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ADHD

Information and resources to support children and young people with ADHD in education and care.

ADHD is a neuro-developmental disorder that generally appears in childhood and is most commonly identified in the preschool and early school years. It is thought to affect between 3-5% of children and is more common in boys. Since the symptoms of ADHD are seen in all children from time to time, it can be difficult to diagnose. Typically a diagnosis is made by the age of seven, when the symptoms are most obvious. 

There are three types of ADHD:

  • Inattentive - where a child shows symptoms of inattention (or is easily distracted) but is not predominantly hyperactive or impulsive. 
  • Hyperactive/impulsive - where a child is predominately hyperactive and impulsive.
  • Combined - where a child is inattentive, hyperactive and impulsive

ADHD is not a developmental phase or the result of poor parenting. There is overwhelming evidence that the frontal lobe region in the brain of children with ADHD is ‘wired’ differently from their non-ADHD peers. These children have problems with executive functioning resulting in an inability to effectively evaluate a situation, plan, take the required action, and adjust these actions as needed. ADHD also affects the ability to focus and maintain attention. ADHD can significantly impede learning, social and general functioning. Academic performance, peer relationships, self-esteem, mood and personal organisation may also be compromised.

More information about how differences in brain development and brain function are involved in ADHD can be found on the Understood website

Where there are concerns that a child may have ADHD the family should be consulted and encouraged to seek help from a health professional.  

Co-morbid (may exist alongside of) disorders

ADHD often co-exists with other neurological disorders including:

  • learning difficulties
  • communication disorders
  • autism spectrum
  • anxiety
  • oppositional defiant disorder
  • conduct disorder
  • depression.

What you might see in a child with ADHD

Children with ADHD can be creative problem solvers, good public speakers, energetic and enthusiastic and have good conceptual skills and intuition.  

A child with ADHD may also:

  • change activities often without finishing them
  • lose or misplace belongings
  • forget what they have been told to do
  • be restless in situations requiring calm
  • be always ‘on the go’
  • have difficulties planning and organizing
  • have difficulties in social situations
  • be constantly talking
  • appear to be daydreaming
  • have atypical interoception
  • experience unpredictable mood swings.

Treating ADHD

Medical and psychological interventions are generally effective in reducing disruptive behaviour in children with ADHD. These include medication, parental training in behaviour management, classroom based behaviour training and social skills training. 

Where a child is prescribed medication for ADHD and this is required to be administered in education and care services a medication agreement HSP151 (DOC 142KB) must be completed. Refer to the medication management page for further information. 

Misdiagnosis of ADHD

Many neurological conditions in children can mirror ADHD symptoms which can make correct diagnosis difficult. It is important not to jump to conclusions and make assumptions about behaviour being ADHD. It is important to consider alternative conditions to ensure accurate treatment.

Consultation with a mental health professional can ensure an accurate diagnosis after a thorough assessment. Many children often go through a phase where they are inattentive or restless  when they first start school and are adjusting from the free-flow environment of preschool to more formalized and ‘sitting still’ based learning.

Bipolar disorder

Bipolar mood disorder and ADHD are often hard to distinguish as they share many symptoms including mood instability, outbursts, restlessness, talkativeness, and impatience. Bipolar is primarily a mood disorder whereas ADHD affects attention and behaviour.

Autism spectrum

In some cases children on the autism spectrum may mimic the hyperactivity and social development issues common with ADHD. Social skills and the ability to learn may be inhibited in children with both conditions. However children on the autism spectrum do have a high rate of ADHD and vice-versa.

Diabetes / Low blood sugar

Low blood sugar (hypoglycaemia) in children can cause uncharacteristic aggression, hyperactivity, the inability to sit still and the inability to concentrate. 

Sensory processing disorder

Children with sensory processing disorder may be under or overly sensitive to touch, sounds, taste or smell and may fluctuate from one activity to the next, may be accident-prone or have difficulty paying attention, especially if they feel overwhelmed. Further information on sensory needs for children and young people is documented under managing ADHD in education and care on this page.

Hearing problems

Children with hearing problems have a hard time paying attention because of their inability to hear properly. This may be assumed to be lack of focus. Children with hearing problems may also have difficulty in social situations and have underdeveloped communication techniques. Many children have fluctuating conductive hearing loss due to Otitis Media (with effusion ie glue ear, acute or chronic) which left untreated can lead to permanent hearing loss. Hearing should be checked regularly in children and young people who have recurrent ear infections or appear to be able to hear some days and not others. Further information on interventions, assessment and support can be found on the Department for Education intranet page Special Educator – Hearing (staff login required).  

Kids being kids

Children who are young for their grade levels may receive an inaccurate diagnosis because teachers mistake their normal immaturity for ADHD. Children who have higher levels of intelligence than their peers may also be misdiagnosed because they grow bored in classes that they feel are too easy.

Education implications of ADHD

Up to 40% of children and young people with ADHD are failing to meet the national minimum standards for numeracy and literacy even when they are taking medication to enhance their concentration levels. 

ADHD can affect a child’s ability to focus, pay attention, listen or put effort into school work. It can make a child fidgety, restless, talk too much and disrupt the class. They may also have interoception difficulties and additional learning difficulties. 

Managing ADHD in education and care

While medication may improve processing speed and some aspects of executive functioning there is currently no evidence suggesting ADHD medications improve educational outcomes. School based interventions where teachers have modified practices and used behavioral management techniques have been found to improve behavioral and literacy outcomes for children with ADHD. Systematic computer based training with working memory has also shown cognitive and behavioral improvement for children with ADHD. 

The Murdoch Children’s Research Institute has developed tips for managing ADHD in the classroom and the Child Mind Institute has developed teachers guide to ADHD in the classroom which may assist education and care services. 

Interoception 

Many children and young people with ADHD have low levels of interoception, which means they are unable to understand or connect with their bodies in ways that would enable them to self-regulate. It is important to integrate the teaching of interoception activities into developing interoceptive awareness.

An interoception support plan HSP421 (DOC 170KB) may be completed by the education or care service, family and the child or young person (where possible). This will provide a detailed understanding of the interoception issues and support the development of individualised strategies to increase interoception.

Refer to the interoception 101 (PDF 3MB) for strategies to incorporate interoception into class activities.

Sensory needs

Many children and young people with ADHD also suffer from sensory processing disorder (SPD) making it difficult to process and act on information received from the senses. Most children with SPD display elements of extremes where they suffer from sensory overload sometimes and seek stimulation at other times.  

It is important to understand their sensory needs and implement strategies to enable a positive experience in the education or care setting. 

A sensory overview support plan HSP431 (DOC 389KB) may be developed by the education or care service, family and the child or young person (where possible). This will provide a detailed understanding of the sensory issues and support the development of strategies to minimise sensory seeking or avoidance.

Regulation scale

The regulation scale HSP432 (DOC 182KB) is a tool that can be used for any child or young person to identify what is happening around them that is impacting on their mood change, what signals their body is giving them, and ways to respond to their body’s signals that will help them manage the change in mood. 

The child or young person should be involved as much as possible in developing the scale, with input from parents and staff to support them. 

The scale can evolve and change over time as the child develops better interoceptive awareness and expands their vocabulary (non-verbal/verbal). This scale is designed to be used in conjunction with interoception activities so the child is working towards meaningful development of interoception skills. 

Interoception is the foundation for developing emotional regulation skills and some children will require explicit teaching to develop these. Some children (especially those who have experienced trauma and/or neglect) struggle to manage mood changes which may be associated with a minor increase in stress levels (new learning, trying something different). For these children, minor stress may induce uncomfortable feelings which trigger a ‘flight, fight, freeze’ response. These children require support to differentiate between feeling slightly challenged/minor discomfort and feeling unsafe/in danger so they can respond differently.

Some examples of completed regulation scales include:

Care plan

A non-specific care plan HSP110 (DOC 166KB) can be completed by a health professional in consultation with parents or legal guardians for children requiring support to manage their ADHD in education and care services. 

Health support agreement

A health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) can be completed where a parent indicates their child may have ADHD and requires additional support and assistance. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service. 

The Health Support Agreement should clearly identify cultural, spiritual and language needs. 

Educational adjustments

Classroom practices can make a difference for children with ADHD and teachers can improve a child’s educational experience through strategies and interventions. 

Educational adjustments are designed to support children and young people on an individualised basis.  Adjustments should be determined by the parents and education and care service and documented in the health support agreement. 

Examples of adjustments may include:

  • working on difficult concepts in the morning
  • developing creative presentations of course material
  • having games that develop working memory as part of the daily routine
  • interoception activities in the daily routine, especially prior to complex tasks
  • encouraging children with ADHD to sit near the BACK of the class so that they can see everything and do not need to turn around each time they hear a distracting noise - this actually minimises the impact of distractions
  • break assignments and reading tasks into small, manageable chunks
  • having individual dot points of each task written down next to the child or young person so they can cross off each dot point as they complete it - this minimizes the need to keep telling them what to do next
  • developing a study routine and time-management and organisational habits, ie writing reminders, keeping diaries and writing lists
  • providing clear, detailed instructions about course structure, key dates, assessment requirements and practical arrangements, in both oral and written form
  • using as many verbal descriptions as possible to help process written material
  • repeating and emphasising important information
  • providing an individual room to minimise distractions during exams
  • extended exam times to assist focus and concentration
  • provision of note-takers 
  • alternative formats and use of adaptive technology ie text to speech, speech recognition software, smartpens
  • an exit plan - permitting a child to leave the classroom with a prearranged designated safe place where they can be supervised by education and care staff.

Further adjustments that may be considered to support children with ADHD can be found by accessing classroom accommodations to help students with ADHD.

Supporting children with ADHD

Without good interoception children and students revert to survival instincts such as fight, fight, freeze/hide when they become overwhelmed. They are not able to control or self-regulate at this point and these behaviours are instinctive and not conscious.

The Department for Education has developed an interoception curriculum that can help children and young people with ADHD improve their emotional awareness and self-regulation:

A  sensory overview support plan HSP431 (DOC 389KB) may be developed by child or young person, their family and/or the education or care service to provide an understanding of the sensory issues and develop strategies to minimise sensory seeking or avoidance, and assist in the development of a health support agreement.

ReachOut is Australia’s leading online mental health organisation for young people. Resources are available for young people, parents and schools. 

KidsMatter have developed suggestions for schools and early childhood services to help children with ADHD engage better in learning activities through adapting instructions to their need for support 

The Centre for Emotional Health is a practicing research clinic established in 2007 in the Macquarie University.  Their research into Cognitive Behavioural Therapy (CBT) for children with anxiety and attention deficit hyperactivity disorder found children being treated for their anxiety, with a secondary diagnosis of mild to moderate ADHD, benefit from participating in CBT based treatment (ie Cool Kids online program).

The Women’s and Children’s Health Network Child and Youth Health have developed information specifically for children about ADHD. 

Dr Jim Chandler is a Canadian-based psychiatrist and provides detailed information on ADHD in young and older children and its management

Resources

Care plans

HSP110  Non-specific care plan (DOC 166KB)

Support plans

Health support agreement

Planning and management tools

Contact

Disability Policy and Programs

Phone: 8226 1769
Email: education.specialeducation [at] sa.gov.au