Demystifying ADHD: A Guide for Parents
When we hear the term ADHD, it is common to think of a child zipping around the playground like the Road Runner from Looney Tunes or an Alvin and the Chipmunks character, sitting at the back of the class, daydreaming, and “bored.” While these behaviours may capture some children with ADHD, they do not accurately describe the majority or the complexity of the disorder. As such, when ADHD is an interfering cause of a child’s struggles, it may often be misunderstood, thought to be something else, or possibly missed.
In my role as Bialik’s clinical child and school psychologist, I hear many concerns about Attention-Deficit/ Hyperactivity Disorder (ADHD) from parents and teachers, describing students who complain of being “bored” or who appear to be “lazy” or “unmotivated,” despite having appropriate intellectual ability. Some of these students may climb and run (not walk) everywhere, appear confused, be able to read and comprehend fluently on Monday but not on Thursday, and are rude one moment and kind the next.
While these behaviours can be related to other medical conditions, mental health, sleep, hearing, vision, etc., they can also suggest struggles with attention, impulsivity, and/or hyperactivity. The above descriptions can sometimes be explained by ADHD when other differentiating factors have been ruled in or out.
Let’s take the confusion out of the equation and demystify ADHD by exploring what it may look like. Parents, please note that all children are different and this blog is meant to educate, not diagnose.
What is ADHD?
ADHD is a medical and neurodevelopmental disorder, often a result of genetic or biological conditions, that involves difficulties with controlling attention and/or regulating behaviour and activity levels. At a very basic level it has to do with how communication within the brain takes place. I like to explain an “ADHD brain” as an “excited brain” which focuses on whatever is most interesting at the moment and usually acts on it. The filtering, planning and organization is often an afterthought, at best, while missed information (visual and verbal) has now been “missed.” This helps explain the child who interrupts, the child who grabs a friend’s toy, and the child who starts thinking about their dance class while the teacher is speaking. Left untreated, ADHD may lead to difficulties with learning, school performance and achievement, friendships, social skills, self-control, memory, emotional-control and family relationships.
ADHD has three subtypes: predominantly hyperactive, predominantly inattentive, and combined. Multiple components of a child’s life are impacted when they have ADHD.
Where does ADHD come from?
While there is no confirming genetic test, it is quite common for a parent or sibling to also have ADHD. Indeed, research studies are beginning to identify genes associated with ADHD as well as related prenatal and birth factors and external stresses. While ADHD generally causes struggles in early childhood, it may go unnoticed until adolescence or even adulthood for many due to an individual’s compensating abilities, intellect, environment, supports, etc.
How many children have ADHD?
Approximately one in every 20 children are believed to have ADHD in Canada, with some studies suggesting up to 12%. Boys are two to three times more likely than girls to be diagnosed with ADHD. Whether more boys actually have ADHD remains unclear; they are often seen to have a higher activity level than girls and this could lead to them being identified as struggling. As such, girls with ADHD are often overlooked. Further, about two-thirds of children with ADHD also present with at least one other condition and 40% of children with ADHD are also diagnosed with a learning disorder.
ADHD and Executive Functions
Executive functions are the skills we require for regulating our emotional, behavioural and cognitive abilities. They are housed in the frontal lobe of the brain, the last part of the brain to mature in early adulthood. Thus, at a time when children are expected to show increased responsibility, ability to plan, organize and manage their time, the lag in these developing skills becomes more apparent in those who are struggling with ADHD.
Children with ADHD are believed to demonstrate an approximate 30% lag in their executive function skills. These skills typically begin to appear in preschool and continue to develop into early adulthood, causing this developmental lag to become more apparent and obvious in these children as they mature. This suggests that a student in Grade 6 may be capable of the same skill set as a student in Grade 3. Further, as executive functions are just beginning to develop in young children, a 30% lag in kindergarten is not significantly noticeable to many, including the child. It is important to note that children with ADHD have the ability to develop executive function skills, even if at a slower pace and with additional support. See Beverley Young’s blog, Executive Functioning at School and at Home https://bialik.ca/executive-functioning-at-school-and-at-home/
ADHD at Different Ages
While children with ADHD struggle with overall attention control and behaviour regulation, it may look quite different as children develop skills and expectations change. Below are some key areas of weakness that children with ADHD may exhibit more than other children their age. The points below are common signs and by no means an exhaustive list of diagnostic criteria.
ADHD in children in JK to Grade 1:
- Difficulty remembering what the teacher has just taught
- Trouble following basic directions
- Becoming very upset or angry over minor incidents
- Talking, fidgeting or frequently getting up during activities that are quiet and seated
- Taking or grabbing things without permission
- Completing tasks or activities too quickly to take the necessary care
ADHD in children in Grades 2 – 5:
- Trouble following directions with more than one step
- Avoiding or delaying beginning different tasks like writing a paragraph or putting their water bottle away
- Working slowly so that assignments take a significant amount of time to complete or are sometimes not completed due to time restrictions
- Acting silly, inappropriately trying to get attention from others
- Distracting peers verbally or through actions (e.g. moving around)
- Doing or saying things without first thinking about the consequences
- Rushing through work and tasks with careless errors and messy final products
- Appearing to forget regular routines, schedules, and instructions, requiring more reminders and redirection than peers
- Appearing restless when not interested in something, regardless of the perceived overall excitement by others
- Losing a lot of their belongings
ADHD in children in Grades 6 – 8:
- Struggling with making friends
- Trouble setting priorities
- Forgetting to write down assignments and manage deadlines
- Needing to re-read information
- Often asking others to repeat what they have said
- Being easily sidetracked when not interested in something
- Appearing to be daydreaming during lessons
- Disorganized in note taking
- Engaging in risky behaviour or making poor choices
Only a clinical psychologist or physician can diagnose ADHD. There is no single test or specific combination of tests that must be used to diagnose ADHD. Typically, diagnosis is based on information from a parent interview, the child’s medical and developmental history, observations and interactions with the child, combined with information from school or other environments.
Depending on the presenting concerns and a child’s history, a specific assessment approach may be better suited to ensure that all differentiating factors are appropriately evaluated and considered. For example, a child’s apparent inattention could be impacted by a possible language-based struggle or a learning disability, which a clinical psychologist would be able to comprehensively assess alongside mental health issues. If the child is in preschool and also presenting with language or motor delays, a physician working alongside speech and language pathologists and/or occupational therapists would allow for a comprehensive assessment.
While treatment differs, children with ADHD fare best with a combination of behavioural and medical intervention such as:
- Explicit instruction of emotion and behaviour regulation skills
- School-based accommodations (e.g., including preferential seating, breaking down large assignments, shortened instructions, opportunities for physical breaks)
- Parenting strategies and home-based supports (e.g., such as using a family calendar)
- General support for organization, planning, time management, etc.
- Private individual and/or group therapy
- Medication, monitored by a physician
Final Thoughts and Moving Forward
“Once you have met a child with ADHD, you have met one child with ADHD.” ADHD has been described as “magic and fire rolled into one” that affects the entire family. It is an invisible disorder that can exhaust parents, teachers, and the individual child — patience and empathy from all involved is necessary. It can be an overwhelming process, which takes time and requires learning.
ADHD is a real medical condition. The struggles for a child and their family are real. Most important to remember is that everyone is trying their best with what they know. Identification and education is key for ensuring that a child is understood and supported. It is about letting the child know that we have their back and recognizing that, with things done a little differently, we can focus on the magic and keep the fire at bay.
The information contained in this blog post is very generalized as the presentation, diagnosis and treatment of ADHD is complex. If you have medical concerns regarding your child, please contact their physician or a clinical child psychologist.
The following websites were used as references for this blog and may be helpful for additional information: