, evolving definitions of adhd, what are the academic and educational characteristics of children with adhd, are academic and educational problems transient or persistent, what are the academic characteristics of children with symptoms of adhd but without formal diagnoses, how do treatments affect academic and educational outcomes, how should we design future research to determine which treatments improve academic and educational outcomes of children with adhd.

• < Previous

Academic and Educational Outcomes of Children With ADHD

ADHD Special Issue, reprinted by permission from Ambulatory Pediatrics, Vol. 7, Number 2 (Supplement), Jan./Feb. 2007,

• Article contents
• Figures & tables
• Supplementary Data

Irene M. Loe, Heidi M. Feldman, Academic and Educational Outcomes of Children With ADHD, Journal of Pediatric Psychology , Volume 32, Issue 6, July 2007, Pages 643–654, https://doi.org/10.1093/jpepsy/jsl054

• Permissions Icon Permissions

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

Problems in school are a key feature of attention-deficit/hyperactivity disorder (ADHD), often bringing the child with ADHD to clinical attention. It is important to establish the nature, severity, and persistence of these school difficulties in children with ADHD. It is also critical to learn how various treatments affect academic and educational outcomes. These findings inform clinical practice, public health, public education, and public policy. This review of academic and educational outcomes of ADHD is organized around 5 questions: (1) What are the academic and educational characteristics of children with ADHD? (2) Are academic and educational problems transient or persistent? (3) What are the academic characteristics of children with symptoms of ADHD but without formal diagnoses? (4) How do treatments affect academic and educational outcomes? (5) How should we design future research to determine which treatments improve academic and educational outcomes of children with ADHD?

We used the International Classification of Functioning, Disability, and Health (ICF) 1 as the conceptual framework for describing the functional problems associated with ADHD. The World Health Organization developed the ICF to provide a systematic and comprehensive framework and common language for describing and assessing functional implications of health conditions, regardless of the specific disease or disorder. Use of this model facilitates comparisons of health-related states across conditions, studies, interventions, populations, and countries.

In the underlying ICF conceptual framework, health conditions impact function at 3 mutually interacting levels of analysis ( Figure 1 ): body functions and structures, activities of daily living, and social participation. Problems of body functions and structures are called impairments , a more specific and narrow meaning for the term than that used in DSM-IV. 2 Problems of activities of daily living are called limitations . Problems of social participation are called restrictions. Environmental and personal factors can also affect functioning. Treatments may address the health condition directly, may be aimed at one or more domains within the levels of functioning, or may be designed to change the environment. Because of the bidirectional influences within and among these levels of analysis, treatments directed at one problem may indirectly improve problems at other levels.

Conceptual model of International Classification of Functioning, Disability, and Health.

Figure 2 applies the ICF model to school functioning in children with ADHD using the specific codes and terminology of the classification system. At the level of body functions, ADHD affects several global and specific mental functions: intellectual function; impulse control; sustaining and shifting attention; memory; control of psychomotor functions; emotion regulation; higher level cognition, including organization, time management, cognitive flexibility, insight, judgment, and problem solving; and sequencing complex movements. At the level of activities, ADHD may result in limitations in at least 2 domains relevant to this review (and other domains addressed by other chapters in this volume): (1) learning and applying knowledge, including reading, writing, and calculation; and (2) general tasks and demands, including completing single or multiple tasks, handling one's own behavior, and managing stress and frustration. Here, we will differentiate between academic underachievement , which will refer to problems in learning and applying knowledge, including earning poor grades and low standardized test scores, and academic performance , which includes completing classwork or homework. At the level of social participation, ADHD can compromise the major life area of education, including creating restrictions in moving in and across educational levels, succeeding in the educational program, and ultimately leaving school to work. Any one of these functional problems may have many contributors, including the health condition and functional problems at other levels of analysis. We will refer to the restrictions in participation as educational problems. Environmental factors relevant to outcomes in ADHD include general and special education services and policies.

Functional problems associated with attention-deficit/hyperactivity disorder using the International Classification of Functioning, Disability, and Health conceptual model.

The clinical criteria for ADHD have evolved over the last 25 years. Studies from the 1980s and 1990s often used different inclusion and exclusion criteria than were used in more recent studies. Some studies carefully differentiate between children with what we now label as ADHD-Combined subtype (ADHD-C) and attention deficit disorder or ADHD-predominantly Inattentive subtype (ADHD-I). We will address briefly the outcomes of the subtypes specifically. Many children with ADHD have comorbid conditions, including anxiety, depression, disruptive behavior disorders, tics, and learning problems. The contributions of these co-occurring problems to the functional outcomes of ADHD have not been well established. Therefore, in this review, we will consider the academic and educational outcomes of ADHD without subdividing the population on the basis of coexisting neurobehavioral problems in affected children.

Children with ADHD show significant academic underachievement, poor academic performance, and educational problems. 3–8 In terms of impairment of body functions, children with ADHD show significant decreases in estimated full-scale IQ compared with controls but score on average within the normal range. 9 In terms of activity limitations, children with ADHD score significantly lower on reading and arithmetic achievement tests than controls. 9 In terms of restrictions in social participation, children with ADHD show increases in repeated grades, use of remedial academic services, and placement in special education classes compared with controls. 9 Children with ADHD are more likely to be expelled, suspended, or repeat a grade compared with controls. 10

Children with ADHD are 4 to 5 times more likely to use special educational services than children without ADHD. 10, 11 Additionally, children with ADHD use more ancillary services, including tutoring, remedial pull-out classes, after-school programs, and special accommodations.

The literature reports conflicting data about whether the academic and educational characteristics of ADHD-I are substantially different from the characteristics of ADHD-C. 12, 13 Some studies have not found different outcomes in terms of academic attainment, use of special services, and rates of high school graduation. 14 However, a large survey of elementary school students found children with ADHD-I were more likely to be rated as below average or failing in school compared with the children with ADHD-C and ADHD–predominantly hyperactive-impulsive subtype. 15 A subset of children with ADHD-I are described as having a sluggish cognitive tempo, leading to the assumption that there is a higher prevalence of learning disorders in the ADHD-I than the ADHD-C populations. One study supporting this claim found more children with ADHD-I than children with ADHD-C in classrooms for children with learning disabilities. 16 Comparative long-term outcome studies of the subtypes in terms of academic and educational outcomes have not been conducted. 17

Longitudinal studies show that the academic underachievement and poor educational outcomes associated with ADHD are persistent. Academic difficulties for children with ADHD begin early in life. Symptoms are commonly reported in children aged 3 to 6 years, 18 and preschool children with ADHD or symptoms of ADHD are more likely to be behind in basic academic readiness skills. 19, 20

Several longitudinal studies follow school-age children with ADHD into adolescence and young adulthood. Initial symptoms of hyperactivity, distractibility, impulsivity, and aggression tend to decrease in severity over time but remain present and increased in comparison to controls. 21 In terms of activity limitations, subjects followed into adolescence fail more grades, achieve lower ratings on all school subjects on their report cards, have lower class rankings, and perform more poorly on standardized academic achievement tests than matched normal controls. 22–26 School histories indicate persistent problems in social participation, including more years to complete high school, lower rates of college attendance, and lower rates of college graduation for subjects than controls. 27–30

The subjects with ADHD in the longitudinal studies generally fall into 1 of 3 main groups as young adults: (1) approximately 25% eventually function comparably to matched normal controls; (2) the majority show continued functional impairment, limitations in learning and applying knowledge, and restricted social participation, particularly poor progress through school; and (3) less than 25% develop significant, severe problems, including psychiatric and/or antisocial disturbance. 31 It is unclear what factors determine the long-term outcomes. Persistent difficulties may be due to ADHD per se or may be due to a combination of ADHD and coexisting conditions, including learning, internalizing, and disruptive behavior disorders. The contribution of environmental factors to outcomes is also unclear.

Studies of outcome in children diagnosed with ADHD suffer from a potentially serious logical problem: circularity. 32 The clinical definition of ADHD in the DSM-IV requires the presence of functional impairment, typically defined in terms of behavior and performance at home and school. School problems are almost always present to make the diagnosis and therefore are more likely to be present at follow-up. Another problem in the use of clinic-referred samples is the selection bias in who gets referred to diagnostic clinics. One research strategy to complement the longitudinal studies of clinic-referred samples and avoid these problems is to evaluate children from community-based samples who demonstrate symptoms of ADHD but who have not necessarily been formally diagnosed with ADHD. In general, these studies find that children with symptoms of ADHD and without formal diagnoses also have adverse outcomes.

An early community-based study that charted the natural history of ADHD 33 followed subjects who were diagnosed and treated during childhood and children with symptoms and/or behavior indications who were never diagnosed or treated. Both groups were far more likely to attend special education schools and far less likely to graduate from high school or go to college than the asymptomatic controls. The magnitude of the difference was greater for the children with formal diagnosis than for those with pervasive symptoms.

Another community-based study on the relationship between symptoms of ADHD, scores on academic standardized tests, and grade retention found a linear relationship between the number of behavioral symptoms and academic achievement, even among children whose scores were generally below the clinical threshold for the diagnosis of ADHD. 34 Similar findings have been found in studies from Britain 35 and New Zealand. 36 Taken together, these findings suggest that the symptoms and associated features of ADHD are associated with adverse outcomes.

By using the ICF framework, treatments can be evaluated in terms of whether they improve body functions, including intelligence, sustained attention, memory, or executive functions; affect activities, including increasing learning and applying knowledge (such as raising standardized test scores or grades in reading, mathematics, or writing) and improving attending and completing tasks; or enhance participation, including moving across educational levels, succeeding in the educational program, and leaving school for work.

Medical Treatments

Psychopharmacological treatments, particularly with stimulant medications, reduce the core symptoms of ADHD 37 at the level of body functions. In addition, psychopharmacological treatments have been shown to improve children's abilities to handle general tasks and demands; for example, medication has been shown to improve academic productivity as indicated by improvements in the quality of note-taking, scores on quizzes and worksheets, the amount of written-language output, and homework completion. 38 However, stimulants are not associated with normalization of skills in the domain of learning and applying knowledge. 39 For example, stimulant medications have not generally been associated with improvements in reading abilities. 40, 41 In longitudinal studies, subjects demonstrated poor outcomes compared with controls whether or not they received medication. 24 , ,25 ,27 ,42–44 One caution in interpreting these findings is that it cannot be determined if outcomes would have been even worse without treatment because studies often lacked a true nontreatment group with ADHD. Another problem was attrition; subjects lost to follow-up may include those with worse outcomes. A third caution is that most children receive medication for only 2 to 3 years, 45 and it remains unclear whether steady treatment over many years would be associated with improved outcomes.

Behavior Management of ADHD

Behavioral interventions for ADHD, including behavioral parent training, behavioral classroom interventions, positive reinforcement and response cost contingencies, are effective in reducing core ADHD symptoms. 17 , ,30 ,46 However, in head-to-head comparisons behavior management techniques are less effective than psychostimulant medications 37 in reducing core symptoms. It has been shown that behavior management is equivalent or better than medication in improving aspects of functioning, such as parent-child interactions and reduction in oppositional-defiant behavior. However, the problem with this literature is that most behavior management intervention studies evaluate the impact on short-term behavior outcomes, not academic and educational outcomes. The impact of behavioral treatments on long-term academic and educational outcomes must be carefully studied.

Combined Management of ADHD

Given the chronic nature of ADHD and its impact on multiple domains of function, it is likely that multiple treatment approaches are needed. However, the impact of such combined treatments on long-term academic and educational outcomes has not been well studied. Combined treatment (medication and behavioral treatment) in the Multimodal Treatment Study of Children With ADHD was better than behavioral treatment and community care for reading achievement; however, the differences were small and of questionable clinical significance. 37 In addition, children with ADHD and co-occurring anxiety or environmental adversity derived benefit from the combination of medication and behavior management. 47, 48 We need studies to determine whether combined treatment has a larger impact on academic and educational outcomes in some subpopulations than others.

In terms of academic achievement and performance, a 2-year study comparing therapy with methylphenidate to therapy with methylphenidate plus multimodal psychosocial treatments found no advantage of combined treatment over medication alone on any academic measures. 49 The multimodal treatment included academic assistance, organizational skills training, individual psychotherapy, social skills training, and, if needed, reading remediation using phonics. In these studies, medication and/or behavior management, whether used alone or in combination, did not improve academic and educational outcomes of ADHD.

Educational Interventions and Services

The impact of remedial educational services on academic and educational outcomes is not known. Most available treatment outcome studies have not been conducted in general education classroom settings 50 and have focused on reducing problematic behavior rather than on improving scholastic status. 51 Even current rates of utilization are difficult to determine because ADHD itself is not an eligibility criterion for special education. 52 Although advocates pursued making ADHD a category of disability under the Individuals with Disabilities Education Act of 1990 (IDEA), this attempt was not successful. 53 Instead, the US Department of Education issued a policy memorandum 54 stating that students with ADHD were eligible for special education services under the Other Health Impairment category if problems of limited alertness negatively affected academic performance. Children with ADHD may qualify for special education services if they are eligible for another IDEA category, such as emotional disturbance or specific learning disability, but the children with ADHD are not disaggregated from students without ADHD in these categories. 55

Educational services are also provided to students with ADHD who do not meet IDEA eligibility requirements under Section 504 of the Vocational Rehabilitation Act of 1973 if the condition substantially limits a major life activity, such as learning. 53 Services include accommodations and related services in the general education setting, such as preferential seating, modified instructions, reduced classroom and homework assignments, and increased time or environmental modification for test taking. There is wide variability in the knowledge and application of Section 504 services among parents and educators. 53

For both special education and Section 504 services, the children most likely to obtain services are those with the most severe functional limitations. Therefore, it would be difficult to interpret associations among use of services and outcomes. There are no data regarding effectiveness of many commonly recommended accommodations, such as preferential seating, on outcomes.

The evidence that ADHD is associated with poor academic and education outcomes is overwhelming. However, studies thus far find that treatments are associated with relatively narrow improvements in core symptoms of inattention, hyperactivity, and impulsivity at the level of body functions and attending and completing tasks at the level of activities. We need prospective, controlled, and large-scale studies to investigate whether existing or new treatments will improve reading, writing, and mathematics skills; reduce grade retention; reduce expulsions and detentions; improve graduation rates; and increase completion of postsecondary education. In a literate, information-age society, these improved outcomes are vital to the economic and personal well-being of individuals with ADHD.

Because of the limitations of previous research, we recommend that future research incorporate several features. In terms of the subjects, the study must specify clear inclusion criteria, including diagnostic criteria for ADHD, subtypes, and coexisting conditions. Given the research history to date, we favor community- or school-based samples as opposed to clinic-referred samples to avoid selection bias. Studies should be conducted in general education as well as secondary school settings, given the lack of data from these settings. In terms of the outcome variables, we support use of standardized definitions of functional outcomes following the conceptualization of function provided by the ICF framework. We specifically favor repeated measures of academic achievement. Unfortunately, measures such as grades may vary across school systems. For this reason, the use of achievement tests may be preferable in large-scale studies. In addition, measures relevant to educational promotion, such as college entrance examinations, may provide more standardized information than graduation rates. In local or regional studies, other repeated measures may be possible, including analysis of portfolios. Another sensitive measure that could be collected on a continuous basis is curriculum-based measurement, 56 which involves probes of reading and math performance relative to the instructed curriculum and permits examination of relative trajectories over time as a measure of treatment outcome.

Designing convincing studies on the long-term impact of medication or behavior management on academic and educational outcomes is challenging because it is unethical to withhold standard treatments for long periods of time from an affected sample to create a control group. To circumvent this problem, we suggest large-scale studies that evaluate rates of change in the outcomes as a function of treatment strategy (or intensity) and that use statistical methods such as hierarchical linear modeling. 57 In this approach, individual students are nested in hierarchies that are defined by grade and diagnosis and also by treatment type and intensity. Repeated measures for outcomes, such as reading or math standard scores, are collected over time. The statistical methods estimate the effects of each factor—age and treatment intensity—on the rate of change. This method can demonstrate if the rate of change increases more rapidly in some groups than other groups and more rapidly than would have been predicted on the basis of status at study entry. The hierarchical linear modeling method is also helpful with differentiating rates of progress among children who adhere to treatment recommendations over long periods of time versus those who discontinue treatment after a few months or years.

We also recommend that the research strategy incorporate a 2-tiered approach. First, improvements in instruction/teaching methods, curriculum design, school physical designs, and environmental modifications should be offered to all students. We can call this phase improved universal design. Schools often try to change the child with ADHD to fit the school environment. Attempts to “normalize” behavior include pulling a child out of the classroom, perhaps applying a remedial strategy, and then putting the child back into the original setting, with the hope that the child will now be successful. 58 This strategy identifies the child as the problem, serves to isolate and potentially stigmatize the child, and precludes the exploration of environment-based solutions. 59 The advantage of universal design is that most children with ADHD are educated in general education settings. Improved universal design in the classroom could potentially benefit all children in the classroom, particularly those with ADHD. Such interventions may not decrease the differences between children with ADHD and their peers without ADHD on some measures, such as standardized test scores. However, more important is whether the children with ADHD reach a higher threshold of achievement, such as improved reading scores or higher rates of high school graduation.

The second tier for research is specific interventions for children with ADHD, layered on top of the basic reforms. These interventions can include teaching methods, new curricula, specific behavior management, and school-based intervention approaches. 60

We will focus on 6 different options that warrant further investigation in this 2-tiered research design: (1) small class size; (2) reducing distractions; (3) specific academic intervention strategies; (4) increased physical activity; (5) alternative methods of discipline; and (6) systems change.

Small Class Size

A study based in London schools of regular education students found that variations in average class size in the 25- to 35-student range are of little consequence in affecting student progress, probably because of a lack of opportunity for differences in classroom management techniques. 61 However, small classes of approximately 8 to 15 students have been beneficial for younger children and children with special needs. 62 Because children with ADHD are reported to do better with one-on-one instruction, smaller class size makes intuitive sense. Teachers perceive class size to be one of the major barriers to inclusion of ADHD students in regular education. 63 Empiric investigation on reduced class size is therefore warranted for all children, and also for children with ADHD. Small class sizes will probably result in use of innovative educational approaches that are precluded in the current system.

Reducing Distractions

Classrooms are often noisy and distracting environments. Children perform more poorly in noisy situations than do adults, and researchers have reported that the ability to listen in noise is not completely developed until adolescence or adulthood. 64–66 If an acoustic environment can be provided that allows +15 dB signal-to-noise ratio throughout the entire classroom, then all participants can hear well enough to receive the spoken message fully. 64 Accommodations in Section 504 plans often include repeating instructions and providing quiet test-taking areas that are free of distractions. Repetition of instructions alone is not likely to increase the attention of children with ADHD. Thus, methods for reducing noise and other distractions should be studied.

Specific Academic Intervention Strategies

As reviewed by Hoffman and DuPaul, 51 the so-called antecedent-oriented management strategies are good universal design features that hold promise for improving outcomes for children with ADHD. Antecedent interventions include choice making, peer tutoring, and computer-aided instruction, all reviewed below. Such strategies are proactive, support appropriate adaptive behavior, and prevent unwanted, challenging behaviors. These strategies make tasks more stimulating and provide students with opportunities to make choices related to academic work. 67 They may be particularly helpful for children with ADHD who demonstrate avoidance and escape behaviors.

Choice-making strategies allow students to select work from a teacher-developed menu. In a study of choice making with children with emotional and behavioral difficulties in a special education classroom, students demonstrated increased academic engagement and decreased behavior problems. 68 Another study demonstrated decreased disruptive behavior in a general education setting, 69 although more variable academic and behavioral performance occurred in a study of 4 students with ADHD in a general education setting. 51 A related concept is project-based learning, which capitalizes on student interests and provides a dynamic, interactive way to learn.

Studies of Class Wide Peer Tutoring, a widely used form of peer tutoring, have demonstrated enhanced task-related attention and academic accuracy in elementary school students with ADHD, 70, 71 as well as positive changes in behavior and academic performance in students without ADHD. 72 Teachers perceive time requirements of specialized interventions as a significant barrier to the inclusion of ADHD students. 63 Peer tutoring reduces the demands on teachers to provide one-on-one instruction. At the same time, it gives students with ADHD the opportunity to practice and refine academic skills, as well as to enhance peer social interactions, promoting self-esteem. Peer tutoring may be particularly effective when students are using disruptive behavior to gain peer attention. 51

Computer-aided instruction has intuitive appeal as a universal design feature and for children with ADHD because of its interactive format, use of multiple sensory modalities, and ability to provide specific instructional objectives and immediate feedback. Computer-aided instruction has not been well studied in children with ADHD. 51, 73 Studies with small numbers of subjects showed promising initial results 74, 75 but did not examine the effects on academic achievement. A small study of 3 children with ADHD that used a game-format math program found increases in academic achievement and increased task engagement. 76

Increased Physical Activity

Given that fidgeting and out-of-seat behavior are common in children with ADHD, increased use of recess and physical exercise might reduce overactivity. A study on the effects of a traditional recess on the subsequent classroom behavior of children with ADHD showed that levels of inappropriate behavior were consistently higher on days when participants did not have recess, compared with days when they did have recess. 77 A meta-analysis of studies on the effects of regular, noncontingent exercise showed reductions in disruptive behavior with greater effects in participants with hyperactivity. 78 Increased physical exercise would be beneficial for long-term health and for behavioral regulation in both children developing typically and children with ADHD.

Alternative Methods of Discipline

Many students receive suspensions or are sent to the principal's office for disruptive behavior. For those children who are avoiding work, these approaches are equivalent to positive reinforcement. Such avoidant or escape behavior could be countered with in-school as opposed to out-of-school suspensions. The use of interventions that teach children how to replace disruptive behaviors with appropriate behaviors is less punitive than suspensions and more effective in promoting academic productivity and success. 17

Systems Change

Classroom changes are unlikely to create adequate improvements without concomitant changes in the educational system. Three potential areas under the category of systems change are improved education of teachers and educational administrators; enhanced collaborations among family members, school professionals, and health care professionals; and improved tracking of child outcomes. Teacher surveys demonstrate that teachers perceive the need for more training about ADHD. 63 The optimal management of children with ADHD requires close collaboration of their parents, teachers, and health care providers. Currently there is no organized system to support this collaboration.

At the policy level, we need mechanisms to track the outcome of children with ADHD in relation to educational reform and utilization of special services. Federally supported surveys could focus on services and treatments for mental health conditions, including ADHD, and their impact on outcomes. Relevant data for the relationship of interventions and outcomes may also exist at the local and state level. Building on existing local and state databases to include health and mental health statistics could provide valuable information on this issue.

We remain ill informed about how to improve academic and educational outcomes of children with ADHD, despite decades of research on diagnosis, prevalence, and short-term treatment effects. We urge research on this important topic. It may be impossible to conduct long-term randomized, controlled trials with medication or behavior management used as treatment modalities for practical and ethical reasons. However, large-scale studies that use modern statistical methods, such as hierarchical linear modeling, hold promise for teasing apart the impact of various treatments on outcomes. Such methods can take into account the number and types of interventions, duration of treatment, intensity of treatment, and adherence to protocols. Educational interventions for children with ADHD must be studied. We recommend large-scale, prospective studies to evaluate the impact of educational interventions. These studies should be tiered, introducing universal design improvements and specific interventions for ADHD. They must include multiple outcomes, with emphasis on academic skills, high school graduation, and successful completion of postsecondary education. Such studies will be neither cheap nor easy. A broad-based coalition of parents, educators, and health care providers must work together to advocate for an ambitious research agenda and then design, implement, and interpret the resulting research. Changes in local, state, and federal policies might facilitate these efforts by creating meaningful databases and collaborations.

Google Scholar

Google Preview

Author notes

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1465-735X
• Print ISSN 0146-8693
• Copyright © 2024 Society of Pediatric Psychology
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

• ADHD in Children: Signs, Symptoms, and Help for ADHD in Kids
• ADHD and School: How to Help a Child with ADHD in School
• ADHD Parenting Tips: How to Help a Child with ADHD
• ADHD in Adults: Symptoms, Effects, and Self-Help

Tips for Managing Adult ADHD

• ADHD Medications for Children and Adults  

Adult ADHD and Relationships

Adhd tests and diagnosis.

• Online Therapy: Is it Right for You?
• Mental Health
• Health & Wellness
• Children & Family
• Relationships

Are you or someone you know in crisis?

• Bipolar Disorder
• Eating Disorders
• Grief & Loss
• Personality Disorders
• PTSD & Trauma
• Schizophrenia
• Therapy & Medication
• Exercise & Fitness
• Healthy Eating
• Well-being & Happiness
• Weight Loss
• Work & Career
• Illness & Disability
• Heart Health
• Childhood Issues
• Learning Disabilities
• Family Caregiving
• Teen Issues
• Communication
• Emotional Intelligence
• Love & Friendship
• Domestic Abuse
• Healthy Aging
• Aging Issues
• Alzheimer’s Disease & Dementia
• Senior Housing
• End of Life
• Meet Our Team

ADHD and classroom challenges

What teachers can do to help children with adhd, classroom accommodations for students with adhd, teaching techniques for students with adhd, teaching students with adhd.

Dealing with attention deficit hyperactivity disorder in the classroom? These tips for teachers can help you overcome common challenges and help kids with ADHD succeed at school.

If you’re a teacher, you know these kids: The one who stares out the window, substituting the arc of a bird in flight for her math lesson. The one who wouldn’t be able to keep his rear end in the chair if you used Krazy Glue. The one who answers the question, “What body of water played a major role in the development of the Ancient Egyptian civilization?” with “Mrs. M, do you dye your hair?”

Students who exhibit ADHD’s hallmark symptoms of inattention, hyperactivity, and impulsivity can be frustrating. You know the brainpower is there, but they just can’t seem to focus on the material you’re working hard to deliver. Plus, their behaviors take time away from instruction and disrupt the whole class.

Students with ADHD may:

• Demand attention by talking out of turn or moving around the room.
• Have trouble following instructions, especially when they’re presented in a list, and with operations that require ordered steps, such as long division or solving equations.
• Often forget to write down homework assignments, do them, or bring completed work to school.
• Often lack fine motor control, which makes note-taking difficult and handwriting a trial to read.
• Have problems with long-term projects where there is no direct supervision.
• Not pull their weight during group work and may even keep a group from accomplishing its task.

Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with attention deficit hyperactivity disorder (ADHD or ADD) have a hard time doing—not because they aren’t willing, but because their brains won’t let them. That doesn’t make teaching them any easier, of course.

Children and teens with ADHD often pay the price for their problems in low grades, scolding and punishment, teasing from their peers, and low self-esteem. Meanwhile, you, the teacher, feel guilty because you can’t reach the child with ADHD and wind up taking complaints from parents who feel their kids are being neglected in the classroom. But it doesn’t have to be this way. There are strategies you can employ to help students with ADHD overcome learning challenges, stay focused without disrupting others, and succeed in the classroom .

So how do you teach a kid who won’t settle down and listen? The answer: with a lot of patience, creativity, and consistency. As a teacher, your role is to evaluate each child’s individual needs and strengths. Then you can develop strategies that will help students with ADHD focus, stay on task, and learn to their full capabilities.

Successful programs for children with ADHD integrate the following three components:

• Accommodations: what you can do to make learning easier for students with ADHD.
• Instruction: the methods you use in teaching.
• Intervention: How you head off behaviors that disrupt concentration or distract other students.

Your most effective tool, however, in helping a student with ADHD is a positive attitude. Make the student your partner by saying, “Let’s figure out ways together to help you get your work done.” Assure the student that you’ll be looking for good behavior and quality work and when you see it, reinforce it with immediate and sincere praise. Finally, look for ways to motivate a student with ADHD by offering rewards on a point or token system.

Dealing with disruptive classroom behavior

To head off behavior that takes time from other students, work out a couple of warning signals with the student who has ADHD. This can be a hand signal, an unobtrusive shoulder squeeze, or a sticky note on the student’s desk. If you have to discuss the student’s behavior, do so in private. And try to ignore mildly inappropriate behavior if it’s unintentional and isn’t distracting other students or disrupting the lesson.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

As a teacher, you can make changes in the classroom to help minimize the distractions and disruptions of ADHD.

• Seat the student with ADHD away from windows and away from the door.
• Put the student with ADHD right in front of your desk unless that would be a distraction for the student.
• Seats in rows, with focus on the teacher, usually work better than having students seated around tables or facing one another in other arrangements.
• Create a quiet area free of distractions for test-taking and quiet study.

Information delivery

• Give instructions one at a time and repeat as necessary.
• If possible, work on the most difficult material early in the day.
• Use visuals: charts, pictures, color coding.
• Create outlines for note-taking that organize the information as you deliver it.

Student work

• Create worksheets and tests with fewer items, give frequent short quizzes rather than long tests, and reduce the number of timed tests.
• Test students with ADHD in the way they do best, such as orally or filling in blanks.
• Divide long-term projects into segments and assign a completion goal for each segment.
• Accept late work and give partial credit for partial work.

Organization

• Have the student keep a master binder with a separate section for each subject, and make sure everything that goes into the notebook is put in the correct section. Color-code materials for each subject.
• Provide a three-pocket notebook insert for homework assignments, completed homework, and “mail” to parents (permission slips, PTA flyers).
• Make sure the student has a system for writing down assignments and important dates and uses it.
• Allow time for the student to organize materials and assignments for home. Post steps for getting ready to go home.

Teaching techniques that help students with ADHD focus and maintain their concentration on your lesson and their work can be beneficial to the entire class.

Starting a lesson

• Signal the start of a lesson with an aural cue, such as an egg timer, a cowbell or a horn. (You can use subsequent cues to show how much time remains in a lesson.)
• Establish eye contact with any student who has ADHD.
• List the activities of the lesson on the board.
• In opening the lesson, tell students what they’re going to learn and what your expectations are. Tell students exactly what materials they’ll need.

Conducting the lesson

• Keep instructions simple and structured. Use props, charts, and other visual aids.
• Vary the pace and include different kinds of activities. Many students with ADHD do well with competitive games or other activities that are rapid and intense.
• Have an unobtrusive cue set up with the student who has ADHD, such as a touch on the shoulder or placing a sticky note on the student’s desk, to remind the student to stay on task.
• Allow a student with ADHD frequent breaks and let him or her squeeze a rubber ball or tap something that doesn’t make noise as a physical outlet.
• Try not to ask a student with ADHD perform a task or answer a question publicly that might be too difficult.

Ending the lesson

• Summarize key points.
• If you give an assignment, have three different students repeat it, then have the class say it in unison, and put it on the board.
• Be specific about what to take home.

More Information

• Attention-Deficit/Hyperactivity Disorder (AD/HD) - Tips and resources for teachers. (Center for Parent Information and Resources)
• In the Classroom: Ideas and Strategies for Kids with ADD and Learning Disabilities - Suggestions for teaching children with ADHD. (Child Development Institute)
• Motivating the Child with Attention Deficit Disorder - How ADHD symptoms interfere with classroom expectations and how to realistically motivate a child. (LD Online)
• Step-by-Step Guide for Securing ADHD Accommodations at School - Meeting your child’s educational needs with ADHD accommodations at school. (ADDitude)
• Contents of the IEP - Guide to developing an Individualized Education Program (IEP) with school staff to address your child’s educational needs. (Center for Parent Information and Resources)
• Neurodevelopmental Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
• Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices– Pg 1. (2008). [Reference Materials; Instructional Materials]. US Department of Education. Link
• Gaastra, G. F., Groen, Y., Tucha, L., & Tucha, O. (2016). The Effects of Classroom Interventions on Off-Task and Disruptive Classroom Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. PLOS ONE, 11(2), e0148841. Link
• CDC. (2019, November 7). ADHD in the Classroom . Centers for Disease Control and Prevention. Link

More in ADHD

Adhd in children.

What Attention Deficit Hyperactivity Disorder looks like in kids

ADHD and School

Helping children with ADD or ADHD succeed in school

ADHD Parenting Tips

Learn what you can do to help your child thrive

ADHD in Adults

Recognizing the signs and symptoms, and what you can do about it

Tips for dealing with symptoms, and being more focused and organized

ADHD Medications

Are ADHD drugs right for you or your child?

Dealing with symptoms together and developing a solid partnership

Learn how ADHD is diagnosed in kids and adults

Professional therapy, done online

BetterHelp makes starting therapy easy. Take the assessment and get matched with a professional, licensed therapist.

Help us help others

Millions of readers rely on HelpGuide.org for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us save, support, and change lives.

Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers

• Original Paper
• Open access
• Published: 01 July 2022
• Volume 53 , pages 3406–3421, ( 2023 )

Cite this article

You have full access to this open access article

• Emily McDougal   ORCID: orcid.org/0000-0001-7684-7417 1 , 3 ,
• Claire Tai 1 ,
• Tracy M. Stewart   ORCID: orcid.org/0000-0002-8807-1174 2 ,
• Josephine N. Booth   ORCID: orcid.org/0000-0002-2867-9719 2 &
• Sinéad M. Rhodes   ORCID: orcid.org/0000-0002-8662-1742 1  

42k Accesses

16 Altmetric

Explore all metrics

Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6–11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child’s strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.

Similar content being viewed by others

Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review

The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD

Concerns About ABA-Based Intervention: An Evaluation and Recommendations

Avoid common mistakes on your manuscript.

Characterised by persistent inattention, hyperactivity and impulsivity (APA, 2013), ADHD is a neurodevelopmental disorder thought to affect around 5% of children (Russell et al., 2014 ) although prevalence estimates vary (Sayal et al., 2018 ). Although these core symptoms are central to the ADHD diagnosis, those with ADHD also tend to differ from typically developing children with regards to cognition and social functioning (Coghill et al., 2014 ; Rhodes et al., 2012 ), which can negatively impact a range of life outcomes such as educational attainment and employment (Classi et al., 2012 ; Kuriyan et al., 2013 ). Indeed, academic outcomes for children with ADHD are often poor, particularly when compared with their typically developing peers (Arnold et al., 2020 ) but also compared to children with other neurodevelopmental disorders, such as autism (Mayes et al., 2020 ). Furthermore, children with ADHD can be viewed negatively by their peers. For example, Law et al. ( 2007 ) asked 11–12-year-olds to read vignettes describing the behaviour of a child with ADHD symptoms, and then use an adjective checklist to endorse those adjectives that they felt best described the target child. The four most frequently ascribed adjectives were all negative (i.e. ‘careless’, ‘lonely’, ‘crazy’, and ‘stupid’). These negative perceptions can have a significant impact on the wellbeing of individuals with ADHD, including self-stigmatisation (Mueller et al., 2012 ). There is evidence that teachers with increased knowledge of ADHD report more positive attitudes towards children with ADHD compared to those with poor knowledge (Ohan et al., 2008 ) and thus research that identifies the characteristics of gaps in knowledge is likely to be important in addressing stigma.

Previous research of teachers' ADHD knowledge is mixed, with the findings of some studies indicating that teachers have good knowledge of ADHD (Mohr-Jensen et al., 2019 ; Ohan et al., 2008 ) and others suggesting that their knowledge is limited (Latouche & Gascoigne, 2019 ; Perold et al., 2010 ). Ohan et al. ( 2008 ) surveyed 140 primary school teachers in Australia who reported having experience of teaching at least one child with ADHD. Teachers completed the ADHD Knowledge Scale which consisted of 20 statements requiring a response of either true or false (e.g. “A girl/boy can be appropriately labelled as ADHD and not necessarily be over-active ”). They found that, on average, teachers answered 76.34% of items correctly, although depth of knowledge varied across the sample. Almost a third of the sample (29%) had low knowledge of ADHD (scoring less than 69%), with just under half of teachers (47%) scoring in the average range (scores of 70–80%). Only a quarter (23%) had “high knowledge” (scores above 80%) suggesting that knowledge varied considerably. Furthermore, Perold et al. ( 2010 ) asked 552 teachers in South Africa to complete the Knowledge of Attention Deficit Disorders Scale (KADDS) and found that on average, teachers answered only 42.6% questions about ADHD correctly. Responses of “don’t know” (35.4%) and incorrect responses (22%) were also recorded, indicating gaps in knowledge as well as a high proportion of misconceptions. Similar ADHD knowledge scores were reported in Latouche and Gascoigne’s ( 2019 ) study, who found that teachers enrolled into their ADHD training workshop in Australia had baseline KADDS scores of below 50% accuracy (increased to above 80% accuracy after training).

The differences in ADHD knowledge reported between Ohan et al. ( 2008 ) and the more recent studies could be due to the measures used. Importantly, when completing the KADDS, respondents can select a “don’t know” option (which receives a score of 0), whereas the ADHD Knowledge Scale requires participants to choose either true or false for each statement. The KADDS is longer, with a total of 39 items, compared to the 20-item ADHD Knowledge Scale, offering a more in-depth knowledge assessment. The heterogeneity of measures used within the described body of research is also highlighted within Mohr-Jensen et al. ( 2019 ) systematic review; the most frequently used measure (the KADDS) was only used by 4 out of the 33 reviewed studies, showing little consensus on the best way to measure ADHD knowledge. Despite these differences in measurement, the findings from most studies indicate that teacher ADHD knowledge is lacking.

Qualitative methods can provide rich data, facilitating a deeper understanding of phenomena that quantitative methods alone cannot reveal. Despite this, there are very few examples in the literature of qualitative methods being used to understand teacher knowledge of ADHD. In one example, Lawrence et al. ( 2017 ) interviewed fourteen teachers in the United States about their experiences of working with pupils with ADHD, beginning with their knowledge of ADHD. They found that teachers tended to focus on the external symptoms of ADHD, expressing knowledge of both inattentive and hyperactive symptoms. Although this provided key initial insights into the nature of teachers’ ADHD knowledge, only a small section of the interview schedule (one out of eight questions/topics) directly focused on ADHD knowledge. Furthermore, none of the questions asked directly about strengths, with answers focusing on difficulties. It is therefore difficult to determine from this study whether teachers are aware of strengths and difficulties outside of the triad of symptoms. A deeper investigation is necessary to fully understand what teachers know, and to identify areas for targeted psychoeducation.

Importantly, improved ADHD knowledge may impact positively on the implementation of appropriate support for children with ADHD in school. For example, Ohan et al. ( 2008 ) found that teachers with high or average ADHD knowledge were more likely to perceive a benefit of educational support services than those with low knowledge, and teachers with high ADHD knowledge were also more likely to endorse a need for, and seek out, those services compared to those with low knowledge. Furthermore, improving knowledge through psychoeducation may be important for improving fidelity to interventions in ADHD (Dahl et al., 2020 ; Nussey et al., 2013 ). Indeed, clinical guidelines recommend inclusion of psychoeducation in the treatment plan for children with ADHD and their families (NICE, 2018 ). Furthermore, Jones and Chronis-Tuscano ( 2008 ) found that educational ADHD training increased special education teachers’ use of behaviour management strategies in the classroom. Together, these findings suggest that understanding of ADHD may improve teachers’ selection and utilisation of appropriate strategies.

Child and teacher insight into strategy use in the classroom on a practical, day-to-day level may provide an opportunity to better understand how different strategies might benefit children, as well as the potential barriers or facilitators to implementing these in the classroom. Previous research with teachers has shown that aspects of the physical classroom can facilitate the implementation of effective strategies for autistic children, for example to support planning with the use of visual timetables (McDougal et al., 2020 ). Despite this, little research has considered the strategies that children with ADHD and their teachers are using in the classroom to support their difficulties and improve learning outcomes. Moore et al. ( 2017 ) conducted focus groups with UK-based educators (N = 39) at both primary and secondary education levels, to explore their experiences of responding to ADHD in the classroom, as well as the barriers and facilitators to supporting children. They found that educators mostly reflected on general inclusive strategies in the classroom that rarely targeted ADHD symptoms or difficulties specifically, despite the large number of strategies designed to support ADHD that are reported elsewhere in the literature (DuPaul et al., 2012 ; Richardson et al., 2015 ). Further to this, when interviewing teachers about their experiences of teaching pupils with ADHD, Lawrence et al. ( 2017 ) specifically asked about interventions or strategies used in the classroom with children with ADHD. The reported strategies were almost exclusively behaviourally based, for example, allowing children to fidget or move around the classroom, utilising rewards, using redirection techniques, or reducing distraction. This lack of focus on cognitive strategies is surprising, given the breadth of literature focusing on the cognitive difficulties in ADHD (e.g. Coghill, et al., 2014 ; Gathercole et al., 2018 ; Rhodes et al., 2012 ). Furthermore, to our knowledge research examining strategy use from the perspective of children with ADHD themselves, or strengths associated with ADHD, is yet to be conducted.

Knowledge and understanding of ADHD in children with ADHD has attracted less investigation than that of teachers. In a Canadian sample of 8- to 12-year-olds with ADHD (N = 29), Climie and Henley ( 2018 ) found that ADHD knowledge was highly varied between children; scores on the Children ADHD Knowledge and Opinions Scale ranged from 5 to 92% correct (M = 66.53%, SD = 18.96). The authors highlighted some possible knowledge gaps, such as hyperactivity not being a symptom for all people with ADHD, or the potential impact upon social relationships, however the authors did not measure participant’s ADHD symptoms, which could influence how children perceive ADHD. Indeed, Wiener et al ( 2012 ) has shown that children with ADHD may underestimate their symptoms. If this is the case, it would also be beneficial to investigate their understanding of their own strengths and difficulties, as well as of ADHD more broadly. Furthermore, if children do have a poor understanding of ADHD, they may benefit from psychoeducational interventions. Indeed, in their systematic review Dahl et al. ( 2020 ) found two studies in which the impact of psychoeducation upon children’s ADHD knowledge was examined, both of which reported an increase in knowledge as a consequence of the intervention. Understanding the strengths and difficulties of the child, from the perspective of the child and their teacher, will also allow the design of interventions that are individualised, an important feature for school-based programmes (Richardson et al., 2015 ). Given the above, understanding whether children have knowledge of their ADHD and are aware of strategies to support them would be invaluable.

Teacher and child knowledge of ADHD and strategies to support these children is important for positive developmental outcomes, however there is limited research evidence beyond quantitative data. Insights from children and teachers themselves is particularly lacking and the insights which are available do not always extend to understanding strengths which is an important consideration, particularly with regards to implications for pupil self-esteem and motivation. The current study therefore provides a vital examination of the perspectives of both strengths and weaknesses from a heterogeneous group of children with ADHD and their teachers. Our sample reflects the diversity encountered in typical mainstream classrooms in the UK and the matched pupil-teacher perspectives enriches current understandings in the literature. Specifically, we aimed to explore (1) child and teacher knowledge of ADHD, and (2) strategy use within the primary school classroom to support children with ADHD. This novel approach, from the dual perspective of children and teachers, will enable us to identify potential knowledge gaps, areas of strength, and insights on the use of strategies to support their difficulties.

Participants

Ten primary school children (3 female) aged 7 to 11 years (M = 8.7, SD = 1.34) referred to Child and Adolescent Mental Health Services (CAMHS) within the NHS for an ADHD diagnosis were recruited to the study. All participant characteristics are presented in Table 1 . All children were part of the Edinburgh Attainment and Cognition Cohort and had consented to be contacted for future research. Children who were under assessment for ADHD or who had received an ADHD diagnosis were eligible to take part. Contact was established with the parent of 13 potential participants. Two had undergone the ADHD assessment process with an outcome of no ADHD diagnosis and were therefore not eligible to take part, and one could not take part within the timeframe of the study. The study was approved by an NHS Research Ethics Committee and parents provided informed consent prior to their child taking part. Co-occurrences data for all participants was collected as part of a previous study and are reported here for added context. All of the children scored above the cut-off (T-score > 70) for ADHD on the Conners 3 rd Edition Parent diagnostic questionnaire (Conners, 2008 ). The maximum possible score for this measure is 90. At the point of interview, seven children had received a diagnosis of ADHD, two children were still under assessment, and one child had been referred for an ASD diagnosis (Table 1 ). The ADHD subtype of each participant was not recorded, however all children scored above the cut-off for both inattention (M = 87.3, SD = 5.03) and hyperactivity (M = 78.6, SD = 5.8) which is indicative of ADHD combined type. Use of stimulant medication was not recorded at the time of interview.

Following the child interview and receipt of parental consent, each child’s school was contacted to request their teacher’s participation in the study. Three teachers could not take part within the timeframe of the study, and one refused to take part. Six teachers (all female) were successfully contacted and gave informed consent to participate.

Due to the increased likelihood of co-occurring diagnoses in the target population, we also report Autism Spectrum Disorder (ASD) symptoms and Developmental Co-ordination Disorder (DCD) symptoms using the Autism Quotient 10-item questionnaire (AQ-10; Allison et al., 2012 ) and Movement ABC-2 Checklist (M-ABC2; Henderson et al., 2007 ) respectively, both completed by the child’s parent.

Scores of 6 and above on the AQ-10 indicates referral for diagnostic assessment for autism is advisable. All but one of the participants scored below the cut-off on this measure (M = 3.6, SD = 1.84).

The M-ABC2 checklist categorises children as scoring green, amber or red based on their scores. A green rating (up to the 85th percentile) indicates no movement difficulty, amber ratings (between 85 and 95th percentile) indicate risk of movement difficulty, and red ratings (95th percentile and above) indicate high likelihood of movement difficulty. Seven of the participants received a red rating, one an amber rating, and two green ratings.

Socioeconomic status (SES) is also known to impact educational outcomes, therefore the SES of each child was calculated using the Scottish Index of Multiple Deprivation (SIMD), which is an area-based measure of relative deprivation. The child’s home postcode was entered into the tool which provided a score of deprivation on a scale of 1 to 5. A score of 1 is given to the 20% most deprived data zones in Scotland, and a score of 5 indicates the area was within the 20% least deprived areas.

Semi-Structured Interview

The first author, who is a psychologist, conducted interviews with each participant individually, and then a separate interview with their teacher. This was guided by a semi-structured interview schedule (see Appendix A, Appendix B) developed in line with our research questions, existing literature, and using authors (T.S. and J.B.) expertise in educational practice. The questions were adapted to be relevant for the participant group. For example, children were asked “If a friend asked you to tell them what ADHD is, what would you tell them?” and teachers were asked, “What is your understanding of ADHD or can you describe a typical child with ADHD?”. The schedule comprised two key sections for both teachers and children. The first section focused on probing the participant’s understanding and knowledge of ADHD broadly. The second section focused on the participating child’s academic and cognitive strengths and weaknesses, and the strategies used to support them. Interviews with children took place in the child’s home and lasted between 19 and 51 min (M = 26.3, SD = 10.9). Interviews with teachers took place at their school and were between 28 and 50 min long (M = 36.5, SD = 7.61). Variation in interview length was mostly due to availability of the participant and/or age of the child (i.e. interviews with younger children tended to be shorter). All interviews were recorded on an encrypted voice recorder and transcribed by the first author prior to data analysis. Pseudonyms were randomly generated for each child to protect anonymity.

Reflexive thematic analysis was used to analyse the data (Braun & Clarke, 2019 ). This flexible approach allows the data to drive the analysis, putting the participant at the centre of the research and placing high value on the experiences and perspectives of individual participants (Braun & Clarke, 2006 ). The six phases of reflexive thematic analysis as outlined by Braun and Clarke were followed: (1) familiarisation, (2) generating codes, (3) constructing themes, (4) revising themes, (5) defining themes, (6) producing the report. Due to the exploratory nature of this study, bottom-up inductive coding was used. Two of the authors (E.M. and C.T.) worked collaboratively to construct and subsequently define the themes using the process described above. More specifically, one author (E.M.) generated codes, with support from another author (C.T.). Collated codes and data were then abstracted into potential themes, which were reviewed and refined using relevant literature, as well as within the wider context of the data. This process continued until all themes were agreed upon.

In the first part of the analysis, focus was placed on summarising the participants’ understanding of ADHD, as well as what they thought their biggest strengths and challenges were at school. Following this, an in-depth analysis of the strategies used in the classroom was conducted, taking into account the perspective of both teachers and children, aiming to generate themes from the data.

Knowledge of ADHD

Children and teachers were asked about their knowledge of ADHD. When asked if they had ever heard of ADHD, the majority of children said yes. Some of the children could not explain to the interviewer what ADHD was or responded in a way that suggested a lack of understanding ( “it helps you with skills” – Niall, 7 years; “ Well it’s when you can’t handle yourself and you’re always crazy and you can just like do things very fast”— Nathan, 8 years). Very few of the children were able to elaborate accurately on their understanding of ADHD, which exclusively focused on inattention. For example, Paige (8 years) said “ its’ kinda like this thing that makes it hard to concentrate ” and Finn (10 years) said “ they get distracted more just in different ways that other people would ”. This suggests that children with ADHD may lack or have a limited awareness or understanding of their diagnosis.

When asked about their knowledge of ADHD, teachers tended to focus on the core symptoms of ADHD. All teachers directly mentioned difficulties with attention, focus or concentration, and most directly or indirectly referred to hyperactivity (e.g. moving around, being in “ overdrive ”). Most teachers also referred to social difficulties as a feature of ADHD, including not following social rules, reacting inappropriately to other children and appearing to lack empathy, which they suggested could be linked to impulsivity. For example, “ reacting in social situations where perhaps other children might not react in a similar way” (Paige’s teacher) and “ They can react really really quickly to things and sometimes aggressively” (Eric’s teacher). Although no teachers directly mentioned cognitive difficulties, some referred to behaviours indicative of cognitive difficulties, for example, “ they can’t store a lot of information at one time” (Eric’s teacher) and, “ it’s not just the concentration it’s the amount they can take in at a time as well” (Nathan’s teacher), which may reflect processing or memory differences. Heterogeneity was mentioned, in that ADHD can mean different things for different children (e.g., “ I think ADHD differs from child to child and I think that’s really important” —Nathan’s teacher). Finally, academic difficulties as a feature of ADHD were also mentioned (e.g., “ a child… who finds some aspects of school life, some aspects of the curriculum challenging ”—Jay’s teacher).

After being asked to give a general description of ADHD, each child was asked about their own strengths at school and teachers were also asked to reflect on this topic for the child taking part.

When asked what they like most about school, children often mentioned art or P.E. as their preferred subjects. A small number of children said they enjoyed maths or reading, but this was not common and the majority described these subjects as a challenge or something they disliked. There was also clear link between the aspects of school children enjoyed, and what they perceived to be a strength for them. For example, when asked what he liked about school, Eric (10 years) said, “ Math, I’m pretty good at that”, or when later asked what they were good at, most children responded with the same answers they gave when asked what they liked about school. It is interesting to note that subjects such as art or P.E. generally have a different format to more traditionally academic subjects such as maths or literacy. Indeed, Felicity (11 years) said, “ I quite like art and drama because there’s not much reading…and not really too much writing in any of those” . Children also tended to mention the non-academic aspects of school, such as seeing their friends, or lunch and break times.

Teachers’ descriptions of the children’s strengths were much more variable compared to strengths mentioned by children. Like the children, teachers tended to consider P.E and artistic activities to be a strength for the child with ADHD. Multiple teachers referred to the child having a good imagination and creative skills. For example, “ she’s a very imaginative little girl, she has a great ability to tell stories and certainly with support write imaginative stories” (Paige’s teacher) . Teachers referred to other qualities or characteristics of the child as strengths, although these varied across teachers. These included openness, both socially but also in the context of willingness to learn or being open to new challenges, being a hard worker, or an enjoyable person to be around (e.g., “ he is the loveliest little boy, I’ve got a lot of time for [Nathan]. He makes me smile every day, you know, he just comes out with stuff he’s hilarious”— Nathan’s teacher). The most noticeable theme that emerged from this data was that when some teachers began describing one of the child’s strengths, it was suffixed with a negative. For example, Henry’s teacher said, “ He’s got a very good imagination, his writing- well not so much the writing of the stories, he finds writing quite a challenge, but his verbalising of ideas he’s very imaginative”. This may reflect that while these children have their own strengths, these can be limited by difficulties. Indeed, Paige’s teacher said, “ I think she’s a very able little girl without a doubt, but there is a definite barrier to her learning in terms of her organisation, in terms of her focus” , which reinforces this notion.

Children were asked directly about what they disliked about school, and what they found difficult. Children tended to focus more on specific subjects, with maths and aspects of literacy being the most frequently mentioned of these. Children referred to difficulties with or a dislike for reading, writing and/or spelling activities, for example, Rory (9 years) said “ Well I suppose spelling because … sometimes we have to do some boring tasks like we have to write it out three times then come up with the sentence for each one which takes forever and it’s hard for me to think of the sentences if I’m not ready” . Linking this with known cognitive difficulties in ADHD, it is interesting to note that both memory and planning are implicated in this quote from Rory about finding spelling challenging. In terms of writing, children referred to both the physical act of writing (e.g., “ probably writing cause sometimes I forget my finger spaces ”—Paige, 8 years; “ [writing the alphabet is] too hard… like the letters joined together … [and] I make mistakes” —Jay, 7 years) as well as the planning associated with writing a longer piece of work (e.g. “ when I run out of ideas for it, it’s really hard to think of some more so I don’t usually get that much writing done ”—Rory (9 years) .

Aside from academic subjects, several children referred to difficulties with focus or attention (e.g. “ when I find it hard to do something I normally kind of just zone out ”—Felicity, 11 years, “ probably concentrating sometimes ”—Rory, 9 years), but boredom was also a common and potentially related theme (e.g. “ Reading is a bit hard though … it just sometimes gets a bit boring” —Finn, 10 years, “ I absolutely hate maths … ‘cause it’s boring ”—Paige, 8 years). It could be that children with ADHD find it more difficult to concentrate during activities they find boring. Indeed, when Jay (7 years) was asked how it made him feel when he found something boring, he said “ it made me not do my work ”. Some children also alluded to the social difficulties faced at school, which included bullying and difficulties making friends (e.g. “ just making all kind of friends [is difficult] ‘cause the only friend that I’ve got is [name redacted] ”—Nathan, 8 years; “ sometimes finding a friend to play with at break time [is difficult] ” – Paige, 8 years; “ there’s a lot of people in my school that they bully me” —Eric, 10 years).

When asked what they thought were the child’s biggest challenges at school, teachers' responses were relatively variable, although some common themes were identified. As was the case for children, teachers reflected on difficulties with attention, which also included being able to sit at the table for long periods of time (e.g. “ I would say he struggles the most with sitting at his table and focusing on one piece of work ”—Henry’s teacher). Teachers did also mention difficulties with subjects such as maths and literacy, although this varied from child to child, and often they discussed these in the context of their ADHD symptom-related difficulties. For example, Eric’s teacher said, “ we’ve struggled to get a long piece of writing out of him because he just can’t really sit for very long ”. This quote also alludes to difficulties with evaluating the child’s academic abilities, due to their ADHD-related difficulties, which was supported by other teachers (e.g. “ He doesn’t particularly enjoy writing and he’s slow, very slow. And I don’t know if that’s down to attention or if that’s something he actually does find difficult to do ” —Henry’s teacher). Furthermore, some teachers reflected on the child’s confidence as opposed to a direct academic difficulty. For example, Luna’s teacher said, “ I think it’s she lacks the confidence in maths and reading like the most ” and later, elaborated with “ she’ll be like “I can’t do it” but she actually can. Sometimes she’s … even just anxious at doing a task where she thinks … she might not get it. But she does, she’s just not got that confidence”.

Teachers also commonly mentioned social difficulties, and referred to these difficulties as a barrier to collaborative learning activities (e.g. “ he doesn’t always work well with other people and other people can get frustrated” —Henry’s teacher; “ [during] collaborative group work [Paige] perhaps goes off task and does things she shouldn’t necessarily be doing and that can cause friction within the group” —Paige’s teacher). Teachers also mentioned emotion regulation, mostly in relation to the child’s social difficulties. For example, Eric’s teacher said “ I think as well he does still struggle with his emotions like getting angry very very quickly, and being very defensive when actually he’s taken the situation the wrong way” , which suggests that the child’s difficulty with regulating emotions may impact on their social relationships.

Strategy Use in the Classroom

Strategies to support learning fell into one of four categories: concrete or visual resources, information processing, seating and movement, and support from or influence of others. Examples of codes included in each of these strategy categories are presented in Table 2 .

Concrete or visual resources were the most commonly mentioned type of strategy by teachers and children, referring to the importance of having physical representations to support learning. Teachers spoke about the benefit of using visual aids (e.g. “ I think [Henry] is quite visual so making sure that there is visual prompts and clues and things like that to help him ”—Henry’s teacher), and teachers and children alluded to these resources supporting difficulties with holding information in mind. For example, when talking about the times table squares he uses, Rory said “ sometimes I forget which one I’m on…and it’s easier for me to have my finger next to it than just doing it in my head because sometimes I would need to start doing it all over again ”.

Seating and movement were also commonly mentioned, which seemed to be specific to children with ADHD in that it was linked to inattention and hyperactivity symptoms. For example, teachers referred to supporting attention or avoiding distraction by the positioning of a child’s location in the classroom (e.g. “ he’s so easily distracted, so he has an individual desk in the room and he’s away from everyone else because he wasn’t coping at a table [and] he’s been so much more settled since we got him an individual desk” —Eric’s teacher). Some teachers also mentioned the importance of allowing children to move around the room where feasible, as well as giving them errands to perform as a movement break (e.g. “ if I need something from the printer, [Nathan] is gonna go for it for me…because that’s down the stairs and then back up the stairs so if I think he’s getting a bit chatty or he’s not focused I’ll ask him to go and just give him that break as well” —Nathan’s teacher). Children also spoke about these strategies but didn’t necessarily describe why or how these strategies help them.

Information processing and cognitive strategies included methods that supported children to process learning content or instructions. For example, teachers frequently mentioned breaking down tasks or instructions into more manageable chunks (e.g. “ with my instructions to [Eric] I break them down … I’ll be like “we’re doing this and then we’re doing this” whereas the whole class wouldn’t need that ”—Eric’s teacher). Teachers and children also mentioned using memory strategies such as songs, rhymes or prompts. For example, Jay’s teacher said, “ if I was one of the other children I could see why it would be very distracting but he’s like he’s singing to himself little times table songs that we’ve been learning in class” , and Paige (8 years) referred to using mnemonics to help with words she struggles to spell, “ I keep forgetting [the word] because. But luckily we got the story big elephants can always understand little elephants [which helps because] the first letter of every word spells because” .

Both groups of participants mentioned support from and influence of others, and referred to working with peers, the teacher–child relationship, and one-to-one teaching. Peer support was a common theme across the data and is discussed in more detail in the thematic analysis findings, where teachers and children referred to the importance of the role of peers during learning activities. Understanding the child well and adapting to them was also seen as important, for example, Luna’s teacher said, “ with everything curricular [I] try and have an art element for her, just so I know it’ll engage her [because] if it’s like a boring old written worksheet she’s not gonna do it unless you’re sitting beside her and you’re basically telling her the answers” . As indicated in this quote, teachers also referred to the effectiveness of one-to-one or small group work with the child (e.g. “ when somebody sits beside her and explains it, and goes “come on [Paige] you know how to do this, let’s just work through a couple of examples”… her focus is generally better ” – Paige’s teacher), however this resource is not always available (e.g. “ I’d love for someone to be one-to-one with [Luna] but it’s just not available, she doesn’t meet that criteria apparently ” – Luna’s teacher). Children also referred to seeking direct support from their teacher (e.g. “if I can’t get an idea of what I’m doing then I ask the teacher for help” – Paige, 8 years), but were more likely to mention seeking support from their peers than the teacher.

Thematic Analysis

In addition to summarising the types of strategies that teachers and children reported using in the classroom, the data were also analysed using thematic analysis to generate themes. These are now presented. The theme names, definitions, and example quotes for each theme are presented in Table 3 .

Theme 1: Classroom-General Versus Individual-Specific Strategies

During the interviews, teachers spoke about strategies that they use as part of their teaching practice for the whole class but that are particularly helpful for the child/children with ADHD. These tended to be concrete or visual resources that are available in the classroom for anyone, for example, a visual timetable or routine checklist (e.g. “ there’s also a morning routine and listing down what’s to be done and where it’s to go … it’s very general for the class but again it’s located near her” —Paige’s teacher).

Teachers also mentioned using strategies that have been implemented specifically for that child, and these strategies tended to focus on supporting attention. For example, Nathan’s teacher spoke about the importance of using his name to attract his attention, “ maybe explaining to the class but then making sure that I’m saying “[Nathan], you’re doing this”, you know using his name quite a lot so that he knows it’s his task not just the everybody task ”, and this was a strategy that multiple teachers referred to using with the individual child and not necessarily for other children. Other strategies to support attention with a specific child also tended to be seating and movement related, such as having an individual desk or allowing them to fidget. For example, Luna’s teacher said, “ she’s a fidgeter so she’ll have stuff to fidget with … [and] even if she’s wandering around the classroom or she’s sitting on a table, I don’t let other kids do that, but as long as she’s listening, it’s fine [with me]” .

Similar to teachers, children spoke about strategies or resources that were in place for them specifically as well as about general things in the classroom that they find helpful. That said, it was less common for children to talk about why particular strategies were in place for them and how they helped them directly.

In addition to recognising strategies that teachers had put in place for them, children also referred to using their own strategies in the classroom. The most frequently mentioned strategy was fidgeting, and although some of the younger children spoke about having resources available in the classroom for fidgeting, some of the older children referred to using their own toy or an object that was readily available to them but not intended for fidgeting. For example, Finn (10 years) and Rory (9 years) both spoke about using items from their pencil case to fiddle with, and explained that this would help them to focus. (“ Sometimes I fidget with something I normally just have like a pencil holder under the table moving about … [and] it just keeps my mind clear and not from something else ”—Rory; “ Sometimes I fiddle with my fingers and that sometimes helps, but if not I get one of my coloured pencils and have a little gnaw on it because that actually takes my mind off some things and it’s easier for me to concentrate when I have something to do ”—Finn). Henry (9 years) spoke about being secretive with his fidgeting as it was not permitted in class, “ if you just bring [a fidget toy] in without permission [the teacher will] just take it off of you, so it has to be something that’s not too big. I bring in a little Lego ray which is just small enough that she won’t notice ”. Although some teachers did mention having fidget toys available, not all teachers seemed to recognise the importance of this for the child, and some children viewed fidgeting as a behaviour they should hide from the teacher.

Another strategy mentioned uniquely by children was seeing their peers as a resource for ideas or information. This is discussed in more detail in Theme 3—The role of peers , but reinforces the notion that children also develop their own strategies, independently from their teacher, rather than relying only on what is made available to them.

Theme 2: Heterogeneity of Strategies

Teachers spoke about the need for a variety of strategies in the classroom, for two reasons: (1) that different strategies work for different children (e.g. “ some [strategies] will work for the majority of the children and some just don’t seem to work for any of them ”—Jay’s teacher), and (2) what works for a child on one occasion may not work consistently for the same child (e.g. “ I think it’s a bit of a journey with him, and some things have worked and then stopped working, so I think we’re constantly adapting and changing what we’re doing ”—Eric’s teacher). One example of both of these challenges of strategy use came from Luna’s teacher, who spoke about using a reward chart with Luna and another child with ADHD, “ [Luna] and another boy in my class [with ADHD] both had [a reward chart]… but I think whereas the boy loved his and still loves his, she was getting a bit “oh I’m too cool for this” or that sort of age… so I stopped doing that for her and she’s not missing that at all” . These quotes demonstrate that strategies can work differently for different children, highlighting the need for a variety of strategies for teachers to access and trial with children.

Some children also referred to the variability of whether a strategy was helpful or not; for example, Henry (9 years) said that he finds it helpful to fidget with a toy but that sometimes it can distract him and prevent him from listening to the teacher. He said, “ Well, [the fidget toy] helps but it also gets me into trouble when the teacher spots me building it when I’m listening…but then sometimes I might not listen in maths and [use the fidget toy] which might make it worse”. This highlights that both children and teachers might benefit from support in understanding the contexts in which to use particular strategies, as well as why they are helpful from a psychological perspective.

For teachers, building a relationship with and understanding the child was also highly important in identifying strategies that would work. Luna’s teacher reflected upon the difference in Luna’s behaviour at the start of the academic year, compared to the second academic term, “ at the start of the year, we would just clash the whole time. I didn’t know her, she didn’t know me … and then when we got that bond she was absolutely fine so her behaviour has got way better ”. Eric’s teacher also reflected on how her relationship with Eric had changed, particularly after he received his diagnosis of ADHD, “ I think my approach to him has completely changed. I don’t raise my voice, I speak very calmly, I give him time to calm down before I even broach things with him. I think our relationship’s just got so much better ‘cause I kind of understand … where he’s coming from ”. She also said, “ it just takes a long time to get to know the child and get to know what works for them and trialling different things out ”, which demonstrates that building a relationship with and understanding the child can help to identify the successful strategies that work with different children.

Theme 3: The Role of Peers

Teachers and children spoke about the role of the child’s peers in their learning. Teachers talked about the benefit of partnering the child with good role models (e.g. “ I will put him with a couple of good role models and a couple of children who are patient and who will actually maybe get on with the task, and if [Jay] is not on task or not on board with what they’re doing at least he’s hearing and seeing good behaviour ”—Jay’s teacher), whereas children spoke more about their peers as a source of information, idea generation, or guidance on what to do next. For example, when asked what he does to help him with his writing, Henry (9 years) said, “ [I] listen to what my partner’s saying… my half of the table discuss what they’re going to do so I can literally hear everything they’re doing and steal some of their ideas ”. Henry wasn’t the only child to use their peers as a source of information, for example, Niall (7 years) said, “ I prefer working with the children because some things I might not know and the children might help me give ideas ”, and with a more specific example, Rory (9 years) said, “ somebody chose a very good character for their bit of writing, and I was like “I think I might choose that character”, and somebody else said “my setting was going to be the sea”, and I chose that and put that in a tiny bit of my story ”.

Some children also spoke about getting help from their peers in other ways, particularly when completing a difficult task. Paige (8 years) said, “ if the question isn’t clear I try and figure it out, and if I can’t figure it out then… don’t tell my teacher this but I sometimes get help from my classmates ”, which suggests some guilt associated with asking for help from her peers. This could be related to confidence and self-esteem, which teachers mentioned as a difficulty for some children with ADHD. In some instances, children felt it necessary to directly copy their peers’ work; for example, Nathan (8 years) spoke about needing a physical resource (i.e. “ fuzzies ”) to complete maths problems, but that when none were available he would “ just end up copying other people ”. This could also be related to a lack of confidence, as he may feel as though he may not be able to complete the task on his own. Indeed, Nathan’s teacher mentioned that when he is given the option to choose a task from different difficulty levels, Nathan would typically choose something easier, and that it was important to encourage him to choose something more difficult to build his confidence, “ I quite often say to him “come on I think you can challenge yourself” and [will] use that language”.

Peers clearly play an important role for the children with ADHD, and this is recognised both by the children themselves, and by their teachers. Teachers also mentioned that children with ADHD respond well to one-to-one learning with staff, indicating that it is important for these children to have opportunities to learn in different contexts: whole classroom learning, small group work and one-to-one.

In this study, a number of important topics surrounding ADHD in the primary school setting were explored, including ADHD knowledge, strengths and challenges, and strategy use in the classroom, each of which will now be discussed in turn before drawing together the findings and outlining the implications.

ADHD Knowledge

Knowledge of ADHD varied between children and their teachers. Whilst most of the children claimed to have heard of ADHD, very few could accurately describe the core symptoms. Previous research into this area is limited, however this finding supports Climie and Henley’s ( 2018 ) finding that children’s knowledge of ADHD can be limited. By comparison, all of the interviewed teachers had good knowledge about the core ADHD phenotype (i.e. in relation to diagnostic criteria) and some elaborated further by mentioning social difficulties or description of behaviours that could reflect cognitive difficulties. This supports and builds further upon existing research into teachers’ ADHD knowledge, demonstrating that although teachers understanding may be grounded in a focus upon inattention and hyperactivity, this is not necessarily representative of the range of their knowledge. By interviewing participants about their ADHD knowledge, as opposed to asking them to complete a questionnaire as previous studies have done (Climie & Henley, 2018 ; Latouche & Gascoigne, 2019 ; Ohan et al., 2008 ; Perold et al., 2010 ), the present study has demonstrated the specific areas of knowledge that should be targeted when designing psychoeducation interventions for children and teachers, such as broader aspects of cognitive difficulties in executive functions and memory. Improving knowledge of ADHD in this way could lead to increased positive attitudes and reduction of stigma towards individuals with ADHD (Mueller et al., 2012 ; Ohan et al., 2008 ), and in turn improving adherence to more specified interventions (Bai et al., 2015 ).

Strengths and Challenges

A range of strengths and challenges were discussed, some of which were mentioned by both children and teachers, whilst others were unique to a particular group. The main consensus in the current study was that art and P.E. tended to be the lessons in which children with ADHD thrive the most. Teachers elaborated on this notion, speaking about creative skills, such as a good imagination, and that these skills were sometimes applied in other subjects such as creative writing in literacy. Little to no research has so far focused on the strengths of children with ADHD, therefore these findings identify important areas for future investigation. For example, it is possible that these strengths could be harnessed in educational practice or intervention.

Although a strength for some, literacy was commonly mentioned as a challenge by both groups, specifically in relation to planning, spelling or the physical act of writing. Previous research has repeatedly demonstrated that literacy outcomes are poorer for children with ADHD compared to their typically developing peers (DuPaul et al., 2016; Mayes et al., 2020 ), however in these studies literacy tended to be measured using a composite achievement score, where the nuance of these difficulties can be lost. Furthermore, in line with a recent systematic review and meta-analysis (McDougal et al., 2022 ) the present study’s findings suggest that cognitive difficulties may contribute to poor literacy performance in ADHD. This issue was not unique to literacy, however, as teachers also spoke about academic challenges in the context of ADHD symptoms being a barrier to learning, such as finding it difficult to remain seated long enough to complete a piece of work. Children also raised this issue of engagement, who referred to the most challenging subjects being ‘boring’ for them. This link between attention difficulties and boredom in ADHD has been well documented (Golubchik et al., 2020 ). The findings here demonstrate the need for further research into the underlying cognitive difficulties leading to academic underachievement.

Both children and teachers also mentioned social and emotional difficulties. Research has shown that many different factors may contribute to social difficulties in ADHD (for a review see Gardner & Gerdes, 2015 ), making it a complex issue to disentangle. That said, in the current study teachers tended to attribute the children’s relationship difficulties to behaviour, such as reacting impulsively in social situations, or going off task during group work, both of which could be linked to ADHD symptoms. Despite these difficulties, peers were also considered a positive support. This finding adds to the complexity of understanding social difficulties for children with ADHD, demonstrating the necessity and value of further research into this key area.

The three key themes of classroom-general versus individual-specific strategies , heterogeneity of strategies and the role of peers were identified from the interview transcripts with children and their teachers. Within the first theme, classroom-general versus individual-specific strategies, it was clear that teachers utilise strategies that are specific to the child with ADHD, as well as strategies that are general to the classroom but that are also beneficial to the child with ADHD. Previously, Moore et al. ( 2017 ) found that teachers mostly reflected on using general inclusive strategies, rather than those targeted for ADHD specifically, however the methods differ from the current study in two key ways. Firstly, Moore et al.’s sample included secondary and primary school teachers, for whom the learning environment is very different. Secondly, focus groups were used as opposed to interviews where the voices of some participants can be lost. The merit of the current study is that children were also interviewed using the same questions as teachers; we found that children also referred to these differing types of strategies, and reported finding them useful, suggesting that the reports of teachers were accurate. Interestingly, children also mentioned their own strategies that teachers did not discuss and may not have been aware of. This finding highlights the importance of communication between the child and the teacher, particularly when the child is using a strategy considered to be forbidden or discouraged, for example copying a peer’s work or fidgeting with a toy. This communication would provide an understanding of what the child might find helpful, but more importantly identify areas of difficulty that may need more attention. Further to this, most strategies specific to the child mentioned by teachers aimed to support attention, and few strategies targeted other difficulties, particularly other aspects of cognition such as memory or executive function, which supports previous findings (Lawrence et al., 2017 ). The use of a wide range of individualised strategies would be beneficial to support children with ADHD.

Similarly, the second theme, heterogeneity of strategies , highlighted that some strategies work with some children and not others, and some strategies may not work for the same child consistently. Given the benefit of a wide range of strategy use, for both children with ADHD and their teachers, the development of an accessible tool-kit of strategies would be useful. Importantly, and as recognised in this second theme, knowing the individual child is key to identifying appropriate strategies, highlighting the essential role of the child’s teacher in supporting ADHD. Teachers mostly spoke about this in relation to the child’s interests and building rapport, however this could also be applied to the child’s cognitive profile. A tool-kit of available strategies and knowledge of which difficulties they support, as well as how to identify these difficulties, would facilitate teachers to continue their invaluable support for children and young people with ADHD. This links to the importance of psychoeducation; as previously discussed, the teachers in our study had a good knowledge of the core ADHD phenotype, but few spoke about the cognitive strengths and difficulties of ADHD. Children and their teachers could benefit from psychoeducation, that is, understanding ADHD in more depth (i.e., broader cognitive and behavioural profiles beyond diagnostic criteria), what ADHD and any co-occurrences might mean for the individual child, and why certain strategies are helpful. Improving knowledge using psychoeducation is known to improve fidelity to interventions (Dahl et al., 2020 ; Nussey et al., 2013 ), suggesting that this would facilitate children and their teachers to identify effective strategies and maintain these in the long-term.

The third theme, the role of peers , called attention to the importance of classmates for children with ADHD, and this was recognised by both children and their teachers. As peers play a role in the learning experience for children with ADHD, it is important to ensure that children have opportunities to learn in small group contexts with their peers. This finding is supported by Vygotsky’s ( 1978 ) Zone of Proximal Development; it is well established in the literature that children can benefit from completing learning activities with a partner, especially a more able peer (Vygotsky, 1978 ).

Relevance of Co-Occurrences

Co-occurring conditions are common in ADHD (Jensen & Steinhausen, 2015 ), and there are many instances within the data presented here that may reflect these co-occurrences, in particular, the overlap with DCD and ASD. For ADHD and DCD, the overlap is considered to be approximately 50% (Goulardins et al., 2015 ), whilst ADHD and autism also frequently co-occur with rates ranging from 40 to 70% (Antshel & Russo, 2019 ). It was not an aim of the current study to directly examine co-occurrences, however it is important to recognise their relevance when interpreting the findings. Indeed, in the current sample, scores for seven children (70%) indicated a high likelihood of movement difficulty. One child scored above the cut-off for autism diagnosis referral on the AQ-10, indicating heightened autism symptoms. Further to this, some of the discussions with children and teachers seemed to be related to DCD or autism, for example, the way that they can react in social situations, or difficulties with the physical act of handwriting. This finding feeds into the ongoing narrative surrounding heterogeneity within ADHD and individualisation of strategies to support learning. Recognising the potential role of co-occurrences should therefore be a vital part of any psychoeducation programme for children with ADHD and their teachers.

Limitations

Whilst a strong sample size was achieved for the current study allowing for rich data to be generated, it is important to acknowledge the issue of representativeness. The heterogeneity of ADHD is recognised throughout the current study, however the current study represents only a small cohort of children and young people with ADHD and their teachers which should be considered when interpreting the findings, particularly in relation to generalisation. Future research should investigate the issues raised using quantitative methods. Also on this point of heterogeneity, although we report some co-occurring symptoms for participants, the number of co-occurrences considered here were limited to autism and DCD. Learning disabilities and other disorders may play a role, however due to the qualitative nature of this study it was not feasible to collect data on every potential co-occurrence. Future quantitative work should aim to understand the complex interplay of diagnosed and undiagnosed co-occurrences.

Furthermore, only some of the teachers of participating children took part in the study; we were not able to recruit all 10. It may be, for example, that the six teachers who did take part were motivated to do so based on their existing knowledge or commitment to understanding ADHD, and the fact that not all child-teacher dyads are represented in the current study should be recognised. Another possibility is the impact of time pressures upon participation for teachers, particularly given the increasing number of children with complex needs within classes. Outcomes leading from the current study could support teachers in this respect.

It is also important to recognise the potential role of stimulant medication. Although it was not an aim of the current study to investigate knowledge or the role of stimulant medication in the classroom setting, it would have been beneficial to record whether the interviewed children were taking medication for their ADHD at school, particularly given the evidence to suggest that stimulant medication can improve cognitive and behavioural symptoms of ADHD (Rhodes et al., 2004 ). Examining strategy use in isolation (i.e. with children who are drug naïve or pausing medication) will be a vital aim of future intervention work.

Implications/Future Research

Taking the findings of the whole study together, one clear implication is that children and their teachers could benefit from psychoeducation, that is, understanding ADHD in more depth (i.e., broader cognitive and behavioural profiles beyond diagnostic criteria), what ADHD might mean for the individual child, and why certain strategies are helpful. Improving knowledge using psychoeducation is known to improve fidelity to interventions (Dahl et al., 2020 ; Nussey et al., 2013 ), suggesting that this would facilitate children and their teachers to identify effective strategies and maintain these in the long-term.

To improve knowledge and understanding of both strengths and difficulties in ADHD, future research should aim to develop interventions grounded in psychoeducation, in order to support children and their teachers to better understand why and in what contexts certain strategies are helpful in relation to ADHD. Furthermore, future research should focus on the development of a tool-kit of strategies to account for the heterogeneity in ADHD populations; we know from the current study’s findings that it is not appropriate to offer a one-size-fits-all approach to supporting children with ADHD given that not all strategies work all of the time, nor do they always work consistently. In terms of implications for educational practice, it is clear that understanding the individual child in the context of their ADHD and any co-occurrences is important for any teacher working with them. This will facilitate teachers to identify and apply appropriate strategies to support learning which may well result in different strategies depending on the scenario, and different strategies for different children. Furthermore, by understanding that ADHD is just one aspect of the child, strategies can be used flexibly rather than assigning strategies based on a child’s diagnosis.

This study has provided invaluable novel insight into understanding and supporting children with ADHD in the classroom. Importantly, these insights have come directly from children with ADHD and their teachers, demonstrating the importance of conducting qualitative research with these groups. The findings provide clear scope for future research, as well as guidelines for successful intervention design and educational practice, at the heart of which we must acknowledge and embrace the heterogeneity and associated strengths and challenges within ADHD.

Allison, C., Auyeung, B., & Baron-Cohen, S. (2012). Autism spectrum quotient: 10 items (AQ-10). Journal of the American Academy of Child and Adolescent Psychiatry., 51 (2), 202–212.

Article   PubMed   Google Scholar  

Antshel, K. M., & Russo, N. (2019). Autism spectrum disorders and ADHD: Overlapping phenomenology, diagnostic issues, and treatment considerations. Current Psychiatry Reports, 21 (5), 34. https://doi.org/10.1007/s11920-019-1020-5

Arnold, L. E., Hodgkins, P., Kahle, J., Madhoo, M., & Kewley, G. (2020). Long-term outcomes of ADHD: Academic achievement and performance. Journal of Attention Disorders, 24 (1), 73–85. https://doi.org/10.1177/1087054714566076

Bai, G., Yang, L., Wang, Y., & Niu, W.-Y. (2015). Effectiveness of a focused, brief psychoeducation program for parents of ADHD children: Improvement of medication adherence and symptoms. Neuropsychiatric Disease and Treatment, . https://doi.org/10.2147/NDT.S88625

Article   PubMed   PubMed Central   Google Scholar  

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Article   Google Scholar  

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11 (4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806

Classi, P., Milton, D., Ward, S., Sarsour, K., & Johnston, J. (2012). Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization. Child and Adolescent Psychiatry and Mental Health, 6 (1), 33. https://doi.org/10.1186/1753-2000-6-33

Climie, E. A., & Henley, L. (2018). Canadian parents and children’s knowledge of ADHD. Vulnerable Children and Youth Studies, 13 (3), 266–275. https://doi.org/10.1080/17450128.2018.1484975

Coghill, D. R., Seth, S., & Matthews, K. (2014). A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in Attention Deficit Hyperactivity Disorder: Advancing beyond the three-pathway models. Psychological Medicine, 44 (9), 1989–2001. https://doi.org/10.1017/S0033291713002547

Conners, C. K., & Multi-Health Systems Inc. (2008). Conners Comprehensive Behavior Rating Scales (Conners CBRS): Manual . North Tonawanda, N.Y: Multi-Health Systems.

Dahl, V., Ramakrishnan, A., Spears, A. P., Jorge, A., Lu, J., Bigio, N. A., & Chacko, A. (2020). Psychoeducation interventions for parents and teachers of children and adolescents with ADHD: A systematic review of the literature. Journal of Developmental and Physical Disabilities, 32 (2), 257–292. https://doi.org/10.1007/s10882-019-09691-3

DuPaul, G. J., Eckert, T. L., & Vilardo, B. (2012). The effects of school-based interventions for Attention Deficit Hyperactivity Disorder: A meta-analysis. School Psychology Review, 41 (4), 387412. https://doi.org/10.1080/02796015.2012.12087496

Gardner, D. M., & Gerdes, A. C. (2015). A review of peer relationships and friendships in youth with ADHD. Journal of Attention Disorders, 19 (10), 844–855. https://doi.org/10.1177/1087054713501552

Gathercole, S. E., Astle, D. A., Manly, T., the CALM Team, & Holmes, J. (2018). Cognition and behaviour in learning difficulties and ADHD: A dimensional approach [Preprint]. Animal Behavior and Cognition . https://doi.org/10.1101/260265

Golubchik, P., Manor, I., Shoval, G., & Weizman, A. (2020). Levels of proneness to boredom in children with Attention-Deficit/Hyperactivity Disorder on and off methylphenidate treatment. Journal of Child and Adolescent Psychopharmacology, 30 (3), 173–176. https://doi.org/10.1089/cap.2019.0151

Goulardins, J. B., Rigoli, D., Licari, M., Piek, J. P., Hasue, R. H., Oosterlaan, J., & Oliveira, J. A. (2015). Attention Deficit Hyperactivity Disorder and developmental coordination disorder: Two separate disorders or do they share a common etiology. Behavioural Brain Research, 292 , 484–492. https://doi.org/10.1016/j.bbr.2015.07.009

Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2007). Movement assessment battery for children – (2nd ed.). Harcourt Assessment.

Google Scholar  

Jensen, C. M., & Steinhausen, H.-C. (2015). Comorbid mental disorders in children and adolescents with Attention-Deficit/Hyperactivity Disorder in a large nationwide study. ADHD Attention Deficit and Hyperactivity Disorders, 7 (1), 27–38. https://doi.org/10.1007/s12402-014-0142-1

Jones, H. A., & Chronis-Tuscano, A. (2008). Efficacy of teacher in-service training for attention-deficit/hyperactivity disorder: Teacher in-service training for ADHD. Psychology in the Schools, 45 (10), 918–929. https://doi.org/10.1002/pits.20342

Kuriyan, A. B., Jr., Molina, B. S. G., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Abnormal Child Psychology, 41 , 27–41. https://doi.org/10.1007/s10802-012-9658-z

Latouche, A. P., & Gascoigne, M. (2019). In-service training for increasing teachers’ ADHD knowledge and self-efficacy. Journal of Attention Disorders, 23 (3), 270–281. https://doi.org/10.1177/1087054717707045

Law, G. U., Sinclair, S., & Fraser, N. (2007). Children’s attitudes and behavioural intentions towards a peer with symptoms of ADHD: Does the addition of a diagnostic label make a difference? Journal of Child Health Care, 11 (2), 98–111. https://doi.org/10.1177/1367493507076061

Lawrence, K., Estrada, R. D., & McCormick, J. (2017). Teachers’ experiences with and perceptions of students with Attention Deficit/hyperactivity Disorder. Journal of Pediatric Nursing, 36 , 141–148. https://doi.org/10.1016/j.pedn.2017.06.010

Mayes, S. D., Waschbusch, D. A., Calhoun, S. L., & Mattison, R. E. (2020). Correlates of academic overachievement, nondiscrepant achievement, and learning disability in ADHD, autism, and general population samples. Exceptionality, 28 (1), 60–75. https://doi.org/10.1080/09362835.2020.1727324

McDougal, E., Gracie, H., Oldridge, J., Stewart, T. M., Booth, J. N., & Rhodes, S. M. (2022). Relationships between cognition and literacy in children with attention‐deficit/hyperactivity disorder: A systematic review and meta‐analysis. British Journal of Developmental Psychology , 40 (1), 130–150. https://doi.org/10.1111/bjdp.12395

McDougal, E., Riby, D. M., & Hanley, M. (2020). Teacher insights into the barriers and facilitators of learning in autism. Research in Autism Spectrum Disorders, 79 , 101674. https://doi.org/10.1016/j.rasd.2020.101674

Mohr-Jensen, C., Steen-Jensen, T., Bang-Schnack, M., & Thingvad, H. (2019). What do primary and secondary school teachers know about ADHD in children? Findings from a systematic review and a representative, nationwide sample of Danish teachers. Journal of Attention Disorders, 23 (3), 206–219. https://doi.org/10.1177/1087054715599206

Moore, D. A., Russell, A. E., Arnell, S., & Ford, T. J. (2017). Educators’ experiences of managing students with ADHD: A qualitative study: Educators’ management of ADHD. Child: Care, Health and Development, 43 (4), 489–498. https://doi.org/10.1111/cch.12448

Mueller, A. K., Fuermaier, A. B., Koerts, J., & Tucha, L. (2012). Stigma in attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 4 (3), 101–114. https://doi.org/10.1007/s12402-012-0085-3

National Institute for Health and Care Excellence (NICE). (2018). Attention deficit hyperactivity disorder: Diagnosis and management . Retrieved August 2021, from https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#managing-adhd .

Nussey, C., Pistrang, N., & Murphy, T. (2013). How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder: A review of psychoeducational approaches in TS and ADHD. Child Care, Health and Development, 39 (5), 617–627. https://doi.org/10.1111/cch.12039

Ohan, J. L., Cormier, N., Hepp, S. L., Visser, T. A. W., & Strain, M. C. (2008). Does knowledge about attention-deficit/hyperactivity disorder impact teachers’ reported behaviors and perceptions? School Psychology Quarterly, 23 (3), 436–449. https://doi.org/10.1037/1045-3830.23.3.436

Perold, M., Louw, C., & Kleynhans, S. (2010). Primary school teachers’ knowledge and misperceptions of attention deficit hyperactivity disorder (ADHD). South African Journal of Education, 30 (3), 457–473.

Rhodes, S. M., Coghill, D. R., & Matthews, K. (2004). Methylphenidate restores visual memory, but not working memory function in attention deficit-hyperkinetic disorder. Psychopharmacology (berl), 175 (3), 319–330. https://doi.org/10.1007/s00213-004-1833-7

Rhodes, S. M., Park, J., Seth, S., & Coghill, D. R. (2012). A comprehensive investigation of memory impairment in attention deficit hyperactivity disorder and oppositional defiant disorder: Memory in ADHD and ODD. Journal of Child Psychology and Psychiatry, 53 (2), 128–137. https://doi.org/10.1111/j.1469-7610.2011.02436.x

Richardson, M., Moore, D. A., Gwernan-Jones, R., Thompson-Coon, J., Ukoumunne, O., Rogers, M., Whear, R., Newlove-Delgado, T. V., Logan, S., Morris, C., Taylor, E., Cooper, P., Stein, K., Garside, R., & Ford, T. J. (2015). Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: Systematic reviews of quantitative and qualitative research. Health Technology Assessment, 19 (45), 1–470. https://doi.org/10.3310/hta19450

Russell, G., Rodgers, L. R., Ukoumunne, O. C., & Ford, T. (2014). Prevalence of parent-reported ASD and ADHD in the UK: Findings from the millennium cohort Study. Journal of Autism and Developmental Disorders, 44 (1), 31–40. https://doi.org/10.1007/s10803-013-1849-0

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: Prevalence, care pathways, and service provision. The Lancet. Psychiatry, 5 (2), 175–186. https://doi.org/10.1016/S2215-0366(17)30167-0

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes . Harvard University Press.

Wiener, J., Malone, M., Varma, A., Markel, C., Biondic, D., Tannock, R., & Humphries, T. (2012). Children’s perceptions of their ADHD symptoms: Positive illusions, attributions, and stigma. Canadian Journal of School Psychology, 27 (3), 217–242. https://doi.org/10.1177/0829573512451972

Download references

The funding was provided by Waterloo Foundation Grant Nos. (707-3732, 707-4340, 707-4614).

Author information

Authors and affiliations.

Centre for Clinical Brain Sciences, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom

Emily McDougal, Claire Tai & Sinéad M. Rhodes

Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom

Tracy M. Stewart & Josephine N. Booth

School of Psychology, University of Surrey, Guildford, United Kingdom

Emily McDougal

You can also search for this author in PubMed   Google Scholar

Contributions

E.M. Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing - original draft, C.T. Formal Analysis, Writing - review & editing, T.M.S., J.N.B. and S.M.R. Conceptualization, Methodology, Writing - review & editing.

Corresponding author

Correspondence to Sinéad M. Rhodes .

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Interview Schedule—Teacher

Demographic/experience.

How many years have you been teaching?

Are you currently teaching pupils with ADHD and around how many?

If yes, do you feel competent/comfortable/equipped teaching pupils with ADHD?

If no, how competent/comfortable/equipped would you feel to teach pupils with ADHD?

Would you say your experience of teaching pupils with ADHD is small/moderate/significant?

Psychoeducation

What is your understanding of ADHD/Can you describe a typical child with ADHD?

Probe behaviour knowledge

Probe cognition knowledge

Probe impacts of behaviour/cognition difficulties

Probe knowledge that children with ADHD differ from each other

Probe knowledge that children with ADHD have co-occurring difficulties as the norm

(If they do have some knowledge) Where did you learn about ADHD?

e.g. specific training, professional experience, personal experience, personal interest/research

Cognitive skills and strategies

Can you tell me about the pupil’s strengths?

Can you tell me about the pupil’s biggest challenges/what they need most support with?

When you are supporting the pupil with their learning, are there any specific things you do to help them? (i.e. strategies)

Probe internal

Probe external

Probe whether they think those not mentioned might be useful/feasible/challenges

Probe if different for different subjects/times of the day

In your experience, which of these you have mentioned are the most useful for the pupil?

Probe for examples of how they apply it to their learning

Probe whether these strategies are pupil specific or broadly relevant

Probe if specific to particular subjects/times of the day

In your experience, which of these you have mentioned are the least useful for the pupil?

What would you like to be able to support the pupil with that you don’t already do?

Probe why they can’t access this currently e.g. lack of training, resources, knowledge, time

Is there anything you would like to understand better about ADHD?

Probe behaviour

Probe cognition

Interview Schedule—Child

Script: We’re going to have a chat about a few different things today, mostly about your time at school. This will include things like how you get on, how you think, things you’re good at and things you find more difficult. I’ve got some questions here to ask you but try to imagine that I’m just a friend that you’re talking to about these things. There are no right or wrong answers, I’m just interested in what you’ve got to say. Do you have any questions?

Script: First we’re going to talk about ADHD (Attention Deficit Hyperactivity Disorder).

Have you ever heard of/has anyone ever told you what ADHD is?

(If yes) If a friend asked you to tell them what ADHD is, what would you tell them?

Is there anything you would like to know more about ADHD?

Cognition/strategy use

Script: Now we’re going to talk about something a bit different. Everyone has things they are good at, and things they find more difficult. For example, I’m quite good at listening to what people have to say, but I’m not so good at remembering people’s names. I’d like you to think about when you’re in school, and things you’re good at and things you are not so good at. It doesn’t just have to be lessons, it can be anything.

Do you like school?

Probe why/why not?

Probe favourite lessons

What sort of things do you find you do well at in school?

Is there anything you think that you find more difficult in school?

Probe: If I asked your teacher/parent what you find difficult, what would they say?

Probe: Is there anything at school you need extra help with?

Probe: Is there anything you do to help yourself with that?

Script: Some people do things to try to help themselves do things well. For example, when someone tells me a number to remember, I repeat it in my head over and over again.

Can you try to describe to me what you do to help you do these things?

Solving a maths problem

Planning your writing

Doing spellings

Trying to remember something

Concentrating/ignoring distractions

Listening to the teacher

Remaining seated in class when doing work

Working with other children in the class

Probe: Do you use anything in lessons to help you with your work?

Probe: What kind of things do you think could help you with your work?

Probe: Is there anything you do at home, such as when you’re doing your homework, to help you finish what you are doing to do it well?

Probe: Does someone help you with your homework at home? If yes, what do they do that helps? If no, what do you think someone could do to help?

Script: In this last part we’re going to talk about your time at school.

How many teachers are in your class?

Is there anyone who helps you with your work?

Do you work mostly on your own or in groups?

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

McDougal, E., Tai, C., Stewart, T.M. et al. Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers. J Autism Dev Disord 53 , 3406–3421 (2023). https://doi.org/10.1007/s10803-022-05639-3

Download citation

Accepted : 06 June 2022

Published : 01 July 2022

Issue Date : September 2023

DOI : https://doi.org/10.1007/s10803-022-05639-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Child and teacher interviews
• Strengths and difficulties
• Learning strategies
• Find a journal
• Publish with us
• Track your research

Effective Classroom Interventions for ADHD Students: Strategies And Tips

Attention deficit hyperactivity disorder (ADHD) affects many children and poses challenges in their educational journey. Attention deficit hyperactivity disorder (ADHD) is a prevalent childhood behavior disorder that affects approximately 7% of children aged 3 to 17 , according to the 2006 National Health Interview Survey (Bloom & Cohen, 2007). The core symptoms of ADHD, including inattention, hyperactivity, and impulsivity, can pose significant challenges in the classroom and hinder academic success. To support students with ADHD and promote positive school outcomes, it is essential to implement effective behavioral interventions. This article will discuss various strategies and interventions that can be employed in the classroom to address the specific challenges associated with ADHD.

What Is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder or ADHD is a neurodevelopmental disorder that affects both children and adults. Individuals with ADHD typically exhibit symptoms of inattention, hyperactivity, and impulsivity.

Inattentive symptoms may include difficulty staying focused, becoming easily distracted, struggling to follow instructions, being forgetful, and having difficulty organizing tasks and activities. Hyperactive symptoms can manifest as excessive fidgeting, restlessness, and difficulty sitting or staying seated, and constantly being "on the go." Impulsivity can make you do things without thinking and interrupt others. It can also make it hard to wait your turn.

ADHD is a complex disorder that can impact various aspects of an individual's life, and mental health, including academic performance, social interactions, and mental health and emotional well-being. ADHD symptoms and expected behaviors are different for each person. Not everyone with ADHD will have the same symptoms or severity. It's essential to keep this in mind.

Natural remedies, like dietary changes, exercise, and herbal supplements, can provide additional support for managing ADHD symptoms . Mindfulness meditation and yoga can also help improve attention and reduce stress. It's essential to consult with healthcare professionals for safe and effective options.

General Approaches to Behavioral Interventions

When addressing the challenges associated with other children with ADHD, it is crucial to recognize the diverse nature of the problem behaviors of younger children in this student population. Instead of solely focusing behavioral treatment on ADHD symptoms, interventions should begin by identifying specific challenging and unwanted behaviors. Moreover, alternative appropriate behaviors that are incompatible with the undesired behaviors should be identified. Educators need to communicate both unacceptable and acceptable behaviors to the students clearly.

Intervention plans need a functional behavior assessment. This means finding out what causes both good and bad behavior. Looking at past behavior can help us create a better classroom. We can make changes that help students succeed. When you study the consequences, you can see what makes behavior happen more often in the environment. The function of the problem behavior should guide behavioral interventions too. For instance, if the behavior is maintained by negative reinforcement, the intervention should ensure that the undesired behavior goal is not achieved through the problem behavior. Simultaneously, the intervention should teach the student that engaging in desirable behavior is a more effective and efficient way to attain the desired behavioral goal.

Environmental And Instructional Considerations

Implementing behavior modification changes disruptive behavior even in the classroom environment can contribute to reducing problematic behaviors and enhancing learning outcomes for students with ADHD. The following interventions are effective in the behavior problems setting up students with ADHD for success:

Task Duration

Students with ADHD have a short attention span, so homework assignments should be short. This way, they can get quick and frequent feedback and often help make sure they're accurate. Long assignments can be split into smaller sections. Students can take breaks during long periods of class work.

Task Difficulty

Assignments can be frustrating for students with ADHD when they are too hard. They may give up more often. Conversely, simple tasks may result in boredom and inattentiveness. Adjusting tasks to match students' skill levels can engage them and prevent frustration. High school students might find it helpful to start with easy tasks and slowly move to harder ones. As they gain confidence and study skills, they can tackle more complex challenges.

Direct Instruction

Teachers can help students with ADHD by giving them activities to do with their teacher instead of working alone at their desks. This can help them pay better attention and stay focused. Explanation Teaching how to take notes has helped students do better in class. They pay better attention, get higher scores, and understand more. Attention training sessions such interventions can help students with ADHD. They teach how to ignore distractions and focus on essential things.

Peer Tutoring

Peer tutoring is effective in supporting academic and also behavioral therapy gains among students with ADHD. To get the best outcome, it's suggested to match ADHD students with peer tutors of the same gender. The tutors should have better academic and behavioral abilities than younger students. Giving immediate feedback and challenging lessons helps kids who learn from their peers.

Class-Wide Peer Tutoring

Peer tutoring in class helps students with ADHD behave better and do better on school work. In this program, each student becomes both a teacher and a student, and teachers watch closely. Students who have ADHD get trained on suitable tutoring methods and partner up with their peers for tutoring. This method helps both the students and the tutors. This approach not only benefits the tutees by providing individualized support but also benefits the tutors by reinforcing their own learning by teaching the child appropriate behaviors.

Behavior Contracts

Behavior contracts are effective tools for promoting positive behavior and accountability among students with ADHD. A behavior contract is a written agreement that outlines how a student should behave. It is made between the parent, teacher, and student. The contract covers rules, rewards for good behavior, and consequences for bad behavior. The contract should be individualized and include goals that are achievable and measurable. To make sure the negative behavior contract works, it's crucial to keep track of and acknowledge the student's progress.

Environmental Modifications

Creating an organized and structured classroom environment can greatly benefit students with ADHD. Teachers can set up their classrooms in a way that helps students concentrate. They can use the space to prevent distractions and use images to guide students' attention. Seating a student with ADHD near the front of the class and away from distractions, like windows or busy areas, can help them focus better and avoid getting off-task. This can be a good classroom rule.

In the classroom, students with ADHD can benefit from visual aids like schedules and clear instructions. These tools make it easier for them kids learn how to follow classroom rules, routines, complete assignments, and meet expectations. Breaking tasks into smaller steps and using pictures or timers can help complete tasks and manage time.

Self-Monitoring And Self-Regulation Strategies

Teaching students how to monitor and regulate themselves helps them control their behavior and do better in school. Self-monitoring is when students watch and write down how they behave or do something to reach a goal. This can be done through self-checklists, behavior charts, or electronic apps. Using self-regulation strategies can help students with ADHD stay focused and in control. Some examples of these strategies are taking short breaks to move or doing deep breathing exercises.

Collaboration With Parents And Support Services

Working together is essential for helping students with ADHD. Teachers, parents, and support services need to collaborate to make effective interventions. Schools can learn a lot about students by talking with parents and helping them during the school day. This can help teachers understand what students are good at, where they need help, and what works for them at home. To make sure that things are the same at home and school, parents and special education services should work together to set goals and track progress.

Additionally, many schools, collaborating with support services, such programs such as school counselors, school psychologists, or special education professionals, can provide additional resources and expertise in supporting students with ADHD. These experts offer extra resources and knowledge to support these students. These experts can help with exams, assignments, personal plans, academic work, and continued support for students and teachers.

Tips for Effective Classroom Interventions for ADHD Students

Creating classroom rules.

An important way to help students with ADHD is to create a structured classroom environment. A structured environment is good for students with ADHD. It provides clear expectations and routines that make them feel organized and secure. Here are some tips for creating a structured classroom:

• Clearly communicate rules and expectations at the beginning of the school year.
• To help students understand and follow routines, use schedules and charts as visual aids.
• Break tasks into smaller, manageable steps, providing clear instructions along the way.
• Maintain a consistent daily schedule to help students anticipate transitions and reduce anxiety.

Incorporating Multi-Sensory Learning

ADHD students often benefit from multi-sensory learning experiences that engage multiple senses simultaneously. This approach can enhance their focus and retention of information. Here are some ways to incorporate multi-sensory learning:

• Use hands-on activities and manipulatives to make lessons more interactive.
• Integrate visuals, such as diagrams, charts, and videos, to support auditory information.
• Incorporate movement breaks and physical activities to help students release excess energy.

Implementing Assistive Technologies

Technology can be a valuable tool in supporting ADHD students. Assistive technologies can help students in many ways. They can keep students organized, help them manage their time, and improve their attention. Consider the following assistive technologies:

• Digital organizers and apps that provide reminders and task management tools.
• Text-to-speech software that helps students with reading comprehension .
• Noise-canceling headphones to minimize auditory distractions in the classroom.

Providing Individualized Accommodations

ADHD students are different, so we need to give them special help that fits their needs. Here are some accommodations to consider:

• Allowing extra time for completing assignments and tests.
• Providing preferential seating near the front of the classroom to minimize distractions.
• Offering frequent check-ins and providing feedback on their progress.
• Implementing a reward system to reinforce positive behaviors and achievements.

Encouraging Active Participation

Engaging ADHD students actively in learning can help improve their attention and motivation. Here are some strategies to encourage active participation:

• Use group work and collaborative projects to foster engagement.
• Incorporate hands-on experiments and real-life examples to make lessons more relatable.
• Provide opportunities for movement and kinesthetic learning.

Promoting Self-Regulation Skills

ADHD students need to learn self-regulation to control their behavior and emotions. It helps them manage their impulses better. Here are some techniques to teach kids to promote self-regulation:

• Teach mindfulness and relaxation techniques, such as deep breathing exercises.
• Help students identify their emotions and provide strategies for emotional regulation.
• Encourage self-reflection and goal-setting to promote self-monitoring.

To help ADHD students, teachers need to understand them well, show empathy, and use personalized strategies. Teachers can help ADHD students succeed by creating a structured environment, breaking tasks into smaller parts, using hands-on teaching methods, encouraging movement breaks, displaying reminders, and maintaining a positive classroom atmosphere. Remember, each student is unique, so it is essential to adapt these strategies to meet individual needs. ADHD students can do really well with support and help. They can succeed in school and other areas too.

Frequently Asked Questions

What is adhd.

ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental disorder affecting children and adults. It is characterized by persistent inattention, hyperactivity, and impulsivity patterns that can significantly impact daily functioning and overall well-being. Individuals with ADHD may struggle with sustaining attention, organizing tasks, managing time, and controlling impulsive behaviors.

What Is Behavioral Parent Training?

Parent training teaches ways to manage children's behavior. It's a structured program to help parents modify their child's negative behaviors. The program is for parents to learn how to help their kids behave better, especially kids with ADHD. They will learn some ways to encourage good behavior and reduce difficult behavior.

What Is the Role of the Individuals With Disabilities Education Act (IDEA) in Classroom Interventions for ADHD Students?

The IDEA law makes sure students with ADHD get the right school support and help they need. Schools have to make plans (IEPs) that help students with ADHD. These plans should focus on the things students need in the classroom and in other areas.

How Do School-based Interventions Support Students With ADHD?

School-based interventions play a crucial role in supporting students with ADHD. There are ways that can help you in class, like sitting close to the teacher, using pictures to organize your day, and changing homework to make it easier. Explanation Teachers can help students with ADHD by using behavior management strategies, positive attention and giving them personal attention to succeed in both academics and social life.

How Can Classroom Interventions Address Challenging Behaviors in Students With ADHD?

Classroom interventions for students with ADHD aim to address challenging behaviors by providing structure, consistency, and positive reinforcement. Teachers promote good behavior by using charts, tokens, and clear rules. Students can improve their self-control by using strategies such as taking a break or regulating their own behavior.

What Are the Benefits of Incorporating Visual Aids?

Visual aids enhance the understanding and retention of information for ADHD students. Abstract concepts become easier to understand with visual aids. Using these aids helps students connect with the material and engage more easily.

How Can Teachers Promote Self-regulation Skills in Students With ADHD?

Promoting self-regulation skills helps students manage their behavior and emotions independently. Teachers can help you relax, remind you to check how you are doing, show you pictures to help you remember, give positive feedback, and praise you for good behavior.

How Can Teachers Support ADHD Students' Organizational Skills?

Teachers can help students with ADHD improve organizational and social skills. They can use things like checklists, classroom management, visual cues, and other tools to make it easier. Students can use these resources to be organized and improve the social skills needed to do well in school.

How Can Parents Support Their Child With ADHD in the Classroom?

Parents can help their child with ADHD by talking with them and their teachers, going to meetings, working together on behavior plans, keeping a regular schedule at home, and supporting their child's strengths and hobbies.

How Can Displaying Positive Behavior Benefit Children With ADHD?

Displaying positive behavior can have significant benefits for children diagnosed with ADHD. It helps improve their self-esteem, social interactions, and academic performance. Teachers and parents can help kids by reinforcing good behavior. This creates a healthy environment that helps the child feel better.

Is Medication the Only Solution for ADHD Students?

Medication is one of many potential interventions for ADHD students, but it is not the only solution. Classroom interventions, academic instruction, individualized accommodations, behavioral treatment, and supportive strategies all play crucial roles in helping ADHD students thrive.

Can ADHD Students Succeed Academically?

Yes, with the right support and academic interventions, ADHD students can absolutely succeed academically. By creating an inclusive and supportive environment, with school interventions tailored to their unique needs, ADHD students can reach their full potential.

What Role Do Parents Play in Supporting Their Child With ADHD in the Classroom?

Parents play an important role in supporting their children with ADHD in the classroom. Parents can talk to teachers about their child's needs, share successful strategies they use to support children at home, and work with the school to create an individual education plan or a plan for special help if their child has a disability. This collaboration ensures consistency in support between home and school environments.

• Our Mission

Writing Strategies for Students With ADHD

Here are six challenges and solutions, based on task simplicity and clear instruction, for helping students with ADHD develop their essay-writing skills.

Too often, students with ADHD (attention deficit hyperactivity disorder) get labeled as "problem students." They often get shuffled into special education programs even if they show no signs of developmental disability. Though these students' brains do work differently, studies prove that it doesn't preclude them from being highly intelligent. That means teachers should pay special attention to help students with ADHD discover their potential and deal with the challenges they face in their learning process.

As essay writing is both the most common and the most complicated assignment for students, writing instruction for students with ADHD requires special efforts. Each step of writing process may present certain difficulties for these young people. Here are some practical solutions for teachers to encourage, motivate, and focus their students on writing process.

1. Difficulty Concentrating on Assignment

Research proves that ADHD doesn’t result in less intelligence, but rather in difficulties controlling emotions, staying motivated, and organizing the thoughts. So a teacher's first task is teaching students focus enough on a writing assignment.

Solution: Give clear, concise instructions.

When assigning an essay or other writing project, be specific and clear about what you expect. Don't leave a lot of room for interpretation. Instead of the assignment "Write about a joyous moment," include instructions in your writing prompt, such as:

• Think about the last time you felt happy and joyful.
• Describe the reasons for your happiness.
• What exactly made you feel joy?
• What can that feeling be compared to?

Make sure every student knows that he or she should come to you directly with any questions. Plan to take extra time reviewing the instructions with students one to one, writing down short instructions along the way.

2. Difficulty Organizing Thoughts on Paper

Several studies have found that students with ADHD struggle with organizing their thoughts and mental recall. These students can often speak well and explain their thoughts orally, but not in writing.

Solution: Get them organized from the start.

Start each project with a simple note system. Give students the freedom to take their own notes and review them together if possible. Have students pay special attention to filing these notes in a large binder, folder, or other method for making storage and retrieval simple.

To help students understand how to organize their written thoughts, teach them mind mapping . A semantic mind map for an essay may include major nouns, verbs, and adjectives, as well as phrases to use in writing each paragraph. Some introductory and transition sentences will also come in handy. Another step after mind mapping is advanced outlining . Begin and end the initial outline with the words "Intro" and "Conclusion" as placeholders. Then have students expand that outline on their own.

3. Difficulty With Sustained Work on a Single Task

ADHD can make it difficult for students to focus on long-term goals, leading to poor attention and concentration when the task requires work for an extended period of time.

Solution: Create small, manageable milestones.

Since accomplishing a five-page essay takes a lot of time, you can chop it into smaller, easier-to-manage pieces that can be worked on in rotation. Each piece may be checked separately if time allows. Treating every issue and section as an independent task will prevent students from feeling overwhelmed as they work toward a larger goal.

4. Difficulty in Meeting Deadlines

Deadlines are the things that discourage students with ADHD, as they work on assignments more slowly than their classmates, are often distracted, and tend to procrastinate.

Solution: Allow for procrastination.

It may sound ridiculous, but build procrastination into the writing process by breaking up the work and allowing for extra research, brainstorming, and other activities which diversify students' work while still focusing on the end result.

5. Spelling Issues

Students with ADHD often have difficulties with writing, especially in terms of spelling. The most common issues are reversing or omitting letters, words, or phrases. Students may spell the same word differently within the same essay. That's why lots of attention should be paid to spelling.

Solution: Encourage spell checkers, dictionaries, and thesaurus.

There are plenty of writing apps and tools available to check spelling and grammar. As a teacher, you can introduce several apps and let students choose which ones work better for writing essays. When checking the submitted papers and grading the work, highlight the spelling mistakes so that students can pay special attention to the misspelled words and remember the correct variant.

6. Final Editing Issues

Students with ADHD may experience problems during the final editing of their work since, by this time, they will have read and reviewed it several times and may not be paying attention to mistakes.

Solution: Teach them to review their writing step by step.

Take an essay template as an example and show students how to revise it. Go through the editing process slowly, explaining the "why" behind certain changes, especially when it comes to grammatical issues. Assign students the task of revising each other's essays so that when they revise their own final draft, they'll know what to pay attention to and what common mistakes to look for.

Addressing the challenges unique to students with ADHD will help these students find ways to handle their condition effectively and even use it to their advantage. Their unique perspective can be channeled into creative writing, finding new solutions to problems, and most of all, finding, reaching, and even exceeding their goals and fulfilling their full potential.

Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers

• Journal of Autism and Developmental Disorders 53(2):1-16

• Anna Freud Centre
• This person is not on ResearchGate, or hasn't claimed this research yet.

• The University of Edinburgh

Discover the world's research

• 25+ million members
• 160+ million publication pages
• 2.3+ billion citations
• J AUTISM DEV DISORD

• Tracy M. Stewart
• Maria Elizabeth Cedillo Tello
• Juanita Catalina Argudo-Serrano
• Gabriel Henrique Nogueira Marques
• Flávio Rodrigues de Almeida
• Mouna Chehabeddine
• Hiba Chehabeddine

• Pooja Yogesh Patil
• Bhargavi Shirish Sarode
• Pallavi Vijay Chavan
• Idongesit Williams
• Man-Chi Lai
• Yu-Feng Lin
• Sheng-Wei Wang

• طاهر عبد الله أحمد فرحات
• زكريا عبد المسيح سوريال
• Tazul Arifin
• Iding Tarsidi
• Andayani Ratnawati
• BRIT J DEV PSYCHOL
• Hannah Gracie

• RES AUTISM SPECT DIS

• J DEV PHYS DISABIL

• Curr Psychiatr Rep

• Laura Henley

• Tanya L. Eckert
• Brigid A. Vilardo
• Susan Dickerson Mayes

• Pavel Golubchik

• Recruit researchers
• Join for free
• Login Email Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google Welcome back! Please log in. Email · Hint Tip: Most researchers use their institutional email address as their ResearchGate login Password Forgot password? Keep me logged in Log in or Continue with Google No account? Sign up

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

8 Simple Strategies for Students With ADHD

Helpful Techniques for Teachers and Parents

Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University.

 Hero Images / Getty Images

Keep Expectations Consistent

Limit distractions, provide frequent feedback, reward good behavior, give them a break, use tools and flexible rules.

• Don't Overload Them

Encourage Support

Frequently asked questions.

ADHD strategies are techniques that parents and teachers can utilize to help students succeed in school. Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems with attention, impulse control, and hyperactivity. It usually develops in childhood, but may not be diagnosed until adolescence or adulthood.

Approximately 9% of children in the United States between the ages of 13 and 18 have ADHD, according to the National Institute of Mental Health (NIMH). It is four times more likely to be diagnosed in boys than in girls .

The struggles that children with ADHD face, such as difficulty paying attention, may become apparent once they start school. As such, parents and teachers will need to work together to help kids learn to cope with their ADHD symptoms.

Kids and teens with ADHD have unique needs in the classroom. Here are some ADHD strategies that parents and teachers of students can use to help them succeed at school.

One of the most important ADHD strategies is to keep classroom rules clear and concise. Rules and expectations for the class should be regularly reviewed and updated when necessary. Rules should be posted in the classroom where they can be easily read.

It's often useful to have a child repeat back rules, expectations, or other instructions to ensure that they understood. Teachers should keep in mind that a child may have heard the words that were said but misunderstood the meaning.

A child with ADHD may find it helpful to have an index card with the rules taped to their desk for quick reference. 

For kids who struggle with time management and "shifting gears" from one task or class to the next, having a schedule handy and reviewing it often can make transitions go more smoothly.   You can also use timers, taped time signals, or verbal cues to help a student see how much time is left for an activity.

Students with ADHD are susceptible to distractions. Helpful strategies for students with ADHD can include seating them away from sources of classroom disruption such as doors, windows, cubby areas, and pencil sharpeners. Try to limit other distractions in the room, like excessive noise or visual stimuli like clutter, as much as possible.

If a child has an especially difficult time dealing with distractions, being seated near the front of the class close to the teacher may be helpful.

Listening to “white noise” or soft background music can actually improve focus and concentration for some kids with ADHD, though it can be a distraction for those children who don't.

Another helpful ADHD strategy is to keep giving kids quick feedback about how they are doing. Kids with and without ADHD benefit from frequent, immediate feedback about their behavior. When necessary, any consequences given for unwanted behaviors should also be swift.

Provide immediate praise for good behavior. If a negative behavior is minimal and not disruptive, it's best to ignore it.

Rewards and incentives should always be used before punishment to motivate a student. To prevent boredom, change up the rewards frequently.

Do not use the loss of recess as a consequence for negative behavior. Kids with ADHD benefit from physical activity and may be able to focus better after being outside or in gym class.

Prioritizing rewards over punishment will help ensure that school continues to feel like a positive place for kids with ADHD.

Breaks and regular activity can be important strategies for kids with ADHD. Kids with ADHD tend to struggle with sitting still for long periods of time, so giving them frequent opportunities to get up and move around can be a big help.

You can provide them with a physical break by having them hand out or collect papers or classroom materials, run an errand to the office or another part of the building, or erase the board. Even something as simple as letting them go get a drink of water at the water fountain can provide a moment of activity.

Students with ADHD tend to be restless. While a standard classroom rule may be that students must sit in their seats during lessons, a child with ADHD may be able to stay on task better if they're allowed to stand up.

For kids who tend to fidget, holding a small “Koosh Ball" or something tactile to manipulate (like Silly Putty) provides a little stimulation without disrupting the classroom.  

Some studies have claimed that chewing gum may improve certain students' concentration, but the research has not been conclusive.   Furthermore, many schools do not allow students to chew gum.

Don't Overload Them

For a child with ADHD who is prone to becoming overwhelmed, it can be helpful to reduce the total workload by breaking it down into smaller sections.

Teachers can help students avoid feeling overloaded with information by giving  concise one- or two-step directions .

Kids with ADHD may also have sleep problems that affect their behavior and their ability to pay attention in class.   In general, students tend to be "fresher" and less fatigued earlier in the day, though teens and college students are more likely to struggle with morning classes. It's also not unusual for kids to have a bit of a slump after lunch.

If possible, plan to have the class tackle the most difficult academic subjects and assignments when they are most alert and engaged.

Children with ADHD may need extra help from a classroom aid, though these staff members are not always available. Likewise, access to academic support services for students with ADHD may not be in place.

Even if a child does have one-on-one help from an adult, it can sometimes be helpful to arrange for peer support. Pairing a student with ADHD up with a willing, kind, and mature classmate can be a beneficial experience for both kids. A child's "study buddy" can give reminders, help them stay on task or refocus after being interrupted, and provide encouragement.

Working with another student can also help a child with ADHD improve their social skills and enhance the quality of their relationships with peers—both of which can be struggles for kids with ADHD.  

A Word From Verywell

A successful school strategy for a child with ADHD must meet the triad of academic instruction, behavioral interventions, and classroom accommodations. While the regular implementation of these strategies can make a world of difference to a child with ADHD, they will also benefit the whole classroom environment.

Behavioral ADHD strategies that can help include using positive reinforcement, sticking to consistent routines, reducing distractions, taking regular breaks, encouring physical activity, and providing regular feedback.

Six teaching strategies that can be helpful when working with students who have ADHD include:

• Focusing on short-term goals
• Breaking projects down into smaller steps
• Rewarding good behavior and work
• Taking short breaks to help kids release energy
• Communicating directions clearly and consistently
• Providing tools and direction that help kids stay organized

National Institute of Mental Health. Attention Deficit Hyperactivity Disorder .

Rief SF.  How To Reach And Teach Children with ADD / ADHD . 2nd ed. Hoboken, New Jersey. John Wiley & Sons; 2012.

Söderlund, GB, Sikström, S, Loftesnes, JM, Sonuga-Barke EJ.  The effects of background white noise on memory performance in inattentive school children .  Behav Brain Funct  6, 55 (2010). https://doi.org/10.1186/1744-9081-6-55

Hartanto TA, Krafft CE, Iosif AM, Schweitzer JB. A trial-by-trial analysis reveals more intense physical activity is associated with better cognitive control performance in attention-deficit/hyperactivity disorder . Child Neuropsychol. 2016;22(5):618-26. doi:10.1080/09297049.2015.1044511

Tucha L, Simpson W, Evans L, Birrel L, Sontag TA, Lang KW, et al. Detrimental effects of gum chewing on vigilance in children with attention deficit hyperactivity disorder .  Appetite . 2010;55(3):679–684. doi:10.1016/j.appet.2010.10.001

Lucas I, Mulraney M, Sciberras E. Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study .  Behav Sleep Med . 2019;17(4):411–422. doi:10.1080/15402002.2017.1376207

Chiang HL, Gau SS. Impact of executive functions on school and peer functions in youths with ADHD .  Res Dev Disabil . 2014;35(5):963–972. doi:10.1016/j.ridd.2014.02.010

DuPaul GJ, Jimerson SR. Assessing, understanding, and supporting students with ADHD at school: contemporary science, practice, and policy .  Sch Psychol Q . 2014;29(4):379–384. doi:10.1037/spq0000104

United States Department of Education. Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices .

By Keath Low  Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.

Celebrating 25 Years

• Join ADDitude
•  | 

• What Is ADHD?
• The ADHD Brain
• ADHD Symptoms
• ADHD in Children
• ADHD in Adults
• ADHD in Women
• Find ADHD Specialists
• New! Symptom Checker
• ADHD Symptom Tests
• All Symptom Tests
• More in Mental Health
• Medication Reviews
• ADHD Medications
• Natural Remedies
• ADHD Therapies
• Managing Treatment
• Treating Your Child
• Behavior & Discipline
• School & Learning
• Teens with ADHD
• Positive Parenting
• Schedules & Routines
• Organizing Your Child
• Health & Nutrition
• More on ADHD Parenting
• Do I Have ADD?
• Getting Things Done
• Relationships
• Time & Productivity
• Organization
• Health & Nutrition
• More for ADHD Adults
• Free Webinars
• Free Downloads
• ADHD Videos
• ADHD Directory
• eBooks + More
• Women’s Health Month
• Newsletters
• Guest Blogs
• News & Research
• For Clinicians
• For Educators
• Manage My Subscription
• Get Back Issues
• Digital Magazine
• Gift Subscription
• Renew My Subscription
• ADHD Parenting

Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine

Your child’s teacher is your partner in a fair and equitable education, but does she have the adhd tools she needs the following adhd teaching strategies will help all students — but especially those with add — learn to the best of their ability in any classroom..

Parents: Is your child’s teacher doing everything possible to support learning? Teachers often dictate the success or failure of a child’s education — particularly if that child has attention deficit hyperactivity disorder (ADHD or ADD).

Next to parents, teachers are the most influential people in a student’s life. The best teacher will develop ADHD strategies to show students that they are capable and worthwhile.

Here are some strategies for teaching children with ADHD that work to establish a supportive, structured classroom that will encourage learning, enforce discipline, and boost self-esteem.

Strategies for Students with ADHD

• Assign work that suits the student’s skill level. Students with ADHD will avoid classwork that is too difficult or too long.
• Offer choices. Children with ADHD who are given choices for completing an activity produce more work, are more compliant, and act less negative. Establish, for instance, a list of 15 activity choices for practicing spelling words like writing words on flash cards, using them in a sentence, or air-writing words.

[ Get This Download: How to Teach Children with ADHD — Classroom Challenges & Solutions ]

• Provide visual reminders. Students with ADHD respond well to visual cues and examples. For instance, demonstrate a skill like essay writing on an overhead projector or on the board. When children get to their independent work, leave key points about a topic visible on the board. Post important concepts the children will use again and again on brightly colored poster board around the room.
• Increase active class participation. Group strategies include asking students to write their answers on dry-erase white boards and showing them to the teacher, asking students to answer questions in unison (choral response), having students give a thumbs up or down if the answer to the question is yes or no — a level palm, if they don’t know the answer. Paired learning is also effective. Have students work through a problem in a group and discuss for maximized understanding.
• Encourage hands-on learning. Create learning opportunities where children experience things first-hand. Have students write and act out a play, record an assignment on videotape or take apart and put together a model of a miniature eyeball when studying the human body.

Establish Rules & Routines for ADHD Students

• For example, instead of saying: “No loud talking when you come into class,” say, “When you come into class, check the assignment on the board and start working quietly.” Or, “Sit down first and then you may talk quietly with your neighbor until I start teaching.”

[ Click to Download: 10 Teaching Strategies that Help Students with ADHD ]

• Establish classroom routines. This will help students with ADHD stay on task. Routines for all students can include: homework always being written on the board, “row captains” checking to see that assignments are written and that completed work is picked up, etc. Students with ADHD can check in with the classroom aide at the end of the day to make sure they understand the homework assignment and what’s required of them.
• Give appropriate supervision to ADHD students. Children with ADHD require more supervision than their peers because of their delayed maturity, forgetfulness, distractibility, and disorganization. Help these students by pairing them with classmates who can remind them of homework and classwork, using student partners to team up on a project, and involving classroom aides as much as you can during and after class.

Offer Accommodations for ADHD in the Classroom

Some students with ADHD may need school accommodations to address academic challenges . Make sure they get them. Some accommodations can be as easy as monitoring the student’s work and developing a plan to help him not fall behind and even accepting the occasional late assignment — this can give the student confidence and get her back on track.

Other common ADHD accommodations include:

• Extended time on tests
• Shortened assignments
• Instruction in note-taking or designating a class notetaker
• Segmented assignments for long-term projects (with separate due dates and grades).

The Attention Deficit Disorder Association ( ADDA ) makes the following recommendations for accommodations:

• Reduce potential distractions. Always seat students who have problems with focus near the source of instruction and/or stand near student when giving instructions in order to help the student by reducing barriers and distractions between him and the lesson. Always seat this student in a low-distraction work area in the classroom.
• Use positive peer models. Encourage the student to sit near positive role models to ease the distractions from other students with challenging or diverting behaviors.
• Prepare for transitions. Remind the student about what is coming next (next class, recess, time for a different book, etc.). For special events like field trips or other activities, be sure to give plenty of advance notice and reminders. Help the student in preparing for the end of the day and going home, supervise the student’s book bag for necessary items needed for homework.
• Allow for movement. Allow the student to move around or fidget, preferably by creating reasons for the movement. Provide opportunities for physical action — do an errand, wash the blackboard, get a drink of water, go to the bathroom, etc. If this is not practical, then permit the student to play with small objects kept in their desks that can be manipulated quietly, such as a soft squeeze ball, if it isn’t too distracting.
• Let the children play. Recess can actually promote focus in children with ADHD so don’t use it as a time to make-up missed schoolwork or as punishment as you might for other students.

Focus on the Positive

• Establish a positive relationship with students who have ADHD. Greet them by name as they enter the classroom or when calling on them in class. Create a class bulletin board for posting students’ academic and extracurricular interests, photographs, artwork, and/or accomplishments.
• Provide frequent, positive feedback. Students with ADHD respond best to feedback that is immediate. Use positive praise, such as “You’re doing a great job” or “Now you’ve got it.” If a student’s answer is incorrect, say, “Let’s talk this through” or “Does that sound right to you?”
• Ask questions rather than reprimand. If the student misbehaves, in class, ask, “Is that a good choice or a bad choice?” The student will get the message that his behavior is inappropriate.

Partner with Parents

For best results, teachers must partner with the parents to ensure that their child is ready to learn in the classroom. Here are some guidelines to share with the parents of your students with ADHD:

• Communicate regularly with the teacher about problems.
• See that your child’s ADHD medication is working effectively at school and during homework sessions.
• Help your child organize papers for evening homework and prepare for the next school day.
• Watch your child put completed homework in the proper folder.
• Monitor completion of work in the classes that he is in danger of failing.
• Save all completed homework until the semester is over.
• Talk with the teacher about using a daily or weekly report, if needed.

[ Your Free Download: The Teacher’s Guide to Better Assignments for Students with ADHD ]

For Teachers: Read These Next

Your Executive Functions Are Weak. Here’s Why.

9 Things I Wish the World Knew About My Students’ ADHD

A Teacher’s Guide to NVLD: How to Support Students with Nonverbal Learning Disability

How to Sharpen Executive Functions: Activities to Hone Brain Skills

Adhd newsletter, success @ school, strategies for homework, accommodations, ieps, working with school & more..

It appears JavaScript is disabled in your browser. Please enable JavaScript and refresh the page in order to complete this form.

Home — Essay Samples — Nursing & Health — Psychiatry & Mental Health — Adhd

ADHD ( Attention Deficit Hyperactivity Disorder) Essay Examples

Adhd essay topics and outline examples, essay title 1: understanding adhd: causes, symptoms, and treatment.

Thesis Statement: This research essay aims to provide a comprehensive understanding of Attention-Deficit/Hyperactivity Disorder (ADHD), including its possible causes, common symptoms, and various treatment approaches.

• Introduction
• Defining ADHD: An Overview
• Possible Causes of ADHD: Genetic, Environmental, and Neurological Factors
• Symptoms and Diagnosis: Recognizing ADHD in Children and Adults
• Treatment Options: Medication, Behavioral Therapy, and Lifestyle Interventions
• The Impact of ADHD on Daily Life: School, Work, and Relationships
• Current Research and Future Directions in ADHD Studies
• Conclusion: Enhancing Understanding and Support for Individuals with ADHD

Essay Title 2: ADHD in Children: Educational Challenges and Supportive Strategies

Thesis Statement: This research essay focuses on the educational challenges faced by children with ADHD, explores effective strategies for supporting their learning, and highlights the importance of early intervention.

• Educational Implications of ADHD: Academic, Social, and Emotional Impact
• Supportive Classroom Strategies: Individualized Education Plans (IEPs) and 504 Plans
• Teacher and Parent Collaboration: Creating a Supportive Learning Environment
• Alternative Learning Approaches: Montessori, Waldorf, and Inclusive Education
• ADHD Medication in the Educational Context: Benefits and Considerations
• Early Intervention and the Role of Pediatricians and School Counselors
• Conclusion: Nurturing Academic Success and Well-Being in Children with ADHD

Essay Title 3: ADHD in Adulthood: Challenges, Coping Strategies, and Stigma

Thesis Statement: This research essay examines the often overlooked topic of ADHD in adults, discussing the challenges faced, coping mechanisms employed, and the impact of societal stigma on individuals with adult ADHD.

• ADHD Persisting into Adulthood: Recognizing the Symptoms
• Challenges Faced by Adults with ADHD: Work, Relationships, and Self-Esteem
• Coping Strategies and Treatment Options for Adult ADHD
• The Role of Mental Health Support: Therapy, Coaching, and Self-Help
• ADHD Stigma and Misconceptions: Impact on Diagnosis and Treatment
• Personal Stories of Triumph: Overcoming ADHD-Related Obstacles
• Conclusion: Raising Awareness and Providing Support for Adults with ADHD

Understanding ADHD: an Informative Overview

A negative critique on adhd diagnosis and treatment, made-to-order essay as fast as you need it.

Each essay is customized to cater to your unique preferences

+ experts online

Rethinking ADHD: Balancing Medication with Holistic Interventions

The effect of adhd on the life of an individual, analysis of treatment decisions for a child with adhd, the effects of methylphenidate on adults with adhd, let us write you an essay from scratch.

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Personal Experience of The Struggles Associated with Asperger's Syndrome and ADHD

Adhd: the child/teacher struggle, the importance of online schooling for add/adhd students, reduction of inhibitory control in people with adhd, get a personalized essay in under 3 hours.

Expert-written essays crafted with your exact needs in mind

Negative Effects Associated with Prescription Drugs on Children with ADHD

How fidgeting actually contributes to a lack of focus in students, diagnosing dyscalculia and adhd diagnosis in schools, the issue of social injustice of misdiagnosed children with adhd, understanding adhd: a comprehensive analysis, behavioral disorders: causes, symptoms, and support.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by excessive amounts of inattention, carelessness, hyperactivity (which evolves into inner restlessness in adulthood), and impulsivity that are pervasive, impairing, and otherwise age-inappropriate.

The major symptoms are inattention, carelessness, hyperactivity (evolves into restlessness in adults), executive dysfunction, and impulsivity.

The management of ADHD typically involves counseling or medications, either alone or in combination. While treatment may improve long-term outcomes, it does not get rid of negative outcomes entirely. Medications used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants. In those who have trouble focusing on long-term rewards, a large amount of positive reinforcement improves task performance.ADHD stimulants also improve persistence and task performance in children with ADHD.

Relevant topics

• Mental Health
• Stress Management
• Schizophrenia
• Eating Disorders

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Pardon Our Interruption

As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen:

• You've disabled JavaScript in your web browser.
• You're a power user moving through this website with super-human speed.
• You've disabled cookies in your web browser.
• A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article .

To regain access, please make sure that cookies and JavaScript are enabled before reloading the page.

How Couples with ADHD Can Reduce Conflict and Get Along Better

Strategies to help couples affected by adhd manage challenges and stay connected..

Posted June 29, 2024 | Reviewed by Devon Frye

• What Is ADHD?
• Take our ADHD Test
• Find counselling to overcome ADHD
• Couples with ADHD may struggle with disagreements that escalate quickly into intense arguments.
• Focusing on what the other person can do differently is a trap; shift to thinking about what you can change.
• Rebalance yourself before attempting to talk about anything with your partner.
• Learn how to use the STEPS method to strategize more effective solutions to conflict.

Every couple struggles with those moments when a switch has flipped and suddenly there’s a bubbling volcano of angry, negative emotions inside of both of you waiting to erupt. Before you know what’s happening, you each say or do things that you’ll surely regret later, but can’t stop.

In a relationship where one or both partners have ADHD , these escalations (amygdala takeovers) can happen extremely quickly due to challenges with emotional regulation , verbal impulse control, metacognition , and weaker working memory . One minute you’re OK; the next, it’s as if a match has been thrown on a pile of old painting rags and putrid fumes are polluting the health of your relationship. Significant emotional damage can ensue for both parties, potentially transforming tender love into toxic rage.

When couples struggle with anger , they often focus on what the other person could do differently or better. This is a trap: You can’t control what anyone else does; you can only control yourself. Thus, learning better tools for dealing with your own dysregulation is what’s called for.

When the amygdala becomes activated, the thinking brain (your prefrontal cortex) goes temporarily offline and feelings rule the day. In neurotypical brains, executive functioning skills help the amygdala calm down by engaging language to name the feelings instead of experiencing them, by accessing the capacity to step back and assess the situation, and by using rational thinking to find alternative solutions.

In ADHD brains, your executive functioning skills, already working so hard to accomplish and maintain daily life tasks, struggle with the extra burden of effectively dealing with a rush of strong emotions. You’ll tend to react quickly with volatility instead of responding with consideration.

How can you do something differently before and during an amygdala takeover? Focus on rebalancing yourself instead of telling your partner to calm down.

In my experience, saying “calm down” usually results in people speeding up and getting defensive. Anger, unkind words, and intense emotions emerge. The so-called "four horsemen," aptly named by psychologists John and Julie Gottman as problematic patterns in couples, appear on the scene to wreak their damage in the form of criticism, contempt, defensiveness, and stonewalling. By now, you and your partner have usually regressed to some ugly version of your 10-year-old selves.

Rebalancing is what’s called for—and preparation will help you make that happen.

How to Rebalance

Rebalancing means creating a couple’s coping strategy in advance so you can rely on it in difficult moments. Identify what will assist each of you from steering into a tailspin. Examine your respective patterns when you have big feelings and work together to create a collaborative plan of action.

My “take a few STEPS back” method can help you with this process. Here’s how the STEPS work:

1. Self-control .

When the intensity of a conversation rises, pay attention to your body’s signals that you are becoming activated. Maybe your heart starts beating faster or you begin perspiring. Perhaps you are speaking louder and out of breath.

If you can catch your dysregulation early, you can avoid a massive eruption. Practicing self-awareness and paying attention to your body sensations when you are not activated will help you notice what is happening and give you important information about slowing things down when you are.

Try saying, “I’m feeling agitated and I’m getting upset. I need things to slow down” instead of “Why won’t you leave me alone? I just want you to stop talking to me!”

2. Time apart.

Instead of pretending that your conflicts won’t re-occur or being so relieved that they are over you want to forget them, be honest with each other and acknowledge that, yes, you will probably disagree again in the future. So, plan for those tricky moments and set up a "time apart" structure.

To do this, decide, in advance, the amount of time you will each need to restabilize, how you are going to call for a break in the action, what each of you will do, and where and when you will come back together.

3. Evaluate.

During your time apart, reflect on what just occurred. Think about what you really want at this moment, in this conversation, or regarding this issue.

If you’re feeling angry and need to vent, grab a pen or your computer and start writing, planning to throw it out later. Create a voice memo if that’s useful. Perhaps draw something, go for a run, or break out the yoga mat.

Then, ask yourself what you could have done or said differently and how you could express your thoughts and desires in a more effective way. Consider what you can be accountable for. We are looking for evenness here—getting back to baseline.

4. Practice reflective listening.

Reflective listening is a key tool for improving respectful communication in couples. To use it effectively during a disagreement, it’s best to practice this technique a few times a week. This will not only improve your ability to do it with satisfaction during or after an argument but also increase your connection to your partner amid your busy lives.

Initially, set the timer for 10 minutes and build up to 20. Each person gets half of that time as the speaker, and the other half as the listener.

The speaker starts to talk about what’s on their mind and pauses after a sentence or two; alternatively, the listener can use a hand signal when their memory capacity is full. Then the listener says: “What I heard you say is X. Did I get that right? Is there anything else?” This back-and-forth continues until the timer rings. Then, switch roles.

When you are practicing this tool, feel free to talk about anything: work, friends, kids, emotions. When you are using this tool for an argument, talk about how you feel using "I" statements rather than blaming ones.

5. Strategize.

Once you’ve shared how you feel with each other and you both feel heard, it’s time to strategize the next right action. Where do you go from here? What’s something you can both do to move forward?

Collaborate on this—but know that it’s OK if you need different things. This is a judgment-free zone. The goal is to proceed with clear minds and open hearts.

Beeney JE, Hallquist MN, Scott LN, Ringwald WR, Stepp SD, Lazarus SA, Mattia AA, Pilkonis PA. The Emotional Bank Account and the Four Horsemen of the Apocalypse in Romantic Relationships of People with Borderline Personality Disorder: A Dyadic Observational Study. Clin Psychol Sci. 2019 Sep;7(5):1063-1077. doi: 10.1177/2167702619830647. Epub 2019 Apr 18. PMID: 32670673; PMCID: PMC7363036.

Gottman J, & Silver N (1999). The Seven Principles for Making Marriage Work. New York, NY: Crown Publishers.

Sharon Saline, Psy.D. , is a clinical psychologist and an expert in how ADHD, LD, and mental health affect children, teens and families. She is the author of What Your ADHD Child Wishes You Knew .

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• International
• New Zealand
• South Africa
• Switzerland
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience