It is well known that students with attention deficit hyperactivity disorder (ADHD) experience significant academic problems. What is less clear is the extent to which these academic problems are due to ADHD itself or due to other risk factors known to be associated with ADHD. One psychological study in which I have been involved has investigated this question.
ADHD is defined by the DSM-5 as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”. Researchers have identified significant executive function, self-regulatory, cognitive, neuropsychological, and biochemical impairments or deficiencies associated with ADHD and we know these can impede school performance.
My study, published in the journal School Psychology Quarterly, studied almost 4,000 Australian high school students: 136 with ADHD and 3,779 non-ADHD peers from the same classrooms and schools. It aimed to identify which academic problems are linked to ADHD itself and which problems are caused by other (related) difficulties.
Personal risk factors known to impede students’ school performance were investigated. These included specific learning disabilities (such as with reading, writing, mathematics), low socio-economic status, low motivation, prior achievement difficulties, and even aspects of personality, such as low conscientiousness or high neuroticism.
Contextual risk factors that may also trigger academic problems were also investigated. These included socio-economic status, low school-average achievement, and poor staff-student ratios.
These personal and contextual risk factors were explored, alongside ADHD, as potential predictors of academic problems at school.
Academic problems in this study included failing a subject, not finishing schoolwork, changing classes, suspension, changing schools, expulsion, and school refusal.
The first set of analyses examined the simple association between ADHD and these academic problems. It revealed that ADHD was a significant predictor of six of the eight academic problems: grade repetition, failing a subject, not finishing schoolwork, suspension, changing schools, and expulsion.
We then analysed the other personal and contextual risk factors experienced by the students involved. This allowed us to identify the role of ADHD in academic problems beyond the effects of other risk factors. After accounting for these other risk factors, ADHD continued to predict four academic problems: schoolwork non-completion, school suspension, school expulsion, and changing schools (with ADHD also having a partial role in grade repetition). Thus, beyond the other personal and contextual risk factors experienced by students, ADHD played a significant role in increasing students’ academic problems.
Importantly, however, beyond the effects of ADHD, we found two other academic risk factors predicted students’ academic problems: lower prior achievement and specific learning disability in mathematics, reading, and/or writing. More precisely, beyond the effects of ADHD, low prior achievement was associated with grade repetition, failing a subject, not finishing schoolwork, changing classes, suspension, changing schools, and school refusal. Furthermore, beyond the effects of ADHD, specific learning disability was associated with grade repetition, failing a subject, not finishing schoolwork, changing classes, and school refusal.
These findings have important implications for psychologists and educators. They help identify what factors are and are not relevant to intervention aimed at assisting students with ADHD.
This study shows that there are some problems at school for which ADHD intervention is advisable, but others where attention to other risk factors is also critical. For example commonly recommended ADHD interventions involving medication, executive functioning (e.g., working memory, planning, control), and behaviour (e.g., reward schedules) are likely to be effective for some adversities (e.g., schoolwork non-completion, school suspension, school expulsion). For other problems, greater attention might be directed to a student’s specific learning disability or skill set relevant to his or her academic achievement.
These results illustrate that multidimensional intervention targeting ADHD and other related risk factors is necessary if we wish to get the best results for students in the school system who are at risk of significant academic problems.