Need to know

As a parent, it can be concerning when you notice your child is struggling with focus, attention, and difficulty managing their emotions. While it’s normal for children to have bursts of energy, not follow instructions, and lose control of their emotions, if these behaviours are persistent and disruptive to daily life, you are right to dig further. 

ADHD is a neurodevelopmental disorder that affects approximately 6-9% of children and adolescents worldwide. It’s characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning and development. It is not due to bad parenting and it is not because children are being purposefully naughty or lazy. 

Symptoms of ADHD may vary depending on the individual and can present differently in girls and boys. In general, ADHD symptoms are categorised as inattention, hyperactivity, and impulsivity. A diagnosis will also include one of the three ADHD subtypes: 

• Inattentive type: This type of ADHD is characterised by symptoms of inattention, such as difficulty paying attention, forgetfulness, disorganisation, and lack of follow-through. Children with this type of ADHD may appear quiet and daydreamy.
  
  
• Hyperactive-impulsive type: This type of ADHD is characterised by symptoms of hyperactivity and impulsivity, such as fidgeting and interrupting others. Children with this type of ADHD may appear loud and impulsive.
  
  
• Combined type: This is the most common type of ADHD and is characterised by a combination of symptoms of inattention, hyperactivity, and impulsivity.

Inattention symptoms can include:

• Difficulty paying attention to details and making careless mistakes
• Easily distracted and has difficulty following through on instructions
• Losing things frequently
• Avoiding tasks that require sustained mental effort
• Disorganisation and difficulty keeping their room tidy
• Poor time management skills which affects their ability to do their school work on time
• Forgetting homework and important notes

Hyperactivity symptoms can include:

• Fidgeting or squirming when seated
• Difficulty staying seated and running or climbing in inappropriate situations
• Excessive talking and difficulty waiting 
• Always “on the go”
• Difficulty engaging in quiet activities
• Sleep-related issues
• Inability to prioritise

Impulsivity symptoms can include:

• Acting without thinking about consequences
• Interrupting others frequently
• Blurting out answers before questions are complete
• Difficulty waiting their turn and interrupting games or activities
• Making impulsive decisions without considering long-term consequences
• Overeating and seeking high-sugar and high-fat foods
• Engaging in risky behaviour like accepting dares

Note that not all children with ADHD will exhibit all of these symptoms, and the severity of symptoms can vary.

Why it’s important

Although the symptoms listed above can impact social and academic functioning, it’s important to know that ADHD is not an issue with knowing what to do, the problem is with the doing. 

The ADHD brain is an interest-based nervous system. Your child might surprise you when they can sit still and play a game, read a book, or draw. This happens because doing something of interest triggers their ability to focus, pay attention, sit still, and follow instructions. Ask your child to do something boring, and the dysfunction will be obvious. This inconsistency can be confusing for parents and often mistaken for defiance or bad behaviour.

Having your child assessed by a specialist paediatrician and psychologist is crucial because there are other conditions and neurological differences that present similarly to ADHD. These include:

• Bipolar disorder
• Autism
• Anxiety
• Depression
• Sensory Processing Disorder
• Learning and cognitive disabilities 
• Foetal Alcohol Spectrum Disorder (FASD)
• Food sensitivities/intolerances
• Giftedness
• PANS/PANDAS (infection-triggered autoimmune disorders affecting the basal ganglia, which can result in a multitude of neuropsychiatric symptoms)
• Vision or hearing problems
• Oppositional Defiant Disorder
• Sleep problems

More than half the children diagnosed with ADHD are also diagnosed with one or more of the conditions listed above.

Tips and strategies

Commence a formal diagnosis process – start with your child’s doctor who should be able to provide you with a referral to a developmental paediatrician and if applicable a psychologist. There are usually long wait times to see a specialist, so book an appointment for both a psychologist and a paediatrician at the same time, it is easier to cancel than to get a booking.

Collect information from teachers, carers, and coaches – if your child has started school, their teacher will be able to provide observations on your child’s ability to follow directions, remember instructions, pay attention and regulate their behaviour. Coaches and carers can provide similar information about how your child functions in different settings.

Record your concerns – the more examples you have about areas of concern, how long it’s been going on and how it disrupts daily life, the easier it will be for specialists to assess your child. Use the Keywell app to record your observations to take to medical professionals.

Create structure and routine – don’t wait for a diagnosis to start implementing strategies that can help your child. To make home life run more smoothly, try the following: 

• implement reliable and visible routines 
• set up timers and reminders 
• change how you give instructions by breaking them down into steps
• assist with getting tasks started
• help with transitions by engaging your child with a game, a challenge, or humour
• find creative ways to trigger their interest by playing around with rewards
• give frequent and positive feedback 

Adjust your expectations – children with ADHD are thought to be ~30% behind when it comes to executive functions (working memory, planning, organisation, regulating emotions, self-control). This means that a child who is 8 years old, will function more closely to a child that is 5.6 years old. Adjust your expectations with this in mind so that your child can meet them using their current skills. 

Prioritize your wellbeing – parents of children with ADHD are often overwhelmed by the daily challenges. Your ability to stay calm and regulated to help your child is fully dependent on your wellbeing, so make it number one on your list.