ADD Syndrome Impairs Written Expression

Skills of written expression, the ability to put thoughts into sentences and paragraphs that others will be able to read and understand, are also problematic for many children with ADHD. Written expression is a more demanding task than is talking, reading, or doing basic math computations. To write one's thoughts places much heavier demands on learned skills and executive functions. Virginia Berninger and Todd Richards (2002) described some of these demands:

Writing, especially expository writing, is not talk written down— it requires self-generated language without social supports during the initial planning and text generation processes. Thus, writing is not the inverse of reading or aural/oral language . . . in the sense that division is the inverse of multiplication. (pp. 168-170)

Put another way, writing lacks the scaffolding—the support—of having a partner in conversation. And a blank page does not offer the structure of other words to read. It therefore is much more demanding on executive functions than is reading or conversation. Berninger and Todd noted that both writing and reading draw on . . . memory, executive processes, and thinking processes—but in different ways. Because the reading system [of the brain] can refer to written text at any time, the memory burden is greatly reduced. In contrast, the writing system . . . may place a greater burden on working memory than does reading comprehension. Writing is an immense juggling act, with more jobs to do than reading. The writing jobs include planning (generating ideas and setting goals), translating those ideas into text, transcribing that text, and reviewing and revising it. . . . Control processes for extracting meaning from a finished text (reading) are not as taxing as the executive processes that go into generating and repairing a text until it is deemed a final product (writing). (pp. 172-174)

Relatively few studies have assessed impairments of written expression in individuals with ADHD. Susan Mayes and colleagues (2000) studied children with ADHD in comparison to children who had other emotional or behavioral problems without ADHD; all of these children were eight to sixteen years old and had been referred to a child psychiatric treatment clinic. Each child was given individually administered tests for IQ and academic achievement. Of the children with ADHD, 65 percent had a score for written expression that was significantly lower than that predicted by their IQ test score; only 27 percent of the clinic-referred children without ADHD had such a discrepancy.

Taken together, these several studies and others not described here show that significant percentages of students with ADHD demonstrate substantial basic impairments in reading, math, and/or written expression, often from their earliest years in learning these skills. These academic impairments suggest that many children with ADD syndrome have a weak foundation of basic academic skills on which to build their education. Such impairments are also important because they tend to demoralize children early in their educational careers and deprive them of "the sense of being able to make things and make them well," which Erikson claimed was the foundation for a "sense of industry."

Many children with ADD syndrome are not able to "win recognition by producing things" in their elementary school classrooms. Rather, they tend to be recognized by teachers and peers as the ones who didn't get the assigned task completed, missed the main point of it, or did it too hastily or with too many errors. When a child encounters such defeats frequently, especially in the early years of schooling, it doesn't take long to become discouraged with academic work, and to develop a sense of inferiority that undermines one's attempts to learn. Shortly before his evaluation for ADHD, a six-year-old boy in kindergarten was asked to try tracing the shape of the letter "H." He told his mother, "I don't even want to try doing that. I'm just going to mess it all up like everything else I do."

Faced with repeated early failures and frustration in trying to learn basic verbal and mathematical skills, many children with ADD syndrome give up on truly learning academic tasks. They may be forced to continue to do their lessons, prepare their papers, and take the tests, but their motivation to invest themselves in such learning, to work at learning, is likely to be markedly diminished. They may continue so as to avoid getting into trouble with the teacher or parents, but they may not anticipate feeling satisfied in having done a task well. Sometimes such discouraged children develop alternative skills that bring other kinds of recognition: clowning to get classmates to laugh, challenging the teacher with defiance, or bullying other children.

But academic weakness is not the only reason that many children with ADD syndrome seem relatively unmotivated. Sometimes parents unwittingly sabotage the motivation of their children to work at learning. Sometimes parents of bright children, like the underachieving Wally described earlier, do not adequately appreciate the importance of teaching their child to work at a task and learn to do it well, even if it is not especially interesting or challenging.

Much of what children are required to do in school is not very interesting to them and much of it may not even be directly useful in later years. But the experiences of accepting an assignment and working to learn a new skill, practicing and refining the skill, applying it to assigned tasks, and working to get it done well can all contribute substantially to a child's developing a sense of industry. If the child finds that recognition is given for significant effort, and if his work or developing skill is acknowledged by others, especially the parents, as having importance and value, then the child is likely to develop some pride and satisfaction in doing the work.

Some parents overlook the value of nurturing the child's developing academic competence, but are quick to give such recognition to their child's efforts in sports, art, music, mechanical tasks, or other nonacademic pursuits. Often this results in the child's becoming strongly motivated to improve those skills while neglecting academic challenges.

Sarah has never been much of a student, but she has always been a good athlete. She says she tries hard to do her school-work, but she never does it very well. Her father and I are both very athletic and we have ADHD like she does; she has to have gotten it from us. But we noticed from when she was just a toddler how much she loves physical activities. She was pretty good at dribbling a soccer ball when she was just five years old. We've spent a lot of time coaching and practicing with her and we've paid for her to get private lessons in ice skating and tennis and skiing. She's been on soccer and Little League teams since she became old enough to sign on. And she's already earned all of the figure skating badges.

Sarah has always worked very hard to improve her performance. Coaches all tell us that she is one of hardest working kids they have ever seen. Her natural talents and hard work pay off. She's always a star! We attend all her games and competitions. We stay in close touch with her coaches and we take her to see the pros in her sports whenever we can. We have a display of all her ribbons and trophies in our dining room. Our only worry now is that her sixth-grade teacher is saying she is failing and may have to repeat the grade. If she can't get all passing grades, she won't be eligible to play on the school teams next term. That would ruin everything. She's never been very interested in working on schoolwork, at school or at home. We are getting worried about that.

It may be true that Sarah is naturally much more talented in athletics than in academics, and thus more motivated to work consistently at learning to improve her athletic abilities. But it is difficult to know how much of Sarah's lopsided motivation is due to her parents' strong enthusiasm for her efforts in sports and their years of relatively weak interest in her academic work. If her parents had invested more effort and interest in encouraging Sarah's academic learning, it is possible that she would have learned to work productively at learning in school, just as she has learned to do in sports. She may never have become as competent and interested in schoolwork as she has become with sports, but she might have developed that aspect of herself well enough that she would not need to repeat her grade. Given her ADHD diagnosis, it is unlikely that her difficulties in school are due solely to the attitudes and behavior of her parents, but these may be contributing to the problem.

Sarah is a good example of someone with situation-specific ADD syndrome impairments. She demonstrates that she is able and willing to work hard at learning and practicing skills that interest her, while she complains that she is unable to sustain enough interest and effort to do the schoolwork that may eventually determine whether she will be eligible to play on school sports teams.

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