Attention deficit hyperactivity disorder can be challenging to address, but practitioners must respond proactively, says Sue Fisher…
Attention deficit hyperactivity disorder, or ADHD, is a neurological condition caused by ineffective functioning of the neurotransmitters in the frontal lobe of the brain. These neurotransmitters are those that regulate attention, impulsivity and motor activity. ADHD is often perceived as a condition that is signified by difficulties with behaviour, and this tends to be the initial area of concern; however, in the early years and beyond, children with ADHD will struggle with many areas of development. Whilst this will differ from child to child, they are likely to have poor concentration, be impulsive and often insatiable. They may also have speech, language or communication difficulties, and social skills are generally an area of particular concern.
Young children with ADHD have difficulty in waiting their turn, sharing and generally, working with others of a similar age. As poor team players, they are inclined to interrupt and can be bossy or dominate other children. They are often described as being constantly ‘on the go’, as if driven by a motor, and are often fearless.
Generally, children with ADHD underperform and do not learn from their mistakes. Coupled with short-term memory difficulties, this leads to behaviours being inconsistent with the child’s developmental level. All young children need help with regulating their own behaviour but a child with ADHD will need this more than most.
It can, however, still be difficult to recognise the signs that indicate this condition during a stage in a child’s life commonly characterised by short attention spans, impulsive acts and lively behaviour, resulting in just a small number of children with the condition receiving a diagnosis during the early years. It is more likely that a diagnosis will be achieved during the school years when children are in an environment that places greater demands on them, and where they are trying to function in larger groups of children with less adult support. During this period, the child’s behaviours will also be seen as becoming more inconsistent with age-related expectations.
Consequently, it is vitally important that in early years settings, staff recognise the signs and put strategies in place to support each child as well as attempting to build or maintain confidence and self-esteem.
Working with a child with ADHD can be a challenge, and I have often heard exasperated staff express the view that “nothing works”. Whilst this may appear to be the case, remaining proactive is important when considering adaptations aimed at discovering what does actually work!
It may be necessary to review the routine, environment, activities or resources, considering, for example, periods of time spent outdoors or adaptations to the layout of the indoor environment. Observing children throughout the routine of the day will highlight those times that children find particularly challenging, and simple changes, such as reducing waiting times for snacks or activities and supporting the child during the activities or times of day they struggle with, will help to reduce frustration and conflict.
Staff working with a child exhibiting signs of ADHD need to be calm, positive and consistent in their approach. The child may often feel, or be, out of control, so it’s important that you are not! Try to avoid confrontation as this will only escalate behaviour and try not to blame or hold grudges – once an incident is over and has been dealt with, ensure a fresh start and do not return to it. The child will rarely understand what they are doing or why they are doing it before or during the incident. They may realise afterwards, but questioning them about it will only add to their confusion and distress. Try not to perceive this as the child having won, or get drawn in to commenting “he knows what he’s doing”, which is extremely unlikely – such assumptions can lead to angry outbursts and sometimes aggression, arising from the frustration and confusion the child is feeling.
If a child is struggling, sharing calming strategies can have a positive effect and help them to understand that we all feel angry and frustrated at times; it’s the way we handle it that counts!
Group situations can be stressful as the child struggles with acquiring the skills necessary for success in social situations. These will include turn-taking, cooperation, listening and sharing, as well as learning to recognise the feelings of others.
Books, puppets and social stories are all effective tools in supporting the development of such skills in an indirect, depersonalised approach. When attempting to gain the child’s attention, speak to them directly, using their name to ensure they understand you are including them. Sometimes it may be necessary to employ attention-grabbing techniques, such as putting on a silly hat or blowing bubbles, to draw their attention to you.
Providing more than one of a popular resource may also support the child in gradually developing skills in sharing and turn taking.
It is important that all children are aware of the rules and expectations of the setting, but aim to avoid any that are not necessary, ignore minor behaviours and build expectations gradually.
Aim to be one step ahead and recognise signs of the child becoming overstimulated. Regular movement will help, but young children with ADHD can become fatigued quickly and when coupled with overexcitement, self-control breaks down and overactivity increases.
Routine, consistency and predictability can all support young children in remaining calm and in control. Pictorial timetables can be useful, and always aim to keep waiting times to a minimum.
One technique that is particularly effective and which we can all provide is one-to-one attention. Young children with ADHD can be encouraged to focus effectively when care, time and attention from a trusted adult is provided regularly. Staff should speak clearly, in short sentences, and wherever possible base conversations on the child’s interests and fascinations. Showing that you are interested in them is a great motivator, and ensuring other children see that you like the child and enjoy spending time with them may help too, as children are often drawn towards those who are seen to be popular with adults.
As with all children in your care, it is important to build a trusting and positive relationship with each child’s family. Whilst it is important to share relevant information on the child’s day, avoid passing on information on all minor incidents and discourage parents from punishing or questioning their child about incidents that have been dealt with throughout the day – always ensure you emphasise the positives!
Diagnosing young children with ADHD is difficult, but it is important to be aware of the early warning signs…
● Children with ADHD are likely to have poor concentration, be impulsive and often insatiable. They may have speech, language or communication difficulties; social skills are generally an area of concern.
● Young children with ADHD have difficulty working with others of a similar age. They are often described as being constantly on the go and are often fearless.
● Generally, children with ADHD underperform and don’t learn from their mistakes. They also experience short-term memory difficulties, and these factors lead to behaviours being inconsistent with the child’s developmental level.
Sue Fisher is an early years training consultant.