ADHD in children: What adults should look out for at school

Why is ADHD hard to identify in the classroom? And why are girls with ADHD often overlooked?

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.

ADHD symptoms can be heavily impacted by the school environment. It is common for parents to be concerned about how to manage school, especially if their child has ADHD. So, how can schools best adapt the way they operate to meet the needs of those with ADHD?

We spoke to the ADHD Foundation’s Tony Lloyd and Emma Weaver to learn more about how ADHD can be managed in schools. Plus, we explore how parents and teachers can work together together to support children’s development and explore some innovative methods some schools are adopting to support their pupils.