Helping kids with ADHD to navigate school

Attention deficit hyperactivity disorder (ADHD) affects around 5% of children worldwide.  Sarah Harrop explains what it’s like to live with the disorder, its risk factors and causes and what can be done to support the education of kids with ADHD.

You feel restless and often have trouble concentrating, especially when it comes to sticking to tedious or time-consuming tasks. You struggle to listen to the teacher and follow their instructions and may have difficulty organising yourself. You might make careless mistakes in your schoolwork. You’re always daydreaming, forgetting or losing things and leaving tasks half finished. You may act impulsively and take risks with little or no regard for danger. You can’t stop talking, frequently blurt into others’ conversations, have difficulty waiting and you can’t stop squirming. This is what life is like for a child living with Attention Deficit Hyperactivity Disorder (ADHD).

How is ADHD diagnosed?

Of course, all of these symptoms taken individually can be quirks and behaviours that many of us show from time to time, but ADHD is defined as a persistent pattern of symptoms of inattention and/or hyperactivity and impulsiveness that interferes with the functioning of a person’s daily activities or development.

An ADHD diagnosis is made when symptoms of ADHD start before the age of 12, occur in two or more life settings, such as at home and at school, interfere with social, academic or occupational functioning and don’t happen only as part of a psychotic disorder or better fit the symptoms of another mental health disorder. The full diagnostic criteria for ADHD are detailed in the American Academy of Neurology’s diagnostic and statistical manual of mental disorders (DSM-5) criteria.

Unfortunately, ADHD can be a lifelong condition. Symptoms usually begin in childhood and they can continue into the teenage years and persist into adulthood.

ADHD is actually an umbrella term for three sub-types of mental health disorder:

• Inattentive ADHD, or attention deficit disorder (ADD): accounting for 20 to 30% of cases people with this condition have problems with attention span, concentrating and focusing, but not with hyperactivity or impulsiveness. ADD can sometimes go unnoticed because the symptoms are less obvious.
• Hyperactive-impulsive type ADHD: a less common sub-type, affecting 15% of cases. The main signs of hyperactivity and impulsive behaviour are being unable to sit still, especially in calm or quiet surroundings, fidgeting, lacking concentration, excessive talking, having almost no sense of danger and being unable to wait their turn.
• Combined inattentive type and hyperactive type ADHD: this is the most common subtype, accounting for 50 to 75% of ADHD cases and includes symptoms of both types of ADHD.
• Who tends to get ADHD and what causes it?

ADHD is a relatively common neurodevelopmental disorder, affecting an estimated 5% of children worldwide, according to the National Institute for Health and Care Excellence (NICE). It is more often diagnosed in boys rather than girls, which may be because boys are more likely to show disruptive behaviour that ends up in a referral to healthcare services and a diagnosis of ADHD. Girls, on the other hand, are more likely to have the inattentive subtype of the disorder which can more easily slip ‘under the radar’.

In the UK, around 3 to 4% of adults have ADHD, and prevalence is three times higher among men than women. Childhood rates of ADHD are highest in the US, according to World Population Review figures, with 8.1% of US children and adolescents diagnosed with ADHD.

ADHD is linked with poverty and families with a low level of income. It is more frequent among unemployed people and those with disabilities. Nobody knows the exact cause of ADHD, but medical evidence suggests that a combination of different factors contribute. These include:

• Genetics – the mental health condition tends to run in families and research shows that if your parents, brother or sister has ADHD then you are more likely to have it too. However the way ADHD is inherited is complex, so no single genetic mutation can be pinpointed as being solely responsible.
• Brain structure and function – research shows structural differences in the brains of children with ADHD. For example, research on brain scans has shown that a part of the brain responsible for memory, emotion, pleasure and hormone production, called the subcortex, is smaller in people with ADHD patients than it is in the rest of the population. Other studies have suggested that people with ADHD have an imbalance in dopamine and noradrenaline, two types of neurotransmitters (signalling molecules) in the brain.
• Being born premature or small – babies born before the 37th week of pregnancy or who were of a low birthweight are at a higher risk of having ADHD
• Epilepsy or brain damage – these are also linked with a higher risk of having ADHD.

How is ADHD treated and managed?

There are a range of medicines and therapies that can help relieve the symptoms and make daily life easier for people with ADHD. While medicines cannot permanently cure ADHD and carry a small risk of side effects, they can aid concentration, help children to be less impulsive and reduce the symptoms of hyperactivity, enabling them to feel calmer and learn and practise new skills.  

ADHD medications prescribed by paediatric clinicians on the NHS include:

• Methylphenidate – better known as Ritalin, this the most commonly prescribed drug for ADHD, which is safe for use in adults, teenagers and children aged over five. It is a stimulant, which increases activity in the prefrontal cortex and striatum of the brain, which play a part in controlling attention and behaviour.
• Lisdexamfetamine and dexamfetamine – amphetamine-based stimulant medications which improve concentration, help focus attention and reduces impulsive behaviour. They may be offered to teenagers and the over fives with ADHD if they’ve had at least six weeks’ treatment with methylphenidate which has not helped.
• Atomoxetine – a non-stimulant known as a selective noradrenaline reuptake inhibitor (SNRI), this increases the amount of noradrenaline in the brain, aiding concentration and helping to control impulses.

Alongside drugs, different therapies can be useful in treating ADHD in children, teenagers and adults, including:

• Psychoeducation – this encourages the child with ADHD and their parents to discuss the disorder and its effects, to make sense of the diagnosis and help with coping and living with the impairment.
• Behaviour therapy – this provides support for carers of children with ADHD, and sometimes also the children’s teacher. This therapy involves management of the child’s behaviour and uses a system of rewards to encourage the child to try to control their symptoms, eg rewarding a child for sitting at the table to eat. For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.
• Educating and training parents – targeted training can help parents to learn specific ways of talking to or playing with their child to help them to improve their attention and behaviour and tackle low self esteem.
• Social skills training – through role play situations this teaches children how their behaviour affects others and therefore how to behave in social situations.
• Cognitive behavioural therapy (CBT) – a talking therapy which aims to help children and parents change how they feel about a situation, leading to changes in behaviour.

What are some strategies for supporting children with ADHD in the classroom?

Starting school can really throw into sharp relief the struggles that children with ADHD face, because they are expected to pay attention, listen, sit still and fit in with the rest of the class. Therefore it’s important that parents and teachers work together to help children cope with their symptoms and find ways to learn along with their peers. Very Well Mind suggests these strategies for teachers to help children with ADHD to succeed at school:

Keep expectations clear – make sure classroom rules are clear and to the point and communicate them clearly. It might help to get children to repeat the rules and expectations back to the teacher to ensure that they have been understood. Signpost transitions between lessons and tasks clearly to make sure that students can see how much time they have left to finish what they’re doing.

Minimise distractions – think about where a student with ADHD is seated, ie away from doors, windows, and other visual stimuli. Listening to white noise or soft background music can sometimes help a child with ADHD to focus.

Tell them how they’re doing – providing rapid and regular feedback to children with learning disabilities, whether it is positive or negative, can benefit a child with ADHD.

Reward good behaviour – and regularly change the rewards you offer them to prevent them getting bored.

Take lots of breaks – children with ADHD find it difficult to stay still, so getting frequent chances to get up and move around can be of great benefit. For example, they could help with handing out worksheet to classmates or running errands.

Allow them to play with fidget toys – having something tactile to manipulate such as an executive stress ball can give kids with ADHD the stimulation they need without causing disruption to the rest of the class.

Bite size learning – to avoid overwhelming children with ADHD it can be helpful to break down the workload into smaller, more manageable tasks that require shorter bursts of mental effort.

Peer support – Pairing up a child with ADHD with a helpful, kind and responsible classmate can be positive for both children, keeping them focused and boosting their social skills.

Schooling that leaves no child behind

For professionals working with those with complex learning needs who want greater depth of knowledge of inclusive education and its role in society, the MA Special and Inclusive Education programme at Queen Margaret University is the perfect fit. Through an interdisciplinary lens, students will explore inclusive education and the role it plays in emancipation, liberation, and true democracy. MA students will learn about the structural inequalities in both society and education, and their impact on educational outcomes. Through this process, the course teaches ways to address these inequalities in different contexts to make education inclusive and ensure that best practice is followed.

Author biography

Sarah Harrop is a freelance science writer and editor with nearly two decades’ experience of communicating about science. Before taking the plunge into freelancing she worked for the University of Reading writing stories about everything from reducing methane in cow burps to cannabis-derived epilepsy drugs. She worked for nearly a decade at the Medical Research Council (MRC) where she edited the MRC’s magazine, wrote and produced its Annual Review and contributed to its podcast, blog and website. In the distant past she dabbled in travel writing, winning a Guardian Young Travel Writer of the Year award. She has a BSc in biological sciences from Sheffield University and a certificate in journalism from Birkbeck College.