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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
- oppositional defiant disorder
- conduct disorder
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 organising
- have difficulties in social situations
- be constantly talking
- appear to be daydreaming
- have atypical interoception
- experience unpredictable mood swings.
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.
An emotional wellbeing care plan HSP400 (DOC 111KB) can be developed by a treating health professional in consultation with parents to describe additional care or supports required for children and young people with ADHD in education and care services.
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 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.
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.
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.
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.
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 behavioural management techniques have been found to improve behavioural and literacy outcomes for children with ADHD. Systematic computer based training with working memory has also shown cognitive and behavioural 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.
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.
Refer to the interoception web page for interoception information and resources.
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.
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 regulation scale guide HSP432A supports the development of the regulation scale.
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:
- HSP432 Externalising behaviour (PDF 354KB)
- HSP432 Internalising behaviour (PDF 130KB)
- HSP432 Symbols and reduced language (PDF 170KB)
- HSP432 Year 3 boy (PDF 159KB)
Traditional behaviour management focuses on what to do after behaviour has occurred, but does not determine the purpose of the behaviour.
The behaviour can often be prevented by making modifications to the environment, people, places, time or activities and teaching the child or young person a more appropriate way to get their message across.
It is important to determine the reason for the behaviour before we can try to prevent the occurrence.
This may include:
- identifying dangerous, damaging and disruptive behaviours; and which behaviours are just annoying or irritating to others
- investigating what triggers the behaviour, when and where the behaviour is most likely and least likely to occur
- looking at what happens after the behaviour
By using this information we can identify the purpose of the behaviour and teach appropriate alternative behaviours and new skills.
The HSP433 understanding behaviour template HSP4333 (456KB) is a useful tool to assist in determining the reason a behaviour is occurring and to plan and implement a replacement behaviour. This worksheet is used for a single behaviour and works most effectively when education staff, families and the child or young person work together to develop.
The template includes a most likely/least likely table that can be used to identify possible triggers for the behaviour of concern. Documenting what is happening when the behaviour is most likely to occur (place, people, time and activity) and comparing it to times when the behaviour is least likely to occur. It is equally as important to identify when the behaviour DOESN’T happen. This form is used to gather additional information that can provide useful clues in identifying the purpose of the behaviour. The information concerning least likely times for the behaviour also signals possibilities for the ideal teaching environment best suited to that young person.
Wellness, stress and distress questionnaire (WSDQ)
The wellness, stress and distress questionnaire (WSDQ) HSP426 (XLSX 264KB) is a brief emotional and behavioural screening questionnaire for children and young people. The tool can capture the perspective of children and young people and their teachers.
The 25 items in the WSDQ comprise 5 scales of 5 items each. The scales include:
- Emotional symptoms subscale
- Conduct problems subscale
- Hyperactivity/inattention subscale
- Peer relationships problem subscale
- Prosocial behaviour subscale.
The WSDQ can be used for various purposes, including clinical assessment, evaluation of outcomes, research and screening.
An emotional wellbeing care plan HSP400 (DOC 111KB) 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 guide to planning health support – HSP125 can assist in the development of the health support agreement by prompting through a series of questions and considerations.
The health support agreement should clearly identify cultural, spiritual and language needs.
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.
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:
- Interoception 101 (PDF 303MB) - interoception explanation, interoception tracking sheet and interoception activities
- HSP421 Interoception support plan (DOC 170KB)
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.
- ReachOut schools provides resources and information for teachers and school-based professionals
- Schools resource information pack with a guide to curriculum links
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.
- HSP421 Interoception support plan (DOC 170KB)
- HSP426 Wellness, stress and distress questionnaire (WSDQ) (XLSX 264KB)
- HSP431 sensory overview support plan (DOC 389KB)
- HSP432 Regulation scale (DOC 182KB)
- HSP432A Regulation scale guide (PDF 503KB)
- HSP433 Understanding behaviour template (PDF 456KB)
Health support agreement
- HSP120 Health support agreement (DOC 243KB)
- HSP121 Safety and risk management plan (DOC 147KB)
- HSP122 Offsite safety and risk management plan (DOC 148KB)
Planning and management tools
- Interoception 101 (PDF 303MB)
- Interoception 201 (PDF 3299KB)
- Interoception guide (PDF 610KB)
- HSP422 Interoception activity plan (PDF 74KB)
- HSP423 Interoception personal best tracking sheet (PDF 116KB)
- Interoception small group session structure (PDF 84KB)
- Interoception in the Australian Curriculum (PDF 150KB)
- Classroom accommodations to help students with ADHD
- Tips for managing ADHD in the classroom
- Teachers guide to ADHD in the classroom
- Suggestions for schools and early childhood services
- HSP125 Guide to health support planning (DOC 87KB)
Disability and complex needs team
Phone: 8226 3620
Email: education.health [at] sa.gov.au