What can I do to recover from parental burnout

The recovery path of parental burnout will depend on the severity of your symptoms and the resources available to you. One thing is for certain, recovery is very personal and requires a combination of strategies rather than one solution.

Reduce demands on yourself and your family - unless it is of critical importance, drop the demand. Forget about regular cleaning, cooking elaborate meals, hosting people, etc. Change gears to survival mode until you have the energy for more than getting through the day.

Practice self-compassion - parenting is challenging for everyone and it’s absolutely okay to make mistakes and have grilled cheese sandwiches for dinner. The idea of perfection is your enemy in parental burnout. Thinking “if I get a good night’s sleep I’ll be ok” or “I just need a few hours to myself” will get you back on track is sure to set you up for failure because burnout requires more than a good night’s sleep or a few hours of solitude.

Ask for help - reach out to friends, family, or parenting groups for emotional support, practical assistance, and reassurance. If you have the financial means, use it to hire a cleaner, buy premade dinners and get a babysitter. There are some free respite and mental health services that might be available to you. Run an internet search for your local area and call them. There are no awards for doing everything alone.

Make self-care non-negotiable - make time for yourself because even half an hour can make a difference to your wellbeing. This can be as simple as taking a lunchtime walk, reading a book at bedtime, calling a friend, writing in your diary or even watching funny YouTube videos. This time is all about doing the small things that give you joy and help you replenish your energy.

Get professional support - if you are feeling so stuck that you can’t see a way out, it’s time to go see your doctor so that they can guide you on the best course of treatment. You might need medication or you might need some counselling sessions to work through the underlying issues. Also, be open to the possibility that the reason you are struggling is because you are neurodivergent yourself. Knowledge and awareness of your neurology can change everything for the better.

How do I prevent parental burnout

Reject perfection

We are constantly bombarded with messages about the importance of nutrition, exercise, and enriching activities for our children. Society puts incredible pressure on parents to:

• Offer delicious and nutritious meals that are also inexpensive (despite the increasing cost of living)
• Enrol kids in sports and ensure they make it to games, competitions and training with the right uniforms
• Create regular opportunities for enriching activities so they get to experience museums, art and culture
• Book extra curricular activities to promote friendships and extend interests
• Make time for playdates, family and one-on-one days
• Keep a model home

Realistically, it is impossible for the average parent to always meet these expectations. Rather than being beacons of guidance for families, they serve only as pillars of guilt for the primary caregiver.

Instead of trying to meet those perfect goals, find the perfect balance for your family. Some options to consider and try:

• Simplify meals - flip the order of things and try breakfast for dinner, or reduce cooking time and serve a mix of raw chopped vegetables and fruits, a protein and bread/wraps that everyone can pick from
• Stay local - walk around the neighbourhood or exploring local parks rather than facing traffic
• Commit to less - select activities that offer drop in sessions rather than committing to a full program
• Handover control - allow family and friends to take the lead on hosting playdates and events
• Embrace homelife - make Saturday or Sunday a pyjama day
• Accept messy days - you have children, only two arms and plenty of other things to do, mess will happen.

Reject self-care guilt

The guilt of self-care is counter-productive in protecting the wellbeing of the whole family, instead it fosters burnout. More parents should heed the common saying “you can’t pour from an empty cup” because the alternative risks burnout. 

Self-care looks different for everyone, and contrary to popular belief, it doesn’t need to include expensive massages and spa treatments. Many parents avoid even thinking about self-care because they associate it with taking time that they don’t have, but when you reduce demands on yourself and your family, you will get back time you can dedicate to your mental health. The question you must ask yourself is - what replenishes my energy and gives me joy? 

Neurodivergent parents should consider implementing sensory regulation activities as an essential part of their day because it is often a physiological need, as important as eating and drinking.

Leverage resources

If burnout is the imbalance of demands and resources, it is only logical that identifying and accepting resources is crucial to protecting your wellbeing. Resources come in a variety of formats and different people will need different things depending on what they already have available to them. As a start, evaluate these statements and they will help identify the possible resource you need:

1. I have the knowledge I need to parent my child - families of newly diagnosed children struggle immensely because of the knowledge gap that often exists between what they know and need to know about their child’s neurology and impact on functioning and regulation. There are plenty of free and accessible resources online, but opt for those who have been created by adults with lived experience. Join online parent support groups and leverage the experience of parents who have experienced similar things.
2. My work is flexible and I can ask for what I need - raising neurodivergent children comes with appointments and therapy sessions, and with great days and not so good days. Talk to your boss or someone in human resources to discuss what accommodations and resources are available to you.
3. I have a support network that I can call upon - a support network includes everyone from a co-parenting partner to family and friends who you can call upon for emotional or practical support. Don’t let embarrassment get in the way of asking for help.

Know the signs

Parental burnout symptoms are cumulative so it’s important to pick up on changes to your physical and mental health quickly. Complete the Working Parent Burnout Scale below to get a sense of where you are at and how it compares to your baseline.

How do I know if I have parental burnout

Ohio State University researchers designed a Working Parent Burnout Scale that you can use to help you determine whether you are experiencing burnout. We have included it below.

Step 1: Complete the scale - Rate the following 10 statements 

Scale reference: Kate Gawlik and Bernadette Mazurek Melnyk, 2021

Step 2: Score each item on the scale.

For all questions except questions 4 and 10, use these point values:

Not at all = 0 points

A little = 1 point

Somewhat = 2 points

Moderately so = 3 points

Very much so = 4 points

Questions 4 and 10 use reverse scoring. Use these point values for questions 4 and 10.

Not at all = 4 points

A little = 3 points

Somewhat = 2 points

Moderately so = 1 point

Very much so = 0 points

Add all points together for a final score.

Step 3: Calculate the total score

Add all points together for a final score.

Step 4: Interpret the score

0-10 Points: No or few signs of burnout. Continue what you’re doing and don’t forget to schedule self-care.

11-20 Points: Mild burnout. This is the time to take preventative actions, including decreasing stressors and identifying what resources that can help and support you.

21-30 Points: Moderate burnout. It’s crucial that you take action and start prioritising things that will improve your mental health and well-being, decrease stressors, make use of available resources and ask for help.

31+ Points: Severe burnout. Seek help immediately from your health professional. Talk to friends and family

References

1. The Power of Positive Parenting: Evidence to Help Parents and Their Children Thrive
2. A systematic review of parental burnout and related factors among parents | BMC Public Health
3. Parental Burnout in Neurodivergent Parents
4. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children
5. Parents’ Voice: Parents’ Emotional and Practical Coping with a Child with Special Needs
6. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
7. A Theoretical and Clinical Framework for Parental Burnout: The Balance Between Risks and Resources (BR2)
8. “Maybe No One Knows We Need Help”: Understanding the Experiences of Autistic Working Mothers in Australia | Autism in Adulthood
9. Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout – Julianne M Higgins, Samuel RC Arnold, Janelle Weise, Elizabeth Pellicano, Julian N Trollor, 2021
10. Where are all the Autistic Parents? A Thematic Analysis of Autistic Parenting Discourse within the Narrative of Parenting and Autism in Online Media | Studies in Social Justice
11. When Parent and Child Both Have ADHD
12. The truth about being autistic and a mother
13. “Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew”: Defining Autistic Burnout | Autism in Adulthood
14. Parents’ Voice: Parents’ Emotional and Practical Coping with a Child with Special Needs
15. Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health | Autism in Adulthood
16. Autistic Parents’ Personal Experiences of Parenting and Support: Messages from an Online Focus Group | The British Journal of Social Work | Oxford Academic
17. The impact of parental burnout
18. Pandemic Parenting: Examining the Epidemic of Working Parental Burnout and Strategies to Help
19. With a little help from my friends: Psychological, endocrine and health corollaries of social support in parental caregivers of children with autism or ADHD – ScienceDirect
20. Motherhood: Autistic Parenting and Supports That Make a Difference

Having the right level of resources to cope with demands is crucial for all parents, but scientists have found that there are certain risk factors that increase your chance of burnout. These include:

• Perfectionist parenting standards - you want to be the perfect parent, striving to make the right and the best decision for your child in everything.
• Low co-parent support - your partner doesn’t share the emotional, physical or mental load, and most of it falls to you.
• Lack of social network - you feel isolated because of your circumstances or physical location and you lack practical or emotional support.
• Children with high-support needs - your child’s needs impact daily life and your ability to meet financial, personal and family goals.
• Work part-time or stay-at-home - a full time job is seen to provide respite and purpose for parents, but not working at all or working part-time increases your chance of burnout.
• Poor regulation strategies - you are someone who has difficulty managing your emotions or you do it in negative ways.

In this article we are going to look a bit deeper into burnout experienced by parents in neurodiverse families.

Parenting a neurodivergent child

A neurodivergent child needs more help to navigate the world than their peers because the systems and constructs were created by and for neurotypical brains.

In addition to standard parenting duties, caregivers of neurodivergent children often also have to:

• Advocate for support across different contexts
• Pursue assessments while dealing with almost impossible barriers
• Sift through information about their child’s neurotype and self-educate
• Navigate funding schemes and support systems
• Organise and take children to a range of allied medical health specialists
• Practise strategies or do activities to support regulation and sensory needs
• Scaffold executive functioning for their children
• Learn, adapt and adjust day-to-day life to support their child’s fluctuating needs
• In some cases, homeschool their children

A recent study conducted by Curtin University found that “80% of caregivers in their study experienced poor wellbeing, high levels of stress and mental health issues.”3 Negative stigma was reported as an issue in local communities, with more than 22% of caregivers in the study cohort feeling even more socially isolated because of their experiences.

Overall, researchers identified a range of problems faced by caregivers of neurodivergent children, “including lack of support groups, available education and training, and financial aid and assistance”.3

When caregivers don’t have the right level of support themselves, it can make life more challenging, resulting in:

• Financial stress
• Hindrances in career success and progression
• Sacrifice of personal goals/needs and impact to self-identity

The more support needed by a child, the more likely the family will experience financial difficulties. A parent’s capacity to earn a living wage is impacted by their availability to work. Finances are further stretched due to the expenses associated with therapy, adaptive equipment and assistive technology.

Additional risk factors for neurodivergent parents

There is very little research that looks at parents with neurological differences like Autism and ADHD, and their experience raising children in relation to burnout. There is even less research conducted by neurodivergent scientists and interpreted by the same. The truth is, unless you have lived it, there are nuances you will miss or data that you will misinterpret.

The following points are a combination of lived experience by the author, informal conversations with other neurodivergent parents, articles written by Autistic parents, themes from neurodivergent support groups and from the available studies in this area.

Undiagnosed neurodivergence

Parents of neurodivergent children are more likely to be neurodivergent themselves. We know that some brain differences are highly heritable, for example inheritability for ADHD was found to be 66%-86% and Autism to be 64%-91%.

In cases where caregivers are unaware of their own neurotype, they can find themselves struggling with parenting and general overwhelm without knowing why. The advantage of knowing what type of brain you have is that you are more likely to identify your triggers, have developed positive coping strategies and structured your home environment to support regulation. A diagnosis also opens up the door to explore and try medications that help manage specific symptoms, increasing a parent’s ability to function more optimally.

Executive dysfunction

A significant proportion of neurodivergent people report some level of impairment in executive functioning. Executive functions include the skills that help us plan ahead, manage priorities and regulate our physical and emotional states, which are crucial in meeting personal, professional, relationship and parenting goals. Impairment to executive functions means that neurodivergent parents work much harder at making things work.

Sensory sensitivities

Sensory overwhelm is an additional challenge that some neurodivergent parents have to contend with. Sensory sensitivities and needs of family members can sometimes clash in households affecting both adults and children. Outside of the home, neurodivergent individuals are also exposed to a barrage of sensory stimuli that they can’t always control or manage effectively. The danger of sensory overwhelm is that it can trigger meltdowns.

Masking

Neurodivergent individuals can find themselves in workplaces that are not inclusive or in groups who do not understand the need for accommodations. This forces individuals to mask their needs to fit in and to protect themselves from ableism. Masking to keep oneself safe has been shown to produce a level of chronic and intense stress that increases the risk of depression, anxiety and, in some extreme cases, suicidality.

Hyperfocus

ADHD and Autistic brains have interest-based nervous systems, which means that the things we are passionate about can supercharge our ability to focus – this is sometimes referred to as hyperfocus. This phenomenon describes a person’s ability to be so absorbed in a task, to the point of completely ignoring or ‘tuning out’ everything else. Shifting attention to internal physiological cues and external cues becomes a challenge when someone is in this mode of intense focus. Regular periods of hyperfocus tend to use up more energy and increase fatigue affecting one’s ability to take on subsequent tasks.

Social stigma

Acceptance, understanding and inclusion are things that neurodivergent individuals have to constantly fight for. For many parents, the stigma of being neurodivergent and a caregiver gets in the way of reaching out for help from friends and family. Research on the parenting experience of Autistic people, shows that stigma also presents a major barrier to accessing services and resources. Neurodivergent parents worry that their neurology will be used against them, and that their capacity to be good caregivers is questioned.

Parenting ability is not predicated on neurotype

There is an undeniable connection and understanding that neurodivergent parents of neurodivergent children have with each other. Parenting is a complex task where one size does not fit all, and many neurodiverse families throw out the typical “parenting manual” and instead adapt their approach to the unique needs of their family.

The truth is, being neurodivergent comes with additional life challenges, there is no doubt, but with accommodations and support they are all manageable.

In part 3 of the series we will cover the signs of parental burnout, recovery and protective strategies.

References

1. A systematic review of parental burnout and related factors among parents | BMC Public Health
2. Parental Burnout in Neurodivergent Parents
3. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children
4. Parents’ Voice: Parents’ Emotional and Practical Coping with a Child with Special Needs
5. Get it right, make it easy, see it all: Viewpoints of autistic individuals and parents of autistic individuals about the autism diagnostic process in Australia – ScienceDirect
6. Caring for the Caregiver: Supporting Families of Youth With Special Health Care Needs – ScienceDirect
7. Correlates of Impairment and Growth in Families of Young Autistic Children
8. The Family Life Impairment Scale: Factor Structure and Clinical Utility with Young Children
9. Implementation of Australia’s National Disability Insurance… : Infants & Young Children
10. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
11. Is Parental Burnout Distinct From Job Burnout and Depressive Symptoms? – Moïra Mikolajczak, James J. Gross, Florence Stinglhamber, Annika Lindahl Norberg, Isabelle Roskam, 2020
12. Parental Burnout and Child Maltreatment During the COVID-19 Pandemic – PMC
13. (PDF) Parental Burnout: What Is It, and Why Does It Matter?
14. Parental Burnout Around the Globe: a 42-Country Study | Affective Science 
15. A Theoretical and Clinical Framework for Parental Burnout: The Balance Between Risks and Resources (BR2)
16. Heritability of autism spectrum disorders: a meta‐analysis of twin studies – PMC
17. A twin study of genetic and environmental contributions to attention‐deficit/hyperactivity disorder over time – Taylor – 2023 – Journal of Child Psychology and Psychiatry – Wiley Online Library
18. “Maybe No One Knows We Need Help”: Understanding the Experiences of Autistic Working Mothers in Australia | Autism in Adulthood
19. Where are all the Autistic Parents? A Thematic Analysis of Autistic Parenting Discourse within the Narrative of Parenting and Autism in Online Media | Studies in Social Justice
20. When Parent and Child Both Have ADHD
21. Motherhood: Autistic Parenting and Supports That Make a Difference
22. The truth about being autistic and a mother
23. A comparative study of autistic and non-autistic women’s experience of motherhood | Molecular Autism
24. Parents’ Voice: Parents’ Emotional and Practical Coping with a Child with Special Needs
25. ‘‘In a State of Flow’’: A Qualitative Examination of Autistic Adults’ Phenomenological Experiences of Task Immersion 
26. Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health | Autism in Adulthood
27. A comparative study of autistic and non-autistic women’s experience of motherhood | Molecular Autism
28.  Autistic Parents’ Personal Experiences of Parenting and Support: Messages from an Online Focus Group | The British Journal of Social Work | Oxford Academic
29. Autistic Motherhood: Honoring Our Personal Choices

Parental burnout refers to a state of physical, emotional, and mental exhaustion experienced as a result of prolonged stress and overwhelming parenting responsibilities. It’s a state of chronic stress that can significantly impact both parents’ wellbeing and the family dynamic as a whole.

Although many parents will resonate with the feeling of burnout, parental burnout as a clinical concept is still very new. For now, there are three proposed measurements that can indicate parental burnout:

1. Feeling exhausted from parenting
2. Feeling emotionally distant from your child
3. Feeling that you are not a good parent and questioning how effective you are

• Contrast with the parent you used to be - is a new proposed dimension to measure parental burnout

Parental burnout is far more common than you would think, regardless of what curated social media profiles might indicate. As of March 2020, a study that spanned 42 countries found that roughly 5 out of every 100 parents feel burned out from parenting. In Western countries, this number goes up to 9 out of 100 parents. 

Risk factors

There are several factors that contribute to the risk of parents experiencing burnout, but the tipping point occurs when the level of stress outweighs the availability of resources to cope with it. Key risk factors include:

• Demanding daily routine - Balancing work, household chores, and childcare responsibilities can overwhelm parents, especially when coupled with unrealistic expectations about parenting.
• Lack of social support - Limited support from family, friends, or community resources can intensify feelings of isolation and stress for parents.
• Perfectionism - Striving for perfection in parenting can lead to constant self-criticism and feelings of inadequacy when expectations aren’t met.
• Needs and resources mismatch -  A significant disparity between a child’s needs and a parent’s capabilities or resources can exacerbate stress and burnout.
• Financial strain -  Financial difficulties can add pressure to parents, impacting their ability to provide for their children and manage household expenses.
• Personal Factors - Individual factors such as mental health issues, sensory sensitivities, past trauma, or relationship problems can contribute to parental burnout.

Impact of parental burnout

The impact of parental burnout can have extensive and damaging effects on the parent themselves, their children and co-parenting partner. 

Parents going through burnout can find themselves:

• Experiencing suicidal and escape ideation
• Engaging in addictive behaviours and substances
• Suffering from sleep disorders
• Dealing with depressive symptoms
• Struggling with physical symptoms
• Managing emotional instability

Children also experience the effects of their parent’s burnout. Researchers have identified that when parents feel overwhelmed and exhausted, it can lead to kids feeling more anxious, lonely, and even behaving aggressively or feeling sad. 

Clinicians have observed a pattern in parents who are exhausted and who care for kids with behavioural issues where they tend to step back emotionally instead of physically. This means they still take care of basic needs like feeding and bedtime, but they become less connected, less understanding, and less responsive to their children emotionally. 

Evidence shows that in some cases children experience:

• Neglect
• Violence
• Psychological abuse

Parents come to realise that they are not the parents they would like to be, further creating distress, shame and guilt. A vicious cycle of burnout and higher levels of coercive or punitive parenting practices emerges.

Burnout of one parent is also felt by the rest of the family.

• Spouses experience an increase in frequency and intensity of conflict
• Family relationships become strained
• Family members’ quality of life is reduced

As a parent, your wellbeing is critical to your ability to effectively support your child’s emotion regulation. If you are also tired, stressed, unwell, or dysregulated, you won’t be able to effectively co-regulate with your child, and that can make situations worse. 

Unsurprisingly, the incidence of parental burnout can soar even higher among parents caring for neurodivergent children and those children with chronic illnesses. 

In part 2 we will go deeper into parental burnout for neurotypical parents and neurodivergent parents of neurodivergent children.

References

1. A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA) – PMC
2. A systematic review of parental burnout and related factors among parents | BMC Public Health
3. Parental Burnout in Neurodivergent Parents
4. The Well-being and Support Needs of Australian Caregivers of Neurodiverse Children
5. Maternal Cortisol Levels and Behavior Problems in Adolescents and Adults with ASD – PMC
6. Caring for the Caregiver: Supporting Families of Youth With Special Health Care Needs – ScienceDirect
7. The Family Life Impairment Scale: Factor Structure and Clinical Utility with Young Children
8. Implementation of Australia’s National Disability Insurance… : Infants & Young Children
9. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
10. Is Parental Burnout Distinct From Job Burnout and Depressive Symptoms? – Moïra Mikolajczak, James J. Gross, Florence Stinglhamber, Annika Lindahl Norberg, Isabelle Roskam, 2020
11. Parental Burnout and Child Maltreatment During the COVID-19 Pandemic – PMC
12. (PDF) Parental Burnout: What Is It, and Why Does It Matter?
13. Parental Burnout Around the Globe: a 42-Country Study | Affective Science

It is evident with more teacher burnout and less people coming into the profession, educators at every level need more support, tools and resources to do one of the most important jobs in our community - help guide and prepare our kids to be happy and successful adults.

In part 4 of the series we discussed how teachers can create inclusive classrooms by considering classroom norms. Classroom norms naturally flow into how teachers discipline and motivate their students. This final article discusses punishments and proposes different approaches to discipline for inclusive classrooms.

Before diving into discipline, it’s important to first highlight that teachers who understand a child’s sensory profile, self-regulation abilities and executive functioning skills are better equipped to maintain a calm and regulated classroom. Why? Because in most cases, what we observe as challenging behaviour is actually dysregulation. It takes an empathetic and curious teacher to distinguish between a stress response, or an attempt to gain additional sensory input, or a symptom of underdeveloped skills from purposeful behaviour.

The research shows that when it comes to children, the majority of “misbehaviour” has nothing to do with premeditated mischief and more to do with unmet needs. The challenge, and it is indeed a challenge, is to identify what set in motion the behaviour so that the child can access the right support and adjustments.

Discipline - small changes with big impact

Changing how schools see and implement discipline is a slow and difficult process because it relies on top down, state-wide department changes. However, there are small changes that teachers can implement immediately starting by re-evaluating outdated and harmful punitive measures.

Name on the board

Shaming practices like displaying a student’s name for everyone to see when they break a rule is unnecessary and damaging beyond student trespasses. Parading a child’s misdemeanours in front of their peers in the classroom extends to their relationships outside of the classroom.

One study found that when camp teachers praised kids’ strengths, those kids were liked more by their peers. This was especially true for kids with ADHD, who also got fewer negative comments from peers. However, when teachers corrected kids in front of others, those kids got fewer likes, even if they didn’t regularly act out. But when teachers corrected kids quietly, it didn’t affect how much they were liked. Basically, how adults treat kids in front of others can impact the way peers feel about them.

• A better option would be to have a discrete signal that tells the student that they are not doing the right thing, or have a quiet word to understand what is going on and either reiterate expectations or help the student regulate.

Sit alone at a desk or outside

When a teacher removes a child and places them away from the whole class, they are taking away the opportunity for connection, understanding and repair. In addition, regularly sending student’s away from the classroom for misbehaving further increases gaps in learning.

We can’t deny the evidence showing that disabled students are disproportionately impacted by restraint and seclusion. We can’t ignore the research that children with neurodevelopmental disabilities are often excluded and experience more loneliness than their typically developing peers, which results in a negative impact to mental health, behaviour, and psychosocial/emotional development, with a likely long-term impact in adulthood.

• A better option would be to have the student sit next to the teacher who is in the best position to address the problem with the child. It’s in these moments that a teacher can use discipline to teach a child rather than send them away to punish.

Self-evaluation sheets

As part of the disciplinary process, teachers tend to give students a form where they evaluate their “behaviour”. A common evaluation sheet asks that the child rate themselves using a happy smiley, neutral smiley, and sad smiley against the following statements:

1. I try my best
2. I listen carefully and follow directions
3. I stay on task and focus on my work
4. I am organised and ready with materials
5. I actively participate in class
6. I am kind and respectful to others
7. I wait for my turn to speak and talk at appropriate times

You can’t make a child do better by making them feel worse about goals they can’t meet.

• A better option would be to use a different set of self-evaluation questions to understand what is getting in the child’s way and identify supports required. For example:

1. I’m feeling my best
2. I can understand and remember instructions
3. I know how to start and finish tasks
4. I feel comfortable asking for help
5. I feel safe and accepted in class
6. I have what I need to stay calm
7. I can write my questions/thoughts/ideas down so I don’t interrupt

Punishing the whole class because of one student

A good way to ensure a student’s social connections are damaged is by punishing all students when one has not met expectations. Not only does this strategy shame the student, it also punishes the kids that shouldn’t miss out on activities or breaks. Shaming doesn’t teach the student what to do, it just makes them feel guilty about what they did wrong.

Evidence on collective punishment shows that although you might see initial compliance, it does not have positive long term effects. Rather, it increases future problematic student behaviour because the misbehaviour is a symptom of disengagement. Collective punishment increases the risk of social exclusion and in turn the student’s disengagement.

• A better option would be to talk to the student separately from the rest of the class. This approach not only helps preserve peer relationships, it gives the student space to be honest and for the teacher to talk about options for doing better next time.

Taking away recess or lunch

Kids need to run and play to regulate their bodies and brains, when we stop them from doing that we are not giving them the opportunity to do the exact thing they need.

The benefits of play for children have been well documented by educational psychologists over the years. The British Psychological Society said in the 2014 position paper Children’s right to play “Withdrawing break time opportunities for play in school should never be used as a punishment (e.g., for misbehaviour or completing unfinished work), nor the threat of withdrawal be used to control children’s behaviour.”

• A better option would be to deal with the incident. In situations where there is a safety issue, the walk and talk option is ideal. This just means the student gets to walk with the teacher on playground duty and have a chat so that they are supervised but also get a physical break.

Rewards as punishments

Teachers use rewards like stars, merit cards, awards, class points, etc, to recognise “good” students. Drawing on research from hundreds of studies, Alfie Kohn presents a different perspective on rewards backed by evidence that when you reward a child for doing something they enjoy, they produce inferior work. Kohn also explains that when you use rewards to motivate behaviour, you are also creating the expectation of a reward when something is done. This not only destroys intrinsic motivation but it also becomes a method of punishment when the child doesn’t get a reward.

Schools that use a token system for “good behaviour” are also creating a mechanism for punishments because withholding a reward is the other side of a punishment coin. What is most difficult to accept is that teachers use these token systems to refuse students who haven’t collected enough points, the opportunity to attend class and school-wide fun activities and excursions. We have to question, exactly what this is teaching that child and doing to their self-esteem and how it impacts their social connections? There is no chance to repair, there is only a long stretched punitive action, making it so far removed from the offences that it means nothing to the child.

• A better option is to give the students the opportunity to learn the skills to do better and for the school to find ways to understand how to support them better.

As for how to reward and motivate students, Kohn raises three key strategies “The first C is content. Far less interesting to me than whether a student has learned what he was supposed to is the question, “Has the child been given something to do worth learning?” If you ask me what to do about a kid being “off task”—one of our favorite buzzwords—my first response is going to be, “What’s the task?” If you’re giving them garbage to do, yes, you may have to bribe them to do it. If the kids have to endlessly fill in the blanks on dittos, you’re not going to get rid of rewards or threats anytime soon.

The second C is community: not only cooperative learning but helping kids feel part of a safe environment in which they feel free to ask for help, in which they come to care about one another as opposed to having to be manipulated to share or not be mean. Some of the outstanding work on creating caring communities is being done by the Developmental Studies Center in Oakland, California.

The third C is choice: making sure that kids are asked to think about what they’re doing and how and with whom and why. You know, kids learn to make good choices not by following directions but by making choices.”

Inclusive frameworks

Positive approaches to discipline have a protective effect on neurodivergent students. Let’s rephrase that: positive approaches to discipline have a protective effect on ALL students.

Two school-wide frameworks to consider include:

• Collaborative Proactive Solutions

  Developed by Dr Ross Greene, it is based on the idea that “Kids do well if they can.”, because no child wants to be in trouble on purpose, it’s not pleasant or beneficial. Dr Greene believes that to get to the bottom of why a child is not meeting expectations, it’s important to first ask what is getting in their way and collaborate with them on a solution. Collaborative Proactive Solutions has been implemented across many schools and has had incredible positive results.

• Restorative Practices

  Conflicts are unavoidable, but teachers can use trauma-informed restorative practices to address disagreements and support positive interactions, this can include mediation or reflection exercises to resolve conflicts and promote accountability, self-awareness and self-advocacy. Restorative practices’ primary focus is on repairing harm and restoring relationships rather than using punitive measures. The process encourages students to understand the impact of their actions and to take responsibility for them.

Schools can be places of academic and personal growth, and discipline plays an important part in teaching boundaries and protecting students and educators. However, more needs to be done to further support students’ wellbeing. Kids need to be explicitly taught social and emotional skills like self-awareness, empathy, and responsible decision-making. They need to have opportunities to practise and apply these skills, and they need adults who believe that they do well if they can.

Creating inclusive classrooms takeaways

In summary, the series on teachers’ impact on neurodivergent students tells us that educators can change the long term outcomes of children. There are 5 takeaways:

1. Seek knowledge about a student’s neurological differences to activate empathy
2. Prioritise teacher-student and peer-peer relationships
3. Adapt delivery of curriculum and resources to address variability in learning rather than disability
4. Rewrite classrooms norms to support needs and protect wellbeing
5. Use discipline to teach, not to punish

References

1. Enhancing Teachers’ Capacity to Manage Classroom Behavior as a Means to Reduce Burnout: Directed Consultation, Supported Professionalism, and the BASE Model – Molly Dawes, Brittany I. Sterrett, Debbie S. Brooks, David L. Lee, Jill V. Hamm, Thomas W. Farmer, 2024
2. Effects of Social Isolation and Loneliness in Children with Neurodevelopmental Disabilities: A Scoping Review – PMC
3. No one is going to recess: How children evaluate collective and targeted punishment
4. (PDF) Peer-peer relationships: A key factor in enhancing school connectedness and belonging
5. Restorative Schools Australia
6. From Reaction to Prevention
7. Strike one hundred to educate one: Measuring the efficacy of collective sanctions experimentally – PMC
8. “I want to help kids like me be heard!” A survey about schooling from the perspective of adolescents with ADHD
9. Teacher Behaviors Toward Children with Attention-Deficit/Hyperactivity Disorder Predict Peers’ Initial Liking and Disliking Impressions in a Summer Camp Setting | Journal of Social and Clinical Psychology
10. Review: typically-developing students’ views and experiences of inclusive education
11. Teacher behavior and peer liking and disliking: The teacher as a social referent for peer status.
12. Effects of disability type, prior contact, and school setting on attitudes toward peers with disabilities among Saudi female students aged 7 to 12 years – PMC
13. Reviewing the literature on integration
14. Creating Classroom Rules for Students with Emotional and Behavioral Disorders: A Decision-Making Guide
15. What Successful Teachers Do in Inclusive Classrooms: 60 Research-Based Teaching Strategies That Help Special Learners Succeed
16. How Inclusive Interactive Learning Environments Benefit Students Without Special Needs – PMC
17. Social Acceptance in Inclusive Classrooms: The Role of Teacher Attitudes Toward Inclusion and Classroom Management
18. A Meta-Analysis of the Effects of Classroom Management Strategies and Classroom Management Programs on Students’ Academic, Behavioral, Emotional, and Motivational Outcomes – Hanke Korpershoek, Truus Harms, Hester de Boer, Mechteld van Kuijk, Simone Doolaard, 2016
19. EDUCATORS & SCHOOLS – Dr Ross Greene CPS
20. Restorative Practices, Affect Script Psychology and the Social and Emotional Aspects of Learning
21. Children’s right to play | BPS
22. A Longitudinal Examination of Withholding All or Part of School Recess on Children’s Physical Activity and Sedentary Behavior: Evidence from a Natural Experiment | Early Childhood Education Journal

Outdated classroom norms 

When we talk about norms we are describing the teacher and students’ shared expectations about attitudes, beliefs, and behaviours that everyone should display.  We can all agree that rules are important because they keep everyone safe and allow all students the opportunity to learn. There are, however, outdated rules which become problematic for neurodivergent students because they have been written with a neurotypical lens. 

For example, many schools and teachers still use the 5L’s of listening and learning, which when looked at more closely are unrealistic and unnecessary.

1. Looking 

There are instances where looking is required, for example where there is a visual concept present, but there are equally many other occasions where a student does not need to be looking to listen or learn. For many neurodivergent students the visual sensory input (especially eye contact) can get in the way of paying attention to auditory content. Forcing a child to look you in the eyes can have the opposite desired effect, meaning the discomfort is so great that they don’t listen even though they appear to be doing the right thing.

Inclusive options - simply allow students to use their gaze as they desire without forcing them to look at you. Where possible provide content as a handout so that students can refer to it.

2. Listening

Auditory input is just one way to learn, and yes it is the most common way students take in information because that’s how teachers deliver information. For students with auditory processing difficulties this expectation excludes them from learning to the best of their ability.

Inclusive options - for a truly inclusive classroom, verbal information, where possible, should be supplemented with another format. In fact, having content in multiple formats helps all students.

3. Lips still

What this is actually saying is no talking. Most kids but especially neurodivergent kids take things literally, and asking them to keep “lips still” can feel like an impossible task. So instead, the challenge for teachers is to keep children from interrupting, and there are better ways to do this than asking them to keep their lips still.

Inclusive options - use visual cues like a talking stick/a microphone to show who has the floor, visually sign post “no talking” so students can be reminded not to interrupt, and always give students an option to write down their questions or comments while someone else is talking.

4. Hands in laps

The expectation that an adult let alone a kid can keep their hands on their lap for longer than a few minutes without moving is unreasonable. The actual point to be made is that kids shouldn’t use their hands in a way that disrupts the rest of the class. Hands on laps is an expectation that automatically fails kids who fidget or who need to move their hands to focus.

Inclusive options - depending on a student’s movement and regulation needs, teachers can offer quiet fidget tools or a pad and pencil for doodling. Some neurodivergent kids listen better when their hands are occupied, so if they aren’t disrupting their peers why not support that need?

5. Legs crossed

Keeping one’s legs crossed is ok for a few minutes, but it starts to become very uncomfortable for kids to keep the body in that position for extended periods, neurodivergent or not. Again, the real request is that students don’t disrupt the class by moving around the room or by bumping/touching/kicking peers. Redirecting and containing movement are much more inclusive options to ensure that doesn’t happen.

Inclusive options - wobble cushions are a great way for kids to direct excessive energy without impacting those around them. Some kids may benefit from sitting at the back of the class with more space to stretch. Personal floor mats are a great way to ensure all the kids have enough personal space to move and adjust their bodies without disrupting peers.

Old expectations like the 5L’s of learning/listening are almost impossible for some children to meet, and it sets them up for constant failure. 

Inclusive classroom norms

When we adjust classroom norms so that everyone is able to meet them, we also change how students feel about themselves and how their peers see them. Results from recent studies revealed that inclusive classrooms norms predicted students’ sympathy and intended inclusion toward hyperactive children. The most encouraging takeaway is that the positive effects of inclusive school norms extend to out-group attitudes, especially in contexts where peer groups are likely to exclude others who don’t fit the mould. 

Inclusive classroom norms are critical in creating an environment that promotes positive social connections, supports regulation and nurtures efficient learners. Classroom norms should be clear, achievable and always visible. Having classroom norms written from a positive perspective encourages students to follow them. Some examples include:

• Everyone has the right to feel safe
• Everyone has the right to be heard
• Everyone has the right to participate
• Everyone has the right to learn

Teachers may also ask students to review classroom norms to increase their understanding and commitment to following them.

For classroom norms to work, students need to understand what they mean and know how to follow them. Students also need to have clear boundaries and directives for dealing with disagreements, giving and receiving feedback, looking after the property of others, accepting different ways of thinking and communicating, etc.

References

1. Enhancing Teachers’ Capacity to Manage Classroom Behavior as a Means to Reduce Burnout: Directed Consultation, Supported Professionalism, and the BASE Model
2. “I want to help kids like me be heard!” A survey about schooling from the perspective of adolescents with ADHD
3. Teacher Behaviors Toward Children with Attention-Deficit/Hyperactivity Disorder Predict Peers’ Initial Liking and Disliking Impressions in a Summer Camp Setting | Journal of Social and Clinical Psychology
4. Review: typically-developing students’ views and experiences of inclusive education
5. Teacher behavior and peer liking and disliking: The teacher as a social referent for peer status.
6. Effects of disability type, prior contact, and school setting on attitudes toward peers with disabilities among Saudi female students aged 7 to 12 years – PMC
7. Reviewing the literature on integration
8. Creating Classroom Rules for Students with Emotional and Behavioral Disorders: A Decision-Making Guide
9. What Successful Teachers Do in Inclusive Classrooms: 60 Research-Based Teaching Strategies That Help Special Learners Succeed
10. How Inclusive Interactive Learning Environments Benefit Students Without Special Needs – PMC
11. Social Acceptance in Inclusive Classrooms: The Role of Teacher Attitudes Toward Inclusion and Classroom Management
12. A Meta-Analysis of the Effects of Classroom Management Strategies and Classroom Management Programs on Students’ Academic, Behavioral, Emotional, and Motivational Outcomes – Hanke Korpershoek, Truus Harms, Hester de Boer, Mechteld van Kuijk, Simone Doolaard, 2016
13. EDUCATORS & SCHOOLS – Dr Ross Greene CPS
14. Teachers’ attitudes towards inclusion, perceived adequacy of support and classroom learning environment
15. Social Acceptance in Inclusive Classrooms: The Role of Teacher Attitudes Toward Inclusion and Classroom Management
16. Neurodiversity is Human Diversity, an Equity Imperative for Education
17. Competitive classroom norms and exclusion of children with academic and behavior difficulties – ScienceDirect

This article is the third part of a series that focuses on the role and importance of teachers in the outcomes of neurodivergent children. We outline strategies, drawn on concepts from the Universal Design for Learning (UDL) framework, to create an inclusive environment for a neurodiverse group of students in mainstream classrooms. Neurodiverse is a term for a mix of individuals who are neurodivergent, an umbrella term for ADHD, Autistic, Dyslexic, etc, and neurotypical. 

The aim of this article is to inform but also empower educators with practical strategies that benefit all students. 

Practical strategies with class-wide benefits

Due to brain wiring differences, neurodivergent students may have a combination of learning differences, movement and emotional regulation needs, executive functioning skills, communication styles and sensory processing variations. This diversity of experiences can be supported by adapting, adjusting and enhancing teaching strategies and the classroom environment.

Classroom environment

Sensory processing differences are hidden and yet have an incredible influence on the wellbeing of a child and their ability to learn. Neurodivergent kids can have a range of sensory needs across all 8 key senses. You might not know this, but sensory input comes from 8 different sensory systems:

1. Visual – responsible for what we see 
2. Auditory – responsible for what we hear 
3. Olfactory – responsible for what we smell 
4. Gustatory – responsible for what we taste 
5. Tactile – responsible for touch sensation including pressure, temperature, and pain
6. Vestibular – responsible for our sense of balance by monitoring the position of our head in relation to our body and its movement
7. Proprioceptive – responsible for the sensation of joint and muscle movements and postural control
8. Interoception – responsible for detecting internal messages like a full bladder, hunger and thirst

Sensory defensive children have high sensitivity to certain stimuli and may experience pain or be reactive to things like fluorescent light, touch from others, smells from art supplies, noisy environments, and even a visually crowded room with lots of paintings and posters. This means they may avoid certain activities or become easily overwhelmed or distracted by particular stimuli.

Sensory seeking children seek out additional stimulation because they don’t register or process all the incoming sensory information. They may have a tendency to bump into furniture or rock in their chair, they might like to make noise by banging things together or use their voice to make sounds, they may have a constant need to touch things or they may enjoy playing with textures like paint. These children need to move their bodies and often become disruptive to peers in the classroom as they naturally seek to regulate through additional sensory input. 

Some children can be both sensory seeking and defensive with fluctuating needs on different days. And although many sensory processing differences are not always obvious in a child, it is the frequent exposure to one or many of these, without the ability to reset the nervous system, that can result in sensory overwhelm, meltdowns, lashing out, absconding, disruptive and oppositional behaviour, and avoidance.

There are some practical considerations and adjustments to the classroom environment that can reduce issues associated with sensory issues. This includes things like:

• Opting for natural sunlight and turning off fluorescent lights
• Offering opportunities for movement to students who need extra sensory input
• Arranging seating to give sensory seeking students space to move and tactile reactive students a safe space
• Rearranging strong smelling paints, glues, and bins so that they are away from students with sensitive smell
• Allowing ear defenders for students who have difficulty with noise
• Setting up a sensory area that allows students to regulate away from the gaze of peers
• Creating a sensory basket with sensory tools
• Embedding regular short breaks throughout the school day
• Laying out student work and resources in the classroom in a way that doesn’t become visually distracting

Learning activities, resources and tools

The images and stories around us influence our thoughts and beliefs, so it’s no surprise that choosing a range of activities and resources is an important part of creating an inclusive classroom. 

This can include things like:

• Ordering books and resources that positively represent all abilities to build a culture of acceptance and knowledge. E.g. readers about kids who think differently, look different and behave differently.
• Selecting activities with options that encourage all students to participate regardless of their learning and communication styles. E.g., giving students the choice to present ideas verbally, by creating a poster or writing a text.
• Supplying tools that support executive functioning skills like planning and organising E.g., graphic organiser handouts and story prompts.
• Agreeing to the use of assistive technology to support low working memory, dysgraphia and dyslexic students. E.g., iPads with voice-to-text apps or apps to write text.
• Support time management by externalising time sense. E.g., display a visible clock, use warning bells to alert students of task checkpoints.

Instruction and assessment

The research and development of the guidelines in Universal Design for Learning promote teaching for variability rather than disability, focusing on the inclusion of all students. Although the current education curriculum is predetermined and very structured, creative teachers can adapt the delivery and assessment of learning outcomes to get the best of the whole class. Some practical strategies that can be used by teachers include:

• Giving choices that cater for all students’ abilities/achievement and encourage responsibility for their own learning. E.g., present options with different levels of difficulty and use innocuous terms to represent easy, hard and advanced, like sweet, salty and spicy.
• Reinforcing the delivery of content or instructions in multiple ways to reduce dependency on working memory and the need to multitask by listening and writing. E.g., supplement verbal instructions with a visual representation or text handout
• Focusing on what outcomes are being assessed and where possible leverage interests and strengths to motivate students. E.g., give students a choice of topics for writing tasks. How important is it that a student writes about a giraffe instead of their preferred animal?
• Reducing cognitive load on assignments and tasks to support executive functions. E.g., organise instructions as numbered steps, where possible break down questions into smaller parts, eliminate irrelevant information that is not required to complete a task, give an example of what “done” looks like.
• Building intrinsic motivation and self-efficacy in students. E.g., make learning goals clear for every task and help students connect to outcomes by setting personal goals, giving frequent and positive feedback and encouraging them to reflect on their learning.

We’d like to acknowledge that even in schools with plenty of resources, making inclusive education work requires a lot of people power and structural changes. As it is now, most of the pressure is on educators to consider and address individual academic, sensory and emotional needs, on top of their teacher duties. Teachers need training, time to plan, appropriate tools and resources, assistance in the classroom, and the ability to collaborate with other professionals. Without the support of the education department and school principals, educators cannot build fully inclusive classrooms.

References

1. The justification for inclusive education in Australia | PROSPECTS
2. The UDL Guidelines
3. Distraction, distress and diversity: Exploring the impact of sensory processing differences on learning and school life for pupils with autism spectrum disorders – ScienceDirect
4. Implications of Sensory Processing and Attentional Differences Associated With Autism in Academic Settings: An Integrative Review
5. School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need
6. Measuring the use of inclusive practices among pre-service educators: A multi-national study
7. Inclusive Education Strategies: A Textbook
8. Full article: A scoping review of perceived support needs of teachers for implementing inclusive education
9. Challenges to preparing teachers to instruct all students in inclusive classrooms – ScienceDirect

What you need to know about how ADHD impacts relationships

Humans are by nature social beings, so it’s not surprising that good relationships are at the core of our emotional wellbeing. Many children with ADHD, and other neurodivergent kids impacted by executive dysfunction, can find it difficult to navigate social situations. 

Executive functions are not only required for learning and achieving goals, they are also essential components of building great relationships. There are three main groups of executive functions: inhibition, cognitive flexibility and working memory; and all three operate together and influence each other to complete tasks. 

The challenges that children have in social settings arise from executive functions that are not yet fully developed, rather than purposeful disrespect or malicious intent. Some examples of where executive dysfunction may get in the way of developing friendships include:

Inhibition - low inhibition impacts our ability to ignore unimportant stimuli like noise, and regulate our movements and emotions to suit the environment and our goals. This may look like:

• Interrupting friends when they are talking - “If I didn’t say it I would forget.”
• Constantly moving and accidently breaking friend’s stuff or invading their personal space. - “It was an accident, I never meant to get that close.”
• Reacting strongly when feeling offended or frustrated - “I hate them. I asked them to play, but they said I had to wait.”
• Impulsively saying things without thinking that can be hurtful to others - “I was just being honest about the drawing.”

Cognitive flexibility - it’s more difficult to solve problems efficiently when our brain gets stuck on a thought or idea and has trouble processing additional information to make a decision. This may look like:

• Struggling to shift attention from a topic when a conversation changes - “I want to finish what I was saying.”
• Having difficulty seeing things from the perspective of friends - “But yesterday she said she would lend me the book and now she’s saying she needs it.”
• Getting upset with peers when they change or ignore rules - “It’s so unfair, I didn’t agree to that.”

Working memory - we need to keep important information in mind so that we can relate what happened earlier to what comes later, and use that to plan and organise. This may look like:

• Losing things that they have borrowed from friends - “I thought I left it at home.”
• Ignoring game rules because they can’t remember what was agreed - “I thought I was on your team.”
• Forgetting their friend’s birthday and other important details  - “I’m sorry I didn’t realise it was a secret.”

The statistics are heartbreaking, with researchers finding that children with ADHD are approximately four times more likely to be rejected by their peers relative to typical children. 

Primary school teachers can significantly change the course of the life of a child with ADHD for the better. Understanding the neurobiology of ADHD, how it can present and how it affects students’ learning and social interactions is critical for a teacher. This knowledge empowers teachers to create inclusive learning environments, which are fundamental in preventing students with ADHD from feeling isolated, judged, or having low self-esteem.

First things first - Laying the academic foundations for inclusivity

Students with ADHD can feel disabled at school, and this is because the classroom environment and the education system have been designed for the neurotypical majority. Neurotypical simply refers to brains that process information, communicate, regulate movements and emotions in what is considered to be a standard or typical way. Being neurodivergent, the opposite of neurotypical, comes with challenges because many of the societal constructs are not flexible enough to support a different way of thinking, learning, communicating, processing stimuli and moving.

When a child with ADHD has accommodations and adjustments that support their physical and cognitive functioning, they are more likely to participate, meet expectations and succeed in all facets of life. Positive experiences in the classroom translates to peers seeing a student with ADHD in a positive light. Although most parents are strong advocates, students still rely on their teachers to implement tailored success enablers that foster equity in a class cohort. 

A teacher’s role in addressing stigma and fostering acceptance

A disability is a high risk factor in students feeling marginalised. Hidden disabilities, like ADHD and learning differences, can be harder to understand because there are no obvious physical differences. Instead, students may struggle academically or behaviourally, making them more vulnerable to social rejection, exclusion and bullying. 

How teachers deal with behavioural symptoms that are a direct result of a student’s unsupported disability can influence how their peers see them. A teacher who believes a student is being purposefully disobedient or disruptive will discipline to extinguish the behaviour rather than identify and address what triggers the child’s response. Over time, peers begin to form a narrative based on what they observe in the classroom and start to associate students who have trouble meeting expectations with negative labels. This in turn confirms the stigma children have about ADHD and further risks the exclusion of peers with ADHD.

A teacher’s knowledge and empathy is then crucial in how they interact, support and discipline students with ADHD, but also how they educate the whole classroom on sensory differences, communication styles, learning disabilities, etc. Above all, students should learn about diversity from a positive perspective that accepts and celebrates the variety of brains and bodies that make up our communities and classrooms.

Inclusive classrooms facilitate social inclusion

Teachers are agents of change, they have the power to influence, educate and cultivate positive connections. Inclusive classrooms promote social inclusion because it is where teachers model and set the precedent for how students:

• Accept and value diversity
• Form and maintain respectful relationships
• Address and resolve interpersonal issues
• Support and collaborate with peers

Research shows that being socially accepted can protect students’ grades and academic performance, especially for those children who struggle with paying attention. Peer relationships not only improve mental wellbeing they can also support academic success through sharing of resources like notes and study techniques.

When a teacher creates an environment that fosters positive peer relationships they are also directly and indirectly improving a child’s academic outcomes. It’s not surprising that students who feel accepted by their peers tend to feel more connected to school. 

There is no doubt that parents need to continue advocating for their children, but at the same time they need to advocate for teachers. We expect a lot from our educators because they are instrumental in our children’s academic and social success, but they need access to the right resources to do this effectively. 

In part 3 we discuss some of the strategies teachers can implement to create more inclusive classrooms.

References

1. The Effects of ADHD Teacher Training Programs on Teachers and Pupils: A Systematic Review and Meta-Analysis – PMC
2. Effectiveness of Educating Program on Knowledge, Attitude, and Performance of Primary School Teachers Toward Attention-Deficit/Hyperactivity Disorder | Iranian Journal of Psychiatry and Behavioral Sciences | Full Text
3. Exploring Teachers’ Knowledge and Attitudes Toward Attention Deficit Hyperactivity Disorder and Its Treatment in a District of Turkey – PMC
4. Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort – PMC
5. Full article: The impact of teacher factors on achievement and behavioural outcomes of children with Attention Deficit/Hyperactivity Disorder (ADHD): a review of the literature
6. Ambivalent bonds, positive and negative emotions, and expectations in teachers’ perceptions of relationship with their students with ADHD – PMC
7. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research.
8. The Protective Effects of Social Factors on the Academic Functioning of Adolescents with ADHD – PMC
9. Effects of Teachers’ Knowledge and Empathy on Educational Intervention for ADHD: Focused on the Mediating Effect of Empathy.
10. The 3 areas of executive function
11. Executive Functions – PMC
12. ADHD symptoms and the teacher–student relationship: a systematic literature review
13. School factors associated with school refusal- and truancy-related reasons for school non-attendance | Social Psychology of Education
14. The relationship between bullying, learning disorders and psychiatric comorbidity – PMC
15. Factors Associated With Bullying Victimization and Bullying Perpetration in Children and Adolescents With ADHD: 2016 to 2017 National Survey of Children’s Health – PMC
16. Inclusive classroom norms, children’s sympathy, and intended inclusion toward students with hyperactive behavior
17. Competitive classroom norms and exclusion of children with academic and behavior difficulties – ScienceDirect

“Teacher X has a short fuse and doesn’t understand ADHD” Two full weeks of school and this is the first impression of the teacher my kid shared with me. Without jumping to conclusions I asked “Why do you say that?”. I always take historical recounting by my child with a pinch of salt, but they told me a story that illustrated how his working memory issues often gets him into trouble. 

The story my kid told me is a common scenario: a student is instructed by a teacher not to do Y, but a short time later they notice that another peer is doing Y, by this point the student has forgotten the teacher’s original verbal  instruction and does it anyway. On the surface this looks like purposeful behaviour, and no doubt in some situations it can be, but I can also see that a weak working memory contributed to the outcome.

How working memory works: the post-it note analogy

Working memory serves as a set of post-it notes where you keep important details to help you make decisions about the future, and it is constantly being accessed depending on the task you are doing. The problem with working memory is that it is a limited resource. 

The ADHD working memory post-it pad is not as big and the notes are not as sticky as those of a neurotypical brain. To make the most of working memory we also have to be really good at focusing on a task and disregarding all the interesting things that happen around us (impulse control). When you are paying attention it is easier to prioritise the information you need to retrieve from working memory to make decisions.

What does this have to do with my kids’ story? Let me step you through the example he gave and point out how working memory and attention regulation were at the heart of his infringement. 

It’s Tuesday morning and there is excitement in the classroom and chatting between students about the story they are writing. My kid walks past a set of cubes and starts rearranging them, and the teacher gives him the following verbal instructions “No playing with the cubes. You need to finish writing your story.”. My kid’s brain takes those instructions and puts them on a working memory post-it note and goes back to writing his story. 

In the meantime, the working memory post-it notes start to fill up with other information to help him complete the story. A friend asks him a question and his working memory uses another post-it note to store the question. My kid then realises that he needs to sharpen his pencil, so he gets up and focuses his attention on finding a sharpener. His working memory adds that task and necessary details to another post-it note.

If you look at all his working memory post-it notes you can see that they are all full with things he has to remember. At this stage, the original post-it note with the teacher’s instructions has either fallen off or it’s buried under all the latest post-it notes.

When my kid gets up to find a sharpener he notices another student playing with cubes. By now his working memory is no longer able to retrieve the post-it note that said “Don’t play with the cubes.” to make a decision on what to do next. Instead, it uses the recent visual image as a cue that it’s ok to play with the cubes.

What happens next is a result of a cranky teacher dealing with a student who has specifically disobeyed instructions. I get it, why can’t these kids do as they are told?

The teacher has every right to get cranky, because if all students do whatever they want, then they can’t teach the class. It is what the teacher does next and how they go about future interactions that can make a difference to the “understanding ADHD”.

This is just one example of how a working memory with limited and not very sticky post-it notes gets in the way of kids meeting expectations.

What advocating looks like

I have no doubt that similar situations will continue to pop up, so my job is to help the teacher understand the different aspects of executive functioning and give them ideas on how to support it.

I’m updating my kid’s About Me profile with the following: 

Our parent and teacher interview is coming up next week and I’ll be taking the teacher through the Supporting Students with ADHD booklet, and more specifically my child’s About Me profile. I’ll report back!

If your teacher’s child could do with extra information about your child and strategies to help them grab the free About Me template download and fill it out.

Our understanding of ADHD and how it presents in children has improved significantly and with it diagnoses have increased. Today, a teacher can expect a cohort of students made up of approximately 5-10% of children who have a suspected or a diagnosed neurodivergence.

Evidence collected over the years show that children with ADHD are at a higher risk of lower academic achievement and dropping out of school, peer rejection and victimisation, and low self-esteem. Childhood is a crucial window of opportunity to implement and prioritise protective factors that change the trajectory of an individual with ADHD and their quality of life.

Primary school is a time of big developmental milestones and the educational environment is particularly important in a child’s positive outcomes. Our children spend approximately six hours a day at school, and in that time they receive more than instruction on the curriculum, they also learn to relate to peers and build relationships.

Teachers are our children’s guides and trusted adults at school, and play a crucial role in shaping their educational and social experience.

Behaviours as a result of executive function challenges

As children move through primary school, they face more challenges including increased academic demands, navigating complex peer relationships and social acceptance. At the same time, parents and teachers become less involved and provide less support. It is usually during this period of increased expectations and reduced support that ADHD symptoms become more obvious. The wheels fall off as students are expected to use their executive functioning skills to plan and organise themselves, self-monitor and evaluate progress towards long-term goals.

Executive functioning delays in inhibitory control, cognitive flexibility and working memory are part of ADHD, and can result in externalising behaviours that are often categorised as disruptive and oppositional.

Teachers who don’t understand ADHD, especially in the context of executive functioning, may resort to using punitive measures for behaviours that are a direct result of a student’s disability.

Executive dysfunction in a child can look like this in the classroom:

• Regularly interrupting other students and the teacher
• Touching items and peers at inappropriate times and without permission
• Constantly moving even when told to keep still
• Reacting with aggression when feeling offended or frustrated
• Easily distracted by other students, noises and the things happening around them
• Getting upset when they are frustrated

The above ‘behaviours’ are a symptom of impaired Inhibition, which refers to our ability to ignore unimportant stimuli like noise, and regulate our movements and emotions to suit the environment and our goals.

Cognitive flexibility, our ability to think flexibly about a situation and look at it from different perspectives, can also be affected and may look like this:

• Very black and white thinking which impacts problem solving
• Having difficulty seeing things from the perspective of others
• Getting into altercations with peers and teacher over rules
• Becoming oppositional when asked to transition between tasks

Working memory, our ability to keep important information in mind so that we can plan and organise, and holding what happened earlier to relate it to what comes later, is greatly reduced by ADHD. A teacher will only see a student who:

• Constantly loses their belongings
• Makes careless mistakes in their work and forgets to answer questions
• Doesn’t follow instructions
• Is told not to do something and does it anyway

Empathy and knowledge of ADHD are intertwined

For many parents, including myself, whose children have had a teacher who understands ADHD, it is clear that they are more likely to be empathetic to behaviour challenges and therefore respond with sensitivity. Results of several studies show that empathy contributes positively to educational interventions by increasing a teacher’s understanding of children with ADHD in various situations. Empathy is a foundational component of a strong and trusting relationship especially between a teacher and a neurodivergent student.

Teacher’s who lack the knowledge and understanding of ADHD are more likely to believe that negative behaviours are wilful and in turn will use direct punishments or withdrawal of rewards in order to extinguish unwanted behaviours. Keeping children from lunchtime and recess breaks is a common consequence for breaking rules or negative behaviours, further dysregulating a child who needs movement to stay regulated and excluding them from social opportunities. These students return to class heightened and the cycle of behaviour, teacher stress and conflict begins again.

This circular problem of behaviour and punishment puts increasing stress on both teacher and student and compromises a positive relationship.

The importance of a teacher’s wellbeing

There is a growing body of research that shows that a teacher’s wellbeing is related to a student’s behaviour and their educational achievement. Evidence indicates that the behaviour of students with ADHD is impacted by:

• How well teachers and students with ADHD get along
• How teachers feel about ADHD
• How teachers can handle their own feelings
• A teacher’s teaching methods

When teachers feel good and understand what causes ADHD behaviours, they can better help their students. The research also highlighted the importance of teachers looking beyond a child’s challenges and seeing their good qualities and potential and being motivated to teach them.

Teachers who find themselves with negative and ambivalent emotions about a student with ADHD usually experience higher levels of stress. Some of the contributing factors include burnout, lack of access to supervision, access to additional educational support in the classroom, too many students in a class or a lack of understanding or misinformation of the symptoms of ADHD.

Positive student and teacher relationships is important for both parties

As our children become older they also become more aware of how they are perceived by their peers and teachers. Over time, the negative messages wear away at their self-confidence and trust in their safe adult at school. School refusal, which is not so much refusal as a child’s inability to cope in a school setting, becomes a reality for many students with ADHD. Without connection and safety in the classroom, children are not ready to learn nor are they willing to go to school, further impacting their educational outcomes.

The quality of a student and teacher relationship is of particular importance for students with disabilities and at risk of academic failure. Positive relationships are shown to be associated with academic achievement, self-efficacy, prosocial behaviours and relationships with peers.

The evidence across a number of studies highlight the importance of positive teacher-student relationship and a secure attachment of students with ADHD. A good relationship is linked to:

• Better emotional regulation, social competence, lower crime rates, and a willingness to accept challenges in students with ADHD
• Higher levels of the teachers’ personal accomplishment over the school year and the professional and personal self-esteem
• Quality of a teacher’s wellbeing

Teachers’ rejection of students with ADHD is a risk factor for not only academic failure, but also peer exclusion and rejection, leading to low self-esteem and loneliness.

Tips & strategies on helping teachers help your child

The pressure of the education department, increasing paperwork and increasing expectations have left teachers very little time to do what they love: teach. Instead they are swamped with administrative tasks and without the skills to effectively support a class of students with different needs.

As a parent, you have very limited direct influence on a teacher’s wellbeing, but you can provide them with resources about ADHD and with strategies on how to support your child. Research shows that teachers’ knowledge of ADHD is linked to confidence in their ability to effectively teach children with ADHD, create an inclusive classroom and manage behaviour. Knowledge helps to increase empathy, which is crucial to a positive student and teacher relationship. The Supporting Students with ADHD teacher’s booklet is perfect for time poor educators, it covers the most important aspects of ADHD and it provides a range of practical strategies that can be easily implemented.

You can also give them a strengths based lens with which to see your child. No one knows your child as well as you do, so use that to your advantage. Fill out the About Me student template and the strengths at school spreadsheet to help teachers connect with your child in a positive way and show them that they are more than the sum of their challenges.

References

1. The Effects of ADHD Teacher Training Programs on Teachers and Pupils: A Systematic Review and Meta-Analysis – PMC
2. Effectiveness of Educating Program on Knowledge, Attitude, and Performance of Primary School Teachers Toward Attention-Deficit/Hyperactivity Disorder | Iranian Journal of Psychiatry and Behavioral Sciences | Full Text
3. Exploring Teachers’ Knowledge and Attitudes Toward Attention Deficit Hyperactivity Disorder and Its Treatment in a District of Turkey – PMC
4. Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort – PMC
5. Full article: The impact of teacher factors on achievement and behavioural outcomes of children with Attention Deficit/Hyperactivity Disorder (ADHD): a review of the literature
6. Ambivalent bonds, positive and negative emotions, and expectations in teachers’ perceptions of relationship with their students with ADHD – PMC
7. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research.
8. The Protective Effects of Social Factors on the Academic Functioning of Adolescents with ADHD – PMC
9. Effects of Teachers’ Knowledge and Empathy on Educational Intervention for ADHD: Focused on the Mediating Effect of Empathy.
10. The 3 areas of executive function
11. Executive Functions – PMC
12. ADHD symptoms and the teacher–student relationship: a systematic literature review

“He has difficulty waiting his turn” 

“He needs to take better care of his belongings”

“He finds it difficult to work in a group”

At the beginning of kindy my son wasn’t yet diagnosed with ADHD, but we began to notice that teachers would use particular phrases that indicated to us that he was struggling. 

His kindergarten teacher was incredibly kind and would always use the poop sandwich to deliver her message - which basically means wedging negative feedback between a couple of positive comments, “he is so bright”, “it’s all very developmentally appropriate, many in the class have similar challenges”.

But, as my kid progressed through school, we noticed that it was becoming more challenging for him to hold it all together, especially at home. My gorgeous boy spent so much of his day trying to be “good” that as soon as the final bell rang, he would explode. 

The intense emotions were reserved for us, his family and safe spot, and teachers were not yet concerned because he was holding it together at school.

Time to investigate

We decided it was time to see a developmental paediatrician in the middle of year 1 to investigate what was going on for him. Our very experienced paediatrician was able to put together a clear picture of what was happening by nuances in the teacher’s comments, experiences at home and her observations at the appointment. We walked out with an ADHD diagnosis. I was so relieved, not knowing was the worst! Now I could stop researching all the catastrophic possibilities!! 

We didn’t want to rush into medication, our kid was still “coping” and everyone was hoping that things would stay stable. Yes, I know, wishful thinking. By year 2 it was clear that the wheels were starting to fall off. My lovely kiddo was no longer able to meet the expectations placed upon him. I would use bed time to ask him for his perspective, his feelings and his worries, but all I got was “school is boring”, “I don’t know why”, “it’s so boring”, and “I can’t help it”.

I can’t watch anyone struggle, especially not my child. My brain sees a problem and hyper-fixates on it. I then become obsessed with uncovering why something is happening so I can fix it (haha I wasn’t diagnosed with ADHD yet). Off to the psychologist we went. We were incredibly lucky to find another experienced professional. She ran a number of cognitive tests, which confirmed the ADHD diagnosis, but also identified him in the gifted range for some of the key components of the tests. No, my kid is not a genius. 

Twice exceptional kids have two exceptionalities and present with something called a spiky profile - this means they can do exceptionally well in certain parts of these cognitive tests and poorly in others because of their disability.

Penny drop. Now I understood why school was so boring and why they were getting in trouble for being disruptive! Not only were they struggling with ADHD executive functioning challenges

• Regulating emotions and impulsivity
• Getting started on boring tasks and being motivated to finish
• Working memory and focus
  

They were also bored in the classroom with nothing to keep their body or mind busy. And what does a bored and impulsive child do? They become disruptive. An inexperienced teacher doesn’t have the skills, tools or resources to help. Sometimes inexperience can make things worse…

• Strategy 1: Ask the child to mark other students’ maths work - failed, because it  doesn’t provide extra stimulation.
• Strategy 2: Give the child more worksheets - failed, it only made them angry at the unfairness of it all, why do they have to do more than the others?
• Strategy 3: Let the child do another (not learning related) preferred activity - failed, it only motivated them to finish teacher assigned tasks even more quickly (rushing and not checking work) so that they can do the preferred activity.
  

At this point we also started noticing social difficulties. When you work so hard at following instructions, paying attention, keeping fidgeting under control, and so on, there is little left in the tank for social interactions with your peers.

Time to advocate

I was also acutely aware that most teachers don’t have the training or resources to help students with ADHD. I put my big advocating pants on and designed a Dear Teacher handout to give to educators. It was a simple one-pager, but  it helped guide our conversations about “concerning behaviours” and the support my kid needed.

One handout was not going to change everything for the better - I knew that. Back to the paediatrician we went, and at this point we knew it was time to give medication a try. I had read enough stories from adults to know that medication can be life changing, and those who didn’t have the option to take it, felt that they had struggled unnecessarily. 

It took a few different medications and combinations, but we finally landed on a good combination. 

Life with ADHD is a rollercoaster, especially in the early years as children are growing and learning to navigate social interactions and relationships with a dynamic disability.

That first single page handout has now grown into a teacher’s booklet: Supporting Students with ADHD. Every year I march into the school with my updated booklet in hand to start the advocating process early. I want each teacher to understand my child, his challenges but also his incredible strengths, so that they feel confident in providing the support he needs. 

A campsite without people is amazing, but there were other families there with different dynamics and other neurodivergent kids. From the moment we woke up until bedtime there were dozens of kids laughing, making noises, singing, moving - in essence kids just being kids, and in other words OVERSTIMULATION!

Although my child had everything to keep regulated, I didn’t realise until we got back home that he couldn’t do it. He didn’t have enough opportunities to balance out the high levels of stimulation with regulation. Not only did we take him away from his room, books and toys, we put him in an environment where he was always surrounded by people. 

My beautiful boy feels things very intensely. Strong emotions often make his brain get stuck in a loop of the same thoughts. This means that he finds it difficult to let go of real or perceived offences by friends, family and strangers. There are hints of RSD (rejection sensitive dysphoria) in my dear boy, and I can see myself in him… 

We have been working on calling out a stuck brain for a while now. It often starts with me saying something like “I think your brain is stuck in a loop.” and him saying “No it’s not!”. I then spend time making observations and asking him questions. “We spoke a few times already about not eating the ice creams until tonight. I know they are very hard to resist, but what do you think will happen, if you wait a few more hours?”. Getting unstuck can take a long time! I believe that with enough repetition, my voice will become part of his inner monologue as he grows up - can you hear your parents voices in your head saying “I’m going to count to three!”.

The real breakthrough though, was not talking about the stuck brain, it was helping him let go of the grudges he holds. These offences that he clutches on to so tightly have the power to ruin relationships, but above all they make him sad and unhappy. After another “But she did it first!”, we spoke about letting go of these “minor offences” and starting fresh. To do this we first need to ask ourselves a few questions:

• Has the person apologised?
• Did they do it on purpose?
• Did they understand how much it would hurt you?
• What would it take for you to move on and start fresh?
• Is retaliating going to make things better or worse?

Unexpectedly and thankfully, I was tired of adjudicating, it was the phrase “start fresh” that helped him let go. There were still disagreements between the kids, especially siblings (of course!), but I was able to pull my boy back from the slippery slide into grudge land!

Our personal capacity to deal with challenges, changes and other stressful situations affects our ability to function at our best. Similar to adults, children experience fluctuations in their emotions, especially during stressful situations. When emotions are at their peak, children lose the ability to “use their words” to communicate what is happening to them.  When we understand what optimal functioning looks like for our child, we can identify physiological and behavioural changes early to provide the support they need. The concept of the Window of Tolerance is a useful method to achieve this.

Dan Siegel, a Clinical Professor of Psychiatry, developed the concept of Window of Tolerance to describe the best state of arousal for an individual to learn, play and relate well to others and themselves. The Window of Tolerance is frequently used in mental health and child development contexts to represent the optimal range of emotional arousal within which an individual can effectively cope with stressors. 

Why it’s important

Neurodivergent children, because of their neurology and sometimes the past trauma they’ve experienced, usually have more difficulty in dealing with different types of stress and therefore have a much narrower Window of Tolerance. Having said that, every child is different and what might be overwhelming for one could be within the comfort zone for another.

When we move outside our Window of Tolerance we can become either hyper-aroused or hypo-aroused.

Hyper-arousal - is usually triggered by the fight or flight response when our brains detect danger. Some signs that a child is hyper-aroused include: 

• Irritable or angry
• Constantly anxious or in panic
• Easily scared or startled
• Engages in self-destructive behaviour

Hypo-arousal - results from the freeze or flop/drop response when our brain detects danger, but instead of mobilising the body it does the opposite. Some signs that a child is hypo-aroused include: 

• Shutting down
• Feeling depressed or numb
• Experiencing exhaustion
• Feeling disconnected or dissociating 

The size of our window is not fixed and it can change from day-to-day depending on the support, environment and coping mechanisms we have available.

Think of it like travelling down a road that is wide in parts but narrow in others. On one side of the road the path is rocky and bumpy, sending you out of control, similar to hyper-arousal. The other side of the road is muddy and boggy, stopping you from moving, similar to hypo-arousal, and the middle of the road is safe and smooth. Sometimes the road narrows and it’s difficult to stay on the comfortable part of the road, at other times it simply feels like you are swerving all over.

The good news is that when we have a wider road, we have more space to move through life without getting stuck or being thrown out of control. You can help your child widen their road by: 

• Helping them develop better self-awareness - this can include drawing your child’s attention to how their body feels when they experience certain emotions, or talking through the impact of decisions and activities on their wellbeing e.g. do they feel tired at the end of the day and therefore can’t take on anything new, or do they struggle in large groups, etc
  
  
• Providing external supports - these can include sensory accommodations, visuals for routines or schedules, or even a buddy that can help them feel safe
  
  
• Teaching them strategies for navigating challenges and unexpected situations - this can include breathing exercises, or giving them self-advocating prompts, or working through options for regulating in specific situations

Whatever strategies you use, remember that any skills you teach your child, need to be practised regularly and when they are calm. When skills are familiar they are easier to use at times when they feel dysregulated.

Tips & strategies for using the Window of Tolerance

Build the foundations for wellbeing - Developed by David Rock and Dan Siegel, the Healthy Mind Platter is based on neuroscience, clinical practice, behavioural research, and psychology. It identifies 7 areas which strengthen the brain’s internal connections, strengthens connecting with other people, and improves integration of different parts of the brain.

1. Sleep time - restorative sleep is crucial in memory consolidation and learning, and it also allows the brain to recover
2. Physical time - strengthen your body with fun physical activities and at the same time strengthen the brain
3. Focus time - turn your attention to a task or goal to assist in making deeper connections in the brain
4. Time-in - create time for just being, thinking and feeling
5. Downtime - give your mind the opportunity to wander and let your brain recharge
6. Playtime - unstructured play allows for spontaneous creativity and helps the brain make new connections
7. Connecting time - connect with friends and family face-to-face, with nature or with a pet if you have one.

Tune in - take the time to observe your child’s behaviour and emotional cues during daily activities, and record them in the Keywell app. When are they most engaged, calm, or, conversely, when might they be showing signs of distress? It’s all the little things that are specific to your child that contribute to a better understanding of their individual Window of Tolerance.

Create a safe environment - Emotional safety is incredibly important for a child, and for adults. Dr. Stephen Porges’ work emphasises the importance of feeling safe for emotional regulation. Safety can be as simple as providing predictability through routines, clear expectations, and creating a space where your child can express themselves without fear.

Prioritise regulation - Explore and adapt strategies to assist your child in self-regulation. The strategies can be very simple like ensuring that your child has regular sensory breaks in their day and where possible allowing them to engage in activities aligned with their interests. 

Validate emotions - Validating your child’s emotions is an important part of connecting and acknowledging your child’s experiences. Whether they are comfortably within their Window of Tolerance or struggling outside it, recognising and acknowledging their feelings builds trust and connection. 

Bring them back on the road of regulation - The most important step in helping your child return to their Window of Tolerance is to first ensure you are well regulated yourself. A dysregulated adult cannot calm a dysregulated child. 

When fight-flight-freeze-flop/drop has been triggered, the thinking part of the brain is put on standby while the survival instinct takes over. At this point your focus is to help your child feel safe rather than work through the problem, show that you understand them by validating their feelings and not berating them for their choices.

Learn to recognise your child’s state of arousal and select the most appropriate strategies to bring them back to a calm state. When your child is experiencing:

• Hyper-arousal - try simple breathing strategies (star breathing, hot chocolate breathing, 2 quick breaths in through the nose and a long exhale through the mouth), drinking from a straw to focus attention and soothe, star jumps to integrate the two sides of the brain, use a weighted blanket to provide deep pressure, or encourage kicking/bouncing a ball to release energy.
  
  
• Hypo-arousal - try strategies that stimulate the senses like using aromatherapy for smell, eating crunchy food to activate taste, shaking a sensory bottle for visual stimulation, walking barefoot for body awareness, or listening to music for auditory input.

To recognise and respect your child’s individual Window of Tolerance can take time and requires you to become more connected and in tune with your child. Do you know what triggers your child? Have you noticed patterns in how they feel/respond/behave? Use the Keywell app to record your observations to keep you in tune with their wellbeing.

“I don’t want to go!”
“This is boring!”
“We never do anything fun!”
“Can we go home now?”

Sound familiar? 

I hear these phrases from my kid pretty much on a daily basis, sometimes every few minutes, and I’m not going to deny that they can be a trigger. We used to question whether we spoiled our kids by organising too many activities and giving in to their constant demands for entertainment. Were we creating ungrateful kids?

The experts tell us that “Kids should be bored.” and that “They have to make their own fun.” because it’s important for their development. I know what they mean, but I feel it’s not a rule that applies to all kids all the time. Not to my ADHD kid anyway. He has an interest based neurology and boredom is a common state for him. What most neurotypical people don’t understand is that boredom for a kid with ADHD feels painful - the kind of pain that can get in the way of thinking up ideas for making your own fun. 

ADHD changes your child’s experience

There are times when we have to attend family events or get together at a friend’s place, and we automatically expect that our children will be fine with it. We grew up being able to do it, and lots of kids have no issues with going where their parents go. They should be fine right? Except that we forget that ADHD impacts more than just our ability to focus. It can also affect:

• Emotion regulation - managing the frustration from waiting, working through disappointment and not getting overexcited
• Sensory processing - seeking sensory input through rough play or being overwhelmed by different and competing sounds
• Flexible thinking - taking someone else’s perspective or thinking through multiple outcomes to effectively solve a problem
• Working memory - keeping multiple steps and requests in mind in order to meet expectation and goals

It’s easy to project our adult expectations, which are defined by our unique experiences and needs, onto our child. We try to convince them that they will have fun, but if we are completely honest and ask questions, we’ll understand that the contrarian attitude has valid reasons.

• Are there things that interest them? 
• Will they have to make small talk with people they only see a few times a year?
• Will they need to be quiet or still? 
• Will they be served food they don’t like?
• Will they be away from their room and personal things?
• Will they have to rely on others to share?
• Will they be able to withdraw to a quiet spot away from people or noise?
• Will they be able to fully relax? 
• Do they have to follow a different set of rules and expectations?

Adapting your parenting to your child

I’m not saying that you have to change all your plans when your child says no to something. I’m saying that understanding their concerns can put you in a better position to problem solve with them. Talking your child through their worries and agreeing on options to address them can change an oppositional attitude to a more flexible one.

What about the complaining that happens when you are doing fun stuff? Your kid should love it, shouldn’t they? You’ve planned something “fun”, you are doing things as a family, or perhaps you are trying to share an activity you enjoyed as a child - but your kid whines about it anyway. 

You have gone through so much trouble to organise things that everyone will enjoy and yet it feels like your child is never happy. We see the complaining as a deliberate attack on our joint enjoyment and a disregard for the effort we have put into arranging these activities. 

Kids don’t really appreciate effort in the traditional way adults do, and our expectations are our own, and often unreasonable for our neurodivergent kids. 

You say: “Let’s go on a bushwalk - you love nature and animals, it will be great!” 

You hear: “I don’t want to go.” 

What they probably mean is something more complex: “I hate the annoying flies” “It’s too hot” “I have to wear uncomfortable shoes” “We never get to have breaks when I want to”. 

You say: “Let’s go to an amusement park! You love going on rides.”

You hear: “This is boring, I want to go home”

What they probably mean is something more complex: “I have to wait too long to go on a ride and I’m frustrated” “I’m scared to go on the rides and there is nothing else to do” “I’m overwhelmed by all the people, sounds and smells” 

Even when you have taken into account your child’s interests and preferences planning the outing around them, things may not go to plan. They aren’t being “ungrateful”, your child’s reaction can be fueled by something as simple as you picking a day when they thought they were doing something else, or because they slept poorly or their brain needs downtime.

I know it sucks for you and for the whole family. It’s hard. You feel discouraged from ever trying to organise outings, and it’s so, so easy to blame it on your child. Sometimes you wish they could pretend to enjoy it and let the rest of the family have fun. The thing is, your child is not only having a bad experience, they are also being blamed for ruining it for everyone else.

So what can you do? 

Involve your child in the choosing of activities and the planning. Talk them through what to expect and when and what options they have when things aren’t going their way.

Lower your expectations. Your child doesn’t have to be jubilant with every activity. Accept that sometimes, your child’s willingness to put up with it for a short time is an acceptable outcome. Understand their worries and agree on a solution.

What you think is fun, might feel like pulling teeth for your child, and you have to accept that. Offer the opportunity to weave in fun things for them to break up the day and make the outing more enjoyable.  

Don’t dismiss the possibility that social anxiety might be at play. If this is the case, offering an ice cream, gaming time or a present in exchange for compliance, won’t work. 

Whatever the case, meet your child where they are at and be curious about their reasons for saying the things they do.

That’s the thing about neurodevelopmental differences like ADHD and Autism - they are dynamic in their nature. Depending on the demands placed upon you, the environment, and the supports available, someone’s needs can change and in turn their mood and behaviour.

This Christmas I decided to do things a little bit differently. I decided to talk to my child about what things were hard for them during this period. Instead of expecting them to remember and articulate their thoughts, I created the image below and asked them to pick 3 things they could do without.

They told me they wanted to take out the following:

1. Expected to participate - I don’t want to be asked repeatedly to do something I don’t want to do
2. Surprises - I don’t want to be rude and make someone feel bad because I am given a present I don’t want and don’t like
3. Endless visitors - There are always people coming by and staying too long so I can’t relax and do what I want

Okay, I’ll be honest, my child’s answers weren’t entirely a shock to me. Over the years there have been comments, pushback, and complaints about these things, but I dismissed them. I didn’t take them on board because I was trying to meet other people’s expectations and deliver what I thought was a “good” Christmas. Not this year. This year I’m listening and actioning.

Kiddo - We’ll support you when you say that you don’t want to participate in games/farewells/hugs/kisses and we’ll handle questions and comments. Let’s agree on what you can do instead.

Expectations to participate only put pressure on kids to perform when we want them to. Is it worth pushing them? Who will it please?

Kiddo - We’ll tell you what gifts you are getting so there are no surprises, but you don’t get to open them until Christmas. You choose if you want to open them with everyone else or separately.

I’ve always been taught that you should always be grateful for what you have and what you get. The problem with this idea is that I’m projecting an adult attitude filled with years of experience on a child. Telling my kiddo what they are getting for Christmas gives us a chance to talk about the gifts privately instead of expecting them to respond “appropriately” in front of family.

Kiddo - We’ll keep visitors to a minimum and we’ll host only the one thing we’ve agreed on. You’ll know what, when, and who, and you’ll have options to tap out. I’ll let you know if things change so that there are no surprises and we can find a solution that works for everyone.

In previous years we’ve hosted both Christmas Eve, the Portuguese tradition, and Christmas Day, which is when Australians celebrate. Tacked on to that we’ve also hosted people staying, drinks, and playdates. It’s too much. Kiddo is right.

This family is fast running out of fuel. Not only has the end-of-year exhaustion truly set in, but in the last week one parent and one kiddo got a nasty virus and the other kiddo broke their leg. I’m the last one standing (literally!!), so I’m filling in the gaps and hoping I don’t catch the malaise. You can call me the eternal optimist because I’m feeling good about the next few days.

Happy holidays!

In part 1, we talk about the neurobiology of emotion regulation and the role our body and brain play in how we control our emotions. For children with ADHD, brain connectivity differences and executive function difficulties can underlie emotion dysregulation.

Part 2 of the series focuses on the impact of emotion dysregulation. We outline the signs of dysregulation in childhood and adolescence, and the impact on relationships. Parent burnout is often not discussed, but it’s an important factor in how you provide long-term support for your child.

To conclude the series, we’ve reviewed research on the therapies and interventions that have been used to improve emotion regulation and added a lived experience perspective.

Tips & strategies

What you can do to support emotion regulation

Don’t burn out - parenting isn’t easy at the best of times, but raising a child who has difficulties with emotion dysregulation adds another level of complexity to life. There is no medal for pushing yourself beyond your limits. To avoid burnout consider the following:

• Don’t wait until you have nothing left to give. You shouldn’t feel guilty about regularly putting aside time to do things that make you happy and help you feel rested and regulated. When you become a parent you don’t stop being human.

   

• Lower expectations for yourself and everyone in the family. You might think this is an impossible task because you’ve deemed everything to be essential, but when you are feeling overwhelmed or your child is constantly stuck in the fight mode, it’s time to just do the basics. Where possible outsource help, delay chores, and say no to events and things that require physical and emotional energy. 

Prioritise your relationship - Choose a few golden rules that you’ll always enforce and be flexible the rest of the time. If you engage in daily conflicts you’ll end up answering every offence with criticism or punishment. Acknowledge all the positive gestures, the effort your child makes and their honest attempts to do the right thing. 

Listen with empathy - Feeling ignored can trigger anger in your child, but being heard can have the opposite effect and help them calm down. It’s important to acknowledge anger as a normal emotion, rather than ask them to suppress it because implicitly this can make things worse.  

A study discovered that when adults with ADHD try to hold back their emotions, it takes them longer to get back to feeling calm compared to when they accept their emotions. Suppressing emotions can lead to using other not-so-helpful strategies to cope, like overthinking or imagining the worst, creating a cycle of feeling out of control. However, it also suggests that practising better ways to handle emotions could help improve emotional responses. This tells us that teaching children with ADHD to accept and manage emotions, empowers them with tools they can use every day and throughout their life. 

Be the emotion coach and link to internal body cues - Dismissing, minimising, or punishing children for their emotional experiences has been found to have a direct impact on how a child expresses emotions in the future. Emotion coaching strategies, however, where you acknowledge a child’s feelings as valid and guide them to feeling calm, have shown to be an important factor for developing self-regulation. 

Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Some children benefit from help naming their emotions and connecting them to accompanying physical sensations (interoception). For example, you might talk about anxiety and the sensation of having butterflies in your stomach or anger as heat travels through your body. 

Note: some children may have a condition called Alexithymia, which affects their ability to recognise and describe the emotions they feel.

Find the triggers - Anger is a primary emotion (immediate and instinctual), but often it can also be a secondary emotion (influenced by thoughts/beliefs/experiences) and used to protect ourselves or cover up emotions. Understanding your child’s triggers can help you avoid them when necessary or plan for them. Talk to your child about situations or things that cause them to feel negative emotions, and work through options on how to identify and deal with them. Involving your child in problem-solving during these circumstances develops multiple skills, including self-awareness and self-advocacy.

Empower your child with options: Work with your child to develop coping strategies for managing frustration and anger. There are many different ways to regulate our feelings, and they can include deep-breathing exercises, counting to ten, reappraisal of a situation, or taking a short break to cool down. Jumping on a trampoline or squeezing a stress ball, can give kids a way to direct and release their anger without hurting anyone. Depending on the situation and their triggers, your child should feel like they always have options for regulating.

Try role-playing: Playing out scenarios that have previously been an issue for your child can give them a safe way to practise self-advocating. Practicing breathing exercises and problem-solving when they are calm is a great to increase your child’s confidence. This preemptive approach is especially helpful as they start to navigate complex social situations.

Boost positivity - Working on amplifying positive emotions and creating daily opportunities for experiencing moments that calm the nervous system, is just as important as helping kids manage negative feelings. Two easy and effective strategies include:

• Gratitude reflection - there is something powerful about taking the time to think about what makes you grateful. Incorporate a regular ritual, where everyone in the family can reflect and share what things they are grateful for.

   

• Finding glimmers - The word “glimmers” is used to describe a small moment that has a regulating effect on our nervous system. Think of tiny cues from the external environment or your own body, that make you feel safe and calm or bring you joy. Encourage your child to increase their awareness of those positive moments throughout their day.

Seek support  - Depending on the severity of your child’s emotion regulation difficulties, it might be worth exploring other underlying issues or conditions. Your child’s psychologist and paediatrician can advise on how to proceed. To help clinicians, keep note of all your observations in the Keywell app so you can confidently discuss the frequency and intensity of your concerns.

Treatment options for emotional dysregulation 

Over the last few years, there have been several studies to test and understand what interventions provide the most significant improvements in self-regulation for children and young people with ADHD. Scientists have found that it is very difficult to design robust studies that measure emotion regulation in a standardised and consistent manner and that meet feasibility, efficacy, and acceptability criteria. 

We’ve summarised some of the established and emerging therapy options that can help with emotion dysregulation. You’ll need to talk to your medical care team to determine whether you want to explore these options further. Depending on your child’s unique neurology they may respond better to one or a combination of therapies.

Medication - ADHD medication has been proven to be a good treatment option for emotional dysregulation as it can help regulate neurotransmitters in the brain, improving attention, focus, and impulse control, which in turn, contribute to better emotional regulation. If emotion dysregulation is a symptom of an underlying and independent condition like anxiety, your child’s paediatrician might suggest a combination of medications to treat different symptoms.

Cognitive behavioural therapy (CBT) - CBT for ADHD is an effective option for emotional dysregulation as it helps children learn to identify situations that cause anger and frustration, and develop techniques to manage negative emotions. In some CBT programs, children learn how to recognise the anger cues from their body, triggering situations, behaviours, and how their thinking changes when they are angry. Children also learn strategies to reduce angry outbursts, reduce their intensity (e.g. through relaxation, activity practice, thinking about something else, cognitive reappraisal), and develop a set of solutions for problem-solving. They learn to understand social situations better and the role of thoughts in causing and keeping anger. Additionally, children may practice ways to peacefully resolve conflicts in situations where they are provoked such as being teased by peers or reprimanded by adults.

Parent–Child Interaction Therapy (PCIT-ED) - there are decades of research supporting the use of PCIT to reduce disruptive behaviours and improve the relationship between a parent and child. PCIT has since been modified to support children with an ADHD diagnosis. There are a few variations of the original program that target anxiety, including PCIT-ED for emotional development, PCIT-Eco for emotion coaching, and PCIT CALM designed to coach approach behaviour and leading by modelling. If you are considering a type of PCIT, please talk to your clinician about whether the program they deliver is neuro-affirming.

Digital interventions: Emerging research on digital solutions is still insufficient to support the effectiveness of apps for children, preadolescents, and adolescents with mental health concerns. That said, you can speak to your psychologist about trialing them.

• Virtual or augmented reality - In a recent study, individual exposure to immersive virtual reality emotion and social skill practice was linked to improvements in emotion regulation in a sample of autistic kids with low support needs.

   

• Digital games - The strongest evidence from digital games is in the reduction of negative emotional experiences (anxiety). This suggests that digital games can be efficacious for training emotion regulation in children and early adolescents.

Neurofeedback: Neuroplasticity is the concept that parts of our brain can be developed and shaped over time. Neurofeedback (NF) is believed to support the brain networks underlying emotion regulation like the prefrontal cortex and amygdala, by changing the frequency and intensity of brainwave activity. Scientists believe that Neurofeedback may be particularly effective when the brain is undergoing substantial development like during adolescence.

This emerging therapy can use real-time fMRI (functional magnetic resonance imaging) or EEG data (electrical activity of the brain recorded via electrodes affixed to the scalp) to help an individual train their brain to improve ADHD symptoms like emotion regulation, impulsivity, and focus. 

Although there are concerns about the validity of the methodology and design of studies on neurofeedback, the results suggest a positive link to emotion regulation improvements, especially when coupled with a digital game. The combination of both interventions may be more effective because they target the emotion regulation framework where top-down and bottom-up regulation strategies are used together.

References

1. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis – PMC
2. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention
3. Managing Frustration for Children (MFC) Group Intervention for ADHD: An Open Trial of a Novel Group Intervention for Deficient Emotion Regulation – ScienceDirect
4. Childhood attention-deficit hyperactivity disorder: Family therapy from an attachment based perspective – ScienceDirect
5. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping | SpringerLink
6. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review – ScienceDirect
7. Profiles of parents’ emotion socialization within a multinational sample of parents 
8. Adult Outcomes of Childhood Dysregulation: A 14-year Follow-up Study – PMC
9. Emotion dysregulation and integration of emotion-related brain networks affect intraindividual change in ADHD severity throughout late adolescence – ScienceDirect
10. Examining the influence of irritability and ADHD on domains of parenting stress | SpringerLink
11. Effectiveness of group psychodrama on aggression and social anxiety of children with attention-deficit/hyperactivity disorder: A randomized clinical trial – ScienceDirect
12. The effectiveness of parent-child interaction training on behavioral problems and aggression of children with ADHD symptoms 
13. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure
14. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial – PMC
15. Regulation of sadness via acceptance or suppression in adult Attention Deficit Hyperactivity Disorder (ADHD)
16. ORIGINAL ARTICLE An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder Dikkat
17. Preschool Intervention Can Promote Sustained Growth in the Executive-Function Skills of Children Exhibiting Early Deficits – PMC
18. Evidence review for universal curriculum approaches – NCBI Bookshelf
19. Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study – PMC
20. Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents – PMC
21. A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA) – PMC
22. Maternal Burnout Syndrome: Contextual and Psychological Associated Factors
23. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
24. Consequences of parental burnout: Its specific effect on child neglect and violence
25. Parents’ Beliefs about Children’s Emotions and Children’s Social Skills: The Mediating Role of Parents’ Emotion Regulation – PMC
26. Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers – PMC
27. Digital Interventions for Emotion Regulation in Children and Early Adolescents: Systematic Review and Meta-analysis
28. Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents – PMC
29. Clinician adoption of Parent–Child Interaction Therapy: A systematic review of implementation interventions – PMC
30. Parent–Child Interaction Therapy With Emotion Coaching for Preschoolers With Attention-Deficit/Hyperactivity Disorder – ScienceDirect
31. A pilot feasibility evaluation of the CALM Program for anxiety disorders in early childhood
32. Modulatory effects of dynamic fMRI-based neurofeedback on emotion regulation networks in adolescent females – ScienceDirect
33. Using real-time fMRI to influence effective connectivity in the developing emotion regulation network
34. Results of Neurofeedback in Treatment of Children with ADHD: A Systematic Review of Randomized Controlled Trials

Research is increasingly looking into how self-control skills are vital for academic performance, achieving personal goals, and having positive outcomes as kids grow up. The studies propose that kids who are good at self-control might find it easier to perform better academically, make friends, and deal with challenges that arise during the school years.

Regulating emotions doesn’t come easy to kids with ADHD, but when they struggle with emotion dysregulation, there are some extra signs to look out for, like:

• Getting easily annoyed
• Being impatient when things are stressful
• Getting really angry over small problems
• Suddenly exploding with anger
• Having regular moments of frustration
• Not being aware of how others feel

Emotion dysregulation and parent burnout

Your child might react strongly to everyday things, and it might feel like you have to be careful around them - like walking on eggshells. Having regular negative interactions with your child can create the conditions for parenting burnout (the same is true for carers, for simplicity I will refer to “parents” throughout this section). 

Although many parents will resonate with the feeling of burnout, parental burnout as a clinical concept is still very new. For now, there are three proposed measurements that can indicate parental burnout construct/syndrome:

1. Feeling exhausted from parenting
2. Feeling emotionally distant from your child
3. Feeling that you are not a good parent and questioning how effective you are

Evidence shows that burnout affects the person in several ways including disrupted sleep, adverse physical symptoms, and addictive behaviours. There is also a strong correlation between parental burnout with co-parenting disagreement, family disorganisation, and emotional instability.

Clinicians have observed a pattern in parents who are exhausted and who care for kids with behavioural issues where they tend to step back emotionally instead of physically. This means they still take care of basic needs like feeding and bedtime, but they become less connected, less understanding, and less responsive to their children emotionally.

Your well-being is critical to your ability to effectively support your child’s emotion regulation. If you are also tired, stressed, unwell, or dysregulated, you won’t be able to effectively co-regulate with your child, and that can make situations worse. 

Emotion regulation and relationships

When a child’s dysregulation escalates to aggression it is important to seek additional help for yourself and your child.

Aggression is when anger goes up a notch and turns into actions that can immediately hurt someone. Several studies have found that more than half of pre-adolescents with ADHD combined type (inattentive/impulsive-hyperactive) score high on aggression. Impulse based aggression, i.e. acting without thinking and getting aggressive, was the most commonly observed form of aggression.

Aggressive kids might:

• Hit
• Grab
• Bite
• Kick
• Shove
• Pinch
• Pull hair
• Scratch
• Throw things

It’s important to know that when kids get aggressive, it’s not because they’re trying to be “bad”, it’s because their emotions are too strong for them to handle at that moment. As parents, we need to find ways to help our children regulate when they have lost control and plan for future triggers. This involves in-the-moment strategies, but most importantly, it relies on implementing day-to-day support and tools that align with long-term regulation goals for your child.

In teenagers, hormones can make ADHD even more challenging, and sometimes it leads to them acting impulsively with aggression. In teens, the signs might not be physical, and might include:

• Insulting friends
• Yelling at family
• Threatening to hurt themselves or others
• Teasing or bullying
• Lying or gossiping
• Spreading rumours
• Using manipulation to keep their social standing

Often, when a child has a hard time managing their emotions, it can create a back-and-forth issue with family and friends. The child’s frequent strong negative feelings can affect how they get along with their family and peers. On the flip side, if the parent has a poor relationship with their child, the child might struggle to see the parent as someone who can help them, making it harder for them to regulate. 

There is significant evidence that shows that children who have a secure relationship with their parents are better at regulating their emotions. In addition, positive maternal parenting styles are thought to be associated with changes in brain structures that are connected to cognitive and emotional functioning. This simply means that your ability to use positive parenting strategies can be a protective factor for your child’s emotional health in addition to supporting the development of their emotion regulation capabilities.

As a parent, the earlier you can start with positive parenting strategies the better it will be for your child’s future development.

Ask yourself “Do my child and I have a good relationship?” If you said no or believe that it has been eroded over time, repairing that relationship is an essential part of addressing your child’s emotion regulation difficulties. And although you might not feel like connecting with your child because of past interactions where you’ve been hurt, this is probably the most important time to prioritise repair and connection. Try the 7 day connection challenge to get you started.

Early intervention for better long-term outcomes

Investigating and addressing emotion control during childhood, when the brain’s plasticity is at its highest, will have the most positive impact on your child. Emotional reactivity and ADHD symptoms have been shown to get stronger with age; this finding is consistent with published reports acknowledging that emotion dysregulation persists over the lifespan. In fact, the percentage of individuals with ADHD who experience emotion dysregulation increases from around 25–45% in childhood to 30–70% in young adulthood.

The combination of ADHD symptoms and emotion regulation is associated with significant reductions in quality of life. In a study that looked at 2076 kids over 14 years, evidence linked problems with controlling emotions in childhood to having more anxiety, mood issues, behaviour problems, and substance abuse as grown-ups.

These types of longitudinal studies highlight the importance of early identification of emotion control problems in kids with ADHD, and the importance of managing them.

Science and research only give us some pieces of the puzzle. Your child’s natural temperament and personality also influence their capacity for self-regulation, in addition to their sensory and neurodevelopmental differences. This is why it is so important to know your child and understand their needs beyond a diagnosis.

References

1. Working memory training improves emotion regulation ability: Evidence from HRV – ScienceDirect
2. The neurodevelopment of executive function skills: Implications for academic achievement gaps.
3. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
4. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis – PMC
5. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention
6. Managing Frustration for Children (MFC) Group Intervention for ADHD: An Open Trial of a Novel Group Intervention for Deficient Emotion Regulation – ScienceDirect
7. Childhood attention-deficit hyperactivity disorder: Family therapy from an attachment based perspective – ScienceDirect
8. Altered Intrinsic Functional Connectivity of the Cingulate Cortex in Children with Severe Temper Outbursts – PMC
9. Abnormal Amygdala Functional Connectivity Associated With Emotional Lability in Children With Attention-Deficit/Hyperactivity Disorder – PMC
10. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation
11. Performance of children with attention deficit hyperactivity disorder (ADHD) on a test battery of impulsiveness
12. Emotion regulation accounts for the relation between ADHD and peer victimization | SpringerLink
13. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping | SpringerLink
14. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review – ScienceDirect
15. Adult Outcomes of Childhood Dysregulation: A 14-year Follow-up Study – PMC
16. Examining the influence of irritability and ADHD on domains of parenting stress | SpringerLink
17. Effectiveness of group psychodrama on aggression and social anxiety of children with attention-deficit/hyperactivity disorder: A randomized clinical trial – ScienceDirect
18. The effectiveness of parent-child interaction training on behavioral problems and aggression of children with ADHD symptoms
19. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure
20. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial – PMC
21. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
22. Regulation of sadness via acceptance or suppression in adult Attention Deficit Hyperactivity Disorder (ADHD)
23. ORIGINAL ARTICLE An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder Dikkat
24. Preschool Intervention Can Promote Sustained Growth in the Executive-Function Skills of Children Exhibiting Early Deficits – PMC
25. Evidence review for universal curriculum approaches – NCBI Bookshelf
26. Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study – PMC
27. Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents – PMC
28. A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA) – PMC
29. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
30. A Review of Associations between Parental Emotion Socialization Behaviors and the Neural Substrates of Emotional Reactivity and Regulation in Youth – PMC

While the core symptoms of ADHD include inattention, hyperactivity, and impulsivity, there is another aspect of this neurodevelopmental difference that doesn’t get discussed, yet can be particularly challenging for families to navigate: emotion dysregulation. Dr. Russell A. Barkley, a leading expert in ADHD research, emphasises that emotional dysregulation is not simply a by-product of ADHD but a core component. 

However, there is no consensus among the medical and research community on making emotion dysregulation a core diagnostic symptom of ADHD because it is also a central aspect of other mood disorders. Three models have been proposed to explain the overlap between emotion dysregulation and ADHD: 

1. Emotion dysregulation and ADHD are related but separate different things; 
2. Emotion dysregulation is a core feature of ADHD; or,
3. The combination of ADHD and emotion dysregulation is its own entity and is distinct from just ADHD and emotional dysregulation.

Emotion regulation refers to the processes that accompany the range of emotions people feel, the intensity of each emotion, how a person experiences emotions, and how they express them. When we talk about emotional dysregulation, we are describing difficulties in managing and expressing those emotions in a manner that does not cause further stress to the individual and those around them.

In general, children with ADHD experience greater emotional distress, emotional intensity, and frequent and intense negative emotion reactivity than children without ADHD, with approximately 40% of children with ADHD having difficulty controlling their emotions.  

Our ability to control our emotions relies on two separate components, emotion regulation and emotional reactivity.  

1. Emotional reactivity - this refers to how much someone’s behaviour and body react when they feel strong emotions. 
2. Emotion regulation - this is about the strategies our brain uses to manage, control, and improve our emotional experiences and expressions. 

When kids face situations that make them feel upset, especially those causing anger and frustration, it can be harder for them to control how they react. Researchers believe that this is likely because dealing with emotions takes up a lot of mental energy, changing the dopamine response needed for a child to stay in control.

Identifying triggers for anger is crucial when you are seeking to manage your child’s emotional responses. While triggers can vary from one child to another, some common factors have been identified:

• Frustration and impatience - children with ADHD often face challenges in sustaining attention and completing tasks. When faced with obstacles, they may become frustrated and impatient, leading to anger. You can help your child by providing clear routines, talking to them about what is coming up and what to expect.
• Sensory overload - ADHD is frequently associated with sensory processing issues. Overstimulation from the environment, such as loud noises or bright lights, can contribute to heightened emotional responses, including anger. You can help your child by getting a sensory profile assessment to help you identify the support they need.
• Social difficulties - many children with ADHD experience challenges in social interactions. Rejection or difficulty making friends can be emotionally taxing, and in some instances, triggering anger as a coping mechanism. You can help by problem solving together with your child and highlighting different perspectives.

Strong negative emotional reactions can make it harder for children to get along with friends and family. 

Scientists have observed that in kids, being unable to control and handle emotions seems to be a significant factor in how often they face bullying from peers. If a child has ADHD, bullying may be worse because they struggle with managing their emotions in the moment.

As parents, it’s vital that we take the significance of social factors in understanding anger in children with ADHD. It underscores the importance of addressing not only individual triggers but also the broader social context for your child. Encouraging multiple friendship groups through school, sports and extra curricular activities is a great way to ensure your child doesn’t become reliant on one group of friends, especially when issues arise. 

Underlying brain structure and connectivity differences

Studies using brain scans of children with ADHD show that difficulties with controlling emotions, like sudden mood swings and temper outbursts, are linked to disruptions in brain circuits. In a sample of children with ADHD, it was found that those who experienced exaggerated mood swings also had altered connectivity between the amygdala and different parts of the brain, compared to kids with fewer emotional challenges. 

The amygdala, which is a part of the brain responsible for emotional memories, fear and panic responses, and decision-making, has been observed to be overactive in people with ADHD. The frontal cortex on the other hand, which is involved in inhibiting impulsive behaviors and regulating emotions, has been found to be underactive. This imbalance of neural connectivity can result in heightened emotional reactivity and impulsivity.

These findings add to a body of neuroimaging research that shows structural differences in the ADHD brain. There are still a lot of unknowns, but scientists propose that the brain differences identified impact key executive functions.

The Role of Executive Functions in Emotional Regulation

ADHD impacts self-regulation, the ability to regulate one’s own physical state, emotions, cognitions, and behaviour. The cognitive processes that support self-regulation are often referred to as executive functions, and they include:

• the ability to direct or focus attention,
• shift perspective, and adapt flexibly to changes (cognitive flexibility);
• retain information (working memory); and
• inhibit automatic or impulsive responses to achieve a goal, such as problem-solving (impulse control).

Even though our executive functions can be influenced by our experiences throughout our lifetime, there are times when they are more flexible and can be shaped by external factors. These skills appear to grow quickly when we’re very young and as we transition to adolescence. 

Mounting research suggests that executive functioning skills can be developed with practice and scaffolding. Regularly engaging the use of executive functioning skills in problem solving and at increasing levels of challenge, strengthens these skills and increases the efficiency of all related brain functions.

Recent studies suggest that a better-developed working memory predicts fewer ADHD symptoms and better emotion regulation skills than self-control or flexible thinking. There is evidence that training working memory can improve emotion regulation ability.

Understanding the underlying neurobiological factors that influence your child’s emotion regulation difficulties can help change how you see your child in moments of dysregulation - they aren’t giving you a hard time, they are having a hard time. It also puts you in a better position to select and prioritise the therapies and supports they need to manage it.

References

1. Working memory training improves emotion regulation ability: Evidence from HRV – ScienceDirect
2. The neurodevelopment of executive function skills: Implications for academic achievement gaps.
3. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
4. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis – PMC
5. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention
6. Managing Frustration for Children (MFC) Group Intervention for ADHD: An Open Trial of a Novel Group Intervention for Deficient Emotion Regulation – ScienceDirect
7. Childhood attention-deficit hyperactivity disorder: Family therapy from an attachment based perspective – ScienceDirect
8. Altered Intrinsic Functional Connectivity of the Cingulate Cortex in Children with Severe Temper Outbursts – PMC
9. Abnormal Amygdala Functional Connectivity Associated With Emotional Lability in Children With Attention-Deficit/Hyperactivity Disorder – PMC
10. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation
11. Performance of children with attention deficit hyperactivity disorder (ADHD) on a test battery of impulsiveness
12. Emotion regulation accounts for the relation between ADHD and peer victimization | SpringerLink
13. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping | SpringerLink
14. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review – ScienceDirect
15. Adult Outcomes of Childhood Dysregulation: A 14-year Follow-up Study – PMC
16. Examining the influence of irritability and ADHD on domains of parenting stress | SpringerLink
17. Effectiveness of group psychodrama on aggression and social anxiety of children with attention-deficit/hyperactivity disorder: A randomized clinical trial – ScienceDirect
18. The effectiveness of parent-child interaction training on behavioral problems and aggression of children with ADHD symptoms
19. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure
20. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial – PMC
21. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
22. Regulation of sadness via acceptance or suppression in adult Attention Deficit Hyperactivity Disorder (ADHD)
23. ORIGINAL ARTICLE An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder Dikkat
24. Preschool Intervention Can Promote Sustained Growth in the Executive-Function Skills of Children Exhibiting Early Deficits – PMC
25. Evidence review for universal curriculum approaches – NCBI Bookshelf
26. Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study – PMC
27. Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents – PMC
28. A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA) – PMC
29. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC

• How does ADHD impact writing
• ADHD handwriting tools
• Inattention when writing with ADHD
• Making writing easier for people with ADHD

ADHD and handwriting

Children with ADHD have been found to use more cognitive effort to complete school tasks, projects, and assessments, as they struggle to stay focused to learn and apply that knowledge. 

Academic success is something that children with ADHD have to work harder at achieving than their peers. The neurobiology of these students doesn’t always shine under the structure of our early education system, which measures speed and memory over originality and curiosity. 

How does ADHD impact writing?

Studies have found that as many as 65% of students diagnosed with ADHD may also meet the criteria for a co-occurring learning disability in writing.

Written expression is a complex process that relies on the use and management of many skills including fine motor skills, and executive functions, a crucial set of skills performed by the brain to help us meet our goals. Research shows that 89% of children with ADHD may have deficits in at least one executive function. This may impact a child:

• How they use their working memory to effectively process and store information
• Their ability to think flexibly so that they can adapt, shift and problem-solve
• How well they can regulate their emotions and control their impulses

Executive functioning is critical to a child’s ability to write narratives, speeches, essays, and more. A child with ADHD may avoid school work and assignments that have writing components because they have difficulty with:

1. Focus and organisation

One of the primary challenges children with ADHD face when writing is maintaining focus and organisation. This affects their ability to plan, structure, and execute their writing assignments effectively. Although a child with ADHD has brilliant ideas and insight, it is common for them to struggle with keeping their thoughts organised in a coherent manner.

2. Working Memory

For many kids with ADHD, working memory is not as efficient as their peers. Working memory is a limited resource and when a child with ADHD has to hold multiple things in mind like forming letters, spelling words, organising thoughts, some things often fall off. In writing, this might manifest as a tendency to write without structure, flowing from one idea to the next without connecting different ideas smoothly. It can lead to unfinished sentences, disjointed paragraphs, and an overall lack of clarity in their work.

3. Time Management

Children with ADHD often struggle with time management. They may underestimate the time required to complete writing tasks, leading to last-minute rushes and incomplete assignments. This not only affects the quality of their work but also adds stress to their academic lives.

4. Inattention when writing with ADHD

A common challenge is the difficulty in revising and proofreading their work. Children with ADHD might overlook typos, grammatical errors, and inconsistencies. This can affect the overall quality of their writing.

Why it’s important

Without the right support at home and in the classroom, a child might start to lose confidence in their abilities, it can affect their mental health and result in them refusing to go to school. Parents, teachers, and caregivers must recognise that the difficulties a child with ADHD faces are not indicative of their intelligence but rather a part of their neurodivergence.

Signs your child needs support with their writing

Not all children with ADHD struggle with writing but if you notice the following signs, then it’s probably time to formulate a plan to help your child at home and advocate for support at school.

1. Inconsistent Quality

Writing from your child varies significantly in quality. They might produce work that is exceptionally well done on one occasion and barely legible or incoherent on another. This inconsistency can be perplexing for you and their teachers, but it is often a reflection of how interested your child is in the topic. 

2. Procrastination 

Does your child struggle with procrastination, waiting until the last minute to start their assignments? This can be due to their difficulties in managing time and maintaining focus.

5. Lack of Planning

In many cases, children with ADHD may have limited pre-writing preparation or fail to create outlines. This lack of planning contributes to their struggles with organising their writing.

6. Impulsivity when writing with ADHD

Impulsivity can manifest as frequent, impulsive changes in topic or style within their writing. They might abruptly shift from one idea to another without a clear transition.

Tips & Strategies

How to help kids with ADHD improve their handwriting

We’ve collated practical ideas on how to help your child with ADHD become a more confident writer and effective learner:

Show understanding and patience

The first step in supporting children with ADHD is to understand that their writing difficulties are not indicative of a lack of effort or ability. Educators and parents need to exhibit patience and empathy.

Create a structured environment

Providing a structured environment with clear instructions, reminders, and deadlines can help your child stay on track. The most important part is getting started - writing a headline is a start, or creating the document, or even picking a topic - every small step is a step forward.

Teach time management skills

Teaching time management skills, such as using planners or calendars, can help your child better estimate the time needed for their writing tasks. Breaking down writing tasks into smaller, manageable steps can make the process less overwhelming. 

Provide scaffolding

Offering guidance throughout the writing process can be immensely helpful. This includes assistance with brainstorming, outlining, and editing. Having a set of general introductory and transition sentences can also aid the process of writing. A checklist with simple items like: I have written a title, I have written an introduction telling the reader what the text is about, I have included adjectives, I have summarised all my points in my conclusion, etc.

Refine writing strategies

Explicitly teach specific writing strategies on how to plan a narrative/essay/story/etc and essential elements of composing a text. Talk to your child about what tools work for them. Visual thinkers might like to use diagrams and post-it notes, children who are better at retaining information auditorily might like to make up a song, a saying, or an acronym to remind them of the process, or your child might like to use a combination of techniques.

Teach self-editing techniques

Teach your child self-editing techniques, like reading their work out loud, using checklists for common errors, and revising in stages. These skills require practice and guidance to become part of their writing process, and you’ll need to help by signposting. For example, you can ask questions like “Now that you have written your first draft, what do you think is the next step?”

Give an example of done

Show your child what done looks like because not everyone can envision a finished product. A document that is similar to what your child needs to produce is a helpful reference that they can go back to as they write their own. 

Support tools to improve your writing

• Text-to-speech - Text-to-speech technology, such as Otter and Google Docs’ Voice Typing, can help your child express their ideas more fluently. This technology converts spoken words into written text, allowing them to focus on the development of thoughts without being hindered by typing difficulties or the speed of writing.
  
  
• Grammar and spell checkers - Tools like Grammarly can assist your child with proofreading and editing. These types of applications provide real-time feedback on grammar, spelling, and writing style.
  
  
• Task management apps - Apps like Trello or Asana are great tools for organising assignments and deadlines. These tools offer visual task management, making it easier to track progress.
  
  
• Graphic organisers - Visual aids like mind maps and concept maps provide a structured way for your child to organise their thoughts before they start writing. Tools like MindMeister and XMind are excellent for this purpose.

Collaborate with the teacher

Ensure you advocate for an ILP/IEP then work with the teacher on classroom supports that focus on the following:

• Building confidence when writing with ADHD - focus on the positives for your child. There is nothing more motivating than feeling that you are doing something right.
  
  
• Supporting working memory - share the tools and strategies we listed in this article, they can also be used in the classroom.
  
  
• Increasing automaticity of handwriting and spelling - this will help by releasing the availability of working memory to support the other processes needed for writing.
  
  
• Reducing cognitive load - all this means is that where possible the teacher should remove unnecessary information from a page, reduce tasks to smaller components, and make steps easy to read and understand.
  
  
• Removing environmental distractions - if your child gets easily distracted by noise, consider buying noise-cancelling headphones for the classroom.
  
  
• Provide feedback on the process not on the final product - because we know the product is simply a reflection of the process, and the process can always be improved.

That’s a summary of points to consider when it comes to ADHD and handwriting.

References

• The Written Expression Abilities of Adolescents with Attention-Deficit/Hyperactivity Disorder

• Using Self-Regulated Strategy Development for Written Expression with Students with Attention Deficit Hyperactivity Disorder

• A rapid systematic review of attention-deficit/hyperactivity disorder (ADHD) and high order writing: Current findings and implications for intervention

• Accessibility in assessment for learning: sharing criteria for success

• Executive Functions and Writing Skills in Children With and Without ADHD

• Handwriting difficulties in children with attention deficit hyperactivity disorder (ADHD)

• Universal Design for Learning for Children with ADHD

• How effective is fine motor training in children with ADHD? A scoping review

• Attention Components and Spelling Accuracy: Which Connections Matter? – PMC

• ADHD And Written Expression

There was a time when a mother felt lost because her child was struggling and she didn’t know how to help them. She knew how to fix a scrapped knee and a fever, but she was unprepared for this. Their family was a team, and when one person had a hard time, they all felt it deeply.

When you are desperate, there is a sense of purpose that sustains you through the darkest of times. Her purpose became clear - to understand her child and their brain.

Amid months spent studying parenting books, scouring the internet for answers, and attending OT sessions, psychologist consultations, and paediatrician appointments, she realised - that money, location, and time stood as vital resources for families raising neurodivergent children.

The average family never has enough of those resources. Assessments, therapy, medication, and appointments all add up, and at some point, a parent has to choose between them.

Knowledge, however, was a powerful resource that a parent could grow. Specialised knowledge often remained in the hands of clinicians or shrouded in terminology decipherable only with educational privilege.

She was privileged, but the generation that came before her wasn’t. Like other members of her family, she fell through the cultural, socio-economic, and diagnostic cracks.

Her experience is not unique, countless others fall through wider gaps.

It is not surprising that neurodivergent children who are well supported at home, at school, and in the community, have a better chance of becoming happy and successful adults. The alternative, she knew all too well, was bleak.

With a brighter future in mind, she got to work with 3 guiding principles - access to knowledge should:

1. Not be determined by geographical location
2. Be free or highly affordable
3. Accommodate the demands of daily life

The once-lost mother had found a greater purpose beyond her own struggles. 

Today she reads countless research papers and distils that information through a lived experience lens. Her dream is to create tools and information that empower adults to better understand and support both themselves and the neurodivergent children in their care. 

Her philosophy is simple - when we direct our energy toward supporting and empowering children, we won’t have to repair them when they become adults.

Hi! I’m Diana, the mother in the story.

I usually don’t share personal stories on this platform, I prefer to hyperfocus on creating resources by combining science and lived experience. 

I also struggle with Rejection Sensitivity Dysphoria, and being vulnerable requires a level of bravery that I’m not always capable of unlocking.
But maybe vulnerability is not such a bad thing…

Want to know more? Here are 5 random facts!

1. I love colour/clashing patterns, and I dopamine dress as a way to influence how I feel
2. I’m a visual thinker and I see ideas in pictures
3. Wood cutlery or ice cream sticks make me gag
4. My out-of-control bouncy leg helps me focus
5. I’m a collector. I love shells, fabric, and plants.

If you managed to read this far, thank you! I’m so glad you’re here.

You might be surprised to learn that children, and adults, with Attention Deficit\Hyperactivity Disorder (ADHD) don’t have a deficit of attention as such, the problem is actually due to a difficulty with regulating and sustaining attention to meet goals and expectations. 

The ADHD brain is an interest-based nervous system, which means that when it comes to things we are passionate or curious about, our focus can be incredibly powerful - this is sometimes referred to as hyperfocus. This can be confusing for parents who watch their child be super focused on building Lego, creating art, reading, or doing another favourite activity, but who struggle with attention while getting ready in the morning.

Daily life is made up of boring and challenging tasks, and also fun and interesting activities. Children with ADHD can do well in exciting and engaging situations, but the mundane parts of reaching a goal or meeting expectations can make it more difficult to get started, sustain attention, and finish tasks.

Scientists think that executive function, an area that individuals with ADHD struggle with, is situationally variable. Children who do intrinsically motivating tasks are more likely to show fewer to no executive functional impairments. It is thought that this is because ADHD affects how the motivation-reward system works. 

Understanding ADHD and hyperfocus

Hyperfocus is not a diagnostic criteria for ADHD, but it is a recognised phenomenon that people with ADHD can experience. Neurotypical people can also experience something similar called “flow” or “in the zone”.

The positives and challenges of hyperfocus

Hyperfocus has many positive aspects that can help people with ADHD be highly productive and focused on meeting intrinsic goals. There are several athletes, business professionals, and artists who credit their ADHD for their accomplishments, because of their ability to be single-minded in doing something they love.

Although the ability to hyperfocus is incredibly powerful, it can also create some challenges for people who experience it and those around them. Hyperfocus is a phenomenon that describes a person’s ability to be so absorbed in a task, to the point of being able to completely ignore or ‘tune out’ everything else.

Shifting attention to internal and external cues becomes a challenge when someone is in this mode of intense focus. You might notice that your child:

• Can’t hear their name being called - you might call out to your child over and over again without a response to the point you think they are ignoring you.
   
• Misses physiological cues like hunger, thirst, and the need to use the toilet - your child might have more accidents while they play video games because they haven’t recognised a full bladder in time to use the bathroom.
  
  
• Loses the concept of time - your child might still be half dressed for school and their breakfast on the table untouched because they are fixing a Lego build that broke when they accidentally walked past it. 
  
  
• Becomes defiant when they need to stop - a request to do something else might trigger your child to respond with defiance or anger because you are asking that they stop an activity that they are intensely focused on.
  
  
• Is more fatigued - your child may use up more energy during periods of hyperfocus, which then affects their ability to take on subsequent tasks. This might present as oppositional behaviour when you ask your child to do anything that requires effort and is not of interest.

Tips & strategies

Hyperfocus isn’t inherently negative; in fact, it can be a powerful tool when managed effectively. 

How to make the most of hyperfocus

Identify areas that trigger hyperfocus

For many children, gaming or technology tend to be areas that activate intense focus. Short videos, exciting games, and bright colours tend to turn on the reward system in the brain and in turn a flood of dopamine. This is why it is always incredibly difficult for kids to end their tech time.

Use multiple visual and audio cues

The intensity of hyperfocus can be so laser-focused that your child might miss external and internal cues. Use audio and visual cues like your voice, a timer, alarms, or similar to give a warning and count down the time to end the activity.

Facilitate transitions

To smooth the move from a highly rewarding task to another activity, you need to make that option worthwhile for your child. The best way to do that is to make the move fun (a race, a competition, etc) and to transition to an activity they love.

Stick to consistent routines

Consistent schedules and clear expectations can help you and your child manage periods of hyperfocus with healthy breaks to attend to physical needs. 

Help with self-awareness when it comes to hyperfocus

Teach your child to recognise when they are in a hyperfocus state and to develop strategies for transitioning to other tasks. This skill is something that develops over time and you will need to be your child’s external awareness system until it matures.

References

1. Hyperfocus: the forgotten frontier of attention – PMC
2. Testing the relation between ADHD and hyperfocus experiences – ScienceDirect
3. ADHD Hyperfocus: What Is It and How to Use It | Psychology Today
4. Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder – ScienceDirect
5. (PDF) Delay and Reward Choice in ADHD: An Experimental Test of the Role of Delay Aversion
6. “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults | PLOS ONE
7. The relations between hyperfocus and similar attentional states, adult ADHD symptoms, and affective dysfunction | SpringerLink
8. Executive Function: Implications for Education
9. ADHD and Screen Time: How to Steer Kids Away from too Much Technology

It’s no secret that kids with ADHD feel emotions strongly. Small incidents that most kids can easily brush off, can trigger a cascade of feelings that cause a child with ADHD to get stuck on a thought or idea. This rigidity in thinking can often be a source of arguments with family members, friends, and teachers because most people assume that the child just wants to get their way.

Cognitive flexibility is the ability to adapt one’s thinking and approach in response to changing situations and is a critical skill for success in various aspects of life.

Examples of cognitive flexibility and emotion regulation

• Multitasking - Your child’s ability to listen to their teacher and copy information off the whiteboard onto a notebook, without losing track of what they are doing, is an example of doing two concurrent tasks.
  
  
• Communication - Switching communication styles happens every school day, your child starts the morning talking to you and then switches to talking to friends at lunchtime, and then to the teacher in the classroom.
  
  
• Problem-solving - Your child needs to solve problems in structured situations like in tests, but also work through problems when they arise unexpectedly. For example, the T-shirt your child planned to wear is in the laundry, and they need to find a different top to put on instead.

Cognitive flexibility, emotion regulation, working memory, and ADHD severity

Recent research has shed light on the intricate connection between cognitive flexibility, emotion regulation, working memory, and ADHD symptoms. While the exact nature of these relationships continues to be explored, several key findings have emerged:

Neurobiological Factors

Studies using brain imaging techniques have revealed differences in the structure and function of certain brain regions in individuals with ADHD. These differences are often associated with impairments in cognitive flexibility, emotion regulation, and working memory. For instance, the prefrontal cortex, which plays a crucial role in executive functions, is frequently found to be underactive in individuals with ADHD.

Working Memory

Working memory is like your brain’s sticky notepad; it’s a mental workspace where you temporarily hold and manipulate information. It helps you remember things in the short term while you’re thinking and solving problems. For example, when you do mental calculations, follow directions, or remember a phone number long enough to dial it, you’re using your working memory. It’s an essential part of cognitive function and plays a crucial role in tasks that require active thinking and problem-solving. Children with ADHD often struggle with working memory, which can impede their capacity to adapt to new information and shift their focus between tasks.

Inhibition

Children with ADHD frequently face challenges related to inhibitory control (suppressing impulsive behaviours) and attention shifting (changing focus between tasks or stimuli). These difficulties can hinder a child’s ability to be flexible and switch strategies to meet expectations at home and school.

Emotion regulation

Emotion regulation means dealing with your feelings in a way that keeps them from getting too strong too quickly or reducing their intensity. It involves how your body reacts, what you feel, and how you act when you’re having a strong emotion. Around half of kids with ADHD struggle with controlling their emotions. This is a big deal because it makes ADHD even harder to deal with. It can lead to problems in school and with friends, more visits to the doctor, and more stress for you as a parent. 

Recent studies suggest that a better-developed working memory predicts fewer ADHD symptoms and better emotion regulation skills than self-control or flexible thinking. This means that when you are looking at different options to help your child, you might want to also consider those that develop and support working memory.

Why it’s important

For many children (and even adults) with ADHD, having a weak working memory and struggling with emotions can make it hard for them to be flexible in their thinking.

From a parent’s perspective, it’s important to recognise that cognitive flexibility is a fundamental skill that influences how your child navigates various aspects of life:

• Academic success - Children with ADHD often struggle academically due to difficulties in adapting to different learning tasks, organising their thoughts, and shifting their focus between subjects. Cognitive flexibility is essential for effective problem-solving and learning. 
  
  
• Social relationships - Our ability to think flexibly when we spend time with friends, play a team sport, do a group project, or simply chat with peers, plays a significant role in building and maintaining positive social relationships. When we interact with others we are exposed to different ideas, needs, and a myriad social cues, which we must process to adapt how we think and what we do. A child with ADHD might struggle in situations where there are competing ideas or where rules are fluid.
  
  
• Daily life - From managing daily routines to handling unexpected changes, all the while staying emotionally regulated, cognitive flexibility is crucial for navigating everyday tasks and challenges. As a parent, you can help your child at home and advocate for them at school so that they can get the support they need.

Compared to peers, children with ADHD can exhibit developmental delays in executive function by as much as 30% (a 3-5 year delay in school & early adulthood). For example, a 9-year-old child is likely to have the executive function of a 6-year-old child. This knowledge is key in ensuring you set your child up for success. Where possible, adjust your expectations to meet your children’s executive function age rather than their biological age. 

Tips & strategies

Support working memory

• Implement structured routines - Create a consistent daily schedule with designated times for different activities, such as homework, playtime, and meals. Predictable routines can help children with ADHD transition between tasks more smoothly.
  
  
• Break tasks into smaller steps -  Divide tasks into smaller, manageable steps to reduce overwhelm. Provide clear instructions and offer frequent feedback and praise for completing each step.
  
  
• Employ visual aids, timers, and music - Use visual schedules, timers, music, and reminders to help your child stay on track and transition between tasks more effectively. Not all children respond to visual cues, some prefer audio reminders and other children respond to a combination of both. Find what works best for your child.

How to develop emotional regulation skills and cognitive flexibility

• Practice mindfulness and relaxation - Teach mindfulness and relaxation techniques to help your child manage stress and improve their emotional regulation. Mindfulness exercises can enhance cognitive flexibility by promoting present-moment awareness and acceptance. This is a long-term strategy and requires regular practice as part of a multi-modal approach for treating ADHD, to reap the benefits.

• Use co-regulation - A child learns to regulate their emotions and behaviour through supportive guidance and interaction with an emotionally stable parent. When your child is feeling heightened you can help them return to a relaxed state by providing a safe environment, modeling calmness and effective coping strategies, and using verbal and non-verbal cues to guide your child’s emotional regulation. When your child is feeling regulated don’t forget to ask them to reflect on their emotions, triggers, and what strategies they can use to help them manage intense feelings.

• Identify triggers and teach reappraisal - Assist your child with identifying situations that set off negative emotions, help them understand those feelings, and work on options to manage their intensity. An evidence-based strategy for regulating emotions you can try is reappraisal. 

Reappraisal simply means changing how one thinks about or re-interprets a situation. For example, your child identifies that they get angry when they are playing a game and someone changes the rules - this is the trigger. Reappraisal would involve you guiding your child to reframe that situation in a way that would change the negative trigger, and it might sound like “the other child probably didn’t realise they were changing the rules” or “the other child forgot to check with everyone that it was ok to change the rules” or even “these new rules might be better than the old ones”.

Tips to increase cognitive flexibility

• Games and puzzles - Engage your child in activities that require problem-solving, such as puzzles, board games, and strategy games. These activities are fun for the whole family and are a great way to develop cognitive flexibility.

• Consider medication - There is evidence to support the idea that children who take stimulant ADHD medication significantly increase their neural flexibility. Scientists noted that children with lower neural flexibility were more likely to experience more severe ADHD symptoms.

• Encourage decision-making - Give your child opportunities to make choices and decisions. This allows them to practise considering different options and consequences, fostering cognitive flexibility. Teach them to look around for clues and ask questions like, “What is my goal?” and “What are my options to achieve it?”, “What are other people saying to me?” and “What if they are right?”.

• Promote physical activity - Regular medium-high intensity physical exercise has been shown to improve cognitive function, including cognitive flexibility, it can also increase neuroplasticity, and there is evidence that it decreases impulsivity and the risk of nervous system disorders. Encourage your child to engage in regular activities they enjoy, such as sports or dance.

References

• Cognitive Flexibility and Emotion Regulation as Transdiagnostic Mechanisms of Psychopathology in Clinically-Referred Youths
• MRI Study Shows Brain Changes and Differences in Children With ADHD – Neuroscience News
• Executive Functioning and Emotion Regulation in Children with and without ADHD. – Abstract – Europe PMC
• Emotion Regulation and Children With Attention-Deficit/Hyperactivity Disorder: The Effect of Varying Phonological Working Memory Demands
• The continuous impact of cognitive flexibility on the development of emotion understanding in children aged 4 and 5 years: A longitudinal study – ScienceDirect
• Working Memory in Attention Deficit/Hyperactivity Disorder is Characterized by a Lack of Specialization of Brain Function – PMC
• ADHD brain vs. normal brain: Function, differences, and more
• Co-Regulation From Birth Through Young Adulthood: A Practice Brief
• Effects of different physical activity interventions on children with attention-deficit/hyperactivity disorder: A network meta-analysis of randomized controlled trials
• Response Inhibition, Response Execution, and Emotion Regulation Among Children with Attention-Deficit/Hyperactivity Disorder
• Systematic review and individual participant data meta-analysis of randomized controlled trials assessing mindfulness-based programs for mental health promotion
• A single session of mindfulness meditation may acutely enhance cognitive performance regardless of meditation experience | PLOS ONE
• Mindfulness meditation and bimanual coordination control: study of acute effects and the mediating role of cognition
• How to Help Kids With Working Memory Issues – Child Mind Institute
• ADHD and Working Memory: What’s the Link?
• The effect of video games, exergames and board games on executive functions in kindergarten and 2nd grade: An explorative longitudinal study – ScienceDirect
• Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
• Fact Sheet: Attention Deficit Hyperactivity Disorder (ADHD) Topics
• Effects of working memory training on emotion regulation: Transdiagnostic review – Barkus – 2020 – PsyCh Journal – Wiley Online Library
• Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial | Trials
• Reappraisal is an effective emotion regulation strategy in children with Tourette syndrome and ADHD – ScienceDirect
• Emotion control training enhances reappraisal success among individuals with reported ADHD symptoms

In this part 2 of a deep dive into Support for Developmental Coordination Disorder (DCD), also known as dyspraxia, you will find:

• An outline some of the key things you can do at home to support your child
• A list of the most current therapies recommended and others still in their infancy
• Accommodations and adjustments you can advocate for at your child’s school to help them succeed

Read Part 1: What is Developmental Coordination Disorder (Dyspraxia) to get a better understanding of DCD: the obvious and less evident signs; ADHD as a co-occurring condition; and the impact of the condition. 

Tips & strategies

Your child will need a lot of support in every facet of their life to be confident, positive, and physically healthy. There are many strategies you can use to help them day-to-day and that will form the foundations for long-term outcomes.

Supporting your child at home: 

Prioritise downtime and breaks

Your child has to manage the inefficiency and additional mental effort that goes into processing, planning, and executing their movements, which often results in fatigue. Make an effort to allow them lots of downtime throughout the day and breaks while doing tasks.

Functional clothing and shoes

Buy clothes with a simple design like elastic waistbands, no buttons, elastic shoe laces, or velcro. You want to make the process of getting dressed/undressed a lot easier for your child to reduce effort and frustration.

Find and leverage strengths

Focus on the things your child is good at and find physical activities that they are more likely to succeed in. Building self-confidence is a crucial component in keeping your child physically and mentally healthy.

Develop spatial awareness/reasoning skills

There are plenty of fun ways to develop spatial awareness in everyday life. You can involve your child in the following activities:

• Draw 3D objects
• Complete jigsaws
• Rotate shapes in a mirror, making note of the changes you see
• Assembling model kits
• Playing video games
• Planning a route on a map and then taking the journey without it
• Making origami

Routine and Structure

Children with ADHD have been found to have issues coordinating and synchronising sensory (like seeing or hearing) and motor (movement) information in a precise and accurate manner. Establishing a consistent daily routine can help your child anticipate tasks and transitions, improving their ability to plan and complete individual steps in a routine. Scaffold the process by talking them through each task, because audio input helps guide your child through the process and can reduce frustration.

Visual Aids

Use visual schedules or charts to make tasks and routines more manageable. One research study suggested that children with DCD may have a potential issue with timing perception, and the use of visual cues can help them learn and retain knowledge better than just being told what to do.

Look into Therapy

There is very little reliable research on which therapies have the best outcomes in improving DCD symptoms.

The two types of therapy that have the most evidence in improving functioning in children with DCD include:

1. Task-oriented interventions - These are aimed at learning specific motor skills that are particularly difficult for the child. The key is to tailor it to the individual needs and particular interests of your child. The use of equipment, like hoops, ropes and ladders, and outdoor games, are also core features of a good program.
   
   
2. Occupational/Physical Therapy - Traditionally, both use an approach that relies on the idea that motor skills have a developmental ladder. Most interventions focus on basic training of gross motor/fine motor, and the development of these basic motor abilities first before developing specific motor skills. 

Other treatments still in their infancy of research include: 

• Process-oriented therapy - This is focused on more global functions (e.g., sensory integration, visual-motor perception, and muscle strength) but these were not as effective as the task-oriented strategies, and occupational and physical therapies in improving DCD-related difficulties.

• Wii-fit, core stability training, self-concept training, Tae Kwon Do, table tennis, and aquatic therapy - At present these activities are not recommended treatments for DCD because the results for these interventions are negligible, small, or there is stronger evidence for more effective interventions. That said, if your child is willing to participate in these sports or enjoy using a Wii-fit (or the equivalent on Switch), you should encourage these activities as they contribute to your child’s physical health and self-confidence.

• Combined action observation and motor imagery (AOMI) - This therapy involves children observing movement videos whilst imagining simultaneously the sensations of executing the same movement. There is little conclusive evidence and more research needs to be done.

• Omega fatty acid supplements - There is some evidence that a mild disorder of fatty acid metabolism may be linked to dyslexia, DCD, and ADHD. Supplements containing DHA, EPA, AA, and DGLA can in some cases improve the management of these conditions. You will need to consult your doctor to run more tests and assess whether your child is a good candidate for omega fatty acid supplements.

• Cerebellar anodal transcranial direct current stimulation (atDCS)/transcranial direct current stimulation (tDCS) - these are forms of non-invasive brain stimulation using a low electrical current, that aim to alter how the brain’s cells work. Researchers believe that it helps the brain become more flexible and better at fixing itself. Although the treatment is safe in children, there is little conclusive evidence of its use to improve DCD symptoms.

Whatever treatments you decide to use, record your observations and therapy notes in the Keywell app so that you can track how your child is progressing. Having this information can help you and your child’s healthcare team make better decisions about what to stop or continue. 

Supporting your child at school: collaboration with teachers and school staff is crucial

Individualised Education/Learning Plan (IEP/ILP)

Work with the school to create an IEP/ILP tailored to your child’s needs. This includes:

• Assistive Technology - Agree on the use of technology or adaptive tools to aid in learning and organisation. This includes dictation apps to capture ideas and write narratives
  
  
• Extra time to complete tasks - Especially with fine motor activities such as maths, writing a story, practical science tasks, and art
  
  
• Physical education/sport/gym - Agree on accommodations required for specific activities so that they meet your child’s abilities and assist with setting appropriate expectations to ensure success and reduce the risk of injury. The aim is to focus on participation, not competition
  
  
• Options for presenting work - This includes the delivery of answers orally rather than in written format, via video presentation, etc
  
  
• iPad or laptop for typing - Although this is a skill that can take time to acquire, it is often easier than writing with a pen
  
  
• Remove additional motor tasks - Where possible, have printed notes to reduce the additional effort children with DCD need to complete them

Educate Teachers

Provide teachers with information about DCD and its challenges. Share this article and other resources to help them gain a deeper understanding of why your child needs adjustments and accommodations. 

References

• Pediatric care for children with developmental coordination disorder, can we do better? – PMC
• Fine motor deficits and attention deficit hyperactivity disorder in primary school children – PMC
• Divergent Development in Dyspraxic Children
• National Survey Evaluating the Impact of Developmental Coordination Disorder in Australia
• DCD and ADHD: A genetic study of their shared aetiology – ScienceDirect
• An Investigation of Dyspraxia: What We Know and Why the Research Is So Far Behind
• Editorial: Current Perspectives on Developmental Coordination Disorder (DCD)
• The Differential Effects of Auditory and Visual Stimuli on Learning, Retention and Reactivation of a Perceptual-Motor Temporal Sequence in Children With Developmental Coordination Disorder
• Procedural learning and retention of audio‐verbal temporal sequence is altered in children with developmental coordination disorder but cortical thickness matters – Lê – 2021
• Diagnosis and management of developmental coordination disorder – PMC 
• A systematic review of high quality randomized controlled trials investigating motor skill programmes for children with developmental coordination disorder
• New trends in developmental coordination disorder: Multivariate, multidimensional and multimodal – PMC
• DYSLEXIA, DYSPRAXIA and ADHD – CAN NUTRITION HELP?
• Motor skill intervention for pre-school children: A scoping review
• Children with DCD: At home, at school and in the community (Booklet)
• Combined action observation and motor imagery improves learning of activities of daily living in children with Developmental Coordination Disorder – PMC
• Cognitive, perceptual, and motor profiles of school-aged children with developmental coordination disorder
• Effects of Transcranial Direct Current Stimulation on Motor Function in Children 8-12 Years With Developmental Coordination Disorder: A Randomized Controlled Trial
• Cerebellar Transcranial Direct Current Stimulation in Children with Developmental Coordination Disorder: A Randomized, Double-Blind, Sham-Controlled Pilot Study – PMC

Do you have a child with ADHD who makes impulsive decisions or reacts without thinking? Then you probably have a few extra grey hairs from worrying about whether they will break a bone from all the risky climbing or from regularly mopping up a flooded bathroom!

Not everyone with ADHD experiences the same levels of impulsivity, hyperactivity, and distractibility, and to reflect that, an ADHD diagnosis is now categorised into three different presentations: predominantly inattentive; predominantly hyperactive-impulsive; and combined.

In all ADHD presentations, it is believed that parts of the brain work and look differently from typical brains. There is evidence to support that inattentive and hyperactive/impulsive presentations are each connected to different parts of the brain and influenced by different neurotransmitters (chemicals messengers that carry signals in your brain): impulsive/hyperactive type is affected specifically by dopamine and inattentive type by noradrenaline/norepinephrine. This discovery, along with evidence that shows stimulant medication is more effective for children with impulsive/hyperactive or combined type, is useful when evaluating the best treatments for your child

Scientists agree that ADHD impacts vital brain functions including attention, planning & organisation, mental flexibility, inhibition (impulse control), abstract reasoning, self-monitoring, and working memory. Our ability to meet daily and long-term goals is predicated on all these functions working well together to accomplish tasks. 

Inhibition, or inhibitory control, is defined as “the ability to control one’s attention, behaviour, thoughts, and/or emotions to override a strong internal predisposition or external lure, and instead do what is more appropriate or needed”.  

Scientists believe that inhibition can be broken down into two components that develop differently:

• Response inhibition - This relates to what you know as self-control and our ability to resist temptation (like wanting to eat another cupcake) and our capacity to resist acting impulsively (like retaliating physically or verbally immediately after we perceive we have been attacked); and
• Interference control - This refers to our ability to direct our attention where it is needed at a particular time in order to accomplish a task and not letting unnecessary or unwanted thoughts or memories bother us.

Research on inhibition control is evolving with various theories on the mechanics of inhibition control in children with ADHD. The key themes still being explored by researchers include: 

Difficulties processing information - Children with ADHD have been shown to have less capacity to process relevant environmental information which impacts their executive functioning and their ability to control impulses. 

Emotional control - Negative emotional situations, particularly those that trigger anger and frustration, have been shown to have a greater impact on children’s ability to control their responses. It’s thought that this is because emotional processing consumes mental resources, and potentially changes the dopamine response needed for self control. 

Processing emotional content - Some studies have looked specifically at a child’s ability to accurately infer how someone feels based on their face or non-verbal context clues. Not all scientists agree that children with ADHD struggle with recognising other people’s non-verbal emotion signals.

Delay aversion, working memory and hyperactivity - Children with ADHD often try to avoid waiting for things, and prefer for instance a small reward immediately than waiting to get something bigger later. When children have no choice but to wait, they might act quickly without thinking or become really active to make the waiting time feel shorter. Increased hyperactivity has been proposed as a self-stimulation strategy used by children to deal with periods of waiting for a reward and in situations that require high cognitive demand, like learning.

Difference in ADHD presentations - In recent times, scientists have been interested in looking more deeply into the brain differences and impact on individual executive functions like inhibition, to inform treatments. There is enough evidence to show that children with inattentive presentation differ from hyperactive/impulsive and combined presentations and therefore could benefit from different interventions.

Why it’s important

Self-control requires a child to manage their impulses, their emotions and their movements to achieve a goal and meet external expectations. The consequences of having an impaired ability to manage impulses can be profound:

• Academic challenges - Impulse control difficulties can hinder a child’s ability to focus in class, complete assignments, and follow instructions.

• Social struggles - Impulsivity can affect a child’s relationships. Children with low inhibition may have trouble taking turns, listening during conversations, or considering the feelings of others.

• Emotional regulation - Impulse control issues are associated with emotional dysregulation. Children with ADHD may be more prone to frustration, anger outbursts, and difficulty coping with stress.

• Risk taking - Studies have found that children with ADHD are more likely to take risks that can culminate in addiction, accidents and injury.

There are some positives to having impaired inhibition including creativity and entrepreneurship. Famous entrepreneurs have spoken about and credited their ADHD for their successes in business, including Richard Branson who said “Instead of allowing my diagnosis to limit my abilities, I overcame the stigma attached to ADHD and built a seven-figure business in just two years — and I’m not alone.”

All the research tells us that there are many elements that affect a child’s ability to control their impulses. The combination of factors like ADHD presentation, level of executive dysfunction, emotion regulation, situational context, etc, all contribute to your child making decisions without thinking.

What does all of this mean? From a parent’s perspective, it’s important to know that the evidence from years of research confirms that impulse control is a real and measurable trait of ADHD that can vary depending on what presentation your child has been diagnosed with. 

This knowledge can help you better assess situations when your child has done or said something that doesn’t meet your expectations, and guide you on how to respond and support them for better future outcomes. 

Tips & strategies

Be careful not to shame - For many children, an impulsive decision is quickly followed by intense shame as a result of their action. Watching your child hate themselves is heartbreaking, but it’s in this moment that you need to find a way to respond so the focus is on repair and problem solving.

Focus on building self-confidence - A child with ADHD receives 20,000 more negative messages than their peers by the age of 10. It is vital that you prioritise the things that will build your child’s self-confidence so they have the capacity to deal with negative situations.

Get a cognitive performance profile - Cognitive assessments are the only way to obtain an accurate picture of your child’s cognitive performance under standard conditions. The results are useful in clarifying the relationship between their cognitive functioning and behavioural symptoms so that you can create an individually tailored treatment plan.

Explore and decide on the appropriate treatment - Becoming intimately familiar with your child’s struggles is key to identifying the right treatments. Use the Keywell app to record your observations and share with your child’s health care team. A multimodal approach using a combination of treatments has shown to have the best outcomes. 

Medication - Methylphenidate is the most common and successful medication for ADHD, with years of evidence that show it reduces symptoms of inattention, hyperactivity, and impulsivity as well as improving executive functions. Keep in mind though, approximately 30 percent of children do not respond well to this treatment, have no long-term benefits, and experience side effects. There are other types of medications that are better tolerated by those who don’t respond to standard stimulant medications,

Psychosocial treatments - the following 3 have significant evidence supporting their use:

• Behaviour management interventions  - these include parent training, classroom interventions (advocate for your child to have an Individual Learning/Education Plan so that they are supported), and peer-based interventions.
• Training interventions - these include cognitive training, neurofeedback, organisation skills, cognitive behaviour therapy (CBT).
• Physiological treatments - physical activity like organised sport.

Non-pharmacological interventions - There is small to medium clinical effectiveness supporting these measures:

• Dietary interventions - This includes adding vitamins ( Vitamin D, Magnesium, and omega-3 fatty acids) and nutritional interventions like removing certain foods.
  
  
• Transcranial Direct Current Stimulation - A weak electrical current is applied directly and non-invasively to change how brain neurons work. 
  
  
• Mind-body interventions - These include meditation-based therapies like mindfulness and some yoga practices.

References

• Executive Functions | Annual Review of Psychology

• ADHD and Injuries: Accidental and Self-Inflicted | The ADHD Report
• Attention Deficit Hyperactivity Disorder and Increased Risk of Injury
• Full article: The association between hyperactive behaviour and cognitive inhibition impairments in young children

• The Maturation of Interference Suppression and Response Inhibition: ERP Analysis of a Cued Go/Nogo Task – PMC

• Double-dissociation between the mechanism leading to impulsivity and inattention in Attention Deficit Hyperactivity Disorder: A resting-state functional connectivity study – ScienceDirect

• Deficits in Response Inhibition in Patients with Attention-Deficit/Hyperactivity Disorder: The Impaired Self-Protection System Hypothesis – PMC

• Is Emotion Recognition Related to Core Symptoms of Childhood ADHD? – PMC

• Visual attention deficits contribute to impaired facial emotion recognition in boys with attention-deficit/hyperactivity disorder

• Evidence Against Emotion Inference Deficits in Children with ADHD – PMC

• Hot executive control and response to a stimulant in a double-blind randomized trial in children with ADHD | European Archives of Psychiatry and Clinical Neuroscience

• Hemodynamic response of children with attention-deficit and hyperactive disorder (ADHD) to emotional facial expressions – ScienceDirect

• Are Emotion Recognition Abilities Intact in Pediatric ADHD? – PMC

• Emotional dysregulation and Attention-Deficit/Hyperactivity Disorder – PMC

• Cortical Dopamine Release During a Behavioral Response Inhibition Task – PMC

• Is Emotion Recognition Related to Core Symptoms of Childhood ADHD? – PMC

• Inhibitory Functioning across ADHD Subtypes: Recent Findings, Clinical Implications and Future Directions – PMC

• Deficits in Conditional Discrimination Learning in Children with ADHD Are Independent of Delay Aversion and Working Memory
• The 5 Superpowers People With ADHD Can Use to Be Better Entrepreneurs
• ADHD-Related Neurodiversity and the Entrepreneurial Mindset – Curt B. Moore, Nancy H. McIntyre, Stephen E. Lanivich, 2021

• Subclinical symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with specific creative processes – ScienceDirect

• Diet and food in attention-deficit hyperactivity disorder – ScienceDirect

• Eating Patterns and Dietary Interventions in ADHD: A Narrative Review – PMC

• Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review – PMC

• How do stimulant treatments for ADHD work? Evidence for mediation by improved cognition – PMC

• Methylphenidate is more effective to improve inhibitory control and working memory compared to tDCS in children and adolescents with attention deficit/hyperactivity disorder: a proof-of-concept study – PMC

• ADHD: Current Concepts and Treatments in Children and Adolescents – PMC

• Long-term effects of repeated multitarget high-definition transcranial direct current stimulation combined with cognitive training on response inhibition gains

• Inhibitory Control and Information Processing in ADHD: Comparing the Dual Task and Performance Adjustment Hypotheses – PMC

• Inhibitory deficits and symptoms of attention‐deficit hyperactivity disorder: How are they related to effortful control? – Kostyrka‐Allchorne – 2023 – British Journal of Developmental Psychology – Wiley Online Library

• A unified framework for inhibitory control – PMC

• Emotional foundations of cognitive control – PMC

Developmental Coordination Disorder (DCD), also known as dyspraxia, is a neurodevelopmental condition that affects motor coordination and planning. Children with DCD have difficulty with moving their bodies in a smooth and coordinated way, which can make it hard to do everyday things at home, school, or with friends. 

Difficulties with coordination don’t present the same in every child. Some kids with DCD might find it harder to do big movements, like running or jumping and others might struggle more with small movements, like writing neatly. 

Researchers believe that children with DCD struggle with movement because they can’t create an internal model of how external movement should happen in the outside world. We learn by comparing how an action looks and feels against a mental picture. As we practise a movement we check it against our internal model and if it doesn’t look or feel right we adapt and correct it. Without this mental picture, it is much harder to learn a physical action because we have no mental reference point. 

Although DCD is a common condition, affecting around 5-8% of school-aged children, it is not easily identifiable and poorly understood. Signs of DCD in your child may look like:

• Takes longer to learn early skills like sitting, crawling, and walking.
• Finds it hard to run, jump, hop, and catch or throw things compared to other kids.
• Has difficulty with closing their lips to blow bubbles or blowing out birthday candles.
• Looks a bit clumsy, slow, and unsure when moving.
• Needs to be taught physical skills instead of figuring them out naturally.
• Often stumbles and falls.
• Has an unorthodox pencil grip and writes slowly.
• Struggles with getting dressed and using eating utensils.
• Doesn’t understand words like “on,” “under,” “over,” or “in front of” very well.
• Has trouble knowing how to act around others, which may impact their ability to make and keep friends.
• Feels worried and has low self-confidence as a result of being different from their peers.
• Has trouble focusing and reacts strongly to things as a result of the frustration of their external movements not aligning with their internal mental model.
• Works better one-on-one or in a small group.
• Has a tough time following directions.
• Struggles with managing time.
• Often misplaces things.

While many of the markers above present very early in life, children with potential DCD are not prioritised for therapy, instead parents are told to ‘watch and wait’. Movement problems in children often get noticed when they begin school. However, there isn’t a consistent system for identifying these issues, referring kids for diagnosis, or providing therapy.

DCD often overlaps with ADHD, approximately 50% of kids diagnosed with ADHD also have motor coordination problems.

Why it’s important

DCD and ADHD can share common traits, leading to misdiagnosis but also co-occurrence. Both conditions may involve difficulties with:

• Concentration and attention: Children with DCD may struggle to concentrate due to the effort required to complete simple tasks, similar to those with ADHD.
  
  
• Organisation: Executive function challenges, common in ADHD, can also affect children with DCD, making tasks like organising school work a struggle.

Recognising DCD is the first step to providing support, but because it can present differently in every child, you need to look more closely at some of the potential signs. If you are wondering whether your child has DCD, think about the following areas of impact and consider your child’s difficulties.

Motor Skills Challenges 

Gross motor: these are movements that use large muscle groups in the legs and arms like running, swimming, jumping, and throwing/catching a ball. 

Questions - Did your child learn to ride their bike unassisted at the same time as their peers? Do they resist playing ball games with other kids?

Fine motor: these movements are small and controlled usually involving the use of our hands, wrists, feet, and toes like eating with utensils, cutting with scissors, and writing with a pencil. 

Studies have found that the handwriting of children with DCD differs from other typically developing peers.  Students with DCD were observed during writing tasks and the following was noted:

• More pressure was applied to the pencil on the paper. 
• More time was spent hovering over their workbook without putting pencil to paper. 
• Slower at getting thoughts down on paper within the first minute of writing. 
• Hand movements weren’t smooth, and their writing looked messy and less organised.

Questions - does your child struggle to hold a pen or pencil comfortably? Do they find it difficult to gather their ideas and thoughts to create a narrative or other text? 

Motor planning: this refers to tasks/activities that involve multi-step or successive movements, such as tying a shoe or putting on pants with a zipper and button.

Questions - does your child appear defiant during routines when they are expected to get dressed or pack their bag? Are they oppositional and argumentative when it comes to chores? 

Cognitive challenges

Children with DCD may face certain learning challenges in areas such as maths, processing speed, and working memory. 

Questions - does your child find it difficult to do simple calculations in their head? Do they take longer than their peers to think about a question and answer?

Spatial awareness/reasoning Issues

A very common sign of DCD is a clumsy child who frequently bumps into objects or people.  Spatial reasoning is essential when learning to use tools and utensils like cutlery. 

Questions - does your child struggle with tasks like drawing within lines? Do they have difficulty doing puzzles or building with blocks?

Social and Emotional Struggles

Children with DCD experience frustration, low self-esteem, and difficulties in social situations. Making and keeping friends can be an issue because children with DCD are often excluded and bullied because of their differences.

Questions - does your child have difficulties in making and keeping friends? Does your child use self-deprecating language?

You can access the Developmental Coordination Disorder Questionnaire and scoring criteria at no cost at www.dcdq.ca if you want to investigate further.

It’s important to remember that difficulty with moving and coordination can make a big impact on a child’s life. It can affect how they feel about themselves and how others see them. These problems can make it hard for kids to reach their potential at school, make friends easily, and do well at sports. Staying on top of your child’s mental health is crucial in ensuring the best outcome for them.

References

• Pediatric care for children with developmental coordination disorder, can we do better? – PMC
• Fine motor deficits and attention deficit hyperactivity disorder in primary school children – PMC
• Divergent Development in Dyspraxic Children
• National Survey Evaluating the Impact of Developmental Coordination Disorder in Australia
• DCD and ADHD: A genetic study of their shared aetiology – ScienceDirect
• An Investigation of Dyspraxia: What We Know and Why the Research Is So Far Behind
• Editorial: Current Perspectives on Developmental Coordination Disorder (DCD)
• The Differential Effects of Auditory and Visual Stimuli on Learning, Retention and Reactivation of a Perceptual-Motor Temporal Sequence in Children With Developmental Coordination Disorder
• Procedural learning and retention of audio‐verbal temporal sequence is altered in children with developmental coordination disorder but cortical thickness matters – Lê – 2021
• Diagnosis and management of developmental coordination disorder – PMC 
• A systematic review of high quality randomized controlled trials investigating motor skill programmes for children with developmental coordination disorder
• New trends in developmental coordination disorder: Multivariate, multidimensional and multimodal – PMC
• DYSLEXIA, DYSPRAXIA and ADHD – CAN NUTRITION HELP?
• Motor skill intervention for pre-school children: A scoping review
• Children with DCD: At home, at school and in the community (Booklet)
• Combined action observation and motor imagery improves learning of activities of daily living in children with Developmental Coordination Disorder – PMC
• Cognitive, perceptual, and motor profiles of school-aged children with developmental coordination disorder
• Effects of Transcranial Direct Current Stimulation on Motor Function in Children 8-12 Years With Developmental Coordination Disorder: A Randomized Controlled Trial
• Cerebellar Transcranial Direct Current Stimulation in Children with Developmental Coordination Disorder: A Randomized, Double-Blind, Sham-Controlled Pilot Study – PMC

“Have children” they said, “it’s a magical experience” they exclaimed. Parenting is indeed a beautiful journey filled with love, laughter, and cherished moments. However, we learn fairly quickly that it also comes with its share of challenges and tests of patience. 

There are moments when our child’s behaviour can trigger intense emotions within us, pushing us to the edge. Our ability to respond calmly is directly correlated with our stress levels and our physical and mental health. Neurodivergent parents struggle significantly more as they balance their own unique neurology with that of their children.

It’s important to remember that our children’s chaos is not a premeditated attack on our person. Challenging behaviour is usually a symptom of an underlying neurological difference and related problems like lack of sleep, sensory processing, frustration, miscommunication, missing executive functioning skills, or other undiagnosed physical or mental health ailments.

Why it’s important

Remaining calm in situations where we are triggered is not easy, but the benefits of keeping composed in challenging moments have an immediate and long-term positive impact on your child.

It’s the foundation of co-regulation: Children learn self-regulation through co-regulation with a calm adult. Remaining in control of your own emotions before you engage with your child is the first step to diffusing an escalating situation. When you stay calm, you are better able to modulate your voice and movements. A screaming child needs a quiet voice and flailing limbs need steady hands.

It makes you an effective communicator: A calm and composed parent can communicate more effectively. It allows for clearer, more empathetic conversations, where you can guide your child without heightened emotions getting in the way.

It keeps you focused on resolving conflict: When you feel like your child’s behaviour is a personal attack and you allow those emotions to take over, a power struggle often ensues. Staying calm fosters a peaceful environment for conflict resolution. It encourages a problem-solving approach rather than escalating confrontations, which can be counterproductive.

It makes them feel safe: When your child sees that you can handle challenging situations without losing control, it builds trust. They feel safer knowing you’re there to support and guide them through difficulties.

Tips & strategies 

Use the power of controlled breath: When emotions flare up, pause and take two quick breaths through your nose, exhaling slowly through your mouth. This technique (cyclic sighing) swiftly calms your nervous system, allowing you to regain clarity and respond thoughtfully. Repeat this process a few times to calm your nervous system, allowing for a more thoughtful response.

Repeat an empathetic mantra: Remind yourself that your child’s behaviour isn’t intended to make your life difficult. Kids typically don’t do things to get into trouble, they want positive attention not negative messages from their parents. Reiterate a mantra like, “My child is not giving me a hard time; they are having a hard time” to encourage a mindset shift and help you respond with empathy.

Put on your curiosity glasses: Imagine donning a pair of glasses that allow you to view the situation with curiosity rather than anger or frustration. Ask yourself “Does my child possess the necessary skills to meet expectations?”. Think about their neurology and how it affects their ability to:

• Regulate their emotions and movements
• Control their impulses 
• Be flexible with their thinking
• Problem solve
• Predict future consequences
• Remember instructions
• Understand unspoken expectations

Activate the mammalian diving response: Take yourself out of the room, but only if safety is not a concern, and find cold water - don’t worry, there is a good reason! Use the bathroom or kitchen sink to splash cold water on your face for an immediate reset of your hyper-aroused nervous system. This technique triggers a process called the mammalian dive reflex, which quickly calms your body’s stress response by regulating your heart rate and breathing.

Remember, your calm response in moments of chaos is a powerful tool in nurturing your relationship with your child.

• Co- and self-regulation in the caregiver-child dyad: Parental  expectations,  children’s  compliance,  and  parental practices during early years 

• Polyvagal Theory: A Science of Safety

• Brief structured respiration practices enhance mood and reduce physiological arousal – ScienceDirect

• Breathwork and Its Effect on Stress in Healthy Individuals A Systematic Review

• Vagus Activation by Cold Face Test Reduces Acute Psychosocial Stress Responses 

• The diving response and cardiac vagal activity: A systematic review and meta‐analysis – Ackermann – 2023 – Psychophysiology – Wiley Online Library

As parents, we play a vital role in nurturing our children’s growth and development so that they can navigate situations independently and confidently. For neurodivergent kids, developing self-advocacy skills is particularly crucial. Self-advocacy empowers them to express their needs, preferences, and challenges effectively. 

Why it’s important

If your child has a neurological or learning difference, they may face unique hurdles in their daily interactions, school life, relationships, etc, and learning to advocate for themselves can be a transformative skill that they can call upon throughout their lives. 

Learning to advocate for oneself has two key components:

1. Self-awareness - to be able to self-advocate a child needs to be aware of their physical and emotional needs or be able to identify situations that in the past have been problematic. Developing self-awareness is a skill that is built over time, comes with experience, and in the early years requires the guidance of a parent or guardian. 
   
   
2. Communication tools - not all children will be able to communicate with words or be able to clearly articulate their thoughts and feelings in tricky situations. This is why as a parent it’s important to equip your child with a script, pre-prepared phrases or actions to help them express their needs and communicate their challenges confidently.

Tips & strategies

Body-autonomy - teaching self-advocacy skills doesn’t have to wait until your child can speak or starts school. Giving your child body autonomy and not forcing them to give or receive physical affection from family members is an excellent start in promoting self-advocacy. Allowing a child to determine when they stop eating, rather than forcing them to eat all the food on their plate, respects and promotes their body cues as important. 

Power of choice - where possible, hold back enforcing expectations and allow your child to make choices and voice their preferences, such as selecting activities or expressing their likes and dislikes. As they grow, gradually expand their responsibilities and decision-making opportunities.

Build self-awareness - help your child understand their strengths, challenges, and emotions, especially in the context of tricky circumstances. Identifying and discussing personal triggers is a fundamental part of recognising problematic situations early and avoiding being overwhelmed, scared, or angry. 

Teach communication strategies - equip your child with effective communication strategies. Role-play various scenarios and practise using different types of communication tools. Having prepared scripts or written phrases can take out the stress of articulating their needs or asking for help when necessary. 

Download our PDF with pre-prepared scripts and a section to write your own. Here are some examples of phrases your child can use:

• “I learn best when I can take short breaks to move around and refocus. Can I have permission to do that when I need it?”

• “I have difficulty processing verbal instructions. Can you please provide written instructions as well?”

• “I prefer sitting in the front of the classroom to minimise distractions. Is there a seat available there?”

• “I sometimes get overwhelmed by loud noises. Could I have a quiet space to work on my assignments?”

• “I have trouble organising my thoughts. Can you help me break down this task into smaller steps?”

• “I find it helpful to use coloured markers when taking notes. Can I use them during the lessons?”

• “I struggle with timed tests. Is it possible to have extra time or take the test in a quiet room?”

• “I might need more time to process and respond during class discussions. Can you give me a moment to gather my thoughts?”

• “I have sensory sensitivities. Can I wear noise-cancelling headphones during independent work time?”

• “I tend to get anxious in large group settings. Can I have a buddy to sit with during assemblies or school events?”

Celebrate neurodiversity - engage in open conversations about your child’s neurodivergence, so they can develop a positive self-image and embrace their unique qualities. Kids can be cruel when they see differences, and as parents, one of the most important things we can do is strengthen our own children’s confidence against harmful words and actions.

Foster independence - encourage your child to take ownership of their tasks and responsibilities. Allow them to solve problems independently and make decisions, even if it means making mistakes. These experiences give your child the opportunity to trust in their abilities and foster their sense of independence.

Get educators on board - meet with teachers and school staff to discuss your child’s needs and collaborate on the adjustments and accommodations that can create a supportive learning environment. Educators play a vital role in teaching self-advocacy and providing accommodations when needed. 

Lead by example - show your child how you advocate for your needs and seek help when required. Talking out loud while you problem-solve is a perfect way of demonstrating how to work through tricky situations. 

Celebrate progress - acknowledge your child’s courage in speaking up and seeking support at home and school. Celebrating achievements, big or small, reinforces their confidence in self-advocating and motivates them to continue growing in this skill.

Teaching your child self-advocacy skills is giving them a life-long gift that not only equips them to seek support and accommodations but also builds their self-confidence and nurtures their self-esteem.

During the school year, your child spends a large portion of their waking hours being taught, guided, and disciplined by someone other than you. Most kids adapt to teaching styles, classrooms, and other students, but if you have a neurodivergent child you know that they need accommodations and adjustments to succeed.

Although we are our children’s strongest advocates, we also have to consider that an educator has on average 28 other children to teach and support. In addition to a large workload, there is often a knowledge gap - most teachers haven’t had formal education on teaching kids with ADHD.

The Supporting Students with ADHD booklet has been written to address this knowledge gap, providing time-poor teachers with important insights into what ADHD is, what it looks like in the classroom, and tools that not only support neurodivergent students but also benefit the whole classroom.

ADHD parent-teacher collaboration

As you gear up for the start of term, it’s essential to remember that your partnership with your child’s teachers can significantly improve their learning experience. 

Empowering educators with information about ADHD and insights into your child’s strengths and support needs at the start of a new school year can inform: 

• Relationship building - teachers know that building trust and rapport with a child is at the foundation of future learning. Students who feel safe and comfortable with their teacher are more likely to want to learn.
  
  
• Design of lessons - although the curriculum supplied by the education department is clear and structured, teachers can have creative licence on how they deliver the content, adapting it to get the best out of their student cohort.
  
  
• Structure of day - especially in early grades, movement breaks are important for kids to release energy. Knowing that some kids need more movement than others can help the teacher structure the school day.
  
  
• Sensory support tools - some schools have the budget to purchase sensory or fidget tools but in some cases, teachers buy these items themselves. 
  
  
• Classroom setup - teachers can design different components of a classroom to get the best out of their students. Everything from sitting arrangements, visuals of routines, clocks, etc, are influenced by the needs of the children in a class.
  
  
• Motivation and discipline - schools typically have a “whole of school” approach to rewards and punishments. Great teachers, with the right information from parents, can adapt strategies to motivate individual students, help them regulate, and when necessary discipline them.

At the heart of it, this booklet is meant to be more than just a teacher resource – it’s also a bridge between home and school, fostering collaboration and common understanding between teachers and parents.

Strategies for students with ADHD

Assessments and reports - is your child seeing a speech pathologist, occupational therapist, or psychologist? Request an updated report that can be used by the teacher to support your child in the classroom. If you are worried that your child has an undiagnosed/untreated neurological or learning difference, organise assessment appointments now to avoid long wait times. Record your observations and concerns in the Keywell app to easily and accurately answer the when/where/how long questions asked in appointments. In the meantime, keep the teacher updated in case they can make temporary accommodations.

Observe and update - kids change quickly and so do their skills and needs for support. Use the About Me template to collate information about: 

• Your child’s strengths - knowing what your child is good at can assist the teacher in formulating strategies to get the best out of them.
  
  
• What your child enjoys - interests and passions are a great tool for teachers to motivate students, especially during tasks that are perceived as boring.
  
  
• What your child needs extra help with - kids with ADHD often struggle with executive functions and highlighting the specific activities that your child struggles with, allows teachers to plan.
  
  
• How the teacher can help your child succeed - an occupational or educational therapist can provide you with scaffolding strategies tailored to your child. If you don’t have access to these professionals, take inspiration from the sample About Me template as it covers common issues and solutions.
  
  
• Individual support strategies - include triggers and identify specific situations that require understanding and an individualised approach to keep your child calm and engaged
  
  
• Adjustments and accommodations - explain your child’s difficulties in detail and the adjustments and accommodations proposed to ameliorate or overcome them.
  
  
• Movement and sensory regulation tools - list the items that help your child to regulate their hyperactivity, focus, and emotions. Depending on your school and budget available, you may have to purchase some of these items yourself.
  
  
• Assistive technology and organisational tools - kids with ADHD can benefit immensely from using tools to support their working memory and processing speed. If your child also has a learning disability like dysgraphia or dyslexia, some of these become crucial supports in their learning.
  
  
• Additional information - this is a good place to explain important historical events, list regular appointments, provide further information/summary of professional recommendations, etc. 

Meet with the teacher - meeting with your child’s classroom teacher ensures that the Supporting Students with ADHD booklet is read and the About Me section is used, fostering a collaborative approach. There might be many reasons why an educator can’t implement everything proposed in your document, but they may have alternatives that have a similar effect. Flexibility and working together will guarantee the best outcome for your child.

Regular check-ins - you don’t necessarily need formal meetings, casual chats over email or during drop-off are just as valuable to discuss issues that need to be resolved quickly.

Bedtime chats - asking your child “How was school?” straight after they walk into the door will usually get you nothing more than a one-word answer. Bedtime often provides a better setting for these conversations, take those moments when everyone is calm and relaxed to find out how your child feels about school. 

Download the Supporting Students with ADHD booklet and the sample About Me template to learn even more strategies for ADHD students.

As the anticipation of a new school year builds, it’s common for both children and parents to feel a twinge of anxiety about what lies ahead. Whether your child is stepping into kindergarten or taking the next grade level, we’ve put together some strategies you can use to ensure a seamless transition. 

Why it’s important

Investing time in preparing your child for the upcoming school year can make all the difference between school reluctance and a positive educational experience. This becomes more important for children who faced challenges in the previous year, fostering their confidence to re-enter the classroom environment.

With a new school year just around the corner, take a moment to observe your child’s growth, strengths, areas for improvement, and triggers over the past few months. This knowledge will not only empower you but also enable you to effectively communicate your child’s needs to their new teacher, ensuring the necessary support is in place.

Tips & strategies

1. Comfort in familiarity - Particularly for neurodivergent and highly anxious children, introducing them to their new school environment early can address common worries. Consider taking a quiet walk around the school grounds with your child and possibly visiting their new classroom when it’s empty. A gentle introduction can provide a sense of comfort without overwhelming sensory stimuli.

1. Meet with the teacher in advance - Begin the school year by updating documents detailing your child’s strengths and the accommodations they need to thrive. Download and use our free ‘About Me’ template. Schedule a meeting with their new teacher to discuss your child’s needs and the necessary adjustments. Early communication helps set the stage for a positive teacher-student relationship and ensures that potential issues are addressed promptly.

1. Foster connections - If possible, arrange playdates or a class meet-and-greet with future classmates. Familiar faces can ease anxiety about the unknown, especially on the first day of school. Similarly, facilitate an opportunity for your child to connect with their new teacher before school starts. An informal introduction can go a long way in building trust and safety.

1. Routine is key - During school holidays the usual school routines get replaced by a more relaxed approach. Don’t wait until school starts to implement a new routine. Although structured routines can provide a sense of predictability that helps alleviate anxiety, you don’t want to iron out any issues in real-time! Develop morning, afternoon, and evening routines that accommodate school tasks and free time. For visual learners, a visual representation of the routine can be particularly helpful, or you can try a music routine to keep everyone on track.

1. Gear up with confidence - Give your child a chance to use and understand their new school items – from backpacks to lunch boxes. Trying on uniforms, including shoes, is crucial for those with sensory sensitivities, ensuring they’re comfortable and ready for the big day. Read the “Back to school – Part 2: Testing new things” article for tips.

1. Sleep Transition - Adjusting to school sleep patterns takes time. Start a week before school begins by gradually shifting bedtime and wake up time. This ensures a smoother transition from holiday to school sleep schedules. Read the “Back to school – Part 1: Sleep” article for tips.

1. Collect Updated Reports - If your child receives support from professionals like occupational therapists, speech pathologists, or psychologists, gather the most recent reports for your child’s teachers. This information empowers educators with insights to create a learning environment where your child can succeed.

1. Communication is Key - Find a calm time in your days to start a conversation with your child about their anticipations and apprehensions regarding school. By addressing their concerns, you can collaboratively find solutions and alleviate unnecessary worries.

1. Carry a Token of Connection -  For children who struggle with separation anxiety, providing them with a special trinket or symbol can offer reassurance and a sense of connection to you. 

1. Empower with knowledge and strategies - Demystify anxiety by explaining what it is to your child. Understanding how our brains work is empowering! Teach your child breathing techniques and other strategies to help them manage their worries. Download the “Anxiety - tuning your alarm system” pdf to read with your child.

1. Prioritise Self-Care - Amidst the hustle and bustle of preparations, don’t forget to take care of yourself. You’ve got this!

As the new school year approaches, your role as a parent extends beyond logistics – it’s about ensuring your child’s emotional well-being. By implementing these tested strategies, you’re not only easing your child’s anxiety but also nurturing their confidence and enthusiasm. With thoughtful preparation, open communication, and a dash of self-care, you’re setting the stage for a successful school year.

I’m not sure about you, but leaving things to chance and hoping everything goes well is a recipe for disaster. Whether your child is starting a new school or a new year, this is a big step for them, and you play a vital role in helping them transition smoothly into this phase. To ensure your child’s success and confidence, there are a few key things you can start testing out and practising together before the big day arrives.

Why it’s important

Neurodivergent children are more likely to have sensory sensitivities and anxiety about change than their neurotypical peers. A new school year can bring about a lot of uncertainty. Testing new things is about removing as much of the unknown for them so that they have less to worry about.

A happy and calm child also means a happy and calm parent. Use the below as a starter list of tasks to get done before the new school year starts:

1. Organise and trial new medications or change in dosages during the holidays
2. Check that shoes, uniforms, and other clothes still fit, and purchase new sizes
3. Check if the school has a list of stationery requirements and purchase accordingly
4. Find the best travel route and ensure you have everything needed for your child to get to school. This may include ordering public transport passes, ensuring their bike is serviced and the helmet is the right fit
5. Plan work, after/before school activities, or care

Tips & Strategies

Shoes and clothes - If your child struggles with new clothes and shoes, the first morning of school is not the time to get them to try these out for the first time. You want to give your child plenty of time to try out new shoes and if necessary, walk around in them at home to ensure they don’t cause blisters or pain. New clothes and school uniforms can also be a source of problems for some kids. Tags or seams can be uncomfortable so you’ll need enough time to make adjustments, change sizes, or find undergarments that help relieve physical contact.

Lunch & snacks - Kids’ tastes change as frequently as day and night, what they liked last year or even last week, maybe off the menu completely. To avoid lunches coming back intact, get your child involved in planning what will go in their lunchbox every day.

Lunchboxes - For children who have issues with different foods touching, it’s crucial to test out lunch boxes and how they are packed. For younger kids, let them practice opening and closing containers in case their little hands find the lids tricky.

Backpacks - New school years can also bring along new fancy backpacks. Take your child shopping, involving them in the selection process. Ensure the backpack is comfortable, has ample storage, and fits their style. Practice packing and unpacking the bag together, ensuring they know where to find their essentials.

Systems for organisation - For children who struggle with executive functioning, implementing the right systems for organising their homework, subjects, projects, etc, is crucial in ensuring they don’t fall behind. Strategies like colour coding folders and stationery, write-and-wipe calendars, and yearly diaries can all support memory, planning, and organisation.

New routes and safety - Whether it’s walking, biking, taking the bus, or carpooling, it’s best to discuss the best ways to get to and from school. Depending on your child’s age, test out the new route together, check timings, and ensure they are comfortable with road safety, using crosswalks, and being aware of their surroundings. This empowers them to take responsibility for their journey while ensuring their safety.

One spot for everything - Keeping your child’s backpack, shoes, hat, and other school-related items in one place is really helpful in staying organised. If this is not possible, at least agree with your child on where each of those things will live. At the end of the day, that’s where they pack away their school gear and in the morning that’s where they will find things.

New routine - Don’t forget that you also need to give yourself a chance to test out changes to your day. Consider things like school drop off and pickup and how they may impact work start and finish times, making lunches, doing laundry, etc.

Ah, school holidays, the time when you can loosen up on strict daily routines and when kids beg (over and over again) to stay up “just a bit later”. As the holidays draw to a close it’s important to start bringing back routines and adjusting sleep schedules so that your family can be ready to survive the first week of school.

During the school holidays, it’s common for kids to stay up later and wake up later than usual. While this may seem harmless as a temporary measure, irregular sleep patterns can disrupt the body’s internal clock, known as the circadian rhythm. 

The circadian rhythm is crucial to our wellbeing: it regulates our sleep-wake cycle, hormones, body temperature, and other essential physiological processes. Research has shown that children, like adults, have their own unique circadian rhythms that influence their energy levels, alertness, and ability to fall asleep and wake up. 

Why it’s important

Shifting from holiday sleep patterns to school routines overnight can lead to emotional chaos. Your child’s internal body clock has adapted to later bedtimes, and sudden changes can trigger resistance. Moreover, abrupt changes heighten the risk of sleep disruption, insomnia, and even symptoms akin to jet lag – fatigue, irritability, and trouble focusing – hardly the ideal start to a new school term!

A gradual approach is your best strategy to get sleep back on track. Start tweaking sleep schedules a week before school. By gently nudging bedtime and wake-up times closer to the desired routine, your child’s body clock gets a chance to adjust gracefully. This gradual shift makes falling asleep and waking up at the right times feel natural.

Remember, our bodies need time to adapt to new routines. Patience and consistency are key. Even if it takes a few days or a week, stick to the gradual adjustments, allowing your child’s sleep cycle to reset itself.

Tips & strategies

To get your child back on their regular sleep schedule, try these strategies:

Craft a Sleep Schedule

Ensure your child gets the necessary sleep: School-aged kids need an average of 9-12 hours of sleep per night. Any less and it will start to impact their day-to-day functioning including their ability to focus, learn, and keep emotionally regulated.

Use a gradual approach to shifting sleep: Start adjusting bedtime and wake-up time gradually, shifting them back by 15 minutes every couple of days until the desired schedule is achieved.

Stick to a routine, including weekends: Although it might feel like weekends are a time to relax routines, it is much better to keep to one sleep schedule. Not only is it less disruptive to our circadian rhythm, but there are also fewer arguments on Sunday nights about bedtime and less pushback about getting up on Monday mornings.

Practice Sleep Hygiene

Create a bedtime routine that is familiar and promotes relaxation: create a calming routine that signals to the body that it’s time to wind down. This may include activities like reading, dimming lights, listening to guided sleep meditation, or progressive muscle relaxation audio. Try a few different things to see what works for your child. 

Limit or avoid caffeine: caffeine can be hidden in many drinks and sugary snacks, check labels and avoid them from late afternoon onwards as they can disrupt sleep. 

Turn off devices 1-2 hours before sleep: light emitted from digital devices, and even overhead LED lights, signal to our bodies that it is still daylight, which delays the natural timing for the secretion of melatonin (sleep-facilitating hormone) and sleep onset.

Additional Sleep Hacks

Maintain a cooler bedroom temperature: there are internal and external signals that encourage our bodies to go to sleep, and body temperature is one of them. A drop in core body temperature is part of our circadian clock and accompanies bedtime and sleep stages.

Review timing of stimulants: ADHD medications can impact sleep depending on the timing of the last dosage. If your child has recently started medication or changed dosage, it might be worth talking to their paediatrician about the impact on sleep. 

Spend time in the morning sunshine: sunlight is the most important mechanism that helps sync our internal body clock to the outside world. The earlier you get your child out in the sunlight the earlier they will start feeling tired. Morning light advances our circadian clock, so that we get tired earlier in the evening, but light exposure late in the day or early at night will delay it, pushing back the time that you will feel tired. Think of the time that your child falls asleep as a result of the push and pull between these opposite effects of light exposure at different times of the day.

Replace blue lights in the bedroom: blue light has been shown to suppress melatonin for about twice as long as the green light and shift circadian rhythms by twice as much (3 hours vs. 1.5 hours). Where possible use dim red lights for night lights. Red light is less likely to shift circadian rhythm and suppress melatonin.

Change the menu: some studies suggest that some foods can help you sleep better because they contain high concentrations of tryptophan, serotonin, or melatonin. If your child needs a late-night snack try giving them complex carbohydrates (oatmeal or whole wheat pasta/bread), fruit like bananas, kiwis and cherries, nuts like almonds and walnuts, or pumpkin seeds (subject to allergies).

1. Back to School Sleep Tips: Routines, Schedules, & Sleep Hygiene | Sleep Foundation
2. Tips for shifting kids back to their school sleep schedule – Sanford Health News
3. Healthy sleep habits before kindergarten help children adjust to school — ScienceDaily
4. Researchers find ways to help teens get more sleep: Time management and bright light therapy prove effective for adolescents — ScienceDaily
5. The Role of Environmental Factors on Sleep Patterns and School Performance in Adolescents – PMC
6. Effect of Extended-Release Dexmethylphenidate and Mixed Amphetamine Salts on Sleep: A Double-Blind, Randomized, Crossover Study in Youth with Attention-Deficit Hyperactivity Disorder | SpringerLink
7. Sleep and Diet: Mounting Evidence of a Cyclical Relationship – PMC
8. Sleep and thermoregulation – ScienceDirect
9. Blue light has a dark side – Harvard Health

It’s taken me a long time to understand that my daughter has something called (undiagnosed) stealth dyslexia and ADHD. This means that her cognitive abilities have been able to mask the specific learning disability which is dyslexia and a neurological difference. 

In year 2, my daughter’s teacher suggested that I get some assessments done because she was still reversing letters and numbers, and had challenges with initiating tasks, procrastination, problem-solving, and following multi-step instructions. I did have worries with her reading and writing, but I put it down to the previous year, where her teacher had to navigate her own challenges and not much learning took place. My biggest worry at the time was my daughter’s self-confidence.

I believe that no stone should be left unturned when there is a concern, so I booked my child for the assessments her teacher recommended. In all honesty, I thought that they would come back with not much other than, “Your daughter is a middle-of-the-road student with no learning disabilities”. Instead, the report came back highlighting sub-clinical anxiety (not within range for treatment), a mildly gifted IQ, but with a very gifted result for her verbal comprehension abilities. The results also suggested that overall there were indicative signs of a learning disability, the numbers however, were not low enough to confirm it.

I knew things weren’t quite right so I disregarded the results and got her a tutor who used evidence-based instruction for kids with dyslexia. My daughter finally started getting her self-confidence back! We supported her at home with strategies that would scaffold her challenges and we doubled down on her strengths. There is nothing more powerful than knowing that you can succeed.

Over the last few years, I have tried to talk to all her teachers and make them aware of the discrepancies between her potential and her achievements. I’ve never been taken seriously. I’m always told not to be concerned, and that she is doing fine. To be clear, I am not a parent who needs their child to be the best or come first in everything. I am a parent who can see that their child has a block in front of them and they can’t quite get through it.

In year 5 I decided to look into ADHD again, but unfortunately, her teacher at the time (like all others before her) said that she was fine and there was nothing to worry about. Again I was dismissed by the teacher, but the psychologist who ran the tests agreed that there were definitely many signs of ADHD. This amazing psychologist has kept her observations in my child’s file, because for many girls (especially those who are gifted) a diagnosis comes late in life, if at all. 

I spend a lot of time reading research papers, articles, and blogs and listening to parents who have neurodivergent kids. Over the last month, I have specifically focused on reading all I can about learning disabilities and giftedness so I could synthesise that information for other parents. The penny has finally dropped… I have now been able to put all the pieces together to confirm that she has never received a diagnosis for ADHD or dyslexia because her giftedness and ability to mask (girls are brilliant at this) have carried her through as an average student.

Next year she starts high school. This will be a crucial time for her, as the expectations put upon her will outweigh her executive functioning abilities. Luckily, I know what to do to support and scaffold her at home. Although they couldn’t be more different, I have significant practice supporting her brother who is also twice exceptional. I’m hyper-aware that this may not be sufficient and she may need to try medication - I’ll be ready with my file for the paediatrician when that time comes!

You have heard of the word gifted used to describe children of exceptional cognitive abilities, and you are pretty certain that your ADHD/autistic/dyslexic/<insert neurodivergence here> child is not gifted. Your child’s experience at school is not remarkable in that sense. Teachers don’t sing their praise and instead are quick to highlight their deficits.

Twice-exceptional children encompass a diverse group of learners who demonstrate exceptional cognitive abilities in one or more areas and have been identified as having learning or neurological differences. While they may have high intellectual potential, these students can also face difficulties in areas such as executive functioning, social interactions, working memory, and processing speed. These challenges may hinder their progress in traditional academic settings, leading to underachievement and behavioural difficulties.

Why it’s important

You’ve wondered about your child’s abilities, they are so bright and you’ve seen glimpses of brilliance, but they only produce average results. School has never been your child’s happy place. Teachers rarely say anything positive about your child and instead might complain about them:

• Being disruptive in the classroom
• Refusing to do anything that involves writing
• Asking too many irrelevant questions
• Not being able to regulate their emotions
• Not sitting still
• Being disengaged
• Not listening
• Getting easily frustrated
• Having difficulty working in groups
• Making lots of mistakes because they want to finish as quickly as possible
• Not trying hard enough, especially in tasks they’re not interested in 
• Not having “social skills” or not understanding “social cues”
• Not showing their working out
• Having a messy workbook
• Being bright but not putting in effort

When you think about your child and learning, you might encounter the following:

• Refusing to go to school
• Whining about school work being easy and also hard
• Refusing to do any homework, to the point of meltdowns
• Complaining that their hand hurts when they write
• Protesting that homework is boring
• Absolute exhaustion and dysregulation when they get home from school

At home and without pressure, you might also observe that your child has:

• A voracious appetite for books of their choice
• An excellent vocabulary for their age
• The ability to understand complex concepts
• A need to know more or go deeper on a subject of interest
• Outstanding creativity in the arts or incredible imagination 
• The ability to extend on ideas
• A sense of humour beyond their years
• A wide range of interests

It is easy for parents and teachers to believe the common misconception that a child who struggles at school or has difficulties with maths or writing can’t be gifted. Most people think that gifted children are exceptional students who perform consistently years above their grade. 

Twice-exceptional children can fall into three categories:

1. first identified as gifted and later shows signs of a specific learning disability; 
2. identified as having a specific learning disability and who also shows outstanding talent in one or more areas; or 
3. may appear average or underachieving because the disability area masks any manifestation of giftedness.

Twice-exceptional children are more likely to perform inconsistently because of giftedness and their learning and neurological differences, which are often disabling in a typical classroom with standardised instruction. 

Research shows that teachers tend to value conformity to classroom norms and achievement over aptitude. Students with a diagnosis are viewed through a deficit-based lens rather than through a strengths-based view. Not “high performing” enough for gifted and talented programs and not “struggling” enough for education support. This is how twice-exceptional students fall through the cracks.

Tips & strategies

Things you can do to support your child at home

Get your child assessed - If you are wondering about your child’s cognitive strengths and weaknesses, it is worth getting them assessed through an experienced educational psychologist who will do a WISC and a WIAT. At the very least you will be able to identify what areas your child will need support with at school.

Encourage interests - Twice exceptional children often develop intense passions or hobbies in specific areas. Even if you consider things like Pokemon a waste of time, it’s important to encourage and facilitate their exploration of these interests, because they provide avenues for personal growth and enhance your child’s overall well-being.

Build emotion regulation skills - Twice exceptional children may experience heightened emotional sensitivity. If your child is deeply affected by criticism, failure, or perceived social rejection, how you navigate these big feelings at home can equip them with the skills to navigate their emotions in other environments. Focus on modeling how to deal with disappointment, giving your child choices for dealing with frustration, and using co-regulation to teach them self-regulation. Use the Keywell app to keep track of your child’s wellbeing.

Focus on the process, not results - Some twice-exceptional children can be crippled by the anxiety that comes with perfectionist tendencies. Avoid setting expectations for things like test results and the final mark on report cards, and instead discuss the importance of mistakes in learning, celebrate the chance to practise new skills, and recognise their personal effort. Focusing on the process rather than the result can also help a child who procrastinates because of perfectionism.

Support executive functioning - Difficulties in planning, organising, and completing tasks can be common among twice-exceptional children. Establishing consistent routines, breaking tasks into manageable steps, and providing visual aids or reminders can help them develop effective strategies for managing these challenges.

Prioritise social interactions through interests - Socialising can be challenging for twice-exceptional children, as they may find it difficult to relate to their peers or experience social anxiety. Interest-based communities can provide the perfect platform for social interactions, which in turn can foster social growth and boost self-confidence.

Things you can do to support your child at school

Request an IEP/ILP -  Twice exceptional children often struggle with traditional classroom structures. They may require individualised educational plans to address their learning needs. These plans can include things like: 

• extended time for assignments - discuss what is possible with your child’s teacher 
• preferential seating - usually away from distractions 
• modified curriculum with enrichment opportunities and flexible pacing 
• alternative assessment methods - e.g. video speeches
• assistive technologies - e.g. voice-to-text, iPad to type instead of write
• sensory tools - e.g. ear defenders, discreet fidgets
• test accommodations - e.g. scribe, extra breaks

Open communication - Maintain regular communication with your child’s teachers to share insights, concerns, and successes. Establishing a partnership between home and school is essential for understanding and supporting your child’s progress. Most teachers don’t have the capacity to follow up on every student, so it will be up to you to check in regularly.

Empower the teacher with knowledge - The typical teacher does not have training on how to identify or support twice-exceptional students. It takes experience and knowledge to see beyond some of the behavioural issues that come from boredom and disengagement and to take a strengths-based approach when a student’s learning differences hinder their progress and cause them to underperform. As a parent, you want to ensure that your child is not mistakenly labelled as unmotivated or as a struggling learner. One of the best ways of setting up your child for success is to equip educators with specific knowledge about your child, reports, and assessments from professionals.

References

Need to know

You are sitting in front of your child and they are crying. Your child threw a book the teacher sent home across the room and they refused to read it. This is not uncommon. When asked to read anything, including books of interest, your child becomes inconsolable and will avoid it at all costs. At first, you wondered if they were being defiant or just lazy, and on occasion, you’ve asked yourself if their inability to read like their peers was a direct result of their cognitive abilities. Now you are concerned that there might be more to it.

Reading difficulties can be an indication of ADHD or a learning disability. Dyslexia is thought to affect 20% of the population and it represents 80–90% of all those with learning disabilities. It is the most common of all neuro-cognitive differences. It is most commonly due to a difference in phonological awareness, a skill needed to associate spoken words with written language, which affects the ability of an individual to speak, read, and spell.

Children have a 50% chance of having dyslexia if one parent has it, and a 100% chance if both parents have it. Researchers also have uncovered evidence that specific regions of the human genome are involved in several reading-related processes within the brain. Dyslexia is not something that can be cured, it is a neurodevelopmental difference that, when diagnosed early, does not impede learning. In fact, it can be an advantage where creative thinking is needed.

Why it’s important

Very few educators have had training on how to identify, let alone support, a dyslexic child. Ideally, all dyslexic children would be identified upon entering primary school, and intervention would be provided immediately. Dyslexia can be identified with 92% accuracy at the age 5.5 years old. The “wait and see” approach for dyslexic children can be incredibly damaging. The earlier a child’s difficulties are diagnosed, and appropriate interventions are started, the better the prognosis for remediation.

Dyslexia remains hidden in most schools, with 4 in 5 dyslexic children (80%) leaving school without their dyslexia being identified. Many unidentified dyslexic children find themselves in special education classrooms because they are classified as slow learners. Most dyslexic children are extremely bright but learn differently from their peers, and without specialist instruction will fall behind. 

As a parent, it is absolutely crucial that you request an assessment by the school or get it done privately. Dyslexic children are at increased risk of anxiety, and academic and social problems, and early identification reduces the risk of the development of emotional and behavioural problems. Unsupported or unidentified dyslexic children may try and cope in 4 different ways:

• • Suppression: The child will internalise feelings of anger, frustration, etc. This can present as task and school avoidance.

• • Aggression: The child will externalise their fear in situations where they feel unsafe. This can present as aggressiveness, deviant behaviour, and delinquency.

• • Depression: The child will internalise feelings of inadequacy, which erodes their self-esteem and over time impacts their ability to feel joy. This can present as withdrawing, hiding, or self-blame.

• • Regression: The child will regress as a reaction to traumatic experiences  This can present as stammering and bed-wetting.

Tips & Strategies

Don’t wait - If you’re concerned about your child’s reading, spelling, or writing, get in contact with their teacher to discuss your concerns and request that the school conduct a dyslexia assessment. Not all schools have the resources to provide this service, in this case, it is best to get in touch with an educational psychologist. Some universities provide assessments either for free or at a lower cost; give them a call or have a look at their website. With a diagnosis, you can access resources, support networks, and specialised professionals who can guide you in navigating the educational system.

Advocate for the right intervention - Evidence-based interventions can be implemented at an early stage, targeting specific difficulties associated with dyslexia. Not all programs have strong and conclusive evidence so be cautious. The best evidence-based programs for dyslexia are based on the following:

• • Direct Instruction (E.g.: Spelling Mastery, Reading Mastery, Elementary Maths Mastery, DISTAR programs, Teach Your Child to Read in 100 Easy Lessons) - Strong research evidence from independent studies showing positive outcomes achieved across most academic areas when delivered exactly as prescribed.

• • Structured Synthetic Phonics (E.g.: Intervention:  Sounds-Write, MultiLit, MiniLit, MacqLit, Phonic Books UK. Whole Class: Sounds-Write, Letters and Sounds, PreLit, PLD Literacy and Learning, Little Learners Love Literacy, Phonic Books UK, No Nonsense Phonics Skills, Jolly Phonics, Read Write Inc.) - Very strong independent research evidence worldwide that shows programs based upon Structured Synthetic Phonics provide the best opportunity to produce significant and long-term improvements in children’s literacy skills. Needs to be delivered exactly as prescribed by a skilled practitioner.

Build self-confidence - Dyslexic children often face frustration, self-doubt, and a sense of inadequacy due to their struggles with reading and writing. Double down on your child’s interests so that they have plenty of opportunities to experience success, helping them develop a positive self-perception and belief in their abilities.

Request individualised instruction and accommodations - Talk to your child’s teacher about developing and implementing an individualised education/learning plan. An IEP/ILP outlines specific accommodations, modifications, and strategies tailored to a child’s unique needs. Educators can implement specialised instructional approaches, provide additional support, and offer necessary accommodations. Audiobooks and text-to-speech applications are two of the most important accessibility tools.

Nurture potential and talents - Dyslexia is often accompanied by unique cognitive strengths, such as creativity, problem-solving abilities, and visual thinking. By focusing on their strengths and providing growth opportunities, you can help your child explore their interests and excel in areas aligned with their abilities. 

Keep track of your child’s wellbeing -  If you are worried about how dyslexia is affecting your child’s wellbeing and general day-to-day school life, particularly when writing, reading, and spelling, use the Keywell app to keep track of your observations and monitor any changes. Being in tune with your child will help you address any concerns swiftly.

References

Need to know: ADHD learning difficulties

• ADHD effects on learning
• Teaching strategies ADHD
• Learning strategies for ADHD
• Is ADHD a learning disability?

Is ADHD a learning disability?

ADHD (Attention-Deficit/Hyperactivity Disorder) and learning disabilities are two distinct conditions that often coexist in children. While they are separate diagnoses, there is a significant overlap between the two. A child with ADHD is likely to experience different levels of difficulties with attention, impulsivity, and hyperactivity, symptoms that impact their ability to sit and learn in a typical classroom. Children with learning disabilities may also exhibit very similar traits to those with ADHD, these commonalities may make it difficult to identify and may delay individual diagnoses. Overlapping features include:

Inattention: Both ADHD and learning disabilities can manifest as difficulties with sustained attention, focus, and staying on task during academic activities. Children may struggle to concentrate and may appear easily distracted or disorganised.

Executive functioning deficits: Executive functions involve cognitive processes such as planning, organisation, time management, and working memory. Deficits in executive functioning are common in both ADHD and learning disabilities, leading to challenges with organising thoughts, task initiation, and self-regulation.

Academic performance: Both conditions can impact academic performance. Children may experience difficulties with reading, writing, spelling, maths, or other subject areas due to attentional difficulties, processing speed issues, or challenges in integrating and applying learned information.

Social and emotional challenges: Children with ADHD and learning disabilities may face social and emotional difficulties. They may struggle with impulse control, managing emotions, or making and maintaining friendships due to executive functioning deficits and the impact of their academic challenges.

Research shows that 30-50% of children with ADHD also have some type of learning disability (LD). An LD sometimes explains why a child on effective ADHD medication can sit still and stay focused and yet struggle academically.

Why it’s important

Learning difficulties with ADHD: Things to consider

Learning disabilities are neurodevelopmental conditions that affect how children process information and acquire certain academic skills. They can impact various areas such as reading (dyslexia), writing (dysgraphia), mathematics (dyscalculia), or overall learning (specific learning disability). Recognising the signs is crucial for obtaining the right support and interventions:

Academic-specific challenges: Learning disabilities tend to manifest as specific difficulties in one or more academic areas. For instance, dyslexia is characterised by difficulties in reading and decoding words, while dyscalculia affects maths skills.

Consistent and persistent challenges: Learning disabilities-related difficulties are consistent and tend to persist over time, even with additional support and practice.

Unrelated to attention: Unlike ADHD, learning disabilities are not directly related to attention and impulsivity issues. Children with learning disabilities may have typical attention and focus but still struggle with specific academic tasks.

Intellectual ability: Learning disabilities are not indicative of a child’s overall intelligence. Children with learning disabilities may have average or above-average intelligence in areas unrelated to their specific learning challenges.

Without early identification and the right support children with ADHD and learning disorders are more likely to:

• Repeat a grade
• Be suspended
• Dropout of school
• Not start or finish a tertiary degree
• Be unemployed

Tips & Strategies

Focus on strengths: Children with ADHD and learning differences struggle every day in the classroom, and without immediate and targeted support, these difficulties may turn into a sense of inadequacy that can permeate their whole world. Take the time to understand your child’s strengths and to share them with their educators. Creating opportunities for children to succeed at home and school is crucial in helping them develop positive self-perceptions and belief in their abilities.

Keep a record: Carefully take note of all your concerns, including your child’s difficulties, and symptoms using the Keywell App. Use that and any other specialist reports/assessments to advocate for accommodations for your child in school, and accurate diagnoses and treatment plans.

Comprehensive assessment: Seek a comprehensive evaluation by qualified professionals, such as educational psychologists or specialists. It’s crucial to identify the specific nature of the challenges your child is facing and to develop an appropriate support plan tailored to their needs. Understanding the unique combination of difficulties is essential in providing effective strategies and interventions to help the child succeed academically and in other areas of their life.

Individualised Education/Learning Plan (IEP/ILP): Collaborate with educators and specialists to develop plans that outline accommodations, modifications, and support strategies. These plans can address academic needs, executive functioning challenges, and social-emotional well-being.

Structured environment: Provide structure, routine, and clear expectations at home and school. Consistency and predictability help children with ADHD and learning disabilities feel more secure and can improve focus and self-regulation.

Supportive environment: Create a safe environment where your child feels comfortable discussing their challenges and seeking help. Encourage open communication and emphasise that everyone learns differently. Highlight their strengths to boost their confidence.

Multimodal instruction: Utilise a variety of techniques that leverage your child’s strengths to reinforce learning. Incorporate visual aids, hands-on activities, and assistive technologies to enhance engagement and comprehension.

Break tasks into manageable steps: Help your child break down complex tasks into smaller, more manageable steps. Teach them strategies like creating to-do lists, using visual organisers, or setting timers to aid in organisation and task completion. 

Teach self-advocacy skills: Teach your child to understand their learning needs and advocate for themselves. Encourage them to communicate their challenges and request assistance when necessary. Help them develop self-advocacy skills so they can actively participate in their educational journey.

Collaborate with professionals: Maintain regular communication with teachers, specialists, and therapists involved in your child’s education. Sharing insights and working together ensures consistent support across different environments.

Seek additional resources: Explore community resources, support groups, and online platforms that provide information, strategies, and guidance for parents of children with learning disabilities. Connecting with other parents facing similar challenges can offer valuable insights and support.

References

1. ADHD? Learning Disability? It May Be Both – CHADD
2. Identifying Struggling Students – NCLD
3. Comorbidities Between Specific Learning Disorders and Psychopathology in Elementary School Children in Germany
4. Is ADHD a Learning Disorder?

Need to know: Becoming your child’s best advocate

You have probably concluded that for your child to succeed in school, in extracurricular activities, in the community, and in accessing healthcare, you have to become their greatest advocate. When your child has neurodevelopmental differences or a learning disability, advocating for their needs becomes an essential part of your role as a parent. As an advocate, you have the power to make a significant difference in your child’s life, ensuring they receive the support, understanding, and opportunities they deserve. 

Why it’s important

The processes, systems, and structures of our world are not always built to support or accommodate individuals who are neurodivergent. 

Although change is happening, we have a long way to go in two key areas:

1. Education - most teachers have had little training on the adjustments and accommodations that can be put in place to help neurodivergent students succeed. Old-fashioned methods of punishments and rewards are often detrimental to neurodivergent students, who by the nature of their neurology are not able to meet certain expectations.

1. Healthcare - not all clinicians and allied health professionals have the training and experience to address the needs of neurodivergent children. Further, high-quality care can be difficult to access, costly, and not always up to date in the latest research and how it intersects with lived experience.

You are your child’s best advocate, and that responsibility to become knowledgeable and proactive can feel overwhelming. There are three components to becoming an effective advocate:

1. Search for knowledge - the adage, “knowledge is power” is a fundamental pillar of advocacy. Read widely and ask questions, you will find different information and alternative pathways in support groups, online, and in books.
   
   
2. Focus on relationships - whether it is building rapport with teachers or connecting with specialists, relationships are incredibly powerful in influencing the change you want.
   
   
3. Willingness to collaborate - working together with those who hold power over your child’s circumstances is always the most effective approach. There might be times when the individual you need to collaborate with is not a willing party; if this is the case, engage directly with their leader.

Tips & strategies

Educate yourself - begin by thoroughly understanding your child’s neurology and how it affects them as an individual. Learn about their unique strengths, challenges, and the support they need. Reliable sources such as books and professionals specialising in neurodevelopmental differences can provide assessments and valuable insights. You might find however that there is conflicting advice about therapy, parenting strategies, and medications. Do your research and don’t pursue anything that does not feel right for you or your family.

Build a support network - seek out advocacy groups, online communities like ADHD/Autism + Parents Support Group, and local organisations that cater to parents of neurodivergent children. Connecting with other parents who have faced similar challenges can be a source of comfort, guidance, and encouragement. 

Collaborate with professionals - collaboration between parents and professionals is vital for a child’s success. Engage in open and regular communication with your child’s healthcare providers, therapists, and teachers. Share insights using the Keywell app about your observations of your child’s progress, challenges, and any changes in their wellbeing. Develop a strong partnership where you work together to create an individualised plan that meets your child’s needs.

Be respectful - it is hard to keep emotions in check when we know our child is struggling. Avoid taking conversations down the path of personal accusations and instead focus on the support your child needs and steps to get that in place. If you are concerned about a meeting and feel like you need additional support, go ahead and ask a partner, friend, or family member to attend with you. 

Be prepared - before going into a meeting, write down all your questions, the key issues you want to address, and desired outcomes - be brief and specific. Each meeting is an opportunity for you to resolve your concerns, don’t leave without either another meeting, an acceptable resolution, a plan, or a contact person who can help you move forward.

Establish an Individual Education/Learning Plan (IEP/ILP) - for school-aged children, an IEP/ILP is a valuable tool for ensuring appropriate accommodations and support in the classroom. Start the process by emailing your child’s teacher, you can use this sample letter as a basis for your email. If your child has ADHD, download and give the Supporting Students with ADHD Booklet to your child’s educators. Familiarise yourself with the process at your school, attend meetings, and actively participate in discussions about your child’s educational goals. Advocate for necessary modifications, additional services, and accommodations that will optimise your child’s learning experience. A psychologist’s report will usually include recommendations that you can use to help you advocate. Some schools can provide WISC, WIAT, and other learning assessments to further inform a student’s education profile - ask if this is an option for your child.

Document everything - maintain a record of meetings, assessments, observations, and communications related to your child. Where possible, aim to summarise actions/agreements and distribute them to stakeholders via email so that you have proof of what was agreed with the relevant dates. Documenting important observations about your child using the Keywell app, can help you recall information accurately and provide evidence of their progress or setbacks. These records can also serve as a reference for future discussions and decision-making. 

Know your rights - familiarise yourself with the laws and regulations that protect the rights of children who are neurodivergent. These may include your country or state’s version of the disabilities education act, government education department, and advocacy network websites. You can start with a few key sites:

• For Australia see Disability Acts for Education and Information products for students with disability and their parents and carers and Education Standards - Adjustments and Disability Standards for Education and Disability Law - Tools to get the support you need at school
  
  
• For America see Individuals with Disabilities Education Act and Center for Parent Information Resources and National Center for Learning Disabilities and Council for Exceptional Children and Special education law and advocacy for children with disabilities
  
  
• For United Kingdom see SEND: guide for parents and carers and Independent Provider of Special Education Advice (IPSEA) and Special Educational Needs and Scotland Children and young people - national neurodevelopmental specification: principles and standards of care
  
  
• For Canada see Understanding Education Rights in Canada and CanChild Parenting Matters! and Inclusive Education Canada

Understand your child’s entitlement to appropriate accommodations, therapies, and educational services, and be prepared to advocate for their rights when necessary.

Encourage self-advocacy - as your child grows older, empower them to become their own advocate. Teach them about their neurotype in an age-appropriate manner, and encourage them to express their needs and preferences. Foster their self-confidence and guide their self-advocacy skills, gradually promoting independence and self-determination.

Finally, it’s important to remember that at the centre of advocacy is negotiation, and there will be times when you won’t get the solution you want, but that doesn’t mean you can’t negotiate a comparable outcome.

Have you ever had a moment when you questioned some of the fundamental beliefs that underpin your parenting? Welcome to my week! After spending years believing that rewards and positive praise were the best way to motivate my children, a person I respect presented a different view and pointed me to the work of a researcher and author named Alfie Kohn.

Before you read any further I suggest you sit down and open your mind, I certainly had to, but now I feel compelled to share what I have learned. 

Like many parents, we implemented a house points system at home (thanks to Harry Potter for supplying the theme) where the kids had to complete all the steps in daily routines to earn iPad time. In addition to this reward system, I spent a lot of time with both children to develop the skills required to complete the steps in a routine. It’s important to note that before introducing rewards and punishments for kids, we had already spent months where we just focused on the skills required in every step.

The elaborate point system didn’t last very long, the kids got bored and so did the adults, but I believed that the short strategic stint of rewards cemented the kid’s ability to complete the tasks continuously from beginning to end. Knowing what I know now, I think that the outcome was probably more of a coincidence than necessarily a result of the rewards. The regular practice and mastery of each task were more likely the reason why we can now get through the routines. 

I also have other scaffolding strategies that work a treat, especially on those hard days. Music is big in our household, and there is nothing better than the motivational beat of a song and the auditory cues it provides for keeping kids on track. When all else fails though, I get in there and offer my help, because we all find it difficult to do things on some days.

I digress… let’s get back to the merit of rewards and punishments for kids, a topic that has long been a subject of debate among parents and researchers. Last week I was introduced to the name Alfie Kohn, an influential educational theorist, who challenged traditional methods of motivating children through his research and writings. One of his most famous books is called “Punished By Rewards”. In it, he highlights that while these external motivators may generate short-term compliance, they often fail to ignite a genuine love for learning. 

According to Kohn, our focus on rewards and punishments can unintentionally hinder a child’s autonomy, creativity, and intrinsic motivation. His research process included asking parents what kind of adults they would like their children to grow into. The answers were very similar and included themes around being happy, independent, productive, and kind adults. Kohn then asked the parents to think about how using rewards and punishments to elicit obedience and compliance without arguments would contribute to raising children who would become the adults they imagined. 

As parents, we don’t want to raise people pleasers who don’t question others’ motives and directives, we want to nurture our child’s ability to be an independent thinker. We also want our children to find the intrinsic motivation to do things, because life will not always hold the proverbial carrot in front of them. Apathy is more likely to be an issue if our children don’t get the opportunity to problem solve and find mastery and within that experience failure and success.

At this point, you might be thinking to yourself, “ Hold on a second. I don’t punish my kids. I’m different from those other parents who use timeouts and other punishments”. I put it to you: isn’t the withholding of a reward because your child didn’t meet your expectations, a punishment in itself?

I know this might sound extreme, but even the use of verbal praise to reinforce behaviour can become a reward, conditioning kids to do things to get verbal recognition and acceptance. This also raises the question of whether the regular use of these common practices creates an environment where children begin to believe that their parent’s love is conditional. 

Am I going to change your mind about rewards and punishments? Probably not. We know they work in the moment and sometimes we don’t have time for anything else, but I ask that you sit with some of what I said and think it through.

I’m committed to being more aware of how I use rewards/praise and to make a conscious decision to:

1. involve the kids in decision-making - it gives them a chance to use problem-solving and it makes them feel valued. They may not always have the experience to make the right decisions, but it opens up healthy discussions

2. give kids the responsibility to set goals for themselves - we still need to help them see the value of meeting those goals, but they will be invested because they have been afforded the autonomy to identify what is important for them

3. give them choices - not just about whether they want the red or blue cup, but more importantly about the process and sequence of things. 

This is where the real opportunity for learning, self-confidence, and intrinsic motivation lie. That wall of rewards and punishments is crumbling in our family.

Does your child go into a complete panic, sometimes to the point of a complete meltdown, at the thought of having to write a story or even a sentence? If you and your child’s teacher are concerned about your child’s ability to meet writing-related expectations, despite adequate instruction and their cognitive potential, it is probably worth looking into dysgraphia.

Dysgraphia is a neurological condition that affects a person’s ability to express themselves through writing. Unlike the more commonly known learning disabilities such as dyslexia or ADHD, dysgraphia specifically hampers the skill of handwriting, making it difficult to produce written work that is legible, organised, and coherent. These struggles extend beyond penmanship and can manifest in various forms, ranging from difficulties with spelling and grammar to challenges in organising thoughts and translating ideas onto paper.

Why it’s important

As a parent who is watching their child fall behind at school, it is really important to approach your child’s writing challenges with curiosity rather than assuming that they are simply a result of a lack of effort.

Dysgraphia is poorly understood and is often undiagnosed. It has a high rate of co-occurrence with other learning and developmental differences. Dysgraphia can occur on its own, but it is often linked to dyslexia and other learning disabilities.

Writing problems can also be seen in children and adults with ADHD, cerebral palsy, and Autism. Studies have found that auditory and visual processing challenges can impact the level and type of dysgraphia challenges a child experiences.  Developmental coordination disorder (DCD), which affects motor development and skills, can also impact writing (in approximately 50% of cases).

Recognising the signs of dysgraphia is crucial for early intervention and support. Here are some common signs to look out for:

In pre-school children 

• An awkward grip or body position when writing: Your child may use an unconventional pencil grip rather than the typical “pincer grip” or they may twist their body/arm in an awkward way. This will reduce your child’s stamina to complete writing tasks.
  
  
• Poor fine motor skills: Dysgraphia can affect a child’s fine motor skills, making it challenging to hold and control a pencil or pen. Your child may experience fatigue or discomfort when writing for extended periods.
  
  
• Reluctant to draw or avoid tasks that include drawing: Due to the challenges they face, children with dysgraphia may show resistance or avoidance when it comes to engaging in drawing. 
  
  
• Difficulty with letter formation and spacing: Your child may struggle with properly forming letters and maintaining consistent spacing between words. They may reverse or mix up letters, leading to spelling errors.
  
  
• Difficulty staying within margins: Children with dysgraphia often face difficulties in spatial awareness and organisation on the page. They may have trouble staying within the given margins, resulting in uneven or cramped handwriting that extends beyond the designated space.

In school-aged children 

• Illegible handwriting: Your child’s handwriting may be messy, inconsistent, or difficult to read. Letters may be poorly formed, uneven, or improperly spaced.
  
  
• Reluctance to write or avoid writing tasks: Due to the challenges they face, children with dysgraphia may show resistance or avoidance when it comes to writing activities. They may feel frustrated or embarrassed by their difficulties.
  
  
• Switching between cursive and print: Your child may not maintain a consistent handwriting style. They might frequently switch between cursive and print, or their handwriting may be a combination of both.
  
  
• Difficulty with word-finding, sentence completion, and written comprehension: Dysgraphia can impact a child’s ability to express themselves in writing. They may have trouble finding the right words or completing sentences fluently. Additionally, written comprehension can be challenging, as they may struggle to understand and interpret written information accurately.

In teenagers and young adults 

• Trouble organising thoughts on paper: Dysgraphia can make it difficult for children to organise their thoughts and ideas coherently. They may struggle with sentence structure, grammar, and punctuation.
  
  
• Difficulty with written syntax and written grammar but don’t have syntax/grammar issues in oral tasks: A child might have no trouble constructing grammatically correct sentences while speaking but struggle to apply those rules consistently when writing. This disparity between their oral and written language skills can be a strong indicator of dysgraphia.

Dysgraphia not only disrupts the learning of writing skills but it also has broader negative impacts on a child’s learning. For children with dysgraphia, any writing task can be extremely difficult and frustrating. This frustration can take away their ability to focus on the more important aspects of the task, such as the content of their writing or understanding the topic they are writing about. 

Tips & strategies

1. Provide alternative tools: Try alternative writing tools such as pencil grips, specialised pens, or adaptive technology to assist in improving handwriting or alleviating physical discomfort.

2. Break writing homework into manageable steps: Break down writing tasks into smaller, more manageable steps. Focus on one aspect at a time, such as letter formation or sentence structure to reduce overwhelm and build confidence.

3. Encourage typing or dictation: For longer written assignments, consider allowing your child to use a computer or voice-to-text software. This can help relieve the physical demands of writing, allowing your child to focus on expressing their thoughts.

4. Practise fine motor skills: Engage your child in activities that promote fine motor skills, such as colouring, drawing, or using playdough to help strengthen hand muscles and improve coordination.

5. Provide visual aids and graphic organisers: Use visual aids like lined paper or highlighted lines to help your child with letter placement and spacing. Graphic organisers, such as mind maps or outlines, can assist in organising thoughts before writing.

6. Focus on content over form: While legibility is important, prioritise the content of your child’s writing over perfect handwriting. Encourage them to express their thoughts and ideas without excessive focus on neatness.

7. Collaborate with teachers: Maintain open communication with your child’s teacher. Share information about dysgraphia and work together to evaluate strategies that fall under: 

(I) Accommodations - offer supportive or assistive resources without changing the educational content to decrease stress associated with writing. For example: 

• Special pencil grips and paper with raised lines for tactile feedback
• Extra time for homework, class assignments, and quizzes/tests
• Alternative ways of demonstrating knowledge, such as oral or recorded responses instead of written exams
• Technological support like spellcheck, voice-to-text recognition software, tablets, and computer keyboards

(II) Modifications - adapts your child’s educational goals and objectives as well as provides services to reduce the effect of the disability. For example:

• Scale down large written assignments 
• Break up large projects into smaller ones 
• Grade based on a single dimension of work (e.g., content or spelling, not both).

(III) Remediation - provide specific interventions to decrease the severity of your child’s disability. For example:

• Include additional activities to develop fine motor skills 
• Teach grip control and good writing posture
• Teach to write using evidence-based approaches

8. Celebrate progress: Acknowledge and celebrate your child’s achievements, no matter how small. Positive reinforcement and support can boost their confidence and motivation to improve their writing skills.

References

1. Developmental Dysgraphia: An Overview and Framework for Research
2. Disorder of written expression and dysgraphia: definition, diagnosis, and management
3. Cognitive Profiles of Developmental Dysgraphia
4. Understanding Dysgraphia

Need to know: Identifying dyscalculia

Do numbers make your child’s head spin? Do they struggle to grasp basic math concepts despite their best efforts? If so, your child might be facing a common but often misunderstood learning difficulty called dyscalculia. 

Dyscalculia is a learning disability that affects a child’s ability to comprehend and work with numbers and mathematical concepts. It is not a result of laziness or lack of effort; rather, it is a neurologically based condition that affects how the brain processes and understands numerical information.

Why it’s important

Dyscalculia can present unique challenges for children to do well in an academic setting. Recognising the signs of dyscalculia is crucial for early intervention and support as children move through school. Here are some common signs to look out for:

1. Avoiding homework or classroom activities that require number manipulation or mathematical problem solving by being disruptive, oppositional, or non-compliant
2. Difficulty understanding basic number concepts, such as quantity, counting, and sequencing.
3. Struggling with basic arithmetic operations, like addition, subtraction, multiplication, and division.
4. Inconsistent understanding of mathematical symbols, such as +, -, x, ÷.
5. Challenges with telling time, understanding money, or reading graphs and charts.
6. Difficulty remembering mathematical facts and formulas.
7. Trouble understanding mathematical word problems and applying concepts to real-life situations.

Dyscalculia is rarely identified early, but researchers have conducted studies to find out what things can indicate if a child might have trouble with math in the future. They have found some important signs that you can look out for, such as your child:

• • Not knowing which number is bigger when given two options. This means they may struggle with understanding the size and relationship of numbers.

• • Having difficulty using effective strategies for counting. They may struggle with counting in the right order or skipping numbers.

• • Having trouble quickly recognising numbers. They may struggle to identify numbers correctly and quickly.

• • Not being able to add simple numbers in their head. They may need to use their fingers or other aids to add small numbers.

• • Having a hard time remembering and keeping track of information while doing math. This is called working memory capacity, and if it’s limited - a possible sign of ADHD, it can make math more challenging.

• • Having difficulty understanding and using words, word structures, and sentence structures. This is specifically linked to weaker performance in mathematics tasks that require expressing or understanding of language (e.g. verbal number sequences, counting of objects, arithmetic)

Not all difficulties with mathematics are caused by dyscalculia. In many cases, dyslexia, visual or auditory processing, ADHD, and others can also affect your child’s ability to meet expectations.

You need to know that the comorbidity of learning disabilities is common. Research shows that comorbid reading, mathematics, and spelling difficulties were four to five times greater for children who were already experiencing significant difficulty in one academic domain than for children in the broader population.

Tips & strategies

• • Investigate and assess: There is no standard test for dyscalculia, but you can start to get answers by first ruling out medical conditions related to vision or hearing impairments, talking to your child’s teacher about areas of weakness, and getting a WISC and WIAT assessments done by a professional with experience identifying learning disabilities.

• • Seek professional help: Educational psychologists or specialised teachers can provide specific strategies tailored to your child’s learning needs, which can be used at home and implemented in the classroom. Remediation strategies you can enquire about include Math Flash and Pirate Math.

• • Encourage a positive mindset: Help your child understand that dyscalculia does not reflect their intelligence or worth. Foster a positive attitude towards math and emphasize that everyone learns at their own pace.

• • Utilise multisensory learning techniques: Engage your child’s senses by incorporating hands-on activities, manipulatives, and visual aids to reinforce mathematical concepts. For example, using blocks or beads to represent numbers or creating number lines.

• • Break down concepts into smaller steps: Math can be overwhelming for children with dyscalculia. Break down complex problems into smaller, more manageable steps. Provide clear explanations, offer examples, and provide ample practice opportunities.

• • Make math relevant and practical: Help your child understand the real-world applications of math. Relate mathematical concepts to everyday situations, such as cooking, shopping, or measuring. This helps make abstract ideas more tangible and relatable.

• • Provide extra support and practice: Offer additional practice at home through maths games, online resources, or worksheets. Practice and repetition can help reinforce mathematical concepts and build confidence.

• • Collaborate with teachers: Maintain open communication with your child’s mathematics teacher. Share information about dyscalculia and work together to create a supportive learning environment. Discuss accommodations, such as extra time for tests or modified assignments, if necessary.

• • Celebrate progress: Acknowledge and celebrate your child’s achievements, no matter how small. Positive reinforcement and encouragement can boost their confidence and motivation to continue learning.

References

1. Kindergarten Predictors of Math Learning Disability
2. First-Grade Predictors of Mathematical Learning Disability: A Latent Class Trajectory Analysis
3. Predicting Mathematical Learning Difficulties Status: The Role of Domain-Specific and DomainGeneral Skills
4. Cognitive Predictors of Difficulties in Math and Reading in Pre-Kindergarten Children at High Risk for Learning Disabilities
5. How to Spot Dyscalculia
6. Intensive Intervention for Students with Mathematics Disabilities: Seven Principles of Effective Practice
7. Adjustments for Dyscalculia

Your child has received an ADHD diagnosis, and you are currently trying to understand what behaviours are developmentally appropriate and what can be attributed to their ADHD neurology. It is common for family, friends, and even partners to question the validity of the diagnosis and make comments like “he’s just a boy being a boy” or “she’ll grow out of it.” In some cases, they may even question your parenting skills.

Being surrounded by these conflicting messages can lead you to question what ADHD truly is. For many parents, the process of acceptance only comes when they genuinely understand how their child’s ADHD brain functions. They begin to see the impact of their child’s neurobiology on their cognitive, behavioural, and motivational functioning, where they previously attributed laziness, rudeness, defiance, or lack of care.

How does ADHD affect the brain?

ADHD affects the brain in three main ways:

1. Structure - Research using MRI scans to examine the brain structure of children with and without ADHD has confirmed structural differences. Kids with ADHD have smaller brain regions, particularly the amygdala, responsible for emotional control, self-control, and prioritising actions. Memory and learning areas are also smaller in size. These structural differences tend to diminish as children age, but ADHD symptoms can persist into adulthood.
   
   
2. Function - ADHD impacts multiple brain networks and the cognitive, motivational, and emotional processes they control. In addition to imbalances in network function, researchers have also identified an imbalance in connectivity between these networks. Two important neurotransmitters, dopamine and norepinephrine, play significant roles in ADHD. Dopamine helps regulate attention, motivation, and reward, while norepinephrine is involved in maintaining focus and regulating alertness.
   
   
3. Development - Studies have shown that brain maturation occurs more slowly in children with ADHD. These differences affect executive functioning, with children with ADHD performing 1-3 years behind their neurotypical peers in tasks related to executive functioning.

Although researchers have identified several differences in ADHD brains, there is still uncertainty about how these differences interact to influence ADHD symptoms.

Why is executive functioning important?

Executive functioning is a vital component for achieving success in every aspect of life. The neurobiology of the ADHD brain has an impact on executive functioning, which is fundamentally related to how your child learns, manages relationships, and meets your expectations. 

Executive dysfunction can present in many different ways. For example, you might see:

Lack of motivation, laziness, addiction to gaming/food, avoiding chores, being easily bored, or engaging in risky behaviour

Motivation and reward play crucial roles in the ADHD brain. Children with ADHD often struggle with maintaining focus and completing tasks that may seem mundane or uninteresting to them. One reason behind this is the brain’s non-typical reward system. Neurotransmitters like dopamine, responsible for feelings of motivation and reward, are not as effectively regulated in the ADHD brain. As a result, tasks that don’t offer immediate gratification or seem less stimulating may be challenging for your child to engage with.

Difficulty following instructions, making decisions, or struggling with learning in a classroom environment

Processing speed refers to how quickly the brain can take in, understand, and respond to information. Children with ADHD may exhibit slower processing speed compared to their peers. This means that they may need more time to process instructions, complete tasks, or make decisions. It’s important to provide your child with ample time and patience, allowing them the space they need to fully understand and respond. Rushing or pressuring them may lead to frustration and hinder their ability to perform at their best.

Not following instructions, forgetting important things, being disorganised, or frequently interrupting

Working memory is like a mental workspace that helps us hold and manipulate information in our minds. It’s crucial for tasks that require multitasking, problem-solving, and following multi-step instructions. Children with ADHD often struggle with working memory, which can make it difficult for them to remember and follow through on instructions, keep track of time, or stay organised. 

Easily becoming frustrated, quick to anger, or getting overexcited

Children with ADHD may experience heightened emotional sensitivity. Not only do they tend to experience feelings more strongly than their peers, they have more difficulty modulating those emotions appropriately. 

Brain training: ADHD Management strategies

Co-regulate to teach self-regulation: A child learns to regulate their emotions and behaviour through the supportive guidance and interaction with an emotionally stable parent. When your child is feeling heightened you can help them return to a relaxed state by providing a safe environment, modelling calmness and effective coping strategies, and using verbal and non-verbal cues to guide your child’s emotional regulation. When your child is feeling regulated don’t forget to ask your child to reflect on their emotions, triggers and what strategies they can use to help them manage intense feelings. 

Establish routines and structure: Creating predictable routines and providing structure can assist children with ADHD in managing their time, tasks, and responsibilities. Establish a consistent daily schedule for activities such as homework, meals, and bedtime. Use visual cues, calendars, music, or checklists to reinforce the routine and help your child stay on track.

Break tasks into manageable steps: Help your child break down complex tasks into smaller, more manageable steps. Provide clear instructions and support them in organising their thoughts and actions. Breaking tasks down can make them less overwhelming and increase the chances of successful completion.

Use visual aids and reminders: Visual aids such as charts, diagrams, or color-coded systems can enhance organisation and planning skills for children with executive dysfunction. Visual reminders can include sticky notes, timers, or visual schedules to keep track of time, deadlines, and upcoming events.

Provide clear and concise instructions: When giving instructions or conveying information, use simple, concise language and make sure your child understands what is expected of them. Breaking down instructions into shorter, explicit statements can help them focus and follow through more effectively.

Teach and practise organisational skills: Help your child develop organisational skills by teaching them strategies like using planners, folders, or digital tools for keeping track of assignments and materials. Encourage regular clean-up of their physical and digital spaces. In the early years, your child will rely on you to do or at least help with tasks, but it won’t be forever.

Make time for lots of breaks: For tasks that require sustained focus, break them into shorter time increments with planned breaks in between. Children with ADHD tire more easily and need more downtime than their peers. For example, set a timer for 15-20 minutes of focused work followed by a 5-minute break. 

Provide positive reinforcement: Praise, encouragement, and occasional rewards are important to boost your child’s efforts. Positive reinforcement can motivate them and increase their engagement in tasks that require executive functioning skills. You can tailor your rewards to your child’s interests and can include privileges, small treats, or special activities.

Collaborate with teachers: Maintain open communication with your child’s teachers and seek their support in implementing strategies that promote executive functioning skills at school. Teachers can also offer visual aids, break down tasks into smaller, more manageable steps, and use repetition and reminders to support your child’s working memory challenges.

References

1. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis
2. What are the differences between an ADHD brain and a neurotypical brain
3. Maturational delay in ADHD: evidence from CPT
4. Neurotransmitters Involved in ADHD
5. Executive Function in Adolescents With ADHD
6. The Brown Model of Executive Function Impairments in ADHD.
7. The Relationship Between Executive Function Deficits and DSM-5-Defined ADHD Symptoms
8. All About ADHD and Executive Dysfunction

Need to know: The natural way to manage ADHD in children

It’s no secret that navigating the world of ADHD can be challenging, but as we embark on this journey, it’s crucial to remember that our kids need more than just medication to thrive. Think of it this way: just like our bodies need a combination of vitamins to stay healthy, our ADHD children need their own set of “vitamins” to truly flourish. 

Why it’s important

Medication and therapy are just a part of providing your child with the support they need, and in some cases these may not be options for your child or family. If your child doesn’t respond well to medication or you can’t afford/access therapy, there are still things you can do that are free, in your control and can be actioned immediately without access to a medical professional. What’s not to like?

Tips & strategies

The top 7 “vitamins” for children with ADHD are a combination of strategies and tools that create an environment that benefits your child and family. 

1 - Vitamin A, Acceptance

By accepting your child’s neurology you are acknowledging and embracing the unique way their brain works, including any differences or challenges they may have.

Acceptance helps you focus your energy on finding ways to empower your child to thrive. It allows you to let go of expectations that hold you both back.

Use your child’s strengths and abilities to build their confidence, while also understanding and supporting their needs.

2 - Vitamin C, Connection

Avoid constant arguing, yelling, and power struggles, as they can wear away at your relationship with your child. Instead, prioritise connection through laughter, affection, and doing things they enjoy. 

Oxytocin, the “happy hormone” is released during positive experiences helping to regulate trust, empathy, positive memories, bonding cues, and communication.

Value your child’s thoughts and feelings to strengthen your bond and reduce challenging behaviour over time. Read more about the 7 day connection challenge to help you strengthen your relationship with your child.

3 - Vitamin E, Exercise

Physical exercise helps release energy and increases the natural production of serotonin and dopamine, both important in mood and emotional regulation.

Choose a light or intense activity, but always add fun by combining it with laughter

• Water fight - get the hose out, or fill up recycled spray bottles for endless fun
• Dance off - turn on the music and practice your moves 
• Obstacle course - use pillows, hula-hoops, and other common household items

4 - Vitamin I, Interest

The ADHD brain is an interest-based nervous system. Your child might surprise you when they can sit still and do a preferred activity.

This is because doing something of interest triggers their ability to focus. Ask your child to do something boring, and the dysfunction will be apparent. 

Use this knowledge to engage your child in boring tasks or difficult transitions by using games and challenges, and relating it to personal interests. Small immediate rewards release dopamine and increase motivation!

5 - Vitamin N, Nature

Nature improves mood and cognitive functioning, increases social interactions, and reduces ADHD symptoms. 

Your child doesn’t have to be sporty, there are lots of different outdoor activities. 

• Make a “Can you spot it?” card to engage your child in finding flowers, trees, and wildlife
• Rock hopping/shell collecting. Use them as inspiration for art projects 
• Take photos of trees, insects, and birds. Research to find interesting facts

6 - Vitamin R, Routine

Routines make life more predictable and safe for kids. Most of what we ask of our kids is rooted in our daily routines.

Implementing the same routine in the mornings, afternoons, and at bedtime sets up your family and your child to do well. Use visuals, music, tokens, or a combination to keep everyone on track.

Consistency is an integral part of routines, it can take weeks to months to create habits, but there will be days when your child still needs your help. Read more on making routines work for your family.

7 - Vitamin S, Sleep

Sleep is fundamental to several brain functions including learning, self-regulation, behaviour, and mood.

Kids with ADHD experience more sleep problems than their neurotypical peers. A child who doesn’t get enough/quality sleep will have more difficulty regulating their emotions, have less capacity to process information, and will find it harder to focus and sustain attention.

Address your child’s sleep issues early and you can significantly improve their ADHD symptoms.

References

• Parental Acceptance, Parental Stress, and Quality of Life: A study with parents of ADHD children
• Predicting aggression in children with ADHD
• Parenting a Child with ADHD
• Maternal parenting styles and mother–child relationship among adolescents with and without persistent attention-deficit/hyperactivity disorder
• The relationship model among parent–child relationship, coping responses and behavioral problems in children with attention deficit hyperactivity disorder
• Effects of physical exercise on children with attention deficit hyperactivity disorder
• Impact of physical exercise on children with attention deficit hyperactivity disorders
• The 4 Core Traits of ADHD, Explained
• ADHD & the Interest-Based Nervous System
• Children with ADHD draw-and-tell about what makes their life really good
• Contact with Nature and Children’s Restorative Experiences: An Eye to the Future
• Does Access to Green Space Impact the Mental Well-being of Children: A Systematic Review
• Green spaces and cognitive development in primary schoolchildren
• A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study
• Child Routines and Parental Adjustment as Correlates of Internalizing and Externalizing Symptoms in Children Diagnosed with ADHD
• Brain Basics: Understanding Sleep
• Children’s sleep linked to brain development
• The Importance of Sleep for Kids
• Sleep, Learning, and Memory

Need to know: Understanding auditory processing disorder

Auditory Processing Disorder (APD) is a complex condition that affects a child’s ability to process and make sense of auditory information. APD affects approximately 5% of school-aged children, with boys being more commonly affected than girls. 

Children with APD may have difficulty understanding speech in noisy environments, following verbal instructions, and distinguishing between similar sounds. APD is often misdiagnosed or overlooked, leading to frustration for both the child and their caregivers.

APD can impact a child’s academic performance, social skills, and self-esteem. Early diagnosis and intervention can help children with APD improve their communication skills and overall quality of life.

Why it’s Important

Children with ADP have normal hearing, the issue is how the ears and the brain work together to process the sounds they hear. This condition impacts a child’s understanding of speech and it can be misdiagnosed as hearing loss, an intellectual disorder, ADHD, or a language/learning difficulty. 

Signs that your child might have an Auditory Processing Disorder include your child:

• missing details or steps when given directions
• misunderstanding words with similar sounds
• having difficulty understanding speech in noisy environments
• struggling with reading and spelling
• having trouble following a conversation
• taking a long time to respond
• often responding with “huh?” “what?” or asks you to repeat
• having problems concentrating and paying attention
• difficulty identifying where a sound is coming from
• struggling to recognise sound patterns or rhythms and learning music

The overlap and comorbidity with other conditions require a thorough assessment for a correct diagnosis. In addition, there are various auditory processing deficits, and because every child is unique, APD can show up in different ways. If you have concerns, it is best to have your child checked by an audiologist to test their hearing, a psychologist to assess their cognitive processing, and/or a speech pathologist to evaluate their oral and written communication skills. In addition, it’s important to speak to your child’s teachers to get feedback on your child’s specific learning challenges. 

Children with APD often struggle to follow instructions, particularly in a classroom setting, which can affect their academic performance. Research has shown that children with APD may have difficulty with reading, writing, and spelling, as well as with other cognitive and language-based tasks.

In addition to academic difficulties, APD can also impact a child’s social skills and self-esteem. Children with APD may avoid social situations or feel anxious in noisy environments, which can affect their ability to form relationships and participate in activities.

Early identification and intervention are important for children with APD. Children who are diagnosed with APD before they become teenagers can “grow out” of the disorder because the brain areas responsible for processing auditory information are still developing until approximately the age of 13. Speech and language therapy, auditory training, and classroom accommodations can help children with APD improve their communication skills, academic performance, and social functioning.

Some of the approaches used to treat ADP include:

• Address sound discrimination - to help your child with difficulty hearing differences between sounds, they might be taught to tell apart sounds by hearing them in a quiet place and then hearing them in noisier places.
  
  
• Strengthen auditory memory - to improve your child’s memory for what they hear, they may be asked to practise remembering a list of numbers or instructions.
  
  
• Support language-processing difficulties - if your child struggles with understanding language, they will be given tools and strategies to help them ask someone to repeat or explain what they said and/or for your child to take notes in class.

Tips & Strategies

• Be present and at their level. Avoid giving instructions from another room, you need to be near your child for them to pay attention to what you are saying.
  
  
• Speak clearly and slowly. Children with APD may have difficulty understanding rapid or complex speech. Use keywords or short simple sentences to allow them to process what you say.
  
  
• Minimise background noise. Where possible, reduce noise distractions at home. The dog barking or TV blaring can make it difficult to listen and focus.
  
  
• Use visual aids. Routines are great for many reasons, use them to supplement verbal instructions and include visual cues, such as pictures or written instructions.
  
  
• Provide repetition and feedback. If necessary repeat instructions or information, and ask for feedback to ensure that your child has understood.
  
  
• Play games to increase auditory attention. Pick games that involve your child listening and taking action (Simon says, musical statues, etc), this can help strengthen their ability to pay attention to sounds.
  
  
• Advocate for accommodations. Work with your child’s teachers and other professionals to provide accommodations, such as preferential seating or extra time for assignments and tests, attention prompts, and visual aids.

References

1. Understanding Auditory Processing Disorders in Children 
2. Central Auditory Processing Disorder
3. Diagnosing central auditory processing disorders in children
4. How to Treat Auditory Processing Disorder
5. Signs a Child Might Have Auditory Processing Disorder
6. What is auditory processing disorder?

Three years ago my days were filled with power struggles, yelling, sadness, and uncertainty about the future of my kid - if this is what they are like at 5 then what will happen when they are 12? Exhaustion and burnout kept clinging to my heels, a fog holding me back from clear thoughts about how to make things better. I couldn’t see a way out and the whole family was suffering.

Rock bottom is a lonely and overwhelming place. I love my child, but during that time I did not like them. I’m sad to say, but I felt like I was in an abusive relationship, always afraid of what was going to happen that day, would it be verbal or physical attacks. I was always on edge and extremely reactive to triggering situations. I no longer had patience or even empathy, I went straight to anger.

This was not the parent I wanted to be. This was not the kind of gentle parenting I imagined I’d be practising. I read something about “mum rage” and it made me realise that things had to change. I listened to podcasts, and read articles and books in the hope I would find the answer. Clarity arrived slowly and it accompanied four life-changing discoveries.

First, my child wasn’t “behaving badly” to annoy me or because they hated me. In truth, their behaviour was the only language they had to communicate that something was not quite right. They couldn’t do what I was expecting of them, not because they didn’t want to, but because they didn’t have the skills.

Second, how I responded in challenging situations made things better or exponentially worse. I had to accept that I was escalating things every time I joined in my kid’s chaos, and that wasn’t easy. They needed a calm adult to help them regulate and I was not calm.

Third, interrupted sleep made everyone’s day 100 times worse every time. My child would wake up every night and jump in my bed, and even though we were all tired, I didn’t understand that the interrupted sleep was making my child more angry, hyperactive, and inflexible. When my child was up, so was I,  and their lack of sleep was also my lack of sleep. Now you have two people who are on edge and without any energy to deal with bumps.

Fourth, neurodivergence is hereditary. Plot twist! I got the same diagnosis as my child a year after they got theirs. Now I could see myself. Sensory triggers, yes! Emotion regulation issues, yes! Impulsivity, yes! 

I finally saw the fog lift. I began to see my child and not just their challenging behaviour. I saw an intelligent, determined, funny, sensitive kid who was struggling to meet expectations because they didn’t have the skills. I felt so much guilt for not having figured this out earlier. I felt like I was to blame, and to some extent, I was.

After a lot of self-reflection, I found the biggest triggers for me: were lack of sleep and auditory sensory overwhelm from multiple sounds like the dog barking, TV, and multiple kids talking at me. They say that you can’t pour out of an empty cup, and they are not wrong! I made a real effort to focus on my well-being, and within a couple of days, I could feel myself able to cope better. 

I knew there were going to be times when I wouldn’t be able to avoid stress or my triggers, so I picked a mantra to ground me. Every time my child displayed “challenging behaviours”, I would stop, count to 10, and say “They are not giving you a hard time, they are having a hard time” “You’re the adult and they look to you. What do you want them to see?”. The pause gave me a chance to respond and not react. My responses were deliberate, I met anger with calm, I met yelling with whispering, and I met mean words with loving ones.

I became more curious about what was underlying their defiance, meltdowns, aggression, etc. What skills were they missing? Were they also being overwhelmed by sensory stimuli and not know it? This curiosity about why and why now, helped me make the time to connect with my child by asking them what was going on for them in these moments. I chose bedtime cuddles as the perfect opportunity to dig deeper. These quiet minutes made my child feel heard and became the daily glue that would mend our relationship.

The more I learned the calmer I became. I picked my battles because no child wants to be constantly reprimanded and no parent has the energy to do so. Things that I previously got caught up about like insisting that my child should be sitting down at the table for a meal or that my child should be able to get ready by themselves, no longer mattered. Recalibrating my expectations put less demands on everyone and it made our days run more smoothly.

Within a few months, we both started medication, and although the path was not straightforward, when we found the right fit things continued to improve at home and school. Medication was only part of the solution for us. I strongly believe that the biggest change in my child happened when I began to change how I parented. Curiosity, empathy, and connection saved our family.

Need to know: A guide for parents with children starting ADHD medication

You’ve probably spent weeks or months thinking about medication, and you’ve now decided that it is time to try it. Although medication is considered to be the first-line treatment for ADHD, you can still understandably be hesitant about starting your child on medication. 

The medication journey is certainly not an easy one. For many, it can take a few different medications and dosages to get it right, but for some, the path ends without finding a suitable option. Before your child starts taking medication, it’s important to understand that finding the right medication, dosage, and schedule for your child can take time.

Why it’s important

You will need to work closely with your child’s doctor, as your child may need to try different types of medication or combinations of medications to find what works best for them. When your child starts taking ADHD medication, there are a few things you can expect throughout the first few weeks:

Dosing and schedule: Your paediatrician may adjust the dosage over time to get the best results and minimise possible side effects. It’s important to follow these instructions carefully, as taking too much or too little medication can affect its effectiveness. The medication schedule may also be adjusted based on the desired outcome. For example, if the goal is to manage symptoms primarily during school hours, you can talk to the paediatrician about your child taking medication only on school days.

Side effects: Like all medications, ADHD medications can cause side effects. Common side effects include decreased appetite, trouble sleeping, and stomach upset. These side effects are usually mild and go away after a few days or a couple of weeks. If your child experiences more severe side effects, such as chest pain or difficulty breathing, contact your doctor immediately.

Improvement in symptoms: In many cases, ADHD medication can lead to significant improvements in your child’s symptoms. You may notice that your child is better able to focus, pay attention, and control their impulses. If you don’t notice a change, then perhaps the medication or dosage needs to be reviewed.

It’s important to note that between 50% and 67% of kids with ADHD also have another co-occurring condition. ADHD symptoms may sometimes mask or obscure the presence of co-occurring conditions, making it more challenging to identify them. Starting medication may quiet some of the ADHD symptoms like hyperactivity or ability to focus, but if your child is still struggling, you might want to consider the possibility that they have another underlying condition. Read more about co-occurring conditions. 

Regular check-ins with doctor: Your doctor will likely want to schedule regular check-ins to monitor your child’s progress and adjust the medication as needed. If you notice any significant changes in your child’s behaviour or mood, it’s important to contact your doctor. In some cases, a change in medication or dosage may be necessary. You should also contact your doctor immediately if your child experiences any of the following:

• Chest pain or difficulty breathing
• Severe headaches or blurred vision
• Fainting or seizures
• Allergic reaction, such as rash or hives

Tips and strategies

Book follow-up appointments ahead of time - seeing a paediatrician can take weeks or months because of waitlists. Plan ahead and book regular check-in appointments within a few days of starting or changing medication. This will allow you to discuss and address your concerns early.

Talk to your child about the medication - Talking to your child about medication in an age-appropriate way can have many benefits around teaching them about self-care, self-advocacy, and self-acceptance. 

• • Explain ADHD in kid-friendly terms: Start by explaining what ADHD is and how it affects their daily life. Use language that your child can understand and relate to. For example, you use a story to explain how your child’s brain works.

• • Discuss the benefits and potential side effects: Talk to your child about how ADHD medication can help them manage their symptoms and improve their ability to focus and learn. Be sure to also discuss the potential side effects of the medication and how they might feel after taking it. Here are some examples of what you can say:
    1. 1. medication is like glasses for people who have trouble seeing - it can help you focus and learn better
       2. medication can help fast brains slow down - it strengthens your breaks so you can stop in time to think and avoid tricky situations.
       3. medication can make your mouth a little dry or it might make you feel like you aren’t hungry - Your body is growing so it’s important to eat and drink throughout the day to make sure you have lots of energy to learn and play

• Answer any questions your child may have: Be prepared to answer any questions your child may have about ADHD medication. Encourage them to ask questions and make sure they feel comfortable expressing any concerns they may have
  
  
• Be positive and supportive: Finally, be positive and supportive throughout the conversation. Let your child know that you’re there to help them and that you’ll be with them every step of the way

Check your child can swallow the medication - some medications need to be swallowed whole, which is no easy feat for a child. A good way to prepare your child and teach them this skill is to practise swallowing a tic tac. Other medications can be crushed, and kids are happy to take them mixed into yoghurt, in a spoonful of honey, or with another sweet food. Don’t forget to ask your doctor how your child needs to take their medication to ensure you administer it correctly. Read more about how to manage medication refusal.

Monitor your child - Keep track of how your child is responding to the medication using the Keywell app. While ADHD medication can be safe and effective, it’s important to keep an eye out for any changes in your child’s behaviour or mood. Here are a few things to look out for: 

• • Changes in appetite or weight: ADHD medication can cause decreased appetite, which can lead to weight loss. If your child is losing weight rapidly or refusing to eat, it’s important to talk to your doctor about it.

• • Mood changes - While medication can improve ADHD symptoms, it can also affect your child’s mood and behaviour. Some children may become more irritable or emotional when taking medication, while others may become more withdrawn. If you notice any significant changes in your child’s behaviour, speak to your doctor immediately.

• • Sleep Problems - ADHD medication can cause trouble sleeping. If your child is having trouble falling asleep or staying asleep, their doctor might need to review the medication, dosage, and schedule.

• • Tics - In rare cases, ADHD medication can cause tics or involuntary movements. If your child develops tics, book an appointment to speak with your doctor.

Food and drink - stimulant medication can be an appetite suppressant, so ensuring your child eats before taking their medication, can help with stomach aches and weight loss. Drinking regularly is also important to avoid headaches at the end of the day. Having a healthy and protein-rich snack after school may help ease “hanger” symptoms and medication rebound. Avoid vitamins or food containing ascorbic acid or vitamin C an hour before and after you give your child ADHD medication, as they interfere with how the medication is metabolised.

References

1. Treatment of ADHD
2. Attention-Deficit/Hyperactivity Disorder – treatment and therapies
3. Side Effects of ADHD Medication
4. Comorbidity in Children and Adolescents with ADHD
5. How to Talk with Your Child About Starting ADHD Meds
6. When Your ADHD Medication Stops Working
7. Attention-Deficit/ Hyperactivity Disorder (ADHD): Parents’ Medication Guide
8. ADHD medication for kids: Is it safe? Does it help?
9. ADHD Medication Q&A: Side Effects, Dosages, Precautions & More

Need to know: A guide for parents looking to learn about ADHD medication

For parents, the idea of medicating their child with ADHD can be daunting. Understandably, many may view medication as a last resort. While your doctor may have already explained the benefits of finding the right medication, it’s common to still have concerns that are reasonable and valid.

The most common questions from parents include:

Will my child become addicted? ADHD medications are not addictive in the way that drugs are. However, they can be habit-forming, meaning that your child may come to rely on them to manage their symptoms. That being said, if the medication is taken as prescribed and not misused, the risk of addiction is low. 

Will my child become a zombie? It is a common misconception that ADHD medication will turn your child into a zombie. While some children may experience side effects, such as decreased appetite or trouble sleeping, these effects are usually temporary and can often be managed with adjustments to the dosage or timing of the medication. ADHD medication is intended to help your child focus and be more productive, not to change who they are as a person.

Will my child lose their spark? ADHD medication is not intended to change your child’s personality. However, some parents may worry that medication will alter their child’s behaviour or emotions. It is important to remember that medication is just one aspect of ADHD treatment, and it is usually prescribed alongside other therapies, such as occupational therapy and parent training. These therapies can help your child develop coping skills and strategies to manage their symptoms.

Will it affect my child’s growth? Some studies have suggested that ADHD medication may slightly slow down a child’s growth, especially during the first year of treatment. However, the long-term effects on growth are usually minimal, and most children catch up to their peers in height and weight over time. If you have concerns about your child’s growth, talk to their doctor about monitoring their height and weight regularly.

Why it’s important

The saying “knowledge is power” holds true, especially when it comes to making informed decisions about medication options. Familiarising yourself with medication options and how they work can help you ask the right questions and make informed choices. The most frequently prescribed types of ADHD medications include:

Stimulants:

Stimulants are the most commonly prescribed medications for ADHD. They work by increasing the levels of neurotransmitters in the brain, such as dopamine and norepinephrine, which can improve attention and decrease hyperactivity and impulsivity. There are two types of stimulants:

• Methylphenidate-based stimulants: These include Ritalin, Concerta, and Focalin. They work by blocking the reuptake of dopamine and norepinephrine, which means that these neurotransmitters stay active in the brain for longer periods. This helps to improve attention and focus. These medications come in short-acting (only last a few hours) and long-acting forms (lasts most of the day) and can be taken orally or through a patch.
  
  
• Amphetamine-based stimulants: These include Adderall, Dexedrine, and Vyvanse. They work by increasing the release of dopamine and norepinephrine into the brain. This helps to improve attention, focus, and impulse control. These medications also come in short-acting and long-acting forms and can be taken orally.

Non-Stimulants:

Non-stimulant medications are an alternative treatment option for children who do not respond well to or have side effects from stimulants. Non-stimulants work by increasing the levels of norepinephrine in the brain, which can improve attention and reduce hyperactivity and impulsivity. There are two types of non-stimulants:

• Atomoxetine: Also known as Strattera, is a selective norepinephrine reuptake inhibitor. It works by blocking the reuptake of norepinephrine in the brain, which helps to increase its levels and improve attention and focus. This medication is taken orally and is approved for use in children and adults with ADHD.
  
  
• Guanfacine: Also known as Intuniv, is an alpha-2 agonist. It works by stimulating certain receptors in the brain that help to regulate attention and behaviour. This helps to improve attention and reduce impulsivity. This medication is taken orally and is approved for use in children and adolescents with ADHD.

Combination Medications:

Combination medications combine a stimulant and a non-stimulant medication. The stimulant component works by increasing the levels of dopamine and norepinephrine, while the non-stimulant component works by increasing the levels of norepinephrine. This can be helpful for children who do not respond well to one type of medication alone. 

For example, Adderall XR is a combination medication that combines a long-acting form of amphetamine with a non-stimulant medication called dextroamphetamine. The amphetamine component increases the release of dopamine and norepinephrine, while the dextroamphetamine component blocks the reuptake of norepinephrine.

Tips and strategies

Medication can be life changing but it certainly isn’t a silver bullet. Your child will do better if you have the tools and knowledge to support them.

Identify what support your child needs - ADHD impacts everyone differently, so it’s important to understand how it affects your child. While some children may encounter difficulties with attention and concentration, others may exhibit impulsive and risky behaviour, and many may find it challenging to regulate their emotions. Knowing what gets in the way of your child the most, will help you and your doctor decide on the right medication to try.

Educate yourself: Learn as much as you can about ADHD and medication options. Consult reliable sources such as healthcare providers and trusted websites

Understand the risks and benefits: Be aware of the potential risks and benefits associated with ADHD medication. It’s important to weigh the pros and cons before making a decision.

Communicate with your child’s doctor: Talk to your child’s doctor about any concerns you have about medication. Ask questions, clarify doubts, and make sure you understand the medication and its side effects.

Join a support group: Thousands of parents have come before you who can share their experiences. If possible, pose those questions to ADHD adults as they have a unique insight into medication. Facebook has lots of groups to choose from, here is a private group you can join ADHD/Autism + Parents Support Group - Private

Consider occupational therapy: ADHD medication is often used in conjunction with other therapies. Occupational Therapists can help your child with sensory processing to develop coping skills and improve their overall functioning.

Identify what skills are missing: Observing your child will provide you with incredible insights to help you adjust your expectations so that they can meet them with the skills they have.  Use this information to provide them with opportunities to build those skills.

Implement strategies at home: Use co-regulation when your child is emotionally dysregulated. Create structure and routines that will scaffold your child’s executive dysfunction. Prioritise sleep, nutrition, and physical exercise.

References

• Could Your Child’s Meds Affect His Height? Likely Not
• Will ADHD Medication Change My Child’s Brain?
• Treatment of ADHD
• Attention-Deficit/Hyperactivity Disorder – treatment and therapies
• Do ADHD Meds Lead to Addiction?

As a parent, nothing is scarier than the thought of your child facing challenges and obstacles that you can’t control. Up until the day of my child’s diagnosis, I had (mostly) everything in hand. I knew how to fix a fever or a scraped knee. The moment when your child is identified as ADHD and autistic, you realise that you don’t have the tools to deal with all the challenges, and you become overwhelmed with fear and uncertainty about what the future might hold for them. How would they navigate a world full of stigma and unkind people? Would they be able to thrive and reach their full potential in a society that is not built for them?

Until recently I allowed myself to be driven by those fears, often reacting or making decisions based on a future state. I found myself worrying about the small things, like getting them to tie their shoelaces and picking up after themselves. My brain was always catastrophising -  I had visions of my adult child not being independent because they couldn’t put their sneakers on, and I shuddered as I imagined their room as an unhygienic den that vermin would be attracted to. 

Thinking about it now, I can see how ridiculous it was to attach myself to those very small things because I believed they were the key to their future. That pattern of thinking was negative in every way by making me increasingly anxious and overprotective, hovering over my child and micromanaging their every move. I couldn’t shake the worry about their ability to succeed in life and felt that it was my responsibility to constantly push them toward success.  

My constant worry and anxiety also made it difficult for me to be present with my child and not sweat the small stuff. Instead of enjoying the moment and building a strong bond, I found myself constantly preoccupied with thoughts of their future and how I could prepare them for it. I wasn’t able to fully meet them where they were, because I needed them to be somewhere else.

Then a friend said something that changed everything, they said: “Look up fear-based parenting”. I know it probably doesn’t sound like groundbreaking stuff, but for me, it put a name to what I had been doing for the last few years. It empowered me to recognise that I wasn’t allowing my child to just be a child. The truth is, kids make their own way and at their own speed towards adulthood and being responsible, and just because they are not hitting some idealised path doesn’t mean they can’t/won’t get there.

I’m so glad I took a step back, let go of my anxiety for the future and put the trust in my child and our family. There is no doubt that parenting a neurodivergent child is a journey with unexpected bumps along the way, but happiness should always come above conventional expectations. 

Need to know: ADHD and co-occurring conditions 

Research shows that between 50% and 67% of kids with ADHD also have another co-occurring condition. Children with multiple diagnoses may be diagnosed at a different age than children with a single diagnosis. For many children, each diagnosis can take months or years to be identified.

Co-occurring conditions with ADHD can include a range of neurodevelopmental differences, mental health challenges, and learning disabilities. Some of the most commonly associated conditions in children with ADHD include:

• Oppositional Defiant Disorder (ODD): ODD is a condition characterised by persistent patterns of negative, defiant, disobedient, and hostile behaviours toward authority figures. 
  
  
• Conduct Disorder (CD): CD is a condition characterised by persistent patterns of behaviour that violate the rights of others and societal norms.
  
  
• Anxiety Disorders: Anxiety disorders, including Generalised Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), and Specific Phobias, are prevalent in children with ADHD.
  
  
• Mood Disorders: Mood disorders, including Depression and Bipolar Disorder, are common co-occurring conditions in children with ADHD.
  
  
• Learning Disabilities: Learning disabilities such as Dyslexia and Dyscalculia frequently co-occur with ADHD.
  
  
• Tic disorders: Tic disorders are a group of neurological conditions that involve repetitive, involuntary movements or sounds that are sudden, rapid, and unpredictable. Tics can be simple or complex and can involve various body parts, including the face, neck, arms, and legs.
  
  
• Autism: a neurodevelopmental difference, that can impact sensory experiences, language, and communication styles, and generally changes how an individual processes the world around them.