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Neurodevelopmental Disorders

Attention-Deficit / Hyperactivity Disorder

or more commonly known as ADHD

What ADHD is not

ADHD is often a misunderstood condition. These symptoms, or manifestations of these brain-based challenges, are not intentional nor are they defects in character or personality. Below are some common beliefs, or myths, surrounding ADHD:

Ψ ADHD is caused by bad parenting.

ADHD is a neurodevelopmental condition and is not caused by bad parenting, although behaviors that arise from ADHD can challenge otherwise effective parenting. Unfortunately, when people see kids being impulsive or not listening to instructions, they assume it is due to a lack of discipline, not realizing that these are signs of a medical condition. That being said, the home environment can influence the symptoms of ADHD to be better or worse.

Ψ Children with ADHD are lazy.

ADHD is not a result of laziness or lack of motivation, but stems from a real difficulty in functioning due to the different ways their brain works.

The resulting outward behavior, such as being unable to sit still in class or finish their homework, may seem like they are not trying hard enough, but they are in fact trying harder than their peers to pay attention.

Ψ Children with ADHD can hardly ever focus.

A boy who can focus on his video games for long periods of time could not possibly have ADHD, right? Highly engaging or stimulating activities like video games are not the tasks which children with ADHD struggle with. Rather, tasks that have less stimulation and require less engagement, like reading or counting, can be the tasks which children with ADHD find difficult to focus on. School can be especially challenging as it requires sustained attention over a long period of time and a child with ADHD may have problems adapting to that environment.

Ψ ADHD only affects children and they will outgrow it.

As symptoms of ADHD are typically observable from childhood, people with ADHD tend to be diagnosed when they are a child. However, this does not mean that adults are not affected by the condition. Adults can get diagnosed with ADHD even if they were not previously diagnosed during childhood. Nevertheless, their symptoms are less apparent. This may be because they could have learnt effective ways to manage or hide their symptoms during their adolescence and adulthood. In fact, adult ADHD is believed to be under diagnosed, with an estimated 2% to 5% of adults having ADHD globally. Consider how often you see a grown-up running around uncontrollably and you get the idea—ADHD appears differently in adults.

The main goal of seeking therapy for ADHD should be to ensure that the individual functions well at every stage of their life (childhood, adolescence, and adulthood) rather than to get off medication as soon as possible. Even though symptoms of ADHD may persist till adulthood, many are still able to lead productive lives.

Ψ ADHD is a “male” disorder.

ADHD is more commonly diagnosed in males across ages. However, this may be due to how the symptoms are presented between the genders. Males with ADHD are more likely to exhibit symptoms of hyperactivity/ impulsivity, such as running wildly and uncontrollably, making them more likely to stand out. In contrast, females with ADHD are more likely to demonstrate symptoms of inattention, such as spacing out. Thus, they are more likely to be perceived as bored and tend to be underdiagnosed for ADHD.

Ψ People with ADHD are deliberately difficult and cannot hold onto jobs / have meaningful relationships / lead a “normal” life.

Children with ADHD tend to experience difficulties with processes that tap on executive functioning, such as planning and organisation, prioritising, focusing and sustaining attention, as well as regulating emotions and behaviours. In addition, there is an area in our brain, called the anterior cingulate cortex, which helps us realise when we’re about to do or say something we probably shouldn’t. In people with ADHD, it doesn’t quite work like it’s supposed to.

For children with ADHD, everything that comes to their attention will get their attention. This makes daily living difficult for people with ADHD.

Nevertheless, the difficulties faced by children with ADHD are not intentional acts, nor are they defects in character or personality. Despite the challenges, people with ADHD can learn coping skills to improve their social, academic and occupational functioning, making it possible for them to secure and maintain jobs, meaningful relationships and satisfaction with life.

What does Childhood ADHD Look Like?

3 subtypes of childhood ADHD

(1) Predominantly inattentive presentation: Display primarily inattentive behaviors. This used to be commonly known as Attention Deficit Disorder (ADD).

(2) Predominantly hyperactive/impulsive presentation: Display primary hyperactive and impulsive behavior.

(3) Combined presentation: Display both inattentive and hyperactive behaviors. This is the most common type of ADHD.

Here are some tips from our partner paediatricians on the medical and physiological causes of ADHD.

How do I know if my child is displaying symptoms of inattention or hyperactivity-impulsivity?

Check out the table below to understand the difference between key symptoms defining inattention and hyperactivity-impulsivity respectively.

The Connors 3rd Edition (Connors 3), Conners Continuous Performance Test (CPT), and Conners’ Continuous Auditory Test of Attention (Conners CATA) are neuropsychological tests that a child clinical psychologist uses to assess if a child has ADHD. Click here for more information on ADHD assessments.

ADHD vs Autism Spectrum Disorder (ASD)

Some may confuse ADHD with Autism Spectrum Disorder (ASD). This is not surprising, as some of the symptoms between these two disorders overlap. However, there are key differences between the two.

The table below highlights these main differences.

Can childhood ADHD be managed?

Yes, ADHD can be managed! When a child has been diagnosed with ADHD, parents usually have concerns about which intervention would be best suited for their child. It is recommended that parents work closely with others who are involved in their child’s life - teachers, healthcare providers, therapists & other family members to ensure the best intervention plan for their child. There are 2 primary interventions for children with ADHD.

1. Stimulant medication - Stimulants may be effective in areas such as increasing sustained attention, persistence in work and impulse control. However, for children younger than 6 years old, medication is not recommended. The American Academy of Pediatrics (AAP) recommends parent training in behavior management first.

   Medication can affect children differently and some may experience side effects such as reduced appetite and sleeping problems. Hence, medication is a tool, not a cure and is more likely to be effective when combined with therapy.

2. Behavioral Parent Training (BPT) - An evidence based therapy approach where parents are taught positive reinforcements in order to improve their child’s behavior. Parents are taught to use more effective discipline methods through the manipulation of antecedents (rules & instructions) and consequences (e.g. rewards & time-outs) 

This has been shown to effectively reduce disruptive child behavior and parent-child conflicts. Furthermore, it enhances parenting skills for parents and helps to promote prosocial & self-regulating behaviors.

Effective Strategies for children with ADHD

Ψ Self-monitoring behaviour
As children with ADHD have difficulties in executive functioning such as decision-making and impulse control, this may lead to many unwanted behaviours in the classroom. Self-monitoring techniques can help a child be more aware of their behaviours and improve over time. Read more about self-monitoring behaviour and how to implement it here.

Ψ Token Economy
A token economy is a positive reinforcement strategy for building up and maintaining appropriate performance and behaviour, be it at home or in a classroom setting. In a token economy, if a child acts or behaves in a certain way, they will be able to trade in their tokens for a reward or a privilege. Read more about a token economy and how to effectively implement it here.

How can I help my child with ADHD?

To achieve positive changes in all settings, children with ADHD need a sense of consistency. They are more likely to be successful in completing tasks when the tasks occur in predictable patterns and settings. This way, they will know what to expect and what is expected of them. Here are some tips that have been found to be effective in helping children with ADHD:

1. Create a routine & follow it. It is important to establish a time and place for everything to help a child understand & follow instructions. Create simple & predictable routines for meal times, homework, play time & bed time.

2. Be clear & specific when talking to your child.  Use clear & brief instructions when you need them to do something. 

3. Use a reward system. Use a chart to monitor goals & track positive behavior, then let your child know when they have done something well by praising them or rewarding them in other ways. Make sure the goals are realistic, as small victories are worth celebrating.

4. Create positive experiences. Children with ADHD may find certain situations very stressful. Finding out & encouraging them to be involved in things they do well (e.g. sports, music, art) can help create positive experiences for your child.

5. Provide a healthy lifestyle. Having enough rest, eating nutritious food & regularly exercising are important and can help prevent ADHD symptoms from getting worse.

Support, not Enable

One of the most helpful things you can do for your child with ADHD is to try and understand their struggles without judgement.

Remember that they are not forgetting things, making careless or reckless mistakes, losing focus, having an emotional meltdown, etc. on purpose or because they are lazy or spiteful. ADHD is not an excuse but an explanation for these behaviours. As a parent or loved one, it is also important to realise that it is not because you are doing something wrong either.

What your loved one may need support with may differ from another person with ADHD, so communicate with them and ask them what they need and how you can help. For example, you can be their accountability partner and help them make progress towards their goals and commitments, keeping them in check and giving them honest feedback along the way.

Be mindful when offering help to not demoralise them in the process. For example, saying things like, “Your room is a mess, as usual. I’ll help you clean it up because you can’t do anything right.” It is common for someone with ADHD to have self-esteem issues after years of frustration from struggling with things other people may consider simple. They thrive on encouragement while demoralisation might make them give up. Therefore, try to notice and appreciate their efforts more rather than pointing out their failures. If you or they are feeling frustrated or emotions are running high, step away and come back when everyone has calmed down.

At the same time do not enable them by trying to do, fix or control everything for them. It will just lead to resentfulness towards your loved one with ADHD or feelings of incompetence in themselves. People with ADHD are known to be passionate, creative, enthusiastic, intuitive people. Be your loved one’s advocate and help the world see them the way you do.

If you think that your child may have ADHD, do reach out and book an appointment with our child clinical psychologists at Annabelle Kids Singapore who are experienced in working with families and children with ADHD and conducting neurodevelopmental assessments. We’re here to support you.