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ADHD

Attention-Deficit/Hyperactivity Disorder

Description, signs and symptoms, life impact, parent impact, diagnosis, treatment, strategies for management, social worker role

Three sections follow:

  1. Background Material that provides the context for the topic

  2. A suggested Practice Approach

  3. A list of Supporting Material / References

Feedback welcome!

Background Material

What is ADHD?

ADHD, or attention-deficit/hyperactivity disorder, is a psychological condition that can cause people to experience issues with behaviour and concentration, such as focusing, organisation and time management. People with ADHD are often impulsive or spontaneous, and also are frequently creative thinkers and good problem solvers (Reach Out, 2023a).  In other words, ADHD brings challenges (e.g. speaking or acting without thinking, struggling with organisation and attention, and appearing to be always active), but there are many positives, e.g. divergent thinking, hyperfocus and resilience:

  • Studies have shown that people with ADHD are very good at divergent thinking tasks. For example, they find creative new ways to use everyday objects, think of new features or ideas for projects, or go about day-to-day, mundane tasks in a different or unconventional way that most people wouldn’t think of.  This may be because people with ADHD tend to be impulsive (a symptom that some find challenging and that needs time management) or easy distracted (this can lead to creative or divergent thinking processes that neurotypical people don’t experience as often).

  • ‘Hyperfocus’ describes a state of being extremely focused on a single task, to the point of losing track of surroundings.  It can enable people to get sizeable amounts of work done in a short period of time and to be committed to achieving goals and completing projects. While hyperfocus can be challenging to control and needs to be well managed to make sure hyperfocus zeroes in on the right topic or project, it can be an important tool for learning, memory, innovation and personal projects.

  • Resilience is a common trait among the ADHD community and a strength that can be of benefit throughout life.  It can be difficult for ADHD minds to consistently complete ‘basic’ daily routines like brushing teeth, tidying a room, or getting dressed.  The fact that people with ADHD manage the stress of these tasks on a daily basis shows resilience (ADHD Foundation, 2021; Reach Out, 2023b; Young Minds, 2022).


ADHD is a lifespan condition that impacts on people to different degrees throughout their lives and may change during a person’s lifetime (ADHD Foundation, 2021).


No one knows for sure why certain people have ADHD. But health professionals have noticed that the brains of people with ADHD function a bit differently from those of people without it.  In the brain, there are parts that drive your ability to focus (your anterior cingulate cortex) and parts that impact your ability to stop yourself from acting on your thoughts or impulses (your prefrontal cortex).  For people with ADHD, the brain’s activity is a bit lower in these areas than in people who don’t have ADHD. However, this doesn’t make them any less intelligent or capable. It simply explains why people with ADHD can have challenges with focusing and with organising their lives, and yet be great at creative thinking and problem solving (ADHD Foundation, 2021; Reach Out, 2023a).


Types of ADHD


The literature refers to three main types of ADHD (Reach Out, 2023a):

  • Hyperactive/impulsive: People frequently experience symptoms such as fidgeting, restlessness and impatience.

  • Inattentive/distractible: People often have symptoms such as forgetfulness, distractibility, and difficulty in listening to or following a conversation.

  • Combined: This is the most common type of ADHD and is characterised by symptoms of both the hyperactive and inattentive types.


Signs and Symptoms


There are three main symptoms of ADHD (Kent Community Health, 2023; Reach Out, 2023a):

  • Issues with concentration and focus

  • Lower likelihood of planning for future rewards or consequences: People with ADHD are less sensitive to delayed reinforcement (Chronaki et al., 2019).

  • Greater likelihood of thinking and acting in the moment


However, a person who experiences these symptoms might not necessarily have ADHD. Many ADHD symptoms are common and are experienced regularly by people without ADHD. When health professionals diagnose someone with ADHD, it’s because that person is experiencing these symptoms more than other people their age.


Challenges with focusing or concentrating (distractibility)            People with ADHD can find it tricky to focus or concentrate on certain things. For example, they may:

  • have difficulty in focusing on work or school

  • find their thoughts wander during important conversations with friends and family

  • be easily distracted by things like noise, persistent thoughts, or notifications on their phone

  • be unable to remember why they walked into a room or opened an app

  • lack awareness of time


However, the same factors in the brain that cause people with ADHD to feel distracted can also cause them to be better at ‘divergent thinking tasks’ such as brainstorming.


Finding it hard to stay organised (less sensitive to delayed reinforcement)            People with ADHD are more concerned with the immediate or short-term outcomes of behaviours rather than long-term consequences. For example, they may:

  • forget to complete tasks around the house, at work or at school.

  • be often late to appointments with friends and family or forget to show up; maintaining friendships can be difficult

  • often lose stuff, such as keys, wallets and headphones.

However, people with ADHD may be more likely to do something worthwhile, such as start a new project or a new hobby, because they’ll be less inclined to think far ahead and be discouraged by the work or planning it might involve.


Thinking and acting in the moment (impulsivity)               People with ADHD often act on the basis of their thoughts at any given moment. For example they may:

  • frequently feel bored or restless

  • interrupt others, often without meaning to

  • fidget with pens, water bottles or other objects

  • take part in risky activities without thinking about the consequences

  • stay really focused on one engaging thing (such as a game or social media app) without realising how much time has passed.

However, a person who often acts impulsively might also be able to live more ‘in the moment’ than other people and not worry about the future or things they can’t control.


Life Impact including mental health


Besides impacting on life at work and at school ADHD can affect other aspects of a person’s life.  For example:

  • Creativity: People with ADHD score higher on ‘divergent thinking’ tasks, which are helpful for humour, creative thinking and problem solving.

  • Addiction: The two factors of ‘impulsivity’ and ‘less sensitive to delayed reinforcement’ can lead people with ADHD to be more vulnerable to addiction.

  • Social life and relationships: People with ADHD can be more affected by rejection by family, friends and co-workers. As a result they sometimes develop ‘people-pleasing’ tendencies or avoid situations where they may experience rejection.  Social difficulties can lead to low self-esteem, anxiety or depression (Reach Out, 2023; Young Minds, 2022).


Impact on parents


In a study of the impact children diagnosed with ADHD had on parents, Corcoran et al. (2017a) found parents struggled with the emotional burden of caring for a child with ADHD and managing the hyperactive, impulsive, inattentive behaviours including lack of focus, forgetfulness, inability to listen and complete tasks, poor grades, tantrums, aggression, risk-taking, poor social relationships and running off.  Parents talked about the constant mess, and the chaos and conflict that besieged their home life.  As a result of this struggle, parents spoke of a myriad of intense, negative emotions: exhaustion, isolation, anxiety, irritation and frustration, anger and resentment, despair and desperation, powerlessness and helplessness, grief, pressure and stress, suicidality, and guilt.

Caregiving was experienced as a 24-hour-a-day undertaking (teacher, mother, minder, carer, everything). Typical family routines proved to be a daily challenge, e.g. night-time (not going to bed), morning (running late regardless of rising time), hours after school around homework and errands.  Normal behavioural discipline techniques (reinforcing positive behaviours and ignoring undesirable behaviours) only worked in a limited way.

The challenges of parenting spilled into other areas of parents’ lives.  Stress impacted on health, psychological, marital and social wellbeing.  Parents changed or quit their jobs to better manage their child’s behaviour.  The children’s relentless misbehaviour negatively affected the marital relationship: disruption to any time together, mothers became primary disciplinarians because fathers did not know what to do, men (due to personal undiagnosed ADHD) were unable to provide the patience, organization and structure that the child demanded (Corcoran et al., 2017a).


Diagnosis


Diagnosis is most commonly made in childhood. In the majority of cases, young people continue to experience ADHD behaviours and qualities into adulthood.  There is no single, definitive test for ADHD. Specialists will base a clinical diagnosis on observations of the child, discussions and questionnaires (with both parents and child), and information from the child’s school.  They will consider how long the behaviours have been present, how much they impact daily life and whether they might be due to another condition. Around 60-80% of children with ADHD have at least one other condition (such as autism, dyslexia, dyspraxia, anxiety or behavioural issues). In some cases, this means a child may be given more than one diagnosis (Karlsson & Lundstrom, 2021; Young Minds, 2022).  ADHD Foundation (2021) discusses the conditions that occur alongside ADHD at length (e.g. autism, Tourett’s Syndrome/Tic disorders, depression, bipolar disorder, anxiety, OCD and sleep disorders).  The document devotes a number of pages to a discussion of the similarities and differences of people presenting with ADHD and autism.


The diagnosis process can be a worrying one for parents.  Parents will be struggling with their child’s problems, be aware of the existence of ADHD but not sure about the path to take.  Parental disagreement can be common with family and friends weighing in.  Pressure can come from school teachers for a diagnosis because of poor behaviour and academic performance.  Once a diagnosis is received parents may be concerned about treatments—the approach to take (behavioural management, natural remedies and prescribed medication).  If medication is advised, parents may be concerned about cost, potential for addiction, and long-term consequences.  They may explore other options before embarking on the medication route (Corcoran et al., 2017b.)


Treatment


In a recent article Karlsson and Lundstrom (2021) state that treatment options consist of pharmacological (in particular methylphenidate) and psychosocial interventions.  There is a general research consensus that methylphenidate has positive short-term effects on ADHD symptoms.  The effects of different kinds of psychosocial interventions, on their own or in combination with medical treatment, do not have the research foundation of pharmacological treatments and show mixed results in effectiveness..


On the other hand, Reach out (2023a), Young Minds (2022) and the AHDH Foundation (2021) all suggest medicine, support from mental health professionals and practical self-directed management techniques (often used in combination) can be effective forms of treatment.  The two types of medication used are:

  • Stimulants: These medications work by increasing the amount of dopamine in the brain, which can reduce the feelings of distraction and hyperactivity people with ADHD experience. They have several known side effects, such as loss of appetite, feelings of frustration, and issues with sleep.

  • Non-stimulants: These medications work differently from stimulants and are often used when stimulants cause too many side effects. They take longer to start working, sometimes up to several weeks (ADHD Foundation, 2021; Reach Out, 2023a).


Mental health professionals such as psychologists, social workers, peer workers and counsellors can’t prescribe ADHD medications, but they can:

  • help identify issues with a person’s mindset that are making symptoms more difficult to manage

  • listen to accounts of the challenges experienced and offer professional analysis and advice

  • use proven therapy methods such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy, which can be helpful for people with ADHD

  • help with experiences such as anxiety and depression, which are more common among people with ADHD and can also worsen its symptoms

  • provide ADHD-focused parent training (Reach Out, 2023a; Young Minds, 2022).


Management techniques are described in the following section.


Practical strategies for management


How to manage feeling distractible (Reach Out, 2023a, 2023b)

  • Forgive yourself for being distracted.  ‘That’s okay. I’ll just get back to what I was doing.’

  • Think about doing the activity in a different way.

  • Change the place where you are working.

  • Make distracting things less easy to access.  Put the phone in another room.

  • Set alarms for things you tend to forget, e.g. medication or taking breaks.

  • Keep reminders around your home (e.g. on the fridge) of things that usually help if you’re having a tough day with concentration or fatigue, such as drinking some water or having a snack.

  • Plan ahead – e.g. make sure you pack your bag for school or work the night before so that you aren’t trying to find everything in a frantic rush in the morning.


How to manage feeling disorganised (Reach Out, 2023a, 2023b; Therapist Aid, 2019)

  • Time things around your ADHD – e.g. if you know that your brain struggles to wake up properly in the morning, avoid scheduling morning meetings; or if you know that you tend to hyperfocus at around 2 pm, set aside time to get schoolwork or projects done then.

  • Use planning strategies, e.g. regularly write lists, bullet journaling, have an online calendar that opens automatically so you can always see it.

  • Create a daily schedule – over schedule rather than under schedule.

  • Break tasks into smaller tasks.

  • Focus on the positive outcomes of completing a task.

  • Reward yourself for completing tasks.


Supporting a child with ADHD

(ADHD Foundation, 2021; Kent Community Health, 2023; Therapist Aid, 2014; Young Minds, 2022)

Be understanding             Try not to get angry or frustrated. Separate the child from the behaviour.


Avoid arguments               Reduce emotion, be specific, keep calm, repeat, use time out, use carrot-and-stick approach “John, I want you to go to the chair now.  If you go now you can watch TV tonight.  If you don’t go now, there will be no TV tonight.  It’s your choice.”


Create a simple list of rules          Focus on the important behaviours and let the small stuff slide; focus on accomplishments.


Clear and open communication  Create a quiet time to talk, ask open ended questions, talk with or not at all, talk calmly in challenging situations, talk positively, listen. 

   

Give simple instructions                 Make sure they are looking at you so you have their attention. Talk slowly and calmly. Break tasks, like getting ready for school, down into steps, e.g. ‘first brush your teeth then put on your shoes’.


Set clear boundaries       Be explicit and consistent about unacceptable behaviour, such as violence. Set appropriate consequences and follow them through but try to stay calm in the moment to avoid escalation.


Involve the family              Explain ADHD to siblings and family members and discuss how everyone has different needs. Make sure attention isn’t always focused on the child with ADHD, recognise the potential impact on siblings.


Build healthy routines   Plan the day so a child knows what to expect. Maintaining regular sleep patterns, physical activity and mealtimes can help a child.


Help with organisation  Checklists, visual timetables and sticky notes (in key places like the front door or desk), phone alarms and other aids are helpful. Try not to completely take over so that a child can develop organisational skills.


Praise the child                   Acknowledge successes (however small), but don’t over-praise. Try to praise or reward immediately and be specific about the reason to help reinforce good behaviour.


Manage triggers                 Look for signs a child is becoming frustrated or over-stimulated and try to remove them from the situation. A diary of times and triggers can be helpful. Keep playdates for younger children short to avoid them being overwhelmed.


Use grounding techniques             Focus attention away from a stressful situation, e.g. use a five-step process: name 5 things you can see, name 4 things you could reach out and touch, name 3 things you can hear, name 2 things you can smell, name 1 thing you can taste.


Recognise strengths        Help your child identify their individual strengths and celebrate them. Recognise that ADHD can bring positives too, such as extra enthusiasm for a hobby, or creativity. Highlight successful role models with ADHD.


Find local support             Parenting programmes and support groups can help reduce stress and isolation as well as be a source of new ideas and strategies.


Supporting teenagers with ADHD

(Young Minds, 2022)

Build independence        Though your child may need extra support for longer than others, it is important to help them develop independence, confidence and build self-esteem.


Manage their support     They should feel empowered in decisions about medication, therapies and how their ADHD or mental health is communicated with others.


Support transitions         Leaving school, starting college or university, finding work or leaving home may be especially challenging. Help them find strategies and sources of support, such as Disabled Students Allowance (DSA) or university support services.


Understand new challenges         Talking about potential issues such as taking risks, substance abuse, stress, anxiety and low mood can help them plan for and articulate challenges and feel supported.


Encourage open and honest communication        Set aside time each day, speak honestly about ADHD, point out people with ADHD who can be role models, encourage activities where teenagers meet success.


Medication

 

A comprehensive treatment plan should include psychological, behavioural, educational advice and interventions. Medication is added when appropriate. Medication does not cure ADHD, but it can provide a window of opportunity in which a child can be helped to manage their own behaviours.  Medication can reduce the signs and symptoms of ADHD in 70 to 80 per cent of children with ADHD but it must be used in conjunction with continued, reasonable and consistent behavioural techniques.  There are a number of different licensed medicines to use so if one does not suit a child, then a different one may be provided by the health specialist (Kent Community Health, 2023).


Social work literature and ADHD


Some recent literature suggests the social work profession should take an active part in discussions and research on how to approach and understand the phenomenon of ADHD for a number of reasons:

  1. The prevalence of ADHD is very high in child welfare populations when compared to the general youth population, e.g. there is a strong correlation between living in foster care or residential care and ADHD diagnosis.  This leads to the conclusion that research on ADHD in the child welfare system should be a top priority in social work (Karlsson & Lundstrom, 2021).

  2. It is important to understand ADHD in context, not just as a medical condition.  Social workers often begin with a biopsychosocial assessment, placing them in an ideal position to understand ADHD in context.  From this position, and with sufficient knowledge of ADHD, social workers can provide appropriate suggestions to clients (Karlsson & Lundstrom, 2021).

  3. Parents are under considerable stress trying to manage their children’s behaviour and experience a toll on their lives in terms of their partner relationships and occupational functioning.  They feel ineffective in their parenting roles.  Social workers can educate parents on typical reactions and validate and normalize their concerns.  Helping parents connect with support—family and friends and/or support groups or formal services—is key for a parent’s own mental health, health and partner relationships (Corcoran et al., 2017a).

  4. Given the marital relationship is often under strain, social workers are ideally placed to work with both parents together to help unify maternal and paternal parenting efforts and help the couple feel supported (Corcoran et al., 2017a).

  5. Social workers, operating from a strengths-based perspective, can point out personal and environmental resources that parents are activating to cope.  “This sounds very difficult.  How are you managing?  What do you tell yourself?  How are other there for you?  What personal qualities do you have that see you through?  How do you find meaning in this?” (Corcoran et al., 2017a).


Practice Approach


The material presented above implies social work practice could revolve around the following.

  • Appreciate both the challenges (e.g. speaking or acting without thinking, struggling with organisation and attention), and the positives (e.g. divergent thinking, hyperfocus and resilience) that an ADHD diagnosis brings.

  • Use a strengths-based approach with all those impacted by ADHD: adults with ADHD, friends and family of these adults, parents of children with ADHD, the children themselves, and teenagers with ADHD.

  • Be able to explain in simple terms the neurological basis of ADHD and how it may provide the person with advantages others do not have such as creative thinking, hyperfocus and problem solving.

  • Know about types of ADHD, signs and symptoms in both adults and children, and the impacts it can have on a person’s life (easily distracted, disorganised, impulsive, creative, vulnerable to addiction and social difficulties) and the life of people around the person, especially parents of children with ADHD.

  • Be prepared to support parents through the diagnosis pathway.  Be aware of the various approaches to treatment (medication, support form mental health professionals, and self-directed management techniques) so adults and parents can feel supported in the choices they eventually make.  Remember to practise self-determination.

Social practice could involve:

  • listening to accounts of the challenges experienced and offer professional analysis and advice

  • using proven therapy methods such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy, which can be helpful for people with ADHD (found elsewhere on this website)

  • helping with experiences of anxiety and depression, which are more common among people with ADHD and can also worsen its symptoms

  • providing ADHD-focused suggestions for both adults and parents of children with ADHD (i.e. listen, reflect, and offer possibilities for both adults and parents with children to consider—see the ‘practical strategies for management’ section above).


The recent social work literature suggests social workers should be aware of the following:

  • A biopsychosocial assessment may provide valuable insight into the adult with ADHD and the parents of children with ADHD, insight that may uncover client strengths than can be utilised to provide appropriate suggestions to clients.  These strengths will arise from personal and environmental resources.

  • Possible questions that may uncover a person’s strengths: “This sounds very difficult.  How are you managing?  What do you tell yourself?  How are others there for you?  What personal qualities do you have that see you through?  How do you find meaning in this?”  A Solution-focused and/or Problem Solving approach may be relevant (found elsewhere on this website).

  • The prevalence of ADHD is very high in child welfare populations when compared to the general youth population.

  • Parents with children with ADHD can find partner relationships and the employment are impacted.  Working with both parents can be an option to provide couple support.

  • Normalizing the concerns parents and adults who are struggling with ADHD have and connecting them with social support (family, friends, or formal services) may help.

Supporting Material / References


ADHD Foundation. (2021). Understanding and supporting my child’s ADHD: An information and resource booklet for parents and carers of children and young people with ADHDhttps://www.adhdfoundation.org.uk/wp-content/uploads/2023/02/ADHD_ParentPrimaryCareBooklet_London.pdf


Chronaki, G., Benikos, N., Soltesz, F., & Sonuga-Barke, E. J. S. (2019). The reinforcing value of delay escape in attention deficit/hyperactivity disorder: An electrophysiological study.  Neuroimage Clinical, 23, 101917.  doi: 10.1016/j.nicl.2019.101917


Corcoran, J., Schildt, B., Hochbrueckner, R., & Abell, J. (2017a). Parents of children with attention deficit/hyperactivity disorder: A meta-synthesis, part 1.  Child and Adolescent Social Work Journal, 34, 281-335.  https://doi.org/10.1007/s10560-017-0497-1


Corcoran, J., Schildt, B., Hochbrueckner, R., & Abell, J. (2017b). Parents of children with attention deficit/hyperactivity disorder: A meta-synthesis, part 1.  Child and Adolescent Social Work Journal, 34, 337-348.  https://doi.org/10.1007/s10560-016-0465-1


Karlsson, P., & Lundstrom, T. (2021). ADHD and social work with children and adolescents.  European Journal of Social Work, 24(1), 151-161.  https://doi.org/10.1080/13691457.2019.1592122  


Kent Community Health. (2023). An introduction to ADHDhttps://www.kentcht.nhs.uk/leaflet/an-introduction-to-adhd/


Reach Out. (2023a). ADHD: Everything you need to know. https://au.reachout.com/articles/everything-you-need-to-know-about-adhd 


Reach Out. (2023b). Learning to love having ADHDhttps://au.reachout.com/articles/learning-to-love-having-adhd


Therapist Aid. (2014). ADHD interventions for parentshttps://www.therapistaid.com/therapy-worksheet/adhd-interventions-for-parents


Therapist Aid. (2019). Tips for managing ADHDhttps://www.therapistaid.com/therapy-worksheet/tips-for-managing-adhd


Young Minds. (2022). Supporting your child with ADHD. https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/adhd/

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