Co-production of research with those with lived experience: an example from an ADHD study

We have been posting about co-production in research over the last few weeks in a series of posts aimed at a researcher audience (‘Insights from Researchers on Co-Production’). We will also shortly have a parallel series of posts from the perspective of a parent of a child with a disability. In our post today, which is aimed at all readers, we will summarise the key findings of a study we recently published that involved working with children and their teachers to gain their insights into our intervention development. We hope to highlight not just how important their role was but actually how their insights were central to making sure our research would work and benefit them in their everyday life.

We interviewed children with ADHD and their teachers about their knowledge of ADHD, the strengths and challenges they faced at school, alongside what strategies they used to support these challenges. We had developed an intervention model around a range of principles and evidence from the research literature. This included for example our research that has shown these children show difficulties in multiple aspects of thinking including really broad aspects of memory and an extensive range of strategic thinking skills such as cognitive flexibility and planning. A second principle of what is called ‘taking a transdiagnostic approach’ (considering presence of multiple conditions e.g. ADHD + ASD) was influenced by the growing array of research studies highlighting the impact of co-occurrences including our own work. It was very important to us though that as well as being influenced by research evidence that the experiences of those with lived experience were also represented in refining the intervention. Not only is this just the right thing to do morally, but taking this approach also ensures we can translate these principles from research into practice effectively. In this case, insights gained from the experiences of teachers and children within the school context were really important. Knowing their perspectives can help ensure research work is feasible in complex environments such as classrooms.

A key finding was the children had little understanding of what the core characteristics of ADHD are. This highlighted that our planned use of Psychoeducation (i.e. their understanding of their strengths and difficulties) in the intervention was critically important for children themselves and not just for those that support them such as their parents and teachers.

Another key finding was teachers’ insights into the strengths of children with ADHD. Surprisingly there are very few studies that look at the strengths of these children as most are focused on the difficulties they have. Teachers in our study commented that many of these children had great imaginations and that this was a positive attribute in areas such as literacy. It is very easy to become focused on supporting difficulties of neurodivergent children and neglect thinking about strengths but actually these attributes may be very important in overcoming the difficulties these children show.

The interviews also probed children and teacher’s use of strategies to support children with ADHD in the classroom. Here teachers commented both on using strategies with the particular child with ADHD but also using the strategies classroom wide. This insight has been invaluable for us and has enabled us to promote both the use of strategies when working with the child individually and also in taking a whole class approach. Children also mentioned using strategies they found useful that the teachers were not necessarily aware of. These often related to personal interests and use of toys such as fidget toys. These interviews and broader Patient and Public Involvement (PPI) work we have undertaken has helped us to incorporate important features that really matter to children such as drawing on their special interests e.g. lego and incorporating the use of the toys they like to play with in intervention activities.

We hope this blog post highlights the importance and value of involving children and those who support them directly in research decisions and practices. There is a common saying ‘nothing about us, without us’ that is increasingly used in the area of research design and procedures. Ultimately if we want to ensure our research better understands children and is optimally effective at supporting them we need to ensure their experiences are central to the development of the research.

Visual production credits: SDI Productions via Getty Images

Thinking skills and learning maths in children with ADHD

Successful maths learning is linked to a range of skills involving processing of numbers. When a child finds learning maths tricky these number skills are often focused on as the source of the difficulty. Learning maths also relies on having good thinking skills such as efficient memory. Much less focus though has been given to the importance of these thinking skills. Understanding this relationship is particularly important for helping children with ADHD learn maths as many of these children show difficulties with these thinking skills.

We recently published a systematic review, which is a ‘study of studies’ on this topic. Our review looked at published papers of studies that had researched the relationship between thinking skills and maths learning in children with ADHD. This review revealed that there are very few studies that have looked at this important relationship – only 4 studies matched the criteria we had set. These studies differed from one another in a number of ways such as the tasks they used to assess thinking skills. However we were able to systematically review them and come to some conclusions about what research is telling us on this topic.

First, as expected, thinking skills were positively related to children’s maths performance. This means that better thinking scores were related to higher maths test scores in children with ADHD. Memory emerged as playing an important role in maths learning. There are different types of memory such as short-term memory where we hold information in a short term store and more strategic aspects of memory which involve not just holding the numbers in our mind but also when we have to update the information we are holding in memory. Updating is far more than just holding the numbers in memory but involved when you have to for example add or delete numbers and really actively update the information you are holding in your mind. Our review showed that this latter type of memory known as ‘working memory’ was particularly important for maths attainment in children with ADHD. Our own research studies has shown that many children with ADHD have difficulties in their working memory and it is therefore important that there is understanding that this may be contributing to any problems that the child is having with maths. Our EPIC intervention focuses on improving understanding and supporting this type of memory and ideas from our booklets may be useful in supporting children’s educational learning.

In our review we found differences between what is known as ‘verbal’ and ‘non-verbal’ types of memory and their relationship with maths. ‘Verbal memory’ involves memory processes such as those involved in rehearsal of number facts (e.g. repeating 5+5=10, 6+6 =12). What is referred to as ‘visuospatial memory’ in a nutshell involves seeing and representing information ‘spatially’. What is meant by that? The best way to understand this is with an example. So when working out what 6+7 adds up to – one way is to visually see 6+6=12 while at the same time working out 12+1=13 in your mind.

Our review seemed to suggest that verbal memory (such as being able to repeat numbers in your mind) was linked to numerical calculation skills (i.e. being able to add numbers). Quite differently, what is known as ‘visuospatial memory’ (described in the example above) was linked to children’s conceptual understanding which means being able to understand the rules of maths while calculating numbers. What does this all mean for children who have memory difficulties? This means that the type of memory difficulties children with ADHD (or other condition) have will impact the type of maths they have difficulties with. If they have typical verbal working memory they may not have difficulties with learning to add numbers. If they have reduced ‘visuospatial memory capacity’ though (see example above of visually holding numbers in mind) they may not be able to use conceptual rules that help us do maths as easily as their peers.

The key question is how can we help children with ADHD (or others with these thinking difficulties) with their learning? Reducing memory load is a really useful technique to support children with this type of difficulty, such as using a mini-whiteboard so they can see a visual breakdown of sums or using items like lego pieces to represent numbers. The child being active in their learning, such as using the lego pieces themselves to work out sums, can make a transformational impact on them wanting to participate as well as their understanding.

Much more research is needed on this important topic. We know that maths attainment can be an important predictor of many life outcomes such as career attainment. It is really important we understand the thinking difficulties that underlie being able to confidently engage in maths learning and develop strategies to support these children. This is not only important for them being able to access learning like their peers but also that they understand the everyday strategies they need to have a happy school experience.

Visual photo credit: Photographer valentinrussanov via Getty images.