ADHD in children

Learn about ADHD, signs to look for, how your doctor determines if your child has ADHD and treatment options.
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Found in: Mental Health Conditions
Date: September 2022

About ADHD

Attention deficit hyperactivity disorder is a common neurodevelopmental disorder. Children with ADHD may be more active and more easily distracted than others. 

There are both strengths and challenges associated with ADHD. For example, children with ADHD may be creative thinkers with high motivation for activities that are interesting to them, but their difficulties with attention and planning may make it hard for them to begin or complete schoolwork and chores. Their behaviour may also be affected if they have trouble regulating their emotions or if they often act without thinking.

Diagnosis and treatment can help support children with ADHD to develop strategies, expand on personal strengths and learn specific skills for navigating these challenges.

Of course, all kids (especially younger ones) act in a busy, distracted and energetic way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur most of the time. They affect the child's ability to function socially, at school, and at home.

In the past, we used the term ADD (attention deficit disorder) to describe children who had extreme attention challengers but were not hyperactive. ADD is now called “inattentive ADHD” and children with this condition may seem to be often lost in a daydream. In a classroom, these children are in danger of being overlooked, because the children who have hyperactivity within ADHD cannot fail to get noticed.

It is important to support children with ADHD to develop their self-esteem. Some children with ADHD experience negative comments from teachers or family/whānau regarding their behaviour or school achievement. This can make them feel “not good enough”. Adults can encourage children with ADHD by acknowledging and celebrating their unique talents, skills and efforts.

With proper treatment and support, kids with ADHD can learn to successfully live with and manage their symptoms.

Who gets ADHD?

Boys are about three times more likely than girls to be diagnosed with ADHD. Experts now believe this is because girls tend to display less of the “disruptive” signs of ADHD, not because they are less likely to have ADHD, meaning they are in danger of being overlooked and missing out on important support. 

ADHD often occurs with other childhood mental health conditions. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD have conduct disorder or experience anxiety or depression.

Learning difficulties that are not recognised or taken notice of present a risk for mental health problems, as they affect progress at school and self-esteem. Likewise, without support in emotional regulation and problem-solving skills, children with ADHD can find interacting with peers difficult, which is another risk factor for mental health challenges.

For teenagers, ADHD and its associated challenges are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicidal thoughts and behaviours. Providing ongoing support and treatment options can increase the safety of young people with ADHD and provide strategies for managing any mental health challenges.

What causes ADHD?

Even though a lot of research into ADHD has gone on around the world, the exact cause is still unknown. What is known is that ADHD is not caused by poor parenting, too much sugar or vaccines. 

There is thought to be a genetic element to most ADHD; that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD are two to three times are likely to have it as well.

Studies of brain scans show that children with ADHD seem to have brain circuits that are wired a little differently from other people. This means they have trouble using executive functioning skills: attention, working memory, time management, organisation, planning, initiating tasks and self-monitoring. 

Research into children with ADHD has also found irregularities in their levels of dopamine and norepinephrine, chemicals in the brain that influence mood. This can make it very difficult for a child with ADHD to complete a task that they find less stimulating, such as a project that takes a long time and isn’t of great personal interest to them.

Likewise, these differences in brain chemistry might mean highly stimulating activities like social media, gaming, risky behaviour and arguments can be more appealing to children with ADHD.

Understanding these physical differences can help adults to support children with ADHD through learning tasks and personal challenges, at home and school.

Symptoms

Signs to look for (symptoms)

A child with ADHD will have some or all of the following signs:

As babies and infants:

  • being colicky, restless, and hard-to-cuddle babies and poor sleepers
  • crawling or walking earlier than other children
  • having lots of energy and being constantly on the go – they seem unable to sit still even if they are enjoying doing something
  • having a short attention span and not following through what they set out to do.

 At school:

  • tuning out or appearing to daydream, especially when being given instructions
  • talking a lot, interrupting others and being unable to wait for their turn
  • having trouble with the work and often giving the impression they have not heard the teacher's instructions
  • having trouble starting a task on their own or completing one without regular one-on-one support
  • frequently calling out in class or a group and being known as the ‘class clown’
  • doing dangerous and impulsive things, like jumping from heights or running out onto the road without looking out for traffic
  • acting before they think
  • being easily upset
  • getting angry and “exploding” quite easily
  • finding it hard to make and keep friends, usually because they are seen as bossy.

Treatment options

It’s important that children with ADHD get support early in life, and throughout each life stage, so they can learn to manage their ADHD and develop the skills and confidence they will need to lead a successful adult life.

There is no single medication, intervention or strategy that can make ADHD “disappear”, but ADHD behaviours/symptoms can be reduced and managed well by providing ongoing support that works well for the individual child.

If you believe your child has ADHD, the first step is for them to be assessed by a specialist. You can ask your GP for a referral to a specialist under the public health system, which will be free of charge but may mean waiting some time for an appointment, or you can contact a private specialist directly, which will incur a cost but may mean you can get an assessment sooner.

If your child is diagnosed with ADHD, the specialist will then work with you to create a treatment plan. ADHD is a complicated condition, generally best managed by a mixed treatment programme, which may include the following components:

Medication

Stimulants are the main kind of medication used in the treatment of ADHD. These are used to help your child concentrate better, be less impulsive, feel calmer and be able to learn and practise new skills. In fact, the same medications are used for both children and adults.

It’s important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with your doctor.

If your child is prescribed medication you are entitled to know:

  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  • how long the child will have to take them for and what their side effects are (short and long term).

Talking therapies and counselling

These are talk-based therapies which look at the child or young person's thinking, behaviour, relationships and environment. 

For ADHD, these treatments include behaviour management and social skills training to help support your child at home and at school. It’s important that children are encouraged to develop and learn coping behaviours and skills, and parents and teachers play a key role to help them learn and practise these new skills.

Family counselling can also play an important part in helping everyone in the family understand the condition and support the child, providing the counsellor has good knowledge of ADHD. Check this with the counsellor before starting.

Any therapy/counselling should be provided to children, adolescents and their families/whānau in a manner that is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.

Other strategies to support a child with ADHD

Complementary therapies

Health and healing practices are varied and differ according to how people view illness. Any health-related practice that increases your child’s sense of wellbeing or wellness is likely to be of benefit.

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it.

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions. 

When considering taking any supplement, herbal or medicinal preparation, consult a doctor to make sure it is safe and will not react with other medication. 

Ways to support a child with ADHD at home

For family/whānau of someone with ADHD, the following strategies are useful:

  • Make sure there are everyday routines in the home. Most children respond to predictability and structure. Routines help the child to know what the rules are around getting up, showering, mealtimes, homework, going to bed and playing. If a child has to navigate this themselves, it increases the demands placed on them, which can be overwhelming for someone with ADHD. Setting up clear structure can help by creating one routine, rather than several tasks to remember. To support this, your child may need a reminder list or picture chart for some things.
  • Give instructions clearly and one at a time, so your child knows exactly what’s expected. It will be less time-consuming in the long run to look your child in the eye when you ask them to do something and check they have heard and understood the request by asking them to repeat what you've said. Instructions such as "please put these toys in your room" (a specific request) will work better than "tidy your room" (a general and, to the child, confusing request).
  • Teach and encourage your child to insert a pause before acting. The act of stopping and breathing first will help your child to pause and think things through before acting. Consider what will work best for your child in teaching and practising this. For example, if your child likes cars, they could practise holding a small toy car in their pocket, slowly feeling the sides and wheels of it as they pause and breathe.
  • Encourage your child to talk about their life – the good things and the not so good. You may be able to help them with a problem, and it’s important to keep the communication going. Build trust with your child by remaining calm and empathetic when discussing challenges. Problem-solve together and model useful conversations and strategies to use. On topics your child has more experience and confidence in, gradually step back so they can learn to problem-solve more independently, with support from you.
  • Build on your child's strengths. Find something your child does well, is interested in or enjoys doing. It is vitally important for them to experience success. This may mean the whole family/whānau takes up rollerblading! Physical activities that can be done in short bursts may work out better than organised sports for the child with ADHD.
  • Be positive about any successes, even if they don't complete a task. It is better for a child's self-esteem if you say that you noticed how hard they tried to do something, rather than to comment on how they didn't do it properly or finish it.
  • If your child raises one of their challenges with you, assure them that everyone has things they find easier and harder. (You can point to examples of this in yourself to normalise and model acceptance of this.) Ask them if they would like more support in those areas, and problem-solve together how you can help them learn more in this area.
  • Take care of yourself and other relationships. At times, a child with ADHD demands more time and attention, and siblings can feel resentful or left out. Try and make sure that their needs are met and use all the help you can get from extended family/whānau and community for babysitting, time-out, or having fun. Consider your own wellbeing, and create a self-care plan that supports your mental health. Marriages can be put under a lot of stress, so it may be helpful to consult a counsellor or family therapist to work out the best ways of living with a child with ADHD, keeping your partnership healthy and the rest of the family/whānau happy. 

Ways to support a child with ADHD at school

It’s best to keep up with your child's school programme and inform the teacher of any changes in behaviour or treatment. A home-to-school notebook is a good idea, in addition to meetings to create solutions to any current challenges. It’s important that the school understands your child’s strengths, interests, goals and areas for support. Some teachers know quite a lot about ADHD − others don't, so as a parent you may have to help with the teacher's education! 

Talk to the school about getting assistance from the Ministry of Education’s Learning Support Service for help with your child's classroom behaviour and learning needs.

The following strategies can be useful to support children with ADHD in school:

  • have the child sit in an area with as little distractions as possible – not beside a busy window or at the back of the classroom 
  • use lists, reminders and predictable schedules
  • break tasks, information and instructions into small chunks 
  • provide close support with each new task, gradually stepping back so the child can become more and more independent 
  • set short, realistic time frames for how long the child is expected to focus for, and extend this time gradually where appropriate
  • include the child’s personal interests in the curriculum as much as possible
  • include “doing” activities like play-based activities and field-based learning
  • provide lots of opportunities for physical exercise 
  • if required, create a behavioural management programme with clear rules, goals and supports.  

As a parent or caregiver, you are your child’s best advocate at school and in dealing with health professionals, because you know your child best. Help teachers and health professionals understand your child, so the best solution can be worked out for them. Don't forget, too, that children themselves are often able to tell adults what is most helpful to them.

Thanks to Kiera Mintoft-Jones, educational psychologist, for reviewing this content. Date last reviewed: September, 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.