Child ADHD

What is ADHD?

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) exhibit persistent age-inappropriate symptoms of inattention, hyperactivity and impulsivity that result in the impairment in important areas of functioning. There are two core dimensions of ADHD.

1) Inattention

• Difficulty sustaining attention, especially for tasks that are repetitive, structured & typically less enjoyable. This involves difficulty following instructions, resisting distractions, planning and organization.

  • Examples of inattentive behaviour include being daydreamy, spacey, processing information slowly, difficulty focusing on tasks, having trouble remembering things & possibly appearing socially withdrawn.

  
  

2) Hyperactivity and/ or Impulsivity

• Lack of control of motor behaviour, poor sustained inhibition of behaviour and the inability delaying a response or gratification.

  • Examples of hyperactive behaviours include often fidgeting, squirming, running, difficulties staying in their seats, being excessively energetic & being talkative

  • Examples of impulsive behaviours include impatience, blurting out inappropriate comments, inability engaging in turn-taking & often interrupting others’ conversations/activities.

  
  

There are 3 subtypes of ADHD: Predominantly inattentive presentation, Predominantly hyperactive/ impulsive presentation, and Combined presentation.

Predominantly inattentive presentation. Display primarily inattentive behaviours. This used to be commonly known as Attention Deficit Disorder (ADD).

Predominantly hyperactive/impulsive presentation. Display primary hyperactive and impulsive behaviour.

Combined presentation. Display both inattentive and hyperactive behaviours. This is the most common type of ADHD.

Key Symptoms

The next two pages show a few key symptoms defining inattention and hyperactivity-impulsivity.

Inattention

• Often fails to pay close attention to details or makes careless mistakes (e.g. overlooks details, inaccurate work).

• Difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lessons, conversations, or reading).

• Often does not seem to listen when spoken to directly (e.g. appearing distracted even in the absence of any obvious distraction).

• Often easily distracted by extraneous stimuli

• Often forgetful in daily activities (e.g doing chores, homework)

• Often does not follow through with instructions and fails to finish schoolwork, chores, or duties (e.g starts tasks but quickly loses focus and easily sidetracks)

• Often has difficulty in organization (e.g. difficulty managing sequential tasks, disorganised work, poor time management)

• Often avoids, dislikes, or is reluctant to engage in tasks that requires extended periods of mental effort (e.g. homework)

Hyperactive - Impulsive

• Often fidgets with or taps hands or feet or squirms in seat

• Often leaves their seat in situations when remaining seated is expected (e.g., leaves his or her place when teacher is teaching).

• Often talks excessively

• Often runs about or climbs in situations where it is inappropriate

• Often unable to play or engage in leisure activities quietly

• Often has difficulty waiting his or her turn (e.g., waiting for food to be served).

• Often blurts out answers before a question is asked (e.g., cannot wait for a turn in conversation).

• Often interrupts or intrudes on others (e.g., using other people’s things without asking for permission, butting into others' activities).

• Is often restless, does not feel comfortable being still for an extended period of time (e.g., may be seen by others as being restless or difficult to keep up with).

ADHD vs Autism Spectrum Disorder

People tend to confuse ADHD with Autism Spectrum Disorder (ASD). Some symptoms do overlap. But there are key differences between the two. Refer to following quick pointers to find out the main differences.

What is it?

ADHD:

A neurodevelopment condition that makes it difficult for kids to focus, sit still, and curb impulsivity.

ASD:

A range of neurodevelopment conditions that results in difficulties with social skills,communicating and thinking. Repetitive behaviours are also part of ASD.

What are the implications?

ADHD:

May have difficulties making and sustaining friendships due to struggles with following social rules.

May result in self-esteem and motivation-related issues if constantly receiving negative feedback about behaviour

The overlaps between ADHD and ASD:

Main difficulties include struggles with social communication, understanding and repetitive routines or behaviours

Face challenges making friends, understanding how to relate to other people and making sense of social cues.

What are the common symptoms?

ADHD:

• Appear distracted, forgetful or daydreamy

• Difficulties with organising and completing tasks

• Prone to tantrums and meltdowns due to the lack of impulse control

• Struggles with following instructions which others are able to

• May or may not have sensory issues

• Lack of patience during turn-taking

• Difficulties sitting still during quiet activities, such as mealtimes or doing schoolwork

• Interrupts people, blurts things out without consideration and may struggle with non-verbal cues

• Constantly appears to be “on the go”

ASD:

• Avoids eye contact and/or physical contact

• Delayed speech/no speech, or repetition of certain phrases

• Prone to tantrums and meltdowns due to sensory processing issues, anxiety or struggles communicating

• Gets upset by changes in routine

• Constantly appears to be “on the go”

• Struggles with social skills

• Uses excessive and repetitive body movements to self-soothe (e.g. rocking, flapping hands)

• Has fixated interests

• Has trouble understanding own feelings and others' feelings

• Reacts strongly to senses such as particular smell/taste (sensory processing issues)

Common Myths of Child ADHD

These are several common myths aboutADHD in children. It is important to fact-check these myths because they may influence how we perceive the child's abilities, which may be detrimental to their development.

Myth 1: ADHD is caused by bad parenting

ADHD is a neurodevelopment condition and is not caused by bad parenting, although behaviours that arise from ADHD can influence parenting approach. Unfortunately, when people see children being impulsive or not listening to instructions, they may assume that it is due to the lack of discipline, and may not realise that these are signs of a possible medical condition. The home environment can also influence the symptoms of ADHD to be better or worse.

Myth 2: Kids with ADHD will outgrow this condition

Most children do not totally outgrow their ADHD, although certain symptoms may decrease in frequency or disappear as they grow older. These children may also have learnt various ways to manage or conceal their symptoms as they grow older.

The main goal of getting treatment should be to ensure that the individual functions well at every stage of their life (childhood, adolescence or adulthood) rather than to wean off medication as soon as possible. Even though symptoms of ADHD may persist till adulthood, many are still able to lead productive lives.

Myth 3: Only boys get ADHD

While it is true that boys are more likely to be diagnosed with ADHD as compared to girls, it does not mean that girls do not have ADHD. Girls with ADHD may display more inattentive/disorganised symptoms and less hyperactive behaviours as compared to boys. Unfortunately, this is why ADHD in girls are often overlooked and less likely to be reported.

Myth 4: Children with ADHD are just lazy & less motivated

ADHD is not a result of laziness or the lack of motivation. Instead, it stems from difficulties functioning due to differences in the way the brain works. The resulting outward behaviour such as being unable to sit still in class or finish their homework may appear as if the child is not trying hard enough, but it is highly likely that the child is trying as hard as he or she can to pay attention.

Myth 5: People with ADHD can never focus

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. For example, a boy with ADHD can spend hours focusing on his video game. School can be especially challenging for children with ADHD since it requires sustained attention over an extended period of time.

ADHD treatments

When a child is diagnosed with ADHD, parents will definitely be concerned about the types of treatment which would be appropriate for the child.

Working closely with the people involved in your child's growing environment - for example, teachers, healthcare providers, therapists and family members - can ensure the best treatment for the child.

Here are the two primary treatment for children with ADHD:

1. Stimulant Medicine

Stimulants may be effective in increasing sustained attention, increasing persistence in work and curbing impulse control. However, medication is not recommended for children below 6. The American Academy of Pediatrics (AAP) recommends parent training in behaviour management as the first line of treatment.

Medication can affect children differently and a handful of children may experience side effects such as reduced appetite and sleeping problems. Thus, it is important to note that medication is a tool, not a cure and is more likely to be effective when combined with other treatments.

2. Behavioural Parent Training

BPT is an evidence-based treatment where parents are taught positive reinforcements to improve their child’s behaviour. Parents are taught to use more effective discipline methods through the manipulation of antecedents (e.g. rules & instructions) and consequences (e.g. rewards & time-outs)

This has been found to be effective in decreasing disruptive behaviour in the child, and thus, parent-child conflict. It also enhances parenting skills and promotes prosocial & self-regulating behaviours in the child.

Effective Strategies for Child ADHD

In addition to treatment, there are also several strategies and tips to help parents manage their child with ADHD. Here are a few:

1. Self-Monitoring Behaviour

Self-monitoring techniques can help a child be more aware of their behaviours and promote improvement over time. These include having a checklist of behaviours that the child periodically reviews, and a rating scale which consists of one or more items that the child can use to rate their behaviour, such as "How well did I: (1) stay in my seat?; (2) participate?; (3) avoid distracting others?"

2. Token Economy

A token economy helps with building and maintaining appropriate performance and behaviour, 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.

3. Create a routine & Follow It

Creating simple & predictable routines can better help a child understand & follow instructions. This includes fixed timing for activities such as meals, homework, play time.

4. Be Clear & Specific When Talking to Your Child

The use of clear and brief instructions can help the child to better understand what they have to do.

5. Use A Reward System

Use a chart to document goals and monitor the child's behaviour. Whenever a child does something well, praise them and reward them in various ways rewarding them in other ways. Make sure the goals are realistic, as small victories are worth celebrating.

6. Creative Positive Experience

Children with ADHD may find certain situations very stressful. For example, doing homework may be stressful since they struggle with focusing. Finding out what these situations are & encouraging them to be involved in things they do well (e.g. sports, music, art) can help create positive experiences for your child.

7. Positive A Healthy Lifestyle

Having enough rest, eating nutritious food & regularly exercising are important and can help minimise the worsening of ADHD symptoms.

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Written and edited by: Eulisia Er and Xavierlyn Tan | Designed by: Tan Ning Xin