A systematic review and synthesis of qualitative research: the influence of school context on symptoms of attention deficit hyperactivity disorder

Abstract

This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for attention deficit hyperactivity disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil’s family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention.

Keywords:

• attention deficit hyperactivity disorder
• ADHD
• school stigma
• attributions
• qualitative research
• meta-ethnography

Acknowledgements

The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS, the Department of Health or the EU. We would like to thank the parents who commented on the interim results of this review, Brahm Norwich for giving comments on an early draft of the review, and Rebecca Abbot, Rebecca Whear and Tamsin Newlove-Delgado for their work on screening titles/abstracts.

Additional information

Funding

This work was supported by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme [project number 10/140/02] and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC). The European Centre for Environment and Human Health, with which Ruth Garside is affiliated, is supported by investment from the European Development Fund and the European Social Fund Convergence Programme for Cornwall and the Isles of Scilly.