New studies of ADHD

Here, I want to present four recent studies related to ADHD. The first, presented by Six Things Psychologists Are Talking About (2022) addresses “ADHD Medication Effects.” Here’s the abstract:

A study in the Journal of Consulting and Clinical Psychology indicates that medication for attention-deficit/hyperactivity disorder (ADHD) has no detectable impact on how much children with ADHD learn in the classroom, but it does impact their classroom behavior. Researchers evaluated 173 children in the United States between the ages of 7 and 12 with ADHD who were participating in a therapeutic summer camp. Over eight weeks, children engaged in two daily half-hour instruction sessions in vocabulary as well as in science and social studies. Each child was randomly given a stimulant medication during either the first or second instructional session, and a placebo during the other. Children learned the same amount of science, social studies, and vocabulary content whether they took the medication or the placebo. Medication did, however, help children complete a higher percentage of in-class assignments and improve their classroom behavior. When taking medication, children completed 37% more arithmetic problems and committed 53% fewer classroom rule violations. 

I love this study because it concludes that medication for ADHD impacts behavior more than learning. The second study is a nice follow-up. Chunta & DuPaul (2022) published “Educational Diagnostic Label and Teacher Self-efficacy: Impact on classroom intervention choice” in School Psychology.  Here’s an edited version of the abstract and impact statement:

Children with attention-deficit/hyperactivity disorder (ADHD) and specific learning disabilities (SLD) face similar academic and behavioral challenges. Although combined behavioral and academic interventions (AIs) are among the most effective for each disability. This study examined the relationship between diagnostic label and teacher self-efficacy on intervention choice using a sample of 206 general education elementary school teachers (female = 69.9%; White = 60.7%). Results showed that teachers were significantly more likely to endorse AIs for children with SLD as compared to ADHD (ds = 0.29–0.35), even when children had identical academic needs. Furthermore, self-efficacy did not moderate this relationship but was an individual predictor of intervention endorsement. General education elementary school teachers are more likely to select academic interventions (AIs) for children with learning disabilities as compared to ADHD, based on the student’s diagnostic label as compared to their specific areas of need. Consequently, academic needs in children with ADHD may be overlooked based on the impact of their diagnostic label on intervention selection. Although teacher self-efficacy may predict teacher selection of specific class-based AIs, it does not moderate the relationship between diagnostic label and intervention selection. 

I find this study important because it emphasizes that teachers may inadvertently deny academic interventions that would benefit children with ADHD. The third article looks at self-regulation. Champ, Adamou & Tolchard (2022) published “Seeking Connection, Autonomy, and Emotional Feedback: A self-determination theory of self-regulation in Attention-Deficit Hyperactivity Disorder” in Psychological Review.  

Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent and highly debated diagnoses for mental disorder in practice today. Current cognitive behavioral-based theories aim to identify the etiology of ADHD and experience challenges in accommodating the full spectrum of both neurobiological and behavioral research evidence. Characterizations historically associated with mental illness have generated public stigma, influencing low self-esteem, negative self-concept, and identity development in ADHD individuals. Recent research in psychology recommends developing approaches beyond symptom control and seeking to develop positive psychological factors and well-being. We propose that the perspective presented by self-determination theory (SDT) on human motivation, self-regulation, and self-determination offers a new understanding of ADHD research evidence and symptomology. According to this theory, humans have a natural tendency toward growth and self-actualization. 

Psychological theory impacts how disorders are understood and defined. We review current psychological concepts of ADHD, demonstrating a common deficit-based perspective drawn from cognitive-behavioral theory. We argue this perspective does not account for variations between individuals or the importance of the context, and automatically defines neuro processing differences as abnormal. Self-determination theory (SDT) provides an alternative approach to self-development, presented as the foundation for a positive perspective on ADHD and key to developing new models and treatment approaches. Deficit-based models identify ADHD neurobiology and resulting behavior as abnormal leading to stigma and a negative sense of self. SDT recognizes variables that research shows are strong in ADHD, like interest and autonomy, as main features supporting internal motivation and self-determination. Viewing ADHD neuro processing through an SDT lens shows ADHD as a natural difference within neurodiversity providing a new understanding and insights for treatment.

I think this work is important in emphasizing positive approaches to ADHD. In the final article, Maguire (2022) published “Building Social Capital is Critical for Strong Relationships. ADHD can get in the way” in Washington Post. Here’s the edited article:

While most people think of this disorder as causing difficulties with completing assignments in school or the workplace, it can also lead to a deficit in what experts call “social capital.” Once you amass social capital, you can then draw on it by asking for help when needed. Children and adults with ADHD sometimes lack social capital due to poorly managed ADHD, e.g., failure to treat symptoms — such as not paying attention or being disorganized — with medication or counseling, can lead to relationship problems. Even those who are being treated might skip their medication during the weekend, believing it’s unnecessary if they’re not at work or school. But weekends are when people socialize with friends or family. 

A second problem is trouble with social cues. Even with the proper medication, people who have ADHD may still struggle with paying attention to social cues.

In social situations, people with ADHD may impulsively interrupt conversations or have trouble waiting their turn during a game. 

A third problem is lack of face-to-face peer interactions. Children who have ADHD might avoid in-person interactions because their difficulties with social cues lead to shallow connections. They’re often drawn to video games because of the stimulation they receive from them.

The fourth problem is difficulty with executive-functioning skills. Organization, planning and memory are helpful not only in school or the workplace, but also in relationships. If a person with ADHD is always late to meet a friend for lunch, then that friend could eventually feel they can’t rely on that person or they don’t value their time. People with ADHD sometimes struggle with what experts call “time blindness” — when you are unaware of the passage of time. 

A lack of social capital may translate to a lack of friends. A 2021 study done at the Peres Academic Center in Israel found that parents of children with ADHD perceived their kids as lonelier than those without the diagnosis. A 2019 study conducted at the University at Buffalo showed that adults with ADHD experienced more interpersonal problems compared to those without the diagnosis. They may try to make up for their lack of social capital by being people-pleasers. Alternatively, they may overpromise to make up for past mistakes. 

One way to build social capital is by managing ADHD symptoms through medication and counseling. Another way to help people with ADHD be successful in relationships is to create routines and structure. A second is to set up positive social environments. Ramsay said that often children don’t have a social-skills deficit; rather, they have trouble understanding when to appropriately use the skills. People with ADHD can improve their social skills through an exercise Maguire created called “Social Spy.” Go to a location where people like to gather and watch them (discreetly), paying attention to social norms like turn-taking. Then challenge yourself to detect social cues. Robertson suggested turning tasks into games for both kids and adults, to make them more interesting and enjoyable. “ADHD brains are at their best when they’re having fun,” the clinical social worker wrote in her book. For example, you could say, “I’m going to time you and see how fast you can put the laundry away.” You could ask them to guess how fast they can do the task or see if they could beat their record from the last time.

Parents may need to educate teachers or their child’s friends about ways their child with ADHD might struggle with relationships. Kids and adults with ADHD may also need to help other people understand their disorder. 

I love this article because it both defines problems and offers helpful solutions. Taken together these articles all offer a more positive ways to think about and help people with ADHD.