ADHD & BEHAVIORAL ISSUES IN

SCHOOL SETTINGS

Sheza Naeem
Institute of Psychology
 ADHD

• Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder marked

by persistent inattention, hyperactivity, and impulsivity that impairs functioning or
development.
• Diagnostic Criteria (DSM-5):
• Inattention and/or hyperactivity-impulsivity present for at least 6 months to a degree that
is inconsistent with developmental level.
• Subtypes:
• Predominantly Inattentive Presentation
• Predominantly Hyperactive-Impulsive Presentation
• Combined Presentation
 ADHD MANIFESTATIONS IN THE SCHOOL SETTING

• Academic Challenges:
• Difficulties in sustaining attention, following instructions, and organizing tasks.
• Struggles with completing assignments and tests within time constraints.
• Behavioral Concerns:
• Frequent interruptions, talking out of turn, fidgeting, and inability to stay seated.
• Impulsive decision-making, leading to conflicts with peers or teachers.
• Social Implications:
• Potential for social isolation, difficulty forming friendships, increased likelihood of
conflict with authority figures.
 CASE STUDY EXAMPLE

Elena is a fourth-grade student recently diagnosed with ADHD, predominantly inattentive type. Her teacher has
noticed that she often daydreams during lessons and has difficulty following multi-step directions. She
frequently loses her supplies, like pencils and notebooks, and is easily overwhelmed by group assignments. She
completes tasks much slower than her peers, often missing the chance to participate in classroom activities
because she’s still working on previous assignments.
Behavioral Observations:
• Inattention: Elena zones out during instruction and struggles to re-engage, often requiring direct prompting
from the teacher to stay on task.
• Organization: She misplaces her work and supplies almost daily, which disrupts her ability to complete
assignments on time.
• Social Dynamics: Other students have noticed her distracted behavior and occasionally tease her, calling her
“spacey.” She seems aware of this and shows signs of frustration and low self-esteem, but doesn’t know how
to address it.
• Teacher Concerns: Her teacher is unsure how to balance her support needs with the demands of the
classroom. Frequent redirection disrupts the class, her missed work is accumulating. The teacher wonders
whether individualized attention might help or if there’s a way to build Elena’s organizational skills without
isolating her.
 THINK ALONG THESE LINES…

• What specific classroom accommodations could help Elena manage her

inattention and organization difficulties without disrupting her peers?

• How can the teacher address the social impact of ADHD on her peer
relationships to prevent bullying or social exclusion?

• How might her frustration and low self-esteem impact her learning?

• Are there strategies to build her confidence in the classroom?

 CASE STUDY INTERVENTIONS

• Environmental Adjustments: Recommend seating her closer to the

teacher or away from high-traffic areas to reduce distractions.
• Task Modification: Break down assignments into manageable steps with
visual aids, and provide frequent, positive reinforcement as she completes
each step.
• Use of Visual Cues and Reminders: Implement organizational supports,
like a checklist for her materials or a “finished work” bin to keep her desk
organized.
• Extra Time for Tasks: Allow her additional time for completing
assignments and tests. This helps reduce stress and allows her to focus
without feeling rushed.
Implement Social-Emotional Support
• Teach Social Skills
• Empathy and Inclusivity Activities
• Supportive Peer Buddy System

Build Self-Efficacy and Confidence

• Goal-Setting and Self-Monitoring
• Use of Positive Reinforcement/Reward Systems
• Teach Coping Strategies
Educate and Support the Teacher

• ADHD Professional Development: Provide information and

strategies on managing ADHD in the classroom, tailored to Mia's
specific needs.
• Emotional Support for Teachers: Acknowledge the teacher's
efforts in managing a classroom with diverse needs and offer
support and resources to help manage Mia’s behavior alongside
other classroom responsibilities.
 BEHAVIORAL ISSUES VS. ADHD IN
SCHOOLS

• Distinguishing ADHD from General Behavioral Issues:

• Behavioral Issues: Often situational and linked to external factors like home environment,
stress, or trauma.
• ADHD: Intrinsic neurodevelopmental disorder with consistent patterns across settings and
time.

• Overlap and Co-Occurrence:

• Behavioral issues such as Oppositional Defiant Disorder (ODD) frequently co-occur with
ADHD.
• Importance of thorough assessments to identify primary concerns.
 EXAMPLES OF BEHAVIORAL ISSUES VS. ADHD

1. Oppositional Defiant Disorder (ODD):

• Characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, and
vindictiveness.
• How it differs from ADHD: While children with ADHD may exhibit impulsive or disruptive
behaviors, these are usually due to inattentiveness or hyperactivity rather than intentional
defiance or hostility. Children with ODD often refuse to comply with rules or requests and
may exhibit this behavior specifically towards authority figures.
• A student with ODD might argue with the teacher about classroom rules, challenge
instructions, or actively refuse to participate in certain activities, whereas a student with
ADHD might struggle to follow the same rules due to forgetfulness or distractibility rather
than defiance.
 ANXIETY-RELATED BEHAVIORS

• Anxiety can manifest in school as avoidance behaviors, excessive worry, or

difficulty concentrating due to preoccupation with anxious thoughts.

• How it differs from ADHD: A student with anxiety may appear distracted or
inattentive, but this is typically due to internal worry rather than an inability to
sustain attention. Anxiety-driven behaviors are often situational and may occur
during specific activities that trigger anxiety, whereas ADHD-related inattention is
more consistent across settings.

• A student with anxiety might avoid group activities or have difficulty focusing
during tests due to anxiety about performance, while a student with ADHD might
struggle with focus across all activities and subjects.
 CONDUCT DISORDER (CD)

• Conduct Disorder involves more severe behavioral issues, such as aggression

towards others, destruction of property, deceitfulness, and serious rule
violations.
• How it differs from ADHD: CD behaviors are intentional and often reflect a
disregard for others’ rights or societal norms. In contrast, ADHD behaviors
are generally unintentional and linked to inattention or impulsivity rather than
a lack of respect for rules or others.
• A student with CD might steal from classmates, engage in physical fights, or
vandalize school property. A student with ADHD might impulsively take
something without permission but is less likely to engage in planned,
rule-breaking behaviors.
 SENSORY PROCESSING DISORDER (SPD)

• SPD can cause children to have heightened or reduced sensitivity to sensory

inputs, leading to disruptive behaviors as they react to their sensory
experiences.
• How it differs from ADHD: While students with ADHD may appear fidgety
or restless, those with SPD are often responding directly to sensory discomfort.
Their behavior may vary depending on the sensory environment, whereas
ADHD behaviors are typically present across environments.
• A student with SPD might cover their ears, avoid certain textures, or have
difficulty sitting still due to sensory overload. A student with ADHD, on the
other hand, may fidget due to hyperactivity rather than a response to sensory
stimuli.
 CASE STUDY – ALEX, AN 8-YEAR-OLD WITH
BEHAVIORAL CHALLENGES

Alex, an 8-year-old, frequently talks back to his teacher, avoids

assignments, and sometimes leaves his seat to walk around the classroom.
While he has some difficulty focusing, he’s particularly oppositional during
structured activities.
Discuss:
Is Alex displaying ADHD symptoms, or might his behavior suggest
something else?

What further information would you need to determine if Alex’s

behavior is related to ADHD or another issue?
 ASSESSMENT TOOLS FOR DIFFERENTIATION

• Teacher and Parent Questionnaires: Use tools like the Conners Rating
Scale or BASC-3 to gather comprehensive perspectives on behavior
across settings.
• Behavioral Observations: Observe the student’s behavior in different
contexts (classroom, recess, etc.) to note consistency and triggers.
• Functional Behavior Assessment (FBA): Identify specific antecedents
and consequences of behavior, which can provide clues about whether
behaviors are impulsive (ADHD) or purposeful (e.g., ODD, CD).
 INTERVENTION STRATEGIES TAILORED TO
BEHAVIORAL ISSUES

• For ADHD: Strategies like visual cues, structured routines, and positive
reinforcement for on-task behavior.
• For ODD: Implementing clear expectations and consistent consequences,
while avoiding power struggles.
• For Anxiety-Related Behaviors: Coping skills training, quiet spaces for
calming, and gradual exposure to anxiety-provoking tasks.
• For SPD: Creating a sensory-friendly classroom with options like
noise-canceling headphones, fidget tools, or sensory breaks.
 EVIDENCE-BASED INTERVENTIONS FOR ADHD
IN SCHOOLS

Behavioral Interventions:
1. Positive Reinforcement (e.g., reward systems for staying on task).
2. Self-Monitoring Techniques (teaching students to track their behavior).
Environmental Adjustments:
3. Minimizing distractions in the classroom.
4. Providing structured routines and visual schedules.
Medication Management:
5. Stimulants (e.g., methylphenidate, amphetamine-based medications).
6. Consideration of potential side effects and individualization.