In this article
Children, especially younger children, are often highly active. It is typical for pre-school children to have short attention spans and be unable to stick with one activity for long. This behaviour is normal and in most cases they will gradually grow out of it. However, for some children, there could be an underlying issue, such as Attention Deficit Hyperactivity Disorder (ADHD).
Great Ormond Street Hospital for Children (GOSH) describes ADHD as “a neurodevelopmental disorder that refers to a pattern of behaviour that affects a child in most situations, is evident from an early age and can persist into adolescence and adulthood.”
The core symptoms of ADHD are:
Difficulty concentrating – the main signs are:
- Having a short attention span and being easily distracted.
- Making careless mistakes – for example, in schoolwork.
- Appearing forgetful or losing things.
- Being unable to stick to tasks that are tedious or time-consuming.
- Appearing to be unable to listen to or carry out instructions.
- Constantly changing activity or task.
- Having difficulty organising tasks.
Hyperactivity and acting impulsively – the main signs are:
- Being unable to sit still, especially in calm or quiet surroundings.
- Constantly fidgeting.
- Being unable to concentrate on tasks.
- Excessive physical movement.
- Excessive talking.
- Being unable to wait their turn.
- Acting without thinking.
- Interrupting conversations.
- Little or no sense of danger.
Most children with ADHD have issues that fall into both these categories – this is called Combined ADHD – but this is not always the case. Some children with the condition may have problems with concentration but not with hyperactivity or impulsiveness. This form of ADHD is called Predominantly Inattentive ADHD and is also known as Attention Deficit Disorder (ADD). Other children may only have problems with hyperactivity and/or impulsiveness but not with concentration; this form of ADHD is called Predominantly Hyperactive/Impulsive ADHD.
What causes ADHD?
There is a great deal of myth and ignorance about ADHD. Many people associate ADHD with poor parenting or poor dietary habits, but the exact cause(s) of ADHD is not clear. Research in the Lancet medical journal suggests it is actually a genetic condition, and factors that may be involved in the development of ADHD include genetics, the environment or problems with the central nervous system at key moments in development.
Risk factors for ADHD may include:
- Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder.
- Exposure to environmental toxins such as lead, found mainly in paint and pipes in older buildings.
- Maternal drug use, alcohol use or smoking during pregnancy.
- Premature birth.
Some statistics about ADHD in the UK
ADHD is a common disorder. In the UK, a survey of 10,438 children between the ages of 5 and 15 years found that 3.62% of boys and 0.85% of girls had ADHD. Regarding the gender split, roughly 4:1 boys to girls, there is an active discussion about whether female ADHD is under-diagnosed and, if so, what the reasons are for that. A recent review of follow-up studies of individuals diagnosed with ADHD as children found that by age 25 only 15% retained the full ADHD diagnosis. The worldwide prevalence for children with ADHD is 5%.
Research on teachers’ experience and understanding of ADHD conducted by ADHDUK found that:
- 89% of teachers currently teach or have taught pupils with ADHD.
- 72% of teachers agree ADHD has a significant impact on a child’s overall life chances.
- 83% of teachers are concerned about the negative impact of teaching someone with ADHD on their ability teach all those in the class.
- 25% of teachers are not confident that pupils showing signs of ADHD can access appropriate services and support.
- 24% of teachers did not recognise a short attention span to be a symptom of ADHD.
- 26% of teachers did not recognise hyperactivity to be a symptom of ADHD.
- 41% of teachers did not recognise impulsive behaviour to be a symptom of ADHD.
- 74% of teachers did not recognise difficulty with organisation to be a symptom of ADHD.
- 78% of teachers did not recognise difficulty interacting socially to be a symptom of ADHD.
- 21% of teachers do not agree that ADHD is a mental health condition.
- 19% of teachers feel uninformed about ADHD.
- 42% of teachers have not received training on teaching children with ADHD.
How can teachers recognise ADHD?
The symptoms of ADHD in children and teenagers as described above are usually noticeable in a child by the age of six; however, the condition may not always be diagnosed this early. The condition often becomes apparent when a child starts school and teachers may notice that a child finds it hard to sit still, struggles to pay attention, or blurts out answers in class.
They may also notice that a child:
- Struggles with making and/or keeping friends.
- Has short-term memory challenges.
- Has difficulties engaging in conversation.
- Interrupts others’ conversation in order to get their point across.
- Overreacts to certain situations.
- Is often the victim of bullying or are bullies themselves.
- May be unreliable and have difficulty following through.
- Has problems keeping up with academic tasks in the classroom.
- Is very impatient and unable to wait their turn in a queue or game.
It is important to remember that some children just naturally have a higher activity level or a shorter attention span than others do. Children should never be classified as having ADHD just because they are different from their friends or siblings.
If a teacher suspects a child of having ADHD, the child should be observed with other children of a similar developmental age. If they then notice something outside the norm, they should speak with the Head Teacher, the Special Educational Needs coordinator and the child’s parents about their concerns.
Teachers cannot diagnose ADHD, although the teacher and sometimes past teachers will play a key role in the diagnosis process by sharing their observations. The professional who makes the diagnosis is usually a specially trained professional either a psychiatrist, paediatrician, psychologist or counsellor.
How to help a child with ADHD in school
Under the Equality Act 2010, schools are required to make ‘reasonable adjustments’ so that all children can access their facilities and services. The Act applies not only to state maintained schools, but also to independent schools, including academies or those offering alternative provision, as well as to both maintained and non-maintained special schools.
The NHS has accepted ADHD as a condition since 2009 and it is now considered a disability in the UK, therefore schools and colleges must make ‘reasonable adjustments’ to support children with ADHD.
Unfortunately, the term ‘reasonable’ is not explicitly defined in the Act, which leaves it up to the discretion of the school to determine this.
Some of the factors that may influence a school’s decision about what adjustments it can make are:
- Financial resources of the school.
- Cost of the adjustment.
- Effectiveness of the adjustment.
- Effect on other pupils.
- Health and safety requirements.
- Provisions already made by the SEN Framework.
Any adjustments need to be tailored to the specific needs of the child. So working closely with the child’s parents is important in coordinating strategies to ensure a consistent system of incentives and discipline between school and home.
Children diagnosed with ADHD will have a treatment plan in place and the school may need to play a role in dispensing ADHD medications and monitoring for side effects. Teachers will be important in carrying out the behavioural part of a treatment plan and in communicating about the effectiveness of any medication.
For teachers, a child with ADHD can place many demands on their time, energy and professional ability. The constant interruptions, the need for repeated instructions and close supervision can be challenging. Some children with ADHD also may have other issues, for example with writing or spelling, which may also need to be considered.
But it is important to remember that children with ADHD are:
- Boundlessly enthusiastic.
- Quick thinking and intuitive.
So, finding useful strategies to unlock these hidden talents and harness them so that the child develops in their own unique way is not only beneficial for the child but also for the impact the child has on the other children in the class.
Research shows that children with ADHD do best with teachers who:
- Are flexible.
- Follow clear routines.
- Are consistent.
- Provide a range of activities.
- Recognise and support individuality.
- Maintain a positive teaching environment.
- Present information and tasks in steps.
- Set firm limits on behaviour.
What can teachers and teaching assistants do to support a child with ADHD?
Children with ADHD can experience more obstacles in their path to academic success than the average student. The challenge is to find strategies that enable teachers to teach the curriculum in a way that also assists in managing the behaviours of the child with ADHD. This may mean modifying the curriculum and the mode of delivery.
Some practical teaching and learning strategies include:
- Giving clear and concise instructions that will enhance the child’s ability to comply.
- Asking questions to actively engage the child.
- Utilising the teaching assistant’s skills and/or learning mentors/buddies will help the child to participate in the lesson.
- Restlessness and fidgety behaviour associated with ADHD can be reduced by taking regular exercise breaks, as can allowing the use of de-stress, tactile or fiddle toys.
- A daily routine that outlines lesson timings and break times will assist the child with staying on task. Provide them with structure through lists, timetables, timescales and regular reminders.
- Using technology helps to maintain interest and attention for longer and adds motivation.
- Allowing the child to doodle, make notes or mind maps when listening.
- Breaking tasks down into small manageable pieces to be submitted at regular intervals, monitoring progress regularly throughout the lesson and giving regular feedback helps keep the child focused.
- Making learning fun – all children hate being bored.
- Reminding the whole class to put their hand up if they want to talk.
- When taking turns in group work, using a timer to set time limits.
- Using large type on handouts.
- Encouraging all children to stop and think before talking; this will help a child with ADHD to learn to slow down before talking. You can do this by waiting 10 seconds before you accept answers from the class.
- Using a ‘traffic light’ system depicted on a poster can help control excessive talking and interruptions. Show the whole class the applicable colour card, remind them about these rules for interrupting and talking, if anyone persists, talk to them on their own and not in front of the class. The rules could be, for example:
– RED means NO talking or interrupting allowed
– ORANGE indicates QUIET talking allowed
– GREEN indicates OPEN talking allowed.
- When setting homework, good planning and communication with parents will help.
The physical classroom environment
A stress-free environment is a very important aspect of daily life for someone with ADHD. The removal of unexpected distractions can make the whole class calmer, as children with ADHD work best under close monitoring and with minimal distraction.
The following strategies may be helpful:
- Place the child with ADHD closest to you. This can enable discreet interaction between you and the child and helps to keep the child on task. Being at the front of the class often diminishes many visual distractions, including the movement and activities of the other children.
- Avoid seating children with ADHD in large clusters of tables with lots of children at each.
- Staying in a seat for any length of time can be difficult for children with ADHD so consider allowing them to stand for some of the lesson, as long as they are not too disruptive to others.
- Use displays to outline the classroom rules, assignment tasks, daily schedules and to celebrate individuals’ good work. Display classroom rules which are unambiguous and written in a positive way.
An optimistic, non-judgemental team approach between the school, SEN coordinator, teachers and parents is essential in managing behaviours in children with ADHD.
The following strategies may be helpful:
- Children with ADHD require regular reminders of classroom rules to consolidate them as part of every school day. Frequently praise those children who are following the rules, especially those with ADHD.
- Implement an incentive scheme using a points or star chart, so good behaviour can earn a reward. Children with ADHD deserve praise for achieving seemingly simple things that other children can do without much effort, for example staying in their seat or putting up their hand before speaking. Positive attention is powerful, so notice and reward them for being good.
- If you have to discuss the child’s behaviour, when you give corrective feedback give it immediately and as privately as possible after the negative behaviour is noticed. Be matter of fact in attitude rather than dramatic and use a brief, specific statement outlining a clear consequence, balancing this with rewards and positive reinforcement for acceptable behaviours. Try to ignore mildly inappropriate behaviour if it is unintentional and is not distracting other children in the class or disrupting the lesson.
- Defiant behaviour is often linked to ADHD, particularly in children whose symptoms are primarily hyperactive. Impulsivity may result in reckless or seemingly aggressive behaviours, whilst an inability to rein in anger may be another root cause of defiance. Harsh discipline rarely works for these children; instead, practising compassion and focusing on skill-building are the strategies most often recommended by experts.
- Beginning each class with a couple of minutes of mindfulness or meditation will clear the working memory so that it can take in new information. It also reduces anxiety by having a calming effect that can benefit the whole class, not only the children with ADHD.
- Symptoms of ADHD change with developmental maturity, a preschool child may present as excessively active across most situations, whereas an adolescent may be more fidgety than frequently getting up and down from their seat, for example. For older children you could head off behaviour that takes time from the rest of the class by working out a couple of warning signals with the child who has ADHD. This could be a hand signal or a sticky note on the child’s desk.
How to help a child with ADHD focus in school
A child might not seem to be listening or paying attention to class material; they may be daydreaming, looking out the window, or focused on irrelevant noises or other stimuli. As a result, they miss instructions, directions and learning.
ADHD is not just an inability to pay attention; it is an inability to control attention. Children with ADHD have a lower level of brain arousal, which in turn decreases their ability to screen out distractions like noise in the hallway, movement outside the window, or even their own inner thoughts and feelings.
To help a child focus on schoolwork the following strategies may be helpful:
- In order to prevent singling out children with ADHD, let everyone try privacy dividers, earphones, or earplugs to block distractions during individual work or tests.
- Alternate between high- and low-interest activities and, when possible, keep lesson segments short or vary the pacing from one lesson segment to the next, keeping things interesting.
- Accommodate different learning styles by using a variety of learning strategies and teaching methods to accommodate the variety of learning styles in the room so all children have the opportunity to approach lessons the way they learn best.
- Include visual, auditory and kinaesthetic components to all lessons and give children opportunities to work cooperatively in pairs, individually and with a group.
- Redirect instead of reprimanding a child who becomes distracted. When redirecting do it in a way that doesn’t cause embarrassment. Sometimes, asking a child with ADHD a question you know they can answer, or giving non-verbal cues, such as standing close or using a hand gesture can bring the child back into focus.
- Work with the parents to establish a daily homework routine. Some children need to take a break between school and homework or may need frequent breaks between assignments. Working with the parents will help to establish what works best for the child in order to help them avoid distractions and procrastination.
- Most children with ADHD may need a significant amount of supervision to keep on task. As situations improve and the child matures, you can move away from constant supervision to frequent check-ins to make sure the child is on task.
- Allow short breaks between lessons, let the child stretch or have a short walk once one lesson is over. This can help make the workload seem more manageable and helps them regain focus.
For children with ADHD, getting through school can be problematic; however, ADHD is not an indicator of a child’s level of intelligence. It is important to know that some of the most successful and intelligent people, such as Albert Einstein, Mozart and Leonardo de Vinci, successfully managed their ADHD.
Neither is ADHD an excuse for challenging or poor behaviour. It does offer, however, an explanation of why some children struggle in some aspects of school life. Although schools aim to meet the needs of all children or young people in their care, many often can’t or don’t because of their lack of understanding around specific mental health issues such as ADHD.
Interventions such as physical exercise and good teaching and learning strategies, giving support with planning, organisation and structure to reduce anxiety, will all help build the resilience in the child’s developing brain and nervous system. Many schools now employ ‘brain friendly’ styles of teaching and learning, including the implementation of the ‘Social and emotional aspects of learning’ (SEALS) initiative.
As children with ADHD develop and mature many have taught themselves a range of coping strategies which work for them. However, it would be helpful for all Special Educational Needs coordinators in schools to access training on how to successfully manage ADHD within the learning environment, in order to support both teaching staff and children and help raise levels of achievement and academic attainment.