How Do ADHD and Executive Functioning Impact Students’ Learning and Academic Performance in a School Setting?

Introduction

About 5-11% of adolescents in the world are diagnosed with attention-deficit hyperactivity disorder (ADHD) [1]. This diagnosis is most prevalent in young boys, as they exhibit more stereotypical symptoms [2]. Yet, ADHD is often misdiagnosed as a behavioral disorder or attributed to laziness [3]. This stigma behind ADHD results in a lack of education about the disorder for teachers and clinicians. This may lead to an inability to help students who exhibit symptoms that may lead to a diagnosis of ADHD.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), adolescents and adults who struggle with inattention or impulsivity that obstructs their abilities to function, and exhibit symptoms of hyperactivity, impulsivity or inattention, may have ADHD [4] . But, this diagnostic criteria is not fully supported by the ICD-11, which diagnoses ADHD when symptoms of inattention or a combination of hyperactivity and impulsivity occur in children below 12 years of age [5] . While the DSM-5 has similar criteria, the ICD-11 limits the diagnosis of ADHD as solely a developmental disorder, ignoring the potential of adult onset ADHD to occur in patients during their adulthood.

ADHD presents as failing to give close attention to details, a lack of attention in tasks, fidgeting, restlessness, interrupting or intruding upon others, and having a difficulty being still for an extended period of time [4]. These symptoms may lead to a decline in academic performance and can impact students’ social interactions. Specifically, constant restlessness and interrupting others may lead to rejection by others and peer relationship difficulties [6] . In addition, those with ADHD tend to have problems with schoolwork due to not being able to pay attention in class, difficulties completing assignments on time, and a lack of accommodations in the school environment [7].

Symptoms of ADHD are also related to executive functions, which include working memory, cognitive flexibility, and inhibition. In the brain, executive functions are mainly supported in the prefrontal cortex [8]. The Miyake-Friedman model discusses how these three functions –also referred to as updating, inhibition, and shifting– are correlated with each other, while still remaining separate entities [9]. Executive functions encompass attentional control, which deals with paying attention to certain stimuli [10], and cognitive control, which manages inhibition and motivation [11]. We can further examine the relations between ADHD and executive functions by investigating the impacts of this correlation on childrens’ academic performance and social relationships.

One study examining the impacts of executive function deficits and ADHD on adolescents’ academics found that those with ADHD and executive function deficits had a decrease in academic achievement and had a higher risk for impairments in academic functioning [12]. The study also found that those with ADHD tended to have executive functioning deficits as well. These impairments impede students’ learning, leading them to perform poorly without accommodations, such as extended time for tests. However, Lovett & Leja suggest that said accommodations should be tailored to each student and set generously, allowing as much time as possible for students to take assessments [13].

ADHD symptoms can manifest in young children and cause them to lose focus in class or be distracted easily. This lack of attention due to the disorder often leads to a decline in grades and less understanding of the material taught in class. School, for students with ADHD, may be a stressful environment with its competitive nature and a curriculum that is not conducive to those with behavioral and learning problems. In addition, many schools do not offer adequate accommodations, so tests and other assessments can become ineffective in assessing students’ learning as they may not get the time they need to complete the assessment. In the present work, I hypothesize that ADHD and executive functioning deficits will lead to a decline in students’ academic performance.

Results

ADHD

As children with these developmental disorders age, they tend to experience more problems in relation to school and academic performance. Loe and Feldman write how children with ADHD are shown to have significant academic underachievement, poor academic performance, and educational problems [14]. These learning problems are engendered primarily by symptoms of the inattentive presentation of ADHD [15], though the stronger a child’s symptoms, the lower their academic achievement [16]. These symptoms, as listed in the DSM-5, refer to acting out in class and having difficulties in social interactions. But, there are ways to help these children manage these behaviors.

Dreschler and colleagues suggest using cognitive behavioral therapy (CBT) to lessen these symptoms of ADHD [17]. In addition, the psychostimulants methylphenidate (Ritalin, Concerta) and amphetamine (Adderall, Dextradine, Evekeo) are commonly used to mitigate these behaviors. These two medications increase dopamine and norepinephrine activity, impacting executive and attentional functions [18]. Pan and colleagues propose a combination of CBT and medication to treat ADHD, which has proven more effective than either treatment by itself [19].

By combating ADHD symptoms, these treatments allow for a greater potential of academic achievement and an increase in academic performance. Medications decrease the intensity of symptoms, allowing students to focus in the classroom and engage with lessons. With this increase in understanding of the material, children with ADHD can perform better academically and engage more with their peers.

Executive Functioning

Pascual and colleagues researched how executive functions impact academic performance in primary school. Specifically, memory processes as well as motor skills were integral variables to the academic areas covered in the study [20]. Thus, when there is a deficit in executive functioning, the child’s academic performance begins to decline. Moreover, children with executive functioning deficits and ADHD are more likely to be placed in special education classrooms, when compared to those without [21].

Executive functioning deficits can be improved through treatments such as computerized training and mindfulness, with practice and when the challenge toward executive functions is progressively increased [22]. Otero and colleagues suggest that schools implement neuropsychological assessments to assist students as well. They also propose strategy instruction, focused on addressing executive functioning deficits through a systematic and structured teaching of the curriculum [23]. In addition, they recommend that we develop more curriculums that specifically target deficits in executive functioning to aid these students. These methods help students in understanding their learning styles and show them that they can take control of the situation and address the areas which need improvement. Furthermore, these strategies give more autonomy to the child, making them more responsive to treatment methods and engendering more independence in the student.

With these potential treatments for executive functioning, students may be able to achieve more academically, without being limited by these deficits. These methods may make it easier for students to complete assignments and assessments, thus overall improving their academic performance.

Further Detriments in Mental Health

ADHD has many comorbidities, including anxiety and depressive disorders [24] . With these additional conditions, the decreased academic performance resulting from ADHD symptoms may exacerbate symptoms of these comorbid conditions. Lower performance in school may lead students to think less of themselves, especially with the high standards they hold themselves to. This feeling of inferiority can worsen symptoms of depression and may even lead to the child developing symptoms of anxiety disorders, distressed by the school environment [25].

Disorders such as depression and anxiety can exacerbate executive functioning, further decreasing the student’s ability to understand and engage with material taught in school. This leads to a decrease in the student’s academic performance, which causes the students to feel worse about themselves, turning into a feedback loop negatively affecting the child’s mental health and performance in school [25].

Discussion

ADHD and executive functioning deficits negatively impact a student’s academic performance in a school setting. Evidence has revealed that ADHD symptoms of restlessness and inattention in students result in a decline in academic areas. Adolescents can face further mental health issues due to declining academic performance, including symptoms of depression and anxiety. In order to help these students, Fowler suggests using fidget toys and employing more interactive lessons in the classroom [26]. She also recommends having a structured task order and using models and planners to aid adolescents with executive functioning deficits and ADHD. Support from teachers and peers is a major factor in lessening mental health problems [27]. Further research, as highlighted by Qui and colleagues, may include more studies on mindfulness practices and how interventions for executive functions may affect social relationships and behavioral problems [28]. More research may be needed in areas surrounding treatments combining medications and therapy.

Material and Methods

We used the Google Scholar data repository to search for articles, using the keywords [ADHD, executive functioning deficits, executive dysfunction, academic performance, adolescents] We identified 28 papers based on if they examined adolescents, if they contained research on executive functioning or ADHD, and if the papers were published within a 25-year time frame. All the included research was conducted with IRB approval at respective institutions. We did not include papers which examined college students or children under 12 years old.

References

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