Early years and primary school

 Hyperactivity

Hyperactivity can be very disruptive not only to learning in the classroom but to family life. It can undermine attempts to develop routines, cause sleep disruption to adult care-givers, and have a significant impact on siblings.

Parents may adjust ‘normal’ family activities such as going out, eating out, visiting friends and family members.

It can thus have a major influence on all members of the family.

UKAP’S Dr Suzy Young offers some advice and top tips on managing hyperactivity in children.

Inattention

We used to think that inattention was the lesser of 3 ‘evils’. Everyone is inattentive at times, especially when things bore them.

But inattention during the early years can affect social development and the acquisition of social skills and mean that it is difficult to build friendships and thus feel valued. In more severe cases, ADHD can look like autism and can have as big an impact on development.

It can affect the ability of a child to master core language and literacy skills regardless of ability and potential, and reinforce a sense of failure when others are making progress.

Inattention can go unnoticed in class and slow progress put down to a ‘lack of effort’, but if this persists, teachers should ask if there is something else contributing to poor performance.

Just because a child is not displaying obvious hyperactivity or serious behavioural difficulties does not mean that they do not have ADHD, especially in girls.

Impulsivity

Blurting-out answers in class, struggling to wait for a turn, making poor choices on the spur-of-the-moment are all indications of possible ADHD or general immaturity and may be regarded more as a nuisance than anything else.

But impulsivity can have severe consequences.

Young children may run into the street without thinking of the danger and we know from hospital data that those with ADHD are at increased risk of fractures and falls as a result, as well as involvement in road traffic accidents.

But there can also be social consequences. Other children find their ADHD peers too inconsistent and difficult to predict, disruptive of games and play, and lacking the finer social skills that allow deeper friendships to develop.

Loneliness is a common characteristic in ADHD.

 Anxiety

Whilst anxiety is very common in young people and adults with ADHD and is often treated ahead of the underlying disorder, it can also be evident in the early years and at a point where children find it difficult to express how they are feeling.

This can result in very challenging and oppositional behaviour (for example, in not wanting to go to school or on family outings).

The causes of anxiety are varied and complex, but can relate to sensory sensitivities (e.g. the fear of loud noises, smells, busy places), worries about social failure, a feeling of not belonging, academic insecurity, and a pervading sense of failure at home and at school.

This is why it is important to boost self-esteem and to put in place scaffolding’ to support, rather than punish, young people through their formative years.

Relationships

Ask most children with ADHD what they really want to change and their answers will involve improved friendships.

They will tend to blame themselves for social failure and have shown by research to have a weak understanding of how they present to others.

Some can appear over-confident because they believe others value them for their friendship rather then just being entertained by their ‘acting-out’ behaviours, but this ‘positive illusory bias’ tends to diminish in the teenage years with a consequent loss of social identity.

Parents and teachers can help. Promoting friendship through organised activities and clubs or teams can mitigate the impact of ADHD on development throughout the life span.

Anger and Frustration

Anger and frustration are natural responses that are common in all young people, but tend to be more severe in those with ADHD.

The first thing to do as a parent is to identify, if possible, what the triggers are by looking for patterns (time of day, place, context) so that these can be avoided or at least reduced or managed better.

Children do not want to be angry. When a child has a ‘melt-down’ they are already being ‘punished’, so don’t double that pain by inflicting yet more hardship on them.

Talk them through how they felt and how better to channel their feelings.

Learn the difference between ‘tantrums’ and ‘melt-downs’ and understand how to respond when they occur.

Low Mood and Depression

A continual diet of social failure and academic under-achievement can, in many circumstances, lead to serious consequences.

A withdrawal from situations in which those ‘failures’ are likely to recur, and a loss of self-esteem and belief.

Chase the positives as a class teacher or a parent. Makes sure that success is first identified (many positives are ‘invisible’; if a child is attending to a task, or prevents an impulsive response, it will tend not to be seen) and then reinforce it.

Be extremely careful about criticising the child themselves. Separate their behaviour from who they are and ensure that they feel loved and valued, even if their behaviour is causing difficulties.

We tend to function and develop best in nurturing rather than hostile environments, so don’t let ADHD become a barrier to family warmth and affection.

Lack of Structure

Children with ADHD tend to have poor executive functions and struggle to cope with the organisational demands we place upon them. This is particularly true as they transition from primary to secondary school.

The developmental delays associated with ADHD mean that we should make demands that are ‘stage’ rather than ‘age’ appropriate, and to put in place the ‘scaffolding’ that will allow a child to perform to the best of their ability.

ADHD causes huge difficulties with short-term memory, so use lists, routines and prompts to reduce organisational failures, and apprecite that the ‘internal clock’ that many of us take for granted may not function well in children with the disorder.

Set boundaries where possible and have clear expectations, but do not over-punish organisational failure because this can have a very corrosive impact on development in general.

Before contacting any professional, write a list of bullet points capturing aspects of his or her behaviour that concern you. Speak to the school to determine what they themselves have observed and have a discussion about the possibility of a referral for further assessment. Referrals can also be made by your GP if he or she thinks that the problems are so significant that they are causing genuine difficulties for you or your child.

Clinicians will usually ask for information from home and school and ask you to complete an initial screening assessment and then a rating scale. It is important that both symptoms and impairment can be demonstratedfor a diagnosis.

If the diagnosis of ADHD is given, it does not mean that medication will be necessary and much will depend upon how severe the presentation is, and whether or not you want to explore that treatment route. It is good practice to consult with your child and explain to them what the options are, and how medication may help them.

ADHD tends not to be diagnosed in children under 6 in the UK because it is difficult to discriminate it from other difficulties that a child may be having without additional information from education professionals, some understanding of how he/she may be coping in different types of environment, and because treatment with medication is not advised until this age.

This does not mean that ADHD is not causing problems for the child and his/her family and these may be apparent in:

• Temper tantrums or meltdowns (link to some good advice on how to identify and manage these)

• Sleep disruption

• Relationship difficulties

• General development

However, these may also be the result of many other factors and may not indicate ADHD. Asessment should include all aspects of a child’s functioning and developmental history, including speech and communication, sensory processing, general health, and family dynamics.

Not all children who display difficulties in their behaviour have ADHD. There are many factors to consider.