Supporting children with ADHD - advise from Child Psychiatrist

TOPICS IN THIS EPISODE

• How to identify Attention Deficit Hyperactivity Disorder  
• When to look for help?
• How to best support children and youth diagnosed with ADHD ?

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• About my Guest - Andy Wiener

Transcript

Ela: Hi, Andy, welcome to the show. It's such a pleasure to see you again.

Andy:  A pleasure to be here.

Ela: Thank you, thank you for your time. So today we are talking about supporting children and young people with ADHD. So as we all know, parenting in itself is a challenge to so many of us.

Andy: Indeed. 

Ela: And, you know, ADHD, when we get those diagnoses, so many parents get really anxious and are completely clueless in terms of what is it? And what does it mean to them? So if you could give us a little bit of introduction to ADHD in terms of definition, and how can we understand that?

Andy: Okay. So yeah ADHD, a lot of people think of it as a separate thing. But if you look at children as a group, so for every 100 children, there's going to be children who are sort of averagely active, you're going to have a group of children who are sort of underactive, and a group of children who are overactive. And within the overactive children, maybe like the most, the top 3%, one to 3% of overactive children, get a diagnosis of ADHD, But the reason that that, like the number of children who are diagnosed is sort of has been going up is because the goalposts move. So for example, in the USA, they're quite quick to think that children have ADHD. So maybe the top 10% of most hyperactive children might get a diagnosis of ADHD. In Europe, in the UK, it's between one and 3%. And so the most important thing is that there's going to be lots of hyperactive kids around, but if the hyperactivity, along with poor concentration, and a lot of impulsive behavior, so just doing things on the spur of the moment without sort of thinking about, so, you know, grabbing something when they shouldn't grab it touching something when it's abandoned, 

Ela: And not thinking about the risks I've heard as well. So not thinking what, what could go wrong, but just reactive, right?

Andy: Yeah, exactly. So there's no waiting involved. It's just doing. And, yeah, and if those problems are causing impairment, and the biggest impairment that I'm sure we'll talk about is educational failure. Good luck, these kids are really bright. So you don't want them to fail in their education? Yeah, that's when you'd make a diagnosis of ADHD.

Ela: Okay, and what does it mean to ask parents in practice? Because I have to be honest, it sounds to me my son has not been diagnosed with ADHD. But it sounds really scary, doesn't it? When, when somebody doesn't know what it is, how serious is it, sir? How serious can it get? In practice, what's the easiest way a parent can understand that diagnosis?

Andy: Yeah, I mean, what I say to a lot of parents is that that children with ADHD, they find it hard to sort of adapt to our modern society when life for children is about going to school and sitting you know, at carpet time, they will have to sort of line up and listen to the teacher. Kids with ADHD find that really hard. But if you go back to our past, we lived in small communities, hunter gathering. Kids who were very hyperactive and impulsive, were often a great benefit to to their, their village because, you know, they might be the one that doesn't care about the danger and climbs up a tree and gets a new food source from honey, for example, wants to sail over the horizon just because it's exciting and they want to just find new stuff. So you know kids with hyperactive impulsive kids will and adults because it's actually a lifelong condition were of great benefit to society. But now they really struggle. I remember there was a family that came over from rural Ireland. And they were telling me that really the teachers were saying all your kids got ADHD, and they brought him along to the clinic to see me they were saying, Well, you know, in Ireland, we didn't really talk about ADHD, you just open the door and let them out, cool off, and they’d run around and burn off all that energy. Sort of coming into clashing with anything.

Ela: Yeah, that's interesting, isn't it? Okay, so what can parents do to, how can parents adapt their parenting style and the way they interact with their children once they have received the diagnosis?

Andy: Okay, well, this wouldn't just go for kids with ADHD, but also the ones that are close to ADHD so that the particular sort of overactive kids. So all children need, you know, warmth, affection, and need to be held in a sort of positive regard by their parents, to be a joy to their parents. And what hyperactive kids find is that they're quite annoying to their parents, their parents can get really worn out, yeah, irritable, and they might find themselves talking negatively. So I think you need so these kids do need a lot of exercise. So parents will talk about, you know, going to the park, two hours later, you know, they still haven't run out of steam. But I think you need it, they need a daily routine, where there is a lot of energy burning stuff going on, swing, parks, running, you know, so, and then hopefully, by the evening, when they get home, they’d be sort of properly tired, cause sleep is often a big issue.  The other thing is, I think these kids, more than other children, need a clear structure to their day. So because it's quite impulsive, they'll go off on a tangent. So like getting dressed in the morning, getting ready for school. You know, parents will say, you know, I also put clothes on and halfway through, he got distracted. And he went off and started sort of doing something else. Yeah. So you know, they need quite a lot of supervision. You know, shirt, trousers, socks, hair, teeth. Almost sort of written down and get a reward for getting through those rides. 

Ela: Right, that makes sense. Whenever I mentioned the reward that always works for my son. So I can't see how that wouldn't work here.

Andy: Yeah, to motivate them to fit in with the rules and this off to school. Yeah, we're talking about schooling in a minute.

Ela: So other than the struggle to sit still and follow instructions and focus on one task, there isn't really anything that serious about it, is there?

Andy: There shouldn't be. The thing is that kids with ADHD often have lots of other things. So just to be clear, being rude and argumentative and defiant isn't ADHD. But kids with ADHD, well, it's often they get in a negative cycle. So they're so sort of pissed off and angry. Yeah, that they will, their behavior will get bad and difficult. They might find that they think that their parents don't like them, and that the only way to get attention is to be naughty, for example, that's a common thing.

Ela: That's very interesting. Do you think that started before the ADHD started developing? Or is it because the aggression in children and being rude, for example, often starts from let's say, observing us adults with how we interact and engage with one another. So is there a chance that they actually became rude first before they started or is it irrelevant?

Andy: No, there's nothing about kids with ADHD that's to do with aggression. So that would come afterwards or separately, as you say, if children are exposed to sort of unhealthy relationships, between adults, they'll pick that sort of stuff up but that isn't ADHD. It’s what's called a neurodevelopmental condition. And so kids with ADHD can have other neurodevelopmental problems. So they can have specific learning difficulties. They could be clumsy, they could have sensory sensitivities, so they could have a whole sort of collection of neurodevelopmental issues. So I think it's unusual. In my experience anyway, but it's a bit different for me, because I see the, you know, the more different kids. It's unusual to have just ADHD, right? Medicine, we see, comorbidity is the norm. That means having other stuff as well as usual. 

Ela: Right. Yes. I've heard about autism, that in autistic children that ADHD is quite often present. About 20 or 30% of them have ADHD. 

Andy: Yeah, as part. So increasingly, we're thinking about children described as neuro atypical, atypical kids. And one of the things that atypical kids can have is ADHD. 

Ela: Okay. And what about education systems? So, as we know, children’s lives are very often split between the time at home and time at school, and time outside with friends or nature. And as they grow older, there's more and more time they spend at school, which I can see can be a huge struggle for children, like you previously described with ADHD. So what, based on your experience and your knowledge about this condition, what can we do as parents to support our children's learning outcomes better, considering they spend so much time at school? 

Andy: Yeah, well, I think if there is a diagnosis, then it's very important that the school know about that, that parents find out what training people in the school have had to manage ADHD. So kids who have, say, an educational psychology assessment within a school setting, there's a number of strategies. So there's, there's things called movement breaks, so that it's understood that, yeah, this particular child can't sit in the class solidly for an hour, every 20 minutes or so they might need to go out and do some star jumps in the playground, then it come back in, was it sort of just got a bit of energy burned or fidget toys as well as things that they're allowed? They're sort of allowed to fidget with their hands while they're also studying or learning. 

Ela: Yeah, that makes complete sense. So I can see now the value of a teacher that had that previous training, right? Because they would need to know what behaviors to allow and what to encourage in those kids, and what doesn't work. Let's just mention a couple of behaviors that definitely don't work in, in school and at home, and they make things worse, just for clarity for our listeners.

Andy: Okay. Well at school, you know, telling a child off, you know, sit still, listen. Sit still, you know, it might be that out of the 30 kids in the class, the kid with ADHD is the one that's kind of picked on and feels picked on. So they need to find other ways of managing that. A lot of the kids I see there'll be classroom assistants in the classroom as well. And some of the kids with severe ADHD might be having an education in health care. Yep. So they need extra resources or there's a whole route at this extra resources a school can bring in. At home, I mean, if you're feeling sort of frazzled, and you're finding yourself shouting at your child with ADHD, you know, you need to sort of find ways of getting a bit of a break. You know, grandparents, husbands, family, friends, etc. You need to be kind to yourself in order for you to be able to give your child a positive experience. 

Ela: And is it common based on your experience that parents don't know how to get there and don't have that skill to know how to relax? Do you feel there needs to be better resources in place to help parents that have children with ADHD? 

Andy: Yeah. Well, there's lots of parenting groups available for kids with ADHD. There's books, there's an approach called 123 Magic, which is specifically designed for kids with ADHD. So it's very clear that they understand it's basically about, you know, one, that they've got to stop this behavior and start doing something that they're right one is positive. And it's one and it's two, and it's three. And they do it. Right. So anyways, there's much more to that. There's a program called Mellow Parenting that's quite popular. Because, you know, parents who lose their temper are just very uncool.

Ela: It's uncool at all times, but especially when you have a child with ADHD, right? So I think that self care, yet again, we're coming back to self-care for everyone is super important, especially for parents whose children have slightly different needs and are more hyperactive. 

Andy:  Yeah, yep. So I mean, some parents, I see, cannot believe that they can manage their children. It must be sort of incredible, some of these kids are really difficult. So to think that you're to expect yourself to be able to manage everything is a bit ridiculous. Because I think you talk about parents being kind to themselves. I think this, if you're a parent of a child with ADHD, you certainly need to nurture yourself and be kind to yourself. 

Ela: And what about teachers? So what approach and skills are missing do you feel in our communities, in our teachers?

Andy:  Yeah, well, I'm not, I'm not a big fan of the education system. I think it's because I work with the more vulnerable children. Most of my kids find school, kids I see find schools really hard to, to just cope with, for a range of reasons. Some of them just have been brought up, you know, that they don't follow rules, or they're very sort of suspicious of authority, or they've got neurodevelopmental problems. So you know, I probably see the 5-10% of kids that really struggle with school. So I would like to see, and of course, if children get educated somewhere else. They don't like that, you know, they want to be part of society to be part of, of a normal school, they don't go to a special school. So, you know, I'd like to see, you know, more flexibility within schools, more capacity to look at the individual needs of an individual child rather than treating 30 of them the same. And I recognize that, you know, teachers are very stretched. And lots of demands from the center, you know, lack of resources. I'm not blaming schools, I'm just wishing that the school system was better funded so that it could meet a wider range of needs. 

Ela: And that teachers would be in a position to be better trained and better qualified in order to address those different needs of different children. Instead of like you said earlier, treating every child in the same way and having the same expectations. 

Andy:  Yeah, so it might mean smaller class sizes, and all sorts of things.

Ela: Well, and what we're looking at the research, what do you feel are the biggest lessons learned from the research? So I appreciate there's things we can do differently, there's things we can adapt. What is the research saying?

Andy: Well, maybe just a couple of things. I haven't mentioned that ADHD runs strongly in families. So it's more common in boys and girls. So often, you'll find that particularly the father might have ADHD. So a classic story would be that that dad had trouble at school and didn't do his GCSEs and sort of ended up in a job that was sort of less than they should have. They didn’t attain what they could have attained. Yeah, well, they, they just sort of got chucked out of school or college or something. And other things about medication. A lot of parents are very suspicious about using medication to treat ADHD. But it is recommended, you know, it can be extremely effective. In child psychiatry, out of all the different medications for depression and anxiety and you know, you name it, the treatment for the medical medication for ADHD is the most effective of all the different treatments available. So it really can make a huge difference. It's not going to make a difference at home because the medication is given in the morning. And it wears off in the afternoon or early evening and then it's completely gone. And then you take it again the next morning, and it works during the day. So it's really there to help with school, to help these kids help them focus, and do well at school. So if the education system was completely different, there probably wouldn't be a need for kids to have medication. So it sort of helps them adapt to the sort of modern education system. 

Ela: Is there anything else that is very effective other than medication and the change of approach?

Andy:  No, that's the mainstay, really, parenting groups generally, what the evidence of the NICE guidelines is that, first of all, you try adapting parenting. And see how that sort of improves things. I think it also wants some adaptations in school, and then medication comes after that. So it's not, it's not the first line treat? It's just often I meet parents who are very worried about the idea of kids taking methylphenidate, it's called jet best known as Ritalin. So I tend to allay their concerns. There are side effects, of course, poor appetite can affect sleep, can cause weight loss. Yeah, but if the target is to improve academic achievement, then it's, you know, that's, that's very good.

Ela:  And is it common that a child or a young person would take that for many years? Although they would, they would need that during university as well. Is that common? 

Andy:  Yeah. I mean,  people used to think it was something that was a childhood issue that wore off in adolescence. That's not the case. It's a lifelong issue. And some adults are coming forward and getting a diagnosis. But again, it would turn on the level of impairment. So if you have difficulty with concentration, yeah, as you get older, you become less hyperactive. But the concentration problems can still be there. Sorry, that’s something I missed there? You are talking about lessons where people get older? 

Ela: Lessons learned from research or from people who maybe have successfully treated that and improved? 

Andy:  Oh, that's right. You're also about university. Yeah. So when kids are finishing school, kids with ADHD might not want to be going into a sort of sit down type of environment. Yeah, they're, you know, they might want to go into a sort of outdoor thing. So lots of kids would like to go into construction.

Ela: Where they can move around more. 

Andy:  Yeah, outdoor time stuff. Is that what they tend to go for?

Ela: Okay, great. Well, this has been super helpful. Hopefully, our listeners find it helpful to any final bit of advice for our listeners, Andy, anything to take away?

Andy:  I think I've covered everything. For parents, you know, good luck, you know, you’re doing a brilliant job. And keep going, I think.

Ela: Yeah, keep strong and keep optimistic and look after yourself. 

Andy: Yeah, absolutely. Yeah. 

Ela: Well, thank you so much. This has been great. Thank you. I wish you a lovely rest of the day. Bye.