The new SEN Code of Practice and the introduction of Education, Health and Care Plans (EHCPs) advocate a model of integrated children’s services and improved inter-agency collaboration to support children with learning difficulties.
The question of implementation and a new culture of schools as commissioners of targeted support from other agencies, suggest there are significant challenges ahead.
Poor behaviour, often associated with ADHD, while finally included in the Code of Practice, is potentially problematic.
ADHD does not correlate with low intelligence and addressing the mental health needs of such children is crucial in understanding their under-achievement.
Cessation of School Action and School Action Plus are designed to prevent poor behaviour being categorised as SEN. The problem with this is that schools are often too slow in identifying children with learning difficulties.
Sadly the imperative for ADHD diagnosis usually arises because the child’s behaviour is difficult to manage – not because the teacher has identified a cognitive impairment.
Invariably children with ADHD have an additional learning difficulty such as dyslexia, dyspraxia, dyscalculia and sensory processing difficulties. As well as the core characteristics of hyperactivity, impulsivity, inattention, poor memory, children with ADHD often have low emotional resilience. They are easily frustrated and predisposed to anxiety and depression, which further undermines their cognitive functioning and attainment.
For a child starting school with ADHD, the very experience of classroom-based learning very quickly becomes a source of distress. Being asked to sit still, not fidget, concentrate, remember information and work independently is very difficult for children with ADHD.
Being disciplined constantly soon erodes the genetic love of learning and the child’s distress manifests in fight or flight behaviours, work avoidance or acting out.
Increased levels of stress hormones will start to affect how the child’s brain develops both structurally and functionally, putting them at greater risk of underachievement and developing mental health problems such as anxiety and depression.
Teachers must know how to tell the difference between ADHD type behaviours and inappropriate chosen behaviours so as to reduce learner anxiety in children with neurodisabilities such as ADHD. ADHD is not an excuse for poor behaviour – not for the child, the parent or the teacher – however the curriculum must be differentiated to address their needs to reduce instances of flight or flight behaviours.
Many children with ADHD achieve and behave well. The learner distress of these children often goes unnoticed – usually until the academic rigours of secondary school and exam performance takes its toll on their low emotional resilience (year 7 and year 11 are tipping points).
The key to improving outcomes for children with ADHD is early identification of ADHD characteristics and the need to implement strategies to support their successful integration into classroom-based learning.
New more accurate forms of testing such as QB Tests (measuring a child’s attention, impulsivity and movement) are improving the accuracy and speed of diagnosis.
The National Institute for Health and Care Excellence (NICE) estimates that ADHD affects
five per cent of children, however approximately only two per cent are actually diagnosed, meaning many children go undiagnosed and unsupported.
As a dimensional disorder, those with mild to moderate ADHD often stay under the radar. What is clear is that there is a lack of knowledge and understanding among teachers about developmental psychology, child and adolescent mental health, and the role this plays in learning and attainment.
Teacher colleagues classed as outstanding classroom practitioners are saying that in spite of great lesson plans, resources, and a track record of attainment, they are increasingly concerned about poor exam results and the lack of academic buoyancy and psychological resilience in pupils.
The threshold to access Child and Adolescent Mental Health Services (CAMHS) is such that many children with mental health problems cannot access support through counselling, cognitive behavioural therapy and the psycho-educative skills training they need in order to learn how to self-manage their mental health needs and learning difficulties. This is especially true of children with ADHD and 40 per cent of children on the autistic spectrum, with a dual diagnosis of ADHD and autistic spectrum disorder.
As local authority support in the form of behaviour specialists and educational psychology services disappear, the responsibility for ensuring specialist targeted support for vulnerable learners has been passed directly to the school. Many schools, however, have yet to embrace the culture of commissioning external agencies to help raise levels of attainment – particularly through providing mental health services to children for whom emotional distress is undermining achievement.
Behaviour Emotional and Social Difficulties (BESD) has been replaced by a new term, “Social Emotional and Mental Health” (SEMH). This is with a view to considering the behaviour “message” of underlying and unmet needs.
The new Ofsted framework requires schools to provide evidence to demonstrate effective practice and the impact of improvement strategies with regards to behaviour issues.
Without better training for teachers and better grasp of the impact that mental health has on behaviour, children with neurodisabilities will continue to underachieve and face a lifetime of disadvantage – their mental health in particular being further harmed as a direct result of schooling that does not understand the needs and vulnerabilities of children with ADHD.
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Dr Tony Lloyd is CEO of the ADHD Foundation. Visit www.adhdfoundation.org.uk