This information originally appeared in ‘ADHD Behaviour Assessment Service: Information for Teachers about Attention Deficit Hyperactivity Disorder (ADHD)’ booklet.

This booklet aims to give a brief overview of Northern Health & Social Care Trust.NHSCT, Behaviour Assessment Service (BAS) and some strategies that may be helpful for teachers to use in the classroom when managing a child who has ADHD.

NHSCT Behaviour Assessment Service (BAS)

The Behaviour Assessment Service provide multi-agency assessments for children who are exhibiting behaviours, suggestive of ADHD which are impacting on their family life, educational attainment, and social and emotional wellbeing.

The multi-agency assessment process involves a number of components depending on the nature of the behaviours and age of the child and can include some or all of the following;

• Comprehensive interview with parents and child/young person
• Online Snap1V rating scale completed by parent
• Online Snap1V rating scale completed by child/young person (depending on age)
• Online Snap1V rating scale completed by School
• School report
• School observation
• Qb test (computer test which provides additional information on activity, attention and impulsivity levels)

The information gathered during the assessment process is reviewed at BAS multi-professional triage meeting. If the assessment is suggestive of ADHD the child/ young person is referred to the Consultant Paediatrician or ADHD Nurse Led clinic. If the initial assessment is not suggestive of ADHD the child/family is referred to a service which best meets their needs.

A diagnosis of ADHD can only be made if symptoms occur in more than one setting. Consequently input from school (school reports and Snap1V rating scale) are essential to clinicians when diagnosing and supporting children and young people with ADHD. Conner’s Rating Scales and school reports can be subjective tools and it is important the teacher completing this information remains as objective as possible.

Symptoms of ADHD are:

• Restless feelings and behaviour
• Impulsive actions and blurting out answers
• Excessive impatience
• Hyperactive
• Very difficult to relax
• Inattentive, distractible or daydreaming
• IntrusiveImpaired ability to inhibit
• Difficulties with attending to work task
• Difficulties with organising work
• Difficulties sustaining mental effort
• Difficulties with task completion
• Difficulties with filtering distractions
• Short term memory problems
• Poor motivation to work

Prevalence of ADHD

• 5-8% of the population worldwide
• 5% of school aged children
• 3 boys to every girl
• 50% of cases persist into adulthood
• 25% have severe learning difficulties
• 50% have poor listening/comprehension skills

Potential Co-morbidities seen with ADHD

Often children with ADHD have other difficulties.

These can include;

• Conduct disorder – where the child is acting in an antisocial manner and committing offences
• Oppositional defiant disorder which can be seen with emotional dysregulation
• Tic disorders such as Tourettes syndrome.
• Specific learning difficulties such as, dyslexia, dyscalculia or dysgraphia.
• Autistic Spectrum Disorders or speech and language difficulties may also be present.

It is important that if the child has co-morbidities that these are identified and appropriate help given as these will impact on the child’s ability to attend and concentrate.

Characteristics of ADHD Symptoms

The list below describes the various presentations of ADHD. Each child is different and therefore it is important to assess the child individually and target the symptoms that the child presents with.

• Procrastinates, has trouble getting started
• Loses focus when trying to listen
• Quickly loses interest in task
• Difficulties with organising tasks
• Preoccupied with own thoughts
• Difficulty completing task on time
• Misunderstands directions
• Needs reminders to stay on task
• Inconsistent work output
• Needs to work under pressure
• Forgets what was read, needs to re-read
• Excess daytime drowsiness
• Effort fades quickly
• Easily distracted both internally & externally
• Appearance unmotivated
• Hate waiting for anything
• Switches tasks frequently
• Slow processing speed
• Over sensitive to criticism
• Loses track of papers
• Does paper too fast, not careful
• Short fuse excessively, perfectionist
• Learns things but cannot retrieve information
• Often butts in or interrupts
• Often sad, unhappy, discouraged
• Difficulty following sequenced directions
• Has difficulty stopping but also knowing when to go

Ref: ADHD Brown ADDISS Conference 2001)

In addition, children with ADHD may also exhibit “Delay Aversion” (Sonuga Barke et al 1999). This means that this cohort of children ‘struggle to wait for anything’ and various behaviours can develop within the classroom. The child appears to become disruptive in order to fill any “waiting moments” This may give the child the perception that the “waiting time” has passed more quickly. They may also have problems waiting for rewards and can become frustrated.

It is important that children with ADHD are provided with sufficient structure especially in the early years of school to work on these issues. Teachers have found giving the children tasks such as collecting books, taking the register to the office or sharpening pencils to fill in such times helpful.

Some children have motivational problems and the usual reward schemes do not seem to work. Teachers need to be very creative in order to inspire the child to learn. Some children also have problems with timing and can struggle to work out how long tasks will take and are often poor timekeeper.

How can schools help children with ADHD?

Listed below are basic ideas/potential mechanisms which may help to manage and help children with ADHD:

• A firm, consistent but fair structure to daily activities. It is helpful if the rules of the classroom are displayed and rather than “telling the individual child off” that they are pointed out regularly to the whole class. These should be framed positively e.g; “we sit quietly in the classroom”.
• Clear understanding of tasks, – children with ADHD have poor short term memories and therefore need visual cues and reminders to stay on task and understand them.
• Eye contact – this is crucial when praising and giving instructions – less so when reprimanding!!
• Problem solving – if the child has got into trouble it is often helpful to give them “what could I have done” scenarios. Children with ADHD often have difficulty problem solving and finding ways to make amends. If they can be shown alternative strategies it can have a positive impact on their relationships with their peer group. Discussing what could be suitable sanctions with these young people are often more productive than detentions which they often forget to go to or react badly to!
• Seat the child in an area with the least distractions as possible, often children with ADHD have good visual skills, but this does mean they are easily distracted. They also have difficulty waiting and therefore need to be given short achievable tasks increasing in length, with acknowledgement when the task is completed.
• Warning of routine change, children with ADHD may struggle to cope with change as they can find it unsettling. This often leads to the child feeling very anxious and may manifest itself in an outburst. Encouraging the child to help with any changes can help allay potential outbursts.
• Be prepared to offer praise frequently even for small tasks achieved. Children with ADHD have low self-esteem and respond better to frequent rewards rather than sanctions. Sanctions should only be used as a last resort to enforce a boundary. If your sanctions have outweighed the positives at the end of the day then things will only deteriorate. Some teachers have used tokens given throughout the day to earn a reward at the end of the day with great effect.
• Small class sizes are preferable if possible or if not LSA support in small groups especially if the child has additional learning difficulties.
• If things are deteriorating then ask another member of staff to help out. Children with ADHD can be exhausting and sometimes it is possible to start over-reacting to situations when trying to teach these children, while also managing a classroom of their peers. If you are finding a young person particularly difficult, find support for yourself and the child, communication is vital as are new ideas and ways of coping.
• Ensure that the school has regular updates on ADHD to maintain knowledge and develop management skills, as well as medication awareness. All of which are crucial to the child’s wellbeing in school.

The rewards of teaching a child with ADHD are often overlooked. Spend time getting to know the child’s strengths, and point them out to them and others as often as possible. Children with ADHD are often very capable, and creative they just need time to prove it.

Additional Information

Further information may be accessed from the following websites;

ADD-NI

Young Minds

ADHD Foundation

The Children’s Society

The following books, DVD’s and web sites offer information and support for parents, teachers and children with a diagnosis of ADHD.

• The Hidden Handicap: How to help children who suffer from Dyslexia,
• Hyperactivity and Learning Difficulties,  Dr Gorden Serfontein
• Understanding Attention Deficit Disorder, Dr Christopher Green
• Teenagers with ADHD/ADD : A parent’s Guide, Chris A Zelgler Dandy
• ‘Living with ADHD’—A DVD produced by the Solent Healthcare). The DVD covers information regarding the diagnosis of ADHD and strategies to help, the beginning is aimed at parents and the end is a section for teachers