ADHD Partnership Support Pack

RAISE AWARENESS OF ADHD This chapter is divided into four sections. The first section examines school policy and procedure and provides sound advice in this
area for both parent/carers and teachers to help build productive relationships in the course of formulating an ADHD management plan. The second section provides advice to parents on the best way
to discuss ADHD with both teachers and the school, so that a good working partnership can be established. The third section addresses the problem of how to explain ADHD
to another parent and how to address some of the negativity surrounding their perception of this condition. Finally, the fourth section looks at the best ways to raise awareness of ADHD with other children. POLICIES AND PROCEDURES Why school policies matter Policies and procedures ensure agreed standards are met across all aspects of education, from class size and staffing levels to the acceptable behaviour of children inside and outside the classroom. Many policies are directly relevant to a child with ADHD, who may face discrimination at school. These include policies on special needs, equal opportunities, anti-bullying, disability discrimination and the use of medication in school. It may be useful for parents and carers to examine these policies and consider how they can help to make the case for ADHD support. Policies may be obtained from the school in printed form or via their website. Policies can vary between schools. Some policies with particular relevance for a child with ADHD are set out in the following table. Policy areas Example principles Equal opportunities All children should have equal opportunities regardless of their race, religion or disability. Special educational needs Most countries offer support to children with special educational needs. Some schools have access to additional funding for specific children. Disability discrimination No child should be discriminated against if they have any form of disability. Anti-bullying Every child has the right to learn in a safe and secure environment, which does not tolerate bullying. Policy areas Example principles Medication Any child with medical needs should receive appropriate care and support while at school. School medication policy can cover areas including: Procedures for managing medication due to be taken during the school day The roles and responsibilities of staff who administer medication Parental responsibilities in respect of a child's medical needs Record-keeping Safe storage of medicines Risk assessment How to explain the need for medication to others. Group sizes The maximum number of children in a classroom setting - dependent on age and special needs of the children. Policy areas for parents to consider Parents should examine particular areas of a school's policies to instigate the best possible support for their child. A good working knowledge of policies can help the parent in meetings with teachers, particularly during handover. These areas can include: Extra support available in the classroom and at break times Knowledge and experience of teachers working with ADHD Extra teaching support during lessons School's policies on children with ongoing medical conditions, including support provided Average number of children in lessons School's policies on discipline and punishment School's policies on the areas included within school reports, e.g. are behaviour and attitude a major part of the report? School's policies on homework Extra support available to children, such as extra time in tests Communication with parents. You can follow up with the school on any of these areas over time to check that the policies are carried out effectively in relation to your child. Getting support for your child If you feel that school policies are not being fully implemented, it is important to tell the school about the areas of concern. Key steps to take can include: OBTAIN If you do not have a copy of the school's policies, obtain them from the school directly or via its website. EXAMINE Examine the policies or refresh your knowledge, noting the key areas relevant to your child. CHECK What was agreed with the school when your child started? Make sure that any requests for support are in line with this. SEARCH Find relevant local, regional or national education policies on the internet. How do they differ from what is actually happening at school? MEET Discuss your views with your child's teacher and the findings of your research, as well as feedback from your child. You may also obtain a written statement from the child's healthcare professional to support you. AGREE Resolve issues that have arisen in respect of policy breaches with the teacher. Useful points to consider: Contact your local ADHD support group. You should be able to speak to other parents with similar experience who may be able to offer help and advice. It is a good idea to keep records of telephone conversations with the school as well as assessments and meetings. Building parent-teacher relationships A positive relationship with teachers can lead to a more successful experience at school for your child. The more a teacher knows about a child with ADHD, the more they can plan for integrating them into the classroom. It is possible that your child's teacher may not be familiar with the characteristics of ADHD and could therefore confuse it with other related conditions. These can include learning disabilities such as dyslexia or conditions such as Oppositional Defiant Disorder (ODD). It can be helpful to meet with your child's teacher(s) as soon as possible, or before the child starts at a new school, to explain ADHD and how it differs to other conditions, so that the teacher has a clearer understanding and any misconceptions can be addressed. You can also explain how ADHD affects your child and how this might affect their behaviour and their approach to schoolwork. It can also be helpful if: Your child can visit the new school prior to starting Your child could meet key teacher(s) as part of the visit, with an opportunity to discuss what they like best about school, how they learn and what they find most difficult Copies of all previous school reports should be provided to the new school. You could also write to the teacher/school, setting out what ADHD means for your child. Example letter to introduce the child to the teacher/school Dear [Name of teacher] [Name of child] has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). We would like to tell you about him/her to help get the school year off to a good start. During the past few years, we have worked with teachers to find strategies that will help [name of child] to achieve success at school. We have listed below how [name of child's] ADHD symptoms can affect his/her behaviour and performance so that you can begin to understand him/her better and develop ways to help. [Name of child] finds it very difficult to sit still for long periods and so it would be helpful if you could give him/her the chance to move around from time to time. In the past, this has involved tasks such as gathering up books and cleaning the blackboard. He/she is extremely impulsive and often acts without thinking. At home, we have an agreed signal between us that reminds him/her to consider what he/she is doing to prevent him/her interrupting or blurting out answers. [Name's] working memory is not good and you may find that you have to repeat information more than is the case with other children. We find that making and keeping eye contact before giving an instruction is an effective way to hold his/her attention better. It also helps to give only one instruction at a time before moving on to the next step. [Name] may act inappropriately at times. We hope that you will do your best to integrate him/her into the class, perhaps giving all of the children the opportunity to talk about themselves which would allow [name] to speak about having ADHD. [Name] finds it difficult to organise him/herself. This is particularly relevant for tasks such as homework. We do hope that [name] will receive your understanding and help in ensuring that the correct books are taken home and the right homework is handed in on time. [Name] has enjoyed school very much in the past and he/she enjoys learning new things, particularly when they are presented visually and he/she has a chance to get involved in practical activities. We hope that this letter has given you an understanding of [name's] ADHD and how it might affect him/her at school. Please don't hesitate to contact us if you have any queries or concerns. Yours sincerely School policies on extra-curricular activities The school's policies may also cover extra-curricular or after-school activities such as music, drama or sport which some children with ADHD can excel at. Children with ADHD who take part in these activities can develop a better attitude towards academic learning and through this, improve their self-esteem. Policies on extra-curricular activities may cover areas including: Safety Teacher to child ratios Level of instruction. Your child's current participation in extra-curricular activities can form part of initial discussions/communication between you and the teacher(s). You may also be able to advise the teacher(s) on which activities may be most suitable for your child: A child who fidgets may gain focus through the level of control required by martial arts An artistic child may benefit from ceramic or art classes, or hyperactive children: dancing or a vigorous sport A shy child may like to express themselves in a drama class. DISCUSSING ADHD WITH TEACHERS Success at school for a child with ADHD may be improved by parents/carers developing a positive working relationship with the child's teachers. A parent should not assume that a teacher will be unsympathetic or
know very little about ADHD. The goal of the exercise is to transfer an understanding of their child to the teacher and garner as much support
as possible. The teacher should be provided with a concise account of the extent of the child's ADHD. The teacher will have the child's best interests at heart and will want them to succeed. Both teachers and parents/carers should be proactive about exchanging information and try to assuage each others' concerns. Starting discussions with the school Areas to consider when you start discussions could include how the school: Uses policies and procedures to address the needs of children with ADHD Provides specialised support for children with ADHD, e.g. a special education coordinator Helps parent and teachers to work together, share information and monitor progress Helps to make sure that children with ADHD are supported appropriately and takes any prescribed medication correctly. Working with the teacher of your child As a parent/carer, one of the most powerful things you can do is develop a strong and positive relationship with your child's teacher. This relationship can be more effective if you work together to find the best solutions, and share strategies that work at home and at school. It may be helpful to meet up with the teacher who is most involved with your child as early as possible. The meeting can involve the following steps. ASK Use the meeting to ask questions and clarify information. e.g. Has the teacher worked with children with ADHD before? If so, how did the teacher manage this situation? Have there been any disciplinary issues concerning the child? Are there any specific questions or concerns? What are the expectations of the school in relation to the child? What school subjects have engaged the child most previously? What are the child's talents and interests? Do the parents have any other children? If so, does one child's ADHD disrupt general family relationships? Which teachers have worked successfully with the child in the past and why? What is the most important aspect in terms of the child's experience at school? SHARE The meeting can provide an opportunity to share a brief history of the child including: What happened at the child's previous school The strategies that have previously worked with other teachers and at home Areas that you find particularly challenging at home. PROVIDE Provide insight into the particular challenges that you face with your child, including the importance of demonstrating a consistent and unified approach. OFFER Offer to help the teacher to learn more about ADHD and support them, if requested. In turn share in the teacher's experience of ADHD and learn from them. DEVELOP Develop a plan with the teacher to provide input, ideas and feedback on what you both realistically hope to commit to, and areas that may prove more challenging. Moving forwards, parents/carers should aim to: TALK Talk on a regular basis to discuss progress and areas of concern. RESPOND Respond to any concerns and work with the teacher to address any problems. OFFER Offer support and let the teacher know that they have an ally when working with your child. Introducing ADHD to teachers This discussion guide is to support teachers and parents/carers when meeting to introduce and discuss ADHD. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals Develop a good parent/teacher relationship Find out as much about the child as possible Agree a plan of action for management and care Actions Think about your own knowledge and experience (if any) of ADHD both inside and outside school Find out the latest research and thinking on ADHD - which websites have information on this? Investigate the experiences of other teachers and colleagues in working with children with ADHD - is there a local support network? Challenges Overcoming the negative views of colleagues and other parents about ADHD Working with parents to try to ensure that there is a strong joint case for getting the resources needed to support the child Questions How can the school work with the parents to ensure that there is a good case for getting resources to support the child? How does ADHD affect the child's day-to-day activities? What effect has ADHD had on the child's behaviour at school in the past? How has ADHD impacted on the child's learning in the past? What successful tactics have previously been used by other teachers? Does the child take medication? Discussion guide for parents: Preparing for the meeting Goals Develop a good relationship with the teacher(s) Ascertain the teacher"s experience of ADHD Determine the level of support that can be expected Actions Find out about the school's policy on children with ADHD - is this available on the school's website or the local/regional education authority's website? Investigate the school's experience of children with ADHD. Is it possible to speak to other parents who have children with ADHD? Tell your child's 'story' and give the teacher as much background as possible Think about information that will be relevant for the teacher, particularly on the child's previous experiences inside and outside the classroom Contact the local ADHD support network. Challenges Working with the school to develop a strong case for getting necessary resources and support for the child Overcoming negative beliefs from the school, teacher or other parents about ADHD. Questions What is the school's experience of working with children with ADHD? What is your experience of teaching ADHD children? How can you help my child to achieve a good education? Do you know where I can obtain the most recent information about ADHD? What is your understanding of how well the school is meeting education policy regarding children with ADHD? Which websites have information on this? Have you seen the school's policy on ADHD? Is it possible to speak to other parents who are in a similar situation? Do you know how other schools near you support their children with ADHD? Discussion guide for teachers and parents: During the meeting Goals To clarify what might work best for the child with ADHD, inside and outside the classroom at school To clarify other procedures for working with the child with ADHD, including the use of any prescribed medication. Challenges Overcoming any personal negative beliefs or bias regarding ADHD Considering the child with ADHD's specific needs in the classroom, including relationships with other children Considering the child with ADHD's additional needs, such as the use of medication. Questions How can the parents/carers support the teacher to help meet the needs of the child with ADHD in the classroom? How can feedback and information regarding the child from both parties be regularly communicated? How often should feedback take place? What kind of feedback will be most useful for the parents/carers and teacher? How can the parents/carers support the teacher in building a case for special resources for the child? Is there any other kind of support that the parents/carers can provide for the teacher? What should be said to other staff, children or parents about the ADHD child? Actions Agree on the potential effects of the child's ADHD inside and outside the classroom Formulate procedures for dealing with any medication prescribed for the child Establish which ADHD management techniques have worked for the parent/carer and can be transferred Examine any classroom management techniques the teacher will use to work to the child's strengths Agree what the teacher(s) will do, for example, confirming a plan for working with the child with ADHD Determine what the parents/carers will do, for example, passing on all relevant information to the teacher/school Instigate a timeline for these actions to be carried out and agree a plan for feedback on both sides Agree who will produce a summary of the meeting with action points. Post-meeting actions Monitor progress and continue to share positive feedback and challenges that arise Maintain a strong and consistent relationship between the parents/carers and teacher, in view of the limited amount of time the teacher may have Ensure feedback and information about the child with ADHD continues to be passed between the parents/carers and the teacher Make sure that the needs of the child with ADHD continue to be taken into account in the classroom alongside those of the rest of the class Ensure the relevant policies and procedures on children with ADHD continue to be carried out by the school and teacher. DIALOGUE ABOUT ADHD WITH OTHER PARENTS Parents of some children may react in different ways when they hear that their child is in a class with somebody who has ADHD. Some may be relatively unconcerned while others may have reservations about the effect that the child with ADHD might have on individual children and on the class as a whole. Given the stigma that can surround ADHD, it may be a good idea for the parents/carers of the child with ADHD and teachers to pre-empt the issues that other parents might raise. It may also help to think of some answers to common questions that other parents might ask. Q: What is ADHD? A: Attention Deficit Hyperactivity Disorder is a condition that affects the pathways in the brain that regulate attention and control impulsiveness The three key symptoms of ADHD are inattention, hyperactivity and impulsivity ADHD means that children do not react and respond to information in the same way as other children. They can also experience difficulties in group activities and relationships ADHD is not caused by poor parenting. ADHD is not a rare condition as 3 to 5 per cent of school-age children are affected In some countries, such as the UK, children with ADHD may be considered to have a disability. This recognises that their behaviour is not always intentional and that intervention and extra educational support is necessary in some cases. Q: How does it affect the child? A: Not all children with ADHD are the same and it can affect them in different ways Certain aspects of ADHD are more obvious than others, e.g. a child can be very inattentive and find it difficult to concentrate for long periods of time or be forgetful or impatient.
Q: What provision does the school make for your child and the other children? A: We have worked closely with teacher(s) from the start to ensure that my child's needs are met in conjunction with the other children in the classroom. A feedback system is in place to ensure that challenges are discussed as they occur and a way forward agreed. Q: How can I be reassured that your child won't be disruptive in the classroom? A: The teacher has worked with us to look at ways of minimising possible disruption, for example, placing our child in a particular position in the classroom. The teacher is aware of the potential for disruption by any child in the class and has a plan in place for dealing with it.
Q: How can I be reassured that your child won't take up too much of the teacher's time in the classroom? A: The teacher is aware that my child cannot dominate the classroom and has techniques to deal with this. If applicable there is special teaching support available. Addressing negative beliefs from other parents around ADHD All children with ADHD are disruptive and out-of-control Things to consider in your response: ADHD affects different children in different ways, at different
times. While some may be impulsive or hyperactive (e.g. saying inappropriate things or being constantly 'on the go'), others may
not be able to focus or concentrate. Children with ADHD take up too much of the teacher's time in the classroom Things to consider in your response: Teachers who have a child with ADHD in their class are aware of the child's needs and have strategies to prevent them taking up too much time. For example, they might allow the child with ADHD to take short breaks to enable them to release some of their energy. The teacher may also have support staff available to help. Teachers aim to create a supportive environment that benefits all children, including those with ADHD. ADHD is largely due to poor parenting Things to consider in your response: Many assumptions are made that the behaviour of a child with ADHD is linked to poor parenting. Medical evidence demonstrates that ADHD is a neurobehavioral disorder and the core symptoms are constantly with the child and are not due to ineffective parenting. However, poor parenting can make a child's ADHD symptoms worse and in some cases, the situation can be exacerbated by a parent also having ADHD. This can make it harder for them to have a consistent approach to the child. Many parents work closely with doctors and other specialists to improve parenting skills, and research suggests that family problems often improve following this support. A child with ADHD will be a bad influence on my child Things to consider in your response: Many children with or without ADHD can have behavioural problems that may result in classroom disruption and can mark them as a bad influence. If the child's ADHD symptoms lead to disruption in the classroom, parents can work closely with the child's teacher(s) on strategies to help minimise this. Parents can also encourage other parents who may have worries about the influence of the child with ADHD to discuss their concerns. All children with ADHD have to rely on medication to get them through the school day Things to consider in your response: Medication is used by some children who have ADHD but it is not required in every case. It is not used to 'control' behaviour but to improve the symptoms of ADHD. For example, it can help children to concentrate more effectively for longer in the classroom. The choice of whether to use medication or not is made by the child's doctor in conjunction with the parents/carers and is also influenced by reaction to the medication. All children with ADHD perform poorly at school Things to consider in your response: Children with ADHD are not necessarily low achievers at school, although many have associated learning difficulties. Children with ADHD can benefit from non-traditional learning styles and it is often a case of finding the right style in a particular subject. With the right support, a child with ADHD can go on to further study at college or university and a successful career. Discussing ADHD with other parents This discussion guide is to support teachers and parents/carers when meeting to discuss ADHD with other parents. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. A meeting to discuss ADHD with other parents may arise because: Some parents may feel that their own child is being disadvantaged or overlooked because of disruptive behaviour from a child with ADHD, or because the child takes up too much of the teacher's time Other parents may believe that befriending or sitting beside a child with ADHD may influence their own child in terms of behavioural problems. Discussion guide for teachers: Preparing for the meeting Goals Consider other parents point-of-view Reassure other parents about time taken for the ADHD child Give information about ADHD Consider the views of the parent with the ADHD child i.e. they are not a bad parent Actions Review key facts on ADHD in the context of children with additional educational needs, e.g. it is a condition that affects 3 to 5% of children Outline the school's policies on inclusivity, based on respecting all children - including those with ADHD - as individuals Consider perceptions of ADHD that the other parents might have Think about the realities of ADHD from your own perspective as a teacher Think about the impact that the child with ADHD has had in the classroom Revisit actions you have taken in the classroom to accommodate the child with ADHD. Challenges Understanding the concerns of the other parents Being sympathetic to both sets of parents Understanding the concerns of the child's parents about the views on ADHD held by the other parents Reassuring other parents about the influence of the child with ADHD on other children Questions What will be the biggest concerns held by the other parents? How can I explain the school's position on ADHD? Who else can support me within the school? How can I explain how I have worked with the child's parents to accommodate the child in the classroom? How can I reassure the other parents that the child with ADHD will not dominate the classroom? What reassurance will other parents look for in terms of the child's potential influence on their children? Discussion guide for parents: Preparing for the meeting Goals Address the concerns of parents of other children Encourage good relations between all parents Get the teacher to explain school policy on ADHD to
other parents. Actions Think about general questions you may have been asked before about your child's ADHD Consider the kind of concerns and potentially strong feelings that other parents might have Think about how you have previously helped people to better understand your child Explain that ADHD is a manageable condition. Challenges Seeing the other parent's point-of-view regarding ADHD Understanding the concerns of other parents Helping the other parents to have a better understanding of ADHD Remaining calm to best support your child as their main
advocate. Questions What can I do to change any long-held views that ADHD is caused by poor parenting? Are there any specific examples that can be used? What can I do to ensure that other parents have a more positive view of ADHD? How can I reassure other parents that my child will not be a disruptive influence? How can I reassure other parents that we are working closely with the teacher(s) to ensure that my child does not take up too much of their time? How can I change any long-held views about children with ADHD taking medication? Discussion guide for teachers and parents: During the meeting Goals To understand the views of other parents on ADHD To give other parents perspective on the realities of ADHD and how it affects the child Explain ADHD to other parents. Challenges Ensuring that the points-of-view of both the parents of the child with ADHD and the other parents are heard Ensuring that they remain unbiased in the discussion and focus on facts rather than fiction Ensuring that they explain the school's position regarding children who have ADHD or simply the potential for discrimination. Questions How can the views of other parents about ADHD be changed if they are negative? What are the main concerns, feelings, beliefs and attitudes of other parents? What information or practical support can be provided to help other parents understand more about ADHD? Could a healthcare professional give an educational talk at the school on mental health in general? Are the other parents passing on their views about ADHD to their children? Can the parents/carers or teacher(s) do anything else to reassure the other parents regarding the child with ADHD? Can the parents get any ideas for further help on dealing with other parents from their local ADHD support group? Actions Give information on what ADHD is and how it affects children differently Explain how ADHD specifically affects the child in the classroom Give assurance about how the teacher takes steps to look after the needs of the child with ADHD and minimises disruption for other children in the classroom Outline what other behavioural management techniques will be used. Agree that the child's parents will recommend or pass on any useful information on ADHD to the other parents if they are interested in finding out more Agree that the parents will help to address any future concerns on an ongoing basis and support positive communication. Post-meeting actions Ensure that all relevant information is passed on within agreed timelines Encouraging other parents to continue to be tolerant and think more positively in terms of children with ADHD Maintaining contact between the parents of the child with ADHD and the parents of other children Consider bringing together the parents of all children with special educational needs to build greater understanding, support and communication between them and the school. RAISING AWARENESS WITH OTHER CHILDREN IN THE CLASSROOM Raising awareness of a child's ADHD with other children in the classroom is potentially difficult for a teacher and requires careful planning and management. The teacher needs to ensure that: Underlying messages are consistent with the school's policies on inclusion, diversity and confidentiality regarding a child's medical condition, including policies on discussing the child's ADHD in the classroom Clear and simple information about ADHD is given, which is appropriate to the age of the children - if a child with ADHD wants to be involved, a section could be covered around 'what it feels like to be me' Information is presented to the other children in a way that is sympathetic Communication counters rather than reinforces stigma The child is not made to feel 'different' as a result of 'raising awareness' Learning reinforces the beliefs and values of the school community, e.g. mutual respect, recognising that everyone is different. Tips for teachers in raising awareness with other children in the classroom Approach the topic of ADHD in the wider context of behaviour, learning and inclusion with the key message that everybody is welcome at the school. A series of discussions may be appropriate dealing with topics such as social skills, bullying, ADHD, learning difficulties and disability. If appropriate for the age of the children, refer to or use materials such as the Percy Jackson books or the Medikidz book on ADHD Inclusion can be handled in different ways, depending on the age of the children. For example: Inclusion and ADHD could form an element of personal, social, health and economic education. The topics can be: Included within the planned curriculum Covered in specific lessons with dedicated curriculum time Part of a whole school activity, such as morning assembly Specific projects. It could also be a topic in a 'circle time' meeting. This type of meeting involves a mixture of children, teachers, support
staff and parents in discussions on interpersonal and organisational issues, with the children sitting round in a circle. Activities and games are encouraged alongside the development of speaking and listening skills. The meetings are not held to discuss academic or curriculum issues and so ADHD could fit well into this type of format. Contact your local ADHD support group. They may be able to put you in touch with other teachers who have experience of raising awareness of ADHD with other children. Focus on the more positive aspects of ADHD, as well as the three key symptoms. For example, highlight the creativity that a child with ADHD can bring to their schoolwork. TALK ABOUT ADHD This chapter gives both parents and teachers some insight into how best to talk about ADHD and address both symptoms and effects. There are sections on symptoms, development and progression into later life. What is ADHD? This checklist provides key information on ADHD that can help you talk about it with other people. ADHD Stands for Attention Deficit Hyperactivity Disorder Has three sub-types: primarily inattentive, primarily hyperactive and a combination of inattention, hyperactivity and impulsiveness Is a condition that affects the brain Has specific causes, which are not fully understood Evidence suggests it may be hereditary Is related to the way in which the front part of the brain works, which means that a child with ADHD may not react and respond to information as expected Makes it difficult for children to control their behaviour Has three key features: inattention, hyperactivity and impulsivity Has other features which can include lack of motivation, frustration, poor self-esteem and sleep disturbance Can be diagnosed through a comprehensive assessment and evaluation at home and school by a healthcare professional such as a psychiatrist Can be treated via different methods including behaviour management/parental training and medication Can co-exist with other conditions including specific and generalised learning difficulties, Oppositional Defiant Disorder (ODD) and Autistic Spectrum Disorder, although over a third of those with ADHD have no other condition. Who can be affected by ADHD? How many school-age children are affected? Between 3 and 5%. Is it more common in boys or in girls? It is more easily identified in hyperactive children, usually boys, although it may also occur in daydreamers, often girls, who can be overlooked but still have ADHD symptoms. How many more boys than girls are affected? About five times more boys than girls are diagnosed with ADHD. This may be a result of the ways in which boys express their attention problems, as they are more likely to be overactive and difficult to manage. When can the symptoms first be seen in children? The symptoms can be present in pre-school children and
are usually seen in children before the age of seven, with
an average diagnosis age of 8 years old. Can ADHD continue into adolescence? Approximately two out of five children will continue to experience symptoms at the age of 18. Can ADHD continue into adulthood? It is recognised that ADHD can continue into adulthood. ADHD is often a life long condition, with adults who lack
the support systems available to children often having
severe symptoms. What are the effects of ADHD as a child grows up? Some of the key effects of ADHD symptoms can change significantly as the child grows up, with a corresponding effect on development and response to life as an adolescent and an adult. How hyperactive impulsive symptoms can change How inattentive symptoms can change Developmental impact of ADHD How can ADHD affect behaviour? In many countries, ADHD is diagnosed only by healthcare professionals - usually a clinical psychologist, child psychiatrist
or behavioural paediatrician. Diagnosis is a lengthy process that includes a number of symptoms being observed at home and school for at least six months. The criteria for diagnosing ADHD are from the Diagnostic and Statistics Manual of the American Psychiatric Association, 1994 (known as DSM IV) and are based on the symptoms of boys aged 6 to 12 years. An alternative set of diagnosis criteria for ADHD is the WHO ICD-10 classification of mental and behavioural disorders, which came into use in 1994. It is important for healthcare professionals to be able to interpret these symptoms in relation to different groups such as girls and adolescents. The following table lists some of the ways in which the three key features of ADHD - inattention, hyperactivity and impulsivity - can affect a child's behaviour at home and at school and also tactics for handling the behaviour. KEY FEATURE EFFECT ON
BEHAVIOUR TACTICS FOR HANDLING BEHAVIOUR THAT CAN BE APPLIED AT HOME AND/OR SCHOOL Inattention Does not pay attention to detail or makes careless mistakes Is easily distracted Does not seem to pay attention when spoken to directly Does not follow instructions through and fails to finish tasks Implement a reward system for good behaviour, e.g. bringing the correct books home to complete homework. Implement systems such as colour-coding to help the child e.g. understand and successfully manage the school timetable. KEY FEATURE EFFECT ON
BEHAVIOUR TACTICS FOR HANDLING BEHAVIOUR THAT CAN BE APPLIED AT HOME AND/OR SCHOOL Inattention Has difficulty organising tasks Is forgetful in daily activities Avoids, dislikes or is reluctant to get involved with tasks that require sustained mental effort e.g. homework. Is often forgetful and loses things. Use tactics that help to maintain the child's attention e.g. holding eye contact when speaking to him/her. Remove all distractions from an area in which the child is trying to concentrate. KEY FEATURE EFFECT ON
BEHAVIOUR TACTICS FOR HANDLING BEHAVIOUR THAT CAN BE APPLIED AT HOME AND/OR SCHOOL Hyperactivity Often fidgets with hands
or feet Often runs or climbs about in inappropriate situations Often talks excessively Has difficulty in engaging in activities quietly. Implement a reward system for good behaviour e.g. sitting still for a period of time. Engage the child if possible in activities that provide focus e.g. extra-curricular activities such as martial arts. Break up larger tasks into smaller chunks to provide short breaks that can offer an opportunity for the child to let off steam and can assist concentration. KEY FEATURE EFFECT ON
BEHAVIOUR TACTICS FOR HANDLING BEHAVIOUR THAT CAN BE APPLIED AT HOME AND/OR SCHOOL Impulsivity Can give answers before questions have been completed Has difficulty in waiting for
their turn Can interrupt or intrude
on others. Aim to minimise or avoid periods of time when the child has to wait If waiting has to take place, engage the child with an activity if possible, such as drawing Implement a reward system that recognises when the child has not interrupted or has waited their turn. Treatment and management options for ADHD ADHD treatment and management involves a multi-model approach with three important components. They are: Behaviour management/parent training, usually the first treatment option to be considered Medication Combination of behavioural management/parent training and medication. Other treatment options, such as counselling, psychotherapy and family therapy, may be considered by the child's healthcare specialists if the child has particular worries, depression or anxieties, or if the child's family is experiencing significant difficulties, for example with siblings. A counsellor can help the ADHD child to talk about their behaviour and its consequences and allow them to gain more self control by organising themselves in a more focused way. A child psychotherapist can provide help for ADHD children helping them to address their own distress in a long-term way as well as helping them relate to their family environment. Some children with ADHD may also experience difficulties in managing social relationships and may benefit from social skills training. This can help them to understand the impact their behaviour has on others so that they can change it. Cognitive Behavioural Therapy (CBT) can also be considered if the child has specific behavioural problems. Behaviour management/parent training Behaviour management focuses on consistency, clear communication, explicit rules and a positive, nurturing approach. It can encourage parents to notice when a child is being good and to reward them, as well as learning to handle more challenging behaviour. The techniques take time and patience to adopt but are extremely effective, with parents often finding they have as much to learn as their children. Educational psychologists are often the best people to advise parents on a behaviour management programme. Parent training can help parents to identify what they want to achieve in their relationship with the child and is often the first-line treatment before alternative treatments are considered. It can use role-play and involve homework between sessions, so that the parents can apply what they have learned to the situation at home. Medication There is evidence that for many children medication can be effective and well tolerated. Opinions differ about using medication to treat children with ADHD and it is a highly controversial area, with concerns including over-prescribing Healthcare professionals should consider the merits of medication in each child's case, based on comprehensive assessment and diagnosis, prior to prescribing While newer types of medication are being developed all the time to try to maximise positive responses and minimise any side-effects, there are two key types of medication that can be prescribed, both of which can be either short- or long-acting: Stimulants - act on the central nervous system. Short-acting stimulants usually last for about three to five hours at a time and there can be a rebound effect when they wear off, with the problem behaviour returning. In these cases the medication may be administered more than once a day and almost certainly by a teacher during school hours. Stimulants have potential side-effects, particularly at the beginning of treatment and healthcare professionals need to calculate the right dose of the medication and monitor its effects. Long-acting stimulants are also available and can last for up to
12 hours so that dosing might only be necessary once
during the day. Non-stimulants - the effects usually last longer than those of stimulants. They act differently and may need to be taken only once a day. Antidepressants are an alternative to stimulants or non-stimulants, but are rarely used and there are very few types licensed or indeed suitable for children. RECOGNISE ADHD SYMPTOMS
AND DIAGNOSIS This chapter gives advice to both parent/carers and teachers on the symptoms of ADHD and how to recognise them in a child. There are sections on ADHD and also on a number of related conditions. Why is it important to know the symptoms of ADHD? ADHD symptoms can often be mistaken for other conditions. Assessment and diagnosis can take a long time to rule out other conditions and it is important to recognise common ADHD symptoms. Parents/carers and teachers generally monitor and record the displayed symptoms over a period of time, both at home and at school. This can then assist with the diagnosis of ADHD by a healthcare professional. The diagnosis can take time and it may be necessary for the school to offer the full support stated in its policies during this period. What are the symptoms of ADHD? ADHD symptoms fall into three categories. Inattentiveness Short attention span Easily distracted Careless mistakes Forgetful Unable to stick at tasks Unable to listen Unable to carry out instructions Unable to concentrate Constantly switch from one activity to another Difficulty organising themselves. Hyperactivity Fidget and are unable to sit still Unable to settle down to completing tasks Move around excessively Talk excessively. Impulsiveness Unable to wait their turn Act without thinking Interrupt conversations Break set rules Little sense of danger. While it is normal for children to behave in one or more of these ways from time to time, a child with ADHD will display many of these symptoms, consistently over a long period. No child is the same and some symptoms are more obvious than others. Attention Deficit Disorder (ADD) If a child has symptoms of inattentiveness but not hyperactivity or impulsiveness, then they may have Attention Deficit Disorder (ADD). The diagnosis of ADD can be particularly hard because the child can often be quiet and dreamy, rather than disruptive. ADHD and other related conditions Children with ADHD may also have other related conditions that can affect their lives and this can make diagnosis and treatment more difficult. Up to half of all children with ADHD may also display a related condition and a third may have two conditions or more. Some examples are given in the table below. Condition Symptoms Anxiety disorder Up to a quarter of children with ADHD may also have an anxiety disorder. This can have a huge impact on, for example, their relationships and normal day to day functioning.
The anxiety may result in symptoms such as a rapid heartbeat, sweating and dizziness. Condition Symptoms Oppositional Defiant Disorder (ODD) Around one third of children with ADHD have ODD as well. These are often stubborn, non-compliant, have temper issues, argue and refuse to behave. ODD should be addressed early as failure to do so can lead to serious problems later. Conduct disorder Between 20 and 40% of children with ADHD also develop conduct disorder. This can include harming other people or animals, stealing, fighting and vandalism. If they are not given professional help and support, such children can run a high risk of falling into crime and alcohol/drug abuse.
While ADHD is a risk factor for developing conduct disorder, having conduct disorder does not increase the risk of developing ADHD. Condition Symptoms Depression Children with ADHD can sometimes develop depression.
A range of symptoms can result including low mood, tearfulness, a loss of interest in surroundings and social isolation. Depression is a mood state in which the child is generally sad or irritable for most of the day over a sustained period of time, representing a change in their normal mood. Symptoms include changes in appetite, sleeping and energy levels, a worsening of attention problems and a lack of involvement in usual pleasurable activities. If depression is suspected it is important to obtain an opinion from a healthcare professional. Behavioural problems, particularly in boys, can mask depressive symptoms which if untreated, can lead to an increased
risk of deliberate self-harm. Condition Symptoms Learning disabilities A third of children with ADHD also have general learning disabilities or specific learning disabilities, such as dyslexia.
Children with learning disabilities may experience reading, spelling, writing and arithmetic disorders. They often need increased concentration to learn how to compensate for their learning disability, something which can be very difficult. Sleep problems Children with ADHD can develop insomnia due to hyperactivity and may experience irregular sleeping patterns. Tourette's syndrome Tourette's syndrome is a nervous system condition characterised by involuntary and repeated movements (motor tics) and sounds (vocal tics). The tics may be suppressed before they happen and often start around the head or face. Vocal tics often develop after the motor tics. In general tics become less frequent or impairing as the child gets older and for many people, they stop at adolescence. Condition Symptoms Epilepsy Epilepsy is a brain condition characterised by seizures (fits). There are around 40 different types of seizures and their effects depend on which areas of the brain are affected.
Epilepsy has an incidence of 0.02 - 0.07 per cent. Around 20 per cent of children with epilepsy have clinical ADHD. Conversely, children with ADHD have a two and a half times higher risk of developing epilepsy than the general population. The assessment and diagnosis process Assessment Assessing a child's behaviour over a set period is the first step to a full diagnosis of ADHD. Assessment procedures can vary greatly. Most children are overactive, fidget or find it difficult to pay attention from time to time. This does not necessarily mean that they have ADHD and most will integrate well into school life making friends and enjoying their education. ADHD may go unnoticed until there are problems at school. A teacher can sometimes be the first person to recognise that a child is hyperactive, inattentive or impulsive in class. Teachers are experienced in understanding how a child should behave in situations requiring concentration and self-control, and if there are continued symptoms of ADHD, they may contact the parents/carers to discuss their observations. Diagnosis There is no quick and simple test to confirm ADHD and the process varies. If parents/carers suspect ADHD, they should arrange to see their doctor. The following pathway is an example and is based on UK procedure but breaks the process down clearly into stages. In other countries, parents/carers should seek a diagnosis based on the opinions of both medical and non-medical professionals. The specialist will ask: What symptoms the child has When the symptoms started Where they occur e.g. at home, at school or both home and school. They may ask for a questionnaire to be completed by the child's teacher to get a full insight into the child's behaviour at school How the symptoms affect the child's quality of life e.g. their ability to make and keep friends If the child has experienced any significant recent changes e.g. a divorce in the family If there is any family history of ADHD or other mental health conditions If the child has any other health problems. The doctor may recommend that parents/carers observe and note behaviour patterns for up to 10 weeks. This is to determine whether a modified method of behaviour management can improve their symptoms. Parents/carers may be offered training or an education programme to learn techniques so that they can manage behaviour more effectively. If the healthcare professional suspects that a child has ADHD, they may refer them to a specialist who can make an official definitive diagnosis. One or more of the following people could be involved (there are descriptions of each of these later in this chapter) and this will vary: Child psychiatrist Child psychologist Paediatrician Psychiatric social worker Educational psychologist. There are three stages involved in the diagnosis of ADHD by a specialist. Stage 1: KEY SIGNS Underperformance at school, despite average intelligence and no major learning disabilities. Symptoms of hyperactivity, impulsivity and inattentiveness are considerably worse than would be expected for their age. Stage 2: EXCLUDE OTHER CONDITIONS Autism Epilepsy Depression Hearing impairment Intellectual disability Significant attachment difficulties. Stage 3: TESTS AND CRITERIA The child can undertake tests and questionnaires to assess attention and behaviour and assist in the correct diagnosis. Parents and teachers may also complete questionnaires to get a more accurate picture of the child's behaviour. An ADHD assessment generally occurs at a young age. If ADHD is being considered for the first time in an older child, it is important to ascertain their views and ask them to complete the questionnaires. The official list of criteria for diagnosing ADHD is from the Diagnostic and Statistics Manual of the American Psychiatric Association, 1994 (known as DSM IV) or alternatively the WHO International classification of disease ICD-10 for mental and behavioural disorders. The key criteria are a display of either inattention or hyperactivity-impulsivity (or both) and symptoms must have been present for at least six months. Usually at least six symptoms are seen under one or both categories. Inattention Fails to pay close attention to detail or makes careless errors in schoolwork or other activities Has trouble keeping attention on tasks or play Doesn't appear to listen Doesn't follow through on instructions or complete tasks or schoolwork Has trouble organising tasks Dislikes or avoids tasks requiring sustained mental effort Loses materials needed for activities Easily distracted by irrelevant information Forgetful. Hyperactivity and impulsivity Hyperactivity: Fidgets or squirms when sitting down Leaves seat inappropriately Runs or climbs about inappropriately Has trouble quietly engaging in activities Appears driven Talks excessively. Impulsivity: Answers questions before they have been fully asked Has trouble waiting their turn Interrupts others Has difficulty in motivation for routine tasks Has difficulty in managing their time. The symptoms must also: Have started before the age of seven Be present in two places, such as at school and in the home Negatively affect day-to-day life Not occur solely due to a psychotic disorder Not be a result of other conditions. The role of different professionals in the assessment and
diagnosis process A number of healthcare professionals can be involved in the assessment and diagnosis process of ADHD, although the specific names and roles vary, these may include, psychiatrists, social workers and educational psychologists. Some doctors and specialists question whether ADHD exists. If this is the case, contact your local ADHD support group who can provide advice and may be able to give you details of healthcare professionals who are more understanding of ADHD. Doctors: The family doctor is a good place to start if parents/carers think that their child might have ADHD. The doctor can assess basic symptoms and if they suspect that the child may have ADHD, they can refer them to an appropriate specialist. Child psychiatrist: Psychiatrists (and paediatricians) are the only healthcare professionals that can prescribe medication for ADHD. A psychiatric diagnosis of ADHD is usually made on the basis of information gathered from interviews with child and parents/carers, as well as information from the school. Child psychiatrists are experienced in diagnosing ADHD and can also identify and treat some of the other physical and mental health problems that can accompany ADHD. Clinical psychologist: A clinical psychologist is a mental health professional who can confirm the symptoms of ADHD and in certain countries may make a full diagnosis. Psychologists can also help a child with some of the other related conditions of ADHD that may be present, such as depression and low self-esteem. They are not able to prescribe medication. Paediatrician: Paediatricians often diagnose and treat children with ADHD. Developmental paediatricians can also be part of the referral process as they specialise in problems associated with development, including behavioural problems. Meeting to discuss the symptoms of a child who potentially
has ADHD This discussion guide is to support parents/carers or teachers when meeting to discuss the possible symptoms for ADHD. It can also help teachers to approach parents/carers regarding a child's behaviour. Each sub-guide can either be printed and written on or completed electronically. Parents/carers may wish to share the guides with teachers in advance of the meeting. Discussion guide for teachers: Preparing for the meeting Goals Mention all concerns about behaviour Give as much support as possible Supply as much information about ADHD as possible Give an overview of support available from the school Actions Give an account of your observations of the child's behaviour in and out of the classroom Mention any issues that have arisen with the child's completion of homework Provide your observations of the child's interaction with other children State why you feel these issues are problematic List positive characteristics and experiences of the child Be supportive and sympathetic to the parent/carer and child Challenges Assimilating the parents'/carers' reaction to your findings Reassuring the parents/carers that you have enough experience to spot potential symptoms Suggest further investigation by a healthcare professional Reassuring the parents/carers that you will do all you can to support their child. Questions Have the parents/carers noticed anything about the child that is similar to your observations? Have the parents/carers considered that the child may have ADHD? How is the child's general behaviour at home? Is the child inattentive at home? Is the child unable to sit still for any length of time at home? Does the child often interrupt at home? How is the child's behaviour towards other family members? Is there any family history of ADHD? Discussion guide for parents: Preparing for the meeting Goals Clarify the reasons for the meeting Share observations about your child's behaviour Obtain an account of your child's behaviour at school Actions Give an account of changes in your child's behaviour that you
have noticed Review problems that your child has experienced with homework Share feedback your child has given you regarding their time at school Give information on any behavioural issues your child may have had with family members Share information on positive experiences your child has had at school List specific observations you have made regarding the attention, impulsivity and hyperactivity that your child has displayed at home and in other situations. Challenges Hearing the teacher's feedback about your child's behaviour Acknowledging that your child may possibly have a psychiatric disorder Addressing any perceptions you may have of ADHD and medicating children. Questions How much experience does the teacher/school have in spotting symptoms of children with potential ADHD? Does the teacher have experience in working with children who have been diagnosed with ADHD? Can I have more detail on the school's policy on ADHD? What role can the teacher play in helping to provide relevant information and monitor the child's progress? Will the teacher provide written feedback on the child's potential symptoms to pass onto a healthcare professional? Can the teacher continue to provide feedback on the child's behaviour inside and outside the classroom? Discussion guide for teachers and parents: During the meeting Goals Share information on behaviour at home and school to enable a consistent approach to management. Challenges Overcoming negative perceptions of ADHD Overcoming any negative thoughts regarding the child's behaviour in the classroom Reassuring the parents/carers that the school will do everything it can to help support the child. Questions How can we best share information? How can we work together to help meet the needs of the child in and out of the classroom? How often should feedback take place? Is there any other kind of support that the parents/carers can offer the teacher? How much information about the child's difficulties will be shared with other children or parents? Actions Set a timeline for further feedback between the parents/carers and the teacher on the child's behaviour Agree that the parents/carers will make an appointment with the family doctor if the feedback continues to be similar at both home and school Invoke extra support for the child in the classroom before the diagnosis is confirmed Produce a summary of the meeting with action points. Post-meeting actions Produce a summary of the action points and timelines Ensure that all relevant information is shared Agree when and where the next meeting will take place Set up a method of communication such as texts or phone calls Report all developments before the next meeting Maintain a strong and consistent relationship between the parents/carers and teacher Ensure that the needs of the child are met inside and outside the classroom. UNDERSTAND THE IMPACT OF ADHD
ON A CHILD This chapter provides an insight into what problems can occur in families with a child with ADHD. There are sections on understanding the condition from the child's point-of-view and how ADHD impacts on their relationships on different levels. Discussing the impact of ADHD The understanding of ADHD can be a difficult and painstaking process for both children and their parents. One of the best ways for a parent/carer to understand their child's concerns is to talk with them and improve their relationship. This process could be aided by suggestions from teachers or advice from healthcare professionals. In talking with your child there could be a number of areas to explore to help you understand what ADHD means. Understanding what ADHD can mean for you To understand what ADHD can mean, you may have to consider how the home and school environment can seem full of challenges for the child. In each area there are many things to think about, including: Relationships with: Parents/carers Brothers/sisters Friends Teachers School work and homework Carrying out day-to-day activities at home, including play and chores. The parent/carer can help the child relate to their environment by making all of the perceived big challenges a bit less daunting. Tasks can be broken down into smaller goals, homework can be carried out in stages and support can be provided at all times. In facing the challenges posed by ADHD, there are a number of tools to make the child believe they are not facing these challenges on their own and that there are other children with ADHD. One of these is the Medikidz cartoon book on ADHD that could help you and the child to understand more about how others live with their ADHD. What ADHD means for a child at school ADHD can affect a child in many aspects of life at school that other children may take for granted. Some of the key issues are outlined in the following table, together with suggested solutions. Challenges What this can mean for a child with ADHD Suggested solutions Maintaining attention Maintaining attention at school can be one of the most difficult tasks for a child with ADHD, as there are so many distractions. If a child with ADHD finds something interesting, they can focus more easily. For example, you can help to keep the child's attention by: Adding variety Breaking learning down into manageable sessions Creating a stimulating environment. Challenges What this can mean for a child with ADHD Suggested solutions Sitting still Sitting still is another task that can prove extremely difficult for a child with ADHD. Try to allow freedom to move occasionally in the classroom. This may mean the child taking small breaks or having silent fidget toys - please note this could be disruptive in some situations. Understanding instructions A child with ADHD can often misunderstand written or verbal instructions. Provide instructions in both written and verbal forms. It can also help if instructions are broken down into single steps. Check to see that the child has understood. Challenges What this can mean for a child with ADHD Suggested solutions Being organised Being organised can be extremely difficult for a child with ADHD. They may struggle: To keep track of their personal possessions To remember schoolwork and tasks To maintain order in their work. Create a management plan for the individual child. Getting started on tasks Starting an activity or task can be difficult for a child with ADHD. Try to provide the child
with simple and specific motivation for doing the activity. Show them how to get over issues preventing them from getting started.
Help them break the task down into manageable chunks. Giving a small signal for the child to start can also help. Challenges What this can mean for a child with ADHD Suggested solutions Changing activities When a child with ADHD has started a task or activity, it can be difficult to get them to change to something new. Prepare the child for the change by: Telling them what is coming next Reminding them of the change until it happens When the change happens, redirect them to a new activity. Challenges What this can mean for a child with ADHD Suggested solutions Completing homework Completing homework successfully requires a number of skills which could pose problems including: Forgetting tasks Getting distracted while doing homework Misunderstanding homework Forgetting to hand homework in on time. Help the child to look at ways of managing and completing their homework. For example breaking a homework session up into achievable chunks, coupled with breaks/distractions at regular intervals Help the child to develop a regular time and place in which to do the homework. If the child is taking medication, consider the timing of the homework in relation to the medication. Challenges What this can mean for a child with ADHD Suggested solutions Understanding boundaries Children with ADHD often invade the space of other children, sometimes taking their things and generally annoying them. Help the child to realise the impact that their behaviour has on people, and on making and maintaining friendships. Making and keeping friends Children with ADHD can struggle to make and keep friends as they are often unable to recognise how other people feel. Some are socially isolated, while others make friendships which do not last, because the friends become intolerant of the child's behaviour. Help the child to look at ways of overcoming barriers to friendships. Challenges What this can mean for a child with ADHD Suggested solutions Dealing with break times Most children enjoy breaks from the classroom but they can present problems for a child with ADHD, including: The noisy and busy environment causing frustration and aggression The opportunity for other children to taunt them The opportunity to get into trouble because of lack of supervision and structure Difficulties getting back to work in the classroom after break time. Try to structure break times, with adequate supervision and activities where possible to reduce disruption. What ADHD means for a child at home The type of problems experienced at school may also be seen at home. Typically, some of these are: Difficulty with tasks that require planning and organisation. A child with ADHD may have difficulty with organising and completing tasks, and time management. If a child is taking medication, this may affect their ability to plan and manage tasks at certain times. Having trouble getting started. A child with ADHD may need help in starting a task. However, once started further help or guidance may not be needed. Struggling with repetitive tasks. Repetitive day-to-day tasks can prove difficult for children with ADHD. Difficulty following rules. A child with ADHD may have difficulty in learning how to comply with rules due to distractions or a lack of attention. Questioning authority. A child with ADHD can often question the parent or carer's authority. Relationship difficulties. Having to constantly correct or give instructions to a child with ADHD, can lead to negative feedback for the child and may lead to poor relationships. The child may not be the only person at home who has ADHD. ADHD runs in families and part of the diagnosis process may be to look at the child's family to see if anybody else exhibits symptoms. The risk of a sibling also being affected by ADHD is over 30% and it is also likely to be present in a parent. The majority of parents with ADHD symptoms may not have been diagnosed or treated. Where one parent has these symptoms, it is important to work together to be consistent with the child, for example, rewarding good behaviour and expected behaviour. If one parent has ADHD, they may have difficulty in being consistent with the child as their parenting skills will be affected by their own ADHD. What ADHD means for a child's relationship with their parents A child with ADHD can cause divisions between parents, as disagreements arise about how to deal with problems. Children with ADHD can also be manipulative and play one parent against the other. These divisions can lead to issues with the parents' relationship. The opportunity for creating divisions between parents can be reduced by making decisions together, and letting the child know that all decisions require both parents' agreement. Example situations involving the child where divisions could occur include: Using other people's things without asking Not doing chores at regular times Being disorganised over homework. An effective management plan helps to build harmony at home, as well as using consistent methods to handle difficult situations such as angry outbursts. What ADHD means for a child's relationship with brothers and sisters Sibling rivalry can often intensify in homes where a child with ADHD has brothers or sisters without the condition. It can result in: Envy. The child with ADHD becoming envious of the opportunities and success at school achieved by siblings. Equally, the siblings can envy the freedom that the child with ADHD is allowed and additional parental attention. Resentment. Brothers and sisters may feel resentment because the child with ADHD is treated differently, and that their parents have little time for them. Equally, the child with ADHD can resent siblings who are allowed to do things that they are not. Poor self-esteem. The child with ADHD may suffer from poor self-esteem, particularly in comparison with their brothers and sisters. Low self-esteem can also affect the sibling if they experience the stigma associated with their brother or sister Anger. The differences, whether perceived or real, felt by the child with ADHD in comparison with brothers and sisters may lead to angry outbursts that can be highly disruptive Attention seeking. Siblings may see the attention given to the child with ADHD, so they may copy the ADHD behaviours to get their parents' time and attention. Coping with sibling rivalry is a day-to-day reality for parents where one of the children has ADHD. Some ideas for preventing difficult situations include: Treat each child according to their abilities. Aim to be fair to each child, regardless of additional needs. Offer each child the same opportunities. Try to offer the same thing to each child. For example, the child with ADHD may be offered certain freedom that the brother or sister is offered because they are more responsible. Spend time alone with each child. Aim to spend some one-to-one time with each of your children on a regular basis. This will help prevent resentment. What ADHD means for a child in terms of friendships Making and keeping friends is a part of the school experience for most children but for a child with ADHD, it can prove difficult and often unsuccessful. Some children with ADHD become socially isolated, following initial popularity with other children their appeal can wear off to be replaced by irritation and annoyance at their behaviour. Problems that affect friendships include: The inability to pay attention to the needs of others The inability to pick up on the feelings of others Poor social skills in terms of meeting and getting along with others The ability to be more 'in tune' with children who are either older or younger than they are, rather than their peer group Difficulty in understanding boundaries Being self-centred Dominating others through bullying or being bossy Finding it difficult to work with others in team sports Being commanding and trying to dominate attention Invading the personal space of others Interrupting conversations Being unable to follow a conversation Dominating a conversation The inability to understand why others are upset with them Misinterpreting others. Although it may seem that there are considerable barriers for the child to overcome, many of these problems can be improved on to promote more positive relationships with friends. ADDRESS ADHD STIGMA This chapter examines the stigma of ADHD and how this can be felt by the child and also members of the family. Suggestions are made about how to address stigma and reduce its effects. Why stigma can exist ADHD is a condition, which garners strong views and opinions from people. Many views are negative and can often lead to mistaken assumptions about children with ADHD and their parents/carers. The stigma around ADHD can potentially be very damaging to the child and can impact strongly on the parents/carers in their relationships with teachers and other parents. Stigma can exist for a number of reasons: COMPLEXITY ADHD is a complex condition involving a range of symptoms and lengthy diagnosis. CAUSES The reasons why a child develops ADHD are not simple to understand. ADHD has a biological basis, but the causes are also the subject of intense scientific debate with some healthcare professionals questioning whether it exists at all. SYMPTOMS The three key symptoms of ADHD are inattentiveness, hyperactivity and impulsiveness, all of which are seen as undesirable characteristics. BEHAVIOUR Children with ADHD are often thought of as being disruptive, out-of-control and difficult to deal with, particularly at school. RELATIONSHIPS Children with ADHD often experience difficulty in relationships with family, teachers and other children. Their innate inability to understand how people feel is one of the main reasons why relationships can be much harder to sustain. POOR PARENTING Parents experiencing any kind of sustained behavioural problems with their children, are thought of by some as having poor parenting skills and being unable to cope with their children. AT SCHOOL Because of the key symptoms of ADHD and the associated behaviour, children with ADHD can be perceived as being a disruptive influence both inside and outside the classroom. They can also be thought of as being difficult and unrewarding to teach, as well as an unwelcome influence. PSYCHIATRIC INVOLVEMENT Diagnosis can involve psychiatrists and psychologists and for some the involvement of mental health specialists leads to a wider stigma that exists about mental health issues in general. MEDICATION Using medication to manage ADHD is frequently perceived negatively. Some of the key reasons are due to mistaken beliefs that: Medication is used to 'control' the child Medication is carrying out what the parents or carers are
unable to do i.e. make the child easier to deal with It is wrong to give medication to young children that: They might become dependent or addicted Could involve negative side-effects Might sedate them. RELATED CONDITIONS Children with ADHD may have other conditions which are also viewed negatively by some. Examples include epilepsy and anxiety disorder. CONFUSION ADHD may be confused with other mental health issues that are viewed negatively by some people. Examples include depression, learning difficulties and oppositional defiant disorder. WEAKNESSES, NOT STRENGTHS The less positive aspects of ADHD are remembered, rather than the more positive characteristics such as creativity and adaptability. LACK OF ROLE MODELS Unlike other medical conditions, there are few public figures with ADHD who could act as role models for children to look up to. Why ADHD stigma matters
'Vicious Circle' ADHD stigma matters because it can have a long-lasting effect on
self-esteem and ongoing relationships. Anticipation: The child, siblings and/or parents/carers can anticipate stigma. This can lead to: A low expectation of the child from the parents/carers Avoidance of situations that involve criticism or opposition. Experiences: The child, siblings and/or parents/carers may experience stigma in situations including: Bullying Being shunned in the street or playground Not being included in activities. The stigma associated with ADHD could cause the child, siblings and parents/carers to avoid situations where they might experience negativity. It is important to break free of this cycle and counteract negative stigma. How parents/carers and teachers can counteract stigma
about ADHD Stigma around ADHD arises from misinformation about the condition. As a parent/carer or teacher, it can sometimes be a battle to change the views of others about ADHD. This is because some ideas are long-held or because the other person will not consider a new perspective. The following tips can help tackle stigma. Parents/carers: Contact your local ADHD support group to meet other parents and share ideas about what can help Be clear and open with other people/parents, about ADHD. By raising the subject first, it might be possible to address some of their concerns Work closely with teachers, particularly if a move to a new school is underway Give the child ideas on how to discuss ADHD with other children Teachers: Work closely with parents/carers to understand more about the implications of their child's ADHD If the child is new to you, find out what may have worked in the past. Use this as the basis for making decisions in the classroom which help the child Find out more about your local/regional education authority's policies on ADHD and discrimination.
How a child with ADHD can counteract stigma As a child with ADHD can face stigma inside or outside school, it is important to find practical ways of addressing the whole problem. Help the child with ADHD understand the perceptions of others so that negative comments can be handled and potentially reduced Reduce the effect of the negative comments by being positive. Counteracting stigma can help the child to focus much more on their strengths, instead of on negative aspects. This in turn can enable the child to develop greater self-esteem and improved self-confidence. Practical steps the child can take to counteract stigma include: Develop positive self coping statements to minimise the impact of negative comments Make sure the child is aware of the perception of others Try to consider different interpretations of the comments/stigma. Are comments justified based on behaviour? Can the child accept that he/she was in the wrong and try to do better next time? Thinking whether the comments were made because the other person is having problems and is therefore less tolerant than usual. If this is the case, they should try not to take the comments personally Thinking about whether the comments are true. Recognise if this is an area with which the child has difficulty and which needs to be worked on Discuss the comments with teachers or parents/carers. Think about how the comments made the child feel, and encourage the child to work with teachers and parents/carers to consider ways of responding Focusing on activities that they are good at and areas of strength, e.g. individual sporting achievement versus team sports. PLAN ADHD MANAGEMENT
AND TREATMENT This chapter is divided into two sections. The first addresses the importance of planning the management of ADHD both at home and school. There is information on plans, checklists and how the child can use their own five point plan to control and understand their own behaviour. The second section outlines the management of medication for the treatment of ADHD. There is information on the policies behind the safe handling of medication at school by teachers and monitoring the possible benefits within the classroom environment. EFFECTIVE PLANNING As part of 'effective planning' it is important to involve the child in choices and decisions. Discussion can be helped by the use of drawn images to represent feelings and opinions. The child may therefore find a 'storyboard' to fill in particularly good in planning
and understanding their whole day. Why effective planning is important Children with ADHD may experience problems with organisation. Their impulsiveness means that planning ahead can be a struggle and everyday tasks can be difficult to carry out. Effective planning by parents/carers and teachers is essential, if life for the child is to run as smoothly as possible. It is also important because: It helps children to know what is expected of them It helps to break down larger tasks into smaller and more achievable steps It can help reduce stress within the home and at school Creating an effective management plan for home Points to consider What this means Plan the plan Set aside time together to think through the different tasks that need to be achieved on a daily basis. Let the child know where the plan is kept Make sure your child understands where the plan is kept. A copy of the school individual education plan could be kept in the same place. Be specific A plan will work if your child knows what is expected of them. Be specific about the tasks in the plan. This will help them break down tasks into manageable steps. One step at a time Explain to your child that one task should be completed before moving on to the next one. Points to consider What this means Set aside time to stay organised Try to set aside some time each day to go over what has and hasn't happened as part of the plan. Remember to reward positive steps. Use colour-coding and pictures Colour-coding and pictures make the plan easier to use and more fun. Use of a reward system Consider whether you think it is worth building in a reward system if your child sticks to the plan. Reassess if necessary If the plan isn't working, reassess the areas that you think could be improved but do not make frequent changes as this will not help establish a routine. Example of a checklist plan for going to school The plan should include specific times for the child to carry out tasks e.g.: Get out of bed Get washed Get dressed in school uniform Eat breakfast Clean teeth Check that homework is in schoolbag Collect packed lunch Be at bus stop. Creating an effective management plan for school Creating a plan for children with ADHD at school will involve discussions between the parents/carers and the teacher. Areas to consider include: The child sitting at the same place in each classroom Making sure that the sitting place minimises the likelihood of distractions Having a timetable in which the same subject takes place in the same classroom, at the same time on the same day during the week Enquiring if teachers can move classrooms, to avoid the disruption of the child moving from class to class Ensure that classes are run on time and allows for adequate transition time from class to class The use of a simple and consistent reward system which is applied immediately Clear boundaries and consequences for unacceptable behaviour. Example of a management plan to emphasise clear boundaries and consequences for unacceptable behaviour Teachers and parents/carers can encourage the child to think through
a five stage plan when faced with a problem that could lead to unacceptable behaviour. 1. What is the problem? 2. What are my choices? 3. What are the consequences depending on the options I choose? 4. Choose an option and see if it works 5. If it works, praise yourself. If the option doesn't work, re-evaluate. Example scenario: Tommy stole your ball. You wanted it back and so you went up to him, pushed him and grabbed the ball back. Tommy told the teacher, she took your ball and you were not allowed to go out to play for the next break. You felt angry and sad for the rest of the day. Using the five-stage plan: The problem was that Tommy stole your ball. The choices include Push him and get the ball back Ask him for the ball Tell Tommy that you and he can play together with the ball Go and play with another friend who has their own ball Don't bring your ball to school again. The options arising from these choices include: Pushing him and grabbing the ball back Asking him and getting the ball back from him but if this doesn't happen, you might move on to other options If Tommy agrees, you might both enjoy the game, if he does not, he may still give you the ball back as you have been kind or if he still keeps it, you can try other options You might enjoy the game with the other friends but you might still be angry with Tommy and will need to get your ball back You might decide not to bring your ball to school again, in which case, you might not have fun playing at break time Having thought through all the options and possible results, decide which one you would feel happiest trying If this option works, praise yourself for making a good choice. If it doesn't work, choose another. Treatment options as part of an effective management plan Treatment options can form part of the overall management plan. The options available can include: Psycho-education Psychological advice, e.g. psychotherapy, cognitive behavioural therapy (CBT) Behavioural advice, e.g. behaviour therapy Educational advice Medication A combination of the therapies listed above. Healthcare professionals, working with parent/carers, will decide the best option or combination of options for the child and review the treatment as the child develops. Meeting to agree a plan for the child This discussion guide is to support teachers and parents/carers when meeting to discuss a management plan for a child at school. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals Put support into place for the ADHD child Engage with the parent/carer Start to formulate a long-term management plan Actions Talk to colleagues who have taught children with ADHD about their experiences of creating management plans for individuals Carry out research into the importance of structured planning for children with ADHD Think about what a plan might involve from the child's perspective Consider what a plan might involve that would work from the school's perspective. Challenges What can be done for positioning the child in the classroom What is possible in terms of providing a fixed and regular timetable Can a reward system be provided that is tailored to the needs of the child with ADHD, without discriminating against other children Reassuring the parents/carers that the agreed plan will be consistent, but will also evolve in line with the child's needs What if the school finds it is unable to carry out many aspects of the plan over time? What if the school is unable to agree to the basic demands of
the plan? Questions What are the parents'/carers' expectations of the school management plan? What key recommendations can the school offer from its own experience in management plans with other children affected with other conditions? How often should the plan be reviewed and how? Discussion guide for parents: Preparing for the meeting Goals Establish a management plan that is acceptable for home and school use Give teachers all pertinent information Establish a good relationship with the teachers Provide the teachers with a profile of your child Actions Decide what relevant information about the child could be helpful in terms of creating a management plan for school Think about what has worked in the child's current school (if the child is moving schools) Think about the child's strengths and weaknesses in terms of sticking to a management plan. Challenges Making sure the teacher understands the importance of creating
a plan Ensuring that the teacher understands the child's strengths and weaknesses in terms of a proposed plan Ensuring that the agreed management plan is adhered to by the school Gain assurance that the plan can be adapted or changed if necessary. Questions Has the teacher any experience of developing a management plan for a child with ADHD? How can parents/carers be reassured that the plan is being carried out? Can the teacher provide feedback on the plan on a regular basis? What can the teacher do to support the child, if it is not possible to carry out a management plan for the child? Maybe an action plan can still be agreed? Is it possible to introduce a reward system as part of the plan without discriminating other children in the classroom? Discussion guide for teachers and parents/carers: During the meeting Goals To establish whether a management plan can be put in place Decide what the management plan should include Engage a procedure for regular feedback, particularly around changes to the agreed plan. Actions Determine what the teacher will do, e.g., confirming that the
plan discussed at the meeting can be carried out Establish priorities for the management plan and the timescale for achieving them Agree what the parents/carers will do, e.g., passing on any additional relevant information to the teacher Agree a feedback procedure for implementing changes to the management plan Agree who will produce a summary of the meeting with action points. Challenges Committing to carrying out all aspects of the management plan Reassuring parents/carers that the school will do its best to support the management plan and vice versa Providing regular feedback on how the management plan is working. Questions How can the parents/carers support the teacher in terms of the management plan? How can the teacher provide reassurance to the parents/carers that the plan is being carried out? How often can feedback take place and what is the most appropriate method - email, text, face-to-face? Can the feedback include the child's views on the plan? Will the parents/carers provide any further support or information that would assist with the plan? Post-meeting actions Produce a summary of action points as agreed at the meeting Carry out actions as agreed to meet the timeline discussed Ensure that all relevant information is passed on as agreed Determine the impact on the child of changes to the plan Manage the expectations of parents/carers regarding the plan being carried out Manage changes to the plan and qualify these to the parent/carers Provide feedback to the parents/carers on how the plan is going. MEDICATION IN THE SCHOOL ENVIRONMENT Medication is one possible treatment option for children with ADHD, alongside other approaches such as behaviour management and counselling for both children and their families. Medication may be prescribed to children with ADHD to help them cope more easily with problems arising at home and at school. When children with ADHD take their medication correctly they may be able to: Focus their attention for longer Be less hyperactive and impulsive Complete more work and focus on accuracy Remember their homework books/tasks Be more cooperative Get along better with teachers and other children Have more time to meet friends or play. Changes in behaviour can help children with ADHD to enjoy a more fulfilling and rewarding experience at school. Areas for teachers to consider when managing a child's ADHD medication in the school environment Is there a policy setting out school responsibilities for managing a child's medication at school? If the school doesn't have a nurse, what are the policies and procedures for the management of medication by another member of staff? What are the parents'/carers' responsibilities in managing the child's ADHD medication at school? What information about ADHD medication needs to be provided by the parents to the school? Have the parents discussed with the prescriber the possibility of the child taking the medication outside school hours? Are records kept at school of the child's medication? What is the school's policy on storing medicines? What should be in a school's policy on managing medication? What practical steps are needed for a child to safely and discretely take medication? A parent or carer may be concerned if medication is not being taken correctly at school. It may help to have a letter from the prescribing doctor to highlight the importance of taking the medicine correctly. Monitoring the effect of the child's ADHD medication in the classroom Teachers play an important role in assessing the effect that medication can have on the child in the classroom. Ideally they can compare it with the behaviour observed before medication. Feedback from the teacher on the effect of the child's medication can be passed to the child's doctor or healthcare specialist so that adjustments to the medication can be made if necessary. Teachers can look for: Positive changes in the child's behaviour, such as: Increased attention span Increased compliance A reduction in impulsivity Increased work productivity Improved behaviour towards others and social integration. Side effects of the medication, which may indicate that an adjustment is needed to the type of medicine and/or the dose include, for example, any changes in mood or behaviour. Any changes in the behaviour or performance should be communicated to the parents/carers, including changes that occur as a result of adjustments to the child's medication. This can help to ensure that the child's needs continue to be met both at home and at school. If improvement occurs, teachers should note how long it lasts and inform the child's parents/carers, as medication can have different duration in different children. This information is very important for the child's doctor as it will help them to understand whether the dose is adequate and if it is lasting them through the school day. ESTABLISH DAILY ROUTINES This chapter contains advice on developing a well founded daily routine at school for the benefit of children with ADHD. Why daily routines are useful at school Children with ADHD can often face a number of challenges during the school day because of attention and behavioural issues. These may include: Disorganisation Poor time management Forgetfulness Boredom Limited attention span. The provision of a well structured home and school routine can be key in assisting them to complete tasks and achieve goals. A good daily routine at school can: Provide structure and differentiation between each subject, teacher and classroom Assist the child to be in class, at the correct time, with the right schoolwork Help the child to focus more easily on achieving each set task by splitting them into smaller, less daunting steps to work towards Incorporate structured rest periods during intense study to allow for a break in concentration - a good motivation factor Help build a familiar pattern to the child's school day. Creating a daily routine at school A number of different factors can help create a structured daily school routine, including: Providing a regular timetable with an unchanging pattern of lessons, locations and teachers. The child can then become familiar with the routine, stick to it and establish that it will not change. Producing a simple colour-coded timetable to help the child differentiate lessons, locations and break times. Incorporating a regular time each morning for the teacher to outline the tasks of the day and the small steps needed to achieve them. Setting time aside at the end of a day to discuss the achievements and challenges. Continual reassessment and positive reinforcement of the daily routine can be very helpful. Assigning a specific place in the classroom to minimise distractions (such as avoiding windows). Providing a permanent storage area in/near the classroom in which the child can keep books and belongings. Planning ahead Preparing ahead for occasional changes to the routine, such as the school's sports day. Forward planning for break times, lunchtimes and sports activities. Ideally these should be supervised and structured as much as possible to aid resettlement back into class and avoid any conflict with other children. Recognising that the child may have dips in energy during the day, e.g. mid-afternoon, which could lead to lack of concentration. This can be helped by scheduling a regular activity during the lesson, which captures the child's interest, e.g. oral instead of written learning. Maintaining a daily routine at school This is just as important as establishing it in the first place. A number of different tactics can help and it may be a case of experimenting to see which one works best over a period of time. The tactics can include: Using a mobile phone, if allowed, to remind the child of what they should be doing next Using colour-coding to highlight aspects of the school timetable including locations, subjects and teachers Ensuring that the child wears a watch to increase awareness of keeping on schedule Making sure that the routine/timetable is easily accessible Using graphics/images as part of the timetable to show what is expected. Creating a routine for going to school There may also be benefits in establishing a routine for going to school that clearly states the actions expected at specific times. The actions in this routine may include: Getting out of bed Getting washed Getting dressed Eating breakfast Cleaning teeth Packing homework Collecting packed lunch Going to bus stop. MAKE A SMOOTH HANDOVER TO A
NEW SCHOOL This chapter comprises three sections that suggest the best ways for a child with ADHD to transfer to a new school and how to support the process. PREPARING TO LEAVE CURRENT SCHOOL Changing schools is a daunting step for any child but involves a number of particular challenges for a child with ADHD. These fall into two key areas: 1. Practical: Change in established routine 2. Emotional/psychological: Abandoning friendships Leaving relationships with supportive and understanding teachers In order to manage the process of moving schools, parents and carers need to: Properly support the child through the period of change As part of information transfer for the new school use a resource similar to the BaSoFiche form* Make sure the current school maintains existing support while required. * The BaSoFiche form was developed in Belgium to transfer preliminary information about all children moving to a new school. The form has sections to provide information about skills, interests, care provided and special needs. In addition there is a section to provide information about external care and home life. Understanding the changes involved in leaving the current school Changing activities, environments or routines can be difficult for children with ADHD and can cause: Frustration Anxiety Depression Tantrums. To help the transition the child may be encouraged to make use of a cartoon strip with the help of parent/carers, which enables them to share their thoughts on leaving their old school and their hopes for the new school. A template cartoon strip is available to download. Many children with ADHD like to adhere to a set routine, so changing schools can be one of their most traumatic experiences and responsible for significant challenges. Practical change Steps to take prior to a child leaving their current school include: Discuss what to expect Explain what needs doing during the change, e.g. finding out about the new school, and/or making a visit If possible, make the move gradual, e.g. suggest well planned visits for familiarisation. This can provide the child with an opportunity to meet key teachers and tell them what they like best about school, how they learn and what they find challenging They can go with a current friend to aid the transition. Emotional change Leaving behind relationships with other children and teachers is part of the process of leaving a school. This can prove difficult for a child with ADHD, particularly when one teacher has looked after the child and knows them well. Children and teachers will have developed an understanding of the child's ADHD and established a relationship with them during their time at the school. Steps you can take to help with the emotional change of leaving a current school: Maintaining existing levels of support in the current school Support from the current school may potentially decline as the date for leaving approaches. This can happen because the school may: See it as a way of letting go of the child Want to prioritise support for younger children. Maintaining the right level of support To ensure that your child receives the right level of support, you could take the following steps: Meeting to prepare handover between schools This discussion guide is to support teachers and parents/carers when meeting to agree how best to manage the handover. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals Set out a clear scope for the meeting Set out your priorities for the meeting and expected outcomes Allow time for parent(s) to voice concerns and opinions Provide a full account of your experience with the child. Actions Find out the policies of the new school Gather experiences from other teachers who have dealt with this child Complete a resource similar to the BaSoFiche form to pass on preliminary information Consider successful strategies and reward systems that have worked with this child. Challenges Consider the challenges relevant to this child: Behaviour in the classroom and disruption to other children Inexperience of other teachers in managing disruptive behaviour Stigma among teachers, children and parents Reward systems that do not discriminate other children. Questions How can you work together to ensure all relevant information is passed on? What do new teachers need to know most? What strategies work best with this child? What strategies did not work? Discussion guide for parents: Preparing for the meeting Goals List the outcomes you want Formulate ways to work with the teacher to pass on information Agree timelines for passing information and implementing strategies. Actions Start compiling information that could be useful for the new teachers Consider how you can work with teachers to smooth the
transition. Challenges Passing on all relevant information to the new school Providing information about successful management strategies at home Think about how any stigma could be overcome. Questions Can you ask all parties to make notes and compare them at the end of the meeting? Discussion guide for teachers and parents: During the meeting Goals Establish a clear agenda for the meeting Compile a handover document Agree successful behavioural management techniques for school and home Ensure that full and accurate information is passed on Allow equal time for every participant to voice concerns or opinions. Challenges Understanding what works best with the individual child Addressing the change of routine at the new school and its potential effects Practical challenges at the new school and possible stigma. Questions How can the new school be best supported? What can be done to ensure that successful strategies are
passed on? How both work together to make the leaving process easier? Actions Agree what each party will do, with timelines Make sure the new school has all relevant information when required Provide as much support for the process as possible Produce a summary of the meeting with action points. Post-meeting actions Keep in contact with the old school and new school by phone, email or text to facilitate information transfer Ensure there is continued cooperation between parent and teachers Support the new school Ensure that all relevant information is passed on to reach the new school in time Ask yourself is there any further support that I can provide to help in this process? HANDING OVER TO A NEW SCHOOL Starting at a new school is a big moment in any child's life, but for a child with ADHD, the change in daily routine and environment can prove difficult and disruptive. Preparing children effectively for the handover period and the imminent change can help them cope more easily with this transition period. The main areas of change involve: New routines at school and at home New relationships with teachers and other children. Preparing for the change in routine A structured and regular routine is central to success at school and it is important to plan ahead for changes that a new routine will bring. Children with ADHD are often disorganised and find it difficult to cope with changes. This is particularly true when leaving a junior or primary school at 11 or 12 years old to move to a higher school for 12 or 16 year olds. Typical changes may include: A new timetable, which can be more changeable over time New surroundings, involving many different classrooms, and different teachers which makes a consistent routine difficult to manage More and varied subjects Increased homework demands, which may impact on home routine. Support from the child's parents/carers and previous teachers may help the new teacher to soften changes. Preparing to meet new teachers and make new friends While the child is getting familiar with the new routine and school they also have to form new relationships with teachers and other children. This can prove to be challenging and may involve: Teachers and other staff misunderstanding ADHD Popularity followed by isolation from other children Discrimination by other children Uncertainty around change. Making and keeping friends can often be difficult for children with ADHD. They may easily strike up friendships, but these become strained over time as the other children tire of their behaviour. This can lead to isolation and reduced self-esteem, as well as bullying as their behaviour can become annoying. While teachers should be aware of group dynamics and potential bullying, parents/carers can also help the child to look at ways of overcoming barriers to friendships. Early discussions between the parents/carers and the new teacher(s) can often help to promote a better understanding of ADHD. The new teacher can be proactive in easing the child_s integration into the new environment and at the same time introduce them in an open and friendly way to the other children. One suggestion is to develop a welcome pack which could: Provide a description of the school Describe the timetable and new lessons Involve other children to provide content and artwork Give an overview of the typical day possibly using a story board (cartoon style). Areas for parents to consider in the handover to a new school Provide as much information as soon as appropriate Make sure that all the experience gained at the previous school is communicated to the new school. This can include: Your child's strengths and weaknesses What has worked for extra educational support Your child's approach to friendships with other children and relationships with teachers Successful feedback, reward and homework systems Techniques to focus attention and enhance study skills Management of medication and behaviour Any challenges and how they were handled Establish a point of contact for all communication with the new school Request regular feedback and agree how it should be provided - phone, email, text, meeting Ensure the school is aware of conditions commonly associated with ADHD Emphasise the need for a regular daily routine to successfully manage your child's behaviour in school. Meeting to prepare handover at the new school This discussion guide is to support teachers and parents/carers when meeting to agree how best to prepare for the handover. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals To reassure the child's parents what level of support you will give their child Request any information from parents and previous teachers to help settle the child into the new school and successfully manage relationships. Actions Identify what support can be offered in the first weeks after joining Establish what experience you or your colleagues have in helping a child with ADHD Investigate any special provision that may be needed in the classroom Assess the handover information from the previous school. Challenges Understanding the specific requirements of the child Obtaining information on previously successful strategies for the child Providing reassurance to the parents about school support for the child. Questions What has previously worked and not worked for the child in the classroom? How does the child cope with change? How does the child make new friends? How does the child feel about moving to a new school? What have they enjoyed most about their previous school? How can the parents and teacher work best together during
the move? What activities does the child enjoy that can help motivate them? Discussion guide for parents: Preparing for the meeting Goals Find out what experience the school has with ADHD Handover useful information for the new school Provide useful background information on your child Ensure that the school will support your child. Actions Consider: How your child will settle into the new school, for example, getting to grips with a new timetable What has worked well for your child in the previous school, for example, homework techniques The kind of information that would be useful to pass on Ways to address any negative beliefs within the school Any questions the teacher may have based on the handover information Contact your local ADHD support group or speak to other parents to find out the new school's experience of ADHD. Challenges Addressing any negative beliefs the teacher may have Providing reassurance over aspects of your child's behaviour based on experiences in the previous school, for example, regarding inattentiveness Ensuring that any communicated information is acted on by the school. Questions What kind of information would be most useful for the teacher/school? What experience does the teacher have with children with ADHD? Does the teacher understand the importance of establishing a routine? What are the teacher_s and school's immediate priorities for children with ADHD as they join the school? Does the school have any particular concerns regarding the child? How can you support the teacher as your child settles in? Discussion guide for teachers and parents/carers: During the meeting Goals Agree the best way to work together to support the child during the handover Agree the school's priorities for the child in the first term at the new school? Decide the most useful information to be passed on to the teacher and when e.g. examples of success Confirm a continuing feedback process. Challenges Committing to carry out actions to accommodate the child's needs Reassuring parents that the school will be able to accommodate any successful strategies developed previously Reassuring the parents that the school will be able to provide regular feedback. Questions How can you work together during the handover period? How often can feedback take place during the handover period? How rapidly can previously successful strategies be put into place at the new school? How will everyone work together in coping with the child's reaction to change? Actions Development of a written statement outlining how the school will accommodate the child's needs inside and outside the classroom Parents to provide as much information as possible based on successful strategies at the previous school Agree a timeline for actions. Post-meeting actions Produce a summary of agreed action points Carry out actions as agreed to meet the timeline discussed Ensure that all relevant information is passed on as agreed Carefully monitor the child's reaction to the new school. SUPPORTING THE START AT A NEW SCHOOL All children face different challenges when they start at a new school. These fall into two key areas for children with ADHD: Classroom and learning challenges, involving a new and more complicated timetable, new and more varied subjects and an increase in homework Difficulty building new relationships with teachers and other children. By recognising what these challenges involve for the child, parents/carers and teachers can provide support during the early weeks at the new school. Classroom and learning challenges in the move from primary to secondary school Potential challenges What this can mean for a child with ADHD How can teachers help? New timetable Children with ADHD thrive on familiar structure and routine and so a new and more complicated timetable can result in disorganisation, forgetfulness and being late for lessons. Reassure the child that the timetable is new for everybody, not just them.
If possible, reassure the child that it will soon become familiar, just as it did at their previous school.
Can you make the timetable easier to understand, e.g. colour-coding? New environment The transition from classroom to classroom (with different teachers for different subjects) can increase disorganisation and a tendency to be late. Discuss with the child (and class) the next lesson - where it is and who is teaching it. Potential challenges What this can mean for a child with ADHD How can teachers help? New subjects Children may encounter subjects for the first time. Some of these may be taught in a style not conducive to those who have difficulty concentrating. As children with ADHD can have a short attention span, breaking up lessons into shorter segments should be considered. New study skills The move to a new school can involve the use of new study skills with more emphasis, for example, on note-taking and testing. Children with ADHD may look to the teacher for more support and motivation in these areas than might normally be provided. Highlight key points by colour-coding and emphasise the important points to write down. Give a handout to make sure they have the main ideas and check the child's notes regularly to make sure they understand. Potential challenges What this can mean for a child with ADHD How can teachers help? More homework An increase in homework can be expected at a new school. This can lead to problems including forgetting tasks, getting distracted while doing homework and misunderstanding tasks. Provide a weekly homework sheet, with each task signed-off by the teacher for whom homework is due and a detailed explanation of the work that parents can review and assist with. Building relationships with teachers and other children To help children explain new relationships it may help for them to draw the people they have met in the form of a gallery. This gives a starting point for discussion about their interaction with and feelings about each new person during the school day. A template gallery is available to download. Alongside getting used to new school systems and methods of learning, a child with ADHD will need to develop relationships with new teachers and other children. A supportive relationship between teacher and child can often help them fulfil their potential. Teachers can help to establish a positive relationship through providing practical support in a number of different ways (many of these suggestions may be routinely used by teachers in any class they teach): Lessons should maintain attention and engagement and allow frequent questions (Sourced from the Mental Health Foundation) It is counterproductive to single children out for special attention in front of the class. Areas of interest must be discovered and encouraged to give the ADHD child a chance to excel To improve an understanding and retention of information the encouragement of team work in any class environment is a good idea Additional time can be given for completion of tasks if concentration is poor Lack of effort or desire is not necessarily the reason behind a child_s poor performance. Teachers can actively support the child with ADHD in building relationships with other children. While the child can develop ways of overcoming barriers to friendships, teachers can take practical steps to help them assimilate with other children at school by minimising the risk of confrontation. The steps can include: Pair work for projects Monitor break times and lunchtimes to prevent bullying, etc Avoid children picking teams due to potential discrimination Do not attempt to force friendships between children. Meeting to discuss early progress at the new school This discussion guide is to support teachers and parents/carers when meeting to discuss the child's progress. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals To provide parents with a concise, accurate progress report Be positive and provide possible solutions to challenges Share all relevant information. Actions Consider: How the child is reacting in general to the new school Any strengths or challenges that have already emerged e.g. new subjects How the child is developing relationships with their teachers How the child is developing/maintaining relationships with other children Particular challenges or successful techniques? Challenges Reassuring parents that the school will continue to support the child, including any special education provision Make sure parents understand that any particular issues that have arisen will be dealt with. Questions What feedback have the parents received from the child regarding their new school? Has the child mentioned any particular areas of concern to the parents? How do the parents feel that the child is coping? Can the parents provide any additional information or support that could help? How is the child coping with increased homework demands? Discussion guide for parents: Preparing for the meeting Goals Make sure teachers understand all of your concerns Get a comprehensive report on your child's progress so far Swap information and determine if there is common ground. Actions What your child has told you about the new school Has your child raised any concerns about any aspect of the new school? Positive aspects of the school that the child has mentioned or you have observed Particular issues that have arisen, e.g. coping with the new timetable Think about aspects of the school that you feel could be
improved. Challenges Reassurance that systems already proving successful will not change Reassurance that the school will continue to support the needs of the child. Questions What is the teacher's impression of your child so far? What does the teacher consider to be your child's strengths and challenges? What is the teacher's impression of your child's relationships with other children? Have any particular challenges arisen yet at the new school? If so, how did the teacher/school handle them? Was it successful? Is there any further support that the parents could provide out of school? Discussion guide for teachers and parents/carers: During the meeting Goals Establish future priorities for the school based on the experience
of the child with ADHD to date - acknowledge any achievements Demonstrate how both parties can offer a joined up approach Agreement on how often feedback should take place and how - email, phone, text or a face-to-face meeting. Challenges Discussing the challenges at school and home that have emerged so far Reassuring the parents that the school will continue to support the child in their future Reassuring the parents that the school will address any particular areas of concern. Questions How do the teacher and parent/carer feel that the child is coping with change? What are the reactions of other children to the child? What are the reactions of other teachers to the child? What are the school's immediate priorities for the child following this meeting? Can the parents provide any additional support or information? How often can feedback take place? Actions Agree what the teacher and parents will do, e.g. provide further information to the teacher and monitor any behaviour changes at home passing on details to the school Agree a timeline for these actions to be carried out Agree who will produce a summary of the meeting with action points. Post-meeting actions Produce a summary of agreed action points Carry out actions as agreed to meet the timeline discussed Ensure that all relevant information is passed on as agreed Ensure that regular feedback takes place Ensure that new strategies agreed at the meeting work and if not, address these in a timely manner. SUPPORT CHILDREN WITH ADHD IN
THE CLASSROOM This chapter gives advice on the best way to provide support for ADHD children in the classroom. There are also suggestions on methodology that can be used to help provide a good support structure. Why it is important to structure learning opportunities? Children with ADHD can be successful at school, especially if management techniques are in place to encourage them and focus
on their strengths. This means the provision of structured learning opportunities as part of a familiar routine. Structure is important because children may need: Clear boundaries and organised support Clear instructions using examples Clear goals and timings Variation in tasks to keep them stimulated. Learning opportunities to support a child with ADHD A number of different tactics can be used in the classroom to provide support. Some tactics to consider include: Review material constantly. Repetition can provide structure, increasing chances of children with fleeting attention hearing the information at least once Clarify and emphasise important information. Make the most important points, the most interesting Break up long lessons into shorter segments. Help maintain focus and attention Face the children when talking to them. Involve a child to draw them back into the lesson Correct and return written work as soon as possible. Children can learn more through immediate feedback Use language and examples that the child can relate to. For example, make maths feel more real by using real life examples Encourage questions. The more actively a child is involved, the greater the maintenance of attention Use colour-coding in materials or on the board. Emphasise key points and reinforce visual learning Combine verbal instructions with illustrations or practical demonstrations Use role play. Bring learning to life. Support across different school subjects All children have strengths and weaknesses in different subjects. Children with ADHD are all individual and may show ability for maths or languages, while others may excel at art or food technology. Across all subjects, learning styles and classroom tactics can play a major role in supporting a child with ADHD. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: English Language Creative expression, e.g. writing stories Spelling and handwriting (possible co-morbidity e.g. dyslexia) Structuring, planning and maintaining interest in stories Getting thoughts clearly down on paper
Completing writing projects Provide visual, auditory and computer support, where possible, to fully engage the child Offer templates or guidance to help children plan and structure their stories Handwriting may need specialist involvement, e.g. an occupational therapist Provide oral exercises as well as written ones for variation to focus attention ì e.g. telling rather than writing stories Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: English Language Creative expression, e.g. writing stories Brainstorm first as a class with ideas written on the board Ask the child to talk about their ideas and record them. Play them back and write them down or get help from a parent to do this Some children with excellent oral skills are unable to write any ideas down on paper. Most of them develop ways to get their ideas down on paper eventually - with help. Some may need scribes to help them in exams later on Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: English Language Creative expression, e.g. writing stories Give each child a paragraph of a story to read. Ask them to write a sentence giving the main idea after reading the paragraph. They then draw the main idea and colour it as creatively as they like. Each child is given a different paragraph so at the end of the exercise, it is possible to make a collage of the story and get the students to explain it to one another. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: English Literature Drama can be popular as it can allow children to act out their feelings, e.g. expressing anger and frustration Reading abilities for scripted drama Ability to focus on tasks with longer commitment, e.g. novels. Discover what works for the individual and focus on their personal strengths Stimulate interest through different approaches, e.g. showing the film of a play or novel. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Maths Some children with ADHD enjoy numbers more than letters Combining words and numbers may prove confusing (possible co-morbidity with dyscalculia) Difficult areas are: algebra, long division, fractions, decimals and percentages Children may find it difficult to remember what different symbols mean. Establish what works for the individual child Break up learning into short segments Use graph paper instead of notepaper to help keep numbers aligned Allow extra time for tests Explain maths terms clearly Allow the use of calculators Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Maths Some children with ADHD enjoy numbers more than letters Use mnemonics to help students learn formulas, times tables, etc Help the child develop their own way of figuring out maths problems and validate this method if it works Teachers should inform parents to get extra Maths help for their children if they begin to get behind in their work. In this way, their self-esteem remains intact. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Science Can involve practical activities and topics which can help to engage the child Practical activities require careful supervision Some topics can prove harder to understand, e.g. chemical equations. Provide a hand-out of science terms and vocabulary Put children in groups of two so that the child with ADHD can work with another child and develop friendships Develop creative ways to help ALL the children remember science terminology. (same as for History/Geography) Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Information technology (IT) Children with ADHD can find that computers hold their attention and are stimulating Choose software to get the balance between stimulating and over-stimulating the child Computers can be slow, software confusing or crash and the child can then become frustrated or lose focus. Include touch typing as part of IT - important in schools that allow children to write their work on computers. This can assist with organising thoughts and structuring essays. It has been proven that children who find it difficult to get their ideas down on paper improve in this respect when they use the computer Keyboard and mouse skills need to be clearly introduced to the child Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Information technology (IT) Children can control the pace at which they work Computers can be slow, software confusing or crash and the child can then become frustrated or lose focus. Get permission to use computers as early as possible because some exam boards do not allow this if the student has not been using the computer regularly for at least 2 years prior to the exam. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Design technology Practical subjects involve the child and can prove to be some of the most popular These subjects allow creative freedom These practical subjects create potential for many distractions, so safety must be considered Tasks are associated with accuracy and co-ordination. Allow extra time for completion of tasks and focus attention on the health and safety implications Coaching the child could help to channel their energy and enthusiasm into the specific tasks Children with ADHD need structure so it is imperative that there is structure in practical subjects too. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Food technology The subject allows creativity and so can be popular Challenges include time management, organisational skills and the impulse to play with the food rather than cook. Clear guidance around recipes is important, in particular, the use of pictures instead of words Teachers should create a clear structure in this class - set guidelines and be consistent. Students should be encouraged and complemented to develop motivation. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Art A practical and creative subject which should suit the strengths of a child with ADHD Impulsiveness could lead to challenges Potential for lots of distractions - if unstructured, children can get distracted. Aim to achieve a balance between instructions and encouraging natural creativity Harness hyperactivity into a creative output It is up to the teacher to provide clear structure in the Art class so that ALL students can develop their skills. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Music Music is a practical, creative subject that provides opportunities for the child to improvise Limited attention can lead to possible day-dreaming or lack of focus whilst listening to recitals or musical pieces Some group tasks may be a challenge, as well as reading music Some children with ADHD who are gifted musically find it difficult still to read music. Structuring tasks around rhythms can assist channelling attention. Try to keep the child_s attention by asking them questions, not necessarily in front of the whole class, but on an individual basis Maximise focus and reduce distraction, make sure the child is actively participating Colour coding sheet music might help make the subject more visual. Activities that can work to a child's strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Modern languages Some children have an aptitude for languages, regardless of whether they have ADHD They may have excellent oral skills but poor written and reading skills Languages can highlight weak concentration and listening skills Possible co-morbidity of dyslexia. Keep teaching as varied as possible Break up longer periods of listening work to help focus concentration Try to be creative in your approach by linking to other subject or points of interest Allow the children who have excellent oral skills to present ideas orally and achieve in this way. Make accommodations for their written work Activities that can work to a child_s strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Modern languages Some children have an aptitude for languages, regardless of whether they have ADHD They may have excellent oral skills but poor written and reading skills Make sure that these students have also been tested for dyslexia and if found to be dyslexic, suggest they work with a specialist Usually, children with dyslexia will have the same problems in each of their languages - it may be best to concentrate on one foreign language. Activities that can work to a child_s strengths Aspects that may prove harder for a child with ADHD Examples of support from the teacher Subject: Physical education Sport can act as a focus for energy Some children can show ability at individual sports Some sports can highlight weak hand-eye coordination skills Sports with periods of inactivity can result in the child getting distracted Safety issues need to be considered. Possible co-morbidity of dyspraxia. Team games need to be highly interactive Avoid sports that involve periods of inactivity Give precise instructions and make sure that the child is looking at you when you give them Allow those children who don't like team sports to achieve at the sport of their choice, tennis, swimming, etc. Children with ADHD may have difficulty remembering facts and dates because of their working memory deficits. Teachers can help put the material they want them to learn into their long-term memory by using a variety of techniques, such as: Group projects - Geography example* *The use of group projects can be a valuable tool for teaching many subjects across the curriculum including history, geography, science, design/technology and even English literature and drama. In this case geography is an example and the same principles may be applied to other subjects. Divide the class into pairs and provide them with various research materials to complete a project. Allow children to work on the project during regular class time. Give strict criteria for the project, such as: Find out 10 facts about the assigned country Use at least three different sources for information Use your own words to summarise the information you find Create a poster for your findings Write five questions about your country for the class on note cards and write the answers on the reverse side Present the poster in pairs, each child doing what they do best Each pair of children asks the class the questions they have created After they have presented their project, the children hand in the cards with the poster and presentation. Group project follow-up The teacher can give a quiz at the end of the lesson using questions provided from the group projects. As the other children know this will happen, they are encouraged to listen attentively when their peers are presenting. Prizes can be awarded for projects according to the most creative, most original, best art work, etc, so that most children will get an award. The teacher can keep the note cards with the questions and put them into a suitable box on their desk, filed under the name of the country questioned. As the year progresses the box fills up with these note cards and children can use them as a resource to quiz each other when other work is completed. In this way material is reviewed multiple times and interest is generated. This is a powerful technique to put material into the children_s long-term memory. It is also an excellent way to reach all the children in the classroom. Also, as each project is presented, the children create a collage of their work on one wall of the classroom. The teacher can then invite other teachers and children to view their work. This technique can be used for a variety of subjects, and it is a very efficient way to get a lot of work accomplished in a short space of time. DEVELOP STUDY SKILLS This chapter encourages the development of study skills and makes suggestions as to the best approaches to adopt for a child with ADHD. Developing strong and appropriate study skills Strong study skills at home and school are key for successful learning. A child with ADHD can be prone to taking longer to complete homework than other children, therefore it may be helpful for parents and teachers to monitor: How much homework the individual child can do Whether there are alternative homework activities for the child, which achieve the same learning goals. The following table outlines some of the core skills that a child with ADHD may need to develop, alongside support to help achieve this. Skill A child with ADHD's possible approach Support suggestions Understanding instructions Misunderstanding can be a problem for children with ADHD. Verbal instructions may be easier to follow, while others may prefer written instructions and pictures. Provide instructions in both written and verbal formats Break down instructions into simple steps and ask questions to ensure full understanding. Reading Children with ADHD can have difficulty reading. This can be because they are easily distracted, find it hard to concentrate, or due to a specific reading problem, such as dyslexia. As a parent: Take time to sit down with your child and listen to them read material they find interesting Provide situations for them to practice as much as possible Skill A child with ADHD's possible approach Support suggestions Reading Watch the film version of a novel - this can stimulate thinking and may encourage the child to read the novel or look at other novels by the same author If the child continues to have difficulty reading, talk to the school about specific tests for reading disorders. As a teacher: Can any additional support be offered to assist their reading? It is advisable to avoid embarrassing situations, such as asking them to read in front of the class. Skill A child with ADHD's possible approach Support suggestions Handwriting Handwriting can prove difficult for lots of children and illegible writing can lead to poor marks, even though the content is good Poor handwriting may be due to a co-ordination problem, or simply lack of concentration. It could also be just a sign of lack of focus and a possible reason for testing for dysgraphia. Assure the child is sitting at their desk at a correct height to help encourage better handwriting Set aside time for the child to practise writing letter shapes Offer praise when any improvement is made Encourage parents to set up a handwriting study with an occupational therapist If the problem persists, allow the child to type all school work - this will also help with focus. Skill A child with ADHD's possible approach Support suggestions Maintaining attention Concentrating and keeping focused can be one of the hardest things a child with ADHD has to do. Try to create a stimulating and interesting learning environment Short focused tasks will help engage all children Allow plenty of short breaks and encourage the class to exercise during these Ask questions and reward those who have been paying attention. Skill A child with ADHD's possible approach Support suggestions Following rules Following rules can be challenging. Some children with ADHD may: Find it hard to understand or remember rules Not be able to think through the implications of impulsive actions they take. Make sure that the rules are clearly displayed If possible use signs or pictures to make the rules easier to see, understand and remember Refer to the rules and repeat them regularly Discuss with the child the importance of following rules and the implications if not followed Give praise when a child follows a rule even if it is short lived Focus on positive behaviour and children will follow the rules faster than if punished or chastised. Skill A child with ADHD_s possible approach Support suggestions Starting a task Beginning a task can sometimes be hard for a child with ADHD, especially if it is an area that is not of interest. Provide a specific motivation for doing the activity Show the child how to get past obstacles that are preventing them from getting started Begin the task for them, the first sentence - write it on the board and ask them to continue Do a class brainstorming activity and write down the ideas on the board Show a short video about the topic and ask questions. Finally ask them to write a summary Ask the children to freewrite to get their creative juices flowing. Handling homework Parents/carers can play an important role in helping a child with ADHD to complete and return their homework successfully. The tips below can provide some practical ideas for helping your child manage their homework. Time management: Do the hardest homework first. Encourage your child to tackle the most difficult task first. Leaving the easier work for later can mean there is still some capacity for concentration left Take a break. Your child can benefit from taking a five-minute break every half-hour Build homework routines. As with all children, settling down to homework can be challenging when tired after school, or there are more attractive things to do. It can be helpful to pace the homework so that activities such as playing or watching TV are used as rewards Use cue cards. During exam revision use cue cards containing key facts to help break down information into smaller sections which are easier to remember Break down bigger tasks. Broken down into smaller sections make tasks more achievable - a timetable on the wall illustrates when each needs completing. Organisation tools: Use a homework book. This contains details of tasks received, the resources needed to complete them and the date when the homework is due. Completed tasks are signed-off by both the parent and the teacher so it provides a practical way to work in partnership. This can help your child take responsibility and prioritise Use a mobile phone reminder. Set a reminder on your child's mobile phone to go off before they leave school to remind them to check homework is given in Set up a homework area. Set up an area, preferably a desk, that is just for doing homework. Encourage your child to keep it tidy so that time doesn't have to be spent in getting organised before homework can be started. It is also better to have your child do their homework nearby, where focus can be monitored Use an in-tray. Encourage your child to empty their school bag into an in-tray when they return home each day. Using the homework book, they can then decide which materials need to be used for tasks to be done that night and which materials are needed for tasks with a later completion date Help return the homework to the teacher. Encourage your child to use a specific folder for all completed homework. You can check that this folder is contained in your child_s school bag before they leave for school on the following day. Reward systems: Agree a reward. Give rewards for the successful completion of homework that is clearly understood by your child Take a realistic view on timing. It takes a child with ADHD longer to complete homework than class work Encourage your child to time themselves doing homework. This makes it more interesting and they can race the clock, which acts as a motivator Reward by: extra TV or computer time positive feedback about results at school staying up later on Friday reading a story or playing a game together. Parents always have to check if the reward is valid by determining what motivates them the most. Rewards have to be something that your child wants badly - otherwise, they do not work. MANAGE DISTRACTIONS IN THE SCHOOL ENVIRONMENT This chapter outlines some of the best methods for the management of distraction and attention deficit in children with ADHD. Managing distractions and health and safety at school Many children can become distracted at school, whether in routine activities such as morning assembly or in lessons that they do not find interesting or stimulating. Children with ADHD find it hard to focus, meaning they can find it difficult to concentrate at crucial times. Distractions can occur because they are: Unable to filter out things happening around them Easily diverted from what they should be focusing on Slower in refocusing their attention. By minimising distractions teachers can help a child to concentrate and learn in the classroom. Managing distractions in the classroom Teachers need time to find successful solutions to managing distractions. There is no one size fits all approach to finding what will work best for a particular child. The following table outlines the main types of distraction, together with ideas for solutions. Possible source of distraction Issues that can arise Ideas for solutions Position of the child's desk in the classroom (Sourced from the Mental Health Foundation) The child's attention can be diverted by other children, windows/doors or people walking down corridors or into the classroom. Move the child's desk nearer to the teacher or a well-focused child, but don't allow them to be distracted Avoid tables with groups of children, seat them in rows of desks Manage the class by circulating, instead of staying at the front (greater interaction and engagement). Possible source of distraction Issues that can arise Ideas for solutions Group work with peers who are themselves hyperactive Some children with ADHD may find working in groups very difficult as they play around and get nothing done. Allow these children to work slightly away from the others, especially if they are talkative and noisy. Another suggestion would be pair work. Too much information on the white (or black) board Children with ADHD may get very distracted and lose their concentration. Teachers should be careful what they write on the board, writing only what is necessary. Things that can be seen and/or heard The child's attention can be distracted by things that take place inside or outside the classroom, either heard or seen through windows and doors. Position the child away from the door and windows The place where the teacher is teaching, has to be kept free of distraction. Only the clock and the white board should be visible and these should be at eye level Possible source of distraction Issues that can arise Ideas for solutions Things that can be seen and/or heard The child's attention can be distracted by things that take place inside or outside the classroom, either heard or seen through windows and doors. If it is impossible to remove the distractions, place the child as far away from them as possible If a child is unusually disturbed by noises (as in the case of children with Sensory Integration Disorder), consider using individual headphones to blank out the noise with appropriate music (for such children, it might also be necessary to have a noise-free area in the classroom where they can retreat when sensory overload is noticeable [depending on level of impairment, this might be indicated by severe temper tantrums, screaming]). Health and safety issues at school that relate to a child with ADHD Maintaining a safe environment for children and teachers is always a priority for schools, regardless of the lesson or activity taking place, and can form part of the school's policies. Subjects that feature practical activities carry additional risks, whether undertaking a science experiment or playing sports. Some of these subjects hold particular appeal for children with ADHD who enjoy the emphasis on doing rather than sitting and listening. Whilst enthusiasm is always encouraging, the impulsive and hyperactive behaviour of some children with ADHD can mean that greater awareness is essential in order to maintain health and safety in the classroom. If the school has a teaching assistant, they offer an extra pair of eyes and ears in the classroom and will help supervise Divide the class into pairs for practical work, to encourage friendships but not offer too many distractions Explain and repeat instructions precisely and clearly, for example, what they may and may not do during breaks with or without a supervisor Keep the child's eyes fixed on you when instructions are given Be aware of attention drifting and have tactics in place to refocus their attention Pay particular attention to planning field trips and visits to ensure safety at all times Reiterate the rules before going on a trip - particular rules can be made about toilet visits, gift shops and spending money, and general behaviour in public. REVIEW PROGRESS AND GIVE FEEDBACK This chapter makes suggestions to parent/carers and teachers as to the best methods for evaluation of progress in learning. Evaluating learning Evaluating learning, recognising progress and passing on feedback at school is particularly important. Positive comments from the teacher, for even the smallest of accomplishments, can provide encouragement and improve any child's self-esteem and motivation. While children with ADHD can be intelligent, traditional academic evaluation methods do not always allow this to be shown which could potentially impact their later life. Evaluation for children with ADHD could work more effectively through the following: Tests taken by everybody in the class Completion of homework More informal recognition of positive behaviour assisting
day-to-day learning e.g. staying focused Quantitative progress tracking using an agreed management plan. Providing feedback on positive progress in the classroom Praising a child after a positive achievement can form an important part of motivation in the classroom. This praise can prove the teacher has faith in their abilities and encourages the child to carry out the positive action again. Positive feedback may be given for the following: Asking questions Asking for help Staying seated Waiting their turn Not interrupting Keeping focused Being on time Being organised. Positive feedback can be most effective for the child if: Specific reasons for the praise are given It occurs immediately after the action so that the praise is connected It is not a backhanded compliment in which criticism is implied alongside the praise, e.g. That was great. Why didn't you do that last week? It is repeated each time the action is successfully completed and is not just the first time. Evaluating learning for a child with ADHD Even though a child may have the knowledge to gain good marks in a test, they may have trouble in reproducing it in the format and time required. (Sourced from the Mental Health Foundation) This can happen for a number of reasons. They may: Become distracted Have difficulty managing their time effectively Take a long time getting started Have difficulty remembering specific facts. Alternative methods of evaluating learning can provide the child with a better opportunity to demonstrate their knowledge. These could include an emphasis on discussions and projects instead of written tests. Many children with ADHD prefer verbal learning, finding it easier to talk about facts. (Sourced from the Mental Health Foundation) When written tests are required, extra help and guidance from teachers can help improve performance. This support can form part of the school's policies and tactics can include: Allowing extra time, where regulations allow Offering practice tests beforehand Allowing the child to take the test in an area with no distractions Preparing using cue cards containing key points Allowing use of a computer to aid written work Reading aloud the questions and the instructions before the test starts Using a separate classroom for children who are allowed more time Providing a Reader for students taking exams with dyslexia Providing a Scribe for students taking exams with ADHD and dyslexia. MAKE THE HANDOVER TO A NEW CLASS OR TEACHER This chapter outlines the preparation and support necessary for the move of an ADHD child to a new school or class. Preparing for a move to a new class or teacher School timetables usually involve moving between classes and teachers throughout the day and even though this may become familiar, they can still prove disruptive resulting in lost time at the start of lessons. Children with ADHD can face the following challenges during class transitions: Being late due to forgetfulness or distractions Being poorly prepared due to disorganisation. Preparation for the transitions can help a child with ADHD face the daily routine more effectively. Preparing the child for change Children with ADHD thrive on routine and can initially be reluctant to change. By taking steps to prepare the child for what is coming up next, the teacher can help with what is happening, why it is happening and what is required. Practical steps to prepare a child can include: Repeating what the next lesson will be, where it will be and the teacher taking it. This will help to establish this information in the child's mind Reassuring the child that in time, the school timetable may become as familiar to them as previous routines Providing a five-minute warning so that the child knows that a change in lesson is about to happen Guiding the child in the right direction to the next lesson Having lockers in a central location where the child can access books/materials for the next lesson. Preparing the child for meeting new adults Meeting new people might be a daunting experience for a child entering a new school for the first time. Below is a suggestion on how to break the ice with teachers and fellow children. Suggest to the parent that the child draw a poster to represent themselves and show it to the teacher and/or whole class as an introduction This poster can illustrate their likes and dislikes as well as introducing them in a humorous and non-threatening way to the new class. Preparing the child for a busier school timetable Teachers and parents/carers can support the introduction of a busier and more complex timetable. Practical steps can include: A colour-coding system for the timetable so that a child can differentiate subjects, locations and teachers in a more visual way Organise a copy of the timetable to be available at all times and an easily accessible version on notice boards Different dividers or folders for each subject, possibly colour-coded with the timetable Stickers with name and subjects on the front and back of the notebooks so that the notebook is immediately recognised for the lesson Checklists of essential materials for each subject that can be completed before each block of classes An electronic organiser or smartphone to provide prompts for what lesson is coming next and what materials are required A watch to prompt responsibility for time keeping and organisation. Preparing for handing over to a new teacher Informing a new teacher in the same school about what can work best for the child in the classroom can be important in setting the scene for successful learning. How does the child react to change? What has worked well with the previous teacher and family? What is the child's preferred learning styles and strengths and weaknesses? What are relationships like with teachers and other children? Can you review online files and written notes (school diary) about student progress and behaviour? AGREE A CONSISTENT APPROACH TO MANAGING BEHAVIOURS This chapter has two sections which explain the importance of developing a consistent approach to behaviour for the child with ADHD. The first section deals with consistency in the school environment and this is followed by a section on the importance of a consistent approach from the parent/carer point of view. As a resource this provides combined advice for both the school and parent/carer in presenting a united front. WITHIN THE SCHOOL ENVIRONMENT Achieving consistency in managing behaviour at school can be difficult, as different teachers may be involved. It can be particularly challenging for children with ADHD who need clear, firm and consistent boundaries. Schools can help to ensure a consistent approach to managing behaviour through: Clearly established policies and procedures from the school, to guide teachers and children Ensuring that staff are carefully selected to work with the child along with monitoring and critical self examination to ensure high performance Good staff support and clear communication Consistency and good management strategy from teachers Establishment of a good relationship between staff, parent/carer and child prior to the start of school. Parents/carers can be very helpful to teachers in achieving a well structured approach to managing behaviour while at school Creating a structure for managing a child's behaviour at school As children with ADHD can thrive on familiar structure and routines, management of their behaviour can form part of a strategy that includes their time before, during and after school. It is important for teachers to agree a consistent approach to behaviour management. Reinforce positive behaviour. Positive feedback for good behaviour can encourage the child to repeat the behaviour and improve self-esteem and motivation Provide consequences for misbehaviour. Set clear boundaries about what behaviour is unacceptable, and carry out any actions promised if the unwanted behaviour occurs Act quickly. Feedback, good or bad, can be most effective if it is given immediately after the behaviour has taken place Keep going. Recognise that it may take time for behaviour to change and achieving results may be difficult. It is also important for teachers to communicate a consistent view of acceptable behaviour in the classroom and across the school day. This includes giving all children praise when they behave well e.g.: Following the rules and instructions provided Completing work accurately and neatly Working quietly Keeping the desk clean and neat to minimise distractions (Referenced to Mental Health Foundation). Maintaining a structure for managing behaviour at school Behaviour can be managed more effectively if the school has a well planned system in place. It is important for all the teachers who teach an individual with ADHD to discuss progress, e.g.: What seems to work best with each child Child's attitude and behaviour in different subjects Child's attitude and behaviour towards different teachers Behaviour towards other children and ability to form and maintain friendships Examples of how to gain and maintain attention Any other particular challenges that need to be addressed. Meeting to agree a consistent approach to managing an individual child's behaviour within the school This discussion guide is to support teachers when meeting to agree how best to manage behaviour at school. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for the child's key teacher: Preparing for the meeting Goals Determine systems in place for behaviour management Establish experience with ADHD across the school Agree united approach to behavioural management. Actions Establish what are the child's specific needs? Investigate what systems are in place to maintain a consistent approach to managing behaviour Identify what aspects are best focused on, to address challenges? Establish the experience teachers have in managing the child's behaviour in a consistent way in the past or at lunch times - what successful techniques can be shared? Think about potential barriers facing the school team and support from parents How can the school team best work together for consistency during break times and other periods outside the classroom? Challenges Make sure all teachers understand the child's needs and there are no preconceived misconceptions Ensure all teachers understand the importance of a consistent approach and its maintenance in all situations. Questions Does everyone understand why a consistent approach is important? What are the views of the other teachers on a consistent management approach? What strategies do the other teachers think should be adopted to manage behaviour? Have other teachers got relevant experience of a consistent strategic approach to behaviour? What system would work best for sharing information and feedback? Discussion guide for other teachers: Preparing for the meeting Goals Establish what experience the whole school has of ADHD Confer with all other teachers about ADHD Agree a united approach to behavioural management. Actions Understand the school's relevant policies on managing behaviour such as bullying Establish what the specific child's needs are and what has been done so far What the priorities for managing the behaviour of that child should be - are there any situations that would benefit from a strategic team approach? Find out how the child may react to a more uniform teaching approach across teachers - in terms of discipline and reward systems Determine what information/experience can be shared with other teachers that might aid consistency and improve management technique How best could a consistent approach be achieved if a teaching assistant helps the child? Challenges To agree what the priorities should be and how to manage the consistent approach in different scenarios To agree how to be consistent if a teaching assistant or other members of staff have contact with the child. Questions Does the school or education authority have experience in applying a consistent approach to behaviour of children with ADHD? What does the school consider to be the priorities for a consistent approach across all classes outside of structured learning? How can the parents/carers best support the school in a consistent approach? How can consistency be maintained between the teacher and a teaching assistant? How often should teachers discuss how the behaviour management strategy is working? Discussion guide for the key teacher and other teachers:
During the meeting Goals Determine the priorities to create and maintain a consistent approach Agreement on how often feedback concerning the child's behaviour can take place between the teachers to ensure improved behaviour How a coherent approach can be maintained between the teachers and other members of staff towards the child What key features of the approach will ensure a 'united front' - specific discipline and reward systems When the approach will be implemented and monitoring methodology How often feedback between teachers will take place and system of communication with the parents/carers. Challenges Agree how consistency can be maintained between teachers and other members of staff What key features of the consistent approach will there be to ensure a 'united front' - specific discipline and reward systems Establishing a regular feedback system involving the child's parents/carers. Questions Do any other children at the school require behavioural management? What challenges does the school face in their maintenance of the coherent approach? How regularly can feedback take place between teachers to fine tune their approach? Actions Agree a timeline for these actions and how progress will be assessed to ensure effectiveness Agree who will produce a summary of the meeting with action points and circulate it to all members of staff. Post-meeting actions Produce a summary of agreed action points Carry out actions as agreed to meet the timeline discussed Ensure that all relevant information is passed on as agreed Maintain a consistent approach to the child's behaviour at school Maintain regular feedback between all members of staff regarding the child and successful techniques Maintain regular feedback between the school and the parents/carers. BETWEEN THE PARENT/CARER AND THE SCHOOL Maintaining a consistent approach towards behaviour at home and at school can help the parents/carers and teachers to develop a better understanding of the strengths and challenges associated with a child's behaviour. It can also show the child that teachers and parents communicate, and that there is agreement on important rules and expectations. Common approaches to managing a child's behaviour at home
and school Key approaches valid for home and school can include: Being consistent. Establish that the same expectations regarding behaviour apply to both home and school Reinforcing positive behaviour. Positive feedback for good behaviour at home or school can encourage repetition as well as improving their self-esteem Providing clear consequences for bad behaviour. Consequences for inappropriate behaviour should be consistent and relevant, as well as communicated clearly so that a child understands the implications Acting immediately. Both good and inappropriate behaviour need to be acted on as soon as it occurs so that a child can make a clear link between the behaviour and the reaction Giving feedback. Frequent feedback on all aspects of a child's behaviour can help them to understand positive and negative consequences and exactly what they have done wrong Ensuring repetition. Children with ADHD need repetition to help reinforce the consequences of good and inappropriate behaviour and this should be consistent between school and at home Changing rewards and consequences as needed. Be flexible and change the rewards and consequences for behaviour over time to help stimulate the child and prevent boredom Keeping going. It may take time to change a child's behaviour either at home or at school so persistence is key for long term change. If a child is not paying attention to a teacher or parent/carer some suggested strategies are: To give clear instruction so that there is no confusion or interpretation Try using humour to change the mood from angry or sullen to cheerful Refuse to be drawn into confrontation with the child; just reiterate the instruction and the consequence of not carrying it out On a one to one basis with a pupil a good technique to finding out what is bothering them is by calmly repeating statements such as "Tell me what's wrong so I can help you." "You talk, I'll listen." "Tell me what's bothering you, I'll listen." In handling confrontation with the child some suggestions are: Adopt non-threatening body language (body to side, open arms) Avoid threatening hand gestures (pointing), facial expressions and verbal language (shouting, accusing) Diffuse and de-escalate - use humour, change subject Calmly offer support... "How can I help?" "I'm listening" Passing on feedback Common approaches to managing behaviour can work more effectively if there is a strong and positive relationship between the parents/carers and the school with regular feedback. This can help both the parents/carers and school to: Share what works successfully Modify behaviour targets as appropriate Ensure greater consistency of approach for best response Build a stronger relationship. Feedback can be improved through: Agreeing the method of communication that works best for all parties, e.g. telephone, text, email, face-to-face meeting Agreeing how regular the feedback should be Teachers letting the parents know when positive as well as challenging behaviour occurs which helps to build a more productive relationship Sharing new approaches that have produced positive results. Meeting to agree a consistent approach to managing behaviour at home and at school This discussion guide is to support teachers and parents/carers when meeting to agree how best to manage behaviour at home and school. There are suggestions on important points and questions to consider. Each sub-guide can either be printed and written on or completed electronically. Parents/carers and teachers may wish to share their thoughts before the meeting. Discussion guide for teachers: Preparing for the meeting Goals Agree a coherent approach to behaviour at home and school Confirm behaviour targets that can be agreed with the child's parents Adopt a regular feedback mechanism Agree to tell parents immediately if any unexpected events occur Be open to reasonable requests and consider timelines and who will action them. Actions List priorities for good behaviour by the specific child Manage the expectations of the parents/carers Determine the feedback interval to the parents/carers Effectively manage the relationship between the parents/carers and the school for a consistent effective approach Discuss how the parents might reward good behaviour and handle bad behaviour at home Listen and acknowledge parents/carers allowing them to express themselves uninterrupted Ask parents/carers what they think they need in order to resolve any issues Give them a clear and realistic date when you will contact them and tell them about progress Thank them and remind them that you have their child's best interest at heart. Challenges Agree on the most appropriate and consistent approach Reassuring the parents/carers that the school will act appropriately and consistently in response to the child's behaviour Agreeing similar consequences for good and challenging behaviour Providing regular feedback to the parents/carers. Questions What strategy can we agree for maintaining a consistent approach at home and at school? What are the parents' expectations of the school in maintaining consistency? Are there particular areas of the child's behaviour that should be focused on, based on home experience? At any previous school, did the child behave very differently at home and at school? What are the main challenges for managing the child's behaviour at home? What has been the focus for previous teachers in managing the child's behaviour? Discussion guide for parents: Preparing for the meeting Goals Pass your opinion to teachers about how behaviour should be handled Listen to teachers" experience of ADHD Agree a coherent approach to behaviour at home and school Obtain an assurance that regular feedback will be given. Actions Confirm your expectations of the school in maintaining a consistent approach to managing behaviour List the priorities for maintaining a consistent approach to managing behaviour Determine how often you would like to receive feedback from the school Provide information that will help agree a consistent approach with the school Relate how you successfully manage good and challenging behaviour at home and how this might apply in school. Challenges Be positive in negotiating with the school on managing particular aspects of behaviour Maintaining a consistent approach between home and school Establishing a regular feedback system. Questions What common approaches can be agreed in terms of behaviour? Has the school any experience of working with other parents/carers in managing ADHD-related behaviour? What does the school consider the most challenging aspects of maintaining a consistent approach? What information could be provided to help maintain consistency? How often can feedback on your child's behaviour take place and what method of communication is best? Can the school reassure you that it will aim to maintain a consistent approach? Can you set joint behaviour targets? Discussion guide for teachers and parents/carers: During the meeting Goals Agree the key areas to focus on in maintaining a consistent approach Determine what the priorities are in creating and maintaining a consistent approach Confirm how the parents can play a role in supporting the school Be positive and proactive when talking about the child Common approaches to managing the child's behaviour How often feedback should take place and the preferred way of communicating. Challenges Reassuring the parents/carers that the school will aim to maintain a consistent approach to managing the child's behaviour Maintaining feedback at set intervals. Questions What are the school's priorities for improving the child's behaviour? What are the child's strengths and weaknesses in terms of behaviour? Have there been any differences in the past between behaviour at home and at school? How often would the parents/carers like to receive feedback? How often can the school provide feedback? What support or information can the parents/carers provide to help in maintaining a consistent approach? Actions Agree what the teacher and parents will do, e.g. provide further information that can help the school Agree a timeline for these actions to be carried out Agree when the common approach to managing behaviour will start Agree who will produce a summary of the meeting with action points. Post-meeting actions Produce a summary of agreed action points Carry out actions as agreed to meet the timeline discussed Ensure that all relevant information is passed on as agreed Maintain a consistent approach to good and challenging behaviour and modify as appropriate Provide regular feedback as agreed Maintain a consistent approach if the child's teacher and the parents' main point of contact at the school leaves. REINFORCE POSITIVE BEHAVIOUR This chapter outlines the importance of using positive reinforcement to show children that they have behaved well. Advice is given on the best strategy to adopt including creating a good environment for positive feedback, building on strengths and offering sufficient support. Why positive feedback is important Praise from parents/carers and teachers can be very effective in improving the behaviour of children with ADHD, and motivating them. Letting the child know exactly what is positive and why, immediately following a successful task or period of good behaviour can: Improve the child's confidence in their ability to manage their behaviour Improve their self-esteem Help the child to link the successful action or behaviour to
praise Improve the chances of the child repeating the positive action or behaviour. Children with ADHD need immediate and direct feedback for their actions and behaviour compared to other children. This may mean that a child with ADHD requires repeated recognition and praise. Praise, where appropriate backed up by a tangible reward, is particularly important when a child has persevered with an onerous task that has required additional concentration. The type of action that might require praise: Playing quietly Sitting still, when appropriate Reading independently Waiting their turn Remaining calm when provoked or upset Following instructions immediately Working neatly Keeping their desk well ordered. Newly learned behaviours may require patience and praise for some time until the child carries out the behaviour regularly. This characteristic is inherent to the disorder because of the attention deficit. The link between attention deficit and not learning rules easily is sometimes not well understood. When the required behaviours are learned, parents/carers and teachers can turn the focus on to another area that needs improvement through positive feedback. Creating an environment for positive feedback Parents/carers and teachers can help to create an environment at home and at school that encourages positive feedback. Respond positively more often. While it is important to provide positive feedback immediately following a successful task, it is also important to adapt a consistent response more often than with other children. As a general rule, children with ADHD are used to receiving negative remarks, therefore they need more positive remarks compared to other children. Focus on the positives. It can be helpful to keep a sense of perspective, and keep in mind the child's overall progress. For example, when considering an afternoon of activity, it's often easier to remember the inappropriate behaviour rather than the positive progress made. Focus on the positives and don't dwell on the negatives. Offer appropriate support. Offering support can help the child to get over problems that stand in the way of starting or completing a task. Learning to ask for help is an important life skill. Provide responsibility. Give the child responsibility using simple tasks which can then be praised when successfully completed. As the child grows in confidence and achieves enjoyment and success, the level of responsibility can be increased. Provide rewards. Consider providing simple rewards, such as a fun task in a break, clearly linked to good behaviour or a successful activity. Build on strengths. Every child with ADHD has a number of strengths, whether they are academic, sports or hobby based. Building on these can provide further opportunities for positive reinforcement and improved self-confidence. Praising positive behaviours Positive messages can be given to a child in many ways, from a smile to words of praise or encouragement. Focus on key stages in the task, e.g. homework at the start of homework time recognise that the correct books and materials have been brought home or midway recognise that the homework is on the way to completion or at the end when homework is finished. Pacing praise is important. Keep it focused and simple. Repetition and relevance is more important than long speeches. Use praise in connection with specific actions or behaviour. Indiscriminate or random praise will not help the child to distinguish between good and inappropriate behaviour. Try to be specific about what you are praising for, e.g. `Thanks for putting that away so neatly' instead of `That's great, thanks.' Be careful not to single the child out. Some children can find accepting praise difficult and may need this to take place in a less public arena. Praise can improve self-esteem. Praise can improve a range of positive characteristics such as self-reliance, autonomy, achievement and motivation. Praise will have different effects. The effects of praise will vary according to the gender, home background, abilities and personality of pupils. Praise should be seen as encouragement and as part of a continuing process. Only use praise when it is deserved, otherwise it may reinforce negative behaviour. Use a reward wall. These are often used by parents to track progress by children. They are good to aid ADHD children to track their behaviour progress because they are graphic (using stickers and drawings) and can be regularly reviewed. Use of the reward wall as a tool gives a good basis for a reward strategy. In this way everything is recorded and there is no room for disagreement. Praise is a skill and the options can be varied by including a range of the following: Wallpaper praise...... 'great', 'lovely' Personal praise...... 'you are brilliant' Directed praise...... 'well done for following the rule' Reflective praise...... 'you should feel good about this work' Contextual praise...... 'this assignment is so good I need to show it to the Head so that we can display it on the wall or enter it for an award' etc... To communicate with the parent about a child's good progress there are several strategies which are useful. Conventional communication such as postcards, telephone or text, which are fairly impersonal but rapid Presentation of the child with an award or certificate for good progress or behaviour, which has an added bonus of handing the child the responsibility to tell the parent about their achievement Meeting the parent face-to-face, which should be positive for all as they can confer and take pride from the child's success. MANAGE DISCIPLINE This chapter provides advice and strategies for managing discipline at home and at school. The remit includes building and using reward systems, the use of positive reinforcement methods for discipline and how teachers can best deal with a range of behavioural challenges. Why focusing on the positive can be effective in dealing with discipline Procedures for managing discipline within the school form part of the school's policies. They include guidelines on how teachers should deal with a range of positive or negative outcomes including behaviour that may put other children at risk. Discipline in modern schools can be different to what parents/carers may have experienced themselves. Minor punishments such as detention, expulsion, extra homework, being sent to the headteacher or standing in a corner are probably much the same. In old schools, discipline was reinforced by fear, ridicule and sometimes physical punishment such as hand slapping or caning. Modern schools are not allowed to administer physical punishment, so more creative and positive reinforcement methods are now used including: Removal of privileges Break time/lunchtime restrictions Parent contact Time out for contemplation Extra tasks (cleaning, studying, helping, etc). Parents/carers may find it helpful to: Read school policy on discipline to see the options available to teachers Talk to their child's teacher about what they do to ensure discipline See if there are ways to reinforce the school's approach to discipline, such as using a reward system if their child has shown good behaviour at school. The reward system could be based around the use of a tracking system such as a star chart, when good behaviour is shown. If a number of stars are collected, they could then be rewarded for continuing to behave well. Maybe ask your child to draw their own chart and reward. Positive feedback can be important for a child with ADHD to help improve behaviour, and this can also be an effective way of managing potential conflict, when discipline is necessary. It helps for parents/carers and teachers to think about discipline not as a method of punishing a child for behaving badly, but instead as a way of teaching the child to act responsibly and appropriately. Punishment is a technique of behavioural therapy to stop bad behaviour and to encourage good behaviour. Administering punishment is not intended to make the teacher less frustrated or less angry! Focusing on the positive when dealing with discipline can also: Motivate the child by providing clear consequences for improved behaviour Help parents/carers and teachers to cope more effectively with stressful situations Reinforce the boundaries between good and bad behaviour Reduce tension at home or in the classroom Support the use of reward systems that are already in place for good behaviour. Moving from discipline to the reward system Whether the need for discipline arises at home or at school, it can be helpful to think about the steps that have led to the conflict, effective management and the benefits of a reward system. Don't act out of anger. Wait to enforce the discipline until you have your own emotions under control Stay calm. Speaking calmly will more likely get and keep the child's attention Be concise. Talking too much can result in the child 'tuning out' and not listening. Use a few carefully chosen words to explain yourself Clearly explain that the behaviour is not acceptable. The child needs to clearly understand what they have done and why their behaviour is unacceptable State what you expect from the child. Maintain eye contact and speak clearly and firmly Ask the child to repeat the expectations back to you. By asking the child to verbalise how they should behave, it will reinforce the action Explain the consequences of not meeting expectations.
Make the consequences logical and make sure that the child understands the full implications. Consequences could include restricting the child's freedom of movement or including some
extra chores Explain the rewards for meeting expectations. Reinforce the kind of reward that the child might receive if the behaviour is not repeated and good behaviour is shown Time out. After explaining the reason for the conflict or need for discipline, take time out by stopping the conversation or activity. Doing this may help the child to reflect about the feelings or beliefs that may have contributed to the situation Implement a reward system. If the child does not repeat the behaviour that led to the requirement for discipline, implement the reward system immediately and explain the reasons for doing so. The child receives a reward that is part of the system that is understood by them Only punish the bad behaviour, never punish the child's personality Avoid unreasonable punishment. After neglecting bad behaviour several times, never punish for all the bad behaviour together, only for the last bad action otherwise the child may feel they have been treated unjustly and will react against unreasonable punishment. Occasions to use reward systems during the day Getting up on time Being ready for school on time Leaving home on time Arriving at school on time Being at lessons on time Having correct books and materials for each lesson Behaving well during break times and lunch time Behaving well during lessons Getting home on time Having the correct books and materials to complete homework Completing homework. Class-wide reward systems Schools also use reward systems in general class activities for other children. The question here is how does a child with ADHD fit into this? The child should take part in the whole class system but there should be an additional element to cover specific targets due to their ADHD By using a different reward system for a child with ADHD the teacher must be careful not to stigmatise or draw undue attention to them from other children in the class The child should also take part in reward systems at home, run for the main benefit of other siblings, but there should also be a specific system for them. DEAL WITH ANGER AND FRUSTRATION This chapter outlines the best strategies in the management of challenging behaviour, anger and frustration. There are sections on recognising the warning signs, how to deal with anger and how the family can cope with a child's anger. There are games and exercises to help the parent/carer discuss and understand a child's emotions and feelings. Dealing with anger, frustration and other challenging behaviour Feeling angry and frustrated is natural, but how we act on those feelings can create difficulties for children with ADHD, their siblings, parents/carers, teachers and other children. All children, including those with ADHD, can learn warning signs and triggers to help control their anger before it gets out of control. This can help to lessen the effect of the anger or frustration on others. Parents/carers and teachers can also learn how to identify warning signs and triggers, how to intervene to prevent the development of challenging behaviour and how to deal with an angry outburst so that the situation can be resolved more effectively. Dealing with an angry outburst Dealing with an angry outburst can prove challenging for parents/carers and teachers of children with ADHD. The following steps can help to cope with the outburst, calm the situation and move forward: Wait until the child has calmed down, however long it might take Try to listen to the child to understand their reasons for anger Explain that you want to understand what was going on Listen to the explanations that the child provides Also listen to the other children involved in the incident Talk about the emotions and feelings that lay behind the anger Discuss a way forward to try to avoid the feelings leading to further outbursts. Some children with ADHD may find it difficult to express how they feel in words and they may find it easier to draw pictures of how they are feeling. Some children with ADHD can display aggression or frustration because they cannot express themselves in any other way. Discussing feelings with the child can help them to find ways to talk about their feelings and emotions. Where there is difficulty in expressing anger in words, it may be useful to use a 'mood thermometer' with a scale from 1-5 to allow anger or frustration to be indicated without needing to express this verbally. A template is provided here to download, and there is also a graphic box to allow the child to draw what is making them feel the way they do. Coping with the challenges of dealing with an angry outburst An angry outburst can involve many things: Actions Thoughts Feelings Words The way the anger is communicated The effect of the anger on others. Coping with these different aspects of an angry outburst can prove challenging for the recipient of the anger. Do not take it personally. Do not interpret the child's anger as being personally directed towards you, but take a step back and put the comments made by the child into context Try to distinguish between the child and the behaviour. By definition, children with ADHD may have less control of their emotions than others. It can damage your relationship further if you blame them, or hold a grudge against them for an outburst. It's not easy when the child says or does hurtful things, but try to see them as the child you know they are - not just their latest outburst Take time out. Walk away from the angry situation for a few minutes to cool off and avoid saying anything that you might regret later. It is also important to remove the child, if possible, from the situation and allow them to calm down Talk it through with somebody afterwards. Talking anger issues through with other people such as members of an ADHD support group, may help you to reassess things and identify other ways of dealing with anger that have been successful Allow the child to express their anger safely. For example, allow them to hit a large cushion with a rolled-up newspaper or stamp their feet loudly outside. This releases built up physical tension and energy in a more controlled way, after which they will be more likely to discuss their feelings in a calmer mood. Family-based strategies for dealing with angry outbursts It can be important to look at strategies for dealing with angry outbursts that involve the whole family. No matter how much the family loves the child, having a child with ADHD can put relationships under strain. The challenges of living together can result in anger from any of the family members. Source of anger Strategy Your child does not agree that specific behaviours are unacceptable Set some 'anger rules' for home and put them in a place where everybody can see them, e.g. counting to 10 slowly or trying to explain your side of the situation - Be specific about what the issue is - Avoid blaming the person, but make clear what is not acceptable Explain that everyone gets angry sometimes, but how we behave when we get angry can hurt others The rules can state that while it is normal to feel angry at times, this does not mean that anger involves hurting yourself or other people. Source of anger Strategy Your child finds it difficult to express anger in words Discuss feelings and emotions with them to help them become more comfortable in expressing their feelings
'Quiz time' - provide quiz questions or word searches that you can help your children work through to enable them to talk through feelings or issues that are prompted by questions such as e.g. 'Why am I happy doing sport?', 'Why am I frustrated doing homework?'
'Picture prompts' - suggest your child draws a picture of how they are feeling in the challenging situation to visually express their emotions and their point of view
'My body' - ask your child to sketch an image of themselves and point out what it feels like when they are really angry, i.e. fast heart, tight tummy, clenched teeth Source of anger Strategy Your child finds it difficult to express anger in words 'Scrap it' - ask your child to reflect on a difficult situation and draw how they feel. You can ask questions to explore with them why the behaviour is wrong and the implications, leading to what they should do to resist the urge in the future. Once in agreement, your child can scribble it all out or screw up the paper and bin it along with the 'old' way of behaving You become angry because of the actions of your child, e.g. untidy bedroom Do not do or say something that you might regret later or make the situation worse Focus on your ability to calmly help your child improve the situation that is causing the anger Ask yourself what your goal is in helping your child. Think about what the next step is in reaching this goal and what you are already doing to get there Areas to consider before discussing feelings with your child It is worth preparing before you discuss feelings and emotions with your child. How do I make time to discuss feelings and emotions with my child? What is stopping me from talking to my child more regularly about feelings? What aspects of emotions and feelings do I think are most important for my child? As a family, how comfortable are we about talking about emotions and feelings? Do I think I know what my child is feeling? Does my child talk to me about how they are feeling? Is there another way of expressing emotion that they may prefer? Drawing or a diary? How I can help my child to talk to me about how they are feeling? When does my child appear to be happy and thoughtful? When does my child appear to be most anxious and angry? What is the likely trigger of this? Do I know if my child talks to anybody else, e.g. siblings, friends, about how he/she is feeling? Before you do talk to your child, it is also worth considering the following: The best time to do this, e.g. when there is no pressure to do tasks such as homework or not too late in the day when the child might be tired How you might introduce the subject of feelings - not only the child's, but how it makes you feel, or the individual who the anger is directed at How you might relate feelings to different aspects of the child's life How you might relate feelings to positive aspects of the child's life How you can deal with trickier areas, e.g. anger management How long you can speak to the child for before the child gets distracted or has had enough. How is your child feeling? The following quizzes can help your child reflect on what they are feeling, where and when they feel this and words to help them express emotions. Work through the quizzes and talk through some of the issues that may arise, e.g. 'Why am I happy doing sport?' 'Why am I frustrated doing homework?' Quiz for children: What do I feel and when do I feel it? Link up a word in the 'What do I feel?' column with a word in the
'Where do I feel it?' column. You can draw as many links as you like between the two columns. When you have finished: See what the words with the most links are Talk about a time when you felt like this What is the happiest link between the two columns? Column 1: What do I feel? Column 2:
When do I feel it? Happy At home Sad While doing a hobby Worried In the classroom Angry In break times Clever While doing sports Grumpy Travelling home from school Frustrated At the shops Excluded Doing homework Frightened Out with my family Bored Out with my friends Annoyed Talking to people who don't know me Silly Watching TV or playing computer games Lonely Talking to teachers Excited. Helping my parents/carers at home. Wordsearch for parents/carers and children An interactive way of discussing emotions: create a wordsearch grid including happy, delighted, excited, pleased, sad, cross, angry, lonely, grumpy, and frustrated. Ask your child to find the words and as they find each word, ask them to think about when they last felt this way and talk about what made them feel like this. Make a note of the words talked about most and use this as a basis to: Improve reward systems by developing a better understanding of what motivates the child Prevent challenging behaviour through understanding what the child finds frustrating or what makes the child angry. LOOK FOR WARNING SIGNS This chapter outlines some of the causes of challenging behaviour
in a child with ADHD and suggests strategies for intervention and management. Triggers and interventions - spotting warning signs for challenging behaviour Helping a child to understand the triggers of challenging behaviour can be the first step to enable them to manage their feelings and approach situations calmly. Parents/carers or teachers can: EXPLAIN Explain that everybody can feel angry at times and have their own way of showing they are frustrated. RECOGNISE Help the child to recognise the warning signs that indicate they are starting to become upset. For example: 'I talk louder' 'My cheeks get hot' 'I clench my fists' 'My heart beats quickly' 'My mouth gets dry' 'I breathe faster' POINT OUT Once a child is aware of their own anger signs, they can be highlighted by parents/carers or teachers whenever they start to show. The more help a child receives to identify the warning signs, the easier they may find it to remain calm. The 'red flag' system This can be used to highlight the child's emotional state. The child can be asked to select a picture of themselves, or draw one, and point out expressions that reflect warning signs for intense emotion. In this way both parent and child can learn the signs, which indicate a need for emotional support prior to a potential period of inappropriate behaviour and intervention can be made possible. Intervening to prevent challenging behaviour Challenging behaviour by a child with ADHD can arise from everyday activities both at home and school. The following table lists some situations that could lead to challenging behaviour, together with ideas for intervention and prevention. Situation Potential problem leading to challenging behaviour Suggestions for intervening to prevent challenging behaviour Waiting Any kind of situation involving waiting can be difficult, e.g. queuing. Plan ahead and try to limit waiting time if possible Situation Potential problem leading to challenging behaviour Suggestions for intervening to prevent challenging behaviour Remembering rules and instructions A child with ADHD may forget rules and instructions as soon as they are provided. Due to the attention deficit, they are less able to retain the rules in their head. Minimise the use of oral instructions and ask the child to repeat them after you - ideally provide this in a written, visual format Consider including simple rules as part of home/school timetables using colour-coding for emphasis. Sitting and concentrating The child's short attention span may make sitting and concentrating difficult. Let the child scribble or draw, in a controlled way while you are speaking Link things to specific interests of the child to help focus attention Make all instructions very clear and consistent. Situation Potential problem leading to challenging behaviour Suggestions for intervening to prevent challenging behaviour Accepting responsibility A child with ADHD may fail to accept responsibility for their part in a situation. Remove the child from the situation to a place where they can vent their frustration Do not try to argue with the child - this may only add to their frustration Clearly explain the situation and why they may be personally responsible - help them understand why. Getting started on tasks There may be a reluctance to carry out a task, i.e. starting homework or leaving for school. Gently explain the need to carry out the task before moving on to more interesting things Highlight the sense of achievement when the task is completed. Situation Potential problem leading to challenging behaviour Suggestions for intervening to prevent challenging behaviour Changes in plans and schedules The child with ADHD may not understand why plans can change at short notice and this may cause a behavioural aberration. Clearly explain why there has to be a change Minimise any disruption if possible Thank them for their understanding or good behaviour. BUILD SELF-ESTEEM This chapter contains two sections that explain the importance of self-esteem in ADHD and suggest the best ways to build and maintain this at school and at home. UNDERSTANDING AND BUILDING SELF-ESTEEM Why self-esteem is important for a child with ADHD Self-esteem can be a problem for people of all ages, but it can be a significant issue for a child with ADHD. Children with ADHD may receive fewer compliments and positive responses, as well as more criticism, than other children They may feel bad about themselves in comparison with their siblings or other children, who can appear to them to be more successful and receive more compliments Being unable to control certain behaviours can lead the child to feel that they have failed, e.g. an inability to remain seated when the teacher has told them to sit quietly Some may feel they have not achieved their parents' expectations which can lead the child to feel that they are a failure at home and/or at school, e.g., poor exam results Struggling with social situations, including difficulties in making
and keeping friends, can reinforce the child's negative view
of themselves Children with ADHD tend to see themselves according to the most recent events in their lives, rather than building up a self-image over time. For example, if they have been in trouble a lot recently, they may consequently feel bad and not remember previous positive events. Parents/carers can work with teachers to agree shared approaches to improve a child's self-esteem by focusing on positives and reduce the effects of criticism. They can also plan projects and events that will engage the whole class and provide an opportunity for children with ADHD to excel. What works well for children with ADHD should be suitable for all children, helping to promote understanding and bonding between the whole class. The effects of low self-esteem Difficulty receiving compliments and may interpret what others say as criticism, even though it may be a compliment Loses belief in their abilities and has little interest in trying to do anything because of a fear of failing and receiving negative comments Negative outlook which can sometimes lead to moodiness and depression. Building self-esteem Point out the positives. Acknowledge things the child does correctly, rather than criticise what is wrong Give compliments. Compliment at the right time, instead of only being critical. When a child is doing something well or being good, tell them immediately that you appreciate what they are doing Provide responsibility. Delegate simple tasks and create a reward system for successful completion. As a child shows increasing ability more responsibility can be given Build on strengths. Encourage the child to develop their strengths and interests, whether they are academic, sporting or creative, and celebrate their achievements Offer encouragement. Provide encouragement, particularly when the child is doing something challenging Have faith in the child's abilities. A child can benefit from sensing that others believe in them and have faith in their abilities. This may also encourage a child to strive to achieve more Acknowledge improvement. Recognise progress (even when small) and offer praise when appropriate - this helps to focus on the positive Put mistakes into perspective. Help children understand that everybody can make mistakes and that we can all learn from them. Some children with ADHD can make the same mistake repeatedly and more patience is required when dealing with this Focus on the process, rather than the product. Try not to focus on the end result, but instead give praise as each section of a task is completed Teachers should provide opportunity to engage. It is important for the teacher to engage the whole class and promote interesting projects that will support the child with ADHD as they work to their strengths in a class 'team' environment. This provides a sense of equality, achievement and 'worth'. It may help children to write down what they feel they are good at, as well as ask their parents and friends to also share their feelings. This will allow the parent/carer and their child to sit down together and produce a written document of what their child is good at to increase confidence and provide support for the future. A template for collecting this information is available to download. AGREEING SHARED APPROACHES The self-esteem of a child with ADHD can be improved if parents/carers work with the child's teacher to agree a common approach to the issues causing the child to develop a poor opinion of themselves. Sharing strategies that work If the parents/carers are working to improve self-esteem at home, but excessive criticism is received at school, the overall effect can still reinforce poor self-esteem with the negative potentially outweighing
the positive. Strategies that can work at home for building self-esteem may need to
be adapted for the whole class at school, rather than just children with ADHD. This can avoid isolating the child with ADHD and making them a 'special case' compared with the other children. The strategies can include: Providing responsibility. Giving simple and clear tasks to children can build responsibility and a sense of achievement. A reward system for the whole class can be developed for use upon completion Building on strengths. Encourage children to develop their strengths and interests. Use positive communication to build up self-esteem Offering encouragement. Provide encouragement, particularly when the class is faced with a difficult task Acknowledging improvement. Recognise progress that any child makes even small steps. Use yourself as point of reference: it makes me happy when you... Balancing criticism. When there is a need, balance the pros and cons. A child with ADHD will tend to just remember criticism, not achievements Strengthening communication. Use a daily report card as a means of communication between teacher and parents, especially in cases of parental separation or divorce where it may be more difficult Giving time and attention to the child on non-scholarly issues. This should not be about results or behaviour but how they feel and what they would like to do Looking proactively for opportunities to show talents. Possibly suggest some appropriate whole class projects or field trips. Communicating feedback Regular feedback can be important in helping parents/carers and teachers to share strategies. As with feedback on other areas, parents/carers and teachers can agree: How often the communication and feedback should take place How the feedback should take place - by phone, email, text or a face-to-face What needs to be discussed in this process, e.g. success and improvements with self-esteem and friendships, as well as current challenges Whether these communications should focus only on the child's self-esteem or be included as part of wider feedback on behaviour and performance Whether to use written material to communicate between school and home, i.e. daily report card To expand the use of resources to benefit all children in the class. DEVELOP TIME MANAGEMENT AND ORGANISATIONAL SKILLS This chapter suggests a range of strategies for the development of good time management and organisational skills in the school and home environment. BUILDING ON KEY STRENGTHS TO DEVELOP CORE SKILLS Tips for time management success Children with ADHD can find time management to be a challenge because: They can get distracted by activities around them They can find it difficult to understand or estimate how long it takes to complete a task Their attention may be diverted away from one task to another. "Time is their enemy" A mother speaking to a member of the Taskforce Improving the child's time management skills can help plans at home and school to run more efficiently. Time management can be improved by the following, which focus on the key strengths of the child. Breaking down larger tasks into smaller achievable actions that do not overwhelm the child. Together you can then decide how much time each smaller action will take. Successful completion can provide a sense of achievement that can improve self-esteem Ensuring that the child can tell the time and wears a watch to help them take responsibility for their own time management Working with the child to develop a schedule for tasks such as homework, give a set time for completion of each within the overall homework timeframe. You can suggest a timer or mobile phone alarm to allow a break of 5 minutes every 20 minutes and encourage the child to get up and move around during the break times Keeping home and school schedules clearly visible to remind the child of the next task and when it should take place Implementing a reward system for successful time management at home and at school. Try to incorporate the talents of the child to help strengthen their self-esteem Being prepared, planning ahead and encouraging your child to do the same. You could also present minor possible choices to help the child have influence over decision making. Tips for keeping organised Keeping organised can also be a challenge for a child with ADHD
who may: Be forgetful and get easily distracted Not concentrate on where things are kept or have been left Not always remember to look at schedules. A child's organisation can be improved by: Using colour-coding to make information on schedules easier to understand Ensuring that schedules/timetables for home and school are in places where the child can easily find and refer to them. They are also in familiar places such as inside their school bag Parents/carers or teachers checking frequently to see that the child is keeping to the schedule and offering encouragement and praise Providing checklists of what to take home and what to take to school Using organising systems such as appropriate storage areas for books, clothes, toys etc. Producing a chart to determine where to keep things (desk at home, desk in the classroom) Keeping a notebook or chart to make sure that the correct materials for completing homework are brought home Implementing a reward system for achievements relating to organisation. MANAGE LIFE AND CAREER EXPECTATIONS This chapter makes suggestions to promote a positive outlook, build on strengths and how to channel energy and enthusiasm to the right career in the future. Encouraging positive goals and expectations As part of providing a positive outlook for children on how their life will develop, it may help them to draw upon what has happened in the past and what they would ideally like to see as part of their future. A template 'life map' is available to download and provides a storyboard for the child to draw in and express their thoughts about their achievements and their future as they perceive it. Understanding the challenges at work The work environment can present a number of challenges for a person with ADHD, some of which can be similar to those faced
by a child at home or at school, e.g. building and maintaining relationships. While the symptoms of ADHD can affect a person's ability to carry out a job many people with ADHD do have successful careers in which their strengths and abilities are developed and maximised. The key challenges facing a person with ADHD at work may include: Creating balance. People with ADHD may go to the extremes, either avoiding work or becoming a workaholic. They may need to work harder at creating and maintaining a work-life balance Getting along with colleagues. Relationships with work colleagues, including those in authority, can present real challenges. Some symptoms, such as impulsivity, may lead to potentially difficult situations and they may need to work hard to build and maintain strong relationships Maintaining perspective. Dealing with the everyday aspects of a job while also looking at the bigger picture can prove difficult - they may find themselves lost in detail and forgetting about other tasks or the reverse Being organised. Organisation can be an ongoing problem for people of any age with ADHD and can be compounded by the demands of the workplace Taking responsibility. People with ADHD can find it difficult to take responsibility for their actions at work and control their emotions, particularly in confrontation Planning. Planning to achieve a specific objective can prove difficult for a number of reasons, including poor planning or time management Staying on task. They can easily get distracted and have difficulty staying with a task until it has been completed. Finding a suitable career A useful starting-point to finding a suitable career is to think about strengths and weaknesses. A person with ADHD may be very aware of their weaknesses through their experiences inside/outside school and may find it harder to think about what they have achieved. It may help to consider strengths and positive abilities that can arise from some symptoms of ADHD, for example: Energy. If harnessed in the workplace, their considerable energy can help them to get a lot done Focus. Although they are often thought of as having problems with focusing, it can actually mean that they have a problem with regulating their attention. One advantage is that they often ignore trivial things, but are able to focus on something interesting very intensely Creativity. As they may have very busy minds, with lots of thoughts and uninhibited ideas springing up, this may offer new solutions and approaches at work Handling chaos. They can tolerate and even thrive in a chaotic and busy environment Adaptability. May be highly adaptable which can enable them to adjust and be flexible in ways that other people might resist or have difficulty with, for example, working alone or at odd hours. Once strengths and weaknesses have been identified, it may be possible for a person with ADHD to channel their search for a suitable career towards particular areas of work while ruling out others. A career should have some aspects which drive their curiosity or has connections with their interests. There are many sources of information that may help in refining the search for a suitable career. The internet Career counsellors both at school and outside Trade associations Libraries Positive role models Job coaches Local ADHD support groups. Looking at longer-term plans Career progression can be difficult, in particular, trying to think long term with likely indecision. Career counsellors may be able to help by offering advice on the options that may be available and the steps that need to be taken to achieve a future position. In producing realistic job plans it must be acknowledged that adolescents with ADHD mature much later than their peers and may need more time
to accomplish the necessary life skills. In this instance a life coach or counsellor might come in useful to help development or highlight potential. READ INDIVIDUALS' FEELINGS This chapter gives some insight into recognising and understanding changing moods and feelings in children with ADHD. In addition some suggestions are made for techniques to help control emotions. Understanding changing moods Children with ADHD can experience extreme and frequent changes in mood, from being happy and hopeful, to angry and frustrated. These changes are not necessarily the result of any specific action and can occur as a result of: Low self-esteem. A child may have poor self-esteem, built up over time, as a result of negative responses from other people A tendency to jump to conclusions. They may jump ahead and reach a conclusion without necessarily having the evidence, resulting in a change of mood according to their conclusion Medication wearing off. If a child is taking medication, they may experience a change in mood as it wears off. If this continues, the type of medication or dosage may need to be adjusted Rebound effect. In this instance as a child's medication wears off there can be an increase in ADHD symptoms or irritability A related condition. Alongside their ADHD, a child may experience depression or anxiety - co-morbidities are very common. Managing moods Parents/carers can try to help the child manage their moods, particularly if they are negative, by talking through and encouraging the child to follow the steps below: THINKING ... about what they feel based on what is happening at the moment and on known facts. CANCELLING ... the thought if it is not based on current actions and known facts TAKING ANOTHER LOOK ... if a negative thought is based on what is happening right now, it doesn't necessarily have to lead to a negative feeling or mood. By taking another look at what is happening, it may be possible for the child to view things more positively. Goal setting exercise An exercise that may help managing inappropriate moods, involves asking your child to draw a picture of what is annoying or hurting them and discussing what they would prefer to happen. This promotes awareness of their emotions and feelings in relation to other people. DEVELOP AND MAINTAIN FRIENDSHIPS This chapter makes suggestions on the best ways to develop and maintain friendships. It explains the difficulties encountered by a child with ADHD and how parent/carers and teachers can help to remove barriers and promote valuable relationships. Creating positive relationships Developing and maintaining friendships are important for all children, however, it can prove difficult for children with ADHD because they: Can have problems reading the signals of successful communication, such as a smile or a frown, which other children understand immediately May appear exciting and different to other children initially, but this attraction may wear off as the other children grow tired of their behaviour May mature at an older age and therefore need adult support even as adolescents. While parents/carers cannot force friendships between children, they can take steps to support and maintain friendships. These can include: Opening the family home to friends Only inviting three friends home at any one time to prevent any situations getting out of control Encouraging the child in building relationship with friends - even though it includes more adult effort Setting clear rules concerning when they can see their friends so that everyone understands the boundaries of what is/isn't acceptable Planning ahead and explaining about ADHD to the friend's family if any visits are planned Avoiding activities with strong elements of competition, whilst encouraging those outdoor activities with better opportunities of breaks and time out. As described above, children with ADHD require extensive support from parents and carers to build up and maintain friendships - they need "external frontal lobes" which are the brain's emotional centre. Below are some of the factors which affect a child's ability to form friendships: Achieving positive self-esteem and self-knowledge - these factors are essential to avoid the conflicts Lack of social and communication skills - social training can be used if problems persist from the age of 10 years Misinterpreting others - the ability to read the signals of body language and empathise with others, as well as understand how others are feeling Inappropriate behaviour - invading the personal space of others and being a poor 'sport', unable to lose in games. Overcoming barriers to friendships Parents should encourage their child to find arenas for excellence, where they can compete with others. They should try to use their creativity and good spirit to inspire classmates. If the child has a skill they could use it to help their class mates, this could promote friendship and also provide a boost to self-esteem. The use of social media is an option that can be encouraged to promote a network of school friends to share in the child's life, increase interests and combat boredom, however it is important for this to be supervised, to monitor for any signs of cyber bullying. Sometimes it may be necessary to realise, that a life with ADHD creates challenges where periodical loneliness is part of life, and may be adjusted by using social media as means of communication and friendship. TRAIN AND SUPPORT PARENTS
AND CARERS This section contains details of materials and websites that provide information for parents/carers of children with ADHD. It includes publications that specifically look at family life and websites that offer links to local resources. Publications: Family Life with ADHD (Familieliv med ADHD) [Danish] Anne Worning and Jan Bjerregaard, Danish ADHD-association, 2010 The purpose of the book is to bring real stories of real families with ADHD in the aspect of changing the common picture of the families and their children. www.adhd.dk ADHD? laat je niets wijsmaken!, Hermien De Backer,
Antwerp, 2005 [Dutch] A book that uses examples of young people with ADHD who have used their talents towards positive goals to show what can be achieved. ADHD for Dummies, Jeff Strong and Michael Flanagan,
Wiley Publishing Inc, 2005 Please donít be put off by the title ñ this is an easily understood guide that helps with symptom recognition and treatment options. It gives an excellent overview of a variety of therapies and offers advice on gaining the best support. Attention Deficit Hyperactivity Disorder: Information booklet. This is an information booklet produced by the Sheffield ADHD Multi-agency Steering Group in 2005 and reprinted in 2008. The publication provides information on the causes, diagnosis, treatment and management of ADHD and explains to parents what should be expected from health and education authorities. Contact details: Lisa Mangle ADHD youth literature series [Dutch] The books contain ADHD-related stories and guides available in Dutch, including an ADHD survival guide, dealing with aggression, organisation and how to make friends. http://www.zitstil.be/shop?page=shop.browse&category_id=5&vmcchk=1 BasoFiche forms [Dutch] These forms are used in the Ghent region of Belgium in Catholic secondary schools to provide a handover assessment for children prior to them starting at the new school. This resource may provide a helpful exercise for both parent/carers and teachers. http://basofiche.zapto.org/ Being a Parent in the Real World: A supportive guide to being clear, staying calm and remaining confident , Laverne Antrobus A resource for parents and carers giving advice on how they should best respond to their childís behaviour and what is best for both parents and child. The pamphlet was written by the well known psychologist, Laverne Antrobus. http://www.dcsf.gov.uk/familyinformationdirect/downloads/BeingParentinRealWorldbkt.pdf Calm Your Hyperactive Child: 52 Brilliant Ideas for Coping with ADHD, Dr Sabina Dosani, Infinite Ideas, 2008 This book provides straightforward advice on what techniques to use in managing ADHD. The independent chapter format of the book allows it to be used as a reference book without having to read it cover to cover. Managing ADHD: Setting the child up for success, Debora Bradbrook, Sheffield ADHD Project This is a ten week course for parents/carers of children with ADHD run by the Sheffield ADHD project. The course gives guidance on advice about all aspects of ADHD, including diagnosis, organisation, communication, understanding and medication. This will provide the parent with an excellent resource in understanding and managing their childís behaviour. Contact details: Lisa Mangle Tips for Management of Children with ADHD, Fintan OíRegan (Behaviour Management Consultant) These are easily understandable lists of hints and tips for managing challenging behaviour from children with ADHD. The three lists cover strategies for managing distractibility and improving concentration, handling the child during homework and strategies for recognising and managing Oppositional Defiant Disorder. www.fintanoregan.com Websites: http://www.addiss.co.uk/adhd.htm The National Attention Deficit Disorder Information and Support Service (ADDISS) provides information, training and support for parents, sufferers and professionals in the fields of ADHD and related learning and behavioural difficulties. All their activity is supported by a Professional Board of expert advisers. http://www.adhdeurope.eu The website of the pan-EU association, ADHD-Europe. It provides a range of resources including news, conference dates and learned articles about ADHD to support all those people involved with the condition. http://www.aifa.it An Italian website for parents and carers of children with ADHD. http://www.hadd.ie A volunteer-led website that provides information on ADHD and the resources available to children with ADHD and their parents/carers in the Republic of Ireland. http://www.feaadah.org/TDAH_Guiapadres.pdf This is the Spanish Federation website guide, which is targeted at parents and carers of children with ADHD. http://www.mentalhealth.org.uk/information/mental-health-a-z/adhd/ This UK web resource provides a short summary of ADHD, implications, symptoms and treatment. http://www.nhs.uk/Conditions/Attention-deficit-hyperactivity-disorder/Pages/Introduction.aspx This UK website provides a range of information for parents/carers, teachers and health professionals on causes, symptoms and treatment of ADHD. The website includes videos, articles and also a forum where parents and teachers can confer with each other, ask questions and relate experiences. www.ukann.co.uk The UK ADHD Nurse Network (UKANN) is a website created to support nurses who work with children, young people and adults who have ADHD. The website is in its early stages, but can be used as a first port of call to provide appropriate information and UKANN conference dates. http://cuentoscuentocontigo.blogspot.com/2008/12/coleccin-cuento-contigo.html Four childrenís stories published in Spanish by CEPE and targeted to help children with ADHD and their parents www.editorialcepe.es The four story titles are: Mi Mam· es verde, mi vecino naranja Elena y el camino azul Prepar·ndome para ir de cumpleaÒos La gymkana de emociones Contact details: clientes@editorialcepe.es http://www.mind.org.uk/help/diagnoses_and_conditions/adhd Mind publishes information on many topics, including ADHD. These
are grouped into seven broad categories: diagnoses and conditions, treatments, mental health statistics, support and social care, communities and social groups, and society and environment. Useful resources containing information about other conditions that may occur with ADHD: ADHD Comorbidities, Handbook for ADHD Complications in Children and Adults,, Thomas E Brown, American Psychiatric Publishing, 2009 Depression NHS Choices (UK) provides guidance for hundreds of conditions, including depression, and advice on healthy living http://www.nhs.uk/conditions/depression/Pages/Introduction.aspx http://www.nhs.uk/Livewell/childhealth6-15/Pages/depressioninyourchildren.aspx Tourette Syndrome Information on this link is provided by Tourettes Action, which is a charity working to make life better for people with Tourette Syndrome. http://www.tourettes-action.org.uk/symptoms/ TRAIN AND SUPPORT TEACHERS
AND SCHOOLS This section contains details of publications, websites and training courses for teachers of children with ADHD. It covers a range of relevant areas including classroom-based learning solutions and teacher training. Training All Kinds of Minds A growing body of research supports the idea that students differ in how they are ìwiredî to learn, and that individual learning profiles ñ including strengths and weaknesses ñ can be better understood through knowledge of the brain activities affecting learning. Research done by All Kinds of Minds shows that when educators have an understanding of this knowledge ñ along with tools and strategies for applying it in their classrooms ñ they are more effective teachers. All Kinds of Minds is based around three components: A learning framework ñ All Kinds of Minds has developed a framework of science-based learning ìconstructsî that form the mindís ingredients for learning. This framework provides educators with a foundation of expertise about learning. Classroom applications ñ All Kinds of Minds promotes a problem-solving model that encourages educators to use observations and other types of data ñ gathered from multiple sources ñ to help them identify studentsí learning assets, passions and affinities, as well as their weaknesses. A philosophy ñ All Kinds of Minds advocates a set of core beliefs about how all students should be treated, based on the conviction that learning differences represent variation, not deviation. http://www.allkindsofminds.org/ ADHD, Fintan OíRegan, Continuum International, 2005 This book examines the effects of ADHD on the school and home environments. The publication outlines the diagnosis of ADHD, tools for assessment and intervention strategies. ADHD-AS-DYSLEXIA Family Resources Belgium (AFRB) AFRB provides in-service workshops for teachers in primary and secondary schools throughout the school year. The workshops are run by education and healthcare specialists, with topics including ADHD psychoeducation, inclusive education, skill-building, multisensory teaching strategies, proactive classroom management and creating a climate for success at school. More information on the full range of workshop topics can be obtained. Contact details: info@adhd-edu.be BasoFiche forms [Dutch] These forms are used in the Ghent region of Belgium in Catholic secondary schools to provide a handover assessment for children prior to them starting at the new school. This resource may provide a helpful exercise for both parent/carers and teachers. http://basofiche.zapto.org/ Evidence-based psychosocial treatment for ADHD children
and adolescents This website gives information about the summer treatment programme run by The State University of New York in Buffalo, which is designed to improve the behaviour of children with ADHD. http://ccf.buffalo.edu/STP.php Master NLP Trainer, Julie Inglis Training teachers, learning support teachers and teachersí aides as specialist ADHD and ASC coaches - can be a good way to ensure that there is an expert on site who has the knowledge and skills to train the other teachers. Julie Inglis provides coach training as well as ADHD and ASC psycho-education for professionals who work with children and adolescents. http://www.pps-training.co.uk/ Sheffield multi-professional ADHD steering group ñ time sampling behaviour observation sheet. This is a resource that can be used by observers or teachers in the assessment of a childís behaviour during a task or class assignment. The form allows the child to be assessed over a fixed period of time and provides a rudimentary qualitative scale for behaviour. The Trouble with Maths, Dr Steve Chinn Many children with ADHD can have difficulties in learning maths.
Dr Chinnís course offers a new perspective on the specific problems that can be experienced by children with ADHD. http://www.stevechinn.co.uk/ The Why Try Programme, Christian Moore The Why Try Programme was created to provide simple, hands-on solutions for: Dropout prevention Violence prevention Drug and alcohol prevention Truancy reduction Increasing academic success It was developed by Christian Moore MSW, LCSW, as a method to motivate at-risk teenagers who were failing at school and to give them the self advocacy skills to succeed in life. Christian was diagnosed as a child with ADHD, conduct disorder and severe learning disabilities, but his friendís mother took him under her wing and gave him the stable family life he had never known. He went on to obtain a Master's in Social Work. The Why Try programme is a resource for schools that have problems with unmotivated and under-achieving students who are at-risk of failing. http://www.whytry.org/ Publications All About ADHD: The Complete Practical Guide for Classroom Teachers, Linda J Pffifner, Scholastic Professional Books, 1996 A very practical and easy-to-read book that is divided into many short sections that give detailed information to help a teacher understand and engage a child with ADHD. The book uses lots of charts, boxes, gives many practical tips, and is very up-to-date and focused on the classroom environment. Attention Deficit Hyperactivity Disorder. ADHD and Education: A Resource for Teachers, HADD Family Support Group, Dublin, Ireland The purpose of this booklet is to provide school staff with information on ADD/ADHD, and redress the absence of a widely available written resource for schools on this subject. http://www.hadd.ie/userfiles/file/ADHD-and-Education.pdf Attention Deficit Hyperactivity Disorder: Information booklet. This is an information booklet produced by the Sheffield ADHD
Multi-agency Steering Group in 2005 and reprinted in 2008. The publication provides information on the causes, diagnosis, treatment and management of ADHD and explains to parents what should be expected from health and education authorities. Contact details: Lisa Mangle Challenging Behaviours, Fintan OíRegan, Teachers Pocketbooks, 2006 This book examines the root of challenging behaviour among school children making extensive use of cartoons and diagrams through the medium of three child characters to explain. There are chapters on ADHD, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). The European consensus statement on the diagnosis and treatment of adult ADHD. Sandra JJ Kooij et al, BMC Psychiatry, October 2010:67. The paper details with the incidence of adult ADHD across Europe and how the condition is under diagnosed (lack of expertise in assessment) and remains untreated because of a lack of resources. http://www.biomedcentral.com/content/pdf/1471-244X-10-67.pdf How can we reinforce positive behaviour and help manage behaviour at school? A helpful resource for teachers to help them manage behaviour in the classroom and at school. How to Teach and Manage Children with ADHD, Fintan OíRegan, LDA, 2002 A practical book which uses an anecdotal style to explain the best way to teach children with ADHD. It contains a number of excellent resource materials including key tips, which are presented in an easily accepted style. Managing Medicines in Schools and Early Years Settings, Department of Health (UK), March 2005 This publication sets out a clear framework for supporting children who require medication. The text sets out the responsibilities of each interested party including: local authorities, local health trusts, schools and early years settings and suggests how they can work together to develop appropriate support policies. Mental Health in Children and Adolescents ñ A Guide for Teachers, Sarah Buckley, Bl·naid Gavin and Fiona McNicholas, Mulberry Publications, 2009 This book is written by psychiatrists with extensive experience of working with teachers at primary and secondary level in the Republic of Ireland. The book is an excellent guide focusing on the essentials of child mental health. Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults , National Institute for Health and Clinical Excellence (NICE) in the UK, updated their Clinical Guidance 72 in September 2008 http://www.nice.org.uk/CG72 Tips for management of children with ADHD, Fintan OíRegan (Behaviour Management Consultant) www.fintanoregan.co.uk These are easily understandable lists of hints and tips for managing challenging behaviour from children with ADHD. The three lists cover strategies for managing distractibility and improving concentration, handling the child during homework and strategies for recognising and managing Oppositional Defiant Disorder. www.fintanoregan.co.uk Troubleshooting Challenging Behaviours, Fintan OíRegan, Continuum International, 2006 This book presents current thinking on behaviour management and introduces the SF3R (Structure, Flexibility, Respect, Relationships and Role Models) model of management including a unique contract template designed for students with Social, Emotional and Behavioural Difficulties (SEBD). Young People's Experience of ADHD and Stimulant Medication: A Qualitative Study for the NICE Guideline , Ilina Singh et al, Child and Adolescent Mental Health, 15(4), November 2010; 186ñ192(7). This paper reports on research conducted into young peopleís perception of ADHD and stimulant medication. The work was conducted to provide support for NICE guidelines on treatment of ADHD. http://onlinelibrary.wiley.com/doi/10.1111/j.1475-3588.2010.00565.x/abstract Websites: http://www.addinschool.com An American website that provides advice and tips on working with children with ADHD in the classroom. http://www.feaadah.org/TDAH_Profesores.pdf The Spanish Federation guide, which is targeted towards teachers of children with ADHD. http://www.fundacionadana.org/sites/default/files/LIBRO_ALUMNO_TDAH_(11)_indd_1.pdf ADANA Foundation guide for children with ADHD, which may be used as a resource for teachers. http://www.mentalhealth.org.uk/information/mental-health-a-z/adhd/ This UK web resource provides a short summary of ADHD, implications, symptoms and treatment. http://www.nhs.uk/Conditions/Attention-deficit-hyperactivity-disorder/Pages/Introduction.aspx This UK website provides a range of information for parents/carers, teachers and health professionals on causes, symptoms and treatment of ADHD. The website includes videos, articles and also a forum where parents and teachers can confer with each other, ask questions and relate experiences. http://www.zitstil.be A Belgian website that provides advice and support for teachers who work teaching and supporting children with ADHD. SUPPORT FOR CHILDREN This section contains details on different areas of support for children with ADHD. It includes information on management and treatment, learning support and practical tools that can help the child manage their ADHD. Tools to help Attention Tracker This works in a similar way to the Time TimerÆ and can be used by teachers in the classroom to set a time for a task to be completed. The Attention Tracker uses red, amber and green lights to show how far the child has progressed through the allotted time. Teachers can add or remove time if they wish. Calvin and Hobbes cartoons, Bill Watterson Calvin is a six year-old boy who seems to be in trouble all the time. He often blames Hobbes for this and even though Hobbes is a toy tiger, he is very real to Calvin. Together, they take part in stories and adventures that children with ADHD can relate to. http://www.calvinandhobbes.co.uk Sensory Integration Tools Children with ADHD maybe under-sensitive or over-sensitive to certain situations and therefore not able to accurately process all information from their senses. By helping children understand and develop their interpretation of sensory information disruptive behaviour can be improved. Hallo ñ what do you have (Hallo hvad har du) [Danish] On this site you meet 10 young people who in many ways are very different in terms of education, living situation and geographical location. They do however have one thing in common: they have all been diagnosed with ADHD. In the 7 movies the young people talk about their lives with ADHD, the difficulties in school and the challenges with getting an education. The movies can be seen at www.adhd.dk/hallo and the Youtube channel: http://www.youtube.com/user/hallohvadhardu. There are 2 editions, one in Danish and another with English subtitles. www.adhd.dk/hallo http://www.youtube.com/user/hallohvadhardu Percy Jackson books, Rick Riordan Percy Jackson is a 13 year old boy with dyslexia, who has been kicked out of seven schools but who manages to fight battles with gods, demons and monsters and emerge triumphant in a series of adventures. http://www.percyjackson.co.uk Tangle (TM) Toys Tangle (TM) Toys can be twisted and turned into an endless variety of shapes. They are available in various types and can help to occupy a child who feels restless. Time TimerÆ The Time TimerÆ is an educational tool enabling children to see how much time has passed. It does not have the hands or numbers that a traditional clock face has and can be set for periods of up to 60 minutes. As the time passes, it clearly shows how much time is left in the set period. Whatís Up with Astra? Medikidz Explain ADHD,
Dr Kim Chilman-Blair and John Taddeo, Medikidz Limited, 2010 The Medikidz series of books aim to explain medical conditions to children in a comic book style. The ADHD book focuses on the adventures of Astra and her journey to finding out what happens to somebody who has ADHD. http://www.medikidz.com/ Wilbur, a real brat (Wilbur, en m¯gunge), RenÈe Toft Simonsen [Danish] Wilbur is an annoying brat. At least that is what most children and adults around the little boy seem to believe. And yet - perhaps there is something else that is bothering the little kid. Perhaps Wilbur is a boy who cannot control his high level of energy and always ends up in trouble? www.adhd.dk Wild and quiet (Vild and Stille) [Danish] ìWild and quietî is a national school campaign launched by the Danish ADHD association in spring 2010 with the goal of bringing attention to attention disorders. The campaign received an enormous response rate of 37%, meaning that more than 900 schools actually requested the material. See the campaign at: http://adhd.dk/foreningen/projekter/indskolingskampagne.html and download the material. The material is currently in Danish. http://adhd.dk/foreningen/projekter/indskolingskampagne.html Timer devices There are timer devices, [(10+2)x5 developed as an iPhone app and (10+2)*5 timer for PC], that break down an hour study time into five 10-minute sections of intense work followed by a break of 2 minutes before a further 10-minute section begins. It can be particularly useful for helping to manage homework. USEFUL LINKS This section lists details of additional parent/patient websites and also provides information on alternative strategies that can be considered for treating ADHD. ADHD patient sites http://www.addiss.co.uk/adhd.htm The National Attention Deficit Disorder Information and Support Service (ADDISS) provides information, training and support for parents, sufferers and professionals in the fields of ADHD and related learning and behavioural difficulties. All their activity is supported by a Professional Board of expert advisers. http://www.adhdandyou.co.uk This website provides all you need to know about ADHD whether youíre a parent, child, teacher or healthcare professional. This is a Shire Pharmaceutical sponsored site. http://www.adhdeurope.eu The website of the pan-EU association, ADHD-Europe. It provides a range of resources including news, conference dates and learned articles about ADHD to support all those people involved with the condition. http://www.chadd.org This is the website for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and is a USA non-profit organisation. It provides an excellent support site for individuals with ADHD and their families, producing a print magazine, hosts conferences and carries lots of useful web articles. Alternative therapies There are a number of alternative therapies available, and these include: Diet. Most of the recent research suggests that only a small number of children are affected by artificial food colourings and flavourings that lead to learning, behaviour and attention problems. In general, children need a healthy, balanced and controlled diet and providing extra sugar, in the form of sweets and fizzy drinks may contribute to unacceptable behaviour. NICE does recommend ìparents or carers to keep a diary if there are foods or drinks that appear to affect behaviourî and to see a dietitian if there appears to be any link. Supplements. Although vitamin deficiency can cause a range of problems, three major studies have shown no evidence of success for vitamin or mineral supplements in treating ADHD. Treatment of candida albicans. This is a yeast that occurs naturally in the body that may produce toxins, which weaken the immune system, making the body susceptible to conditions including ADHD. Treatment is based on stopping the growth of candida yeast. There is little evidence that treatment can be effective against ADHD. European ADHD Awareness Taskforce The material contained within this programme has been developed in collaboration with ADHD Europe and an expert European ADHD Awareness Taskforce. Their range of professional expertise has ensured the material has been developed for parents and teachers by their peers, with practical advice based on each taskforce memberís wealth of experience. On the next pages is a short biography from each of these experts. Ms Rita Bollaert (Belgium) Co-ordinator ADHD-Europe Rita has an MA in Classical Philology and is a former ADHD Educator at Centrum ZitStil, Antwerp, a published author of Zit Stil op school (Sit quietly at school, 2002) and co-author of Tieners, Zit Stil op school (Teenagers, sit quietly at school, 2004). She is a founder and coordinator of ADHD-Europe, and responsible for bringing about an effective collaboration between the Dutch, French and English-speaking ADHD organisations in Belgium, with the aim of better supporting people affected by this and related conditions in this country. Tireless in her efforts to spread awareness both in Belgium and in Europe, Rita still manages to teach Latin and Greek at a secondary school in Flanders and bring up four school-age children, one of whom has ADHD. Dr Eric Dickhaus (Italy) Research Director Fondazione Attento Eric graduated from the Universt degli Studi di Firenze in 1985 and subsequently with an MD and a PhD from the University of Missouri in 1992. He was diagnosed with ADHD in 2004. He started the Fondazione Attento in 2008 to address the lack of clarity and coordination of ADHD in Italy, after working with the Italian family organisation as scientific director and regional representative. His ongoing research is in patient safety and error prevention and control. His previous research work was in Cystic Fibrosis. He also works as a Volunteer for the Arezzo ambulance service (Misericordia Val díAmbra) and is a member of the governing board. Ms Agneta Hellstrom (Sweden) Director, ADHD Centre, Stockholm Agneta is a well known and experienced Swedish administrator and policy maker, who has worked for many years with knowledge dissemination and service development concerning children, adolescents and young adults with ADHD and related disorders. She has also written books, chapters, booklets and reports about ADHD and is frequently requested for lecturing, supervising and consultation about ADHD in Sweden. She has a special interest in psychosocial intervention, especially parent education and teacher training. She is also very concerned about parent advocacy and service coordination. Agneta has also developed STRATEGI, a widely used ADHD parent education programme and currently runs SINUS AB, an institute for information and knowledge dissemination in the field of neurodevelopmental disorders, and was one of the founders of Riksfrbundet Attention, a national association for people with neurodevelopmental disorders, founded in 1999. She is a member of their advisory board and also a member of the advisory board of Mind-room, a Scottish charity organisation for people with learning disabilities. Mr Fulgencio Madrid Conesa (Spain) Murcia Social and Economic Council Fulgencio teaches Criminal Law at the University of Murcia and works for the Social and Economical Council of this Spanish Region. He is married with three children and his two boys (aged 19 and 25) both have ADHD. Because the disorder was almost unknown in Spain, he worked to help raise awareness on ADHD-specific problems. As a result, he is one of the founders of the Spanish Federation and ADHD Europe. He is very proud of all the work he is doing with both of these organisations. Professor Fiona McNicholas (Ireland) Consultant Child and Adolescent Psychiatrist Fiona is a Consultant in Child Psychiatry in Ireland since October 2001 and works in Our Ladyís Hospital for Sick Children, Crumlin and Lucena Clinic, Rathgar, with an academic chair at University College, Dublin. Previously, she has worked in Columbia University New York, Stanford University, California and as a Consultant Neuro-Psychiatrist in Guy's Hospital, London. She has a particular interest in increasing public awareness of child psychopathology and developing early intervention and screening at a primary care level. She is committed to teaching both to medical colleagues and other disciplines. Her research interests include ADHD, eating disorders and psychopharmacology. Ms Lisa Mangle (UK) ADHD Clinical Nurse Specialist, The Ryegate Children's Centre, Sheffield, UK At the time of development of this support pack Lisa worked as an ADHD Specialist Nurse and Independent Nurse Prescriber at the Ryegate Children's Centre in Sheffield. Lisa managed the ADHD nurse-led service supporting in excess of 500 children and young people. She was chairperson of the UKANN (UK ADHD nurse network) holding 2 day annual conferences for nurses working in ADHD and won the Florence Nightingale Leadership scholarship in 2010. Lisa Mangle is now a Shire employee, as of 26 September 2011, and has joined the Medical Specialist Liaison team. Ms Joanne Norris (Belgium) President/Chair, ADHD-AS-Dys Family Resources Brussels Joanne is a writing instructor, special needs trainer, coach and ADHD educator. She is also President of ADHD-AS-Dyslexia Family Resources Belgium (AFRB), an English-speaking non-profit advocacy organisation in Belgium. For most of her professional life, she has championed underprepared students at primary, secondary and university level and now advocates on behalf of children and adolescents with ADHD, Aspergerís Syndrome, Dyslexia and other learning disabilities in Belgium for AFRB. Professional memberships include: Institute for the Advancement of AD/HD Coaching (IACC), European Dyslexia Association (EDA), World Federation of AD/HD and PHI BETA KAPPA. She is a Graduate Fellow of the Childrenís Literature Center at USF School of Education, San Francisco. She was elected to the Board of ADHD-Europe in 2007 and has been actively involved in its formation and development since then. Mr Fintan OíRegan (UK) Behaviour Management Consultant
Taskforce Chair Fintan has a well-established reputation as a national and international lecturer in ADHD and related learning difficulties. He has been a teacher and a head teacher in both public and independent schools for over 16 years. Fintan is a Special Education Needs (SEN) advisor for Surrey LEA, an associate lecturer at Leicester University and Director of DC educational services. He was Vice Chairman of the Corporate Members of the British Dyslexia Association from 1996 to 2000 and a member of the London International Schools Association Headmasters Committee from 1997-2002. Fintan is an active member of the National Association for Special Educational Needs (NASEN), the Royal Charter of the College of Teachers and a number of Parent Support Groups. Dr Kirsten Stollhoff (Germany) Consultant neurologist, child and youth paediatrician and neuropaediatrician For the past 15 years, Kirsten has been working in a neuropaediatric community clinic, specialising in the care for children with ADHD, providing neuropsychological testing, EEG, parent training, behavioural therapy group training for children/young people and neurofeedback. Her current professional and extraprofessional activities include: a community clinic as a doctor specialising in neuropaediatrics, clinic specialisation (ADHD - circa 500 patients with ADHD per quarter for the last 16 years), chair of the AG ADHS der Kinder- und Jugendrzte (Paediatriciansí Consortium for ADHD) and member of the editorial board of the journal Pdiatrie Hautnah (Paediatrics at First Hand). Ms Anne Worning (Denmark) Executive Director, ADHD association, Denmark Anne is a Master of Public Policy and a Master in Social Work. She has been Executive Director for the ADHD association since 2007 and is a former Executive Director at the Research Center for Social Vulnerability. Before that she was President in the Danish Association for Social Workers, teacher and consultant at the School of Social Work in Copenhagen, member of the Danish Council on Third Sector (appointed by the Minister of Social Affairs) and Danish Representative in ADHD-Europe. During more than 35 years in Social Work and Social Protection, she has presented on different topics nationally and internationally, and has written articles in Danish, Nordic languages and English.

(IRE/ADHD/11/0009 - 15 September 2011)