Often, we use the terms “schooling” and “education” interchangeably, but they have different meanings. Education is not solely concerned with the basic academic concepts that a student learns in the classroom. Education is a social institution through which a society’s children are taught basic academic knowledge, learning skills, and cultural norms. Societies also educate their children outside of the school system in matters of everyday practical living. These two types of learning are referred to as formal education and informal education.
Formal education describes the learning of academic facts and concepts through a formal curriculum. Arising from the tutelage of ancient Greek thinkers, centuries of scholars have examined topics through formalized methods of learning. Education in earlier times was only available to the higher classes; they had the means for access to scholarly materials, plus the luxury of leisure time that could be used for learning. The Industrial Revolution and its accompanying social changes made education more accessible to the general population. Many families in the emerging middle class found new opportunities for schooling.
The modern U.S. educational system is the result of this progression. Today, basic education is considered a right and responsibility for all citizens. Expectations of this system focus on formal education, with curricula and testing designed to ensure that students learn the facts and concepts that society believes are basic knowledge.
In contrast, informal education describes learning about cultural values, norms, and expected behaviors by participating in society. This type of learning occurs both through the formal education system and at home. Our earliest learning experiences generally happen via parents, relatives, and others in our community. Through informal education, we learn how to dress for different occasions, how to perform regular life routines like shopping for and preparing food, and how to keep our bodies clean.
The Functions of Schools
Schools teach us far more than reading, writing, and arithmetic. They also socialize us to cultural norms and expectations of our society. These cultural expectations and norms are reinforced by our teachers, our textbooks, and our classmates. (For students outside the dominant culture, this aspect of the education system can pose significant challenges.) You might remember learning your multiplication tables in second grade and also learning the social rules of taking turns on the swings at recess. You might recall learning about the U.S. Constitution in an American Government course as well as learning when and how to speak up in class.
Schools are one of the more important social institutions in a society and contribute to two kinds of functions: manifest (or primary) functions, which are the intended and visible functions of education; and latent (or secondary) functions, which are the hidden and unintended functions.
Manifest Functions of Education
There are several major manifest functions associated with education. The first is socialization. Beginning in preschool and kindergarten, students are taught to practice various societal roles. The French sociologist Émile Durkheim (1858–1917), who established the academic discipline of sociology, characterized schools as “socialization agencies that teach children how to get along with others and prepare them for adult economic roles” (Durkheim 1898). Indeed, it seems that schools have taken on this responsibility in full.
This socialization also involves learning the rules and norms of society as a whole. In the early days of compulsory education, students learned the dominant culture. Today, since the culture of the United States is increasingly diverse, students may learn a variety of cultural norms, not only that of the dominant culture.
School systems in the United States also transmit the core values of the nation through manifest functions like social control. One of the roles of schools is to teach students conformity to law and respect for authority. Obviously, such respect, given to teachers and administrators, will help a student navigate the school environment. This function also prepares students to enter the workplace and the world at large, where they will continue to be subject to people who have authority over them. The fulfillment of this function rests primarily with classroom teachers and instructors who are with students all day.
Education also provides one of the major methods used by people for upward social mobility. This function is referred to as social placement. College and graduate schools are viewed as vehicles for moving students closer to the careers that will give them the financial freedom and security they seek. As a result, college students are often more motivated to study areas that they believe will be advantageous on the social ladder. A student might value business courses over a class in Victorian poetry because she sees business class as a stronger vehicle for financial success.
Latent Functions of Education
Education also fulfills latent functions. As you well know, much goes on in a school that has little to do with formal education. For example, you might notice an attractive fellow student when he gives a particularly interesting answer in class—catching up with him and making a date speaks to the latent function of courtship fulfilled by exposure to a peer group in the educational setting.
The educational setting introduces students to social networks that might last for years and can help people find jobs after their schooling is complete. Of course, with social media such as Facebook and LinkedIn, these networks are easier than ever to maintain. Another latent function is the ability to work with others in small groups, a skill that is transferable to a workplace, and that might not be learned in a homeschool setting.
The educational system, especially as experienced on university campuses, has traditionally provided a place for students to learn about various social issues. There is ample opportunity for social and political advocacy, as well as the ability to develop tolerance to the many views represented on campus. In 2011, the Occupy Wall Street movement swept across college campuses all over the United States, leading to demonstrations in which diverse groups of students were unified with the purpose of changing the political climate of the country.
Another role of schools, according to functionalist theory, is that of sorting or classifying students based on academic merit or potential. The most capable students are identified early in schools through testing and classroom achievements. Such students are placed in accelerated programs in anticipation of successful college attendance.
School, particularly in recent years, is taking over some of the functions that were traditionally undertaken by family. Society relies on schools to teach about human sexuality as well as basic skills such as budgeting and job applications—topics that at one time, were addressed by the family.
Table 7.2.1. Manifest and Latent Functions of Education
Manifest Functions: Openly stated functions with intended goals
Latent Functions: Hidden, unstated functions with sometimes unintended consequences
Transmission of culture
Working in groups
Creation of generation gap
Political and social integration
Diversity means different things to different people, and it can be understood differently in different environments. In the context of education, diversity generally refers to the differences among people in the school environment by race, culture, ethnicity, religion, socioeconomic status, sexual orientation, abilities, opinions, political views, and in other ways. We also think about how groups interact with one another, given their differences (even if they’re just perceived differences.) How do diverse populations experience and explore their relationships?
Students have, of course, always been diverse. Whether in the past or in the present day, students learn at unique paces, show unique personalities, and learn in their own ways. In recent decades, though, the forms and extent of diversity have increased. Now more than ever, teachers are likely to serve students from diverse language backgrounds, to serve more individuals with special educational needs, and to teach students either younger and older than in the past.
Cultural and Language Diversity
Take the case of language diversity. In the United States, about 40 million people, or 14% of the population are Hispanic. About 20% of these speak primarily Spanish, and approximately another 50% speak only limited English (United States Census Bureau, 2005). The educators responsible for the children in this group need to accommodate instruction to these students somehow. Part of the solution, of course, is to arrange specialized second-language teachers and classes. But adjustment must also happen in “regular” classrooms of various grade levels and subjects. Classroom teachers must learn to communicate with students whose English language background is limited, at the same time that the students themselves are learning to use English more fluently (Pitt, 2005). Since relatively few teachers are Hispanic or speak fluent Spanish, the adjustments can sometimes be a challenge. Teachers must plan lessons and tasks that students actually understand. At the same time, teachers must also keep track of the major learning goals of the curriculum.
Cultures and ethnic groups differ not only in languages but also in how languages are used. Since some of the patterns differ from those typical of modern classrooms, they can create misunderstandings between teachers and students (Cazden, 2001; Rogers et al., 2005). Consider these examples:
In some cultures, it is considered polite or even intelligent not to speak unless you have something truly important to say. Chitchat, or talk that simply affirms a personal tie between people, is considered immature or intrusive (Minami, 2002). In a classroom, this habit can make it easier for a child to learn not to interrupt others, but it can also make the child seem unfriendly.
Eye contact varies by culture. In many African American and Latin American communities, it is considered appropriate and respectful for a child not to look directly at an adult who is speaking to them (Torres-Guzman, 1998). In classrooms, however, teachers often expect a lot of eye contact (as in “I want all eyes on me!”) and may be tempted to construe a lack of eye contact as a sign of indifference or disrespect.
Social distance varies by culture. In some cultures, it is common to stand relatively close when having a conversation; in others, it is more customary to stand relatively far apart (Beaulieu, 2004). Problems may happen when a teacher and student prefer different social distances. A student who expects a closer distance than does the teacher may seem overly familiar or intrusive, whereas one who expects a longer distance may seem overly formal or hesitant.
Wait time varies by culture. Wait time is the gap between the end of one person’s comment or question and the next person’s reply or answer. In some cultures, wait time is relatively long, as long as three or four seconds (Tharp & Gallimore, 1989). In others, it is a negative gap, meaning that it is acceptable, even expected, for a person to interrupt before the end of the previous comment. In classrooms, the wait time is customarily about one second; after that, the teacher is likely to move on to another question or to another student. A student who habitually expects a wait time longer than one second may seem hesitant, and not be given many chances to speak. A student who expects a negative wait time, on the other hand, may seem overeager or even rude.
In most non-Anglo cultures, questions are intended to gain information, and it is assumed that a person asking the question truly does not have the information requested (Rogoff, 2003). In most classrooms, however, teachers regularly ask test questions, which are questions to which the teacher already knows the answer, and that simply assess whether a student knows the answer as well (Macbeth, 2003). The question: “How much is 2 + 2?” for example, is a test question. If the student is not aware of this purpose, he or she may become confused, or think that the teacher is surprisingly ignorant. Worse yet, the student may feel that the teacher is trying deliberately to shame the student by revealing the student’s ignorance or incompetence to others.
Preference for activities that are cooperative rather than competitive. Many activities in school are competitive, even when teachers try to de-emphasize the competition. Once past the first year or second year of school, students often become attentive to who receives the highest marks on an assignment, for example, or who is the best athlete at various sports or whose contributions to class discussions gets the most verbal recognition from the teacher (Johnson & Johnson, 1998). A teacher deliberately organizes important activities or assignments competitively, as in “Let’s see who finishes the math sheet first.” Classroom life can then become explicitly competitive, and the competitive atmosphere can interfere with cultivating supportive relationships among students or between students and the teacher (Cohen, 2004). For students who give priority to these relationships, competition can seem confusing at best and threatening at worst. A student may wonder, “What sort of sharing or helping with answers is allowed?” The answer to this question may be different depending on the cultural background of the student and teacher. What the student views as cooperative sharing may be seen by the teacher as laziness, freeloading, or even cheating.
Diversity of Special Educational Needs
Another factor making classrooms increasingly diverse has been the inclusion of students with disabilities into classrooms with non-disabled peers. In the United States, the trend began in the 1970s, but accelerated with the passage of the Individuals with Disabilities Education Act in 1975, and again when the Act was amended in 2004 (United States Government Printing Office, 2005). The law guarantees free, appropriate education for children with disabilities of any kind—whether the impairment is physical, cognitive, emotional, or behavioral. The laws also recognize that such students need special supports in order to learn or function effectively in a classroom with non-disabled peers, so they provide for special services (for example, teaching assistants) and procedures for making individualized educational plans for students with disabilities.
Children with Disabilities: Legislation
Since the 1970s, political and social attitudes have moved increasingly toward including people with disabilities into a wide variety of “regular” activities. In the United States, the shift is illustrated clearly in the Federal legislation that was enacted during this time. Three major laws were passed that guaranteed the rights of persons with disabilities, and of children and students with disabilities in particular. The third law has had the biggest impact on education.
Rehabilitation Act of 1973, Section 504: This law, the first of its kind, required that individuals with disabilities be accommodated in any program or activity that receives Federal funding (PL 93-112, 1973). Although this law was not intended specifically for education, in practice, it has protected students’ rights in some extra-curricular activities (for older students) and in some child care or after-school care programs (for younger students). If those programs receive Federal funding of any kind, the programs are not allowed to exclude children or youths with disabilities, and they have to find reasonable ways to accommodate the individuals’ disabilities.
Americans with Disabilities Act of 1990 (or ADA): This legislation also prohibited discrimination on the basis of disability, just as Section 504 of the Rehabilitation Act had done (PL 101-336, 1990). Although the ADA also applies to all people (not just to students), its provisions are more specific and “stronger” than those of Section 504. In particular, ADA extends to all employment and jobs, not just those receiving Federal funding. It also specifically requires accommodations to be made in public facilities such as with buses, restrooms, and telephones. ADA legislation is therefore responsible for some of the “minor” renovations in schools that you may have noticed in recent years, like wheelchair-accessible doors, ramps, and restrooms, and public telephones with volume controls.
Individuals with Disabilities Education Act (or IDEA): As its name implied, this legislation was more focused on education than either Section 504 or ADA. It was first passed in 1975 and has been amended several times since, including most recently in 2004 (PL 108-446, 2004). To be eligible under IDEA, a student must be adversely affected in oral expression, listening comprehension, written expression, basic reading skills, reading fluency skills, reading comprehension, mathematics calculation, or mathematics problem-solving. In its current form, the law guarantees the following rights related to education for anyone with a disability from birth to age 21. The first two influence schooling in general, but the last three affect the work of classroom teachers rather directly:
Free, appropriate education: An individual or an individual’s family should not have to pay for education simply because the individual has a disability, and the educational program should be truly educational; i.e., not merely care-taking or babysitting the person.
Due process: In case of disagreements between an individual with a disability and the schools or other professionals, there must be procedures for resolving the disagreements that are fair and accessible to all parties, including the person himself or herself or the person’s representative.
Fair evaluation of performance in spite of disability: Tests or other evaluations should not assume test-taking skills that a person with a disability cannot reasonably be expected to have, such as holding a pencil, hearing or seeing questions, working quickly, or understanding and speaking orally. Evaluation procedures should be modified to allow for these differences. This provision of the law applies both to evaluations made by teachers and to school-wide or “high-stakes” testing programs.
Education in the “least restrictive environment”: Education for someone with a disability should provide as many educational opportunities and options for the person as possible, both in the short term and in the long term. In practice, this requirement has meant including students in regular classrooms and school activities as much as possible, though often not totally.
An individualized educational program: Given that every disability is unique, instructional planning for a person with a disability should be unique or individualized as well. In practice, this provision has led to classroom teachers planning individualized programs jointly with other professionals (like reading specialists, psychologists, or medical personnel) as part of a team.
Students with Disabilities
Students are eligible for the rights afforded under the IDEA if their academic achievement is being impacted due to a learning disability, autism spectrum disorder, visual or hearing impairment, orthopedic impairment, traumatic brain injury, speech or language impairment, intellectual disability, emotional disturbance, or other health impairment.
A Learning Disability (or LD) is a specific impairment of academic learning that interferes with a specific aspect of schoolwork, and that reduces a student’s academic performance significantly. An LD shows itself as a major discrepancy between a student’s ability and some feature of achievement: The student may be delayed in reading, writing, listening, speaking, or doing mathematics, but not in all of these at once. A learning problem is not considered a learning disability if it stems from physical, sensory, or motor handicaps, or from generalized intellectual impairment. It is also not an LD if the learning problem really reflects the challenges of learning English as a second language. Genuine LDs are the learning problems left over after these other possibilities are accounted for or excluded. Typically, a student with an LD has not been helped by teachers’ ordinary efforts to assist the student when he or she falls behind academically, though what counts as an “ordinary effort,” of course, differs among teachers, schools, and students. Most importantly, though, an LD relates to a fairly specific area of academic learning. A student may be able to read and compute well enough, for example, but not be able to write. LDs are by far the most common form of special educational need, accounting for half of all students with special needs in the United States and anywhere from 5 to 20% of all students, depending on how the numbers are estimated (United States Department of Education, 2005; Ysseldyke & Bielinski, 2002). Students with LDs are so common, in fact, that most teachers regularly encounter at least one per class in any given school year, regardless of the grade level they teach.
These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school), these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.
Video 7.2.1. Learning Disability explains the different types of disabilities and their symptoms.
Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. Common characteristics are difficulty with phonological processing, which includes the manipulation of sounds, spelling, and rapid visual/verbal processing. Additionally, the child may reverse letters, have difficulty reading from left to right, or may have problems associating letters with sounds. It appears to be rooted in neurological problems involving the parts of the brain active in recognizing letters, verbally responding, or being able to manipulate sounds. Recent studies have identified a number of genes that are linked to developing dyslexia (National Institute of Neurological Disorders and Stroke, 2016). Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.
Dysgraphia, a writing disability, is often associated with dyslexia (Carlson, 2013). There are different types of dysgraphia, including phonological dysgraphia, when the person cannot sound out words and write them phonetically. Orthographic dysgraphia is demonstrated by those individuals who can spell regularly spelled words, but not irregularly spelled ones. Some individuals with dysgraphia experience difficulties in motor control and experience trouble forming letters when using a pen or pencil.
Dyscalculia refers to problems in math. Cowan and Powell (2014) identified several terms used when describing difficulties in mathematics, including dyscalculia, mathematical learning disability, and mathematics disorder. All three terms refer to students with average intelligence who exhibit poor academic performance in mathematics. When evaluating a group of third graders, Cowan and Powell (2014) found that children with dyscalculia demonstrated problems with working memory, reasoning, processing speed, and oral language, all of which are referred to as domain-general factors. Additionally, problems with multi-digit skills, including number system knowledge, were also exhibited.
Autism spectrum disorder (ASD) is probably the most misunderstood and puzzling of neurodevelopmental disorders. Children with this disorder show signs of significant disturbances in three main areas: (a) deficits in social interaction, (b) deficits in communication, and (c) repetitive patterns of behavior or interests. These disturbances appear early in life and cause serious impairments in functioning (APA, 2013). The child with autism spectrum disorder might exhibit deficits in social interaction by not initiating conversations with other children or turning their head away when spoken to. These children do not make eye contact with others and seem to prefer playing alone rather than with others. In a certain sense, it is almost as though these individuals live in a personal and isolated social world others are simply not privy to or able to penetrate. Communication deficits can range from a complete lack of speech to one-word responses (e.g., saying “Yes” or “No” when replying to questions or statements that require additional elaboration), echoed speech (e.g., parroting what another person says, either immediately or several hours or even days later), to difficulty maintaining a conversation because of an inability to reciprocate others’ comments. These deficits can also include problems in using and understanding nonverbal cues (e.g., facial expressions, gestures, and postures) that facilitate normal communication.
Repetitive patterns of behavior or interests can be exhibited in a number of ways. The child might engage in stereotyped, repetitive movements (rocking, head-banging, or repeatedly dropping an object and then picking it up), or she might show great distress at small changes in routine or the environment. For example, the child might throw a temper tantrum if an object is not in its proper place or if a regularly- scheduled activity is rescheduled. In some cases, the person with autism spectrum disorder might show highly restricted and fixated interests that appear to be abnormal in their intensity. For instance, the child might learn and memorize every detail about something, even though doing so serves no apparent purpose. Importantly, autism spectrum disorder is not the same thing as intellectual disability, although these two conditions can occur together. The DSM-5 specifies that the symptoms of autism spectrum disorder are not caused or explained by intellectual disability.
The qualifier “spectrum” in autism spectrum disorder is used to indicate that individuals with the disorder can show a range, or spectrum, of symptoms that vary in their magnitude and severity: Some severe, others less severe. The previous edition of the DSM included a diagnosis of Asperger’s disorder, generally recognized as a less severe form of autistic disorder; individuals diagnosed with Asperger’s disorder were described as having average or high intelligence and strong vocabulary, but exhibiting impairments in social interaction and social communication, such as talking only about their special interests (Wing, Gould, & Gillberg, 2011). However, because research has failed to demonstrate that Asperger’s disorder differs qualitatively from autistic disorder, the DSM-5 does not include it. Some individuals with autism spectrum disorder, particularly those with better language and intellectual skills, can live and work independently as adults. However, most do not because the symptoms remain sufficient to cause serious impairment in many realms of life (APA, 2013).
Currently, estimates indicate that nearly 1 in 88 children in the United States have autism spectrum disorder; the disorder is 5 times more common in boys (1 out of 54) than girls (1 out of 252) (CDC, 2012). Rates of autistic spectrum disorder have increased dramatically since the 1980s. For example, California saw an increase of 273% in reported cases from 1987 through 1998 (Byrd, 2002); between 2000 and 2008, the rate of autism diagnoses in the United States increased 78% (CDC, 2012). Although it is difficult to interpret this increase, it is possible that the rise in prevalence is the result of the broadening of the diagnosis, increased efforts to identify cases in the community, and greater awareness and acceptance of the diagnosis. In addition, mental health professionals are now more knowledgeable about autism spectrum disorder and are better equipped to make the diagnosis, even in subtle cases (Novella, 2008).
The exact causes of autism spectrum disorder remain unknown despite massive research efforts over the last two decades (Meek, Lemery-Chalfant, Jahromi, & Valiente, 2013). Autism appears to be strongly influenced by genetics, as identical twins show concordance rates of 60%– 90%, whereas concordance rates for fraternal twins and siblings are 5%–10% (Autism Genome Project Consortium, 2007). Many different genes and gene mutations have been implicated in autism (Meek et al., 2013). Among the genes involved are those important in the formation of synaptic circuits that facilitate communication between different areas of the brain (Gauthier et al., 2011). A number of environmental factors are also thought to be associated with increased risk for autism spectrum disorder, at least in part, because they contribute to new mutations. These factors include exposure to pollutants, such as plant emissions and mercury, urban versus rural residence, and vitamin D deficiency (Kinney, Barch, Chayka, Napoleon, & Munir, 2009).
There is no scientific evidence that a link exists between autism and vaccinations (Hughes, 2007). Indeed, a recent study compared the vaccination histories of 256 children with autism spectrum disorder with that of 752 control children across three time periods during their first two years of life (birth to 3 months, birth to 7 months, and birth to 2 years) (DeStefano, Price, & Weintraub, 2013). At the time of the study, the children were between 6 and 13 years old, and their prior vaccination records were obtained. Because vaccines contain immunogens (substances that fight infections), the investigators examined medical records to see how many immunogens children received to determine if those children who received more immunogens were at greater risk for developing autism spectrum disorder. The results of this study clearly demonstrated that the number of immunogens from vaccines received during the first two years of life was not at all related to the development of autism spectrum disorder.
Video 7.2.2. Autism Spectrum Disorder discusses the range of symptoms associated with ASD.
Other Health Impairment
Attention Deficit Hyperactivity Disorder (ADHD) is not a learning disability but can be considered as an ‘other health impairment’ if it is impacting academic performance. Individuals with ADHD show a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning (American Psychological Association (APA), 2013). Some of the signs of inattention include great difficulty with, and avoidance of, tasks that require sustained attention (such as conversations or reading), failure to follow instructions (often resulting in failure to complete schoolwork and other duties), disorganization (difficulty keeping things in order, poor time management, sloppy and messy work), lack of attention to detail, becoming easily distracted, and forgetfulness. Hyperactivity is characterized by excessive movement, and includes fidgeting or squirming, leaving one’s seat in situations when remaining seated is expected, having trouble sitting still (e.g., in a restaurant), running about and climbing on things, blurting out responses before another person’s question or statement has been completed, difficulty waiting one’s turn for something, and interrupting and intruding on others. Frequently, the hyperactive child comes across as noisy and boisterous. The child’s behavior is hasty, impulsive, and seems to occur without much forethought; these characteristics may explain why adolescents and young adults diagnosed with ADHD receive more traffic tickets and have more automobile accidents than do others their age (Thompson, Molina, Pelham, & Gnagy, 2007).
ADHD occurs in about 5% of children (APA, 2013). On average, boys are 3 times more likely to have ADHD than are girls; however, such findings might reflect the greater propensity of boys to engage in aggressive and antisocial behavior and thus incur a greater likelihood of being referred to psychological clinics (Barkley, 2006). Children with ADHD face severe academic and social challenges. Compared to their non-ADHD counterparts, children with ADHD have lower grades and standardized test scores and higher rates of expulsion, grade retention, and dropping out (Loe & Feldman, 2007). They also are less well-liked and more often rejected by their peers (Hoza et al., 2005).
Video 7.2.3. Attention Deficit Hyperactivity Disorder explains the symptoms associated with the three types of ADHD.
Is the prevalence rate of ADHD increasing? Many people believe that the rates of ADHD have increased in recent years, and there is evidence to support this contention. In a recent study, investigators found that the parent-reported prevalence of ADHD among children (4–17 years old) in the United States increased by 22% during a 4-year period, from 7.8% in 2003 to 9.5% in 2007 (CDC, 2010). ADHD may be over-diagnosed by doctors who are too quick to medicate children as behavior treatment. There is also greater awareness of ADHD now than in the past. Nearly everyone has heard of ADHD, and most parents and teachers are aware of its key symptoms. Thus, parents may be quick to take their children to a doctor if they believe their child possesses these symptoms, or teachers may be more likely now than in the past to notice the symptoms and refer the child for evaluation.
ADHD can persist into adolescence and adulthood (Barkley, Fischer, Smallish, & Fletcher, 2002). A recent study found that 29.3% of adults who had been diagnosed with ADHD decades earlier still showed symptoms (Barbaresi et al., 2013). Somewhat troubling, this study also reported that nearly 81% of those whose ADHD persisted into adulthood had experienced at least one other comorbid disorder, compared to 47% of those whose ADHD did not persist. Additional concerns when an adult has ADHD include worse educational attainment, lower socioeconomic status, less likely to be employed, more likely to be divorced, and more likely to have non-alcohol-related substance abuse problems (Klein et al., 2012).
Family and twin studies indicate that genetics play a significant role in the development of ADHD. Burt (2009), in a review of 26 studies, reported that the median rate of concordance for identical twins was .66, whereas the median concordance rate for fraternal twins was .20. The specific genes involved in ADHD are thought to include at least two that are important in the regulation of the neurotransmitter dopamine (Gizer, Ficks, & Waldman, 2009), suggesting that dopamine may be important in ADHD. Indeed, medications used in the treatment of ADHD, such as methylphenidate (Ritalin) and amphetamine with dextroamphetamine (Adderall), have stimulant qualities and elevate dopamine activity. People with ADHD show less dopamine activity in key regions of the brain, especially those associated with motivation and reward (Volkow et al., 2009), which provides support to the theory that dopamine deficits may be a vital factor in the development this disorder (Swanson et al., 2007).
Brain imaging studies have shown that children with ADHD exhibit abnormalities in their frontal lobes, an area in which dopamine is in abundance. Compared to children without ADHD, those with ADHD appear to have smaller frontal lobe volume, and they show less frontal lobe activation when performing mental tasks. Recall that one of the functions of the frontal lobes is to inhibit our behavior. Thus, abnormalities in this region may go a long way toward explaining the hyperactive, uncontrolled behavior of ADHD.
Many parents attribute their child’s hyperactivity to sugar. A statistical review of 16 studies, however, concluded that sugar consumption has no effect at all on the behavioral and cognitive performance of children (Wolraich, Wilson, & White, 1995). Additionally, although food additives have been shown to increase hyperactivity in non-ADHD children, the effect is rather small (McCann et al., 2007). Numerous studies, however, have shown a significant relationship between exposure to nicotine in cigarette smoke during the prenatal period and ADHD (Linnet et al., 2003). Maternal smoking during pregnancy is associated with the development of more severe symptoms of the disorder (Thakur et al., 2013).
Recommended treatment for ADHD includes behavioral interventions, cognitive behavioral therapy, parent and teacher education, recreational programs, and lifestyle changes, such as getting more sleep (Clay, 2013). For some children, medication is prescribed. Parents are often concerned that stimulant medication may result in their child acquiring a substance use disorder. However, research using longitudinal studies has demonstrated that children diagnosed with ADHD who received pharmacological treatment had a lower risk for substance abuse problems than those children who did not receive medication (Wilens, Fararone, Biederman, & Gunawardene, 2003). The risk of substance abuse problems appears to be even greater for those with ADHD who are un-medicated and also exhibit antisocial tendencies (Marshal & Molina, 2006).