EM Counselling and Psychology
SCHOOL AGED CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)
Current research indicates that children with ADHD have structural and functional differences in their brains when compared to their peers, especially in the frontal lobe. The frontal brain regions are responsible for executive functioning (i.e. planning, organising, regulating behaviour and emotions). Approximately 3% to 7% of school aged children present with symptoms of ADHD.
Core features
Inattention:
Making careless mistakes
Difficulty sustaining attention over time
Does not appear to listen when spoken to
Does not follow through on instructions and fails to finish work
Poorly organised (poor time management, messy, fails to meet deadlines)
Avoids tasks that require sustained mental effort
Often loses things
Easily distracted
Forgetful
Hyperactivity and impulsivity:
Fidgety or squirmy behaviour
Problems remaining seated
Excessive motion
Difficulty engaging in quiet activities
Often “on the go”
Talks excessively
Blurts out answers
Difficulty waiting his turn, impatient
Often intrusive to others
Developmental considerations and associated features
Children with ADHD typically struggle with emotional regulation and often experience big emotions. They might have meltdowns more often and require lots of co-regulation from adults (that have a calm brain). They can experience difficulty forming and maintaining friendships. Due to their impulsivity and not considering consequences, their behaviour might often be seen as rule breaking and inappropriate. Furthermore, their impulsive nature puts them at risk for academic difficulties. Rushing through assignments, poor time management, failing to wait for all instructions and inability to filter essential from non-essential information have direct influence on children’s grades and performance in class. Additionally, children with ADHD often become frustrated with themselves and suffer from low self-esteem and poor confidence. Rejection sensitivity dysphoria (RSD) is a common condition co-existing with ADHD. Those with RSD are extremely sensitive to criticism, often holding on to negative words or actions made towards them for months, or even years. An ADHD-RSD combination is difficult to overcome, but some strategies include focusing on one's strengths and practicing self-compassion.
Parents of children with ADHD should be aware of the fact that their child hears many more negative comments about their behaviour and themself as a person each and every day, as compared to a neurotypical child. Being critisised or being told off so frequently whilst knowing that they struggle to change their actions, has a direct negative impact on these children's self esteem and overall well-being. Neurodivergent children are diagnosed with co-morbid anxiety and depression more often than their neurotypical peers.
SUGGESTIONS TO PARENTS / CARERS
Children would benefit from utilising calendars to note when to hand in projects or homework. You can help your child break down the big task into small steps that will be completed each day after school. Furthermore, visual (either written or pictorial depending on child’s age) step-by-step schedules of daily routines and list of chores to be completed daily/weekly would greatly increase your child’s independence and improve self-esteem. Children benefit from their parents or other carers helping them organise their thoughts and actions.
Create a rewards system and use stickers/tokens/small coins to reward your child's appropriate behaviour. It is helpful to involve the child in setting up the rewards system (e.g. how many stickers for individual rewards) and also in identifying the positive behaviours (rules) expected of him. Being rewarded for changing your child's way of behaving and trying suggested coping strategies will lead to implementing them more often. Even us adults choose to do things that we get rewarded for over the ones that do not yield any monetary, social or other reward. And children will put more effort into trying tricky and new behaviours when they see there’s appreciation of their efforts. Fade rewards once the new behaviour is well established.
It is suggested to create a routine about completing homework. E.g. have a set time for beginning working on tasks, plan for a break (breaks), plan the duration of a break and what activities your child can engage in while having a rest. Your child should also think of some positive reinforcement (rewards for completion of homework) that would help him/her stay on task and remain motivated.
Children with attentional difficulties thrive on structure and predictability. Structure and routines help them organise their world and decrease anxiety.
Your child's self-esteem is likely to be frequently challenged at a social and academic level therefore chances to experience a sense of achievement and positive peer recognition is vital. Participating in extracurricular activities/clubs that your child enjoys (e.g. karate, soccer, swimming) is recommended.
Additionally, modelling positive self-talk (e.g. “I am worried about my job interview tomorrow, but I’ll give it a go.”) and providing positive reinforcement (praise, rewards) for attempting challenging tasks will increase your child’s self-esteem and lower anxiety and frustration that your child might often experience at school.
It is recommended to spend a good amount of quality time with your child on a regular basis. Some families choose to have family meetings every Friday with a pizza, other families have a karaoke night, joke night or monthly family outings. Ask for your children’s input on how to spend time with them and come to a compromise if their ideas are too tricky or costly to follow through. Sometimes the simplest yet most appreciated activity with your child might be a game of football in the backyard or time spent in the park or playground.
Children's misbehaviour and meltdowns should be seen as a call for help and parents should wonder around what their child need in that very moment rather than being focused on the outcome (i.e. having a "well-behaved" child).