Attention Deficit Hyperactivity Disorder (ADHD) is grouped in disruptive behavior problem. It is a neuropsychiatric condition (Barkley, 2006; Conners, 2000; Palmer & Finger, 2001; Rafalovich, 2001; Rothenberger & Neumärker, 2005). It is a combination of inattention and hyperactive behavior, inattention characterizing difficulties in gaining attention, following directions, and being seemingly careless in direct conversation while in hyperactivity over activity, over efficiency, and impulsivity is dominant. The American Psychiatric Association has identified three types e.g. ADHD (predominant Inattention), ADHD (predominant impulsivity) and combination of both where each has different symptoms. However, current study followed only two categories.

Gratification delay is identified as a major symptom of ADHD (Barkley, 2006). Parents of HIC usually complaint about the behavior of their children because they are unaware about that particular behavior disorder by name. They often criticized child’s unrest behavior but they never considered it as a disorder.

Still (1902) described ADHD as a defect of moral control but without an impairment of intellect. Teaching is not only concerned with delivering contents to the children. Objectives of the curriculum cannot be fulfilled without effective teaching. Therefore, it is necessary for students to pay attention towards the lesson as well as for teachers to grasp students’ concentration before starting the lesson and during the lesson. To achieve the goals of curriculum or objectives of the particular lesson, involvement of learner and teacher is an integral part.

Several studies reported ADHD as a most common disorder, affecting about 6-9% youth and 3-5 % adults (Dopheide & Pliszka, 2009 & Froehlich et al., 2007). Similarly, Scahill & Schwab-Stone (2000) discovered ADHD as the most common behavioral disorder in children, affecting about 5% to 10% of school-age children. In addition, previous studies also declared that ADHD more frequent in males as compared to females the ratio recorded as 1:3(Biederman & Faraone, 2004; Lindemann et.al, 2012).

Kaplan, Gheen and Midgley (2002) noted male students more disruptive in nature as compare to female students. Stephenson, Martin and Linfoot (2000) also agreed with the fact that male students exhibited more behavior problems as compared to female students. Kovacs & Devlin (1998) declared ADHD among HIC become more problematic and complex. Similarly, Mitchell & Quittner (1996) recorded poor auditory system, attention problems and only visual clue works here. Ruff & Rothbart (1996) listed memory problems in HIC whereas Leigh, Robbins, Welkowitz, and Bond (1989) identified social adjustment problems among HIC.

Frank-Briggs (2011) pointed common symptoms present in a child with ADHD include constantly motion, playing with whatever is in sight, or talk incessantly, blur answer before completion of question at school , squirm and fidget in their seats, roam around the room, wiggle their feet, touch everything, noisily tap their pencil, restless.

Hearing Impaired children are already suffering from many psychological and attention problems, so the probability of prevalence of ADHD increased. Feldman, Heidi and Irene (2007) described ADHD in terms of body functioning and performing various activities. With respect to body functioning although everything looks normal but children with ADHD usually show low IQ score. Alderson, Kasper, Patros, Hudec and Lea (2015) stated poor usage of working memory especially auditory memory and McBurnett, Pfiffner and Frick (2001) detected low cognitive skills in ADHD children. Ross & Ross (1976) observed a brain dysfunction in hyperactive children. Barkley, Fischer, Edelbrock and Smallish (1990) indicated children suffering from ADHD showed poor grades and low academic achievement level.

Ross and Ross (1976) supported the idea of link between brain dysfunction and deviant behavior with respectto performing activities, Child with ADHD has limited social participation, low social adjustment level, low school performance, repeated grades, and required additional academic services and sometimes needed to be a part of special education classes. So they show a high prevalence of tutoring, extra time services in school, after school programs to address deficit body functioning and require special efforts to cope with poor activity performance. These special efforts may become fruitful in decreasing dropout rate and failure rate among ADHD children.

Alderson, Kesper et al., (2013) found deficits in working memory especially auditory memory among inattentive children whereas McBurnett et al., (2001) added slow cognitive approach. Faraone et al. (1993) stated ADHD also has so many secondary effects the most visible and observable one is low academic achievements level. Barkley et al., (2006) connected ADHD with sub average school performance and Serra-Pinheiro et al., (2008) linked ADHD with very slow progress in studies. Feldman, Heidi and Irene (2007) reported a high ratio of dropout, expelled from school, suspended or repeating various courses among ADHD children. Previous studies also added the presence of learning disabilities in children with ADHD (Douglas & Peters, 1979; Richards, Samuels, Turnure, & Ysseldyke, 1990; Rosenthal & Allen, 1978; Taranowski, Prinz, & Nay, 1986).

Different HIC have different hearing level depending upon the degree of hearing loss. Unit for hearing assessment is decibel. Clark (1981) classified hearing impairment into following categories.

Table 1. Classification of Hearing Levels

Current Study was very helpful for special educators, educational administrators, policy makers, psychologists, parents and general public. Moral and behavior training is an integral part of the education. The current study was an attempt to aware people to identify ADHD child. The study was important to control secondary effects of ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is grouped in disruptive behavior problem. It is a neuropsychiatric condition (Barkley, 2006; Conners, 2000; Palmer & Finger, 2001; Rafalovich, 2001; Rothenberger & Neumärker, 2005). It is a combination of inattention and hyperactive behavior, inattention characterizing difficulties in gaining attention, following directions, and being seemingly careless in direct conversation while in hyperactivity over activity, over efficiency, and impulsivity is dominant. The American Psychiatric Association has identified three types e.g. ADHD (predominant Inattention), ADHD (predominant impulsivity) and combination of both where each has different symptoms. However, current study followed only two categories.

Gratification delay is identified as a major symptom of ADHD (Barkley, 2006). Parents of HIC usually complaint about the behavior of their children because they are unaware about that particular behavior disorder by name. They often criticized child’s unrest behavior but they never considered it as a disorder.

Still (1902) described ADHD as a defect of moral control but without an impairment of intellect. Teaching is not only concerned with delivering contents to the children. Objectives of the curriculum cannot be fulfilled without effective teaching. Therefore, it is necessary for students to pay attention towards the lesson as well as for teachers to grasp students’ concentration before starting the lesson and during the lesson. To achieve the goals of curriculum or objectives of the particular lesson, involvement of learner and teacher is an integral part.

Several studies reported ADHD as a most common disorder, affecting about 6-9% youth and 3-5 % adults (Dopheide & Pliszka, 2009 & Froehlich et al., 2007). Similarly, Scahill & Schwab-Stone (2000) discovered ADHD as the most common behavioral disorder in children, affecting about 5% to 10% of school-age children. In addition, previous studies also declared that ADHD more frequent in males as compared to females the ratio recorded as 1:3(Biederman & Faraone, 2004; Lindemann et.al, 2012).

Kaplan, Gheen and Midgley (2002) noted male students more disruptive in nature as compare to female students. Stephenson, Martin and Linfoot (2000) also agreed with the fact that male students exhibited more behavior problems as compared to female students. Kovacs & Devlin (1998) declared ADHD among HIC become more problematic and complex. Similarly, Mitchell & Quittner (1996) recorded poor auditory system, attention problems and only visual clue works here. Ruff & Rothbart (1996) listed memory problems in HIC whereas Leigh, Robbins, Welkowitz, and Bond (1989) identified social adjustment problems among HIC.

Frank-Briggs (2011) pointed common symptoms present in a child with ADHD include constantly motion, playing with whatever is in sight, or talk incessantly, blur answer before completion of question at school , squirm and fidget in their seats, roam around the room, wiggle their feet, touch everything, noisily tap their pencil, restless.

Hearing Impaired children are already suffering from many psychological and attention problems, so the probability of prevalence of ADHD increased. Feldman, Heidi and Irene (2007) described ADHD in terms of body functioning and performing various activities. With respect to body functioning although everything looks normal but children with ADHD usually show low IQ score. Alderson, Kasper, Patros, Hudec and Lea (2015) stated poor usage of working memory especially auditory memory and McBurnett, Pfiffner and Frick (2001) detected low cognitive skills in ADHD children. Ross & Ross (1976) observed a brain dysfunction in hyperactive children. Barkley, Fischer, Edelbrock and Smallish (1990) indicated children suffering from ADHD showed poor grades and low academic achievement level.

Ross and Ross (1976) supported the idea of link between brain dysfunction and deviant behavior with respectto performing activities, Child with ADHD has limited social participation, low social adjustment level, low school performance, repeated grades, and required additional academic services and sometimes needed to be a part of special education classes. So they show a high prevalence of tutoring, extra time services in school, after school programs to address deficit body functioning and require special efforts to cope with poor activity performance. These special efforts may become fruitful in decreasing dropout rate and failure rate among ADHD children.

Alderson, Kesper et al., (2013) found deficits in working memory especially auditory memory among inattentive children whereas McBurnett et al., (2001) added slow cognitive approach. Faraone et al. (1993) stated ADHD also has so many secondary effects the most visible and observable one is low academic achievements level. Barkley et al., (2006) connected ADHD with sub average school performance and Serra-Pinheiro et al., (2008) linked ADHD with very slow progress in studies. Feldman, Heidi and Irene (2007) reported a high ratio of dropout, expelled from school, suspended or repeating various courses among ADHD children. Previous studies also added the presence of learning disabilities in children with ADHD (Douglas & Peters, 1979; Richards, Samuels, Turnure, & Ysseldyke, 1990; Rosenthal & Allen, 1978; Taranowski, Prinz, & Nay, 1986).

Different HIC have different hearing level depending upon the degree of hearing loss. Unit for hearing assessment is decibel. Clark (1981) classified hearing impairment into following categories.

Table 1. Classification of Hearing Levels

Current Study was very helpful for special educators, educational administrators, policy makers, psychologists, parents and general public. Moral and behavior training is an integral part of the education. The current study was an attempt to aware people to identify ADHD child. The study was important to control secondary effects of ADHD

Yeschin (2000) considered the psychoanalytical theory of object relations helpful in understanding the psychological and social problems connected with a child having ADHD, it linked the responses of child with ADHD via dynamic intera and interpersonal processes. Evans and Foster (2001) recommended interactional model of synchrony to explain ADHD. Various psychological models consider impulsiveness as poor behavioural inhibition but Kuntsi & Stevenson (2000) suggested hyperactivity in ADHD as a diminished activity in the brain’s behavioural inhibition system. Kuntsi and Stevenson (2000) also stated energetic state of person with ADHD depends upon different aspects of inhibition system. Schachar, Mota, Logan, Tannock and Klim (2000), pointed out that stimuli in the environment act as an indicator for activation and inhibition of responding.

Bailey (2000); Berlin et al., (2004) considered Barkley’s theory of ADHD as most prominent theory of ADHD. It proved to be helpful in understanding ADHD in all dimensions. Barkley’s theory focused the learner with ADHD, which highlighted the neurocognitive functioning of the learner with ADHD. Barkley, Edwards, Laneri and Fletcher, (2001) stated involvement Bronowski’s theory of language that revolved around the behavioural inhibition, executive functions and self-regulation regulation. (Quay & Hogan, 1999; Berlin et al., 2004) pointed four major executive functions adversely affected in a child with ADHD in Barkley’s theory. These four executive functions included working memory, speech, self-regulation and reconstitution. The target population of the study consisted of HIC, not having developed speech, so only three executive functions working memory, self-regulation and reconstitution was not included for the study.

Working Memory

Working memory kept the events in respective

sequence which seemed to be problematic. Consequently, students with ADHD exhibited problems in retaining information, linking it and sequencing new instructions. Such children who have impaired working memory faced difficulties in managing time. Barkley’s model recognized non-verbal working memory as a significant feature to be developed (Berlin et al; 2004). The functioning of working memory is linked with concentration and attention paid by a person. Thus, this part of theory supported to identify ADHD predominantly inattention. Children with ADHD /Inattention faced problems in organizing, objects and time management of tasks, consequently failed to follow teacher’s instructions. This lack of attention led to lack of interest so they distracted easily, and usually started new task in class without completing prior one. Learners who have deficit working memory, faced difficulties in processing new information, anticipating their own future behaviour and understanding the passing of time.

Self-Regulation of Affect, Motivation and Arousal

Human brain represents information in four forms namely affective, appetitive, motivational and arousal sense. Individual with ADHD usually find hard to handle emotional conditions like anger, sadness, happiness, anxiety, frustration, feeling upset in a positive manner. Which causes impulsiveness in them for a long span of time as compared to normal peers. It also becomes a reason in self-regulating emotions. The researcher used this feature of theory to identify the child with ADHD predominant Impulsivity or hyperactivity. This inhibits emotional control resulted in talkativeness, roaming around the room, running meaninglessly, restlessness, and unnecessary interruption, etc.

Reconstitutions

Reconstitution include investigating and assembling internally perceived information and behavioural structures linked with this information. Learner with ADHD usually found it hard with behaviour that is based upon certain rules. The researcher linked poor academic achievement level with low degree of analyzing and assembling information.

Barkley’s (1997) Model of the Impairments in Executive Function

Objectives

The current study focused on the following objectives to

1. identify Attention Deficit Hyperactive Disorder among Hearing Impaired Children

at elementary level

2. correlate the degree of hearing loss and ADHD

3. find out the impact of ADHD upon academic achievements of the HIC

4. trace out the prevalence of Attention Deficit Hyperactive Disorder gender wise

Two types of data collection tools were used by the researcher. An observational sheet was used to directly record the behaviour of hearing-impaired children in class by the researcher for a period of six months. A questionnaire was prepared to conduct a survey from parents of hearing-impaired children. This questionnaire was distributed among 300 parents but 292 questionnaires were finally included in the study the return rate was 97%.

Total 18 items were present in the data collection tools (observational sheet and Questionnaire). These items were adopted from, The Diagnostic and Statistical Manual (DSM V) of Mental Disorders (Fifth Edition). Nine out of the 18 items were used to measure ADHD Inattention and remaining 9 were used to measure ADHD impulsivity among students. If 6 out of these 9 items were consistently exhibited by the child, the prevalence of ADHD is accepted.

Before recording observation of students’ researcher collected bio data of the students related to their family and Student’s hearing level. For the purpose researcher contacted Audiometerist of school and got the hearing assessment report collected there after pure tone audiometry. Result of students was also recorded to check the achievement level of students. Academic achievement of the students is recorded at average (greater than 45% and lea than 70%), below average (less than 45%) and above average (greater than or equal to 70%) levels based on the %age marks secured in last final examination.

The observation of students was recorded in a separate observational sheet. Students were observed for a period of six months. On the basis of recorded data presence of ADHD was identified and recorded in SPSS 17 for further processing.

Observed data is recorded analyzed and then assessment of each participant included in the sample was made. So, total 993 students where 701 students on the basis of direct classroom observation through observational sheet and 292 on the basis of data recorded by the parents of HIC through questionnaire were assessed for ADHD.

All HIC enrolled in government special education institutes of southern Punjab were included in the target population of the study. There are 27 institutions in Bahawalpur division. Total population is 1610 and sample of 701 students and 292 mothers were selected by random sampling methods.

Table 2. Distribution of Population and Sample

Data Analysis

SPSS 20 was used for the data analysis of collected data. F- Test was applied to find out the impact of ADHD upon the academic achievements and hearing level of hearing-impaired children.

Table 3. Gender Wise Frequency Distribution in Sample

Ratio of male and female hearing-impaired children in parents and student’s data was found almost same. Student’s data have 65% male and 35% female and parents’ data have 66% male and 34% female HIC.

Table 4. Frequency Distribution of HIC with respect to Hearing Level

Hearing impaired children have different hearing level, table 3 shows 21% severe, 1% moderate and 78% profound children were found in students observed at school and 2% moderate, 22% severe and 76% profound HIC were present in data collected from parents.

Table 5. Frequency Distribution of Academic Achievement Level

Table 4 represents 50% students with average, 28 % with Above Average and 22% with below average academic achievement level in student Data. Parents’ data column indicates that 16% students with below average, 56% with average and 28% show above average academic achievement level.

Table 6. Frequency Distribution of Attention Deficit Hyperactive Disorder

Data present in table 6 shows 22.3% hearing impaired children with ADHD/Inattention and 47.9% HIC with ADHD Impulsivity according to data recorded from parents while 29.8% with ADHD/Inattention and 48.4% HIC with ADHD impulsivity found in data recorded by students.

Data recorded from parents showed 84.6% male and 15.4 % female with ADHD inattention and 71.4% male, 28.6% female with ADHD impulsivity on the other hand data recorded from parents showed 68.4% male, 31.6% female hearing impaired children were with ADHD inattention and 71.7% male, 28.3% male with ADHD impulsivity or hyperactivity.

Table 8. Frequency Distribution of Academic Achievement Level among ADHD Hearing Impaired Children

Table 8 presents that from students’ data with ADHD Inattention children 31.1% were with below average academic level, 54.1% average and 14.8% at above average academic and students with ADHD Impulsivity 25.7% were at below average, 54.6% at average and 19.8% at above average academic achievement level. Table also denoted that in parents’ data prevalence of ADHD Inattention is 22.3% out of which 27.7% students were at above average academic achievement level, 60% at average academic level, and remaining 12.3% with above average academic achievement level while for ADHD Impulsivity out of 47.9% of hyperactive hearing-impaired children 18% showed below average, 60% average and 22% above average academic achievement level.

Table 9. Effect of ADHD /Inattention upon Level of Academic Achievement (Students’ Data)

Table 8 shows that effect of ADHD / Inattention is significant upon Academic Achievements. It shows that value of F=15.730 is significant at the level of 0.05. Degree of freedom for the F is between 2 and 698. It can be inferred from the table that F (2,698) =15.730 is significant <0.05.

Table 10. Effect of ADHD/Impulsivity on Academic Achievements Level (Students’ Data)

Table 10 reveals that F value of 11.4 at the significance level of less than 0.05. Degree of freedom for F is between 2 and 698. It can be stated that F (2,698) = 11.400 is significant (< 0.05). This value indicates strong effect between groups and within groups.

Table 11. Effect of ADHD/Inattention on Academic Achievements Level (Parents’ Data)

Table 11 represents that effect of ADHD / Inattention is also significant upon Academic Achievements according to the data collected from parents. It shows that value of F=7.636, is significant at the level of 0.05. Degree of freedom for the F is between 2 and 289. It can be concluded from the table that F (2,289) =7.636 is significant < 0.05.

Table 12. Effect of Academic Achievement Level upon ADHD/ Impulsivity (Parents Data)

Table 12 represents that effect of ADHD / Impulsivity is also significant upon Academic Achievements according to the data collected from parents, it is found that value of F=12.383, and p=0.014 is significant at the level of 0.05. Degree of freedom for the F is between 2 and 289. It can be concluded from the table that F (2,289) =12.383 is significant < 0.05.

Table 13. ADHD/ Inattention and Child’s Hearing Level

Table 13 presents that 29.8% children with ADHD predominant Inattention and 2.4% have moderate hearing level, 19.6% have severe hearing loss and 78% profound level of hearing loss in student’s data while in parents’ data from 22.3% children with ADHD/Inattention 1.5% have moderate hearing loss, 21.5% have severe hearing loss and remaining 76.9% have profound level of hearing loss. According to the table 11 out of 48.5% children who show ADHD/impulsivity 1.8% have moderate level of hearing loss, 19.8% have severe hearing loss and 78.5% have profound level of hearing loss in student’s data. While in parent’s data out of 47.9% children who show ADHD/impulsivity 2.1% have moderate level of hearing loss, 19.3% have severe hearing loss and 78.6% have profound level of hearing loss.

Current study was an attempt to identify co-occurrence of hearing loss and ADHD and its impact upon academic achievements of students. The study revealed the presence of ADHD among hearing impaired children is fivefold high as compared to normal hearing children. Dopheide and Pliszka (2009) and Froehlich et al., (2007) reported 3-5 % normally hearing school going children with ADHD while previous studies, Parasnis et al. (2003) and Sibley (2015) also reported a higher rate (up to 38.7%) of ADHD among HIC. Hearing loss might be one of the reasons of higher rate of ADHD occurrences among HIC as (Miller, (1980); Morgan and Vernon, (1994) concluded hearing impairment with similar symptoms to ADHD inattention including looking around the room and seeking visual cues and (Marschark, 1993) found hyperactivity among HIC due to the lack of language access early in childhood. Therefore, hearing loss may be considered the reason for high rate of ADHD among HIC.

The current study identified almost equal ratio of ADHD impulsivity among HIC from both sources i.e., parents of HIC and Students’ direct observation in classrooms. However, results for ADHD inattention were not found relatively similar. It was high from students’ perspectives as compared to parents’ perspectives. It clearly shows that child’s hyperactive behavior is equally noticed both at school and at home too whereas parents ignore inattention behaviour present in their hearing-impaired child. One of the reasons is that parents consider hearing problem as a possible reason of inattention and they usually ignore their child’s inattention.

The results of the study are consistent with the findings of previous studies (Biederman & Faraone, 2004; Lindemann et al. 2012; Parasnis, 2003; Sibley, 2015) that found ADHD more frequent in males as compared to females. ADHD inattention and ADHD impulsivity both represented almost same ratio 71% for males and 29% for females.

ADHD has significant impact upon academic achievements of the students. The results supported the prior studies that found relationship between poor academic achievement level of children and ADHD (Faraone et al., 1993; Barkley et al., 2006; Serra-Pinheiro et al., 2008; Feldman, Heidi & Irene, 2007). The majority of hearing-impaired children with ADHD showed average level in academic achievements and secured 50 to 60 percent marks. The study revealed that among students with ADHD inattention number of low achievers raised and number of high achievers fell down as compared to ADHD impulsivity. Almost equal percentage (54-60) of students was recorded at average level of academic achievement. It shows that the lack of concentration of ADHD inattention has adverse effect upon the academic achievement of the hearing-impaired children. ADHD impulsivity and ADHD inattention have no significant effect upon degree of hearing level (moderate, severe, profound) of the students. Therefore, no direct relationship between degree of hearing loss and ADHD exists.

In the present study, the data were collected from parents and recorded by the researchers, both showed a high prevalence of ADHD impulsivity than ADHD Inattention among hearing impaired children. ADHD has no significant relationship with degree of hearing loss. Special care and strategies are required by the teacher to cope with ADHD children.

In view of the results of the study, following recommendations are listed with respect to various stakeholders including special educators, parents and administrators of special institutions.

Special educators are the most important stakeholder who are responsible to implement all services and are directly linked with students. Special Educator are recommended to identify children with ADHD, evaluate their special needs and strengths, Select appropriate instructional practices according to age and needs of the student then integrate these services with Individualized Educational Plan (IEP). Special Educators are suggested to integrate the three components academic instruction, behavioral interventions, and classroom accommodations. Both special educators and school management should provide counselling and guidance to parents of child with ADHD.

Administrators are recommended to modify programs for students with ADHD and other intellectual and behaviour disorders. As behaviour problems resulted in various secondary issues such as social and emotional disturbance therefore it is suggested to provide screening services to detect early indicators of ADHD and other behavior disorders to address the issues influencing other personality aspects of a student. To minimize secondary effects, arrangement of staff training programs on continuous basis may play a significant role. Government should launch awareness campaign to aware society regarding behavioural disorders including ADHD