ADHD in children: What adults should look out for at school
Why is Attention Deficit Hyperactivity Disorder (ADHD) hard to identify in the classroom? And why are girls with ADHD often overlooked?
In part one of our blog series on ADHD in children at school, Simon Kitson of EDGE Psychology, an experienced Educational Psychologist specializing in working with children with Autism Spectrum Disorder (ASD) and ADHD, considers various factors.
How does ADHD present itself in the classroom?
With any neurodevelopmental condition, there is a continuum of difficulties, ranging from mild to more severe - which acts as a considerable barrier to accessing education. There are key red flags that adults, particularly teachers, within the school should look out for to identify symptoms of ADHD . Children with ADHD can have low self-esteem, underachieve at school, be at risk of exclusion, and might develop social and emotional problems. What teachers might see is a disorganized child, who produces incomplete ‘slapdash’ work, is easily distracted, can be impulsive, and might be subjected to unwanted attention from others. Adults working with such children often feel less emotional closeness and co-operation in their relations with their students with ADHD than those without. This ‘interpersonal affect’ is another red flag .
Why children with ADHD can be difficult to identify in the classroom?
Imagine a classroom of 30 children. They all have different wants and needs, and you (as the teacher) have to manage the learning journey of these children, which is a lot of information to manage. With ever-increasing demands on teaching staff to deliver outcomes for children, it can be hard to differentiate the effects of learning difficulties such as dyslexia, social, emotional, and mental health issues from ADHD symptoms. Those children with obvious ADHD characteristics will be identified sooner and they tend to be boys.
How do adult perceptions contribute to the under-identification of girls with ADHD?
I worked as part of a neurodevelopmental complex cases diagnostic team for over ten years. Members of the group would frequently comment on the disparity between the number of males and females that were referred (both ASD and ADHD) mostly by schools. Why were more boys referred? By adulthood, males and females have the same rate of diagnosis, so why are four times as many boys diagnosed? The term ADHD has entered the vernacular and is now a shorthand for a range of behavioral characteristics but tends to describe male presentation. It has been speculated that these results from much of the research in the area focus on males, and so, the diagnostic criteria might reflect that. Furthermore, teachers are often the first to raise concerns about the children in their care (as they spend so much time with them). If they are not aware of red flags for ADHD in girls, this group will continue to remain unidentified.
Teachers must become more aware of the differences between boys and girls who have the same underlying condition, but different presentations. This is very much a training issue, and such information should be cascaded from Special Educational Need Coordinators (SENCOs) to all school staff attending staff meetings and In-Service Training days with that single focus. I appreciate that this is yet another demand on teaching staff but identifying and supporting young people sooner means that they might require less intervention later. This is also important as diagnosing ADHD early in childhood could have a life-changing impact on a child’s future, such as their career and personal life.
Additionally, other than raising ADHD awareness among school staff, SENCOs and/or specialist school nurses could utilize objective testing aids to support children with ADHD. Remote testing tools such as QbCheck, which is a CE-marked and FDA-cleared medical device used for measuring the three core symptoms of ADHD: activity, inattention, and impulsivity, can help strengthen teachers’ referrals of children for ADHD assessment. The test takes 15-20 minutes and captures the child’s performance, allowing SENCOs and specialist school nurses to compare the results with a normative group of the same age and gender.
In our next blog, Simon Kitson will provide his thoughts on the role of objective testing in the assessment/diagnosis of children who may have ADHD at school and general comments on the recently published research by Swansea University on birthdate bias. Meanwhile, you may also find our blogs on a similar topic insightful such as Identification of ADHD and ADHD tests for schools.
When working with schools, healthcare professionals also find significant value in having objective data available via QbTest (an equivalent FDA-cleared medical device used to measure core ADHD symptoms). In our recent interview with Michael Walsh, Clinical Nurse Specialist for HSE South and South Wexford Child and Adolescent Mental Health Service, he had this to say about their work with schools:
"The QbTest report has been especially useful in supporting our work with schools, in particular with younger children. Before Covid-19, we would typically schedule school observations for patients, with permission from the parents, which would help us better understand the impact of a patient’s symptoms in the school environment.
“Sometimes teachers don't recognize symptoms of ADHD; more often the inattentiveness or the impulsivity goes unnoticed. The teachers might report back that the student jumps up from their desk, is disruptive or they're not focused on what they're supposed to be doing. When you show the teacher the report and what it shows it is like a flashbulb moment for them, where the students' challenges suddenly make sense. It’s useful to be able to show the patient (and all those involved in supporting them) their symptoms in black and white on the report.”
He added: “Teachers have found the report useful in terms of medication too. For some medications, they can wear off around two or three o'clock, and teachers become more attuned to when their student’s attention may start to fade. We can run a QbTest with patients at those times to see more clearly the impact of the medication wearing off. Understanding the impact of this can be important when considering how best to manage the class timetable and incorporate movement breaks and other suitable adjustments.”
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