Understanding ADHD

What to know and how to support children

During the pandemic, TikTok was alive with snippets of people’s lived experiences of ADHD. Many people, especially younger women and girls, were able to identify with the stories being shared: struggles to follow instructions, to start tasks, and resist temptations, to name just a few. Whilst this was helpful in raising awareness of the disorder amongst the general public, a recent study found that 52% of the information presented on TikTok with ADHD related content contained misinformation. So what is ADHD, which brain processes cause the traits we experience, and how can we support young people with these agile and energetic brains?

Let me start by defining ADHD and the criteria for diagnosis. ADHD stands for Attention Deficit Hyperactivity Disorder, and is defined by the Royal College of Psychiatrists as: “A pattern of behaviour which usually appears in childhood. Parents and teachers notice that a child is: unusually over-active; distracted, cannot stick to anything for any length of time; impulsive, does things on the spur of the moment or without thinking; unable to concentrate for any length of time. Many of us might have one of these problems, but we do not have all of them. To have a diagnosis of ADHD, these problems must be bad enough to interfere with: How you get on with other people - or How you get on at work or school.”

It is important to note here that the key defining factor for an ADHD diagnosis is how it affects relationships or performance at school or work: it must have an adverse effect on someone’s life to be a disorder.

There are three types of ADHD presentations: inattentive (not hyperactive- impulsive), hyperactive-impulsive (not inattentive) and combined.

Traditionally, girls are much less likely to be diagnosed with ADHD than their male peers. The ratio of boys to girls diagnosed in childhood falls in the range of 2:1 to 10:1. This is a result of both environmental and systemic factors. Firstly, girls are much more likely to mask their ADHD traits at school than their male classmates. This is because girls are socially expected to be more compliant, quiet, tidy, etc. Secondly, the criteria for diagnosis, as is too often the case, was devised around male norms and doesn’t account for norms in females. Women and girls often receive diagnosis of anxiety, depression or bi-polar disorder before the underlying causes are better understood. The rise in girls and women being diagnosed with ADHD is largely thought to be a correction of this discrepancy - there have always been girls with ADHD, we just didn’t recognise it. Many

people describe girls with ADHD as a bit “scatty”, however, we prefer clever but chaotic… let me explain more about what I mean here.

Regardless of a person’s gender, ADHD is largely understood to be caused by differences in the development of cognitive executive functions - brain functions found in the prefrontal cortex of the brain (just behind the forehead). These brain processes are responsible for: inhibitory control - stopping ourselves from following our instinctual responses; working memory - holding information in mind whilst completing complex tasks; and cognitive flexibility - the ability to mentally play with ideas and see things from different perspectives. These three brain functions are behind a series of 11 or more executive function skills, such as: organisation - maintaining systems to keep things tidy; time management - the ability to sense time passing and be punctual; sustained attention - the ability to maintain focus and concentration and task initiation - the ability to get started on tasks in a timely manner. People who have executive function challenges, are often very academically able, but really struggle to get things down on paper, keep their belongings tidy and manage their workload - especially as more independence is needed, in senior school, at A Level and at university. Hence, often their intelligence is noticed to be out of kilter with their performance and general organisation. Everyone has strengths and challenges in their executive function skills and when we are stressed, tired, hungry or feeling lonely, these traits can worsen. As parents, we can all remember the sleepless nights with our newborns and how this impacted our ability to be productive the next day. Executive function challenges are a natural and normal part of being human. Most people with ADHD often have variable executive function strengths in sustained attention - when motivated (think computer games or YouTube), we can hyperfocus for hours, but when we lack interest in a task (i.e homework), it can be like pulling teeth to get anything done. This can change from day-to-day depending on how well we have slept and eaten and how stressed we are. I dream of a future where everyone knows about executive function skills, can talk openly about their strengths and challenges and feel understood and supported by those around them. Whilst medication to help improve concentration can help people with ADHD, it is widely accepted that a ‘pills and skills approach’ is most effective. This approach acknowledges that there is no quick fix with medication and that working on executive function skills can develop life long habits and ways of living which are beneficial throughout all stages of life. At Connections in Mind, we offer executive function coaching which supports students to develop these skills according to their own goals. We also offer training for schools, workplaces and families to help create neuroinclusive environments where everyone’s executive function strengths and challenges are understood. In these environments, people feel supported to build stronger skills - helping them to flourish and meet their potential.

“Regardless of a person’s gender, ADHD is largely understood to be caused by differences in the development of cognitive executive functions.”

VICTORIA BAGNALL, Co-Founder and Managing Director www.connectionsinmind.com