ADHD?

There is no avoiding the fact that everything about ADHD is controversial. Some claim that Attention Deficit Hyperactivity Disorder (ADHD) is a legitimate challenge preventing many children from keeping up with their peers at school and acting as a barrier to success. Others claim that it is merely giving poorly behaved children with little self-control, and their parents, a medical label to hide behind. Some believe that those who exhibit behaviour associated with ADHD should be treated with medication in order to best control their behaviours and limit their impact on others, while others believe that this is unnecessary medication for what are, essentially, normal childhood behaviours.

Whichever side you stand on, there is no denying that, in recent years, ADHD has become more and more of a challenge for classroom teachers in the UK and the staff that support them. A cursory glance around the internet demonstrates how prevalent the ADHD discussion has become. Medical websites, mental health charities, and ADHD-specific organisations all provide advice about dealing with the symptoms of ADHD in schools. Indeed, many schools themselves, particularly in the private sector, market their specific abilities to work with children with ADHD and accommodate their special educational needs. Tutoring companies receive myriad requests from parents of children with ADHD for help keeping their children caught-up in school and combating problems with focus and attention.

But whether you believe ADHD is a legitimate behavioural challenge or not, teachers in schools are having to cope with the consequences of ADHD’s increased presence in educational discourse. What does this mean for teachers in the classroom?
Harman, a Year 2 teacher in Haringey, feels relatively lucky. ‘To be honest, I’ve not had many students whose parents claimed that they had ADHD, but I know some of my colleagues have. As a primary teacher, we’re in a difficult position because there is already so much that we’re meant to be looking out for…When we are teaching kids to read we are meant to be looking out for signs of dyslexia. I’ve got plenty of children in my class who don’t speak English at home, which creates another set of challenges. It’s a long list. When you have to worry about ADHD as well, it can put a lot of pressure on an already challenging situation.’

When children are as young as Harman’s, it can often be difficult to distinguish between normal behaviours and ADHD. ‘When they tell you about looking out for ADHD,’ she says, ‘ they’re telling you to look out for things that kids mostly do anyway…like being unable to sit still or not being able to focus on one thing for an extended period.’
These criteria are all relative, and guidance can be vague. For instance, guidance issued by the Department of Education in Northern Ireland states that ‘ADHD cannot be…caused by environmental factors such as diet, parenting or education. However, we must remember that environmental factors can influence every child and so are still important.’ Thus, environmental factors are central, but not causal. It becomes easy to understand how teachers can feel lost.

Some children can focus for longer periods than others in their same age group, and indeed, the younger children within a year group are more likely to be labelled as attention-deficit, as are boys, who develop later than their female peers. Practical guidance for schools often instruct teachers to look for students who are often off task, make careless mistakes, appear disinterested, can’t focus or maintain effort, are disorganised, are talkative, shout out answers or interrupt, can’t wait their turn, are restless, etc. At what point do these normal childhood behaviours, which every child, particularly very young children, exhibits at some point or another, become present to an inappropriate or significant degree?

Jamie, who teaches Year 6 in Tower Hamlets, feels that teachers are being unfairly burdened. ‘Look, I’ve read all the guidance, and if people who are a lot smarter than me are saying that ADHD is the result of some kind of chemical imbalance in the brain then I believe them. I have a hard time, though, believing how many kids actually have it. Most of the time, I feel kids in my classes who claim that they have ADHD don’t actually have a diagnosis to back that up, its just something that their parents have told them over and over again as a way of explaining bad behaviour that they can’t control or don’t want to take responsibility for. They’re clever. By the time they get to me they’ve learned that if they say they have ADHD they can get away with things other kids would get in trouble for.’
Jamie contends what many have long suspected. While in a strict medical sense, ADHD should only be a diagnosis reached after consultation with a number of doctors and specialists, the subjective nature of the condition, as well as a reliance on those who see the child most (parents, teachers, carers, etc.) for a determination of what is normal, leads to many children being labelled ADHD whose behaviour is actually explainable by any number of other factors, including home environment, age, gender, diet, or amount of physical activity. Many children who exhibit behaviours associated with ADHD eventually grow out of these behaviours as they mature, throwing any initial diagnosis into severe doubt.

Indeed, questions have been raised about whether a broadening of the definition of what ADHD is in recent editions of the most common diagnostic manual (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) has led to over-diagnosis, wherein very mild or moderate symptoms are slapped with the ADHD label.
Jan Heller, a former teacher in the United States with more than 30 years of experience, believes that parents need to take more responsibility. ‘Sugary and fatty diets, lack of sleep, lack of exercise…all of it contributes. When I first started teaching, if a child came to me behaving in a way that we would now associate with ADD, I would have perhaps advised the parents that they needed to get more sleep…I obviously can’t speak for the UK, but here, teachers are dealing with so much. Class sizes are a lot bigger than they used to be, the shape and size of families is different, children are exposed to different influences. There needs to be a more honest dialogue between teachers and parents regarding child behaviour, what is normal, and why it happens. Otherwise, schools get lumbered with these behaviour issues in a way that is quite unfair.’

The problem of over-medicalising child behaviour is much less prevalent in the UK than in the United States, but similar trends are emerging. For teachers and schools, the best approach seems to be twofold. Harman, teaching year two, believes that more resources solve the problem. ‘The smaller the groups are the easier it is to handle children whose behaviour is a little more challenging. Smaller classes would be great, but I don’t really see that happening. It seems more realistic to make sure that, for younger children, there are enough teachers and teachers’ aides in a classroom to give the children that need it extra help.’

For Jamie, teaching year six, the solution lies elsewhere. ‘Parents and students need to take responsibility for the way they behave. As the kids get older they should be held to account for the way that they behave and the way that it affects the other kids in their class. And when parents are confronted with the poor ways their kids are behaving, the solution shouldn’t be to just say ‘Oh, well, he’s got ADHD.’ That’s not an excuse. I’m not saying that if there is a genuine issue there that I wouldn’t do whatever I could to help, or that schools shouldn’t give extra assistance. But I’ve taught enough kids to know when it’s genuinely ADHD or if, actually, they just have a problem with authority or can’t control themselves.’

If you believe that your child is struggling with ADHD, what can you do?
First and foremost, eliminate other possibilities. Try changing your child’s routine to ensure they are getting enough sleep. Or monitor their diet closely; balanced diets high in fruits, vegetables, whole grains, and lean proteins help manage ‘sugar spikes’ and promote the ability to focus. Also, talk to your children! Many of the behaviours associated with ADHD can be a mask for emotional difficulties or a reaction to bullying, and many young people will not volunteer that sort of information.

Once all other possibilities have been exhausted, the NHS recommends that you turn to your GP, who may recommend or refer specialist services such as child psychiatrists or other mental health professionals. Parenting guidance and courses may also be offered, aimed at helping use behavioural techniques to manage or change a child’s behaviour, with or without an official ADHD diagnosis.

Websites such as www.adhdtogether.com , www.livingwithadhd.co.uk , www.addiss.co.uk, and www.youngminds.org.uk can also provide additional information about symptoms, treatment, and management should non-medical solutions fail to address the problems. These resources can help you navigate the medical environment, as well as provide advice and guidance on working with your child’s condition, and framing the discussion with those who work closely with them, such as teachers.

Teachers and schools are accustomed to working with children with any number of difficulties. ADHD is not, and should not be, the catch-all excuse for behavioural or attention issues in children. However, if you have received a confirmed diagnosis from the relevant clinicians, it is important to keep your school and teachers informed and involved. This will allow them to aid your child in the most effective way possible, and to provide the best support available.