How Should You Treat a Child With ADHD?

I am writing this article not as a parent but as that child. I received my diagnosis at twenty-three, which means nobody treated me like this in my childhood; nobody knew.

So some of what I write here comes from research and some from my own memory: which sentences said to me I carried for years, and which ones really made something easier.

A preliminary note is necessary: ADHD is not caused by parenting. It is a developmental picture with high heritability, and I covered this separately in the article on whether ADHD is hereditary. The blame laid on families for years rested on a wrong foundation.

But what a parent does still changes a great deal. Not the symptoms; what kind of life the child will build with those symptoms.

What the evidence supports

The NICE guideline (NG87) recommends behavioral parent training programs as the first step in children. The meta-analysis by Sonuga-Barke and colleagues (2013) also shows that these programs have a positive effect on parent reports; the same study honestly reports that this effect is not seen when the person doing the assessment does not know which group the child is in. So the effect of these programs on core symptoms is debatable; even so, the reason they stand at the first step in guidelines is that they change the tools in the parent's hands and the tension at home.

The shared logic of these programs is simple: instead of trying to change the child, changing the environment and the feedback.

Core principles

1. Let feedback come immediately.

In ADHD the value of a delayed reward drops fast. In the glossary it appears as reward delay.

In practice: "We'll look at the report card at the end of the month" does not work. "You sat down and did your homework today, let's do something together this evening" does. Small and immediate is more effective than big and later.

I lived this the other way around. Every reward I was told about was far away: the summer holiday, the report card, university. None of them reached the homework desk in front of me.

2. Reduce the number of rules.

Five rules work better than twenty. Few, clear and consistent rules.

A rule needs to be concrete. "Be good" does not count as a rule; "the phone stays on the table at meals" is a rule.

3. Catch the positive.

A child with ADHD receives far too many warnings through the day. This balance has to be tipped deliberately: noticing and saying what was done right.

This does not mean showering with praise. Being concrete is enough: "You put your shoes away, I noticed." The sentences that did me the most good were in this tone and there were few of them; I still remember a few of them today.

4. Break the instruction up.

One job at a time. Making eye contact while saying it, then having it repeated back, helps.

The third item of a three-part instruction will probably get lost. This is not a sign of stubbornness; it has to do with the limit of working memory.

5. Build visible structure.

A morning list hanging on the wall, a flow with pictures, a visible timer. In ADHD the structure that cannot be built from the inside is built from outside; in the glossary it appears as an external scaffold.

6. Announce transitions.

Saying "we're leaving in five minutes" markedly reduces the resistance created by a sudden transition. I still live through how hard it is to pull away from a task in my adult form, and as a child the name put on this in me was "stubbornness."

A child may not know the rule. Or may know the rule and still be unable to apply it in that moment. Responding to these two in the same way is trying to solve the wrong problem.

Why punishment is not enough

Punishment stops behavior in the short term. What it does not do is teach what to put in its place.

Also, a child with ADHD already receives many negative feedbacks a day. The long-term result of this accumulation is the verdict the child reaches about themselves: there is something wrong with me.

This is the heaviest load to carry, and it stays even years later. I covered the details in the article on shame and self-compassion in ADHD.

Punishment does not disappear entirely; there have to be consequences. But the consequence needs to be known in advance, proportionate and consistent. Punishments set in a moment of anger are inconsistent and do not teach.

Not overlooking the quiet child

I have a personal reason for writing this section. I was not the child who wrecked the classroom. My grades were not low either. I did my homework the last night, I drifted away while listening to the lesson and nobody noticed anything.

This is how the inattentive presentation works: because it causes no disturbance, no referral comes. Teacher comments usually go like this: absent-minded, a daydreamer, not living up to potential.

If your child has no restlessness but the following picture is there, it is worth taking into account: constantly losing things, doing homework and forgetting to take it to school, getting stuck on multi-step tasks, going back to the same line when reading. I wrote the childhood form of the symptoms in detail in the article on ADHD symptoms in children.

A common mistake: taking the good day as the measure

There is a sentence that still tightens my chest when I hear it today: "But you could do it yesterday."

In ADHD performance changes from day to day, and one good day does not mean the task can now be done every day. Reading this fluctuation as a choice produces in the child the conclusion "I don't want to."

It is possible to use a good day as information rather than as evidence: what was different that day? Had they slept better, was the environment quieter, had the job been broken into smaller parts? The answer usually turns out to be in the environment, and the environment is something that can be repeated.

I wrote about homework follow-up, the daily matter at home, step by step in a separate article.

The school side

Working together with the teacher is as decisive as everything at home.

Concrete requests that help:

• Sitting in the front row.
• Instructions given in writing too.
• Long assignments broken into parts and intermediate hand-in points.
• Short movement breaks during the lesson.
• Extra time or a quiet environment in exams.

When asking for these, there is no need to hesitate with "it will look as if I asked for special treatment"; most of these arrangements help the other children in the class as well. I went into the subject in more detail in the article on ADHD at school and university.

The parent themselves

This is the least talked about heading. The review by Johnston and colleagues (2012) examines the parenting experience of adults with ADHD and shows that sustaining consistency can be an additional difficulty.

Given that heritability is high, the chance that the picture is also present in the parent of a child with ADHD is high. What this means: if you struggle to build a system, this may not be a parenting failure. Having your own assessment done helps your child too. I covered this side in the article on being a parent with ADHD.

How to explain it to the child

Explaining in an age-appropriate and non-blaming language prevents the child from seeing themselves as "broken."

The framework that works is this: your brain does some things differently; remembering and starting are hard for you, so we are setting up tools that will help you.

This does not remove responsibility. It only shows the place of the difficulty correctly. It also needs adding that diagnosis and medication decisions belong to the doctor; this article is not a substitute for a treatment plan.

What remains after years

When I look back on my own childhood, what I remember is not the warnings I got. It is what the warnings left in me.

A child carries for years the difference between the sentence "you were messy today" and the sentence "you are a messy person." The first describes a day, the second builds an identity.

The most valuable thing that can be done, I think, is never to say that second sentence.