Child:

Review Article
care, health and development
doi:10.1111/j.1365-2214.2009.01046.x

ADHD and academic performance: why does ADHD

impact on academic performance and what can be
done to support ADHD children in the classroom? cch_1046 455..464

D. Daley* and J. Birchwood

*North Wales Clinical Psychology Programme, and
School of Psychology, Bangor University, Bangor, Gwynedd, UK

Accepted for publication 13 October 2009

Keywords Abstract
attention deficit
hyperactivity disorder,
This paper reviews the relationship between attention deficit hyperactivity disorder (ADHD) and
school, executive academic performance. First, the relationship at different developmental stages is examined,
dysfunction, attainment focusing on pre-schoolers, children, adolescents and adults. Second, the review examines the factors
underpinning the relationship between ADHD and academic underperformance: the literature
Correspondence:
Dave Daley, North Wales suggests that it is the symptoms of ADHD and underlying cognitive deficits not co-morbid conduct
Clinical Psychology problems that are at the root of academic impairment. The review concludes with an overview of
Programme, School of
Psychology, Bangor
the literature examining strategies that are directed towards remediating the academic impairment
University, Bangor, of individuals with ADHD.
Gwynedd LL57 2DG, UK
E-mail:
d.daley@bangor.ac.uk

Attention deficit hyperactivity disorder (ADHD) is a develop-
mental, neurobiological condition defined by the presence of
severe and pervasive symptoms of inattention, hyperactivity and
impulsivity [American Psychiatric Association (APA) 1994].
DSM-IV criteria (APA 1994) state that the child must exhibit a
number of inattentive, impulsive and hyperactive behaviours
over a period of 6 months, before the age of 7, which should be
present in school and at home, and which significantly impair
daily functioning. The ADHD individual has difficulty taking
turns, talks excessively, often appears not to be listening when
being spoken to, and tends to interrupt and intrude on others in
games, conversations and classroom discussions (APA 1994).
Cases of ADHD tend to be concentrated in school-age children;
however, research now shows that ADHD also exists in pre-
school children (Lavigne et al. 1996; Daley et al. 2009),
This work has been supported by a scholarship from the Economic and Social
Research Council, UK awarded to the second author.
adolescence (Faigel et al. 1995; Wolraich et al. 2005) and in adult-
hood (Mannuzza et al. 1993; Barkley et al. 2002).
As well as exhibiting the core symptoms of inattention,
hyperactivity and impulsivity, individuals with ADHD often
experience other co-morbid problems: 3050% of ADHD chil-
dren also have oppositional defiant disorder (ODD), and/or
conduct disorder (CD) (Biederman et al. 1991); there is a
co-occurrence of anxiety in 2030% of cases (Biederman et al.
1991; Pliszka 1998); and bipolar disorder in between 11 and
22% (Biederman 1998). Twenty to thirty per cent of ADHD
children have an associated learning disorder of reading, spell-
ing, writing and arithmetic (Biederman et al. 1991; Pliszka
1998). Neuro-imaging studies of children with ADHD have
shown a decreased size of the prefrontal cortex (Hill et al. 2002;
Mostofsky et al. 2002) therefore there are expected deficits in
certain prefrontal executive functions, such as response inhibi-
tion (Barkley 1997) and working memory (Tannock 1998).
Research into underlying neuropsychological deficits of ADHD

2010 Blackwell Publishing Ltd 455

456 D. Daley and J. Birchwood
has typically fallen into one of two camps: that ADHD is a
disorder of dysregulation of thought and action associated with
poor inhibitory control (Schachar et al. 2000), and that ADHD
is the manifestation of a motivational style associated with
altered reward mechanisms (Sonuga-Barke et al. 1996;
Sagvolden et al. 1998; Nigg 2001). In a head-to-head study
(Solanto et al. 2001), these opposing accounts of ADHD were
pitted against each other, with each theoretical camp selecting
what they viewed as the best measure of their theoretical con-
struct. The results showed that the constructs were not corre-
lated but, when combined, were both highly diagnostic of
ADHD cases. It was concluded that they are independent coex-
isting characteristics of ADHD (Sonuga-Barke 2002).
Individuals with ADHD may experience impairments in all
aspects of life (APA 1994); however, it is educationally based
impairments that are the subject of this review. The interaction
of core ADHD symptoms with co-morbid problems and neu-
ropsychological deficits suggests that individuals with ADHD
are likely to experience problems in academic settings. One
cannot expect a child to operate successfully in an academic
environment if they are inattentive, disruptive and aggressive,
and have problems with working memory, planning and
organization.
The academic disadvantage of ADHD
individuals. A developmental perspective, from
pre-school to university
The majority of research on the relationship between ADHD
and academic performance is concentrated on school-age chil-
dren, as ADHD is traditionally viewed as a childhood disorder
(Willoughby 2003). However, there has been some research into
the relationship in adolescents and adults (university students).
In the case of pre-school children, research has focused on the
impact pre-school ADHD has on the acquisition of basic aca-
demic skills and school readiness (Spira & Fischel 2005).
The pre-school years are a key period of a childs develop-
ment, where the building blocks for later success are laid, and
where social, behavioural and academic skills necessary for aca-
demic development are acquired. However, for a minority of
pre-school children their pathways to school readiness are com-
promised; some children encounter difficulties with impulse
control, attentional capacity and hyperactivity, which hinder
their ability to acquire crucial skills such as focusing on teachers,
interacting with peers and authority figures, and learning emer-
gent literacy, mathematics and language (Lahey et al. 1998;
Spira & Fischel 2005). Indeed, ADHD has been identified in 2%
of pre-school age children (Lavigne et al. 1996). Research in
2010 Blackwell Publishing Ltd, Child: care, health and development, 36, 4, 455464
pre-schoolers has looked at the impact of ADHD on school
readiness and later academic development.
In studies comparing individuals with ADHD and controls,
ADHD pre-schoolers have been shown to experience problems
with memory, reasoning, academic skills, conceptual develop-
ment, general cognitive ability (DuPaul et al. 2001), and acquir-
ing basic pre-reading and mathematics skills (Mariani &
Barkley 1997). Lahey and colleagues (1998) found impaired
mathematics abilities, but intact reading skills, in their sample
of 4- to 6-year-old children.
In a longitudinal study, McGee and colleagues (1991) fol-
lowed pre-schoolers who were rated as hyperactive (a key
symptom of ADHD) through to adolescence, and found that
they had poorer reading ability than controls at ages 7 and 9. By
age 15 the hyperactive children were still behind the controls
in reading performance, and there were significantly more
reading-disabled individuals in the hyperactive group com-
pared with controls. Rabiner and colleagues (2000) studied
ADHD symptoms and reading achievement in 387 pre-school
children. They found that inattention and hyperactivity was
negatively associated with reading achievement, with the stron-
gest correlations appearing with inattention. Moreover they
found that pre-school inattention was associated with poor
long-term reading achievement; this was studied up to 5 years
after baseline, where 34% of inattentive pre-schoolers were
reading-impaired.
However, it should be noted that not all individuals who
show early signs of ADHD go on to express fully the disorder
and experience the associated academic impairments. Sonuga-
Barke and colleagues (2005) proposed that pre-schoolers who
display significant early signs of ADHD but are exposed to
proactive, firm limit-setting at home and appropriately struc-
tured classrooms can avoid the downward spiral into long-term
expression of the disorder and poor school achievement.
However, there are pre-school children with ADHD who are
likely to enter school without many of the key academic readi-
ness skills that their non-ADHD peers will have acquired. It
seems that once at school, children with ADHD will struggle
with academic work (McGee et al. 1991; Biederman et al. 1996;
Rabiner et al. 2000).
The literature shows that school-aged children with ADHD
experience an abundance of academic and educational prob-
lems (Biederman et al. 1996; Barry et al. 2002; Loe & Feldman
2007). Compared with controls, ADHD children are more likely
to use remedial academic services and be placed in special edu-
cation classes (Biederman et al. 1996), and experience behav-
ioural problems that lead to suspension or expulsion (LeFever
et al. 2002). The literature also demonstrates that children with

ADHD are likely to show significant academic underachieve-
ment; in a review, Loe and Feldman (2007) found that ADHD is
associated with poor grades, poor reading and mathematics
standardized test scores, and an increased likelihood of repeat-
ing a school year. Barry and colleagues (2002) found that
ADHD children obtained significantly lower scores than con-
trols in all academic subjects. Kaufmann and Nuerk (2008)
investigated specific aspects of academic difficulties experienced
by ADHD individuals by looking at various components of
mathematical processing. There were no differences between
the ADHD-diagnosed and control groups on explicitly trained
simple and complex calculation skills, but the ADHD group did
perform significantly worse on basic number processing abili-
ties such as comparing the magnitude of single digit numbers.
In this study the two groups did not differ on working memory
and executive functioning tasks, therefore the authors conclude
that ADHD individuals could have specific deficits in magni-
tude comparisons.
There are a growing number of studies that look at the rela-
tionship between childhood ADHD symptoms and academic
performance in community-based samples. Merrell and
Tymms (2001) found that children who exhibited symptoms of
ADHD performed significantly worse than those who did not
on Key Stage 1 tests of reading and mathematics. Similarly,
Diamantopoulou and colleagues (2007) found that, in a com-
munity sample, childrens ADHD symptoms were correlated
with poor school performance. In a large-scale study of ADHD
symptoms in the general population (n = 13 087), Rodriguez
and colleagues (2007) established significant negative associa-
tions between core symptoms and reading, writing and math-
ematics; with a more pronounced relationship for inattentive
symptoms.
The academic performance of adolescents with ADHD has
faced less empirical scrutiny than the performance of their
younger counterparts, but research suggests that adolescents
with ADHD are also likely to struggle at school (Barkley et al.
1991; Biederman et al. 1998). Bauermeister and colleagues
(2007) found that children and adolescents with ADHD (aged
between 4 and 17) were likely to have educational problems;
these individuals were more likely to receive counselling or
special education, and have a history of suspension or expul-
sion. In a meta-analysis, Frazier and colleagues (2007) found
that adolescents with ADHD displayed significantly lower levels
of academic achievement compared with controls.
While direct relationship studies with adolescent samples are
few and far between, evidence for adolescent academic impair-
ment has also come from longitudinal studies that follow
ADHD individuals from a young age through to adolescence
ADHD and academic performance 457
and even adulthood. As mentioned previously, McGee and col-
leagues (1991) found that 15-year-old adolescents who were
rated hyperactive as pre-schoolers displayed poorer reading
ability than controls, and were more likely to be reading-
disabled than controls. Mannuzza and colleagues (1993) found
that at adult follow-up, men who were diagnosed with ADHD as
children had completed on average 2.5 years less schooling than
controls, and nearly one quarter of the ADHD group did not
complete high school, compared with 2% of controls. Child-
hood hyperactivity has been shown to predict adolescent
behavioural problems (such as CD, juvenile delinquency and
substance use), and adolescent academic problems, which tend
to culminate in leaving school with no qualifications (McGee
et al. 2002).
While current DSM-IV criteria (APA 1994) only recognize a
child form of ADHD, research shows that ADHD symptoms
persist into adulthood, with between 11 and 40% of childhood
cases continuing to meet criteria for the disorder in adulthood
(Fischer et al. 1993; Mannuzza et al. 1993). However, associated
academic underachievement has not been fully demonstrated in
adult populations. In their longitudinal study, Mannuzza and
colleagues (1993) found that in a sample of adults diagnosed
with ADHD as children, only 12% had completed a bachelors
degree or higher, compared with nearly half of controls; and
only 1% had completed a postgraduate degree, compared with
8% of controls.
Studies examining adults who continue to exhibit symptoms
of ADHD typically unearth a history of academic under-
achievement, with many individuals leaving school early (Klein
& Mannuzza 1991). Adolescent research shows that individuals
with ADHD are likely to perform poorly at school, and leave
with few or no qualifications (Barkley et al. 1990; Biederman
et al. 1998; McGee et al. 2002), therefore university prospects
seem bleak. However, a small body of literature suggests that
some individuals with ADHD manage to cope with their
symptoms and continue with their education to university
level. Some research suggests that these individuals do not find
themselves at an academic disadvantage (Sparks et al. 2004);
however, other findings suggest otherwise. Heiligenstein and
colleagues (1999) compared a small number of students who
were classified as having ADHD (n = 26) with non-ADHD
students (n = 28). They found that the ADHD group had lower
grade averages and were more likely to be on academic proba-
tion. Also, university students with ADHD encounter problems
with tasks and processes that are synonymous with the require-
ments of higher education, such as study strategies, note
taking, summarizing and outlining, test taking, test strategies,
time management, concentration, motivation, information
2010 Blackwell Publishing Ltd, Child: care, health and development, 36, 4, 455464
458 D. Daley and J. Birchwood
processing and self-testing (Javorsky & Gussin 1994; Reaser
et al. 2007). Therefore from a developmental prospective the
negative impact of ADHD symptoms on academic attainment
can be seen across the lifespan of children, adolescents and
young adults.
Why do ADHD individuals experience
academic problems?
The research reviewed so far supports the notion that ADHD
individuals experience academic problems. However, are these
academic problems the result of factors directly related to
ADHD (symptoms, underlying processes) or are they the result
of factors that are indirectly related to ADHD? ADHD is a
highly co-morbid disorder i.e. individuals with ADHD are
likely to experience many other associated problems and have
other diagnoses. These other diagnoses can include CD
(Biederman et al. 1991).
Because of the close association between ADHD and CD,
there has been a body of research investigating the outcomes of
individuals with a co-morbid ADHD + CD diagnosis. This
research promotes the idea of a double dissociation whereby
ADHD + CD individuals experience both future academic and
offending problems; however, it is their ADHD behaviours that
predict only future academic problems, and their CD behav-
iours that predict future criminal behaviour. Frick and col-
leagues (1991) investigated children with a diagnosis of ADHD
and CD and found that CD was only related to academic prob-
lems because of its close ties with ADHD; ADHD was the sig-
nificant predictor of academic performance. After controlling
for co-morbidity rates between ADHD and CD, Farrington and
colleagues (1990) found that childhood CD was a strong sig-
nificant predictor of later criminal offending, whereas child-
hood ADHD was only weakly related.
Fergusson and colleagues (1993) looked at the relationship
between ADHD and CD behaviours at ages 6, 8 and 10, and
later academic performance and juvenile offending at age 13.
They found that early CD behaviours were a precursor for
future juvenile offending, but were not linked to later school
performance, when the correlation between CD and attention
deficit behaviours was controlled for. They also found that
early attention deficit behaviours were related to future school
performance, but not to juvenile offending problems (again,
when the correlation between attention deficit behaviours and
CD behaviours was taken into account). These results were
also found when the sample was tested at 17 and 18 years of
age (Fergusson et al. 1997). Rapport and colleagues (1999)
support Fergusson et al.s work; they found strong links
2010 Blackwell Publishing Ltd, Child: care, health and development, 36, 4, 455464
between ADHD and later scholastic achievement, and only
found links between CD and scholastic achievement by virtue
of CDs correlation with ADHD. Targeting symptoms of severe
behaviour disorders (ODD, CD) will not likely bring about an
improvement in an ADHD childs academic performance
(DuPaul et al. 2004).
The ADHD/CD literature suggests that the ADHD indi-
viduals academic struggle cannot be put down to associated
conduct problems. However, could IQ be the root of the aca-
demic disadvantage? Research has shown that negative associa-
tions exist between ADHD and intelligence (McGee et al. 1992;
Sonuga-Barke et al. 1994), and although the link between IQ
and achievement is an age-old debate evidence suggests that
psychometric intelligence predicts future achievement (Watkins
et al. 2007). However, studies that demonstrate the link between
ADHD and academic underachievement have controlled for
intelligence (Diamantopoulou et al. 2007), or matched experi-
mental and control groups for IQ (Barry et al. 2002), suggesting
that ADHD individuals perform academically at a lower level
than would be predicted by their IQ. While ADHD individuals
have been shown to score lower than controls on IQ tests, this
may not be the primary cause of their impaired academic per-
formance. These results mirror finding from children with
ADHD and intellectual disability who show the same reduction
in their level of attainment as predicted by IQ as seen in children
of normal ability (Simonoff et al. 2007).
Cognitive deficits and academic performance
A DSM-IV diagnosis of ADHD focuses on the behavioural
problems of inattention, hyperactivity and impulsivity, but does
not explain the cognitive impairments that are commonly expe-
rienced by ADHD individuals, which has drawn criticism in
some quarters (Barkley 1997). The cognitive deficits or execu-
tive function (EF) deficits experienced by ADHD individuals
include response inhibition (Barkley 1997) and working
memory (Tannock 1998). Indeed, Barkley (1997) suggests that
while poor response inhibition is the core deficit in ADHD, it
subsequently gives rise to other EF deficiencies, such as cogni-
tive flexibility, planning and fluency.
Research into the relationship between ADHD and academic
performance has studied the role played by EFs. Biederman and
colleagues (2004) found that children with ADHD and poor
executive functioning performed worse on tests of academic
achievement than children with ADHD and adequate executive
functioning. Interestingly, Biederman and colleagues (2004)
showed that impaired executive functioning in controls was
unrelated to academic achievement, suggesting an interaction

between ADHD, executive functioning and academic perfor-
mance. Diamantopoulou and colleagues (2007) found that
ADHD symptoms and poor executive functioning indepen-
dently predicted poor school performance; however, an interac-
tion was only evident when ADHD was broken down into its
subtypes: high levels of inattention along with deficits in execu-
tive functioning predicted higher levels of special educational
needs.
Barry and colleagues (2002) attempted to explain academic
impairment in ADHD by examining whether the relationship
between ADHD and academic performance could be attributed
to problem behaviours associated with the core symptoms of
ADHD (i.e. the child does not pay attention in class, does not
complete work, etc.), or to the childs cognitive impairments
that could negatively impact on learning. Thirty-three ADHD-
diagnosed children and 33 controls completed a battery of EF
tasks, and were rated for ADHD symptom severity. Results
showed that ADHD behaviours were a stronger predictor of
academic performance than EF, and even when controlling for
executive function, symptom severity significantly predicted
academic achievement. However, the ADHD group did not
exhibit significant EF deficits, and interaction effects of ADHD
and EF were not studied.
While some research into the reasons behind the relation-
ship between ADHD and academic performance has studied
the role of EFs, it should be noted that EF deficits are not
common to all ADHD children (Sonuga-Barke 2002). The
dual-pathway model of ADHD (Sonuga-Barke 2002) suggests
that two distinct, but parallel pathways underpin ADHD. The
first pathway accounts for individuals whose ADHD symp-
toms are the manifestation of impaired EF. The second
pathway accounts for individuals whose ADHD symptoms are
the functional expression of an underlying motivational style,
characterized by aversion to delay, where the individual
expresses fundamental alterations in reward mechanisms, typi-
cally choosing small, immediate rewards over larger, delayed
rewards. Thorell (2007) examined the effect of the two arms of
the dual-pathway model on early academic skills in kindergar-
ten children. First, it was found that delay aversion was only
related to symptoms of hyperactivity/impulsivity, and EF
deficits were only related with symptoms of inattention.
Symptoms of inattention were correlated with academic skills,
but symptoms of hyperactivity/impulsivity were not. Also
delay aversion was not linked with early academic skills,
but there were significant correlations between EFs and
mathematics and language skills; EFs were shown to mediate
the relationship between inattention and early academic
skills.
ADHD and academic performance 459
Thorell (2007) tentatively suggests that ADHD children who
have EF deficits could be more likely to experience academic
difficulties than those who are delay averse. However, this study
was carried out in a pre-school sample, therefore to make more
concrete assumptions of this type; research with older cases
needs to be done.
The implication of EFs in the research reviewed above sug-
gests that deficits in executive functioning could be at the heart
of ADHD-related academic underperformance. This, taken
with the consistent finding of the significant role played by
inattentive symptoms in the ADHD-academic performance
relationship, suggests a possible inattentionEF impairment
pathway to academic problems in ADHD individuals.
Academic intervention
The significant, negative link between ADHD and academic
performance has been demonstrated in this review. While find-
ings in the literature are mixed, a picture is beginning to be
painted of a link between inattentive symptoms and academic
performance, which is being underpinned by EF deficits. This
could have implications for the treatment of ADHD. In ADHD
individuals, academic performance does not seem to be related
to co-morbid conduct problems, or the disruptive hyperactive/
impulsive symptoms. While a teacher may be more aware of the
disruptive nature of externalizing behaviours, it is not these
problems that should be targeted when considering improve-
ments in academic performance (DuPaul et al. 2004). Academic
interventions for ADHD individuals should focus on EF deficits
(such as working memory, planning and response inhibition)
and inattentive symptoms. Recent research has found that
training ADHD childrens working memory skills improved
response inhibition, reasoning and parent-rated inattentive
symptoms (Klingberg et al. 2005).
The most common ADHD treatments include stimulant
medication and behavioural interventions, which are used
to target (and improve) off-task and disruptive behaviour
(Swanson et al. 1995; Chronis et al. 2005). However, the impact
of these approaches on academic performance is smaller and
less studied (DuPaul & Eckert 1997; Raggi & Chronis 2006). In
a review, Raggi and Chronis (2006) discussed several academic
interventions that have received research attention and demon-
strate academic benefit to children and adolescents with ADHD.
Peer and parent tutoring
Being placed in large classes, with a lack of one-on-one instruc-
tion are conditions likely to increase ADHD individuals
2010 Blackwell Publishing Ltd, Child: care, health and development, 36, 4, 455464
460 D. Daley and J. Birchwood
academic difficulties. Peer tutoring is a strategy whereby an
ADHD individual is paired with a peer tutor to work on a
certain academic activity, with the peer tutor providing one-on-
one instruction and assistance at the ADHD individuals own
pace. Research has shown that peer tutoring improves class-
room behaviour and academic performance (DuPaul et al.
1998). Research into peer tutoring has also been extended to
parent tutors (Hook & DuPaul 1999). Parents were asked to
tutor their ADHD child on oral reading tasks, with the proce-
dure involving one-on-one instruction, feedback and active
responding. It was found that reading performance increased at
home and at school (Hook & DuPaul 1999). While the research
into peer tutoring in ADHD is sparse, the results so far are
encouraging.
Task/instructional modifications
This involves manipulating tasks and instructions to meet the
needs of the ADHD individual. Manipulations include reducing
task length, dividing tasks into sub-units, giving explicit instruc-
tions, and modifying the delivery or modality of instruction
according to the pupils learning style (Raggi & Chronis 2006).
Unfortunately research into most task and instructional modi-
fications has focused on single cases, thus external validity
comes into question; however, results so far have been promis-
ing (Raggi & Chronis 2006). Studies evaluating Computer
Assisted Instruction (CAI) have demonstrated improvements in
mathematics performance in both special education settings
and general education classrooms (Ota & DuPaul 2002;
Mautone et al. 2005).
Classroom functional assessment procedures
This involves developing an intervention that is specific to the
child, based on the identification and manipulation of environ-
mental variables that initiate, maintain and/or increase the
childs problematic behaviour in a particular setting (Ervin
et al. 1998). This approach has been used to increase on-task
behaviour and reduce disruptive behaviour in ADHD individu-
als, but as of yet has not been studied in terms of academic
productivity and accuracy (Raggi & Chronis 2006).
Self-monitoring
This involves the individual setting goals for classwork comple-
tion and accuracy, monitoring these goals and administering
rewards upon successful completion. Research suggests that
these strategies help to improve the academic performance of
2010 Blackwell Publishing Ltd, Child: care, health and development, 36, 4, 455464
ADHD individuals (particularly older children and adoles-
cents), especially in combination with stimulant medication
(Raggi & Chronis 2006).
Strategy training
This involves teaching children a specific skill so they can imple-
ment it in an academic situation, to improve their performance
(Evans et al. 1995). Although this method has received little
research attention, Raggi and Chronis (2006) suggest that it
could be a useful tool for ADHD individuals, where children
and adolescents learn useful skills to improve academic perfor-
mance, while taking responsibility off parents and teachers.
Some support for strategy training has come from Kaufmann
and Nuerk (2008) who found that ADHD children performed
significantly worse than non-ADHD peers on basic number
processing tasks (such as comparing the magnitude of two
numbers), but there were no differences between the groups on
explicitly trained simple and complex calculation skills.
Homework-focused interventions
Aside from ability, time spent on homework is the best predictor
of student grades and achievement (Cooper et al. 1998). As
children and adolescents with ADHD experience problems with
planning, prioritizing, filtering out distractions, focusing on
individual tasks, forgetfulness and lack of organization, it is
likely that homework will suffer. Therefore teaching parents
homework strategies based around these problems seems ben-
eficial to ADHD individuals (Raggi & Chronis 2006).
Parent tutoring and homework interventions could be a
useful tool in boosting the academic abilities of children with
ADHD; however, there is research to suggest that in some cases
these parent-based strategies should not be the only method
employed. A significant minority of children with ADHD will
have a parent with ADHD or presenting with high ADHD
symptoms (Faraone & Biederman 1997). Sonuga-Barke and
colleagues (2002) found that high levels of maternal ADHD
reduced the effectiveness of parent training interventions for
pre-school ADHD. Perhaps when deciding on appropriate aca-
demic interventions for Children with ADHD, their parents
level of ADHD symptoms should be taken into account, in
order to develop the most effective treatment programme the
effectiveness of a parent-based intervention may be influenced
by parental ADHD symptoms.
The dual-pathway model of ADHD (Sonuga-Barke 2002)
could be used to design strategies to improve ADHD individu-
als in-class focus, thus improving their academic performance.

For example, delay-averse ADHD individuals could be given
distractor objects such as Blu-Tak or a stressball to fidget
with during class, thus distracting them from the passing of
time and subsequently reducing their delay aversion. In a review
of non-pharmacological interventions for pre-school ADHD,
Sonuga-Barke and colleagues (2006) promote the need to com-
pensate for poor executive functioning in ADHD children by
teaching parents to communicate using short clear messages.
This strategy could also be utilized in the classroom, with teach-
ers communicating in this suggested manner, thus enabling
more efficient information processing, and subsequently an
improved understanding of work on behalf of the student.
Another approach to addressing the academic performance
of ADHD individuals could be altering teachers attitudes
towards ADHD behaviours and treatments. In a review,
Sherman and colleagues (2008) suggest that teachers patience,
knowledge of intervention techniques, ability to collaborate
with interdisciplinary teams, use of gestures when communi-
cating with students and positive attitude towards ADHD chil-
dren are key factors in the academic success of ADHD pupils.
Stressing these points to teachers could generate a more positive
classroom environment, which could prove valuable to both
ADHD and non-ADHD individuals.
Changes could also be made to the examination (assessment)
environment to ensure students ADHD behaviours do not
impact on exam performance. Raggi and Chronis (2006)
suggest that tasks should be reduced in length and divided into
subunits. As such, perhaps ADHD individuals could be assessed
in smaller units, where examinations are shorter, thus not allow-
ing symptoms of inattention, hyperactivity and impulsivity to
become too much of a concern in the examination setting.
Flexible examination environments could also be introduced
where pupils with high levels of ADHD symptoms are permit-
ted to leave and re-enter the examination room (under super-
vision) whenever they feel their attention is waning. Reducing
exam length is a strategy that would fall in line with the dual-
pathway model of ADHD (Sonuga-Barke 2002): when faced
with a long examination, delay averse ADHD individuals will
most likely elicit certain behaviours to distract themselves from
the passing of time; however, these behaviours will most likely
stop the individual from working and could be distracting to
other pupils. A shorter examination length would be a much
more attractive prospect for the ADHD individual, thus increas-
ing the likelihood of full focus on the examination. Alterna-
tively, to boost the focus of ADHD individuals in long
examinations, the in-class delay aversion strategy proposed
above (the use of distractor objects) could also be utilized in this
setting.
ADHD and academic performance 461
Conclusion
Attention deficit hyperactivity disorder is associated with aca-
demic underachievement across the developmental spectrum,
from pre-schoolers to adults. Of the features of ADHD, it
is inattentive symptoms and EF deficits that are associated
with academic problems, while hyperactivity/impulsivity and
co-morbid conduct problems are not. Building on Thorells
(2007) pre-school findings future research should focus on the
neuropsychological underpinnings of the relationship between
ADHD and academic performance across the ADHD develop-
mental spectrum, to examine the roles of cognitive dysregula-
tion and motivational style. This will enable professionals to
gain a broader understanding of what explains academic disad-
vantage in ADHD, in order to develop effective study strategies
and school-based interventions for ADHD individuals. A
greater understanding of older individuals with ADHD is also
needed in order to develop academic interventions for those at
high school, post-16 institutions and university.
Key messages
ADHD symptoms impact on academic attainment across
the lifespan from school readiness to performance at
university.
Deficits in executive functioning appear be at the heart of
ADHD-related academic underperformance.
A wealth of possible classroom-based interventions are
available to help and support children with ADHD in the
classroom.
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