Attention Deficit Hyperactivity Disorder (ADHD) - Worcester

394 Pages·2008·11.5 MB·English

Attention Deficit Hyperactivity
Disorder (ADHD): identification,
assessment, contextual and curricular
variability in boys at KS1 and KS2 in
mainstream schools

Linda Wheeler

A thesis submitted in fulfilment of the requirements of
Coventry University for the degree of Doctor of Philosophy

March 2007

University of Worcester
in association with
Coventry University
Abstract
The concept of Attention Deficit Hyperactivity Disorder (ADHD) in children presents
conceptually controversial and practical challenges on several levels. These include the
theoretical basis of the disorder, its manifestations in everyday life and identification and
assessment procedures. The field has attracted considerable attention from professionals in
the areas of education, psychology and health. One of the major areas where ADHD
behaviours can present problems is in school settings.

The present research derives from, and addresses, English educational perspectives and
practices, based in school settings. It was primarily concerned with seeking new insights
and generating testable hypotheses concerning incidence, multi-professional identification,
assessment and management of the condition and situational variability in ADHD
symptoms in schools. The exploratory study was in two related parts. These were
undertaken concurrently using a combination of quantitative and qualitative techniques and
data gathering methods.

Part 1 of the research was based on detailed analyses of data from the first countywide
ADHD survey covering all schools in a Local Education Authority in the West Midlands
(LEA 1) in 2003. Data pertaining specifically to pupils at key stages 1/2 have been
extracted from the 2003 survey data and subjected to further descriptive analyses.
Comparisons have been made with findings from five other LEA school surveys in order to
obtain a more extensive appraisal of the reported incidence of the disorder.

Part 2 adopted a case study approach in which data-gathering techniques included the use
of field notes, a range of interviews, analysis of documents and observation. Two
classroom observation schedules have been devised and used extensively over a two-year
period throughout six individual case studies in schools within LEA 1. The case studies
have produced a wide range of unique data on the variability of ADHD symptoms across
curricular contexts and over time.

The findings and hypotheses generated in the present research have significance for
inclusive educational practice, highlighting the importance of multi-professional
approaches to the identification and management of ADHD and pedagogical and curricular
flexibility in schools. These form part of the Government’s ongoing reform of children’s
services as set out in Every Child Matters (DfES, 2003) and Removing Barriers to
Achievement (DfES, 2004a).
Page

Contents i
Acknowledgements vi
Abbreviations vii
List of Tables ix
List of Figures xii
Foreword xiii

SECTION I – BACKGROUND TO THE RESEARCH
Chapter 1: Research Outline 1

Chapter 2: Statement of the Problem 3

Chapter 3: Review of Literature 6
3.1 Introduction 6
3.2 Legislative framework 7
3.2.1 International context
3.2.2 National context
3.2.3 LEA level
3.3 ADHD - theoretical concept 13
3.3.1 Definition and diagnosis
3.3.2 History
3.3.3 Aetiology
3.3.4 Prevalence
3.3.5 Comorbidity
3.3.6 Prognosis
3.3.7 Interventions
3.4 ADHD - current theoretical concerns 26
3.4.1 The existence of ADHD
3.4.2 Conceptualisations of ADHD
3.4.3 Multi-professional identification and assessment
3.4.4 Use of medication
3.4.5 Variability in ADHD symptoms

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SECTION II – RESEARCH METHODOLOGY
Chapter 4: Research methodology – general considerations 39
Introduction
4.1 Traditional research paradigms 39
4.1.1 Quantitative designs
4.1.2 Qualitative designs
4.2 Mixed methods designs 42
4.3 Ethics 46
4.3.1 Ethics in the present research
4.3.2 Survey ethics
4.3.3 Case study ethics
4.4 Validity and Reliability 49
4.4.1 Validity
4.4.2 Reliability
4.5 Sampling 56
4.5.1 Size and representativeness
4.5.2 Access
4.5.3 Sampling strategy

Chapter 5: Measurement techniques 60
5.1 Survey questionnaire 60
5.2 Systematic observation schedules 62
5.2.1 Fixed Interval Sampling (FIS)
5.2.2 Instantaneous Time Sampling (ITS)
5.2.3 Features common to both FIS and ITS
5.2.4 Validity and reliability
5.3 Self-esteem questionnaire 72

Chapter 6: Methodological approach 75
6.1 Part 1 – Survey methodology 75
6.1.1 Methodological approach
6.1.2 Sample
6.1.3 Procedure

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6.2 Part 2 – Case studies methodology 77
6.2.1 Research strategy
6.2.2 Sample
6.2.3 Procedure
6.2.4 Data collection

SECTION III – RESEARCH FINDINGS
PART 1 – SURVEY 90
Chapter 7: Survey results 90
7.1 Findings from 2003 survey 90
7.2 School training needs 93
7.3 Comparison with another ADHD project 96
7.4 Findings from KS1 and KS2 survey 98
7.5 Comparison with other LEAs 101

PART 2 – CASE STUDIES 106
Introduction to case study chapters 106

Chapter 8: Case Study 1 108
8.1 School setting 108
8.2 Classroom setting 108
8.3 Ben 109
8.4 Findings 109
8.5 Summary 124

Chapter 9: Case Study 2 126
9.1 School setting 126
9.2 Classroom setting 126
9.3 Carl 127
9.4 Findings 127
9.5 Summary 142

Chapter 10: Case Study 3 143
10.1 School 3 setting 143
10.2 School 7 setting 144
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10.3 David 144
10.4 Findings 145
10.5 Summary 159

Chapter 11: Case Study 4 161
11.1 School setting 161
11.2 Classroom setting 161
11.3 Edward 161
11.4 Findings 162
11.5 Summary 176

Chapter 12: Case Study 5 178
12.1 School 5 setting 178
12.2 School 8 setting 178
12.3 Freddy 179
12.4 Findings 179
12.5 Summary 195

Chapter 13: Case study 6 196
13.1 School setting 196
13.2 Classroom setting 196
13.3 Adam 197
13.4 Findings 197
13.5 Summary 211

Chapter 14: Cross-case analyses of case study findings 212
14.1 Introduction 212
14.2 Identification and assessment procedures 212
14.3 Variability in ADHD symptoms 217
14.3.1 Variability across curricular contexts
14.3.2 Variability over time
14.4 Co-existing conditions/ associated difficulties 232

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SECTION IV – DISCUSSION, REFLECTIONS
Chapter 15: Discussion 236
15.1 Evaluation of methodology 236
15.2 Discussion of key issues 238

Chapter 16: Conclusions and recommendations 250

Bibliography 254

Appendices 274

CD documents CD
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Acknowledgements
I should like to acknowledge the assistance given by East Sussex County Educational
Psychology Service, who gave permission for the use and modification of the original
ADHD schools’ survey questionnaire and associated documents. Thanks go to
colleagues from the County Educational Psychology Service, now the Access and
Inclusion Service, who collaborated in the planning, undertaking and dissemination of
the 2003 survey.

The schools involved in the case studies remain anonymous, but a special thank you
must go to the headteachers, staff and pupils who provided a warm welcome and
offered every assistance with the research.

In supervising the research, the overwhelming support and encouragement received
over the last six years from Peter Wakefield and Professor Peter Pumfrey have been
invaluable.

I am grateful to Professor Jean Webb and the Graduate Research School staff for
steering me through the research process from beginning to end.

Thank you to Julie Perry for all her help in the data processing for the survey and to
both Julie and Jenny Lewis for their administrative help and friendship.

Finally, the research would not have been possible without my husband, David, who has
had faith in me over the years and provided IT support when needed.
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Abbreviations
The following words and phrases appear in the text in full on the first occasion they are used.
Subsequently the abbreviation is used.

ABC clinic Attention and Behaviour Children clinic
ADD Attention Deficit Disorder
ADDISS Attention Deficit Disorder Information and Support Service
ADHD Attention Deficit Hyperactivity Disorder
ALS Additional Literacy Support
ASD Autistic Spectrum Disorder
APA American Psychiatric Association
BERA British Educational Research Association
BESD Behavioural, Emotional and Social Development/Difficulty
BID Behavioural Inhibition Disorder
BPS British Psychological Society
CAMHS Child and Adolescent Mental Health Service
CASBAT Communication and Social Behaviour Assessment Team
CD Conduct Disorder
CNS Central Nervous System
CPD Continuing Professional Development
DAMP Deficits in Attention, Motor control and Perception
DCD Developmental Co-ordination Disorder
DDAT Dyslexia, Dyspraxia and Attention Disorder Treatment
DfE Department for Education
DfEE Department for Education and Employment
DfES Department for Education and Skills
DES Department of Education and Science
DHT Deputy Headteacher
DLA Disability Living Allowance
DSM-IV Diagnostic and Statistical Manual (of Mental Disorders) (4th ed.)
DT Design and Technology
(S)EBD (Social), Emotional and Behavioural Difficulties
EP Educational Psychologist
EPS Educational Psychology Service
EWO Educational Welfare Officer
FIS Fixed Interval Sampling
FSM Free School Meals
GP General Practitioner
HA Health Authority
HKD Hyperkinetic Disorder
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ICD-10 International Classification of Diseases (10th ed.)
ICT Information and Communication Technology
IEP Individual Education Plan
ITS Instantaneous Time Sampling
KS Key Stage
LEA Local Education Authority
LBSS Learning Behaviour and Support Service
LMS Local Management of Schools
LSB Learning Support Base
NCB National Children’s Bureau
NC (Y) National Curriculum (Year)
NG Nurture Group
NHS National Health Service
NICE National Institute for (Health and) Clinical Excellence
OCD Obsessive Compulsive Disorder
ODD Oppositional Defiant Disorder
OFSTED Office for Standards in Education
ORACLE Observational Research and Classroom Learning Evaluation
OT Occupational Therapy
PACE Primary Assessment, Curriculum and Experience
PE Physical Education
PRU Pupil Referral Unit
PSHE Personal, social and health education
RE Religious Education
SA Statutory Assessment
SALT Speech and Language Therapy
SAT Standard Assessment Task
SEN Special Educational Needs
SENCO Special Educational Needs Co-ordinator
SENDA Special Educational Needs and Disability Act
SSA Special Support Assistant
T Teacher
TA Teaching Assistant
TOAD ‘Talking out, Out of seat, Attention Problem, Disruption’
UK United Kingdom
UNESCO United Nations Educational, Scientific and Cultural Organisation
US (A) United States (of America)
WHO World Health Organisation
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