The Varsity Blues scandal infamously highlighted how some well-to-do families exploit special education services to give their children an edge on college entrance exams. But it also reminded me of how even affluent families who play by the rules are able to navigate the educational system to make sure their children can get services and support to overcome any challenge. Those parents should consider the results of a new study finding that children who are mildly symptomatic for attention deficit hyperactivity disorder (ADHD) often end up worse off in school if diagnosed with the condition.
An analysis of national student data collected by the U.S. Department of Education compared students who displayed identical behavioral issues, such as rare or occasional inattentiveness or restlessness, between kindergarten and third grade. Those who were diagnosed with ADHD during those early elementary years subsequently received lower behavioral ratings from teachers in fifth grade than similar children who were undiagnosed. An earlier 2017 study found that the diagnosed children had worse reading scores in eighth grade than the undiagnosed. Both medicated and unmedicated children with mild forms of diagnosed ADHD had lower teacher ratings and reading scores than similar undiagnosed children.
“There are millions of kids in this country who have ADHD and legitimately need a diagnosis,” said Jayanti Owens, a Brown University sociologist who conducted the data-driven study, “but the question for me is when you have kids for whom it is not a clear-cut ADHD diagnosis. Oftentimes educated parents from high social class backgrounds assume that more services for their kids are better than fewer services. And in those subset of instances, where it’s not a clear-cut diagnosis, this research is showing is that the stigma of being labeled as ADHD can outweigh the benefits of the services.”
ADHD is one of the most prevalent childhood disorders. Estimates range from 7 percent to 11 percent of the U.S. child population. Owens calculates that more than a quarter of students who are diagnosed with ADHD have a mild form of it, with low levels of hyperactivity and inattention, and this subset of students with mild cases are more likely to be white and less likely to be black than the overall ADHD student population, which is disproportionally black and low-income. The study, “Relationships between an ADHD Diagnosis and Future School Behaviors among Children with Mild Behavioral Problems,” was published online March 4, 2020 in the academic journal Sociology of Education.
Owens’s theory is that the label of having a disability, even a common one like ADHD, creates a negative stigma. Children might feel that they are different, perhaps less competent than their peers, after receiving the diagnosis. Both teachers and parents might treat a child who has been diagnosed differently, perhaps by lowering expectations. Lower self-esteem and expectations can undermine performance. But Owens’s data analysis doesn’t prove that stigma is the cause of the worse educational outcomes for the diagnosed children. She would need additional surveys of the children and the adults in their lives, which the federal dataset didn’t include.
In her research, Owens relied on surveys given to parents and teachers of more than 9,000 children whom the Department of Education has been following from kindergarten in 1998 onward. The students were especially selected to reflect all the geographic regions and races and ethnicities in the United States. Owens identified students who had been diagnosed with ADHD between kindergarten and third grade and focused on the most mild cases. She noticed that immediately before the child’s diagnosis, parents and teachers had mostly answered “rarely” or “sometimes” to survey questions about problems with attention and concentration or impulsiveness (acts without thinking) and restlessness.
Owens then matched these mild ADHD students with otherwise similar students who received the same behavioral ratings. Years later, in fifth grade, teachers rated the diagnosed students as having worse academic behaviors and more observable social problems in the classroom. In eighth grade, the diagnosed students had lower reading scores. In math, it was more nuanced. Students with mild ADHD who were on medication had lower math scores than the undiagnosed students. But the unmedicated students with ADHD did no worse or better than the undiagnosed.
Owens also checked how students with more severe forms of ADHD fared. These are students whose parents and teachers answered “sometimes,”,”often” and “always” for problems with attention, hyperactivity and impulsivity. They had no negative consequences from the diagnosis. Their teacher ratings and test scores were not impaired compared to similar undiagnosed students.
To be sure, the broad behavioral questions that are part of the national education survey were not intended to diagnose ADHD and are not nearly as precise as the clinical ones a psychologist or a pediatrician would use to diagnose ADHD, such as SNAP-IV or Conners. It’s possible that an experienced professional would see and note behaviors that even a parent or teacher wouldn’t observe. Inattentiveness can be difficult to measure because it isn’t visible. So it’s possible that the diagnosed children had far more severe ADHD symptoms than the undiagnosed children and that’s a big limitation of this study, which Owens acknowledges.
But since most undiagnosed children don’t receive formal screenings for ADHD, there’s no better way to assemble a control group and estimate how a child might have otherwise fared without the diagnosis.
Deciding whether to categorize a child as having ADHD is an understandably agonizing decision for many families. Of course, parents want to help their children focus and thrive in school. Labels, like ADHD, can come with enticing support services. These labels matter on a very practical level but they also have a downside. Not every impediment needs to be labeled a disability.
This story about mild ADHD was written by Jill Barshay and produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.