Teaching English to students with Attention Deficit (Hyperactivity) Disorder

Dr. Anne Margaret Smith

In a previous article I offered an overview of the most common Specific Learning Differences (SpLDs) and focussed on dyslexia, especially in relation to English language learning. In this article, the focus is on another of these very common SpLDs – Attention Deficit (Hyperactivity) Disorder, more usually known as AD(H)D. This is another developmental difference in the brain that can have significant impacts on learning, and this article will first of all outline the distinguishing characteristics of learners that may have AD(H)D, before discussing the ways that language learning may be affected, and suggesting some strategies that could reduce the effects and encourage successful learning.

First of all, it is important to remember that these SpLDs rarely appear alone, so often learners who already have an identification of dyslexia or dyspraxia may well show some characteristics of AD(H)D as well. The second thing to note is that the name is completely misleading. It is not a lack of attention at all that leads to the particular behaviours that we notice, but rather too much attention:  a focus on everything in the immediate environment, all at the same time. The key issue is an inability to filter out things that are not relevant to the task in hand.  The ‘H’ is shown in brackets here, because the hyperactivity is not a key characteristic in all people with ADD. Some have the attention and focus issues, but do not experience the excess of energy that constitutes hyperactivity.

Key characteristics of AD(H)D

It is important to recognise that AD(H)D is not just poor behaviour. It is not the result of too many sweets or too much computer game playing, nor is it due to poor parenting (although all of these factors may play a role in the way that it is managed).  Neuroimaging has confirmed that there are differences in the way the brains of people who have AD(H)D function. It is thought that the particular patterns of neurological development seen in these people mean that the hormone dopamine is not transmitted easily. Dopamine is needed for emotion regulation and attention focussing – particularly when there are choices to be made about where to focus. It seems that a lack of dopamine will lead a person to choose the options with the most immediate rewards, rather than thinking about long-term benefits.

There are three main indicators of AD(H)D:
i) inability to focus attention on one thing at a time and to sustain attention for any length of time;
ii) impulsivity in responding to stimuli, not planning or thinking through actions, or working within social conventions (for example in conversational turns);
iii) excessive energy levels, or hyperactivity, leading to constant motion even when sitting down.

People at different ages will show their AD(H)D in different ways, but it is not something that people grow out of. As with dyslexia, they may find ways to reduce the effects of the SpLD, but they will always have some traces of it in their daily lives. Younger children may seem to have unlimited energy, running around constantly without any particular aim, and they may be very impulsive, moving before they have considered the situation, and reacting before thinking about what they want to say. This can make it very difficult for them to play with other children, and they get upset easily, or feel that things are not fair if they do not get their way. If they do sit down, there may be fidgeting and constant moving (rocking or squirming) even when sitting on a chair. Injuries (ranging from bruising to broken bones) are very common in this age group, as the constant running, climbing and jumping often leads to falling and bumping into things. Many teachers and parents reading this may think that this describes all the young children they know, but the key is the degree to which these behaviours are seen. While most children like to run around and seem to have more energy than us, the majority will also be happy eventually to sit for a while and have a story or a quiet game. If the attention to everything, the excessive energy and the impulsiveness persist in an extreme form for more than 6 months, and are apparent in more than one setting (i.e. not just at home but also at school, in shops, in church or other public places) then it is possible that AD(H)D may be the cause. A medical practitioner would need to make the formal diagnosis, as this is still considered a medical condition. Here, however, we are considering only the educational impact of it as a SpLD.

Teenagers with AD(H)D may seem calmer, as they learn to control their behaviour, to fit in with their peers. However, they may report feeling restless inside; they may talk in sudden bursts and find it hard to regulate their volume, or to notice turn-taking cues. Some young people with AD(H)D seem to do many tasks quickly but not accurately, because of not paying attention to details, and therefore be prone to taking risks. Exercise seems to help, with many people reporting that after intensive physical activity they feel calmer for a while, probably due to the increased release of dopamine. A key characteristic associated with AD(H)D is anxiety, and this may be made worse by lack of success in education. Persistent worries about not getting work done, getting things wrong or saying or doing the wrong thing socially may show itself in nail-biting, constantly seeking approval, or refusing to comply with instructions that might lead to them taking part in a new activity or a new experience. Of course, many adolescents experience lower self-confidence as they take on more responsibility and have to make more life-determining decisions, but for those with AD(H)D, the lack of self-esteem may be marked and prolonged.

As these young people become adults, they may find that they learn to manage more different situations better. However, many will still find that in situations that evoke strong emotions in them (whether grief, anger or joy) they will find it hard to control their behaviour. Another difficulty that persists in adults with AD(H)D is with using working memory – the ability to hold information in the mind for  short time while using it to accomplish a task. This can lead to problems with following instructions and completing tasks, and can obviously affect their work-place relationships.

All of these characteristics can affect the daily lives of people with AD(H)D, and it is not hard to imagine how they might also affect language learning. 

The impact of AD(H)D on language learning

Students with AD(H)D are often a challenge to have in the language classroom, even for the most accommodating teacher. These students find it hard to stay on-task, being easily distracted, for example, by a passing car outside the window, the change in light as the sun goes behind a cloud or a conversation on the other side of the room. While they may be paying attention to everything else going on, unfortunately, they may not be able to focus on the details of language and may find it hard to remember which letters represent which sounds, or where punctuation should go to make sense of a sentence. They are not helped by their working memory issues, which may mean that they forget what they are writing before they complete their sentence. While they may enjoy the communicative side of language learning, students with AD(H)D are more likely to develop fluency at the expense of accuracy. In terms of pragmatic competence, some students may find that they become impatient with peers who cannot respond as quickly as them (or who are more concerned with accuracy than fluency), and start to disregard turn-taking conventions. This impulsivity can make interaction difficult and lead to tension in the group dynamics. However, the students with AD(H)D may not pick up on the social signals that their peers are sending, and so do not become aware that they need to modify their behaviour to maintain their relationships. 

How to manage AD(H)D in the language classroom

The role of the teacher is clearly to manage the classroom situation to the benefit of the learners, and this can be challenging when students with SpLDs are included. However, there are a number of strategies that can be implemented to make the classroom a place where everybody can learn. Some students who are identified as having AD(H)D are prescribed medication that can help them regulate their emotions, and their attention. This inevitably has some side-effects, and therefore some parents and young people decide to manage the situation without the use of medication. Some people find that altering their diet can have a dramatic effect on their ability to concentrate, and it is certainly worth exploring this possibility. Indeed, the best outcomes are usually achieved by students who are open to a combination of medication, dietary intervention and behavioural counselling to make them more aware of the triggers that might lead to inappropriate or unacceptable behaviour.

There are many small things that teachers can do to make the classroom easier for the learner with AD(H)D. For example, although it is nice to have bright colourful pictures and students’ work on the walls, it is advisable, if at all possible, to keep the wall around the board (or screen) free of other items. That way, the learner will find it easier to focus only on the board and the teacher. Some learners benefit from being allowed to wear headphones when working individually, perhaps playing quiet music to provide a consistent background, rather than being distracted by occasional noises in the room. If the learner constantly fiddles or doodles while listening, this may be a way of helping him/her to concentrate. The trick is to make sure that the fiddling is not disturbing for other learners, and if possible, that the doodling serves as a form of note-taking. Rather than having a pen clicking on and off, offer the learner a piece of blutac or a wikistik – something silent and unbreakable – and suggest that the doodling learner draws something relevant to the lesson, that will jog the memory when s/he looks back at it.

Lessons need to be divided into a series of fairly short activities (5 – 10 minutes ideally) with plenty of variety in terms of the type of input and action required. It can be helpful if the outline of the lesson is available for the learners to see, so that they always know how far they have got. Some of the activities should also involve moving around the classroom, or at least getting off the chair. All learners benefit from a bit of physical movement, but for those with AD(H)D it is absolutely crucial for their concentration. If the task is a reading or writing task, the instructions need to be absolutely explicit, and broken up into short manageable goals. For example, tell the student: “you have five minutes to write 3 sentences – I’ll come and see how you are doing then”. A timer showing how the 5 minutes is going can be helpful, helping the learner to stay on track at least for a specified period. This also gives the opportunity to praise them, if they manage it, thus raising self-esteem.

 Fintan O’Regan (2006) outlines a 5-pronged approach that he has found useful in working with students with AD(H)D, which he calls SF-3R. The first two elements are Structure and Flexibility. Students need to know what is expected of them at any point in the day, what the rules are and where the boundaries are. Equally, teachers may need to exercise discretion when applying sanctions. Learners with AD(H)D are habitually in trouble for one thing or another, which is tiring for both the teacher and the student, who may end up feeling s/he can do nothing right. Sometimes it may be necessary to bend rules slightly in order to avoid constantly punishing a learner for minor things. The main thing is that the learning objectives are met, even if some classroom rules are overlooked.

The 3 Rs of the O’Regan model (2006) are Respect, Relationships and Role Model: 3 elements which are all closely related. The relationship that the teacher forms with the student with AD(H)D is crucial to his/her success in language learning. The teacher must take the lead in this, by recognising the student as a person who would like to succeed, like any other learner, and trying to establish a productive working relationship by modelling the kind of mutually respectful interaction that would be expected in the classroom. It is important that the teacher consistently and promptly points out when behaviour is not acceptable, and gives explicit direction about what is expected. Establishing some common ground can be helpful (perhaps a shared interest, or a local connection) as a way of starting difficult conversations, and signalling that any negative feedback is not personal. In my experience, I have found it easier to keep my temper, and remind the learner again of what s/he is supposed to be doing, if I also remind myself how hard it is for learners with AD(H)D to control their attention; in my mind I try to separate the learner as a person from the behaviour that s/he exhibits. S/he is not deliberately trying to be difficult, and a small success for him/her will mean so much more if it is recognised and praised, so finding opportunities to praise for appropriate behaviour or attempts to stay on task is really important. Praising as well as telling off needs to be done promptly, to make sure the learner makes a connection between the behaviour and the feedback.

Raising awareness of the challenges faced by learners with AD(H)D and other SpLDs amongst classmates and staff can be very helpful in helping to provide a support network for the learners with AD(H)D. In the English language classroom this might be approached as a discussion activity about individual differences. However, perhaps the most valuable awareness raising that we as teachers can do is with the learners themselves. We can help them understand what kinds of things distract them, and offer concrete rewards as incentives to encourage them to overcome that distractibility, as well as slowing down their responses to situations, enabling them to think first. Once success is being experienced, the concrete rewards can be replaced by more intrinsic motivational factors.

Finally, as AD(H)D is a specific learning difference, the four key principles that I suggested in relation to dyslexia will also benefit these learners. That is, we should offer multisensory input and practice activities, focussing on small chunks of language at any one time. We should provide explicit explanations of how the language structures work, with lots of practice and repetition, as well as lots of positive reinforcement when they do well (or try hard). These are principles that will benefit all learners in the class, and make our classrooms truly inclusive.

Reference:  O’Regan, F. (2006) Troubleshooting Challenging Behaviour. London; Continuum International Publishing Group Ltd.

Bio details

Dr. Anne Margaret Smith has been teaching English for 25 years and is also dyslexia specialist tutor. Her company, ELT well, aims to bring these two fields of education closer together, by sharing good practice from both sides. Anne Margaret teaches on the MA TESOL at the University of Cumbria and was part of the DysTEFL project which was awarded a British Council ELTon this year.