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What is ADHD?
Everybody struggles with paying attention, sitting still or controlling sudden impulses from time to time, and these problems are a normal part of life. Though learning to control these urges is part of growing up, to some children such problems are pervasive and persistent enough to interfere with academic learning and daily living.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity. Some children with ADHD are easily distractible, appear absent minded or forgetful (Inattentive). Others perform excessive movements not fitting to the setting, and may rush through things resulting in careless mistakes (Hyperactive). Others may have poor self control, interrupt, and experience overly intense emotional reactions (Impulsive). Children with ADHD typically have trouble getting organized, staying focused, making realistic plans and thinking before acting.
ADHD affects 11 percent of school age children on average (Visser et al 2014), and in three quarters of cases, symptoms continue into adulthood and is associated with an increased tendency towards depression, mood or conduct disorders and substance abuse in later years if left unaddressed (Brown, 2013).
What are the symptoms of ADHD?
Children as young as age 4 can be diagnosed with ADHD. The Diagnostic Systems Manual of Mental Disorders (DSM-5) describes three possible presentation of the disorder. ADHD-Inattentive, Hyperactive-Impulsive, and Combined.
Below is a list (not exhaustive of) possible symptoms:
ADHD – Inattentive
- Fails to give close attention to detail or makes careless mistakes
- Difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Avoids tasks that require thinking
- Is easily distracted
- Forgetful in daily activities
ADHD – Hyperactive-impulsive
- Fidgets with hands and feet, squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively
- Talks excessively
- Blurts out answers before questions have been completed
- Has difficulty waiting turn
- Intrudes or interrupts others
ADHD – Combined
- Has symptoms from both lists above.
Promoting effective learning with ADHD Children
Within the classroom:
Incorporate movement into the classroom schedule
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Brain breaks, and gym time
Having break times in which the children can move around the class can greatly improve a child’s focus when it is time to sit down and focus on their work. Research show that incorporating around 15 minutes of moderate exercise into a classroom schedule can promote the development of a child’s executive functions, that allow him or her to control their impulses, while simultaneously promoting neuron growth.
Movements breaks can serve as a useful tool to help children regulate, expend some energy. As such, this causes a reduction in inappropriate behaviors, and an improvement in cognitive function in children with clinical disorders characterized by impulsive or hyperactive behavior such as ADHD.
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Movement during work time & Whole body listening
Often times, children are expected to sit still during lesson times. For some children with ADHD, doing so can be hard, if not very challenging. Providing a rubber seat cushion for children who are fidgety or distractible is okay! It is possible to support a child’s learning by giving them some room to fidget whilst not causing a distraction to the children around them. Studies done with children who have ADHD show that cognition is actually not inhibited by moving – for a child with such a profile, keeping his hands/feet still while listening may actually interfere with how much they would be able to take away from the lesson.
Facilitate the child’s engagement by getting him/her more involved in the task
Though the notion that engaging a hyperactive child by delegating him more duties in task seems counterintuitive, but it can act as a very effective avenue in allowing him or her to move, regulate and expend excess energy. Get your child to repeat instructions, help to set up games, distribute materials or erase the board.
Have a sense of visual clarity in the way the classroom is set up
Doing so allows the child to have a clear understanding of what behaviors are appropriate in which spaces. Make sure the environment is clutter free – ensuring that the child is not over stimulated, or distracted by the items around him/her. Having clearly defined boundaries, such as where to keep his hands when they work, where are the areas to play, and where are the areas to study, and where are the areas to eat, help a child organize and understand their environment and behave appropriately to what is expected. You can do this by something as simple as tape markings on desks and on the floor.
Outside the classroom:
Reduce screen time
Recent research indicates that too much screen time during the critical years of development (0-3 years) can affect the brains development in several key ways:
- Children’s brains need stimulation from the world outside the screen in order to develop certain neural processes. Looking at a screen involves less cognitive effort, which means that key neural processes are not developed when a child is looking at a screen compared to being outside.
- Too much passive stimulation can also impact a child’s ability to sustain focus and process information. Screens give immediate and instantaneous feedback, which is often not the case with real life interactions. This affects a child’s ability to delay gratification, affecting attention span and learning.
- Social skills cannot be learnt from screen-held devices, thus excessive screen time affect a child’s ability to read facial cues and empathise, as they lack the experience and learning from looking at real faces to do so properly.
The American Academy of Pediatrics recommends less than 2 hours of screen time per day for children aged 2 and older.
Increase playground time
Research shows that incorporating movement into a daily schedule is beneficial to all children, being essential to neurological development in the preschool years. Bringing your child to the playground often helps build fine and gross motor skills, which form the foundations of later cognitive development.
Doing so also helps children:
- Regulate themselves
- Learn how to behave and interact with others
- Improves attention span.
- Improves engagement and attention span in classrooms
Have a regular, fixed sleeping routine
It is also vital that children have a healthy, uninterrupted sleep schedule. Having irregular or disrupted sleep can severely affect a child’s arousal levels during the day, alertness and attention span. Having a healthy sleep pattern positively impacts neurological development, and can work to prevent many learning and behavioral problems. Having sleep problems can not only make a child less attentive but also result in them being more physically impulsive or lazy.
How can intervention help?
Child psychology
A child psychologist can diagnose and treat ADHD with different types of behavioural therapies to improve a child’s behaviour, self-control, and self-esteem, by teaching children to better control their symptoms. Therapy can focus on strategies for helping the child with ADHD stay organized and focused, or aim at reducing disruptive behaviours which may affect a child’s performance in school, both academically and in getting along with one’s peers. Other skills-based interventions aim to team techniques for children to stay focused and responsible with their tasks, and to develop social skills.
Psychologists often work closely with parents through approaches including Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P). These programs equip parents with skills and strategies that use praise, positive reinforcement, structure, and consistent discipline to manage their child’s behaviour, along with teach parents positive ways to interact and communicate with their child. This creates and reinforces better parent-child interactions, and reduces parental stress.
Occupational therapy
The purpose of Occupational Therapy (OT) is to develop and maintain a person’s capacity and empower them with the ability to perform day-to-day tasks and roles. An occupational therapist helps children with ADHD hone organization and physical coordination skills to equip them with the ability to carry out everyday tasks like getting dressed or making their beds in an efficient manner, while controlling their energy levels and hyperactivity.
Recent research indicates that difficulties in regulating sensory stimulation from the environment could be a basis for the behavioural patterns in children with ADHD (Cermak 1988a, Mangeot et. al., 2001). During OT, a technique called sensory integrative therapy is employed to help children with ADHD reorganise their sensory system, through approaches that stimulate a child’s sense of balance (vestibular), internal state (proprioceptive), and touch (tactile).
Speech therapy
Speech therapists do not diagnose ADHD but often treat children who have symptoms of, or have been diagnosed with ADHD in conjunction with language delays and communication disorders. Children who have difficulty maintaining focus in the classroom frequently miss out on important linguistics lessons, such as picking up new vocabulary, reading, and writing.
The speech therapist thus works with children to help them gain the ability to communicate through speech. Speech therapy sessions involve modelling proper speech, in terms of correct pronunciation, articulation, and expression, and using repetition exercises to maintain a child’s attention, and stimulate communication while increasing their chances of developing language skills. (Bruce, Thernlund, & Nettelbladt, 2006).
Read to learn about learning interventions for children with:
Acknowledgement:
Ms. Tricia Tam, Psychologist at MindChamps Allied Care, who has contributed to this article.
References:
Berwid, O., & Halperin, J. (2012). Emerging Support for a Role of Exercise in Attention-Deficit/Hyperactivity Disorder Intervention Planning. Current Psychiatry Reports, 14(5), 543-551. doi: 10.1007/s11920-012-0297-4
Kathleen, D. (2018). Too Much Screen Time Can Threaten Attention Span. Retrieved from https://www.medicinenet.com/script/main/art.asp?articlekey=117789
Whole Body Listening in the Classroom – Sensational Achievements, LLC. (2018). Retrieved from https://sensational-achievements.com/whole-body-listening-in-the-classroom/
American Psychology Association. (n.d.). ADHD. Retrieved from http://www.apa.org/topics/adhd/index.aspx American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. (2013). Arlington, VA: American Psychiatric Publishing.
American Psychiatric Association. (2017, July). What Is ADHD? Retrieved from https://www.psychiatry.org/patients-families/adhd/what-is-adhd
Bruce, B., Thernlund, G., & Nettelbladt, U. (2006). ADHD and language impairment. European Child & Adolescent Psychiatry, 15(1), 52–60. https://doi.org/10.1007/s00787-006-0508-9
Cermak S (1988a) The relationship between attention deficit and sensory integration disorders – Part I. AOTA Sensory Integration Special Interest Section Newsletter, 11(2), 1-4.
Chu S, Reynolds F (2007) Occupational therapy for children with attention deficit hyperactivity disorder (ADHD), part 1: a delineation model of practice. British Journal of Occupational Therapy, 70(9), 372-383.
Hinojosa J, Sproat CT, Mankhetwit S, Anderson J (2002) Shifts in parent-therapist partnerships: twelve years of change. American Journal of Occupational Therapy, 56(5), 556-63.
KidsHealth. (2017, December). ADHD. Retrieved from https://kidshealth.org/en/parents/adhd.html
Mangeot SD, Miller LJ, McIntosh DN, McGrath-Clarke J, Hagerman RJ, Goldson E (2001) Sensory modulation dysfunction in children with attention-deficit/hyperactivity disorder. Developmental Medicine and Child Neurology, 43, 399-406.
N Brown, T.E. (2013). A New Understanding of ADHD in Children and Adults: Executive Function. Routledge.
Visser, S.N., Danielson, M.L., Bitsko, R.H., et al. (2014). Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1):34–46. e2.
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by Joanne Lee
Multipotentialite. Loves creating and seeing ideas come alive. View all articles by Joanne Lee.
