Funciones del mito como relato actual Al hablar de la función metafísica del mito, se aborda la relación del hombre con los dioses En los mitos

A number of reports in the literature have linked externalising behavioural problems with poor educational outcome and LD (eg Rutter et al., 1970;

Rutter, 1974; McGee & Share, 1988; Frick et al., 1991; Fergusson et al., 1993; Mannuzza et al., 1997). An early follow-up study identified that up to 58% of adolescents with behavioural problems are likely to fail at least one school grade (Mendelson, Johnson, & Stewart, 1971). In comparison, only a few studies have reported a relationship between emotional behaviours and reading retardation (eg Pearson, 1952), although the relationship between externalising behaviours and LD (specific or nonspecific) has been more reliably documented. This does not imply, however, that no relationships exist between internalising behaviours and LD (Rutter, 1974). In fact, Rutter (1974) suggested that emotional problems may perpetuate the occurrence of RD, under circumstances where reading problems act to lower motivation and increase levels of anxiety and depressive symptomatology which, in turn, result in maintaining poor reading skills. More recently, a study by Fergusson & Woodward (2002) identified that depression in adolescents (aged 14-16) significantly increased the risk of poor outcomes including impaired educational performance. However, they suggested that this relationship may be attributable to other confounding factors, such as social, familial and individual factors. Conclusive evidence of this proposed relationship is, however, somewhat limited by the paucity of available studies.

The levels of association between externalising behaviour and educational performance have varied depending on the type of population, the diagnostic criteria used for identification of disorder and the overall design of the study. Consequently, interpretation and generalisation of some of these findings to other populations may be restricted by the use of same sex populations (eg Mendelson et al., 1971; McGee, Williams & Silva, 1984; Schonfeld, Shaffer, O'Connor & Portnoy, 1988; Mannuzza et al., 1997), clinic populations (McGee et al., 1984; Frick et al., 1991), or young people with LD (Rutter et al., 1970; McGee, Williams, Share, Anderson et al., 1986; Marshall, Hynd, Handwerk & Hall, 1997). Whilst these factors are likely to have resulted in identifying higher rates of poor school performance and academic attainment amongst some of these special populations (eg Barkley et al., 1990b; Frick

et al., 1991), further examination may provide alternative explanations. For example, Fergusson & Norwood (1997) investigated the relationship between gender differences in both academic attainment and behavioural problems. Whilst they found that girls outperformed boys in the classroom and in examinations, the gender effect disappeared once teacher ratings of disruptive behaviours were controlled for. They concluded that the gender differences were attributable to difficult behaviour rather than cognitive abilities, as both sexes had similar IQs.

These associations, between mental health and educational performance, have been consistently reported in the majority of studies over the past 40 years. For instance, an early national survey in the UK found that children with persistent aggression or conduct disorder were more likely to perform poorly in all school subjects, when compared with their peers with emotional problems (Douglas, Ross, & Simpson, 1968). A series of later studies on the Isle of Wight and in an inner London borough, conducted during 1964, 1969 and 1970, distinguished between specific reading retardation (SRR) (normal IQ) and general reading difficulties (GRD) (low IQ) in 10 year olds (Rutter et al., 1970; Berger, Yule, & Rutter, 1975; Rutter & Yule, 1975). Both groups of children with RD were reported to have behavioural problems (either emotional or conduct problems), according to parent and/or teacher questionnaires, and poor acquisition of educational skills, using nonverbal and reading tests. Additionally, the authors reported prevalence rates for both SRR and GRD to be higher in the inner London than Isle of Wight children, being 6.6% and 2.9% for SRR, as well as 19% and 8% for GRD respectively. Identification of both types of RD in the inner London children, has implications for use of services and for education (Berger et al., 1975).

More recently, the publication of the DSM-IV (APA, 1994) and DSM-IV-TR (APA, 2000) further delineated the symptoms of attention deficit problems, by identifying three subtypes - Attention Deficit Hyperactivity Disorder (ADHD) predominantly hyperactive (ADHD-HI), ADHD predominantly inattentive (ADHD-I) and ADHD combined type (ADHD-CT). Despite the

paucity of data using these ADHD categories, some studies have investigated the relationships between these three ADHD subtypes and educational performance, using school children from community samples, to see whether or not different behaviours impact differently on performance at school.

For example, Wolraich et al (1996) compared different outcomes of schoolchildren (from kindergarten to age 11 years) according to these three subtypes, although they did not adequately fulfil diagnostic criteria for pervasiveness, relying on teacher report only. A number of between group differences were identified, whereby the ADHD-I group were more likely to experience academic problems than the ADHD-HI group, who only showed increased rates of poor behaviour. The ADHD-CT group, however, scored highly on both academic and behavioural problems, from which they concluded that this category was the most likely to reflect the original DSM-III subtype for ADD (with hyperactivity), with its associated high levels of comorbidity and academic problems. Gaub & Carlson (1997b) also identified that not only did schoolchildren identified with any ADHD subtype perform worse than undiagnosed controls overall, but strong intergroup differences in the same direction between the three subtypes occurred. Yet the ADHD-CT group was most impaired in all domains under study, resulting in high levels of comorbidity and poor academic attainment and social functioning.

Using a similar methodology, again relying on teacher reports, Merrell & Tymms (2001) found a negative association between academic attainment (reading and mathematics tests) and ADHD (using a rating scale designed to meet DSM-IV criteria). Performance was particularly poor in young schoolchildren (aged 4-5 years) who were identified by teachers as having high scores on ADHD predominantly combined type (ADHD-CT) or ADHD predominantly inattentive type (ADHD-I). These differences increased with age, so that by the ages of 6-7 those children with high behaviour scores and low levels of attainment had made little or no progress. Of particular interest, is that after taking underlying abilities into account, the behaviour (particularly

inattention) rather than the LD of these children was found to contribute more substantially to their low academic attainment. Despite methodological difficulties in meeting full diagnostic criteria, through the use of reliance upon teacher ratings only for the diagnosis of ADHD, these studies are remarkably consistent in their findings.

These studies have shown that overall young people with ADHD-CT perform worse on all measures of educational performance, with poor school behaviour and low levels of academic attainment. Young people with ADHD- I are also found to perform poorly on measures of academic attainment, and both ADHD-CT and ADHD-I groups are more likely to require special educational needs. However, this weakness in assessment may undermine the strength of generalising these findings to other school populations and older age groups.

Similar associations have been found in studies using clinic cases, as well as those comparing clinic cases with community controls. For example, Barkley et al (1991) compared community based controls with clinic referred adolescents (aged 12-17) fulfilling DSM-III-R criteria for ADHD. Compared to normal controls, they found that the ADHD group underperformed on academic tasks of verbal learning and were more likely to be retained in grade or suspended from school. These adolescents were also identified by parent and teacher questionnaires as being more socially maladjusted and exhibiting more antisocial behaviours, although these behaviours were infrequently reported by the adolescents themselves. These conclusions are somewhat weakened by the different origins of the sample groups (ie comparing clinic and community groups). An improved methodology would have been to compare the clinic group with a community group with ADHD. Using a retrospective follow-up of clinic referrals, who were diagnosed between the ages of 6-12, Wilson & Marcotte (1996) compared adolescents (aged 14-18) with a DSM-III diagnosis of ADD (clinic cases) to those with other neurodevelopmental conditions (clinic controls). Adolescents in both groups completed a battery of questionnaires about their emotions and

behaviours, as did their parents. The findings supported the literature whereby an association between the ADD group and academic underattainment (low grade point average scores) and school performance (more school suspensions) was reported, despite similar full scale IQ scores between the two groups. This suggests that low IQ is not entirely responsible for poor outcomes. The clinical cases were further subdivided into those with and those without CD. This mixed group was found to underperform on all variables of academic attainment, school performance and psychosocial measures more than the other two groups, indicating that comorbidity increases levels of impairment.

In contrast, Fergusson et al (1997) used an unselected sample of clinic referred children and adolescents subsequently diagnosed with or without ADHD (DSM-IV, APA, 1994). Similar to Wolraich et al (1996) and Gaub & Carlson (1997b), they found that those with disorder performed worse than controls overall. They also found a few differences between the subtypes on psychometric measures of cognitive functioning, LD (mathematics or reading tests) or school performance (attendance, special education classes or repeated grades). Specifically, the ADHD-CT group were more likely to have reading difficulties and attend special classes, and both ADHD-CT and ADHD-I were more likely to need extra help at school than controls.

These studies lend further support to the literature whereby not only do young people with all forms of ADHD perform worse than those without, but their performance is also affected by the nature of their symptomatology. This has been clearly indicated in studies delineating the individual ADHD subtypes. The research also indicates that impaired outcomes are similar between referred and nonreferred populations with disorder, in terms of poor school performance or low academic attainment, which reflects the influence of disorder rather than the act of referral. This also suggests that increased levels of associated psychopathology in clinic samples may hide differences in educational performance that appear to exist between community identified ADHD subtypes (Faraone, Biederman, Weber & Russell, 1998).

Specifically, there is some suggestion that inattentive subtypes are more common in community samples and combined types in clinic samples, which may be reflected in different referral patterns for this disorder. As such, only those young people perceived to be more impaired or showing more overt symptoms are referred to clinics ie with high levels of comorbidity and severity (discussed in 2.2.1), although these characteristics alone may not necessarily reflect their need for additional educational support.

The literature reviewed in this section of the thesis indicates that young people with behavioural problems are more likely to do badly at school on a number of criteria, compared to those with no disorder. Specifically, young people with ADHD-I or ADHD-CT are most vulnerable and often require special educational needs. It also appears that the relationship between behaviour and poor educational performance is not wholly accounted for by low IQ. This suggests that, in many cases, behaviour is the key contributory factor for poor educational performance.

2.5.4 Comorbid behaviour and learning difficulties and their