When you think of ADHD, what first springs to mind? Hyperactive, misbehaving boys, day-dreaming girls? ADHD might stand for Attention Deficit Hyperactivity Disorder but there’s a lot more to it than hyperactivity and inattention. A more accurate acronym would be more like this: A.D.H.I.E.D.R.S.D.E.F.D – and that’s the short version!

Whilst hyperactivity (H.) and attention deficit (A.D.) (alongside impulsivity (I.), which doesn’t even make the title) are the key diagnostic features, there are several other evidence-based traits associated with ADHD. These include emotional dysregulation (E.D.), weak executive functioning (E.F.) (planning, organising, problem-solving), mental health problems including depression and low self-esteem, and rejection sensitivity dysphoria (R.S.D.) (emotional over-reactivity/ sensitivity to criticism or rejection). Oppositional behaviour is also a common issue, and for girls, the interaction of hormones and ADHD means that they are more likely to have severe pre-menstrual syndrome (PMS). Add this to the evidence that “70% of those with ADHD have a comorbid condition” (NICE, 2018) – often ASD and anxiety – but also eating disorders, tics, learning disabilities and dyslexia, and an array of associated physical conditions including asthma and epilepsy, then we are looking at a very complicated condition. Unfortunately, its significance and impact on all areas of life is widely overlooked.

An even lesser-known characteristic of ADHD is language difficulties – children may find it hard to formulate sentences, to find theright word and to process the information they hear. This is partly because they find it difficult to listen and poor executive functions make it difficult to order thoughts. Research shows that it affects social language too. Children who find it difficult to process and articulate sentences, struggle to listen, and are constantly talking, butting in, and getting over-excited, not only find conversations hard, but are likely to struggle with making and maintaining friendships too.

It is estimated that “1.9-5% of children in the UK have ADHD” (Murphy et al, 2014) but it is largely under-identified, particularly in girls. The long-accepted ratio of boys to girls as 4:1 is now disputed due to the strong male bias in assessments and the different presentation of ADHD in girls (more likely to have the inattentive type and fall under the radar). Yet despite the numbers and the huge impact ADHD has on learning, social participation, wellbeing and life outcomes, teachers are taught little about ADHD in their training.

School staff are in the unique position of being able to spot differences in the way those with ADHD interact, behave and learn compared to their classmates. However, it is not an easy task, especially with the oftensubtle characteristics or masking behaviours of girls. It is not uncommon for students to suppress their symptoms and then go home to have a meltdown.

Infant and Junior Language Link’s assessments can be used by schools to screen all pupils to ensure early identification of SLCN needs, including some of those associated with ADHD.

4 Signs of ADHD

So what can schools do to help enable the all-important early identification of ADHD and reduce ADHD’s impact on their pupils’ education?

  1. Train staff on how to recognise ADHD and encourage timely assessment referrals via the SENCo or family. Training should cover practical strategies to support students both academically, socially and emotionally.
  2. Primary SENCos need to carefully plan transitions with their secondary counterparts. At secondary school, children will face increased academic, organisational and social demands which could push their ADHD to its limits (already elevated in girls during puberty).
  3. Teaching staff should look out for a disparity between a pupil’s contribution in class, versus their achievement. In particular:
    • Unintentional mistakes
    • Inattention to detail
    • Difficulties: sustaining attention, listening, following instructions, taking turns, completing tasks, organising activities, quietly engaging in physical activities
    • Frequent loss of belongings
    • Forgetfulness
    • Fidgeting and/or frequently leaving seat; always ‘on the go’
    • Excessive talking, frequent interruptions
  4. Children should be offered additional support in the classroom and during tests, taught behaviour and anxiety management techniques, and adjustments should be made to the classroom layout (i.e., sitting the child with ADHD at the front to minimise distraction and provide quiet spaces)

Other support could include:

  • Visual aids e.g., visual timetables and ‘Now and Next’ boards to help remind and focus
  • Giving children more time to formulate their thoughts and find their words – silently count to 10 before asking again
  • Giving plenty of planning time before written tasks – provide story planners
  • Getting the child’s attention before speaking to them
  • Providing written and verbal instructions, broken into short steps
  • Reducing the length of independent tasks and homework and providing extra time
  • Providing a fidget-toy, stress ball or wobble cushion
  • Allowing regular movement breaks or time-outs
  • Providing adult-guided small-group social opportunities
  • Encouraging barrier games and activities which model good turn-taking
  • Regular check-ins to ensure the pupil has heard and understood
  • Social skills and attention and listening interventions
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