Academic Motivation in Youth With and Without ADHD (Attention-Deficit/Hyperactivity Disorder)

In this Papers Podcast, Dr. Zoe Smith discusses her JCPP paper ‘Academic motivation decreases across adolescence for youth with and without attention-deficit/hyperactivity disorder: Effects of motivation on academic success’ (https://doi.org/10.1111/jcpp.13815). Zoe is the first author of the paper.

There is an overview of the paper, methodology, key findings, and implications for practice.

Discussion points include:

• An overview of the self-determination theory of motivation.
• How motivation presents in young people with ADHD and how this may differ from youth without ADHD.
• Surprising and unexpected findings from the JCPP paper.
• The interventions that are known to foster autonomy growth in young people with ADHD.
• The implications for child and adolescent mental health professionals, policymakers, education professionals.

In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.

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Through the ACCTION Lab at Loyola University Chicago I focus on community-based assessment and intervention development for youth with attention-deficit/hyperactivity disorder (ADHD) and sluggish cognitive tempo (SCT). We are a health equity focused lab that uses liberation focused methods to increase engagement and understanding of treatment needs for youth that have been systemically oppressed (e.g., creating culturally responsive interventions for Black and Latina/e/o by listening to needs of the community and allowing flexibility in the intervention development). We focus on working with Black and Brown youth and their families using a cultural responsiveness and healing-focused lens. This is particularly important for youth with ADHD, who often face discrimination, oppression, and racism related trauma in school, the medical system, and from peers. I also have expertise in longitudinal data analyses and psychometrics. Currently, we are working on Project CRAFT (Culturally Responsive Assessments for Teens), which is focused on creating healing and strengths based psychodiagnostic assessments for teens from systemically oppressed backgrounds (i.e., Black, Latina/e/o adolescents with ADHD). (Bio from Loyola University, Chicago)

Transcript

[00:00:01.430] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.

Today, I’m interviewing Dr. Zoe Smith, Assistant Professor of Psychology at Loyola University, Chicago. Zoe is the First Author of the paper, “Academic Motivation Decreases Across Adolescence for Youth With and Without Attention-Deficit/Hyperactivity Disorder: Effects on Motivation on Academic Success,” recently published in the JCPP. This paper will be the focus of today’s podcast.

If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues. Zoe, welcome, thank you for joining me. Can you start with an introduction about who you are and what you do?

[00:01:13.130] Dr. Zoe R Smith: Thank you so much for having me. I’m really excited to be on the podcast. I am a Child and Adolescent Clinical Psychologist and I really focus on working with, and serving, adolescents with ADHD, particularly Black and/or Latina, Latine, Latino adolescents with ADHD. As an Assistant Professor, my job consists of research, consists of teaching, supervising, both graduate and undergraduate students, mentoring, as well as service. But my research is specifically focused on creating culturally responsive assessments, interventions, measures, for Black and/or Latine adolescents with ADHD, who tend to be excluded a lot from research.

[00:01:58.360] Jo Carlowe: Zoe, your paper references the self-determination theory of motivation. So, before we go into the detail of the paper, I think it would be helpful if you could give us a brief overview of self-determination theory as it relates to motivation.

[00:02:13.010] Dr. Zoe R Smith: The self-determination theory of motivation is a bit complicated, but – so, I’m going to talk about it in a little bit more of general terms. Generally, it looks at three different aspects of motivation on a continuum and so, those three types of motivation are amotivation, intrinsic motivation and extrinsic motivation.

Amotivation is a lack of motivation to complete a task, being apathetic towards a task, not really feeling motivated to complete work. Intrinsic motivation is motivated by interest or curiosity of learning, something that comes internally from that person, not outside reinforcers. Finally, extrinsic motivation is being motivated to complete a task for a reward, for example, a good grade or being pushed to do something by Teachers, by parents or other outside forces. So, for this paper, we specifically focused on academic motivation, but the self-determination theory could be used for really anything.

[00:03:18.269] Jo Carlowe: Yeah, fantastic, that’s super clear. Can you say something about how motivation presents in young people with ADHD and how this may differ from youth without ADHD?

[00:03:28.480] Dr. Zoe R Smith: We learned that younger people with ADHD have lower amounts of motivation when compared to their peers without ADHD. Which is not surprising, because we know that there are multiple theories of ADHD that are related to having motivation deficit, related to the executive functioning deficits that we see a lot with people with ADHD. And when I say the word ‘deficit’, what I really mean is that it’s different. That for people with ADHD, their executive functioning skills are not as linear or convergent, they’re more divergent. So, that’s what something like motivation can look much harder for someone with ADHD, because it’s so much harder to get from Point A to Point B.

So, youth with ADHD have a harder time staying motivated to complete tasks that are uninteresting, that are boring. They’re much more sensitive to interest, to curiosity, and urgency, and novelty than youth without ADHD, and then, unfortunately, school and academic motivation often tends to be boring or punitive. Our education system doesn’t always have the most fun homework experiences or in-class experiences, and so, school’s typically really unfriendly to people with ADHD and can even punish them for having ADHD.

And so, with that, that can, kind of, lead to what some people call a failure cycle or a shame cycle, where youth with ADHD get in trouble because maybe they didn’t finish their homework on time, or they forgot. They completed it at home, but then they forgot it because of those troubles with remembering to keep organised and have an executive functioning, and then, they get in trouble. So, they get punished for just having ADHD, having this difficulty with doing these things, which can lead to low self-esteem, negative self-talk, negative beliefs about themselves, depression, guilt, shame or any other negative internalised beliefs about themselves. Which can lead to thoughts like, “I’m stupid,” or “I don’t care about school,” or “I’m a bad kid,” which then, obviously, is not a very motivating thing.

[00:05:49.699] Jo Carlowe: No.

[00:05:50.699] Dr. Zoe R Smith: And this can happen really, really on in the kid’s academic career. Kids without ADHD can also experience this cycle, of course, but it’s much more common and sometimes, much more stronger with kids with ADHD, ‘cause they get a lot more negative attention for their behaviours.

[00:06:08.280] Jo Carlowe: And so, a terribly demotivating cycle that they get into. Let’s turn to the paper itself. Can you tell us what you looked at and why?

[00:06:17.150] Dr. Zoe R Smith: So, we had a few important goals for this paper. One was to understand whether motivation really does change across adolescence for youth with and without ADHD. And then, secondary to that, does that look different for youth without ADHD and youth with ADHD? We were expecting probably both groups to decrease on motivation, but we were really curious about, okay, what does that look like for teens with ADHD and teens without ADHD? Do they look similar? Are there different processes going on? And so, we really wanted to look at how does it change over time, from 8^th Grade to 10^th Grade, and then, is there a difference between group?

And then, the second goal was to understand, okay, now that we’ve looked at this change in motivation, is that associated with academic success? Is there a specific aspect of motivation that maybe is tied to a different aspect of academic? And so, we looked at that and whether an ADHD diagnosis made that different, as well.

And so, our overall goal was to find, basically, which aspects of motivation, using the self-determination theory, so, amotivation, intrinsic and extrinsic motivation, and whether those are linked to academic achievement. And this is going to help us inform treatment, inform educational policy, teaching practices, for both youth with and without ADHD.

Academics is typ – is a very common treatment discussion, oh – with kids in this age group, particularly kids with ADHD. Because middle school and high school tends to have a lot of need for executive functioning skills, which is not always supported for our teens with ADHD or who struggle with that kind of executive dysfunction.

[00:08:13.699] Jo Carlowe: And can you tell us a little about the methodology that you used for this study?

[00:08:18.500] Dr. Zoe R Smith: The study had two sites that recruited youth in 8^th Grade who were suspected of having ADHD, and this was led by the wonderful Dr. Stephen Becker in Cincinnati, as well as Dr. Josh Langberg in Richmond, Virginia. And this was funded by an IES grant here in the United States. What we did is we had a measure of academic motivation that was informed by the self-determination theory of motivation. So, we had an amotivation scale, an intrinsic motivation scale and an extrinsic motivation scale, and we wanted to look at these separately because these are very different aspects of motivation. And so, we wanted to see how the current school system is eliciting different types of motivation and whether that’s associated with an academic achievement.

It’s important, because myself and Dr Langberg wrote a review, I think it was in 2018, I want to say. And what we found was that, particularly related to adolescents with ADHD, but even though we talk about motivation a lot in the ADHD world, there weren’t really as many papers using, 1) a measure that was clearly linked to a theory of motivation and, 2) looked at adolescents. We had looked at a lot of kids in elementary school, so for the United States, that’s, like, ages five to 11, but not really, for us, middle school and high school. Our last year of what we call middle school or junior high and then, kids transition to high school, which is 9^th through 12^th grade, which is ages around 14 to 18 for high school. We also wanted to make sure that we were specifically getting teen report of motivation because there is that internal process.

So, sometimes studies would get parent and Teacher report. ‘Cause that’s really common in ADHD studies that we focus a lot on parent and Teacher report, because for a very long time, we said our goal standard of assessment for ADHD is getting that perspective. And we’ve really missed the youth perspective on themselves, which I think – which we have now found is really, really important in understanding how teens with ADHD, you know, experience school, experience motivation.

And so, we used this theory-based measure, using self-report, to get the teens’ perspective on their own motivation and then, like I said, we did 8^th Grade, which again, is around ages 12-13, and did a full assessment. So, we did a clinical interview, we did surveys, we did academic achievement testing, which was, like, standardised testing, and we also asked for a GPA. And then, in the middle timepoints, and I believe in 9^th Grade and maybe the spring of 8^th Grade, as well, and the next three did not have all of this in-person activity.

It was mostly focused on just survey measures and getting GPA information. So, GPA stands for grade point average and in the United States, it’s what’s used, typically, to show academic success, and so, I’ll get into that a little bit later about why that may or may not be the best standard. And what we do is we took the four most commonly taught subjects, so English language, arts, mathematics, science and social studies, which is, like, history, and then averaged that on a four-point scale, and so, that’s what GPA is.

So, what we did is, then, in 10^th Grade, so this – which is our final timepoint for the study, and we also did academic achievement testing again. So, we asked for a GPA, we did surveys about homework performance, with all of that data, which was a lot of data. We used what’s called longitudinal structural equation modelling, to understand, first, how academic motivation changes, so how amotivation, intrinsic and extrinsic motivation change across five timepoints, from 8^th Grade to 10^th Grade. And then, we looked at whether that was different for teens with and without ADHD and then, we did that exact same thing, like looking at that change in motivation and using longitudinal structural equation modelling again, we then added in, are these associated with academic success variables? And that is a brief overview of the method.

[00:13:01.670] Jo Carlowe: So, Zoe, what key findings from the paper would you like to highlight?

[00:13:05.750] Dr. Zoe R Smith: So, the first one I want to highlight is that adolescents with ADHD did report lower motivation at each timepoint. No matter what age they were, they were always lower on extrinsic and intrinsic motivation and higher on amotivation, that apathy, related to academic motivation. But interestingly, adolescents who did not have ADHD actually decreased on motivation at a higher rate, at a faster rate, than kids without ADHD.

One thing that we thought about why this might be the case is that teens with ADHD already start pretty low on motivation and so, there’s not as much room to change. Where teens in 8^th Grade without ADHD maybe haven’t hit something like a failure cycle yet, or maybe haven’t started having that higher levels of apathy, lower levels of intrinsic and extrinsic motivation. And so, that might happen a little bit later for the youths without ADHD. The big take home message is that all teens are decreasing on academic motivation from ages 12-13 to ages, like, 15-16, and that’s obviously a problem, ‘cause these are really important academic years.

Then, the next step we wanted to do is look at, okay, so, now we know that all teens are decreasing on motivation, how is that affecting their academic success? And so, we looked at this with an ADHD group and a non-ADHD group and what we found is, with the non-ADHD group, only amotivation and extrinsic motivation, so only two aspects of motivation, were associated with only one outcome, and that was GPA. So, we looked at homework performance, we looked at reading, we looked at two different aspects of math and then, we looked, again, at that grade point average, that GPA. And on – that was the only thing for typically developing youth that was associated with motivation.

And so, what we found was that higher levels of amotivation, so that apathy, was associated with worse GPA and then, higher levels of extrinsic motivation, so extrinsic motivation is external motivators, like getting a good grade, was strongly positively associated with GPA. So, more extrinsic motivation, higher GPA, which makes sense, because getting a good grade, getting that external motivation, then makes kids want to get better grades, which then helps them have a higher grade point average.

So, for kids with ADHD, there were a lot more associations. What we found was that all aspects of motivation were associated with some aspect of academic achievement. So, amotivation, extrinsic motivation and intrinsic motivation were all associated with different aspects of academic success. For GPA, it was similar findings for teens with and without ADHD. The one difference was that intrinsic motivation was also associated with GPA for kids with ADHD. So, we’re still seeing that this self-belief, this intrinsic motivation about being able to learn, has – is really important for kids with ADHD, where it was not an association for kids without ADHD.

And so, that can be really important for Therapists, Teachers, parents and most importantly, teens themselves, to think about how to best support their academic success and thinking about how to grow that, kind of, autonomy, that growth mindset, that internal motivation for themselves. Multiple aspects of motivation were also associated with homework performance, math fluency, which is, like, a timed math test and then, numeric operations, which is a independent math worksheet, and that those were all also affected by motivation for kids with ADHD, but not for kids without ADHD.

[00:17:28.900] Jo Carlowe: It’s so interesting. Were any of your findings surprising or unexpected?

[00:17:33.840] Dr. Zoe R Smith: The first one that I talked about, we, at first, were surprised that teens who do not have ADHD decreased at higher rates when compared to youth with ADHD. But then, again, like I explained, we realised that that was most likely because there was just less room to move for teens with ADHD and teens with ADHD still remained lower on motivations. They still were significantly lower than their peers on motivation. So, they start lower, and they stay lower across time.

I think that this is pretty informative, though, for us to recognise, because it’s showing that already, in 8^th Grade, teens with ADHD are struggling with motivation, which now we know affects their grades, their math scores, their homework performance in high school. Meaning we really need to intervene much earlier than 8^th Grade in helping to foster different aspects of motivation.

The other somewhat surprising finding was that for neither youth with or without ADHD, we didn’t find an association with basic reading ability. The reason this was surprising was that a lot of previous work with younger kids, so kids at, you know, ages five to 11, there’s actually a pretty strong association between intrinsic motivation and reading skill, particularly basic reading skills. And so, we thought 1) this could be ‘cause we’re looking at it in adolescents and maybe that is – there’s just a difference, but, you know, we didn’t test it in younger kids, so we’re not sure. And then, the other thing is that basic reading is, kind of, assumed at this point, by 10^th Grade, that you have basic reading skills. So, it could also be that assessing things like reading comprehension, or something a little bit more advanced, would be a better assessment. You know, that’s for another study to find out. We didn’t have that measure.

[00:19:35.059] Jo Carlowe: Absolutely. Your paper points to motivation increasing when students are given more autonomy. That was something I picked up and that I thought was interesting in your paper. What interventions are known to foster autonomy growth in young people with ADHD?

[00:19:51.800] Dr. Zoe R Smith: To be honest, there are very few interventions that look at that for all youth, but particularly for youth with ADHD. The biggest exception is Dr. Maggie Sibley’s STAND intervention, which incorporates motivational interviewing into her treatment, and motivational interviewing is a really excellent tool that focuses on increasing autonomy. So, basically, one, like, basic skill that I really like to use for motivational interviewing is the Readiness Ruler. I use it with almost all the kids that I work with, particularly kids with ADHD, is trying to figure out how ready they are to complete a certain goal that they’ve created.

First, you know, I want to make sure that I’m getting a goal from the teen that’s actually their goal and not necessarily a parent’s goal or a Teacher’s goal, which is very important and not always, unfortunately, looked at. And so, I help the teens create their own goals and then, I learn through motivational interviewing, really, how ready they are to do the tasks that are needed to complete that goal. And if they’re not ready, we say, then, “That’s okay, this goal can be later, but we need to find a goal that you can do right now. And how can we move and use motivational interviewing to help you feel ready and learn what you’re ready to do right now?” ‘Cause a lot of times, we have unrealistic expectation of ourselves, of other people and so, I think that that’s just a really important tool, and it’s a really easy tool that Teachers, parents, Paediatricians and teens themselves can use to foster this autonomy to increase motivation for academic success.

And the other thing we suggest in the paper is that although this has not directly been researched with teens with ADHD, but has been researched with teens in a more general sample, is that creating a school environment that includes things like choices, education that corresponds with students’ interest. Even communicating a rationale for why a task is important, providing opportunities to question the work. Those are different things that Teachers and parents can help teach their teen to do, to really understand not only how to critically think about information, which is really important in this world, but also to increase interest, which then increases motivation, which then increases academic success.

[00:22:36.520] Jo Carlowe: Sticking with Teachers, but let’s also bring in CAMH professionals and, let’s say, policymakers, too, what are the implications of your findings for all these groups, so for CAMH professionals, educationalists and policymakers?

[00:22:50.310] Dr. Zoe R Smith: In the United States, and also in many other countries, I think the UK is also similar, academic success is really focused on a very specific area of education, which is really being good at memorisation and standardised test and having the most resources to succeed in those two areas of education. And so, here in the United States, this is because of, you know, continuously problematic educational policy. So, for example, No Child Left Behind was in the 2000s, Race to the Top was a little bit later, and are still affecting teens today. And so, it’s really focused on teaching that’s like teaching to the test, not teaching to learn or to grow or to think critically about things.

And so, it’s very important for us to recognise the systems that our students are learning in and how that reflects what they are conceptualising as what success is and what incentives are built into the curriculum that is undermining our students’ motivation and academic success, and even learning for students.

Currently, Teachers and School Administrators are really incentivising students to test well on national performance benchmarks, which then leads, again, to that teaching practices that focus on being good at standardised test taking, but not necessarily be good at learning. And so, it’s really focused on performance, which is an extrinsic motivator, instead of learning and growth, which are intrinsic motivators.

What I would want educationalists, CAMH professionals and Teachers and parents to hear is that we need to foster autonomy in our education system, and to do that, we need to change the benchmarks, the policy and just the educational system itself. What Teachers, parents, CAMH professionals, teens themselves, can do now is just include that student autonomy by providing those choices in learning, by teaching how to find interest in a homework assignment that may really not be interesting at all. And trying to find that novelty or urgency or interest that helps our students learn and think critically, instead of just memorisation.

The theory that we’ve been talking about this whole time, that theory that states that motivation is really closely tied to wellbeing and that intrinsic motivation really helps increase not only academic success, but really thinking critically, which are needed, really, in this time, with the amount of content and misinformation that is out and online, really, those should be the goals that we have for education. So, I’m a Professor at Loyola and I have students, let’s say, you know, when they take a test, they just remember it for the test and then, it leaves their brain almost immediately, and that’s not learning. And so, what we need to do is foster that interest and engagement in the work.

[00:26:02.169] Jo Carlowe: Any specific tips for young people themselves, or for their parents who are – can encourage them?

[00:26:07.960] Dr. Zoe R Smith: That’s such a good question. So, I think parents should really try to work to foster their teen’s autonomy and critical thinking skills. Even if, you know, they have to exist in an education system that right now, does not foster that autonomy, it really can be done at home. And so, teens – I don’t want to always put things on teens, because, you know, they’re the ones who have a lot going on in their lives and should have the support of adults in their life. But let’s say you just want a few skills to think about doing, just try, in every task that you have to do, whether it’s a chore, whether it’s academics, whether it’s homework, to try to find something about each task that you have to do that you’re curious about or you have questions about. This will help increase your intrinsic motivation to complete that task because there’s something new, or novel, or interesting, now, essentially associated with that task.

I also really want to speak specifically to teens with ADHD. This can be true for all teens, but I really want to speak to my kids at their – for the teens with ADHD out there. So, to young people with ADHD who are struggling, I really want you to know that it’s not you. It’s the educational systems we have in place that are incredibly unfriendly to A – to having ADHD, and even punitive, so punishes you for having ADHD. So, I want you to know that having ADHD is a natural variation of the human experience and there are so many reasons why ADHD exists in our world, and that even if you’re in a place right now where you feel like you’re not valued, you really are. You’re – you have so many amazing skills. You have so many strengths.

So, right now, if you’re struggling or falling into one of those shame or negative or failure spirals that I talked about, I just hope that you maybe have resources to speak support, talk to a parent, a Teacher, a Therapist, about that and focus on, kind of, understanding that it’s not you, it’s these outside enforcers around you. I really want you to know, you teens with ADHD, that you are smart, you are curious, you are fun, and I really don’t want the education system to really take that brightness away.

So, know that my team here at Loyola, I know that ACAMH, I know so many people really believe in you. You’re incredibly valuable to this world, and one thing that I think is really cool is that people with ADHD are amazing Scientists, Researchers, Entrepreneurs, Policymakers, Engineers, Content Creators, Athletes and so much more, because people with ADHD can think divergently and can see solutions that people without ADHD don’t notice. And I just want, again, teens with ADHD to know that you got this and we also got you.

[00:29:19.980] Jo Carlowe: Zoe, is there anything else in the paper that you would like to highlight?

[00:29:23.169] Dr. Zoe R Smith: So, I think – again, motivation is incredibly important. We’ve seen that it’s associated with academic success, as highlighted by what we talked about earlier and shown in the paper, particularly for teens with ADHD. I also actually want to highlight a few of our limitations from the study, where we can just grow and expand upon our research. So, we did not really examine how external environments and social determinants of health, how those affect motivation. And so, having chronic stressors early in life, like racism, food insecurity, lack of safety at home or school, absolutely affects development, affects motivation, affects academic success. So, one thing that we weren’t able to assess, but hope to do so in the future, is really understand and assess these contextual factors when examining motivation.

[00:30:19.040] Jo Carlowe: So, sticking with future work, are you planning any follow-up research, or is there anything else in the pipeline that you would like to share with us?

[00:30:27.730] Dr. Zoe R Smith: Yes, multiple things. So, we want to understand how the pandemic has shaped motivation and so, Doctors Rosanna Breaux, Stephen Becker, Melissa Dvorsky and Josh Langberg all collected that motivation data with the same group of teens. And so, that’s, kind of, a follow-up study that we’re really interested in looking at and seeing if there are any changes in motivation or in changes in growth in motivation. So, when I say ‘growth’, I don’t necessarily mean that it’s increasing. What I mean is that, is it changing over time? And so, we’ll be able to understand how motivation may have changed over that time period for both teens with and without ADHD.

And then, the other project that my current team is focused on, so, we’re providing culturally responsive assessments for Black and/or Latina, Latine and Latino teens with ADHD. We are still recruiting, so if any listeners know of Black and/or Latine teens who have, or are suspected of having, ADHD in the Chicago area, or willing to travel once to the Chicago area, then you can reach out to us at Loyola University, Chicago. But we also include motivation, so we include the same scale of motivation in that study, along with what I just talked about, those contextual factors that may affect motivation, such as discrimination, pandemic distress, that may affect motivation, as well as academics. And so, first, we’re going to look at the psychometric properties of the measure and then, examine whether motivation affects academic success with the teens that we served, and including, again, like, those contextual discrimination, pandemic, and social turbulence and health measures.

So, they can go to ACCTIONLab.com, that’s A-C-C-T-I-O-N-L-a-b.com and click on ‘Projects’ and there’s information on how to talk to us. Or they can give us a call at – 1 is the United States’ code, so 1 312 487 1489.

[00:32:48.299] Jo Carlowe: Thank you. Finally, Zoe, what is your take home message for our listeners?

[00:32:56.160] Dr. Zoe R Smith: Motivation is decreasing for all teens from 8^th to 10^th Grade, but continues to be lower for our teens with ADHD. So, we really need to intervene early to help support teens with and without ADHD by changing our education systems, teaching practices, homework, etc., to really support teens’ academic success and foster that autonomy and intrinsic motivation.

[00:33:24.400] Jo Carlowe: Zoe, thank you ever so much. For more details on Dr. Zoe Smith, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.