The Co- Occurrence of Attention Deficit Hyperactivity Disorder and Anxiety Disorders in School Aged Children
Haley Kane, Westfield State University
Abstract: Attention Deficit Hyperactivity Disorder and Anxiety Disorders are incredibly common among elementary school aged students (Child Mind Institute). These disorders impact behavior in the classroom and subsequently challenge learning. There is research on these individual disorders, however, Attention Deficit Hyperactivity Disorder and Anxiety Disorders often overlap and children can be diagnosed with both. This project includes research on Attention Deficit Hyperactivity Disorder, Anxiety Disorders, and these diagnoses together. This project also explores the impacts both these disorders have on children during the school day. The methodology of the project includes interviewing educators of elementary school children. Twelve educators were interviewed about their experiences with students who have ADHD and/or anxiety. All twelve of the educators had experience working with ADHD and anxiety in children. All the educators reported that they felt ill prepared to work with ADHD and anxiety and would appreciate professional development to assist them. The educators working with kindergarten students reported incomplete diagnoses for the children so in some cases the ADHD or anxiety was not reported. This research examines both disorders, and the challenges students face every day at school, and what strategies the teachers used to help support the students. This project raises awareness of the co-occurrence of these disorders and illuminates the need for extensive professional development opportunities for those working with students who have Attention Deficit Hyperactivity Disorder and Anxiety Disorders.
Introduction
This project explores Attention Deficit Hyperactivity Disorder (ADHD), Anxiety Disorders and the co-occurrence of these diagnoses. According to the Center for Disease Control (CDC), the estimated number of children aged three-seventeen ever diagnosed with Attention Deficit Hyperactivity Disorder is six million, using data from 2016-2019. Specifically, there are 265,000 (2%) people aged three-five years, 2.4 million (10%) people six-eleven years, and 3.3 million (13%) twelve-seventeen years old, with an ADHD diagnosis. According to the CDC, between 2016-2019, 9.4% of children ages three-seventeen (approximately 5.8 million) were diagnosed with an Anxiety Disorder. According to the American Academy of Pediatrics, at least one fourth of children with Attention Deficit Hyperactivity Disorder also are diagnosed with an Anxiety Disorder.
The purpose of this project is to explore the occurrence of ADHD and anxiety in school aged children and how teachers work with this dual diagnosis. A specific focus here is on the teacher’s self-evaluation of their competence to work with students with ADHD and anxiety. The results from the self-evaluations will demonstrate the need for professional development aimed at preparing teachers to work with children with these diagnoses. All teachers in training and in practice would benefit from training in working with these diagnoses in children.
Literature Review
Since the topic of this project involves school children with co-occurring disorders of ADHD and anxiety, the literature review will define each disorder.
Attention Deficit Hyperactivity Disorder is defined as an ongoing pattern of inattention and/or hyperactivity-impulsivity that impacts functioning and/or development (The National Institute of Mental Health, September 2023). ADHD is broken up into three categories. The categories are Inattention, Hyperactivity, and Impulsivity. Some people with ADHD mainly have symptoms of inattention, others mostly have hyperactivity-impulsivity. Whereas, other people have both types of symptoms. People with the inattention symptoms of ADHD typically overlook or miss details and make careless mistakes in their school work. Additionally, they have difficulty sustaining attention during tasks such as conversations and do not seem to be listening when spoken to directly. Also, they find it hard to follow through on instructions or finish their school work and chores. They also may start these kinds of tasks, however, they lose focus and get easily sidetracked. Oftentimes, people with inattention ADHD avoid tasks that require sustained mental effort such as homework. Also, connecting to this, they have difficulty managing their time and meeting deadlines. People with inattention ADHD have difficulty organizing tasks and activities, doing tasks in sequence and keeping belongings and materials in order.
The Hyperactivity-Impulsivity part of Attention Deficit Hyperactivity Disorder can present as multiple symptoms. For example, they often fidget and squirm while they are expected to remain seated. People with Hyperactivity-Impulsivity ADHD often feel restless. They are constantly in motion and described as “act if driven by a motor”. Additionally, they tend to talk excessively and are unable to play or engage in hobbies quietly. Oftentimes they answer questions before they are fully asked, finish other people’s sentences or speak without waiting for their turn. (The National Institute of Mental Health, September 2023)
According to the CDC, the estimated number of children aged three-seventeen ever diagnosed with Attention Deficit Hyperactivity Disorder is six million, using data from 2016-2019. Specifically, there are 265,000 (2%) people aged three-five years, 2.4 million (10%) people six-eleven years, and 3.3 million (13%) twelve-seven years old, with an ADHD diagnosis.
The DSM-5, is a manual of diagnosis and statistics on mental disorders developed by the American Psychiatric Association. Diagnoses are defined with specific criteria cited for the diagnosis. For diagnosing ADHD, several symptoms are required to be present before the age of twelve. In making the diagnosis, children should have at least six or more of the symptoms present. The DSM-5 lists three presentations of ADHD: ADHD Predominantly Inattentive presentation, ADHD Predominantly Hyperactive-Impulsive presentation, or ADHD Combined presentation. As ADHD symptoms affect each person to varying degrees, the DSM-5 now requires professionals diagnosing ADHD to include the severity of the disorder (mild, moderate or severe). For mild ADHD, few symptoms beyond the required number for diagnosis are present and symptoms result in minor impact in social, school or work settings. For moderate ADHD, symptoms or functional impact between “mild” and “severe” are present. For severe ADHD, many symptoms are present beyond the number needed to make a diagnosis. Several symptoms are particularly severe or symptoms result in social, school or work settings. In the parent-report data from the National Survey of Children's Health in 2019, 14.5% had severe ADHD, 43.7% had moderate ADHD and 41.8% had mild ADHD.
Diagnosing Attention Deficit Hyperactivity Disorder is complex (Children and Adults with Attention Deficit Hyperactivity Disorder). It is critical to obtain information from individuals who observe a child across different settings. For an ADHD evaluation, there should be input from parents, teachers, and other childcare providers. The clinical evaluation of ADHD should be comprehensive and include its impact on home and school. The clinical evaluation may include parent and child interviews, parent and teacher completed child behavior rating scales, and parent self report measures. Additionally, it should include a biopsychosocial assessment interview including family history, review of prior school and medical records and a pediatric examination to rule out any medical conditions. Along with this, it should include clinic based psychological tests and direct behavioral observations of the child in natural and clinical settings. To be diagnosed with ADHD, a child must have symptoms in at least two settings such as home and school. Since it is common to see children be inattentive and/or hyperactive sometimes, these symptoms must last for at least six months and be consistent. It is important to note that Attention Deficit Hyperactivity Disorder is a clinical diagnosis. Even though there is research about the brain structure of ADHD, there are no lab and/or imaging results that officially diagnose people with ADHD.
ADHD can affect a student’s ability to focus, pay attention, listen or put effort into schoolwork. ADHD can also make a student fidgety, restless, talk too much or disrupt the class. Teachers do have strategies that they can use to best support their students with ADHD. It is important to remember that every student with ADHD is different and has different needs. These are some examples of strategies, however, not all the strategies work for each student with ADHD. Some strategies include seating a student where there are fewer distractions, and giving breaks to move around the classroom. Some other strategies are giving instructions that are clear and brief and having simple classroom routines and rules. Additionally, giving prompts to stay on task, helping with organization, teaching students to check their work to look for mistakes, and giving extra time to complete work can all help a student with ADHD. Teachers who are warm, encouraging, and positive is crucial for working with students who have ADHD. (Kids Health, June 2020).
Several disorders have comorbidity with ADHD (DSM5) including Anxiety Disorders which occur more in those with ADHD than in the general population. This research examines this comorbidity and how it impacts school aged children. Comorbidity of these disorders adds multiple symptoms that also can impact the student in the classroom. Anxiety is something that everyone experiences from time to time, however, when the anxiety is not temporary, it can be defined as an Anxiety Disorder. People who have Anxiety Disorders experience anxiety that does not always go away and can get worse over time. Anxiety Disorders are quite common in children. According to the CDC, between 2016-2019, 9.4% of children ages three-seventeen (approximately 5.8 million) were diagnosed with an Anxiety Disorder.
There are many common types of Anxiety Disorders that children can have. For example, Separation Anxiety can occur because they are anxious about being away from their parents. Social Anxiety is also common. This is when you are anxious involving social interactions. Another common type of anxiety are phobias, which are extreme fears about a specific thing or situation. Generalized Anxiety is also common. This is when you are anxious about the future and about bad things occurring. There is also Panic Disorder, which are repeated episodes of sudden, unexpected, intense fear that comes with symptoms like heart pounding, trouble breathing or feeling dizzy, shaky or sweaty.
According to the children’s mental health advocacy group, Child Mind Institute, children’s anxiety about school can appear in many ways. For example, these students with anxiety might feel “ill” often and some people might describe it as “faking being sick”, when in reality, it’s their anxiety making them feel “off” or “ill”. These students may also become “clingy” compared to students their own age. Students with school anxiety often throw tantrums or display other behavioral problems. In class, students with anxiety may avoid eye contact or freeze and/or panic when asked a question. Often, students with anxiety keep to themselves at school instead of socializing with the other children. Additional symptoms for school anxiety are struggling to pay attention and having a hard time sitting still. Students with anxiety typically have difficulty in school. They struggle with their school work or don’t turn in their homework. If a child’s anxiety is getting worse/becoming severe, then they may experience physical symptoms, such as nausea, loss of appetite, trouble sleeping and headaches.
Attention Deficit Hyperactivity Disorder and Anxiety Disorders can and do co-occur. Research supports the co-occurrence of these two diagnoses. According to the American Academy of Pediatrics, at least one fourth of children with Attention Deficit Hyperactivity Disorder also are diagnosed with an Anxiety Disorder. A study in the Journal of Psychiatry and Neurological Sciences, called “The Interaction between Attention Deficit Hyperactivity Disorder and Anxiety Symptoms” included fifty children with ADHD and forty-eight controls, who did not have any psychiatric diagnosis. All the participants were ages eight-fifteen. The result of this study was that the ADHD and Anxiety Disorder comorbidity rate was 24% in the ADHD group. These results can be used as evidence to support the fact that it is not uncommon for children with ADHD to also have anxiety.
It can be challenging to determine if a child has both diagnoses because certain signs of anxiety can be misinterpreted as ADHD. For example, restlessness and poor concentration can be signs (DSM5) of both diagnoses. It is important to consider that children with Anxiety Disorders experience more than just a lack of focus or a restless response to boredom. Their anxiety is “clear-cut” and often focuses on specific situations/thoughts. However, despite the differences between these two diagnoses, symptoms from both diagnoses may be present and necessitate different strategies for the classroom teacher.
This study focused on the co-occurrence of Attention Deficit Hyperactivity Disorder and Anxiety Disorders. However, it also focused on educators and how prepared they are to teach students with this dual diagnosis. Additionally, are college students majoring in education learning about these diagnoses?
Future educators go to college to take Education classes which include classroom management and specific curriculum classes. Additionally, in an Education program, college students take a class related to Special Education. At Westfield State University, it was called Introduction to Students with Exceptional Learning Needs. This class introduces a different disability each week. One of the week’s is focused on Attention Deficit Hyperactivity Disorder. In this class you learn information about ADHD, typically what the symptoms are and how it presents challenges in the classroom. Then, the following week you move on to a different disability. One week is focused on mental health disorders, which does include anxiety. However, one week is not enough for either ADHD or Anxiety Disorders. Oftentimes, ADHD does come up in class discussions in other classes such as Classroom Management. At this point in time though, there is not a class at Westfield State University that specifically focuses on ADHD or Anxiety Disorders. Future teachers are receiving a wonderful education from Westfield State University. However, are we going to be prepared to teach students who have the dual diagnosis of ADHD and Anxiety? If we are not learning in full depth about these two diagnoses and learning how we can support these students, then how prepared are we?
Additionally, are current teachers prepared? Do they know that ADHD and Anxiety can co-occur? Do they feel that they can best support their students and ensure that they can be successful? While conducting interviews with educators, these questions were a critical part of the interview.
Methods
Participants
This study included twelve educators. Specifically, two kindergarten teachers, a first grade teacher assistant, three second grade teachers, a special education teacher, a second grade reading specialist, a school counselor, a school psychologist, a music teacher and an English Language Learner teacher.
Materials
Before this study could begin, it had to go through the Institutional Board Review (IRB) process. I wrote about what the purpose of this study was and how the interviews were going to be conducted. I also submitted the questions I was going to be asking. Once the IRB officially approved of my project, the interviews took place in the span of two weeks. For this study, there was a list of questions that the participants received ahead of time. During the interviews, I asked each question and follow up questions if necessary. The questions were about their experience working with students who have Attention Deficit Hyperactivity Disorders and/or Anxiety Disorders. There were also questions asking if they were aware that ADHD and Anxiety Disorders could overlap. Some of the questions also asked about how prepared they feel to teach students with these diagnoses.
Procedure
These interviews took place on zoom and prior to the interview, I asked if they gave consent for the interviews to be recorded. All the participants gave permission for these interviews to be recorded. These interviews lasted between forty-five minutes to an hour.
Results
Every educator I interviewed has experience working with students who have Attention Deficit Hyperactivity Disorder. Since ADHD is quite common, it would be rare if a teacher did not have a student in their class who had ADHD. As the school year goes on, it is common for students to be in the evaluation process for ADHD and have an official diagnosis by the end of the year. When I asked the educators if the students with ADHD are on IEPs or 504’s, my results were mixed. All twelve educators explained how if the ADHD is impacting a student’s learning and/or there are additional learning disabilities, most of the time these students have an Individualized Education Program (IEP). If the ADHD is certainly impacting them during the school day, however, they are not academically behind, then typically these students are on a 504. Additionally, some students with ADHD are not on an IEP or a 504. It is such an individual process which means you cannot assume that just because a student has ADHD, they are automatically on a 504 or an IEP. Most of the teachers did explain how they often see that the ADHD is impacting their students academically, so as the time goes on, they witness more students with ADHD being placed on an IEP. Additionally, the student may get diagnosed with ADHD in first grade then they go to second grade and continue to struggle academically. At this point, there may be a discussion on whether or not the IEP evaluation process should begin.
There are numerous accommodations that can be listed on an IEP for a student who has ADHD. During the interviews, all twelve educators shared some of the common accommodations that they typically see. One of the most common accommodations was preferential seating. Some students with ADHD tend to work better closer to their teacher’s desk or closer to the front of the classroom. Preferential seating can also include what kinds of chairs these students sit in. For example, eight teachers talked about how their students with ADHD benefit from sitting in a cube chair, especially while sitting on the rug. Additionally, five teachers talked about how they have stand up desks in their classroom. If a student is having difficulty sitting still, however, they have work to do, they can go to the stand up desk. Another accommodation that teachers have seen is frequent movement breaks. As much as all students benefit from movement breaks, it is important to make sure students with ADHD are getting their movement breaks throughout the school day. The educators explained how some of the students with ADHD realize that these movement breaks are beneficial for them and they can sense when they are having difficulty. However, for other students, teachers need to tell their students to go for a movement break.
One accommodation that all twelve of the educators mentioned that has mixed results are the use of fidgets. For some students, fidgets work great because they can keep their hands occupied while listening to the teacher’s directions. For some students, fidgets can cause more distraction and end up having to be taken away.
The overall opinion from all twelve educators is that school is significantly more challenging for students with Attention Deficit Hyperactivity Disorder compared to students who don’t have this diagnosis. For example, learning to read is extremely challenging for students with ADHD because it requires their full attention and for some students, they cannot remain focused for a long period of time. Some students with ADHD have difficulty with reading comprehension because they cannot retain the information from the book that they read. Even if they appeared that they were focusing throughout the story, they tend to miss important details. This is why reading is not always a preferred activity for these students because it requires a lot of focus and remembering key details of the story. Writing can also be difficult for students with ADHD because some students with ADHD struggle with organization. Oftentimes when you give a student with ADHD a writing assignment, they are not sure where to begin. Additionally, asking them to write for a long period of time can be challenging as they are unable to focus.
ADHD can create challenges for all students, however, it can add onto additional challenges for English Language Learners (ELL). For English Language Learner’s ( ELL) specifically the students who just moved to the United States, are experiencing their first U.S educational system. They come to school and now have all these expectations such as sitting on the rug/at their desk, listening to their teacher and focusing throughout the school day. This widens the learning gap for them because they don’t speak English and they are having difficulty focusing. These students are already facing challenges because of the language barrier then add in challenges with ADHD and they are experiencing even more difficulty. It’s incredibly challenging to explain that these students have the language barrier, having difficulty with learning and also having difficulty with focusing. A strategy that the ELL teacher uses in her classroom is incorporating movement and music as much as possible. For example, when teaching the alphabet, specifically with kindergarten and first graders, every letter has a specific movement. This is helpful for all ELL’s, especially for the ELL’s who have ADHD because they can move around while learning.
These interviews provided a lot of beneficial information regarding Attention Deficit Hyperactivity Disorder. These interviews also discussed Anxiety Disorders.
Every educator I interviewed has experience working with students who have Anxiety Disorders. One of the most common types of anxieties that all twelve educators have experience with is Separation Anxiety. All twelve educators have had students cry at the beginning of the school day because they don’t want their parents to leave. These students typically get anxious when they are away from their parents because they feel more comfortable with their parents around. One educator shared an example of a conversation that she had with her student who had separation anxiety. She asked her student questions about their feelings and the student described how they feel unsafe when they are not with their parents. They trust their parents and it’s difficult for them to be away from them throughout the school day. The twelve educators discussed how Separation Anxiety is different for each student. For some students, they experience this kind of anxiety the first couple weeks of school since they are adjusting back to the school routine. For other students, it can take a few months until they feel comfortable being away from their parents during the school day. There are some students who have Separation Anxiety the entire school year.
All twelve educators also have experience with students who are anxious, however, it is not always related to a specific situation. The educators referred to this as Generalized Anxiety Disorder. These students can become anxious about multiple parts of the school day and the educators discussed how this can be quite challenging. The educators discussed when you know the triggers of the student’s anxiety you know when they will become anxious and you can learn the best ways to support the students. However, when multiple situations can cause a student to become anxious and this may look different each day, it can be difficult to learn how to support the student.
During the interviews, all twelve educators shared how each child experiences anxiety differently. For example, some children can become quieter when they are feeling anxious and want to be left alone. However, there are some children who feel anxious and tend to talk excessively. The educators also discussed how some children with anxiety will talk about their feelings to either their teacher or another trusted adult at school. However, other children with anxiety tend to “bottle up their feelings” and not talk about it. During this part of the interview, educators also shared how not every child understands their feelings/what they are experiencing. The educators I interviewed do work with younger children and they brought up the fact that during this part of elementary school children learn more about feelings during Social Emotional Learning lessons. However, not all the children are able to identify that they are feeling anxious. The educators shared that often the child will tell their teacher “my stomach hurts”, “ I don’t feel good” or “ I don’t want to do this activity”.
All twelve educators discussed how it is common for a student in their class to have ADHD and an Anxiety Disorder. However, not each student with ADHD will also have anxiety. They also discussed the overlap in symptoms, which leads to questioning if it is ADHD, anxiety or the dual diagnosis?
Discussion
Attention Deficit Hyperactivity Disorder is increasing. Year after year, educators are seeing more students diagnosed with ADHD. As common as ADHD is, all twelve educators explained how they did not feel prepared to teach students with ADHD. They explained how they did not learn much about ADHD in their college classes, which can contribute to why they felt unprepared. A lot of their knowledge regarding ADHD has been learned while teaching and learning strategies while working with these students. Nine educators explained how they have attended professional development workshops regarding ADHD, however, they did not learn a lot of new information. These workshops discuss the same strategies and/or resources that the teachers have heard before. In the interviews, educators brought up concerns that they have and what they would like to learn about ADHD. One of the common questions was: How do you hold the students with ADHD to the same expectations that you would of neurotypicals? In fact, should you hold them to the same expectations or should there be “less pressure” for these students because school is already challenging enough for them? Educators also discussed the increasing pressure on “time on learning”, which leads them to asking: “How do we make sure our students with ADHD are still able to take their breaks even though there are requirements that these students must meet” or “we have so much to teach, how can I ensure that my students with ADHD are learning the curriculum?”. All of the educators are in agreement that professional development needs to address these questions so that moving forward, teachers have the resources that they need.
Anxiety Disorders are also increasing and it is incredibly common for educators to work with students who have Anxiety Disorders. All the educators talked about how they did not learn about anxiety while they were in college and when they began teaching, they did not feel prepared. However, they all agreed that Anxiety Disorders were not as prevalent as they are now. This is why more professional development needs to occur so educators are receiving the resources that they need to teach students with Anxiety Disorders.
The educators have worked with students who have ADHD and Anxiety Disorders. However, they all agree that they were never taught that these diagnoses can co-occur. Instead, they learned this while working with students who do have the dual-diagnosis. Additionally, how do you best support students with these diagnoses? There are strategies for ADHD and for anxiety, however, when a student is diagnosed with both, it significantly increases the challenges. Educators feel they are not prepared for this and with a dual diagnosis becoming more prevalent, they believe they need additional support.
During the literature review, I did not find a significant amount of research related to the co-occurrence of Attention Deficit Hyperactivity Disorder and Anxiety Disorders. It was clear that these two diagnoses can overlap, however, there are limited resources to support educators working with these students who have the dual diagnosis. Additionally, the educators I interviewed still don’t feel that they are prepared to teach these students and they are learning as they go. While it is important that teachers realize that they will always be learning and coming up with different approaches, it is just as important that they receive education on Attention Deficit Hyperactivity Disorder and Anxiety Disorders. Specifically, future teachers are not receiving this education and are entering the teaching field without the proper preparation that they need for these two diagnoses.
I was surprised that the school psychologist and the school counselor explained how they do not always feel prepared for supporting children with the dual diagnoses. They both have various strategies for working with students who have ADHD and students who have Anxiety Disorders. When teachers go to the school psychologist and/or the school counselor for help, both of them are ready to support and give strategies. However, they both said how it becomes a challenge when it’s ADHD and Anxiety Disorders. The main challenge is determining which diagnosis to “treat” first? Do they provide strategies for ADHD? Or is the Anxiety Disorder creating more challenges that they need to address first? Specifically, when the symptoms can present themselves similarly, it creates a significant challenge. This surprised me that the school psychologist and the school counselor don't always feel prepared because all the teachers rely on these two people. Every teacher told me that whenever there is a student that is struggling with ADHD or Anxiety and the teacher has done what they can, they go to the counselor to discuss this student. This makes sense because school counselors and school psychologists are there to support the teachers who are looking to help their students. However, the school psychologist and the school counselors are still learning and we cannot assume that they know everything.
For future research, it would be interesting to research how Attention Deficit Hyperactivity Disorder and Anxiety Disorders impact middle school and high school students. This research was focused on elementary school students, however, these diagnoses can certainly impact older students. Future studies could focus on questions such as What happens if the student never gets diagnosed in elementary school and gets the diagnosis later in school? What support does this student have? What if a student gets diagnosed with just ADHD and they also have an undiagnosed Anxiety Disorder? These studies could also further explore the differences between a boy with ADHD and a girl with ADHD. The questions for that study could be: How are the symptoms different? How does this lead to misdiagnosis or not getting diagnosed at all? Also, how does Anxiety Disorders impact boys and girls differently? What if a student gets diagnosed with just an Anxiety Disorder and they also have undiagnosed ADHD?
Both Attention Deficit Hyperactivity Disorder and Anxiety Disorders are complex and there is so much you can research. The hope is that this project introduced research on both these diagnoses, how these diagnoses impact children in school and most importantly, are educators prepared to teach students with the dual diagnosis?
References
Centers for Disease Control and Prevention. (2023, October 16). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html
Centers for Disease Control and Prevention. (2023, March 8). Anxiety and depression in children: Get the facts. https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html
Children and Adults with Attention Deficit/Hyperactivity Disorder. About ADHD- symptoms, causes and treatment. (2019, June 13). https://chadd.org/about-adhd/overview/
Children and Adults with Attention Deficit/Hyperactivity Disorder. Diagnosis in children. https://chadd.org/for-professionals/diagnosis-in-children/
Campbell,L. (2021). How to Help When Your Child Is Anxious About Going Back To School. PsychCentral https://psychcentral.com/anxiety/school-anxiety
Gokce. S, Burcu Ayaz.A, Rodopman Arman. A, Kayan.E. The Interaction between Attention Deficit Hyperactivity Disorder and Anxiety Symptoms. The Journal of Psychiatry and Neurological Sciences
Hasan, S. (Ed.). (2020, June). ADHD and school (for parents) - nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/adhd-school.html
Healthy Children. Anxiety Disorders and ADHD. https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Anxiety-Disorders-and-ADHD.aspx
Magnus, W. Nazir, S. Anilkumar, A. Shaban, K. (August 2023) National Library of Medicine. Attention Deficit Hyperactivity Disorder. https://www.ncbi.nlm.nih.gov/books/NBK441838/
U.S. Department of Health and Human Services. (n.d.). Attention-deficit/hyperactivity disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
Appendix
Qualitative Instruments
Questions related to Attention Deficit Hyperactivity Disorder:
How many years have you been teaching? What are your levels of education? What grades have you taught?
Have you taught students who have ADHD? If you remember, were these students on IEPs? Or 504’s? Did these students have any learning disabilities?
If they were on an IEP/504, were there any accommodations specifically for ADHD?
In your experience, do you believe school is more challenging for students with ADHD? If so, explain these challenges? Also, does anything “increase these challenges” (such as coming back from a week off of school, are these students “struggling a bit more”)?
What kinds of strategies do you use with students who have ADHD? Do certain strategies work with students that don’t work with others? Is it a lot of trial and error before you find strategies that work?
If you remember, did you learn about ADHD in any of your college education classes or is a lot of your knowledge about ADHD from doing your own research/working with students who have ADHD? Besides education classes, did you take any psychology classes/did you take any other classes that would talk about these topics?
Did you feel prepared to teach students with ADHD? Or did you learn strategies, resources etc as you were teaching?
Have you ever been to any training/professional development that focused on learning strategies/resources for teaching students with ADHD? If not, do you believe this would be beneficial for future teachers?
Questions related to Anxiety Disorders and the co-occurrence of these two diagnoses:
Have you taught students with anxiety before? If so, what were some of the anxieties (school anxiety, social anxiety etc)?
What kinds of behaviors did you notice from a student with anxiety?
Were students able to express that they were feeling anxious/or did they not know how to process their feelings?
Any certain time of day/part of school that the anxiety was worse?
What kinds of strategies do you use with students who have anxiety? Do certain strategies work with students that don’t work with others? Is it a lot of trial and error before you find strategies that work?
For the students who have anxiety, do they have any other comorbidity such as ADHD? In other words, is it common for the students who have ADHD to also have anxiety?
What do ADHD and anxiety look like together in the classroom? Challenges? As the teacher, what do you do to support them?
Did you know that it is quite common for children with ADHD to also have anxiety? Is this something you learned about?
As a teacher, if you believed a student was experiencing anxiety, what would you do? Would you involve a school counselor/what are the next steps?
As a teacher, do you believe you need more training on teaching students with ADHD and anxiety? Would this help teachers feel more prepared?
Anything else that you would like to share from your teaching experience that would be helpful information regarding ADHD and Anxiety.
Have you taught students with anxiety before? If so, what were some of the anxieties (school anxiety, social anxiety etc)?
What kinds of behaviors did you notice from a student with anxiety?
Were students able to express that they were feeling anxious/or did they not know how to process their feelings?
Any certain time of day/part of school that the anxiety was worse?
What kinds of strategies do you use with students who have anxiety? Do certain strategies work with students that don’t work with others? Is it a lot of trial and error before you find strategies that work?
For the students who have anxiety, do they have any other comorbidity such as ADHD? In other words, is it common for the students who have ADHD to also have anxiety?
What do ADHD and anxiety look like together in the classroom? Challenges? As the teacher, what do you do to support them?
Did you know that it is quite common for children with ADHD to also have anxiety? Is this something you learned about?
As a teacher, if you believed a student was experiencing anxiety, what would you do? Would you involve a school counselor/what are the next steps?
As a teacher, do you believe you need more training on teaching students with ADHD and anxiety? Would this help teachers feel more prepared?
Anything else that you would like to share from your teaching experience that would be helpful information regarding ADHD and Anxiety.
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