ADHD, ODD and CD

Today it is World Mental Health Day and I want to celebrate this day by drawing attention to some of the lesser known mental health conditions that sometimes exist alongside ADHD.

When one or more additional conditions exist alongside a primary condition, we call it ‘comorbidity.’ In some cases, the comorbid condition can mask the symptoms of ADHD and make its diagnosis much more difficult- I once taught a child with a diagnosis of Global Developmental Delay and it took me a while to realise that she probably had extremely inattentive ADHD that we just had not spotted before- her mum agreed.

*Side note- whilst having English as an additional language (EAL) is not a medical condition or considered comorbid by any means. Sometimes EAL children also struggle to have their symptoms recognised as the language barrier is blamed for some of their challenges. *

More than two thirds of individuals with ADHD have at least one other coexisting condition (CHADD, 2017). Some of the most common comorbid mental health conditions that exist alongside ADHD are Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety, Depression and Bipolar Disorder.

When I was researching this piece, ODD and CD were missing from some articles completely, but others had startling information. CHADD, The National Resource on ADHD (USA) reports that around 40% of individuals with ADHD have ODD, rates of CD vary to around 27% of children, 45% to 50% of adolescents and then back down to 20% to 25% in adults with ADHD.(CHADD, 2017).

Another study carried out called, ADORE (Attention-Deficit Hyperactivity Disorder Observational Research in Europe) was a study carried out in ten European countries with 1478 children between 6 and 18 (84% were male). While the percentages in the study differ from the figures reported by CHADD, the most common comorbid condition found was ODD at 67% and CD at 46% (ADHD Institute, 2017).

Despite the evidence that ODD and CD are clearly very prevalent alongside ADHD, so little is known about them that they don’t even merit mentions in every publication.

This is pretty significant to me, as I also have ODD as a comorbid condition with my ADHD, but I never realised I was part of such a large sub group.

In fact, when I was first diagnosed, I went online searching for ADHD groups and I found an abundance of them- in a post later on this month I’ll be talking about how important support groups are- but I could not find anything online about ODD in the UK at all. So, I joined some American groups in the hopes of meeting people like me but found that most groups were for parents of children with ODD. I have remained a member because reading the stories about their children and reflecting on how similar some them are to me, has been a very useful experience and I’ve learnt more about myself through that reflection than I would have from a limited number of articles.

So, on World Mental Health Awareness Day, I will attempt to describe ODD, or certainly my experience of it, in a bid to raise awareness of this little-known condition.

Oppositional Defiant Disorder

Lots of children are stubborn and on occasion, defiant and even the most well-behaved children have arguments and conflict with their siblings, parents, teachers and other adults. That does not automatically mean that a child has ODD.

Using the DSM-5 criteria for diagnosis of ODD symptoms should:

  • Occur with at least one individual who is not a sibling
  • Cause significant problems at work, school or home
  • Occur on its own, rather than as part of the course of another mental health problem, such as a substance use disorder, depression or bipolar disorder
  • Last at least six months

In addition, there should be at at least four symptoms from any of these categories:

Angry and irritable mood:

  • Often loses temper X
  • Is often touchy or easily annoyed by others X
  • Is often angry and resentful X

Argumentative and defiant behaviour:

  • Often argues with adults or people in authority X
  • Often actively defies or refuses to comply with adults’ requests or rules X
  • Often deliberately annoys people X
  • Often blames others for his or her mistakes or misbehaviour

Vindictiveness:

  • Is often spiteful or vindictive
  • Has shown spiteful or vindictive behaviour at least twice in the past six months

(Mayo Clinic, 2017)

The items on the list that I have marked X are all behaviours I can identify in myself as a child and adolescent after a long period of reflection- some persist to this day. When I first found a really good article about ODD, I sent it to my mum to read. Shortly after, she text me back to say, “yes, I would agree with all that.” And if she is reading this (she knows about the blog) then I’m sure she would agree with all of the items that I have marked X, though I imagine there is one unticked item on that list she would include;

“Often blames others for his or her mistakes or misbehaviour”

Now, while I AM oppositional and defiant, I think our disagreement on that item would come from the different way we interpret things. In fact, the reason that I can recognise my ODD symptoms today is that I am being treated successfully for ADHD and I have been able to experience clarity for the first time in my life, so can now reflect on some of my childhood behaviours and realise that my parents and others saw me in a completely different way to how I saw myself.

Debate on that point aside, I did not have the vindictive traits, my ADHD brain moved so fast that it protected me from people who hurt me, so I quickly moved on from incidents that other people dwell on… thank goodness, I had enough of the other traits to deal with!

ODD, like many conditions, is a spectrum and:

  • Mild: Symptoms occur only in one setting, such as only at home, school, work or with peers.
  • Moderate: Some symptoms occur in at least two settings
  • Severe: Some symptoms occur in three or more settings.

(Mayo Clinic, 2017)

My ODD was mild, in that I only exhibited behaviours at home and generally kept it away from school- barring one incident in my 3rd year where five boys were allowed to goad me for an entire lesson without intervention. Eventually I answered them back… well at least I thought I did. I found myself sitting in a room, being left to “calm down” for what felt like hours. To this day I have no idea how long I was left there without being checked, anger building and the injustice.

I was obsessed by fairness and justice, and could be quite black and white about fairness consequently, any time I believed my brother to be favoured over me, I would lose my temper.

The oldest anecdote in my family is one my gran loves to tell, when I was four days old and being taken home from the hospital, she brought a hat for me that had a huge fluffy bobble on the top and when she tried to tie it round my chin… apparently, I touched my chin to my chest to stop her! Now I’m not sure if a four-day old baby has the strength in its neck to do that, but my gran insists I did, and I find it quite funny too.

True or not I have certainly always been wilful and fiercely independent. As a teenager, I never asked for help because I never wanted help- not because I thought I knew it all- far from it. I just wanted to do everything my way and if I make a mistake, I’d deal with it and learn from it. I was never afraid of making mistakes as long as they were my own with no outside interference. Inside my head was utter chaos so maintaining control over one aspect of me gave me comfort and focus.

By far, my biggest trigger, guaranteed to make me lose my temper was (and still can be) any perceived slight. If I feel belittled or mocked-  I am hypersensitive to people’s emotions, their tone of voice, facial expressions and the choice of words they use. When you live in a world as an alien species and your brain does not process light, sound, words… anything, the same way as the rest of the inhabitants, you function with an incredibly wound up tight stress level. It’s bad enough being that stressed, but if you feel under attack…

Of course, other people may not think they have done anything to warrant the reaction they get and that is true if it is out of the blue and unexpected, but if the same incident happens every day and your child loses their temper every day over the same thing, you can persist in pushing their button until they magically grow out of reacting badly (they won’t). Or you can be the bigger person and choose not to push their buttons and work on building a relationship, rather that building resentment.

Conduct Disorder

I did not know much about Conduct Disorder prior to writing this post, but as it affects a lot of people with ADHD and is lesser known, I definitely wanted to include information about it today.

Conduct disorder is a serious behavioural and emotional disorder where the child may display disruptive and violent behaviour and have difficulties with following rules.

While some children and teens may have behaviour-related problems at one point, “a phase.” Conduct Disorder occurs when the behaviour lasts for a longer period and violates the rights of others, goes against accepted norms of behaviour and disrupts the child’s or family’s everyday life.

Symptoms of Conduct Disorder

Symptoms may vary depending on the age of the child and the severity on the spectrum; mild, moderate, or severe.

Typical symptoms are as below:

Aggressive behaviour:  threatening or causing physical harm e.g. fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.

Destructive behaviour: Intentional destruction of property e.g. arson and vandalism.

Deceitful behaviour: Repeated lying, shoplifting, or breaking into homes or cars in order to steal.

Violation of rules: This involves going against accepted rules of society or engaging in behaviour that is not appropriate for the person’s age. These behaviours may include running away, skipping school, playing pranks, or being sexually active at a very young age.

So what causes these behavioural disorders in such a high number of children with ADHD.

Some studies suggest that defects in or injuries to the brain can lead to serious behavioral problems and ODD has been linked to abnormal functioning of  neurotransmitters.  If these chemicals are not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses.

Many people with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.

A dysfunctional family life, family history of mental illnesses and/or substance abuse, and inconsistent or overly harsh physical discipline by parents may contribute to the development of behavior disorders.

 

I hope you learned more about ODD today and please remember to share far and wide to spread awareness.

References

https://www.additudemag.com/common-comorbid-conditions/

http://ncpamd.com/add-comorbidity/

http://adhd-institute.com/burden-of-adhd/epidemiology/comorbidities/

https://www.webmd.com/mental-health/mental-health-conduct-disorder#1

https://www.webmd.com/mental-health/oppositional-defiant-disorder#1

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ADHD: Myths vs Facts

I’ve lost count of the times I’ve been told that ADHD does not exist and read people proffering judgemental ‘insights’ into what ADHD really is. 

There is an adage, that always rears its ugly head in any debate or discussion when one party has run out of ideas, exhausted their bank of relevant opinions and chucks in the towel- but can’t quite leave it before one last snarky comment…

“I’m entitled to my opinion.”

This phrase is, of course, a logical fallacy that you always find in debates pitting science against pseudoscience. The implication is that the pseudoscientists’ “entitlement” to an opinion somehow trumps the scientific basis of the debate.

It doesn’t.

As my son and boyfriend often point out, my ODD symptoms put me at odds with anyone who thinks they are “entitled” to anything, but when I see it being used in professional dialogue, I despair.

Some of you may have opinions about ADHD that conflict with science because you just haven’t had the time to do any research, or just hadn’t thought about researching that topic before, that is ok! As I said in a previous blog, I knew NOTHING about ADHD beyond the hyper boys’ stereotype until I was diagnosed with the condition myself.

The table below includes some commonly believed myths about ADHD on the left, and on the right is the science debunking it. If reading through the list and you would like more information, contact me and I’ll send you on some links to articles or publications that I have found useful.

Myths

Facts

ADHD does not exist ADHD is a neurodevelopmental condition backed by medicine and science.
ADHD is caused by bad parenting. All the child needs is discipline. ADHD is a neurodevelopmental condition and is not caused by bad parenting.  Parenting techniques can often improve some symptoms and make others worse.
ADHD is caused by a poor diet with too much sugar and e-numbers. ADHD is a neurodevelopmental condition and is not caused by dietary choices. A healthy and nutritious diet may benefit children with ADHD, as it would benefit all children.
ADHD is caused by children watching too much TV or playing too many video games. ADHD is a neurodevelopmental condition and is not caused by too much screen time. Many children with ADHD struggle to pay attention to television programmes or computer games due to inattentive and impulsive symptoms and often prefer to play outdoors or in active play tasks.
ADHD is a life sentence. While ADHD symptoms continue into adulthood, the person often learns ways to cope with the symptoms and may choose a career path that suits their personality.

People with ADHD have plenty of energy, are creative, and they are known for developing a variety of interests so can often accomplish more than people who do not have the condition.

Having ADHD means the person is lazy or they are not very clever. ADHD has no connection to a person’s intellectual ability. Some highly intelligent people have ADHD.
People with ADHD should be in a special needs school. Most people with ADHD do not have any special educational needs or need an adjusted curriculum. They will function well in mainstream schools if supported appropriately.
Medicine for ADHD will make a person seem drugged like a zombie, ADHD medication is a stimulant so, if administered properly, medicine for ADHD sharpens a person’s focus and increases his or her ability to control behaviour.
Medicine for ADHD changes a person’s personality. ADHD medication is a stimulant that helps with focus and concentration. It is not a hallucinogenic drug and does not make people change their personalities.
Prescriptions for ADHD have increased because the condition is being over diagnosed. There is little evidence to support claims that ADHD is over diagnosed and that ADHD medicines are overprescribed.
Psychostimulants are no longer useful after puberty. Teens and adults with ADHD continue to benefit from medicine.
Children with ADHD and their parents’ use the condition as an excuse for their behaviour. Children and parents may attribute behaviours to ADHD. It is very likely that a parent of a child with ADHD has gained knowledge of the condition through support groups, the GP, CAMHS or online so they are probably quite knowledgeable about their child’s condition.

Before making judgements or challenging parents, it would be prudent to undertake specific ADHD training.

If a child has ADHD, he or she can always be diagnosed in the doctor’s office. A child is diagnosed by a specialist after periods of observation, an examination and a lot of evidence has been gathered. The process can take a long time.

I am sure there are other myths and misrepresentations about ADHD floating around there, we can abolish those myths by making one simple commitment…

The next time you are told a fact or statement about ADHD that you are unfamiliar with or is unsupported by several references, google it to fact check.

Hopefully this has helped bust some common myths- please share with anyone you think needs it!

Laura

Useful Websites

https://www.additudemag.com/adhd-myths-and-facts-learn-the-truth-about-attention-deficit/

https://www.webmd.com/add-adhd/childhood-adhd/tc/adhd-myths-and-facts-topic-overview

https://www.webmd.com/add-adhd/childhood-adhd/tc/adhd-myths-and-facts-topic-overview

 

Behaviour Charts and ADHD

Whether you call them Behaviour Strategies or you prefer the terminology rebrand, ‘Positive Behaviour strategies,’ practises such as Golden Time, group points, raffle tickets, house points, sticker charts, colour charts, Dojo, Behaviour Charts, clips etc.  all exist to modify and control behaviour through a system of punishment for bad behaviour and rewards for good behaviour.

These ideas originate in the work of B.F. Skinner’s ‘Radical Behaviourism’ theory and systems related to this work are used in schools and institutions the world over.

Whilst Pavlov was an example of early work on conditioning, the first theory of Behaviourism came in 1912 when John B Watson wrote an article titled, “Psychology as the behaviourist views it,” and set out the basic assumptions behind Behaviourist theory:

  • All behaviour is learned from the environment
  • Behaviourism is about observable behaviour and discounts internal events like thinking and emotion
  • Behaviour is the result of stimulus-response

(McLeod, 2017)

This became known as Methodical Behaviourism and it influenced the work of Skinner who developed much further on these theories and acknowledged that people had thoughts and emotions, but wrote in 1971 that there was no free will or “autonomous man” and that behaviour was controlled by their environment.

“A person is responsible for his behaviour, not only in the sense that he may be justly blamed or punished when he behaves badly, but also in the sense that he is to be given credit and admired for his achievements.” (Beyond Freedom and Dignity, p. 21, 1971)

If you behave badly and break the rules you are punished, if you are given credit you get a reward. Whilst you may agree that is a good way to operate, many people do, let us reflect for a moment that we are still using behaviour systems that are influenced by work that doesn’t believe thoughts and emotions influence behaviour. The court system has moved on and will take people’s psychiatric conditions into account when sentencing them for crimes, but schools still use the bad= punishment and good= reward… Where is the gray area of children’s needs?

Firstly, what is bad behaviour?

I’m sure we can all agree that the following are examples of behaviour that should have consequences:

  • Violence or threatening violence
  • Wilful destruction of property
  • Victimising and bullying others
  • Unnecessary rudeness*
  • Persistent use of foul or offensive language
  • Sexualised behaviours
  • Drug or alcohol misuse in school
  • Any other criminal act

*Rudeness can often be a matter of interpretation, particularly when talking about “tone of voice” or “facial expressions.” Rudeness is also a social construct and as our society becomes multi-cultural we must accept that the majority of the world speak more directly and are often “blunt.” Dancing around issues to be delicate is a very British concept and sanctioning children who may not have the same cultural background for “their tone” or “their manner” is just petty.

Then there are other behaviours that are often described as “low level disruption” which often include:

  • Calling out without putting their hand up
  • Being chatty
  • Consistently not following instructions
  • Not listening to teachers instructions
  • Interrupting
  • Making noises or singing

Usually, if a child exhibits one of the behaviours on the first list they will receive some form of punishment that may vary due to the severity of the act, the context of the act or the school policy. If they persistently display these behaviours those punishments will usually escalate, but more importantly, the reason why they are behaving that way will be questioned or investigated i.e. a child may punch someone in a fight once, be sanctioned and then never punch anyone again, but a child who acts violently frequently will worry the school and they will try to find out the underlying causes of this anger, as they should do.

Unfortunately, a completely different approach is taken to low level disruptive behaviour, it is considered annoying and I have heard several teachers say before,

“they are like that because they have no rules or boundaries at home and they get away with murder.”

I always get really annoyed by this sweeping judgement because they have never been into those children’s homes and these bold and often inaccurate generalisations can subconsciously damage the way other school staff think of the family.

After several warnings, if the behaviour persists, a very common punishment for persistent low-level disruption is to put the child on a behaviour chart but rarely are questions asked about WHY these behaviors persist, it is more common to blame a factor like bad parenting or label the child “a chatterbox.”

Now, every child that causes low level disruption will not have ADHD but all of those traits listed are common symptoms of ADHD  and happen automatically without premeditation. To be clear, a child with ADHD cannot help doing the above BUT these traits are considered BAD behaviour in schools and are frequently punished.

When I was younger I was frequently punished for talking too much, interrupting and calling out. I could not count the amount of times I was told, “Well you couldn’t have been listening properly!” when I did not know what to do in a task.

I missed choosing time, was shouted at, given detention, lines, my parents were called, I got shouted at again, sent to my room, no tv, things taken away… yet I still kept on doing them.

There was no amount of punishment that I could be given, no consequence so severe that it could stop me from blurting out answers that popped into my head, chatting to the person next to me when I didn’t know what I was doing or interrupting people. The most severe and brutal torture as a punishment could not have stopped my mind from wandering off to 5000 different things when I was supposed to listen to something that I did not find engaging.

Let’s be blunt. There is no teacher who would punish a child in a wheelchair for not standing up, so why are children with ADHD punished for their neurology?

Luckily, I was never a victim of a behaviour chart but I have seen them used and I think they are a completely ineffectual form of “punishment” for several reasons.

A Behaviour Chart can take various forms but two of the most common I have seen are; a sticker every time they have made a good choice (common for young children) or the more widely used teacher comment after every lesson which is then sent home for parents to see.

I have already expressed my concern that these charts are given out to children with ADHD whose neurology means that they cannot help some of their behaviours. What results is a written record of all the child’s imperfections sent home every day for their parents to be disappointed in them too.

You might have children in your class with behaviour charts and really object to what I’ve just said. If so, answer me this, if your boss wrote down every one of your imperfections on a list every day and you then read it on the way home from school, how would that affect your self-esteem? Would you think you were performing well in your job? Would you worry about disciplinary action or being fired?

Behaviour charts do nothing to fix behaviour that is neurologically predisposed but they do make children feel like they are bad, worthless, that they hate school and have little worth.

Similarly, the famous Golden Time display, big pictures of; a sun, a sun covered in a cloud and a dark angry cloud. At the beginning of the week the children all start on the sun and as the week goes on, they move towards the dark cloud, if they have been guilty of  rule breaking and classroom indiscretions. At the end of the week, the children who are on the sun all get to enjoy Golden Time, where they can choose activities to do with their friends as a reward for being good all week. Those who have advanced towards the cloud will serve some time out as punishment for their indiscretion or some may lose all their Golden Time. At the end of the week, are the ADHD kids more likely to be on the sun or the cloud? All of the children I spoke to in a support group said they were ALWAYS on the cloud and some joked that they would be shocked if they ever saw a full Golden Time.

What’s more, the display is usually up on the wall so that the whole class and anyone who walks into the room- another child, teacher, Head teacher or parent- sees the names of all the children who have been breaking rules, this public shaming builds a reputation and some of the kindest most gentle children have been known as “bad” in places I have worked because they are always missing Golden Time. If you don’t think this affects children and their self-image then you are mistaken. Every school and class has that rare occasion when the “good girl” gets a Golden Time sanction- a moment of temporary insanity for the girl who has never been in trouble a day in her life and always tries her hardest and best. You see that girl red faced and sobbing because she has lost some Golden Time, her name is off of the sun, and she is inconsolable- her perfect world has ended and she is so worried about telling her parents… that girl’s feelings of upset and embarrassment are not more worthy that the child who constantly interrupts or never stops talking. That red face, sobbing and embarrassment is what they feel every week, they just get used to hiding it on the outside.

A brief word on ‘Class Dojo.’ This is an online way of rewarding points to children and has taken the country by storm. There are very few teachers who have anything bad to say about it, in fact most rave about it as the best creation on earth.

I must disagree.

Aside from the dubious Data Protection issues- the data is stored in the USA and while there is a current agreement about some kinds of data sharing- that agreement is not permanent, but the data you uploaded about the children is permanent. It doesn’t matter if you only use a first name, if they are linked to the school, the class, you as a teacher or if the part of Dojo that links to parents is activated- then you may as well have used the surname because the data link to the child now exists.

Most schools do not ask parents for permission before signing their child up for Dojo, why not? And even where parental permission is granted, I do not believe the child knows the implications of having their behavioural profile kept online? You may think that this is an overreaction, but I have strong moral objections to keeping an online behaviour profile for a child when the way that data is used may change according to policy in the USA which we have no influence over.

I’m not even going to go into the fact that Article 16 of the UNCRC allows the child a right to Privacy and creating a behavioural profile online and sharing their every joy or indiscretion in an environment they do not understand certainly does not give them privacy.

These are all of my own thoughts as someone who received repeated punishment for being me, and still receives constant criticism for my personality traits- I talk too much, I’m too emotional, why can’t I just act like everyone else? I don’t want to.

I have also come to these conclusions as a teacher who has watched children in the various schools I have worked in look defeated for being punished AGAIN and worked with children in support groups who have just accepted their fate as “bad.” There is nothing more crushing than hearing that come out of the mouth of a wonderful child with a beautiful soul- that not many people take the time to get to see.

While these are my own thoughts, I am not the only one who holds these beliefs and some of the articles below explain it so much better than I do. There were literally HUNDREDS of these articles online and I think I have read every one of them, please google some more!

If your school uses Behaviour Charts, show them this post and the links below and ask them to reconsider.

Laura

From around the web

http://www.pbs.org/newshour/updates/column-hey-teachers-please-stop-using-behavior-charts-heres/

https://www.washingtonpost.com/news/parenting/wp/2016/09/29/the-darkside-of-classroom-behavior-management-charts/?utm_term=.6af25f6129fe

https://www.theatlantic.com/health/archive/2016/02/perils-of-sticker-charts/470160/

http://www.teachinginprogress.com/2012/10/why-i-will-never-use-behavior-chart.html

http://www.huffingtonpost.ca/2015/05/07/child-discipline-sticker-charts-alyson-schafer_n_7161840.html

 

References

McLeod, S (2017) ‘Behaviourist Approach’ [online at] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014776/ Accessed 1st October 2017

Skinner, B. F. (1971). ‘Beyond freedom and dignity.’ Harvard (18th edition)

 

ADHD Act: Bonus Post

Hello everyone,

Today’s post is all about Behaviour Charts and Behaviour Tracking systems and the many reasons that they unfairly target children with neurodevelopmental conditions, are a method of public shaming and profile children that are too young to consent to being profiled… But I decided to post that later today and first post this…

If you are a UK Citizen, can you please consider signing this petition.

https://petition.parliament.uk/petitions/202061

“The charity ADHD Action calls upon the UK Government to pass an Act of Parliament that will broadly:
1) Place a duty on the Government to produce a broad strategy for ADHD adults and children which is kept under regular review.
2) A duty to produce statutory guidance to ensure implementation.

There are currently many challenges to the UK ADHD community, which affects approximately 5% of children and 2.5% of adults.
Changes in areas below will ensure significant cost savings to public services, and improve quality of countless lives:
Education
Health (including mental, sexual and addiction support)
Criminal justice (police, prisons, probation)
Work, pensions and benefits
Employment law
Local authorities (e.g. social services, homelessness)
Media (responsible reporting)”

For more information please go to adhdaction.org

What does that mean? People with ADHD are more likely to underachieve at school which affects their job prospects and employability.

There is a high correlation between ADHD and self harm, eating disorders, obesity and the development of comorbid mental health conditions which put a strain on the NHS.

There is also a significant percentage of our prison population who have been found to have ADHD as unregulated impulsive behaviour, high frequency of exclusions from school, underachievement and a lifetime of being told you are bad or naughty can often become a self-fulfilling prophecy…

As it happens, most of these topics will appear on this blog at some point this month.

So, for most of today I am leaving this petition up and will be reposting it periodically. I really would urge you to consider signing the petition if you are a citizen of the UK and to send it to everyone you know.

My behaviour chart post that is scheduled for today will be up later on.

Many thanks

Laura

The Physical Environment of a Classroom

There are a multitude of classroom strategies that we can adopt to make our classrooms better learning environments for children with ADHD and other neurodevelopmental disorders, and most of these strategies actually benefit all of the children in the class, regardless of any conditions they may have.

Lists of classroom strategies are available all over the internet, but still I see teachers come onto forums to ask, “What ideas do you have for flexible seating?”

While some lists may give brief descriptions of the strategy, they often fail to elaborate on the details; WHY the strategy is beneficial or how you implement it.

I’m really lucky in that the Senior Leadership Team from my school allowed me to research a lot of these strategies with my last class. They were a big group with multiple additional support needs, of varying complexities, and I needed to change the environment to support them.

Every strategy that I recommend here has been researched, used in my class, monitored for effectiveness and evaluated by the most important people in the classroom- the children.

But… every class and group of children are different, what I recommend may not suit your class’s needs, so at the bottom of the post I will link to some useful resources from around the web that reference classroom strategies, in case you want to carry out a bit of research beyond my recommendations.

The strategies I am going to talk about relate to the physical environment of the classroom. My first draft of this post included additional strategies related to the social and cultural environments of the classroom, but as that post ended up at nearly 5000 words… I thought you would appreciate a cut down version- and I can talk about those strategies through other posts.

Classroom Display

I am not sure if it is wise to talk about this first, as I fear that most of you may unfollow me!

To make our classrooms inclusive for children with ADHD, ASC, Sensory Processing Disorder (SPD), anxiety and those who are just easily distracted, we really need to have a rethink of the current, common, approach to classroom display that is the busy, rainbow art attack.

As primary school teachers, we traditionally love a bright and vibrant classroom display and often put a monumental amount of effort (and our own money) into creating beautiful, Pintrest-worthy, masterpieces. I once worked with a teacher who ordered special 1960s wallpaper for her topic on that decade, and I have seen the posts on teaching groups of beautiful displays that teachers have spent hours planning, resourcing and assembling. Display is important to us primary teachers!

I recently watched a video about an American Algebra teacher who transformed his classroom into a magical Harry Potter wonderland using bits and pieces that he has collected as a fan of the series over the years and considerable additional expense (around $400)! His classroom is beautiful; so professionally decorated and on point that a career in interior design could easily be his calling! (I’ve included a link to this at the bottom of the page to the video- it really is worth checking out) But while I was watching the video, I did wonder how he would manage to get his class to concentrate on their work with so much visual stimulation.

Until I met my last class, I was like every other teacher with my vibrant exciting displays, but then I had never come across a group like them before! 29 children, and a large group with Additional Support Needs including, ADHD, visual processing disorder, global developmental delay, dyslexia, anxiety and some other children who did not have an official diagnosis yet.

The whole class spent most of the day looking round the room, concentration and focus were poor, they were restless, noisy and always used to look over my shoulder at the pictures on the wall as I was talking to them (which was rather annoying)! One little girl told me,

“I just like to have a read of the walls when I can’t be bothered listening to you!”

I needed to take some action!

After a lot of research, the approach I took was a kind of amalgamation of the Reggio Emilia Approach and Montessori Approach.

The Reggio Emilia Approach places a lot of importance on the physical environment of a classroom, amongst other things, and should be filled with natural light, order and beauty and free from clutter. (Reggio Children, 2017)

The Montessori Approach also advocates natural lighting, soft colours and uncluttered spaces where learning materials are accessible to students and kept in order so that students will always know where to access them (American Montessori Society, 2017)

After researching these approaches and reading other teacher testimonials, I stripped away my classroom signs and labels, all of the colourful backing paper and borders and covered the walls in hessian or a light beige backing paper.

I carefully considered all the signs and labels I routinely used and decided to keep my large place value sign on the wall- as I refer to it constantly throughout numeracy lessons and removed the rest, opting to use two Tolsby frames from IKEA per group- one for maths and one for literacy- and used the pre-made Twinkl Tolsby times tables, VCOP etc. and the Twinkl create function to make any others I needed.

I kept my Maths, Literacy and Health and Wellbeing walls and replaced the labels with children’s work, that they selected, and all were mounted onto a muted or light pastel backing paper.

The Tolsby Frames sat on the desk and as they were accessible to the children, this helped them to actually engage with what was written on the labels and had previously been more like wallpaper to them. When we weren’t using the frames, they went into the fidget box in the middle of the table (more on that below), which meant they would not become a distraction.

At the front of the room, where the smart board, whiteboard and my desk lived, I took down every single picture, sign and display- leaving a completely blank wall. This meant that when I was teaching, the children were more likely to look at me where they used to get distracted by all the things behind me.

The concentration in the class improved overnight and most importantly, it stayed that way. The class, who had always been quite noisy and restless, seemed to calm as their senses were not subjected to the multicoloured overload, and their work rate improved. Overall classroom behaviour was much better, and I didn’t have to remind as many children to focus on tasks- meaning I could support the children who needed me without constant interruptions.

While beige may sound boring, it brightened our dark classroom up considerably and gave it a much lighter, airier feel.

However, we didn’t abandon our amazing artistic displays altogether, we just used the corridor space for any particularly arty displays, so the children (and me) still got the chance to be creative.

Most importantly, the children liked the change, they liked the classroom environment, recognised they weren’t as distracted as before and after one girl went on a message to another class in the school, which still had bright, rainbow walls, she said,

“I love rainbows and multicoloured stuff so I was looking around thinking that class was amazing, but I’d never do any work in there, far too distracting.”

 

Visual Support

While most class teachers will use some form of a daily timetable, in the upper school this will often consist of a written timetable on a small-medium whiteboard on the wall. That is absolutely fine and I don’t think you should change that- I haven’t. I do think that the addition of a visual timetable and resource labelling- that is consistent with the visual time table- is a beneficial addition, even better if it is adopted by the whole school!

Children like routine and when they come into class in the morning one of the first things my class do is look at the daily timetable. Knowing what is happening through the day makes children feel secure.

But why a visual timetable?

“The use of visual symbol supports in education settings aims to ‘prevent, remove or alleviate the effects of barriers within the learning environment.’” (Communication Matters, 2017)

Children who have literacy difficulties, those with English as an Additional Language and children with processing disorders or dyslexia may struggle to understand words as they are written, particularly if they are written in certain fonts or on certain colours of paper.

In addition to a classroom visual timetable, a personal visual timetable would benefit children with ADHD, ASC and anxiety conditions. The personal version would just be a smaller version of the one used by the class, and would be on the child’s desk. The personal timetable could also be differentiated to include groups that the child attends throughout the school day or special reward times that have been incorporated. Knowing what is happening can help children feel secure but can also help them to remember their routine- remember that internet browser metaphor from yesterday!

 

Classroom Seating

I don’t know about you, but when I go home and do school work, my University study or writing work, I very rarely sit at a table or desk. I’m most often found sitting on my couch with my laptop on my knee, lying in my bed reading text books or sometimes sprawled across the floor marking jotters, even though I have a dining room table I could sit at.

Last year I trialled ‘flexible seating’ in my classroom. I introduced this to the whole class to be inclusive and we discussed the different seating options that we had and our resources.

As there was a few large floor cushions and a good bit of floor space, I procured some clipboards from the school office and allowed the children to sprawl out on the floor if they found that comfortable. Initially a lot of the children in the class chose this as an option, but they slowly filtered back to their desks if they realised it didn’t help them.

I know that some people have special standing desks that are taller than the usual desks, I didn’t have any of them in my classroom, but I did suggest standing as an option and one girl did opt to stand during most of her work.

For specific children; I introduced a gym ball for a boy who was always very uneasy and fidgety in his chair. He has a visual processing disorder that made school work challenging and he often moved and fidgeted as he tried to concentrate. The gym ball allowed him to bounce up and down and he didn’t feel so uncomfortable in his seat.

I also bought a few yoga/wobble cushions for children who really found it difficult to sit still in their chairs- particularly one child who I suspected of having ADHD. I found the wobble cushion actually reduced her need to take movement breaks away from her table, as she would stop her work when concentrating was getting too much and have a wobble on her chair. She also chatted less as she had an alternative distraction.

Whilst everyone was keen to try every single option the first couple of days, a lot migrated back to their usual desks and those who didn’t were more comfortable.

It really encouraged the children to reflect on how they learned- which is always a good thing!

 

Tactile devices

Yes that’s right, I’m talking fidgets, but before you completely turn away at the thought of another year of fidget spinners- let’s talk about the concept of fidgeting.

A study by the Universities of Missouri and Texas-Arlington found that fidgeting was beneficial for people who had to sit for a long time as it kept blood flowing and improved heart health! (McQuillan, S, 2016)

Fidgets are said to be calming and can reduce anxiety, something I agree with as I often find myself manipulating a small lump of blu tak during events like Parent Consultations, which are long, require a lot of focus and can be quite stressful.

I have a box on each table in my class containing:

  • Some blu tak
  • Elastic bands
  • Fidget spinner
  • Fidget cube
  • A stretchy snake
  • A device that you can twist round your fingers
  • Twist and lock blocks
  • Some stress balls we were given by a charity
  • Some homemade stress balls

Any child in the class can use a fidget if they wish and if they think it really benefits them, but we have two rules surrounding the use of fidgets:

  1. They are not fidget TOYS they are fidget devices- calling them toys means we want to play with them and that is not their purpose.
  2. The fidget is for the hands, not they eyes and if you are looking at it then you are playing with it.

Just like flexible seating, initially the whole class wanted to use a fidget and then the novelty wore off, and those who didn’t need them didn’t use them. We don’t often give children enough credit for their maturity!

Fidgeting helps control restlessness are the children are generally respectful of the boundaries I have set. If I’m fidgeting with blu tak all day- id be a hypocrite to ban them from fidgeting too!

 

There are other physical changes that you can make to your space to make your classroom more inclusive and help children with ADHD or other conditions feel secure, but the most important change you can make is the language used within the classroom and I will be talking about that in a later post about ADHD and self-esteem.

You may also note I did not mention “behaviour charts.” I am dedicating a whole post to behaviour charts this weekend, so please come back and have a look at that!

 

Useful Information

Link to video of the Harry Potter Class- https://youtu.be/aUlzB04SJ2g

Resource website with Tolsby sized resources- https://twinkl.co.uk

Tolsby Frames- http://www.ikea.com/gb/en/products/decoration/frames-pictures/tolsby-frame-for-2-pictures-white-art-30151035/

ADHD Foundation Primary School Classroom strategies- https://www.adhdfoundation.org.uk/wp-content/uploads/2017/05/Primary-School-Classroom-Strategies.pdf

ADHD Foundation Secondary School Classroom strategies- https://www.adhdfoundation.org.uk/wp-content/uploads/2017/05/Secondary-School-Classroom-Strategies.pdf

ADDitude Teaching Strategies- https://www.additudemag.com/teaching-strategies-for-students-with-adhd/

 

Resources

American Montessori Society (2017) ‘Montessori Classrooms’ [online at] https://amshq.org/Montessori-Education/Introduction-to-Montessori/Montessori-Classrooms Accessed 23rd September 2017

 

Communication Matters (2017) ‘Visual Support Project: Structured implementation of visual symbol supports within mainstream schools’[online at] http://www.communicationmatters.org.uk/conference-session/2014-visual-support-project Accessed 23rd September 2017

 

McQuillan, S (2016) ‘Fidgeting Has Benefits’[online at] https://www.psychologytoday.com/blog/cravings/201609/fidgeting-has-benefits Accessed 23rd September 2017

 

Reggio Children (2017) ‘Identity’ [online at] http://www.reggiochildren.it/identita/?lang=en Accessed 23rd September 2017

Special bonus feedback post!

The blog is only 5 days old but I’ve been sent two excellent pieces of feedback that add much more to things I have said.

Firstly, in response to my post about diagnosis in children and adolescents, one person told me, “Thank you for this Laura. You have written this from a teacher’s perspective whereby you might have to have the parents onboard when you suspect there might be ADHD however it can also be the other way around (personal experience) the school/teachers not accepting a diagnosis even after the diagnosis was given by the NHS expert paediatrician. Much awareness still to do so good to see a teacher carrying this out. You keep on keeping!”

This is an excellent point, even though I have ADHD myself, I do often (always) have my teachers hat on. While I have not experienced or known of this to happen with ADHD, I have definitely known this to happen with Autism- parents frantically describing challenging  symptoms that are coming out at home and the school not believing them because the child is well behaved in school (they are holding it all in)!

This just shows me that schools and parents need to work together as partners and trust each other more.

The second bit of feedback comes in response to the adult diagnosis blog; “For the part about adult diagnosis I would very much recommend that you link to the new adult guidelines for Scotland published by the Royal College of Psychiatrists- http://www.rcpsych.ac.uk/pdf/ADHD_in_AdultsFINAL_GUIDELINES_JUNE2017.pdf as the information there is much more relevant than the generic stuff from the NHS Choices website.”

This is a great link and anyone who needs more information about Adult ADHD should definitely look here!

If anyone else has any feedback or tips they think other people should know about, please let me know and I’ll share them for you.

9am tomorrow morning I’m posting about classroom strategies that support ADHD (and all children)!

A Peak Inside an ADHD Mind

In the past couple of days I’ve written about the different subtypes of ADHD, the history of ADHD in medical literature and the diagnosis process for children and adults, so today I’d like to describe what goes on inside the brains of us ADHDers. Telling you about symptoms gives you some information about ADHD, but you could have googled that if you had wanted to. I really want to promote a deep awareness of the challenges faced by people with ADHD, and that all starts inside our heads…

In this post, I’m not going to reference the scientific or medical research that has been carried out into the workings of an ADHD brain- that is coming in a later blog about the causes of ADHD. This post is a self-reported commentary from me and some of my ADHD family, where we articulate our thought processes. I also want to talk about some common teaching strategies and how they can be used to support children.

Recently I read an article where someone described their mind like an internet browser with 45 different tabs open at once- something that I am totally guilty of every single day. Having all those tabs open isn’t great for your computer’s memory, so when I read that article I thought it was a beautiful metaphor for ADHD!

When I am asked to describe the way my mind works, I often use this analogy…

The well-known comic Michael McIntyre talks about having a ‘man drawer’ full of old batteries, drachma from holidays past, spare keys to unknown doors, an abundance of takeaway menus and a multitude of additional spare parts that don’t quite have another home… you get the picture.

Take that man drawer and contents out into your back garden to where your 8-year-old daughter has invited all of her friends over for a party. This already excitable gaggle of 8-year-olds have spent the last three hours drinking gallons of red bull, they have been pouring bags of sugar into their mouths- bags of sugar with added E numbers- whilst a crazed clown has been chasing them around the garden and giving out free puppies as One Direction (or whoever 8 year old girls like these days) play a private set- right there in your garden!

The youngsters screech and roar whilst moving en masse, like wildebeest  towards the trampoline, screaming so loudly that seismologists around the globe are awoken by unexplained readings on their equipment.

Now… imagine walking over to that trampoline and emptying all of the contents of that man drawer onto it; the drachma, batteries, menus, spare keys and the rest of the contents- bouncing and springing and flying all over the place while the children scream louder and louder and louder…

THAT, is what it is like to be inside my head.

The contents of the drawer bouncing and flying about are my thoughts and the 8-year-olds high on sugar and screaming their heads off represent the way my brain regulates my thoughts i.e. it doesn’t- it just creates a constant, loud screaming noise ALL DAY.

As extreme and bizarre as that sounds- it wasn’t until my diagnosis aged 32 that I realised this was not normal!

Disclaimer: Obviously that scenario is full of health and safety hazards and ‘Me And My ADHD’ does NOT sanction or encourage anyone recreating this scenario as an experiment or for amusement- as it will most probably lead to serious injury (there’s always one)!

I realise that posting about my experiences on this blog can make it a very one-sided story and just like Autistic Spectrum Condition, ADHD is also a spectrum.  So, when discussing this post with my lovely friends from my ADHD support group, I asked some of them if they could give me a word, sentence or paragraph about what is going on inside their minds at any given time- and if I could quote them anonymously. My lovely friends did not disappoint and shared the following glimpses of what goes on inside their minds;

“Chaotic, busy, constant movement from one idea to the next, fast moving. Can often get stuck in negative thought spirals. Immensely creative and regularly seeing the outcome, a number of stages ahead of others, which is great for pre-emptive intervention but horrendous for just getting things done… Oh and when all the noise becomes too overwhelming then I liken it to the white noise you hear in environments like indoor leisure centre swimming pools. I know that probably sounds a bit random but those are the moments when I am unable to focus or concentrate because of that noise. For reference when I am saying all the noise, I mean the constant ideas and thoughts in my head.” (Friend 1, 2017)

 

“Without meds I have a 100 radio stations, tuned in at once in my head. I cannot pick one out above the others, I am exhausted just trying to decide what is the important stream to listen to. With meds it gets down to one, the one I want to listen to.” (Friend 2, 2017)

 

“So, so many thoughts going through head throughout the day, completely random or because of external stimuli, makes me forget one thing and then moves me to another. Silence or at least better control would be so beautiful sometimes so I could focus on one thing or task. Trying to do a task and then not get distracted away from that task because something pops into your head randomly or because of an external stimuli that distracts you. AND then when you throw in for good measure my constant restlessness, my indecisiveness and my fluxation of moods it’s chronically annoying. Sometimes I just accept it and other times I want to cry. Just constant thoughts, they never ever stop. Total involuntary, I have no control. For me it’s like I’m constantly internally talking to myself and having various private chats with myself but they change quickly. AND then there is the daydreaming when I totally zone out and not even aware that it’s happening, just enjoying my thoughts. But the speed of the change of my thoughts is ridiculous, super-fast. Jumping from one thing to the next. Whatever weirdness jumps into my head. AND then when you add an external stimuli, then that interferes with the present thought and you start then thinking about something else, which can then make you think of something else. And then when emotions or moods interact then they can vary your thoughts from happiness to sadness in the matter of minutes, possibly even seconds. However, I am getting better with one-to-ones and work hard to concentrate but that depends how excited or bored I get. BUT in a multiple conversation it’s extremely difficult and at times impossible. Sorry I find this really difficult to explain. AND now my head feels like it’s going to implode writing this.” (Friend 3, 2017)

 

“Chaos” (Friend 4, 2017)

 

“Mental!… just came out the nut quacks… psychologist cancelled again because her trains late! I’d be booted out if I kept cancelling… think that’s the third time it’s happened now….no best pleased! So now I’m sitting in my van, just ate a Greggs pastie… in my head I’ve already jumped over the rooftops on a motorbike… fantasised about an orgy… hammered a passer by (I noticed him ogling a schoolgirl) had a gunfight n thot about my Great Grandparents…. that’s just a wee sample… was on a training course (theory) all day yesterday. I was the last one in as I got my dates wrong, last one to hand in exam paper n last one to leave the class! Got 29 out of 30 btw.” (Friend 5, 2017)

 

“All of the above but also I feel like I’m an alien dumped in a strange world looking in from the outside.” (Friend 6, 2017)

 

I completely identify with every single one of these descriptions.

So, what does this mean for our children in school?  If your mind is constantly processing several, often wildly different thoughts at the same time, how can you possibly concentrate on school work?

In a later blog I’m going to talk more in depth about specific teaching strategies but for the purposes of this blog, I think it is important to remember that a lot of the strategies you already employ every day as a class teacher can be used to support children with ADHD- you do not have to learn anything new but could tweak the way you implement your strategies:

  • If a child with ADHD is not listening to an instruction, gets distracted during an instruction or impulsively calls out about something completely random and unconnected- they are not wilfully ignoring you or being disobedient. Often their brain is buzzing, particularly if there are a lot of stimuli.

 

  • While all teachers usually check for understanding after they have given an instruction, this is especially important for children with ADHD as they will probably catch bits and pieces of what you said, and the bits they did catch might have merged with some other thoughts (see my post from October 1st about Robert the Bruce taking his dog on a campervan holiday)!

 

  • When you have checked for understanding and are satisfied the child knows what to do, as they sit down to begin the task you may find them slow to start, if they start at all. Sometimes just before we start a task we can become quite overwhelmed as the ideas, instructions (and distractions) buzz about our heads. Supporting them through the start of the task or providing an example or frame could help here.

 

  • Amidst the task, the child may lose focus and concentration and may start to get chatty, move about a lot or fidget. This means they might need a brain or movement break, so ask them to do a quick task. I often ask children who need these breaks to fill up my water bottle at the fountain, empty the recycling bag, go a message, straighten the books in the class library or sharpen my pencil for me. These are short tasks lasting five minutes or less but it helps their brains refocus- though please bear in mind that they will probably need prompting to start the task again.

 

  • If there are multi-step instructions, write each part out on the board for reference or if you are unable to do that, each part could be written on the child’s whiteboard to sit on their desk.

 

  • Shoulder partners and/or face partners can be useful here.

 

I’d also like to reference my post from the 1st of October about excessive talking, if the child is too chatty, this could be a sign of anxiety or confusion about the task.

Hopefully you have found this helpful or interesting, please comment if you have any feedback and share the post with others who you think might find it useful!

Laura