Reflective Academic Paper (RAP)
In Response To: “Linkages between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD” by Jenna R. Rinksy and Stephen P. Hinshaw
Notre Dame De Namur
Socio/ Mulicultural Foundations
I was diagnosed with ADHD Predominately Inattentive Type was 12. My mom knew years before the official diagnosis, but it finally got to a point where I was struggling in school so much, that intervention was needed. It is not surprising that I have ADHD considering my mom does too. Children of parents with ADHD are 50% more likely to have it than their peers with parents who don’t. Being a child of something with ADHD comes with its own challenges, but there is no one more qualified to be empathetic than a parent who understands.
My mom was hesitant for me to take medication as part of my ADHD treatment plan. You’ve probably heard of Adderall or Ritalin being abused by college students trying to get an edge; how they have addictive properties; how students sell them for extra cash. I got to a point, where all the extra help from my mom and after school tutoring, couldn’t beat an Individualized Education Plan (IEP), a 504 plan, in classroom help, a resource teacher, a psychiatrist, and medication.
I started on Adderall when I was thirteen. My journey to finding a medication that worked well and had minimal side effects was a long one. I went from Adderall, to Adderall XR, to Focalin, then Strattera, and Daytrana (patch Ritalin), and back to Adderall. Eventually, I couldn’t take the side effects anymore and stopped the most helpful drug of the bunch, Adderall, cold turkey. Seven years after my initial dose of medication, a new drug came on the market, called Intinuv. It’s a non-stimulant, dose of Guanfacine. This 2 mg orange pill changed my life, in the best was possible. I still take it to this day.
I pushed through high school- I wasn’t noisy, I didn’t disrupt class, I wasn’t violent with my peers- in sum, I didn’t demand to be seen. I didn’t meet people’s preconceived notions of what having a learning disability was or meant. I wasn’t spastic, aggressive, sometimes violent, young boy. People often think that ADHD is a diagnosis only given to boys. People think that ADHD is only messy, disruptive kids, with behavior issues. I’m messy and I sometimes shout out the answer before talking, but as a girl, I’m far more likely to struggle with Executive Functioning than be sent out of the classroom.
Also as a girl with ADHD, I am more likely to look spaced out, struggle with organization, take longer on tests, and struggle with timeliness and meeting deadlines. I feel that girls with ADHD are more likely to fall beneath the cracks. My mom worked with me so much behind the scenes, I don’t think that my teachers saw how much I was truly struggling and needed help.
I learned to be an advocate for myself at a young age. In a school system that often failed me, I learned to talk to my teachers, tell them about myself, my struggles, my learning disabilities, my documentation. I told them, “See me. Help me” and with the help of my mom and learning disability services, I learned to compensate in areas that I lacked the skills to succeed.
Part of having ADHD is struggling with Executive Functioning (EF). EF includes: keeping track of time, finishing on time, making plans, multitasking, applying previously learning information, and seeking help when needed.
Executive Functioning (EF) is defined as, “a group of high-level cognitive processes essential for complex cognition, such as developing and undertaking goal-directed behaviors, monitoring progress, and modifying behavior flexibility in response to changing demands” (Rinksy & Hinshaw, p. 368). Think of it this way: there’s a research paper due tomorrow. You’ve thought about it for weeks and you have a planner, but you don’t think to actually use it. You don’t think to pace it or to make a goal of working on it a little bit each night. So now you’re researching, writing, and trying to make comprehensible sentences. You’re rushing, so your usually bad handwriting (thanks to poor ADHD related motor skills) is worse and probably illegible (so you can’t read your notes, which wouldn’t make sense anyway, because they’re missing so much information). You can’t remember any of the related information that you’ve learned over the past three months, because you’re working memory is terrible, and the only way you know how to respond to stress is to scream and cry and then scream and cry some more, because your emotional response is inflexible and so you always react the same way.
During my undergraduate degree, I worked with my school’s disability services program. I met with them once a week. Each week, I received photocopies of class notes, from a peer without my struggles. They would no doubt catch information I missed or information I had, but couldn’t decipher my notes enough to know. I would meet with a counselor and we would create an agenda for the whole term. Then, we would create a schedule to help me budget my time for in and outside of class and for individual assignments. Sometimes, I would go to the counseling center at school, because part of having ADHD and EF is for me having comorbid anxiety disorders.
As painful and stressful as school was for me and often work and life as a result of having ADHD, I wouldn’t be me without it. I wouldn’t be me if I was neurotypical.
As a teacher, I know that I will be more empathetic and empowering to my students, because I will understand them in ways a neurotypical teacher might not. My mom showed me that. I will be on the lookout for students with learning disabilities that might not be so obvious at first or students who don’t demand to be seen. Of course, I will be an advocate for those students, as well, because I know the wonders that a supportive teacher can work.
In sum, personally I understand why it is important for students to have active advocates and as a teacher, I plan to be one.
For my article, I chose “Linkage between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD” by Jenna R. Rinksy and Stephen P. Hinshaw. Researches followed around 200 ethnically and socially diverse girls with ADHD (both hyperactive and inattentive types) and without ADHD (p. 368). Initial observations were at a summer camp style clinical, where researchers followed the girls for the primary source of data (Rinksy & Hinshaw, p 368). Researchers followed up with the girls for five years. They are currently waiting on the data for the follow up after ten years (Rinksy & Hinshaw, p. 368).
Researchers noticed that there was a connection between girls with Executive Functioning Disorder struggle with social, behavioral, and emotional issues. Girls with ADHD often have emotional and social issues, as well. Students with EF often struggle with social issues into adulthood (Rinksy & Hinshaw, p. 369). They also often have comorbid, internalized disorders, such as anxiety, social anxiety, depression, or Opposition Defiance Disorder (ODD) (Rinksy & Hinshaw, p. 369).
Rinsky and Hinshaw hypothesize that, “poor social functioning and psychopathology during adolescence among girls with and without ADHD but these predictive associations will be particularly salient in girls with ADHD” (p. 370). They also hypothesize that the combine subtype of ADHD will have stronger associations between EF and adolescent social functioning (Rinksy & Hinshaw, p. 370).
Before the experiment, researchers had the girls do a 24-hour stimulant medicine washout (Rinksy & Hinshaw, p. 371). Participants were screened to be match with other participants of similar age and ethnicity (Rinksy & Hinshaw, p. 371). “Girls with an IQ lower than 70, overt neurological damage, psychosis, or pervasive developmental disorders were not included” (Rinksy & Hinshaw, p. 371).
The researches used a slew of tests to come to their conclusions. They used tests that determined planning skills, response inhibition, working memory tests, fine motor skill tests, measures of social functioning, a social relationships questionnaire, and a child behavior checklist, and teacher report form, and a childhood depression inventory (Rinksy & Hinshaw, p. 373).
So does executive functioning in childhood predict adolescent psychopathy? Yes. There is a significant predictive association between working memory and the presence of an internalized disorder (Rinksy & Hinshaw, p. 378). But no significant predictive associations between EF and the presence of an externalizing disorder during follow up during adolescence (Rinksy & Hinshaw, p. 378).
The article sums up the researchers findings:
Childhood EF predicted adolescent social functioning, with a marginally significant effect of childhood working memory on this outcome (Rinksy & Hinshaw, p. 383). There is a specificity here: fine motor control, which was impaired in the baseline sample, did not predict social functioning in adolescent; only EF measures were predictive (Rinksy & Hinshaw, p. 383). Neither childhood ADHD status no ADHD subgroup moderated the association between childhood EG and adolescent social functioning; poorer scores on EF measures predicted poorer scores in all girls, indicating that childhood EF impacts upon adolescent social functioning independently from ADHD status (Rinksy & Hinshaw, p. 383).
However, for adolescent psychopathology, childhood planning predicted the presence of internalizing/ externalizing comorbidity, and working memory marginally predicted the presence of an adolescent internalizing disorder (Rinksy & Hinshaw, p. 383).
In conclusion, “executive functions are crucial for the development of appropriate social functions” (Rinksy & Hinshaw, p. 383). This suggests that childhood EF deficits go beyond ADHD symptoms alone- that targeting ADHD symptoms at high-risk children may not be enough- EF problems should be addressed specifically (Rinksy & Hinshaw, p. 383). Better planning and working memory skills are associated with lower incidence of psychopathology in girls both with and without ADHD” (Rinksy & Hinshaw, p. 383).
This could be because girls’ externalized problems may be closely related to social and environmental factors than to other individual and biological factors like EF (Rinksy & Hinshaw, p.384). ADHD status moderated the relationships between planning, internalized psychopathy, and comorbidity (Rinksy & Hinshaw, p. 384). The findings reflected researching showing that people with ADHD-Combined type have poor neuropsychological performance (Rinksy & Hinshaw, p. 384). Evidence exists that says girls with Combined type of ADHD may demonstrate poorer performance in these areas than boys with the Combined-type (Rinksy & Hinshaw, p. 384). Therefore, it is important to understand the unique set of issues that come with girls versus boys who have ADHD (Rinksy & Hinshaw, p. 384).
Girls specifically, are sensitive to disruptive behavior and struggle to follow unwritten social rules (Rinksy & Hinshaw, p. 384). These girls are more likely than boys to be aggressive towards each other (Rinksy & Hinshaw, p. 384). Interventions targeting peer relationships and psychopathology are crucial during adolescence, because that is the time when stress-sensitive development in life may be triggered by genetic causes (Rinksy & Hinshaw, p. 384).
As you leave, know that this study is still waiting for the 10-year follow up of these girls, many of whom, are now in young-adulthood. Know that there is still not that much information on girls with ADHD and with ED, specifically, so the long-term outcomes are not known (Rinksy & Hinshaw, p. 387).
Rinsky, J., & Hinshaw, S. (2011). Linkages between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD. Child Neuropsychology, 17(4), 368-390. Retrieved October 12, 2015.