ADHD in schools:Strengths based perspective

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ADHD is one of the most commonly diagnosed childhood ‘disorders’, and numbers of diagnoses are increasing both in the UK and internationally.  In essence, the neurocognitive deficits associated with this disorder are executive functions associated with cognitive control such as ability to control movement, planning, organisation, and inhibitory control.

There is much controversy regarding the veracity of diagnoses (highlighting the potentially subjective nature of self report survey and observation) and the treatment of ADHD using medication. Many commentators have highlighted the nature/nurture debate and suggested that in some cases, taking a closer look at family, school and peer contexts could enable better functioning than just medication, and that in some cases, there may be no need for the medication.

It is widely understood that children with a diagnosis of attention deficit / hyperactivity disorder may present challenges in terms of behaviour, and academic engagement. Sometimes, behaviour can mask what is going on cognitively, and as such, teachers have to work hard to ensure work is at sufficient level of challenge and that support is structured in a way that enables the child to thrive.

In a recent article published this year by the Canadian Psychological Association, it is claimed by the authors (Climie and Mastoras) that ADHD is most commonly viewed by schools and other support agencies through a ‘deficit’ lens. That is to say that children with a diagnosis of ADHD are more commonly identified by what they struggle with or cannot do, rather  rather than the strengths and abilities the children already have and what can be done to build capacity for the future.

It is argued (from a positive psychology perspective – the foundations of a strengths based perspective) that by starting with an individual’s abilities both in terms of assessment and intervention, can create more accurate picture of progress and capability. 

Mental health and emotional wellbeing perspectives have been through three major transitions. Pre WWII, alleviating mental illness was closely aligned with improving life satisfaction and promoting positive characteristics. Post war psychology turned towards a deficit model, in which an understanding of how and why people struggle and attempts to explain and control aspects of the ‘illness’ took precedence. In the final turn, at the start of the 21st Century, the concepts of capacity and talent  once again regained status in psychology research and practice.

In general ‘positive psychology’ (the emergent wave mentioned above), emphasises building and maintaining personal well-being by concentrating on key elements including positive emotion, engagement, relationships, meaning, and achievement.

Taking a strengths based approach also acknowledges the complex systems and influences on the individual – there may be some aspects of the individual’s life that is going really well or they are successful in, even if they experience difficulties in other areas.

Informed by resilience perspectives, the authors of this article propose “looking for and learning from success trajectories to identify critical protective factors within children and their environments most important for this population (Masten, 2014)”. The justification for this approach is that there is no ‘cure’ for ADHD and neither medical nor behavioural techniques alone eradicate the elevated risk for negative outcomes children with this diagnosis typically face.

Resilience research talks about protective Vs risk factors (protective factors helping to increase resilience whilst risk factors threaten resilience). Although research into risk and protective factors associated with ADHD are underdeveloped – the article does highlight some initial research in this area that suggests that “higher IQ, family marital and financial stability, lower early behavioural problems, and social skills were more predictive of better out- comes than the type of treatment received” (e.g., medication vs. behavioural training; Molina et al., 2009).

Maternal mental health, socioeconomic status, individual intelligence

and positive parenting practice (in research looking at parent training programmes) may also act as a ‘buffering’ factors , according to research cited in the article.

So what to do in schools?

The first suggestion the authors make is to introduce strengths based assessment. This means that “in addition to evaluating core ADHD symptomology and co-morbid risks, a strengths-based assessment would use interviews and/or strengths-based rating scales to probe positive areas”, for instance, if football is a skill and strength, how and why is this going well and how can these successes be applied in other contexts in the school environment? A strengths based assessment would also explore how a child is coping with challenges, what is helping to cope well with some challenges and how to transfer these coping skills to other contexts. Finally, a strengths based assessment will look at multiple outcomes rather than just academic progress – such as subjective well-being, life satisfaction, optimism, motivation, and self-esteem. This more valuable assessment technique is likely to be more time consuming but show a clearer and more complex picture of progress.

Within the classroom, the authors suggest that ‘using collaborative group activities, a child with ADHD might be valuable in contributing out-of-the-box ideas, whereas he or she may be less successful in a role of organizing group tasks, taking notes, or creating the timeline’. Planning will obviously need to be differentiated based on individual students, but a detailed data collection of past and current experiences both and out of school should inform this process.  Therefore it is suggested that teachers audit specific strengths and skills a student has and create ‘islands of competence’ from these points, so that the individual feels more confident, has higher self esteem and receives more positive feedback from peers, improving self perception. Encouraging active participation, wide range in variety of tasks, providing task-related choice, using computer-assisted instruction, and scheduling more expectations in morning periods are also all likely to build on strengths.

Children at risk of educational underachievement (not only those with ADHD) will benefit from improving and strengthening relationships with both staff and peers. This will also significantly support staff who are working with children with ADHD, since studies have suggested that developing a meaningful relationship in which staff feel they are an important influence in the child’s life go some way to ameliorating the stress and frustration sometimes experienced by challenging behaviour.

Here is the link to the article : https://www.questia.com/library/journal/1P3-3786190811/adhd-in-schools-adopting-a-strengths-based-perspective

We would welcome any ideas about good existing practice and suggestions for future practice. 

Please do leave your comments below!

 

 

Erik Erikson’s Developmental Stages

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An oldie but a goodie, Erik Erikson’s psychosocial stages of development is a theory central to our pedagogical understanding that educators have been drawing on since its emergence in 1959. So why a blog post about it now? I find myself having renewed interest in the stages of development in the context of rapid educational reform that is undoubtedly influencing teachers and students experience of work and school. I wonder what links there are between this developmental theory and current school climate and what significance this has for school policy and practice.

Erik Erikson was a student of Anna Freud, daughter of Sigmund Freud, Freud’s famous theories of psychoanalysis surely contributed to the basic outline of the eight stages Erikson later developed, at least those concerned with childhood. The key difference between the two is that whilst Freud believed that development was complete by adolescence, Erikson held the view that we continue to develop all the way through our adult lives. Eight stages were identified between infancy and late adulthood which, to be considered developmentally healthy, we pass through. Ecological and cultural factors combine with biological or genetic factors to draw out these innate challenges. Each individual experiences a psycho-social conflict of these two conflicting forces. If the individual confronts and masters the life challenge presented, he or she will gain a virtue that they carry with them throughout each further life stage. For example, in early adulthood, if a person has more intimacy than isolation, they enter adulthood with the virtue of love.

These stages are presented in more detail below:

Approximate Age Virtues Psychosocial crisis Significant relationship Existential question Examples
Infancy0-2 years Hope Basic trust vs. mistrust Mother Can I trust the world? Feeding, abandonment
Early childhood2–4 years Will Autonomy vs. shame and doubt Parents Is it okay to be me? Toilet training, clothing themselves
Preschool age4–5 years Purpose Initiative vs. guilt Family Is it okay for me to do, move, and act? Exploring, using tools or making art
School age5–12 years Competence Industry vs. inferiority Neighbors, school Can I make it in the world of people and things? School, sports
Adolescence13–19 years Fidelity Identity vs. role confusion Peers, role model Who am I? Who can I be? Social relationships
Early adulthood20–39 years Love Intimacy vs. isolation Friends, partners Can I love? Romantic relationships
Adulthood40–64 years Care Generativity vs. stagnation Household, workmates Can I make my life count? Work, parenthood
Maturity65-death Wisdom Ego integrity vs. despair Mankind, my kind Is it okay to have been me? Reflection on life

As can be seen in the table, the significant relationships that impact psycho social development broaden at each stage. School age children and adolescents have the capacity to be strongly impacted positively by their relationship with peers and trusted adults in the school community. The capacity of students to thrive in school and to progress through the developmental threshold will also be impacted by their experiences in previous stages, for example, whether they have experienced strong healthy attachment relationships, developed a sense of purpose and competence and had opportunities to experiment creatively and enjoy play.

Two stages  are especially of interest to educators and they are school age and adolescence.

During school age, children are developing a moral complex and experimenting with disobedience, rebelliousness and responsibility. This is also a critical stage for developing self confidence – “If children are encouraged to make and do things and are then praised for their accomplishments, they begin to demonstrate industry by being diligent, persevering at tasks until completed, and putting work before pleasure” (https://en.wikipedia.org/wiki/Erikson%27s_stages_of_psychosocial_development). If children perceive their efforts to be inadequate or do not feel that they gain meaningful recognition or praise from their teacher, and develop inferiority. Industry leads to an internal motivation to follow desires, ambitions and foster talents whilst inferiority is likely to lead to hostility, apathy, low self esteem. If teachers, as is being reported in the current press (https://www.tes.com/news/school-news/breaking-views/i-can-be-happy-–-or-i-can-be-a-teacher) are under increasing pressures of workload, higher levels of accountability and less emotionally and physically resourced, then it is likely that the important function of the teacher to enable children to manage this stage will be compromised. It is of fundamental importance that schools do not lose sight of the importance of the small moments of meaningful interaction, the investments of time and resources that over the child’s whole journey through education will powerfully influence their ability to engage academically, contribute to their socio-moral development and also raise teacher satisfaction and efficacy in the process. 

During adolescence, a particularly challenging threshold is presented, identity versus role confusion. Childhood to adulthood transition comprises significant biological development with rapidly increasing understanding of own identity and intentions as well as the needs and intentions of others. In this stage, adolescents “are confronted by the need to re-establish [boundaries] for themselves and to do this in the face of an often potentially hostile world.” (Stevens, 1983) This is particularly challenging since boundaries are enforced, expectations are raised and commitments are being asked for before particular identity roles have formed. In school, students are also summatively assessed, (significantly affecting future life chances), arguably right in the middle of a stage of experimentation, exploration and self discovery which might not be conducive to methodical application of knowledge to standardised testing. Better methods of tracking progress in multiple ways (not just summative test data), allowing more agency, participation, making content relevant and challenging, and allowing time for creative exploration and collaboration are both vital to school success in supporting adolescents.

Current educational climate has the ability to affect professionals in their own personal development too. The most significant stage, generativity versus stagnation, is concerned with making a difference, caring for others and having virtue. Although these desires are primarily what attracts teachers to the profession, it has increasingly been reported that disparity between these ideals and the reality of teaching is the primary cause of the current teacher retention crisis. In order to get the best from their teachers, schools will need to prioritise teacher support (non judgemental and non pay related) and develop a strong sense of school community that draws from shared values of holistic wellbeing and equal participation of staff and students, in addition to reducing administrative tasks and fostering and celebrating staff strengths and achievements.

It is my view that in the current educational climate of increased testing, target setting and accountability; using theories such as Erikson’s psycho-social stages to develop assessment tools (looking at which developmental stages have been problematic), monitor progress and create school policy, will ensure that schools maximise their special position to be able to impact staff and student development and to tell the story of progress more holistically than purely academic data.

As always, we welcome your views on the blog post, questions and personal anecdotes or tips based on own practice. Please comment below and remember, you don’t need to sign in or sign up to do so.