ADHD and Kids

By: Jennifer Bellman, Psy.D.

Ah, fall. For many it means a time for apples, visiting fall farms, enjoying the cooler respite from the days of Indian summer, and purchasing any pumpkin-spice-infused food or drink or scent that hits the consumer-driven market. It’s also the time of year when parents (who might have been holding their breath for the first few weeks of school) may grow concerned about their homework-resistant child and when interim reports and/or parent-teacher conferences provide knowledge about a child’s academic progress and behaviors at school. And for some families, notices and emails of concern from teachers arrive well before the parent-teacher conferences are even scheduled.

Fall. It is when parents wonder if their child might have Attention Deficit/Hyperactivity Disorder (ADHD).

ADHD takes on different forms, depending on the age of the child. Generally speaking, the younger the child, the more behavioral problems he or she has likely exhibited in the classroom. These can include anything from talking in class, interrupting the teacher, blurting out answers, pushing others as they form a line, invading others’ personal space, and needing continual reminders to sit in one’s chair. All these are symptoms of impulsivity and hyperactivity and are the most noticeable symptoms teachers observe in class, and they are the most “disruptive” to the process of teaching and learning. It is not uncommon for these children to start exhibiting these difficulties in preschool, when they first enter into a structured group environment with expectations of age-appropriate rules and directions.

Struggles with inattentiveness (without impulsivity or hyperactivity) may start being observed in children as early as the 2nd or 3rd grades, when the fundamentals of reading and math are already expected to have been sufficiently established. Many of these children are not exhibiting outward signs of problems, nor are they causing enough of a disturbance in the class for teachers to place on their radars. Instead, these children are ones who may struggle to complete their seatwork and are required to take it home to finish, make “simple” mistakes in their work, sometimes “stare into space,” forget to turn in their homework, become distracted by other tasks, and/or “do not seem to be performing up to their academic potential.” Due to the quiet nature of inattention, it is also not uncommon for children to first become identified as having ADHD in junior high or high school, when the demands for the academic work become increasingly more difficult. Sometimes, high intelligence in a child can mask underlying inattention and distractibility; the child may still grasp the academic work without showing any difficulties. The more complex the work in school becomes, though, the more opportunities there are for a highly intelligent child with ADHD to exhibit their underlying struggles.

Many people only focus on struggles with inattentiveness, distractibility, impulsivity and/or hyperactivity when wondering if a child has ADHD. The less obvious (and yet very important) areas to consider are those of executive functioning. These are higher-order cognitive abilities “housed” within the frontal lobe of the brain, which is the last lobe of the brain to develop and is not fully formed until one’s mid-to-late 20’s. These skills involve planning, organizing, inhibiting (or, controlling) one’s impulses or behaviors, and other complex skills. We can easily observe how behavioral disinhibition (i.e., dyscontrol) is represented by impulsive acts. Two other areas of executive functioning that are especially noteworthy to consider when wondering about ADHD (and how impairments are observed) include:

Poor time management:   procrastination; conceptually minimizing the time it actually takes to complete a project or an activity; rushing; arriving late most of the time; not utilizing one’s time most effectively; taking longer to complete homework than is expected

Disorganization: having a messy backpack; keeping a messy bedroom or other areas of personal space; being unprepared; losing or misplacing belongings; difficulty knowing how to prioritize tasks in terms of importance; problems completing tasks or projects; forgetting assignments, due dates, appointments, or other tasks

Many parents question whether their child is just “not motivated enough” to complete their work. This is certainly of note to consider. It is important to understand, though, that for individuals with ADHD, it is much less about internal motivation to complete a task and much more about the desire to avoid the difficult work one faces with having to sit for a seemingly long duration, sustain one’s attention, organize one’s thoughts, and minimize distractions. We have a natural tendency to avoid what we find difficult; so, of course, individuals with ADHD try to put off tasks that require significant mental effort.

Besides medication, strategies to help improve attention, inhibitory control, organization, and time management involve implementing structure and routine. Limits and expectations, especially for house rules such as not allowing leisure or “screen” time until homework is completed, are helpful. Reminding children about the differences between tasks that are required (i.e., homework) versus optional (i.e., play time) can also be helpful. Using multiple forms of scheduling items also is recommended, such as a daily agenda, a week-in-view planner, and a month-in-view calendar help to prioritize activities and time so as to accomplish tasks.

Of course, the struggles discussed here may also represent other underlying issues beyond ADHD. For instance, problems with impulsivity, inattentiveness, behavioral disruption, and physical restlessness could be accounted for by an underlying medical condition (e.g., hyper- or hypo-thyroidism), insufficient or poor quality of sleep, adjustment to significant changes in one’s life (e.g., a move or a parents’ divorce), affective or mood states (e.g., anxiety or depression), a behavioral disorder (e.g., Oppositional-Defiant Disorder), or other possible contributions. These must always be considered when assessing whether one has ADHD. Regardless of the underlying cause of such struggles, the recommendations used for improving structure, time management, and organization are helpful for most children, anyway.