ADHD is one of the most provocative diagnoses that exists in the world of child and adolescent psychology. Tell someone that your child has ADHD and armchair experts will tell you exactly what the issue is:
A parent whose child experiences ADHD will probably refrain from ripping the skin off your face when you say this to them. But they might want to. And that’s for three central reasons:
1. All of those opinions have been shown to be categorically untrue.
2. Parents of children with ADHD hear these false statements from unqualified but over-confident ‘others’ all the time.
3. They’re probably having a pretty rough day… because when you parent a child with an ADHD diagnosis, you often do have a pretty rough day.
“a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
According to the American Academy of Child Adolescent Psychiatry, a child with ADHD “may often be easily distracted, make careless mistakes, forget things, have trouble following instructions, or skip from one activity to another without finishing anything.” The Diagnostic and Statistical Manual for Mental Disorders also suggests that a child with ADHD will be engaged in constant movement, chatter, fidgeting, and energy expulsion, and behave impulsively by failing to consider consequences, interrupting others, and risk-taking.
This makes it sound as though a person diagnosed with ADHD is unable to stay focused on tasks (or life) and is simply overactive, with “ants in their pants”. But researchers like Russell Barkley, a world leader in ADHD research, argue that ADHD is probably less a disorder related to paying attention and more a challenge with self-regulation. The key word, according to Barkley, is inhibition. It’s just plain hard for a child with ADHD symptoms to stop themselves doing what they want to do now, even if it’s not helpful.
This is because the concept of the “future” is just that – a concept. And if the future doesn’t really exist and all we have is now, the present will always take precedence over some weird future concept that might never arrive.
This inability to hold onto the concept of the future (like “I need to put on my shoes so I can be at school on time”) means that the things that need to be done will always be at the mercy of immediate gratification. While walking to the bedroom to put on school shoes, your child might be distracted by the here and now of the graphic novel on the bedside table, or the lego on the desk, or the dog wagging its tail with a tennis ball in its mouth, or… get the picture? Because the future (school) is so far off that it doesn’t make sense and the distraction is right here – and because of a lack of regulation or inhibition – the new opportunity provides a present focus that means the original task won’t get done. This is infuriating (and tiring) for parents, and it is often distressing for children.
1. ADHD characteristics describe most children
Little children are naturally inquisitive, impulsive, active, inappropriate, and unfazed by the future (and their parents’ plans to get out the door on time).
School-aged children don’t like sitting in an office-like environment absorbing information (which is what many school classrooms are). They don’t want to come home from school and sit through round two – completing homework – when they could be active and move their bodies.
2. We diagnose ADHD so young, often when those characteristics are ‘normal’
According to Melbourne’s Royal Children’s Hospital, diagnoses can be given for ADHD from the age of 5. In fact, they state that “in some cases, especially when there is a strong family history of ADHD, a child may be assessed at a younger age.” This may be problematic because of the way children are wired. Expecting them to not exhibit ADHD traits at this early stage of life is developmentally inappropriate.
There is some evidence that kids are being diagnosed even younger. A 2017 report by Melissa Danielson and her colleagues at the US Centre for Disease Control and Prevention (CDC) found that 2.4% of children aged 2-5 years received an ADHD diagnosis. Diagnosis at age 2 except in the rarest of circumstances is, to me, unconscionable.
3. ADHD doesn’t appear like other illnesses
If a child has a broken arm, it’s visible. If a child has diabetes, we can see it. If a child suffers from asthma, it becomes quickly apparent that something is wrong when they cannot breathe. ADHD doesn’t show itself in the same way as these other illnesses. Instead, it shows up as challenging behaviour. A child who is uninhibited, energetic, and unable to consider the future – or whose motivation for an important task is limited – is not seen as having an illness. They’re just called “a brat”.
4. Kids grow out of ADHD
It is true that symptoms typically improve as children get older, but close to 65% of children diagnosed with ADHD continue to have some symptoms of ADHD into adulthood, with about 15% continuing to meet full criteria for ADHD as adults. (For more, see here and here.)
5. Kids who are youngest in their class are more likely to be diagnosed
Adding weight to the hypothesis that it’s a development/maturation issue, new research suggests that the youngest kids in class are being diagnosed with ADHD, intellectual disability and even depression around 30% more often than their oldest classmates. Children born in the last quarter of a school year were 36% more likely than kids born in the first quarter of a school year to be diagnosed with ADHD. The youngest kids were 30% more likely to have an intellectual disability and 31% more likely to have depression than their older classmates. A US study of nearly half-a-million children found similar results.
Oh, and it’s been replicated in Australia too.
There are other reasons we could explore for the controversy around ADHD. But let’s focus on whether ADHD really is a thing. Big names in ADHD research like Russell Barkley (in Taking Charge of ADHD) make a clear argument that it’s a neuro-biological disorder. This simply doesn’t square with point 5, above.
Being young isn’t the only risk factor for medical treatment for an ADHD diagnosis. Your racial profile is a predictor, as is your social class, the postcode you live in, along with other provocative considerations like who your therapist is, or your attitude to ADHD as a parent (or the teacher’s attitude). There’s sleep, bullying, adverse childhood experiences (like abuse or trauma), toxins, medial issues, being gifted (and thus, bored), being of below average intelligence (which can lead to major acting out), and so many other factors that have nothing to do with a child’s neurobiology.
I’m on the record – and have been for a number of years – as suggesting that labels are more useful on food products than on people, particularly children. My focus is less on whether ADHD is a thing, (and for the record, I do believe it is) and is more on how we can help children who are struggling with skills and capacity around emotional and behavioural regulation, motivation, focus, and socialisation.
Whether you’re a skeptic or a believer, let’s acknowledge that about 5% of kids show up with the symptoms of ADHD. If this is the case, let’s consider:
In a word… it stinks. Kids who exhibit ADHD symptoms are more likely to:
Struggle with school. They don’t have an intelligence problem. They have a focus and inhibition problem, so they typically get lower grades.
Struggle with friends. Kids with these challenging behaviours are the ones who miss out on birthday parties, sleepovers, bike rides in the neighbourhood, and so on. They don’t inhibit themselves so well (unless they’ve also got anxiety), they talk over people, they talk too much, and their communication is often overdone in their often desperate attempts to make and keep friends.
Struggle with family relationships. Tired, stressed, ‘over-it’ parents sometimes do and say things that leave them feeling lousy. Siblings can be unkind too.
Struggle with big emotions. When inhibition and regulation are your kryptonite, it means that big emotions get really big, and they’re hard to control.
Struggle with big behaviours. Impulsivity and inattention mean that if anything is uninteresting, a child is going to want to move on. They’re looking for something worthy of their focus, and ‘boring stuff’ just doesn’t cut it. Lack of inhibition combined with big emotions can mean explosive behaviour.
Struggle with self esteem. When they are constantly questioning their competence (or having the significant adults and peers in their life question their competence), they question their worth. This increases their risk of depression, anxiety, and other ‘comorbidities’.
The list goes on but you get the picture. It’s tough.
This is where it gets really tough for us. Parents of kids with ADHD symptoms or diagnoses might:
From a purely empirical point of view, there is surprisingly little high-quality research that provides clear direction on intervention for parents raising a child with ADHD (or its symptoms). All research studies of any reasonable quality that I found emphasise standard behavioural parenting techniques. And what research there is on these techniques (like this meta-analysis) shows that it ‘works’, in that it alleviates challenging behaviour and reduces parent stress.
Again, deferring to Russell Barkley (although I could have chosen nearly any ADHD expert), he suggests that parents rely on the same parenting practices that have been extolled for decades. His 8-step system recommends:
Step 1: Learn to pay positive attention to your child
Step 2: Use your powerful attention to gain compliance
Step 3: Give more effective commands
Step 4: Teach your child not to interrupt your activities
Step 5: Set up a home token system
Step 6: Learn to punish misbehaviour constructively
Step 7: Expand your use of time-out
Step 8: Learn to manage your child in public places
Barkely’s research resembles that of other similar parenting guidelines. He indicates that more than 75% of families who visit his clinic experience positive outcomes through implementing these steps. As a scholar and scientist, I have to report these findings to you.
But… I find these suggestions unsatisfactory. Why?
I’ve written extensively on the problems with time-out (while acknowledging research that shows it can be effective when administered “correctly”). I’ve argued strongly against token/reward systems. Ultimately, I don’t like a behavioural approach that demands we treat our children with sticks and carrots and make our love conditional on their behaviour. Why? Because at the very heart of the best parenting is unconditional positive regard and connection. Those techniques advocated by so many experts make connection contingent on child behaviour. They require no perspective, empathy, compassion or connection. Indeed, those techniques often sever connection at times when it’s needed most.
And ultimately, ADHD seems to be an issue of connection. Have you noticed that your child is perfectly behaved when connection and love are strong?
Another reason I feel the way I do is that, presently, “positive parenting” interventions are almost invisible in ADHD populations. There are barely anything beyond preliminary, small studies that can tell us whether positive parenting interventions actually work, including ‘mindfulness’ interventions, positive psychology interventions, or even in the extraordinarily deep Self-Determination Theory.
I suggest the following as possible (kinder) alternatives to the behavioural approaches that are currently the only approaches studied and published at present:
Perhaps the best place we can start is to acknowledge the developmental reality of children’s lives. In traditional cultures – and in several advanced nations around the world, even now – children are not expected to play rule-based games, share, show common-sense, develop social skills and so on until at least the age of 6 or 7. Skills like reading are not formally taught in places like Finland (a leading world country in education) until the same age. Instead, children in these places (and historically) have been allowed to wander, watch, explore, and develop in natural ways rather than being placed in artificial classroom settings where they are required to sit still, passively learn, and behave like mini-adults.
When a child behaves well, traditional approaches to discipline suggest we praise the positive and encourage more of this behaviour. (Research shows this can be effective, but not always). When a child behaves in a challenging way it is natural to become annoyed and punish by withdrawing privileges or using a time-out. (That’s what Barkley and others propose.)
But discipline is best when it’s not about punishing and hurting our kids to ‘teach them a lesson’. Rather, discipline is best when it’s about teaching and helping our children: working with them. We do this best by trying the following:
1. Talking to a child ahead of time about expectations
2. Exploring their preferences and desires
3. Explaining your needs
4. Empowering them to develop a strategy you can both work with
According to research, such an approach is remarkably effective with neuro-typical children and teens. And with patience, I have heard of countless parents of ADHD children (and those on the spectrum) who have enjoyed success using this approach too. It may just take a little more patience, intention and experimentation than it does with the child’s neurotypical siblings. When we Explore, Explain, and Empower, we guide our children to mutually agreed upon outcomes.
It simply doesn’t work to try to have a teaching, guiding, instructing conversation with a child when they’re emotionally ‘hot’. We tend to be less effective when we are triggered by them and are slightly less composed too. Instead, solve problems when everyone has clear heads.
The best outcomes happen when:
1. They’ve had time to process their emotions.
2. You warn them that you are going to want to revisit this later. Let them know that they’re not in trouble, you just want to work on a solution together.
3. It’s best if you can be DOING something at the time. Going for a walk, cooking, playing a game. It will reduce some of the pressure and help them to think more clearly if they’re able to move their bodies at the same time. With teenagers who might not be as co-operative, even going for a drive tends to be better than sitting face to face.
Keep the conversation short.
BONUS TIP: If they’re on medication, use that to your advantage. Avoid tough talks at the end of the day after their medication has worn off. Try and engage them just as it’s kicking in.
When offering behavioural guidance and stating expectations it can be easy to say to a challenging child, “Don’t do that!” Such a statement is unhelpful. Not only does a child need to try to inhibit an unwanted behaviour but they also now need to try to fill the void caused by stopping what they’re doing. It’s far more effective to say, “Let’s play the saucepan drums in the rumpus room so we don’t disturb your big sister while she does her homework.”
Kids will play up to a crowd in some cases. Other times they’ll refuse to engage because they’re embarrassed. Either way, effective discipline is usually impossible in this scenario.
Ahead of time, let your child know that their game needs to go off when dinner is ready. Gain agreement. Then 15 minutes out, let them know. Remind them again at 10 minutes (and have them repeat it back to you, with their understanding that they’ll be ready). Remind them again at 5 minutes, and again at 2 minutes. When it’s time, ask them, “What was the deal with the game and dinner?” When they reply let them know, “Time’s up. Let’s have dinner.”
This is pretty simple. When you’ve done your homework, then you can play games. When you’ve picked up ten things on the floor, then you can have that milkshake. I’m not recommending a reward system here. It’s simply letting a child understand that A follows B. It’s a statement that we need to work through all the things that need to be done, and not just do the awesome fun stuff.
People with ADHD have a tendency to skip meals because they don’t pay attention to their body signals. And ADHD medication is notorious for reducing appetite. So parenting a child who is also undernourished creates all kinds of bonus problems. It’s a bit of a vicious cycle.
Solution: Let kids snack on healthy stuff as much as they want throughout the day. They’re likely to eat more overall that way, even if they don’t eat much at dinner time. Offer a variety of food so they don’t get bored. (ADHD kids need a lot of variety in general.) Develop a lunch plan where the kids get a different thing on each day of the week. And if you’re the one making the food, it means you get to make something different every day too!
Parents – make sure you’re eating too!
At its core, ADHD is about lower than average executive function and regulation. Whether your child is medicated or not, the goal as a parent is to reduce the executive function load on your child.
You can do this by creating simple habits and processes for your child to follow. A morning checklist (get dressed, eat breakfast, pack lunch in bag, brush teeth) can help. Routine reduces cognitive load.
Exercise is the best way to quiet the noise in your child’s brain and get them back into their body. Being active and moving is great for a child who is hyperactive, energetic, and struggling to focus. As they get older, give them training programs (heart rate monitors, timed running/cycling segments) so they can track improvement.
People with ADHD have a hard time taking in a lot of information at once, particularly if they can’t see the immediate relevance to what they’re thinking about. This is why school can be so hard. (It’s even tougher if the information is going to counter what they’ve already made up their mind to do.)
If you have to “download” information to your child:
People with ADHD tend to gravitate to other people who also have ADHD. They can keep up the conversational pace, they can match each other’s energy, and they’re looking for the same kind of stimulation. This is great! EXCEPT that they can spur each other on and find themselves in trouble very quickly. Research tells us kids with ADHD are more likely to experiment with drugs, take risks, engage in sexual behaviour, and so on. Thus parents should gently monitor and stay close to their children, remaining aware of what they’re up to.
Friendships among parents with children who exhibit ADHD symptoms can also be a life-saver for grown-ups too.
ADHD kids tend to hyperfocus on things they love. What are those things and can you channel them into something positive?
You’ll probably try these ideas and struggle. It’s hard to change habits. Kids respond with resistance. And sometimes they won’t work.
Guess what though? Those behavioural techniques that cause anger, stress, and frustration? They rarely work either. Maybe you get short-term compliance, but the rupture in the relationship is painful. Keep at it. Results take time to measure.
ADHD is heritable. If a parent is experiencing ADHD which something like 25%-50% of parents of an ADHD child probably will, things get really tricky. You’re not doing so well regulating your emotions and staying on top of your own planning and focus, and then your child does something crazy. This triggers you. You react in a way you don’t mean to, they blow up, and everyone feels rotten. Several studies show that parent ADHD or elevated ADHD symptoms are associated with less improvement following behavioural treatment for their children with ADHD.
If you’re a parent of a child with ADHD and you have it yourself, make sure you’re following the same advice we give to the kids. Eat well, sleep well, create routines, and keep your emotional fuel tank topped up so you can respond effectively to your child when s/he struggles.
A blog like this can’t be comprehensive. However I have saved the best and most important information till the end. It’s this:
The relationship between parent and ADHD child (or any child for that matter) is the soil in which the child grows and develops. Your emotional availability, compassion, guidance, and autonomy support are the rain, the sun, and the nourishment that makes that soil healthy and fertile.
As parents of children with specific and significant challenges, we need to understand what lies at the heart of our child’s challenging behaviour – and often it is how they feel about what we do in response to it that makes it worse.
When we put down our child for being challenging, they question their worthiness. They feel shame. This questioning and this painful feeling sometimes leads to improved behaviour. More often than not, however, it leads to anxiety – and deep down, rage as well.
What our children need instead (and it can be the very hardest thing to give) is our connection. They need to feel seen, heard, and valued. Just like dollars are the currency of our economy, connection is the currency of our relationships.
We can’t – we don’t – cure ADHD. We grow through it, as do our children. And this, ultimately, isn’t about techniques. It’s about our attitude. It’s not about creating habits. It’s about our hearts. And a heart of unconditional love and connection reduces shame, elevates self-esteem, and grows and develops healthier, happier children.
Want more resources? View the webinar recording of ‘A Parent’s Guide to Raising a Child with ADHD’.
Article supplied with thanks to Happy Families.
About the Author: A sought after public speaker and author, and former radio broadcaster, Justin has a psychology degree from the University of Queensland and a PhD in psychology from the University of Wollongong.