A systematic review and synthesis of qualitative research: the influence of school context on symptoms of attention deficit hyperactivity disorder

Abstract

(word count: 150) This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for Attention Deficit Hyperactivity Disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil's family. We theorise that this 'invisibility' is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem 'natural and right' in the context of schools needs to be taken into account when planning any intervention.

School‐based interventions for attention‐deficit/hyperactivity disorder: A systematic review with multiple synthesis methods

“…Delivery of interventions in the classroom avoids issues of stigma, strain on peer relationships and, of particular relevance to academic outcomes, mean that children in regular education miss less curriculum content. Other previous work stresses the importance of self-regulation as a key challenge for children with ADHD in school settings (Barkley, 1997;Gwernan-Jones et al, 2015a). Furthermore, Purdie et al (2002) reported strong effects for self-regulation interventions both in and out of school settings for children with ADHD.…”

“…As the vast majority of children in the UK are in mainstream school settings, challenging behaviour arising from the difficulties associated with ADHD can cause problems in the classroom, for the child, the teacher and for other children (Abikoff et al, 2002;Greene et al, 2002). The classroom context, as well as teachers' attitudes and behaviour towards children with ADHD, impact on children's outcomes (Sherman et al, 2008;Gwernan-Jones et al, 2015a). The nature of the school setting in the UK, where children are often taught by one teacher, in large seated groups, is clearly at odds with the challenges experienced by children with ADHD in the domains of social and peer interactions, regulation of impulsive behaviour and verbal expression, and difficulty keeping on task and focussing attention.…”

“…The cause of ADHD is complex: both genetic and environmental risk factors interact to produce the core symptoms, although the severity of expression of the core symptoms is distributed throughout the population. Some children who do not meet full diagnostic criteria for ADHD can still be impaired by high symptom levels (Faraone et al., ). Diagnostically, ADHD has three subtypes: primarily inattentive (approximately 30% of diagnosed individuals), primarily hyperactive/impulsive (<10%) and combined (approx.…”

“…Individuals who have ADHD are more likely to have cognitive impairments (Kuntsi et al., ), socio‐emotional difficulties (Wehmeier et al., ), problems regulating their behaviour (Barkley, ) and high levels of co‐occurring disorders and mental health difficulties including emotional disorders such as depression and anxiety (Reale et al., ). Children with ADHD are also more likely than their peers to have low educational attainment, substance use, vehicle accidents, involvement in crime, antisocial behaviour and experience socioeconomic disadvantage (Able et al., ; Shaw et al., ; Tarver et al., ; Faraone et al., ).…”

Review: Experiences of healthcare transitions for young people with attention deficit hyperactivity disorder: a systematic review of qualitative research

“…Data on sample, study details, research methods and findings were extracted using a checklist adapted from a recent systematic review (Gwernan‐Jones et al., ) by AP and checked by MA.…”