Understanding ADHD

Read a summary of the key ideas discussed during our recent webinar with Associate Professor Dione Healey on understanding ADHD.

What is ADHD and how does it present?

ADHD is a neurodevelopmental disorder, which affects varying areas of self-regulation. It can present very differently in different people and has three sub-types:

1. Predominantly hyperactive, which results in challenges with behavioural regulation such as impulsivity and hyperactivity.
2. Predominantly inattentive, which results in challenges with behaviour regulation, such as attention, focus, concentation, and memory.
3. Combined type, which includes both hyperactive and inattentive elements.

Many people with ADHD may also struggle wiht emotional regulation.

ADHD across childhood and adolescence

ADHD can present in different ways over the lifespan, even for an individual diagnosed with ADHD. There are higher rates of the hyperactive subtype among younger children, which aligns with the generally higher levels of activity in early childhood. Activity levels tend to reduce throughout childhood, and one longitudinal study found that about fifty percent of children with ADHD symptoms at age 3 no longer met diagnostic criteria at age 6. However, diagnosis became more stable between the ages of 6 and 9. It is more common for children to be diagnosed with the combined subtype or the inattentive subtype in later primary school and into adolescence.

Diagnosis of ADHD

ADHD is diagnosed by a clinical psychologist, psychiatrist, or paediatrician. Symptoms must be present before the age of 12 and across multiple settings. Furthermore, it is not enough just to have symptoms of ADHD, but these must also result in impaired functioning. Only about one third of people with symptoms of ADHD are actually impaired by those symptoms.

What a teacher might notice in the classroom

It’s important to note that ADHD can look very different in different children and there is no ‘normal’ profile. Some behaviours that a teachers might notice are:

• An inability to sit still and higher levels of activity compared with other children in the class
• Struggling to focus or concentrate on tasks or activities
• Daydreaming
• Forgetting things
• Emotional dysregulation – outbursts, tantrums
• Social difficulties and challenges in making and maintaining friendships, which can be a result of impulsiveness, overactivity, or inattentiveness
• Hyperfocus, when a child is so absorbed in a task that they block out everything around them

It should be noted that inattentiveness can often be misinterpreted as a learning difficulty.

ADHD more often than not (80% of the time) occurs with other conditions, including:

• Oppositional defiant disorder (ODD), which affects emotional regulation
• Learning difficulties
• Anxiety and depression in later childhood and adolescence
• Low self-esteem (often stemming from poorer academic outcomes and being told off 400% more frequently than other children)
• Susbtance use in adolescence

What teachers can do to support children with ADHD

Teachers need to be aware of what ADHD means for a child and be supportive of them. However, it is also crucial that they remain firm and direct about the rules. Research has shown that too much praise of children with ADHD actually leads to decreases in their functioning. It is helpful to think about where children are seated in the classroom and make sure that they are removed from distractions as much as possible.

Many children with ADHD struggle getting started on a task, so clearly outlining the steps and supporting children with planning a task before they get started on it can be useful, as can helping them to undertake the first couple of steps of an activity. Also beneficial is explicitly teaching children self-regulation skills and encouraging them to stop, think, then do.

The ENGAGE programme

The ENGAGE programme was designed by Dione for children of early childhood and early primary school age. It stemmed from a dissatisfaction with existing methods for supporting children with ADHD, namely medication and reward-based systems, which were only effective when they were being used and did not lead to children learning skills to support them throughout life.

ENGAGE is a skills-based intervention to build self-regulation skills in young chidlren. Children practice self-regulation skills through participating in traditional children’s games. For example, Simon Says or musical statues support inhibitory control. Children are taught the game, which is then increased in complexity over time to build up their regulatory skills. Teachers or parents then link the skill being taught back to everyday life, and make explicit links to the game when children use the skill at a later date. Evidence has shown that the programme has a positive impact on the self-regulation skills of all children, including those with ADHD.

Additional resources

If you wish to find out more about ADHD and how to support children and young people with ADHD, you might want to explore the resources below:

• The work of Dr Russell Barkley, including the books he has written can be found on this website
• ADHD NZ 
• CHADD – a US-based organisation which has a lot of resources for parents, educators, and adults with ADHD
• Games and activities you can play with young children to support the development of self-regulation skills
• Games and activities for supporting executive function and self-regulation skills in lower primary school
• Activities and strategies for supporting executive function and self-regulation skills at upper primary school
• Strategies for supporting executive function and self-regulation at secondary school