ADHD

the

Volume 22

Russell A. Barkley & Associates

Number 6

ISSN 1065-8025

September 2014

Academic Buoyancy, Resilience, and

Adaptability in Students with ADHD
Andrew J. Martin, Ph.D., and Emma C. Burns, B.A.
Adversity and change are two realities of lifeincluding academic life.
How students respond to adversity
and change shapes their pathways at
school and beyond. As detailed below,
students with attention-deficit/hyperactivity disorder (ADHD) are at particular risk in their efforts to successfully navigate adversity and change
in their lives. Academic buoyancy and
academic resilience are two factors that
are relevant to successfully handling
adversity; adaptability is a factor relevant to successfully handling change
(and uncertainty, transition, variability,
and novelty). This discussion explores
the roles of academic buoyancy, academic resilience, and adaptability in
assisting students with ADHD to more
effectively navigate adversity and
change in their academic lives.
ACADEMIC BUOYANCY AND
ACADEMIC RESILIENCE
ADHD and Academic Risk and
Adversity
Drawing on Coleman and Hagells
(2007) multidimensional risk framework, there are two major dimensions
of risk and adversity in young peoples

lives: risk factors and risk behaviors. Both

are relevant to students with ADHD.
ADHD itself is a risk factor in the
sense that it is a persistent pattern
of inattention and/or hyperactivityimpulsivity that interferes with functioning or development (American
Psychiatric Association, DSM-5, 2013,
p. 59). Major conceptual frameworks of
ADHD emphasize impairments to executive functioning and self-regulation
(Loe & Feldman, 2007; Nigg, 2001),
neuropsychological and cognitive risk
(Brown, 2005; Gray & McNaughton,
2003; Sergeant, 2005), and biochemical and neurological risk (see Barkley,
2006; Chandler, 2010 for summaries).
There are also risk factors in the form
of comorbidities (e.g., specific learn-

ing disabilities, anxiety) that further

compound academic difficulties of
students with ADHD (Bauermeister,
Shrout, Ramrez, Bravo, Alegra, Martnez-Taboas, & Canino, 2007). These
risks and adversities compromise and
disrupt academic outcomes of students
with ADHD (Martin, 2013b, 2014a;
Vostanis, 2007; Wilmhurst, Peele, &
Wilmhurst, 2011).
The second dimension of risk and
adversity relates to risk behaviors
(Coleman & Hagell, 2007). Risk behaviors pertain to potentially challenging
and harmful behavior. In relation to
this, the ADHD condition has negative
behavioral effects across a wide range
of academic outcomes (Barkley, Murphy, & Kwasnik, 1996; DuPaul, Ruth-

Contents
Academic Buoyancy, Resilience, and Adaptability in Students
with ADHD, 1 The Importance of Screening Routinely for
Suicidality in ADHD, 9 Research Findings, 12
NOTICE TO NON-PROFESSIONALS The information contained in this newsletter is not intended as a
substitute for consultation with health care professionals.

2014 The Guilford Press

The ADHD Report 1

Russell A. Barkley, Ph.D.

Department of Psychiatry
Medical University of South Carolina
Send correspondence to:
2321 Darts Cove Way
Mount Pleasant, SC 29466
E-mail: drbarkley@russellbarkley.org
www.russellbarkley.org
Dr. Russell Barkley discloses that his work includes serving
as a paid Speaker/Consultant for pharmaceutical companies
in his area of expertise.

ADVISORY BOARD
Lenard Adler, M.D., New York University School of
Medicine Kevin Antshel, Ph.D., State University
of New York Upstate Medical University Jos J.
Bauermeister, Ph.D., University of Puerto Rico, San
Juan Andrea M. Chronis, Ph.D., University of
Maryland, College Park George J. DuPaul, Ph.D.,
Lehigh University, PA Gregory Fabiano, Ph.D.,
University of Buffalo Jeff Epstein, Ph.D., Cincinnati
Children's Hospital Medical Center Sam Goldstein,
Ph.D., University of Utah, Salt Lake City Michael
Gordon, Ph.D., State University of New York Upstate
Medical University Stephen Hinshaw, Ph.D., UC
Berkeley Betsy Hoza, Ph.D., Univeristy of Vermont
Charlotte Johnston, Ph.D., University of British
Columbia, Vancouver Scott Kollins, Ph.D., Duke
University Medical Center, Durham, NC Sandra
Kooij, M.D., Expertise Center Adult ADHD, The
Netherlands Laura E. Knouse, Ph.D., University of
Richmond, Richmond, VA Florence Levy, M.D., The
Prince of Wales Childrens Hospital, Australia Larry
Lewandowski, Ph.D., Syracuse University, NY Sandra Loo, Ph.D., Neuropsychiatric Institute, UCLA
Keith McBurnett, Ph.D., University of California, San
Francisco Richard Milich, Ph.D., University of Kentucky, Lexington Brooke Molina, Ph.D., University
of Pittsburgh Kevin Murphy, Ph.D., Adult ADHD
Clinic of Central Massachusetts Joel Nigg, Ph.D.,
Oregon Health Sciences University, Portland, OR
Linda Pfiffner, Ph.D., University of Chicago Mark
Rapport, Ph.D., University of Central Florida Luis
Rohde, M.D., Federal University of Rio Grande do Sul
Steven A. Safren, Ph.D., Harvard Medical School
Julie Schweitzer, Ph.D., UC-Davis MIND Institute,
Sacramento, CA Mary V. Solanto, Ph.D., The Mount
Sinai School of Medicine Dan Waschbusch, Ph.D.,
Florida International University Jeanette Wasserstein, Ph.D., The Mount Sinai School of Medicine
Lisa Weyandt, Ph.D., University of Rhode Island
Alan Zametkin, M.D., National Institute of Mental
Health, Bethesda, MD

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2 The ADHD Report

erford, & Hosterman, 2008; Martin,

2012a, in press). For example, there are
higher rates of attention seeking, offtask behavior, and poor task completion
(Vile Junod, DuPaul, Jitendra, Volpe, &
Cleary, 2006). These risk behaviors lead
to poor outcomes on many academic
dimensions, such as school exclusion,
schoolwork non-completion, poor
achievement, grade repetition, school
refusal, and changing classrooms and/
or schools (DuPaul et al., 2008; DuPaul
& Stoner, 2003; Martin, 2014a; Pliszka,
2009; Purdie, Hattie, & Carroll, 2002).
As 3060% of ADHD cases are estimated to continue on to adulthood, these
risk factors and risk behaviors constitute major psychological, sociological,
and educational challenges that must
be addressed in order to improve students post-school lives (Harpin, 2005;
Parker, Majeski, & Collin, 2002).

negative interactions with teachers

(Martin & Marsh, 2008a, 2008b, 2009).
The operationalization of both constructs is also different. Because academic buoyancy is relevant to all
students, the simple unidimensional
Academic Buoyancy Scale (Martin &
Marsh, 2008a), comprising 4 items (e.g.,
I dont let study stress get on top of
me) is used. Academic resilience requires a more nuanced, two-step approach using the Academic Risk and
Resilience Scale (Martin, 2013a). First,
students rate themselves on a 10-item
(major) academic adversity scale (comprising such adversities as suspension,
expulsion, learning disability, grade
repetition, chronic failure). Second,
those that endorse any of the major
academic adversities are then asked 4
questions probing how well they managed or navigated that adversity.

Academic Buoyancy and Academic

Resilience

ADHD, Academic Buoyancy, and

Academic Resilience

Respectively, academic buoyancy and

academic resilience have been suggested as two attributes relevant to students capacity to navigate low-level
and major academic risk and adversity. Academic buoyancy is defined as
an ability to successfully deal with everyday academic adversity (i.e., minor
adversity; Martin & Marsh, 2009; see
also Malmberg, Hall, & Martin, 2013;
Putwain, Connors, Symes, & DouglasOsborn, 2012; Putwain & Daly, 2013).
Academic resilience is defined as an
ability to successfully deal with chronic
and/or acute academic adversity (i.e.,
major adversity; Martin & Marsh, 2009).
Martin and Marsh (2008a, 2008b, 2009)
have identified numerous examples of
how academic buoyancy and academic
resilience are different. For example,
whereas academic resilience is relevant
to chronic underachievement, academic
buoyancy is relevant to patches of poor
performance and isolated poor grades;
whereas academic resilience is relevant
to truancy and disaffection from school,
academic buoyancy is relevant to dips
in motivation and engagement; and,
whereas academic resilience is relevant
to alienation from school or opposition
to teachers, academic buoyancy pertains to relatively minor or infrequent

The fact that there exist different degrees of academic adversity (minor and
major) holds implications for students
with ADHD. Low-level (minor) adversity is experienced by most (perhaps
all) students, including students with
ADHD. As suggested above, this everyday or low-level academic adversity includes difficult schoolwork, large
or multi-part assessment tasks, competing assessment deadlines, an occasional
poor result, and a negative interaction
with a teacher. In contrast, major adversity is experienced by a relative minority of students. Importantly, however,
such adversity is quite common for
students with ADHD (Martin, 2014a;
Purdie et al., 2002). Given this, students
with ADHD must wrestle with both
low-level academic adversity and major
academic adversity, whereas most nonclinical students typically face just lowlevel academic adversity. Extending
this line of argument, it therefore is apparent that students with ADHD would
benefit from both academic buoyancy
and academic resilience, while for most
other students, academic buoyancy suffices because major adversity is relatively uncommon for them (Martin, 2013a).
There have been numerous studies investigating academic buoyancy among
general (non-clinical) populations (e.g.,
2014 The Guilford Press

see Malmberg et al., 2013; Martin, 2013a;

Martin & Marsh, 2008b, 2009; Parker
& Martin, 2009, 2011; Parker, Martin,
Colmar, & Liem, 2012; Putwain et al.,
2012; Putwain & Daly, 2013). However,
only one study (Martin, 2014a) to our
knowledge has investigated academic
buoyancy among students with ADHD.
This study found that the adaptive role
of academic buoyancy is positive and
statistically significant for students
with ADHD. Specifically, for students
with ADHD, academic buoyancy significantly and positively predicted academic achievement, class participation,
enjoyment of school, and educational
aspirationsbeyond the effects of age,
gender, socioeconomic status, language
background, and personality.
In that same study, the effects of academic buoyuancy for students with
ADHD were compared with academic
effects for a non-clinical sample. Interestingly, significant differences in
academic buoyancy effects emerged for
class participation and school enjoymentwith the ADHD group evincing
stronger positive effects of academic
buoyancy than the non-ADHD group.
Further, the bulk of positive effect sizes
for academic buoyancy trended larger
for the ADHD group. Martin (2014a) reported that, to the extent that this is the
case, we begin to gain some insight into
the potential for academic buoyancy to
help close the academic engagement
differences between ADHD and nonADHD groups. That is, there are some
factors on which at-risk students stand
to gain to such an extent that parity in
academic engagement becomes possible.
To date, there has been no research investigating academic resilience among
students with ADHD. In fact, academic
resilience is the less studied of the two
phenomena. In the one empirical investigation conducted with a general student sample, it was found that academic buoyancy and academic resilience
were distinguishable factors, sharing
approximately 35% variance (Martin,
2013a). Given that students with ADHD
experience major academic adversity
(Martin, 2014) and given that academic
resilience is proposed as a factor important for navigating such adversity,

2014 The Guilford Press

there is a need to empirically examine

academic resilience in ADHD samples.
There is also a need to understand the
relative roles of academic buoyancy
and resilience as relevant to students
with ADHD.
ADAPTABILITY
Change, Uncertainty, Transition,
and Novelty
Through a young persons life span, the
world will undergo substantial change
on economic, sociocultural, technological, medical, geopolitical, and other
fronts (Hofcker, Buchholz, & Blossfeld,
2010; Tomasik, Silbereisen, & Heckhausen, 2010). A young persons current
and future life will be characterized by
frequent change, uncertainty, variability, transition, and novelty. They will
experience most or all of the following:
begin school, adjust to new year groups
and subjects at school, move out of
home, start and change jobs, marry or
partner, have or care for children, and
retire from work. In addition, within a
school day, a student will change lessons and tasks, interact with many
students and teachers, and experience
new or changing situations and circumstances (Martin, Nejad, Colmer, & Liem,
2012, 2013). Thus, change, uncertainty,
novelty, transition, and variability are
salient through childhood, youth, and
beyond.
These changes might also be considered in terms of minor and major transitional milestones (Martin et al., 2013).
Major transition milestones include beginning school, moving home, managing relationships, choosing a significant
other, child rearing, and the like. Minor
transitional milestones occur daily, such
as the changing nature of deadlines, directions, and criteria for a project or assignment.
These changes interrupt routines and
present new circumstances to which
young people must habituate (Pinquart & Silbereisen 2004; Tomasik &
Silbereisen 2009; Tomasik et al., 2010).
They are relevant to all young people,
including those with ADHD. However,
it may be that students with ADHD
are less capable of successfully navi-

gating these changes and uncertainties

(Burns & Martin, 2014). Adaptability is
an attribute that has recently been the
focus of investigation among adolescents at school, including students with
ADHD. Here, we suggest that alongside academic buoyancy and academic
resilience, adaptability is another factor
important for students with ADHD as
they navigate the ever-changing world
around them.
Adaptability
The American Psychological Association defines adaptability as the capacity to make appropriate responses to
changed or changing situations; the
ability to modify or adjust ones behavior in meeting different circumstances
or different people (VandenBos, 2007,
p. 17). This definition was recently extended to include not just behavioral
and cognitive regulation in response to
change, uncertainty, and novelty, but
also emotional regulation (Martin et al.,
2012, 2013). Behavioral regulation connotes ones capacity to adjust the level,
nature, and degree of action or behavior
to effectively navigate changing, novel,
and uncertain circumstances and conditions. Cognitive regulation pertains to
ones capacity to adjust thinking to deal
with changing, new, and uncertain circumstances and conditions. Emotional
regulation connotes ones capacity to
adjust typical emotional responses to
effectively interact with an uncertain,
new, or changing environment. This is
referred to as the tripartite perspective of adaptability (Martin et al., 2012,
2013). Each of the three dimensions (behavioral, cognitive, emotional) is important for building and sustaining a
positive relationship between the individual and his/her changing academic
and non-academic environment (Wessel, Ryan, & Oswald, 2008).
As with academic buoyancy and resilience, adaptability has been operationalized via self-report items, using
the Adaptability Scale (Martin et al.,
2012, 2013). The Scale contains nine
items, each of which meets three essential criteria: 1) a behavioral, cognitive,
and/or emotional response to change,
novelty, and uncertainty, 2) adjustment,
regulation, or revision of one or more of

The ADHD Report 3

these behavioral, cognitive, and emotional functions, and 3) a constructive

purpose or outcome (Martin et al., 2012,
2013). For each of the three factors there
are three items: cognitive adaptability
(sample item: I am able to adjust my
thinking or expectations to assist me in
a new situation), behavioral adaptability (sample item: To assist me in a new
situation, I am able to change the way I
do things), and emotional adaptability
(sample item: When uncertainty arises,
I am able to minimize frustration or irritation so I can deal with it best). There
is also a brief 3-item scale in which each
factor is represented by just one item.
ADHD and Adaptability
Because there are regulatory processes
involved in adaptability, there may be
some young people who are at particular risk with regard to their capacity to
adapt to change, uncertainty, novelty,
and transition. In turn, this may place
them at risk on a variety of academic
and personal outcomes that rely on
their capacity to successfully navigate
change, uncertainty, transition, and the
like. This brings into consideration the
issue of ADHD, a disorder known to
involve behavioral, cognitive, and emotional regulatory impairments (Barkley,
2006).
To provide a sense of this as relevant to the tripartite (behavior, cognition, emotion) adaptability framework,
Burns and Martin (2014) drew on three
functionstemporal discounting, planning, and emotional hyper-responsivenessas useful illustrations of the
ways in which students with ADHD
may struggle with the regulatory factors
and processes central to adaptability.
Temporal discounting is the extent to
which an individual discounts a future
reward, yet instead favors a more immediate and proximal reward. Many important educational outcomes are distal
(e.g., an end-of-year grade; high school
graduation), requiring ongoing application and delay of proximal gratification.
Attaining important distal educational
outcomes requires impulse control and
behavioral regulation (Barkley, 2006;
Barkley, Edwards, Laneri, Fletcher, &
Metevia, 2001). Students with ADHD
experience difficulty with tasks that do
not have immediate rewards; they will
4 The ADHD Report

often choose smaller immediate rewards

in preference to larger future rewards.
Thus, individuals with ADHD can have
difficulty looking long term and appropriately adjusting their present actions and behaviors (Barkley, 2006). This
(and similar regulatory functions) may
hold implications for the behavioral regulation required for adaptability and,
by extension, for students with ADHD
(Burns & Martin, 2014).
Planning involves hindsight and
forethought to inform and regulate future action and behavior. This cognitive
function has relevance to adaptability:
adaptability requires an individual to
consider how best to regulate thought
in order to navigate novelty, uncertainty, and change (Martin, 2013c). There
is the need to review past actions and
thought processes to ascertain the degree to which they were successful. It
is known that those with ADHD are
less likely to review their behaviors or
thoughts based on immediate and recent outcomes; they therefore find it
difficult to prepare and initiate anticipatory behavior (Barkley, 2006). This
(and similar regulatory functions) may
hold implications for the cognitive regulation required for adaptabilityand
by extension, for students with ADHD
(Burns & Martin, 2014).
Emotional hyper-responsiveness is
a trait identified in those with ADHD
(Barkley, 2006; Parker et al., 2002). In the
academic context, students with ADHD
may express somewhat marked irritability, frustration, and hostility more
frequently and readily than non-ADHD
peers (Parker et al., 2002; Pisecco, Wristers, Swank, Silva, & Baker, 2001). To
the extent that emotional regulation is
an important dimension of adaptability and given that young people with
ADHD experience difficulty regulating their emotions, these young people
may experience significant difficulties
in their capacity to adapt. This (and
similar regulatory functions) may hold
implications for the emotional regulation required for adaptabilityand by
extension, for students with ADHD
(Burns & Martin, 2014).
Given the centrality of regulatory
functions relevant to adaptability, it is
reasonable to consider adaptability as a
construct residing under the broad self-

regulatory umbrella. There has been

substantial research into self-regulation
and ADHD (e.g., Loe & Feldman, 2007;
Nigg, 2001); however, only preliminary
descriptive work has explored the specific construct of adaptability among
students with ADHD. In this work,
Burns and Martin (2014) collected data
from 3,905 high school students from
nine schools. Within this sample, there
was a sub-sample with ADHD comprising 136 students (59% in junior
high, 41% in senior high school; 68%
male, 32% female). Students were presented with the Adaptability Scale. Of
particular interest was the pattern of
adaptability scores for students with
ADHD compared to those without
ADHD. Findings showed that students
with ADHD scored significantly lower
on cognitive adaptability, behavioral
adaptability, and total adaptability.
Interestingly, there was no significant
difference between the two groups on
emotional adaptability. Hence, impairments experienced by students with
ADHD seemed to intersect core components of the tripartite adaptability
construct. This preliminary work thus
signals important differences in adaptability between students with and without ADHD. Further work is now needed to better understand the academic
and non-academic consequences of low
adaptability for students with ADHD
and to explore intervention approaches
that might promote adaptability for
these students.
ADHD AND THE ADAPTABILITYBUOYANCY-RESILIENCE CYCLE
Although there are conceptual and applied distinctions between buoyancy,
resilience, and adaptability (see above),
it is also the case that they share common empirical ground. For example,
Martin and colleagues (2013) found
that academic buoyancy and adaptability share 36% variance. Although
research has not yet investigated overlap between academic resilience and
adaptability, given that buoyancy and
resilience share 35% variance (Martin,
2013a), it is reasonable to infer that resilience and adaptability will also share
variance.
This brings into consideration the
task of identifying the specific opera 2014 The Guilford Press

tional and applied means by which the

three factors are connected. Here, we
speculate on a possible process between
the three that might operate for a student with ADHD.
1. There exists an impaired capacity
to regulate behavior, thought, and
emotion (along the lines of regulatory impairments of students with
ADHD) that makes it difficult for
the ADHD student to keep abreast
of or adapt to the often unpredictable unfolding of events, tasks,
people, and conditions that characterize the typical school day.
Difficulty along these lines reflects
poor adaptability.
2. Failure to cope with these changing
and unfolding events may lead to
low-level academic risk, such as
an inability to manage deadlines,
strained relationships with teachers,
and early evidence of poor performance. Difficulty along these lines
reflects poor academic buoyancy.
3. An ongoing inability to deal with
these low-level academic risks leads
to the possible emergence of more
chronic work non-completion, maladaptive teacher-student relations,
and ongoing underachievement.
Difficulty along these lines reflects
poor academic resilience.
4. As underachievement and disaffection builds, the student with ADHD
becomes systematically disconnected from the academic processes and
opportunities that are important
for further developing behavioral,
cognitive, and emotional regulatory skills. Impoverished regulatory
capacity further diminishes the
students capacity to keep abreast of
or adapt to the often unpredictable
unfolding of events, tasks, people,
and conditions that characterize the
typical school day, further perpetuating the maladaptive AdaptabilityBuoyancy-Resilience cycle.
Figure 1 demonstrates this possible
Adaptability-Buoyancy-Resilience cycle for students with ADHD.
2014 The Guilford Press

Figure 1.

POTENTIAL
PSYCHOEDUCATIONAL
INTERVENTION
Attending to Behavior, Cognition, and
Emotion
The theory and research described thus
far also provide a basis for applied and
intervention recommendations to assist the academic outcomes of students
with ADHD. For example, drawing on
the resilience research by Rutter (1987)
and Morales (2000), Martin and colleagues (2013; see also Burns & Martin,
2014) identified the following steps for
students to help them deal with both
adversity (buoyancy and resilience)
and change (adaptability):
1. The student is taught how to recognize academic adversity and/
or change, uncertainty, and novelty
that require buoyancy/resilience
and adaptability;
2. The student adjusts his or her cognition, behavior, and/or emotion
to navigate the adversity and/or
change;

3. This adjustment helps the student

deal with the adversity and/or
change;
4. The student recognizes the benefits
of this psycho-behavioral adjustment;
5. The student continues to engage
in cognitive, behavioral, and/or
emotional adjustment in response
to adversity and/or change, leading
to the development of their buoyancy/resilience and adaptability.
As Burns and Martin (2014a) point out,
in order to optimize adaptability and
buoyancy/resilience, step 2 (adjusting
cognition, behavior, and emotion) is
perhaps the most critical part of the process. According to Martin (2014; see also
Burns & Martin, 2014), ways students
might adjust their cognition include:

Thinking about a new or changing

situation in a different way (e.g., considering the opportunities this new

situation might offer)
Adjusting assumptions or expectations during a time of transition (e.g.,

The ADHD Report 5

thinking that change is not necessarily a bad thing).

Students might adjust their behavior by:

Seeking out more or new informa-

tion, resources, or help (e.g., asking

a teacher to recommend additional
reading when a new topic is announced)
Adopting a new course of action
(e.g., reorganizing the study timetable when a new assessment is
announced).
Students can adjust their (positive and
negative) emotions by:

Minimizing negative emotions (such

as disappointment, frustration, fear,

or anger) if circumstances change
(e.g., choosing not to focus on disappointment if the teacher cancels a fun
activity)
Looking for enjoyment in a new task
when the situation changes (e.g.,
focusing on the fun aspects of a new
activity)
Managing excitement (e.g., keeping a level head when in a winning
position).
The 5Cs of Academic Buoyancy and
Resilience
Previous recommendations for intervention with academic buoyancy have
been driven by research identifying
factors that predict students capacity to bounce back from academic setback. One promising line of research
by Martin and Marsh (2006) and then
validated in subsequent longitudinal
work (Martin, Colmar, Davey, & Marsh,
2010) identified five psychoeducational
predictors of academic buoyancy: Confidence (self-efficacy); Coordination
(planning); Commitment (persistence);
Control; and Composure (low anxiety).
These were referred to as the 5Cs of academic buoyancy. Interestingly, of these
five factors, low anxiety (i.e., Compsure) was the strongest predictor. As
anxiety is a factor known to be comorbid with ADHD (Chandler, 2010), this
is an important recognition for intervention. Identifying factors that predict
students capacity to bounce back from
academic setback lays a foundation for

6 The ADHD Report

targeted intervention aimed at promoting academic buoyancy.

Strategies to help reduce anxiety (enhancing composure) include showing students how to deal more effectively with fear of failure (e.g., encouraging
them to learn from mistakes), developing effective relaxation techniques,
better preparing them for pressure
situations such as tests and exams, providing special conditions for test-taking
and similar performance scenarios, and
helping them deal with the stressors
and anxieties associated with academic challenges and adversities that face
them (see Martin, 2007; Martin & Marsh,
2003, 2006). Intervention can also take
the form of cognitive monitoring to
increase awareness of when anxiety and
frustration are triggered, as well as the
associated distracting thoughts and distracted behaviors. Over time, the individual learns to replace these negative
emotions, thoughts, and behaviors with
positive alternatives (Young & Bramham, 2012).
Enhancing
academic
self-efficacy
(confidence) involves restructuring
learning so as to maximize opportunities for success (e.g., mastery learning
approaches, chunking schoolwork
into smaller and manageable units), individualizing tasks where appropriate
and possible (Schunk & Miller, 2002),
challenging students (negative) beliefs
about themselves (Bandura, 1997, 2006),
developing skills in goal-setting that optimize opportunities for success (Locke
& Latham, 2002), and implementing explicit instructional techniques (Liem &
Martin, 2013; Martin, 2014b).
Research into self-regulation and
goal-setting provides guidance for enhancing students planning (coordination) and persistence (commitment).
Encouraging students to set effective
goals (see Locke & Latham, 2002) and
teaching them the steps involved in
working toward these goals can boost
persistence (Locke & Latham, 2002).
Of relevance to students with ADHD,
in a recent study the positive effects of
personal best (PB) goal-setting generalized from non-clinical samples to a
sample of students with ADHD (Martin, 2012b, 2013b). Although sustained
attention and long-term goals are areas

of difficulty for students with ADHD,

encouraging these strategies will significantly increase their chances of academic success (Martin, 2012b, 2013b).
Incorporating these strategies with effective motivational tools, such as reward charts or behavior contracts, can
yield positive results (Pfiffner, Barkley,
& DuPaul, 2006). Developing students
self-regulatory skills (Zimmerman,
2002) can also enhance their planning
and persistence when faced with challenge. This might involve teaching
skills, such as how to develop and use
timetables and simple daily planners,
explicitly instructing students how to
prioritize, showing them how to identify the key elements and requirements
of assignments and homework, and developing strategies for monitoring and
checking the progress of schoolwork
while it is being done (Martin, 2007,
2014b).
In terms of enhancing students sense
of control, previous research has suggested showing students that effort
(how hard they try) and effective strategies (the way they try) are important
means of improvingand that their
effort and strategy are in their control
(Martin, Marsh, & Debus, 2001a, 2001b,
2003; Martin, Marsh, Williamson, & Debus, 2003). Control is also developed by
practitioners providing consistent feedback and focusing on the task (not the
person) and ways it can be improved
(Martin et al., 2001a, 2001b, 2003). In addition, attribution training can promote
a sense of control by helping students
credit their successes and failures to the
appropriate factors. This is especially
important for students with ADHD, as
they have a tendency to attribute success to external factors (Hoza, Waschbusch, Pelham, Molina, & Milich, 2000).
In doing so, they discount their personal success and do not capitalize on the
skills they have developed.
Interpersonal Relationships
In another study investigating predictors of academic buoyancy, Martin and
Marsh (2008a) identified the importance
of good teacher-student relationships.
It is the case that students with ADHD
require more time, patience, tolerance,
flexibility, and classroom accommoda-

2014 The Guilford Press

tions to assist their academic journey

(Martin, 2012a; Purdie et al., 2002). In
a review of the impact of interpersonal
relationships on student motivation
and engagement, Martin and Dowson
(2009) identified three key dimensions
underpinning teacher-student relationships: 1) the interpersonal relationship
(the student connecting with WHO the
teacher is as a person); 2) the substantive relationship (the student connecting with WHAT the teacher is saying
and the tasks assigned by the teacher);
and, 3) the pedagogical relationship
(the student connecting with HOW the
teacher communicates the subject matter and assigns the tasks to be accomplished).
They referred to this relational approach to instruction as connective instruction and, importantly, suggested
that this approach to instruction might
have distinct yields for at-risk populations.
Taken together, recent research and
seminal work over the past three decades provide grounds upon which to
promote the adaptability, buoyancy,
and resilience of students with ADHD.
CONCLUSION
How students navigate the adversity,
change, variability, uncertainty, and
novelty in their academic lives is important for their academic motivation, engagement, and achievement in school
and their pathways in post-school life.
Academic buoyancy, resilience, and
adaptability are proposed as important
factors that may assist students to deal
with these phenomena. Students with
ADHD are significantly more likely to
experience minor and major academic
adversity and are deficient in particular
regulatory functions that are important
for navigating change, novelty, and uncertainty. Accordingly, academic buoyancy, resilience, and adaptability may
have particular yield for these students.
Identifying the conceptual and empirical dimensions of academic buoyancy,
resilience, and adaptability among students with ADHD lays a foundation for
psychoeducational practice aimed at
enhancing the capacity of students with
ADHD to more effectively navigate

2014 The Guilford Press

their challenging and ever-changing

world.

Coleman, J., & Hagell, A. (Eds.). (2007).

Adolescence, risk, and resilience. London: John
Wiley.

This project was partially supported by

funding from the Australian Research
Council. The authors are affiliated with
the School of Education at the University
of New South Wales. Professor Andrew J.
Martin can be contacted at School of Education, University of New South Wales, Sydney NSW 2052, Australia. E-mail: andrew.
martin@unsw.edu.au.

DuPaul, G. J., Rutherford, L. E., & Hosterman, S. J. (2008). Attention-deficit/hyperactivity disorder. In R. J. Morris & N. Mather
(Eds.), Evidence-based interventions for students with learning and behavioral challenges
(pp. 33-58). New York: Routledge.

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The Importance of Screening Routinely for

Suicidality in ADHD
Judit Balzs, M.D., Ph.D.
Attention-deficit hyperactivity disorder
(ADHD) is one of the most prevalent
child psychiatric disorders; its prevalence is 212% among school-aged children (Barkley, 1996; 2002; Dulcan, 1997;
Goldman Genel, Bezman, & Slanetz,
1998). In 4060% of the cases it persists
into adulthood (Mannuzza et al., 1993;
Murphy & Barkley, 1996). It is wellknown that in more than two-thirds
of ADHD cases there is at least one comorbid psychiatric diagnosis, with the
pattern of comorbidity being influenced
by developmental aspects (Balzs & Gdoros, 2005; Huh et al., 2011; MTA Cooperative Group, 1999). Oppositional
defiant disorder (ODD) and conduct
disorder were found to be the most
common comorbid disorders in both
children and adolescents with ADHD
(Huh et al., 2011; Keenan & Wakschlag,
2000; Wilens et al., 2002). Additionally, mood disorders and psychoactive
substance use are common comorbid
conditions in adolescents with ADHD
(Barkley, Murphy, & Fischer, 2008; Biederman et al., 1997; Bird, Gould, & Staghezza, 1993; Huh et al., 2011; Kessler

2014 The Guilford Press

et al., 2006; Wilens, Mick, Faraone, &

Spencer, 1997), while the prevalence of
anxiety disorders was found to be high
among children with ADHD (MTA Cooperative Group, 1999; Posner et al.,
2007).
As suicide is the third leading cause of
death among people aged 1524 years
in the United States and the second in
Europe, it represents significant mental health problems all over the world
(National Institute of Mental Health,
2014; World Health Organization, 2012).
More than 90% of youth with suicidal
behavior (people who commit, attempt,
or think about suicide) have at least
one psychiatric diagnosis, mostly untreated (Brent et al., 1988; Fergusson &
Lynskey, 1995; Gould, Greenberg, Velting, & Shaffer, 2003; Marttunen, Arom,
Henriksson, & Lonnqvist, 1991; Shaffer
et al., 1996), whether or not they fulfill
all the criteria for formal diagnosis (Balzs et al., 2000; Balzs et al., 2013; Bertha & Balzs, 2013; Lecrubier & Ustun,
1998; Olfson et al., 1996; Oral, Aydin,
Gulec, & Oral, 2012). The most common
threshold and subthreshold psychiatric

disorders that are risk factors for suicide among children and adolescents
are mood disorders, substance use disorder, and conduct disorder (Balzs et
al., 2013; Beautrais, 2003; Brent, 1995;
Brent et al., 1988; Cavanagh et al., 2003;
Gould et al., 2003; Lowe & Gibson, 2005;
Lowenstein, 2005). Additionally, impulsivity, which is one of the core symptoms of ADHD, is a well-known suicide
risk factor as well (Conner et al., 2001;
Kim et al., 2003).
Based on all the above, there is a
growing interest among researchers
and clinicians to evaluate whether there
is any association between ADHD and
suicide. Most of the studies demonstrated a positive association between
ADHD and suicidality, with most suicidal population studies showing a
higher rate of ADHD than among controls. Conversely, children/adolescents
and adults with ADHD have a higher
prevalence of suicidal behavior than
non-ADHD controls. But the results
on this possible association are controversial, and it remains unclear whether
there is a direct association between

The ADHD Report 9