Inattentive Achievement: The Challenges and Opportunities of Learning With Attention-Deficit/Hyperactivity Disorder

Abstract

Inattention and disruptive behaviors are complex symptoms experienced in childhood and result in multilevel dysfunction. In this issue of the Journal, Sayal et al. 1 examine how increasing levels of inattention, hyperactivity-impulsivity, and oppositional-defiant behaviors starting at 7 years of age affect academic achievement at 16 years. This study contributes to established research demonstrating that symptoms associated with attentiondeficit/hyperactivity disorder (ADHD) and disruptive behavioral disorders can negatively affect long-term academic outcomes. 2-4 Such negative outcomes are not limited to poor grades but extend to poor reading and mathematics standardized test scores, increased grade retention, and, ultimately, decreased rates of high school graduation and postsecondary education. 5 The study by Sayal et al. was conducted in a large community-based sample of 11,640 youth in Great Britain, where scores on a national General Certificate of Secondary Education (GCSE) examination define academic achievement outcomes at 16 years of age. They found an inverse linear association between inattention symptoms and GCSE scores. Among boys, those with ADHD had a more than 2-fold increased likelihood of not achieving 5 good GCSE scores compared with those without ADHD. Inattention at 7 years of age showed the strongest and most consistent association with outcomes at 16 years. Nevertheless, in boys, oppositional-defiant behaviors also were independently associated with worse outcomes, and disruptive behavioral disorders, including oppositional-defiant and/or persistent rule-breaking behaviors, were associated with lower GCSE scores. Collectively, these findings parallel those described in other longitudinal outcome studies 4,5 that suggest that ADHD and disruptive behavioral disorders are associated with worse academic outcomes. This has important implications for policy and allocation of educational resources for youth with these conditions. Conceptual models of ADHD that embrace its heteroge