At a glance
- October is ADHD Awareness Month, drawing public awareness to attention deficit/hyperactivity disorder, which affects an estimated 6 million US children.
- Exclusionary and punitive school discipline practices can be especially harmful for children with behavioral health conditions, including ADHD, indicating a need for new approaches in the education system.
- Creating supportive and inclusive school environments may help improve children’s mental health.
- ChangeLab Solutions has compiled resources that describe some of the strengths and needs of children with ADHD as well as supports within the educational systems that serve them.
What is ADHD, and how does it affect school children?
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by a pattern of behavior and symptoms that may include inattention, hyperactivity, and impulsivity. ADHD affects approximately 11% of school-age children. Many policy options could support children with ADHD — for example, Medicaid policies that guide physicians toward best practices for ADHD treatment in children. In this blog, we focus on supportive school environments for children with ADHD.
All children — including children with ADHD — thrive in educational environments that value who they are and nurture their unique talents and perspectives. Although children with ADHD sometimes face challenges in paying attention in school, it is important to remember that children with ADHD have many strengths that can allow them to excel in school. In fact, experts often celebrate the unique strengths of children with ADHD, such as hyperfocus, creativity, and experiential memory. However, children with ADHD are also more likely to experience problems in social relationships and are more likely to have lower academic achievement than their peers without ADHD. They may also have reduced self-esteem. In adulthood, on average, people with ADHD have lower lifetime earnings and a greater likelihood of being incarcerated.
Parents, teachers, and schools often work diligently to ensure that schools are supportive for students, but many factors affect the school environment, such as the physical classroom setup and the availability of school-based mental health services and extracurricular activities. Importantly, school disciplinary practices can also shape school climate, especially for children with ADHD. Because children with ADHD are often less able to regulate emotions and control impulses, they may find it more difficult than other children to refrain from verbal outbursts, such as speaking out of turn or shouting when they are frustrated with a teacher.
The good news is that with early interventions and treatment, students with ADHD can experience fewer symptoms as well as improved outcomes in both academic and adult life. Schools, teachers, and parents have many options for building more supportive systems that allow children with ADHD to thrive and be their truest selves.
How does school environment affect children with ADHD?
When students feel connected to their school environment, they feel cared for, valued, and supported. This feeling of school connectedness has a positive health impact. Unfortunately, emergency room data from recent years indicate increased emergency room visits related to mental health during fall and spring school semesters compared with summer, suggesting that better protective supports in schools could improve children’s mental health. In contrast, common school practices may lead to decreased school connectedness. For example, students who experience punitive school discipline (also referred to as punitive discipline or punitive practices) generally feel less connected to their school due to overall social and emotional disengagement from others. Punitive school discipline occurs when schools address student behavior deemed disruptive or in violation of student conduct codes through discipline that is primarily focused on excluding students from the learning environment or imposing other overly harsh punishments that do not address the root causes of the underlying behavior or provide supports to redirect the student to engage in desired behaviors. Common examples of punitive school discipline include suspensions (in-school and out-of-school), expulsion, informal removals, referrals to law enforcement, and corporal punishment.
School discipline can be reimagined to foster healthier school environments for children with ADHD, who may respond to punishment and reward differently than children without ADHD, rendering punitive discipline especially ineffective. Understanding how ADHD affects children’s response to punishment is key to reducing the impact of punitive disciplinary practices on this population.
For children with ADHD, thinking about the consequences of their actions beforehand can often be harder than for other children. Even the best intentions to follow all rules can sometimes go awry. Punishment may trigger a response that actually leads to poorer task performance, hindering learning and possibly making children more vulnerable to further punishment. On the other hand, anticipatory guidance, which sets clear expectations and supports good choices, as well as use of rewards can be very effective for children with ADHD. Research suggests that children with ADHD respond to reward with greater improvement in task performance than their peers without ADHD. Schoolwide positive discipline approaches such as positive behavioral interventions and supports can benefit children with ADHD.
What does research say about punitive discipline, disability, and race?
The US Department of Education’s Civil Rights Data Collection (CRDC) reveals that students who are Black, Indigenous, and people of color (BIPOC) with disabilities, including ADHD, are disproportionally subject to punitive discipline. Despite overall declines in out-of-school suspension rates among students with disabilities between the 2011–2012 school year and the 2017–2018 school year, racial disparities in out-of-school suspensions among this population persisted as follows:
- 18.5% of Black students with disabilities
- 6.6% of Latinx students with disabilities
- 9.6% of Native American students with disabilities
- 8.4% of Pacific Islander students with disabilities
- 7.4% of white students with disabilities
Research indicates that suspensions and other forms of punitive discipline lead to negative educational outcomes. A 2021 meta-analysis of the effect of severity and length of exclusionary discipline such as suspension and expulsion found that more severe exclusionary discipline has no positive effect on student behavior and that severe punishment may exacerbate behavioral problems in younger children.
Although CRDC data do not show what portion of suspended students with disabilities have ADHD, the findings demonstrate that BIPOC students disproportionately bear the brunt of punitive discipline directed at students with disabilities. These numbers may not tell the whole story, either. At least one researcher has posited that racism and racial bias that underrecognizes Black illness may account for overrepresentation of Black children in suspensions and expulsions, given that Black children are underdiagnosed with ADHD and are more likely to face punitive discipline for manifestations of ADHD. This research suggests that the number of Black children with ADHD who are disciplined may be even greater than we know.
Additional supportive school resources for children with ADHD
Educators and others whose work affects the education system may be interested in additional resources related to ADHD, supportive school environments, and punitive school discipline. We recommend exploring these publications from ChangeLab Solutions and other organizations:
- ChangeLab Solutions, School Discipline Practices: A Public Health Crisis and an Opportunity for Reform.
- Thalia González, Alexis Etow, Cesar De La Vega, Health Equity, School Discipline Reform, and Restorative Justice
- Thalia González, Alexis Etow, Cesar De La Vega, A Health Justice Response to School Discipline and Policing
- Alexis Etow, Cesar De La Vega, Creating Safe & Supportive Schools: 5 Promising Areas for Policy Change
- Centers for Disease Control and Prevention, ADHD in the Classroom: Helping Children Succeed in School
- Centers for Disease Control and Prevention, Creating a Healthy and Supportive School Environment
By Patrick Glass, Amanda Fernandes & Melani Tiongson