How to Support Children with ADHD
How to manage these disorganized and inattentive children
One of the leading authorities on Attention Deficit Hyperactivity Disorder, Russell Barkley, PhD., defines ADHD as a “neurodevelopmental condition that consists of developmental delays or deficiencies” in attention and inhibition. These delays or “lags” result in children’s inability to stay still, attend to details, organize activities, wait for gratification, or persist in goal-directed tasks. In his 2016 publication, Managing ADHD in School, Dr. Barkley writes that ADHD “interferes with thoughts, actions, words, motivations, and emotions aimed at organizing behaviour across time and preparing for the future, instead of just reacting to the moment.” It’s important to note that the impulsive and disorganized behaviour exhibited by these children is “beyond their control” so that no amount of lecturing, shaming, or punishing will result in improvement. They cannot ‘will’ themselves to pay attention or to self-regulate.
Some children display only the deficits in attention and organization but not the impulsivity or hyperactivity. In order to qualify for the diagnosis, children must display the symptoms of ADHD before the age of twelve and across multiple settings. For instance, if a child is restless and inattentive exclusively at school, it might be an indication that the child is anxious and/or not comprehending the teacher’s instructions, rather than showing symptoms of ADHD. Children who are hyperactive and impulsive tend to be referred for diagnosis and treatment earlier and more frequently than children who show only the inattention, but the academic and social difficulties are very pronounced for both groups, overall.
Children with ADHD differ considerably in their presentation and functioning, depending on their intelligence, personality characteristics, talents, family and school supports, and life events. There is a significant genetic component in ADHD and parents with the condition are more likely to have children with ADHD. Other factors include exposure to alcohol or lead during pregnancy, low birth weight, intellectual impairment, and learning disabilities. There is no evidence that ADHD is caused by watching excessive amounts of television or playing video games. Important statistics about ADHD include:
ADHD occurs in 5-8% of children, 4-7% of teens, 3-5% of adults.
Symptoms of hyperactivity decline with age but the inattention continues.
Males are 3-4 times more likely to have ADHD than females
Boys with ADHD are more likely than girls to develop aggressive, antisocial, or risk taking behaviour, and to be involved in the criminal justice system.
Girls with ADHD are more likely to have peer problems, depression, anxiety, and bulimia.
Children with ADHD do poorly when they are in situations that are boring, unstructured, unsupervised, and where movement is restricted. They perform much better when they are involved in stimulating, novel, supervised activities with lots of movement and minimal waiting.
Because children with ADHD have difficulty keeping in mind the things they are supposed to do, it is very important to reduce distraction and also to provide external cues to guide them. Timers, clocks, calendars, charts, schedules, pictures, and lists are all helpful in assisting these children to complete goals and tasks. Shorter time frames and immediate feedback are also helpful to keep the children motivated and increase the likelihood of them completing tasks and experiencing success. Children with ADHD tend to be more motivated by external rewards than self-generated or internal motivations which is why tokens, stickers, stars, and praise are necessary and useful, both at school and at home.
Rules and instructions which are short, clear and concrete will be better understood and more easily followed by children with ADHD than more obscure rules such as “show respect for your peers.” Similarly, consequences need to be clear and delivered immediately. By the end of the day, a child with ADHD is unlikely to recall what he did during recess for which he is now receiving punishment. As with younger children, clear feedback and action yield the best results. As with children generally, praise and encouragement are affirming and highly motivating.
One of the greatest challenges for parents and teachers of children with ADHD is the need to repeat rules and instructions over and over, interrupt activities to attend to the child, problem solve again and again about the same problem, and do it without losing their patience or sanity. One of the greatest challenges for children with ADHD is to get through childhood with their self-esteem intact and with the continuing motivation to learn, socialize, and cooperate. Children with ADHD are often extremely bright and it is hard for parents and teachers to fathom that these articulate, intelligent, creative, computer savvy youngsters cannot organize themselves, remember simple rules, or sit still and be quiet. It is equally, if not more difficult, for the children to understand what they are doing wrong and why people are so frustrated with them.
In addition to external cuing, clear directions and immediate feedback, children with ADHD respond well to brief and frequent exercise breaks, physical touching and prompts, animated faces and voices, work on the computer, and frequent praise and approval. In the past, teachers encouraged fidgety, inattentive children to “sit still”, but new research shows that children with ADHD work better when they are allowed to bounce on a ball, stand and rock, and squirm. Listening to music while doing desk work or homework also helps these children to stay on task.
Between 40 and 80 percent of children with ADHD take medication to improve their attention and decrease hyperactivity and impulsivity. The medications control the symptoms of ADHD; they do not produce permanent effects and the symptoms return when the medications are discontinued. The use of stimulant medication (Ritalin, Concerta, and Dexadrine) and non- stimulant medication (Straterra) for ADHD has been controversial because of the side effects (weight loss, insomnia, irritability) and because the medications reduce the symptoms of ADHD without curing the underlying deficits. Stimulant medication has also been criticized because it affects the reward centres of the brain and consequently, has been abused by teens and adults who sniff it or inject it. Straterra does not affect the reward centre of the brain and is therefore, less likely to be abused. Both classes of medication are effective but some individuals respond to one, better than the other. Although the medications do not cure ADHD, many experts have concluded that children who take medication are more receptive to behavioural interventions and programmes, and that the combination of the two approaches yields better results than either approach, in isolation.
ADHD is a chronic condition which needs to be managed, first by teachers and parents and then by the individuals, themselves. Using the right tools will enhance learning, motivation, and self-esteem so that children with ADHD can develop their enormous potential. Over the years, some mental health professionals have argued that ADHD is over diagnosed with significant stigma for the identified children, as well as harm from the medications. Others have argued that diagnosing and treating children with ADHD is critical because the research shows that these children tend to have serious secondary problems including school failure, peer rejection, depression, high risk behaviours, and involvement with the criminal justice system. Clearly, it is important to get a proper assessment and diagnosis. There are specific criteria set out in the Diagnostic and Statistical Manual, 5th edition (DSM-5) and the Conner questionnaires/rating scales for clinicians, parents, and teachers are commonly used to assist in the diagnostic process.
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.
Listen to our podcast episode on ADHD: Episode 8 | How to Support Children with ADHD