What is Attention-Deficit/Hyperactivity Disorder?
Attention-Deficit/ Hyperactive Disorder, or ADHD, is a neurodevelopmental disorder that interferes with a person’s functioning or development. It is characterised by (a) inattention, (b) hyperactivity and impulsivity, or both.
Symptoms of ADHD are persistent and interfere with a child’s executive functioning or development. Executive functioning is the set of processes in our brains that allow us to do things like pay attention, plan, prioritise and regulate emotions and behaviours effectively – all of which are things that children with ADHD struggle with.
What ADHD is not
ADHD is often a misunderstood condition. It is important to realise that these symptoms, or the manifestations of these brain-based challenges faced by children with ADHD, are not intentional nor are they defects in character or personality. Below are some common beliefs, or myths, surrounding ADHD:
Ψ ADHD is caused by bad parenting.
ADHD is a neurodevelopmental condition and is not caused by bad parenting, although behaviors that arise from ADHD can challenge otherwise effective parenting. Unfortunately, when people see kids being impulsive or not listening to instructions, they assume it is due to a lack of discipline, not realizing that these are signs of a medical condition. That being said, the home environment can influence the symptoms of ADHD to be better or worse.
Ψ Children with ADHD are lazy.
ADHD is not a result of laziness or lack of motivation, but stems from a real difficulty in functioning due to the different ways their brain works.
The resulting outward behavior, such as being unable to sit still in class or finish their homework, may seem like they are not trying hard enough, but they are in fact trying harder than their peers to pay attention.
Ψ People with ADHD can hardly ever focus.
You may think that a boy who can focus on his video-games for long periods of time could not have ADHD. However, children with ADHD usually have problems with focusing their attention on a specific task for long periods of time and this does not include highly engaging or stimulating activities such as a video game. School can be especially challenging as it requires sustained attention over a long period of time and a child with ADHD may have problems adapting to that environment.
Ψ ADHD only affects children and they will outgrow it.
As symptoms of ADHD are typically observable from childhood, people with ADHD tend to be diagnosed when they are a child. However, this does not mean that adults are not affected by the condition. Adults do get diagnosed with ADHD, even if they were not previously diagnosed during childhood. Nevertheless, their symptoms are less apparent. They may have also learnt effective ways to manage or hide their symptoms into adolescence and adulthood. In fact, adult ADHD is believed to be under diagnosed, with an estimated 2% to 5% of adults having ADHD globally. Consider how often you see a grown-up running around uncontrollably and you get the idea—ADHD appears differently in adults.
The main goal of getting treatment for ADHD should be to ensure that the individual functions well at every stage of their life (childhood, adolescence, and adulthood) rather than to get off medication as soon as possible. Even though symptoms of ADHD may persist till adulthood, many are still able to lead productive lives.
Ψ ADHD is a “male” disorder.
ADHD is more commonly diagnosed in males across ages. However, this may be due to how the symptoms are presented between the genders. Males with ADHD are more likely to exhibit symptoms of hyperactivity/ impulsivity, such as running wildly and uncontrollably, making them more likely to stand out. In contrast, females with ADHD are more likely to demonstrate symptoms of inattention, such as spacing out. Thus, they are more likely to be perceived as bored and tend to be underdiagnosed for ADHD.
Ψ People with ADHD are deliberately difficult/ cannot hold onto jobs, meaningful relationships/ lead a “normal life.
People with ADHD tend to experience difficulties with processes that tap on executive functioning, such as planning and organisation, prioritising, focusing and sustaining attention, as well as regulating emotions and behaviours. In addition, there is an area in our brain, called the anterior cingulate cortex, which helps us realise when we’re about to do or say something we probably shouldn’t. In people with ADHD, it doesn’t quite work like it’s supposed to.
For someone with ADHD, everything that comes to their attention will get their attention. This makes daily living difficult for people with ADHD.
Nevertheless, the difficulties faced by people with ADHD are not intentional acts, nor are they defects in character or personality. Despite the challenges, people with ADHD can learn coping skills to improve their social, academic and occupational functioning, making it possible for them to secure and maintain jobs, meaningful relationships and satisfaction with life.
What does Childhood ADHD Look Like?
2 core dimensions of ADHD
(1) Inattention: Children with ADHD display an inability to sustain attention, especially so for tasks that are repetitive, structured & less enjoyable. It also involves difficulty in following instructions, resisting distractions, planning and organization.
Examples of inattentive behavior: Daydreamy, spacy, process information slowly, difficulty focusing on tasks, have trouble remembering things & may appear socially withdrawn.
(2) Hyperactivity/Impulsivity: Children with ADHD have a lack of control of motor behavior, poor sustained inhibition of behavior and the inability to delay a response or gratification.
Examples of hyperactive behaviors: Often fidgeting, squirming, running, finds it difficult to stay in their seats, excessively energetic & talkative
Examples of impulsive behaviors: Impatient, blurting out inappropriate comments, unable to engage in turn-taking & often interrupt others’ conversations/activities
3 subtypes of childhood ADHD
(1) Predominantly inattentive presentation: Display primarily inattentive behaviors. This used to be commonly known as Attention Deficit Disorder (ADD).
(2) Predominantly hyperactive/impulsive presentation: Display primarily hyperactive and impulsive behavior.
(3) Combined presentation: Display both inattentive and hyperactive behaviors. This is the most common type of ADHD.
How do I know if my child is displaying symptoms of inattention or hyperactivity-impulsivity?
Check out the table below to understand the difference between key symptoms defining inattention and hyperactivity-impulsivity respectively.
Difference between ADHD and Autism Spectrum Disorder (ASD)
Some may confuse ADHD with Autism Spectrum Disorder (ASD). This is not surprising, as some of the symptoms between these two disorders overlap. However, there are key differences between the two.
The table below highlights these main differences.
Can childhood ADHD be treated?
Yes, ADHD can be treated! When a child has been diagnosed with ADHD, parents usually have concerns about which treatment would be best suited for their child. It is recommended that parents work closely with others who are involved in their child’s life – teachers, healthcare providers, therapists & other family members to ensure the best treatment for their child. There are 2 primary treatments for children with ADHD.
- Stimulant medication – Stimulants may be effective in areas such as increasing sustained attention, persistence in work and impulse control. However, for children younger than 6 years old, medication is not recommended. The American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment.
Medication can affect children differently and some may experience side effects such as reduced appetite and sleeping problems. Hence, medication is a tool, not a cure and is more likely to be effective when combined with other treatments.
- Behavioral Parent Training (BPT) – An evidence based treatment approach where parents are taught positive reinforcements in order to improve their child’s behavior. Parents are taught to use more effective discipline methods through the manipulation of antecedents (rules & instructions) and consequences (e.g. rewards & time-outs)
This has been shown to effectively reduce disruptive child behavior and parent-child conflicts. Furthermore, it enhances parenting skills for parents and helps to promote prosocial & self-regulating behaviors.
Effective Strategies for children with ADHD
Ψ Self-monitoring behavior
As children with ADHD have difficulties in executive functioning such as decision-making and impulse control, this may lead to many unwanted behaviors in the classroom. Self-monitoring techniques can help a child be more aware of their behaviors and improve over time.
Ψ Token Economy
A token economy is a positive reinforcement strategy for building up and maintaining appropriate performance and behavior, be it at home or in a classroom setting. In a token economy, if a child acts or behaves in a certain way, they will be able to trade in their tokens for a reward or a privilege.
How can I help my child with ADHD?
To achieve positive changes in all settings, children with ADHD need a sense of consistency. They are more likely to be successful in completing tasks when the tasks occur in predictable patterns and settings. This way, they will know what to expect and what is expected of them. Here are some tips that have been found to be effective in helping children with ADHD:
- Create a routine & follow it. It is important to establish a time and place for everything to help a child understand & follow instructions. Create simple & predictable routines for meal times, homework, play time & bed time.
- Be clear & specific when talking to your child. Use clear & brief instructions when you need them to do something.
- Use a reward system. Use a chart to monitor goals & track positive behavior, then let your child know when they have done something well by praising them or rewarding them in other ways. Make sure the goals are realistic, as small victories are worth celebrating.
- Create positive experiences. Children with ADHD may find certain situations very stressful. Finding out & encouraging them to be involved in things they do well (e.g. sports, music, art) can help create positive experiences for your child.
- Provide a healthy lifestyle. Having enough rest, eating nutritious food & regularly exercising are important and can help prevent ADHD symptoms from getting worse.
Support, not Enable
One of the most helpful things you can do for your child with ADHD is to try and understand their struggles without judgement.
Remember that they are not forgetting things, making careless or reckless mistakes, losing focus, having an emotional meltdown, etc. on purpose or because they are lazy or spiteful. ADHD is not an excuse but an explanation for these behaviours. As a parent or loved one, it is also important to realise that it is not because you are doing something wrong either.
What your child may need support with may differ from another child with ADHD, so communicate with them and ask them what they need and how you can help. For example, you can be their accountability partner and help them make progress towards their goals and commitments, keeping them in check and giving them honest feedback along the way.
Be mindful when offering help to not demoralise them in the process. For example, saying things like, “Your room is a mess, as usual. I’ll help you clean it up because you can’t do anything right.” It is common for someone with ADHD to have self-esteem issues after years of frustration from struggling with things other people may consider simple. They thrive on encouragement while demoralisation might make them give up. Therefore, try to notice and appreciate their efforts more rather than pointing out their failures. If you or they are feeling frustrated or emotions are running high, step away and come back when everyone has calmed down.
At the same time do not enable them by trying to do, fix or control everything for them. It will just lead to resentfulness towards your loved one with ADHD or feelings of incompetence in themselves. People with ADHD are known to be passionate, creative, enthusiastic, intuitive people. Be your loved one’s advocate and help the world see them the way you do.
Click here for more tips on supporting a child with Attention-Deficit / Hyperactivity Disorder. If you think that your child has ADHD, do reach out and book an appointment with our child clinical psychologists at Annabelle Kids Singapore who are experienced in working with families and children with ADHD. We’re here to support you.