Poor school performance and underachievement are almost universal for individuals with ADHD. A child who has extreme trouble sitting still at school, or is otherwise disruptive to the learning of other students (e.g., interrupting others during quiet work time) will be very noticeable. Initially, hyperactive or impulsive behaviors, like interrupting or touching others, may be viewed as a discipline or environmental problem rather than a legitimate mental health issue. As a result, a child who exhibits hyperactive or impulsive symptoms may be judged as having eaten too much sugar or having parents that are too permissive at home. In contrast, the child who appears to be a daydreamer (who actually has ADHD Inattentive Type), is often overlooked, or, if noticed at all, viewed as lazy or unmotivated.
Most children with ADHD are first identified as having problems while they are in the school setting (particularly those with hyperactive or impulsive behaviors) since the teacher is forced to intervene with such students on a frequent basis. As mentioned before, some researchers believe that fewer girls are diagnosed with ADHD because they are more likely to have inattentive behaviors that do not draw attention in the same ways as do hyperactive behaviors. This is particularly problematic because early identification and treatment of this disorder is strongly linked to better outcomes.
Students with ADHD tend to have lower than average IQ (intelligence) scores on standardized tests, however, most of these students demonstrate above average capabilities on school work when given adequate opportunity to complete it. Typically, standardized tests are timed, the instructions cannot be repeated, and no modifications are allowed. A child with ADHD, no matter what type, is sure to perform poorly on tests that require concentration, sitting still for long periods, and that discourage interruptions or modifications.
Academic tasks that require repetition, problem-solving and memory (e.g., spelling, math, and writing) are greatly impacted by ADHD symptoms. Learning tasks that do not require concentration and disciplined effort, like comprehension, general information (e.g., Who is the current President?), and vocabulary are not as greatly affected. Psychologists who evaluate children to determine if they have ADHD often look for such discrepancies in school performance as one indicator of the disorder.
When children have Attention-Deficit/Hyperactivity Disorder, their behaviors have a profound effect on the entire family system. The high activity level, moodiness, constant difficulties, and problems at school can generate a great deal of tension and anxiety for both the parents and siblings of children with ADHD. There are frequent family conflicts, often revolving around social gatherings, meals and other activities that can be unpleasant events as a result of the child's behaviors. The strain on the parents can be overwhelming. The typical parenting response to such behaviors is reactionary, rather than preventative or corrective. For example, a child who is constantly on the go, touching things and people, and engaging in angry outbursts will demand a lot of time and energy from parents who must be vigilant to ensure that nothing gets broken and no one gets hurt. Parents often react to the child's behavior once it has occurred and find it difficult to get ahead of the behavior and take action to avoid behavioral problems.
Raising a child, or children, with ADHD can lead to excess stress for the parents and a breakdown in communication between not only parent and child, but also between parents. Parents may argue with each other over discipline because nothing seems to work. They often experience their own negative emotions such as feelings of sadness, guilt, anger and helplessness. Parents with ADHD have an even harder time as they struggle to balance their own symptoms with those of their child. As parents learn about the nature of ADHD and what to do about the symptoms, their ability to correct or prevent such behaviors will improve. We will discuss parenting tips in more detail in our section on Treatment.
Having ADHD can make it difficult for a child to make and keep friends. This is a critical issue for individuals with ADHD, since children's immediate happiness is strongly tied to their relationships with other children. Difficulties in maintaining relationships, particularly friendships with peers, can have a severe impact on a person's self-esteem and long-term development.
Research shows that children with ADHD are often rejected by their peers, or taken advantage of by them, and tend to become loners who may be at a higher risk for developing anxiety, mood disorders, substance abuse, and delinquency. Problems with peers often begin in preschool, especially for hyperactive children. Bossiness, trouble taking turns, and impulsive acting out cause peer difficulties in elementary and secondary school. The aggressive behavior that Hyperactive/Impulsive Type children display can also lead to peer rejection. Perhaps as the result of difficult peer relationships, children with ADHD tend to be less involved in school activities. Children with predominately Inattentive ADHD may be perceived as shy or withdrawn and are often targets for bullies.
Despite the frequent peer problems and painful rejection that often occurs, these children may be singled out by parents or school personnel for extra discipline. Research indicates that children with ADHD may be punished more often at home or school as adults struggle to correct their behavior.