Recently, the NY Times ran an excellent article entitled: A Natural Fix for ADHD. In this piece, Dr. Richard Friedman, Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at Weill Cornell Physicians, explores the neuroscience behind ADHD (Attention Deficit Hyperactivity Disorder). In so doing, Friedman attempts to reframe our understanding of just what ADHD is, and how much more nuanced our approaches for treating it need to be.
Photo credit: Mararie
On the one hand, advocates of pharmaceutical interventions like Ritalin and Adderall point to the substantial scientific and anecdotal evidence confirming that ADHD medications help students concentrate in the classroom and better manage their workloads at home. Many teachers consider these medications essential in terms of classroom management, as untreated students with ADHD can derail class discussions and require the teacher to devote enormous wells of energy just to keeping the class in line. (That said, it should be noted that ADHD manifests in many forms and affects quieter students at high rates as well; in fact, ADHD can take an even more serious toll in this case, as it often goes undiagnosed for much longer). For these reasons, it is not uncommon to hear teachers, parents, and even students themselves refer to ADHD medications as a “miracle.”
However, take a scroll through the comment section of any article written in support of these medications, and you are bound to see many commenters offering stories of inappropriate medication use. ADHD is often used as a catch-all diagnosis for all perceived behavioral issues, as it is easier to prescribe medications without probing further into root causes of outwardly displayed symptoms. Many parents and students describe feeling pressured into taking medication, and often lower resource students aren’t given any outside support beyond the prescription. When these students become adults, they describe feeling like they were pathologized for brain chemistry that was out of their control.
And yet every teacher, counselor, and administrator knows the frustration that ensues when a student clearly has ADHD and a family dismisses the medication route out of hand. Many counselors feel that treating ADHD with medication is just like treating depression, anxiety, and any other condition that arises in the brain.
Is there a compromise to be made here by stitching together a pharmaceutical, behavioral and pedagogical approach customized to suit the unique needs of the individual student? The answer to that is a clear yes — but in order to get to what that approach might look like, we first must begin with a deeper look at ADHD itself.
ADHD may sound like a singular diagnosis, but it actually falls into three different subtypes. For students who mostly exhibit symptoms of inattentiveness, studies indicate that the neurotransmitter norepinephrine is at the root of the problem; that is, these students have variations in their norepinephrine transport genes that make it so that the amount of norepinephrine circulating in their systems is different than that of neurotypical control subjects.
In contrast, students with the hyperactivity-impulsivity ADHD tend to have fewer dopamine receptors. As Dr. Friedman describes it in his NY Times article, dopamine is a part of our brain’s reward pathway, so with fewer receptors available, students with this kind of ADHD need more stimulation in order to keep their minds’ from wandering. By blocking the reuptake of dopamine, stimulants like Ritalin and Adderall keep the levels of dopamine high in the brain, while a nonstimulant like Strattera blocks the reuptake of norepinephrine. In this way, all three medications (and medications like them) help students to focus.
(Wondering what the third subtype of ADHD is? A combination of the previous two.)
Look up any definition for ADHD (from WebMD to the DSM-IV) and you will find a laundry list of oft-repeated symptoms: easily distracted; has trouble maintaining attention; disrupts class; fidgets; always on the go; blurts out answers; butts into conversations. The list goes on.
But while these symptoms may be clear, there is less agreement on just how to interpret them. For instance, when Stephen Tonti spoke about his ADHD at TEDxCMU, he argued that attention “deficit” is a misnomer, as people with ADHD can hyperfocus when the task at hand interests them. Instead, he locates the heart of his difficulty in selecting something to apply that full attention to, and argues that what he experiences is a difference in cognition rather than a disorder. He is, in his own words, “attention different.”
In his NY Times piece, Dr. Friedman focuses on the tendency of the ADHD-brain to seek out novel experiences. In so doing, he argues that ADHD was once evolutionarily adaptive, pointing to a recent study of the Ariaal, a mostly nomadic tribe in Kenya with a recently splintered and settled subgroup. The study found that nomadic men with a dopamine receptor variant related to ADHD were more likely to be well-fed, while those with the variant in the settled splinter tribe were gaunt. Friedman hypothesizes that ADHD is adaptive for a dynamic environment, in which novelty-seeking and a short attention span actually keep nomads aware of their surroundings and make them better hunters. In contrast, ADHD becomes problematic in a more sedentary culture where activities like school, farming, and selling goods require more sustained focus.
This explanation gels with a critique often raised by ADHD advocates: that it is not the ADHD-brain that is problematic, but an overly regimented school environment constructed for an industrial age with a high need for workers and bureaucrats. Still, whether you agree with that statement or not, this is the system we have right now, and students with ADHD will need to navigate it both here and as they enter the work world. What’s more, teachers must have the ability to teach their classes without constant interruptions.
Many students with ADHD work best with hands-on learning. As such, to appeal to their learning style, it is often better to “do” rather than “tell.” Whether it’s engineering their own popsicle stick building, manipulating blocks, typing on a computer, drawing illustrations for a class book, putting science into action in the lab, participating in a Maker Fair, or getting to be the “teacher for the day,” hands-on activities are sure to engage and build confidence.
That said, it’s important not to assume that all students with ADHD will be kinesthetic learners, and to engage students in the modality that most speaks to them.
If we know that students with ADHD are novelty-seeking, why not use that to our advantage? Keep lectures as short as possible, and rotate students often through activities. While it is important to keep students with ADHD organized with a structure you have provided, changing the routine up once in awhile will be a nice surprise and will help prevent boredom. Encouraging students with ADHD to pick up extracurricular activities can also be useful, as it will allow students to hyperfocus with their passions and also to nibble at many different tasks throughout the day.
If you’ve determined that your student with ADHD is a kinesthetic learner, there are many creative ways to incorporate movement into the classroom. When reviewing questions for an upcoming test, try tossing a ball to students you want to call on rather than addressing them by name. Acting out great scenes from history will embed facts and dates deeply into student minds, as will turning letters and sounds into characters and acting out their characteristics as you are teaching a class to read. And never underestimate how fun it can be to simply get out of that desk, stretch, and do a little dance break!
Teaching mindfulness in the classroom is becoming an increasingly popular technique, and one that can be particularly helpful for students with ADHD — although a student with ADHD may need intensive, individual coaching in this area. In so doing, it can help to have reminder words that you can say to let a student know when it might be time to pull back for a moment, reflect, and draw on the mindfulness techniques you’ve covered previously.
All students deserve a customized, student-centered learning experience, but students with ADHD will need extra attention in developing sets of tools and strategies for navigating the classroom. Smaller class sizes would be ideal here, but since class size is beyond teacher control, it can be more useful for teachers to advocate for a tutoring or mentoring program for the school. With one-on-one attention, students with ADHD will have someone there for them to help provide structure and stay on top of their progress, while also translating the neurotypical classroom experience for them, and helping them to develop the skillsets they need to operate well in school and beyond.
Students with ADHD are highly intelligent and packed with potential, just as long as they are given the resources they need to thrive. That may mean medication, but that also means working hard to find customized teaching and behavioral strategies as well. In the end, only a nuanced, multi-pronged approach will prove effective — all the more so when those approaches are backed up with a diverse support network.
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