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With nearly one in 10 children diagnosed with attention deficit hyperactivity disorder (ADHD) in Australia, and it being twice as common in boys than in girls, parents may find themselves wondering if there are any signs or triggers1.
Dr Alison Poulton, Senior Lecturer in Paediatrics at the University of Sydney, explains that with ADHD it is not just about a child not being able to sit still and concentrate, but rather the bigger picture.
“We often think of ADHD in terms of a child who has it or doesn’t have it, but in truth, there are a lot of shades of grey between those two points,” she says.
“A child may slide on that scale, only being diagnosed when the cognitive tasks become more demanding.”
She also explains that it is important to understand the child’s behaviour in different settings, such as at home or at preschool or school, as well as the effect their behaviour is having on those around them, for example the parent’s mental health or disrupting their classmates.
This is why Dr Poulton recommends enlisting the support of a preschool.
“If parents are worried about their child having ADHD due to their behaviour in the home, it is really helpful to put that child into preschool,” she explains.
“It first gives the opportunity for a professional to see how the child functions – does the child fit in within the normal range or are they different?
“It also gives the parent a bit of a break which is really positive.”
Dr Poulton points out that ADHD in a child shouldn’t been seen as a poor reflection on parents and their parenting, rather that parents often need additional parenting resources to be able to support their child.
How does ADHD affect a child, their learning and their family?
ADHD is a neurodevelopmental condition that results in poor concentration and control of impulses, usually affecting a child’s learning and social skills, but can also impact family functioning.
“The cardinal features are usually inattention, so that’s a short concentration span, hyperactivity, so a high level of activity, and impulsiveness, so the tendency to act or say things quickly without having that moment to consider whether it’s a good idea or not,” says Dr Poulton.
If parents are worried about their child having ADHD due to their behaviour in the home, it is really helpful to put that child into preschool.
While the features of ADHD are common in the under-five age group, it doesn’t necessarily mean they have it, but rather that diagnosis before five is challenging.
“Toddlers are rapidly developing, so if they are showing features of ADHD, they may grow out of those features as they mature,” explains Dr Poulton.
“The key concern is whether the child is going to outgrow those features sufficiently to be able to manage once they start school.”
Dr Poulton explains that ADHD affects a child’s learning as they find it difficult to concentrate on a task.
“For ADHD children to be successful in a task, that task has to be short, easy or sufficiently interesting, motivating or rewarding for them to carry that concentration through,” she says.
“Quite a lot of tasks at school require a level of concentration and time, and a child with ADHD may not have the patience to put the time into that task.
“If they aren’t concentrating and engaged in the task, they may start to get bored and become disruptive to their peers.”
It is also important to understand the impact a child with ADHD may have on the family.
If parents notice that their child’s behaviour is making them unduly stressed, if it’s impacting on their relationship, on their mental health and on the family dynamics, Dr Poulton says these signs should not be dismissed.
“My approach is not to look for a problem until there is a problem that you can’t ignore,” advises Dr Poulton.
“I would prefer to give preschool children the benefit of the doubt for as long as possible to avoid diagnosing a child who may be exhibiting normal preschool behaviour, instead of ADHD.
“Essentially, some questions to think about are, is this child causing unreasonable stress or disruption within the family and is the child unmanageable in a preschool as they are always getting angry and hitting out at other children?”
What can parents do?
Children tend to be diagnosed with ADHD once they start school as they don’t meet the cognitive demands of schooling.
Dr Poulton recommends that children with the signs of ADHD should not start their primary schooling too early.
“A child at school has to be able to sit and concentrate to get through a task,” she explains.
“Every year a child is at school, the tasks become more demanding.
“If a child is one of the youngest in the year, the tasks they are presented with may be harder for them than their peers.
“A bright child with ADHD might cope with the demands in the early years of school as they don’t have to concentrate too long to pick up the skills.
“As they go up in the years, the demands of the tasks might go beyond their ability to cope.
“They may reach a stage where they can’t meet the demands on their concentration.
“This is likely to happen sooner in children who are young for their school year.”
Dr Poulton recommends good classroom management by the teacher as one of the strategies to support the child through the learning environment.
She also recommends parents of ADHD children take their parenting level to ‘super parenting’ and be consistent in the behaviour management strategies they use.
“This doesn’t mean that the parents aren’t good parents or haven’t been parenting their child properly, rather that they need extra skills to be able to cope and manage a child with ADHD,” she adds.
Parents need to remember that ADHD is not due to bad parenting, but it is an inherited condition and parents need to support each other and avoid allocating blame.
Finally, a paediatrician may prescribe stimulant medication which has been found to be effective in improving a child’s concentration, impulse control and hyperactivity.
 Sawyer MG, Reece CE, Sawyer ACP, Johnson SE, Lawrence D. Has the Prevalence of Child and Adolescent Mental Disorders in Australia Changed Between 1998 and 2013 to 2014? J Am Acad Child Adolesc Psychiatry 2018; 57(5): 343-50.e5. [https://pubmed.ncbi.nlm.nih.gov/29706164/]
Symptoms of inattention include:
- failing to complete activities or being slow to complete them
- not following through on instructions
- making ‘careless’ mistakes
- having trouble organising activities
- frequently switching between activities
- being easily distracted and forgetful.
Symptoms of hyperactivity include:
- excessively active behaviour
- inappropriately running and climbing
- frequently leaving their seat
- fidgeting and squirming in their seat
- excessive talking
- being unable to play or work quietly
Symptoms of impulsivity include:
- difficulty waiting for their turn
- interrupting conversations and calling out
- generally acting without thinking
Source: Brain Foundation