ADHD FRIENDLY SCHOOLS QUALITY MARK

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Laurel Watkins
6 years ago
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1 ADHD FRIENDLY SCHOOLS QUALITY MARK Guidance and Support Registered Charity No:

2 Contents Page: 3 Completing the Audit 4 How do I recognise ADHD? 5 What do I do if I think they have ADHD? Can I Diagnose? 6 Assessment and diagnosis process 7 Ten point observation list on ADHD behaviour 9 What is QB Check? 10 Co-morbid Conditions 12 Questions we should ask ourselves in support of ADHD 13 Celebrating Difference - #BornToBeAdhd Appendices: Licensed Instructor Parents Programme Licensed Instructor Parents Programme Booking Form Further advice and guidance documents are available at or contact jane.cordes@adhdfoundation.org.uk

3 Completing the Self-Audit: Have you got the right IDEA? Using the grid provided you need to establish where you are on the journey to becoming an ADHD Friendly School. As stated in the overview, this is not another bolt on initiative but rather a way of presenting your curriculum and learning to ensure progress for all. You will collate your evidence (IDEAL) through a number of mechanisms, some of which might be: School Development Plan Subject/Year Development Plans Lesson Observations Peer Review Whole School Policies SEND Interventions including screening, referrals and sound external partnerships School Data Academic and SDQ s Minutes of Meetings SLT, SMT, Subject, Year Team, KS Leader, Governors etc Ofsted Report External Reviews Once you have established where you are on the IDEA continuum then you can create an action plan for each standard that requires further work to embed. You can only go for ADHD Friendly Schools Assessment once you feel you have achieved Embedded in all AFS standards. We would expect at this time that some areas will be Advancing and will be seen as areas of outstanding practice within your organisation. Once you have registered your intention to achieve ADHD Friendly Schools Status then you will be able to access direct support from a member of the team at the ADHD Foundation. They will be available via phone or . This could also include a preliminary visit to help you get started (*additional cost). However, you will be encouraged to join the ADHD Friendly Schools Facebook group where you can communicate with other schools to support your journey. It is vitally important that all staff are involved in this process as only then will your organisation achieve ADHD Friendly Status. The first part of this journey will be to timetable a full staff (whole day) training session Understanding and Managing ADHD. It is only from this starting point that staff will be able to apply the knowledge and skills to their pedagogy and practice. Additional materials will be provided during the training to assist with successful assessment. 3

4 How do I recognise ADHD? Here are some ways ADHD can present: Poor organisation Why do we take so long to get out of the house in the morning? Trouble staying on task Why do you never finish anything? You just don t care. It would be much easier for you to just finish the task. Poor sense of time What have you been doing all lesson? You have spent 30 minutes and have only written the title and date. Time moves too slowly Sir, this game is taking too long to play. Let s do something else. Poor internalisation of rules Josh, how may times have I had to tell you that you that you can go out after your tea Poor sense of self-awareness What were you thinking? Did you not ask yourself what would happen if you didn t hand in your homework? Poor reading of social cues Can t you see that the other kids think what you are doing is inappropriate behaviour? Inconsistent work/behaviour Why did we have such a great day yesterday and today is awful? Hyper-focusing How come you can spend hours on computer games but when I ask you to do your homework on the computer you find this so difficult? Frequently overwhelmed Mum stop it! I can t stand this talking, just stop talking to me! Push away those who want to help Dad, go away! Stop checking my work! Leave me alone! Get away from me! Children with ADHD can become very critical of themselves. It is instinctive for children to want to learn and to please the adult. When they say I don t know why I didn t do as I was told: often they genuinely did not know why? They know they create difficulties but they do not choose this behaviour but rather act/speak impulsively without thinking about the consequences. If behaviour management isn t approached correctly, the child with ADHD will internalise into their self-concept that they are naughty and will act out according to the identity they have been given by the adult. 4

5 What do I do if I think a child/young person has ADHD? Fact: A Teacher/School cannot diagnose ADHD Early intervention is key and if you think that a child/young person is demonstrating ADHD characteristics then act immediately by introducing ADHD strategies into teaching, the curriculum and support, both academic/pastoral. Time lost has a significant impact on both attainment and positive life outcomes. Clinicians will not diagnose under the age of 6 years. The referral process can be quite slow and this varies significantly around the country. As the teacher you will need to have a meeting with the parents/carers to discuss your concerns and also to discuss if there are any patterns or characteristics which are exhibited at home. It is very important to establish and maintain a positive relationship with the parents/carers as you both want the best for the child/young person. Remember that ADHD is genetic and so there is a possibility, but not in all cases, that the parent you are dealing with also has ADHD, whether diagnosed or not. You will need to advise the parents/carers to visit their GP to start the process. You can also make a referral to the CAMHS team and/or the school nurse. The GP Visit: The GP can't formally diagnose ADHD, but they can discuss concerns with the parents/carers and refer the child/young person for a specialist assessment, if necessary. Advise parents that the GP will ask: about the symptoms of the child/young person when these symptoms started where the symptoms occur for example, at home or in school whether the symptoms affect your or your child s day-to-day life for example, if they make socialising difficult if there have been any recent significant events in your life or your child's, such as a death or divorce in the family if there's a family history of ADHD about any other problems or symptoms of different health conditions you or your child may have It would be helpful if school provided a letter to take to the GP which outlines the characteristics which are consistently observed. This may help speed up the referral process. If the GP considers that the child may have ADHD, they may first suggest a period of "watchful waiting" lasting around 10 weeks to see if the child's symptoms improve, stay the same or get worse. They may also suggest starting a parent training or education programme to teach ways of helping and supporting the child whilst on the diagnosis pathway. 5

6 If the child/young person s behaviour doesn't improve, and both the parents/carers and the GP believe it's seriously affecting their day-to-day life, the GP should make a referral to a specialist for a formal assessment (NHS Choices, 2016). Assessment: There are a number of different specialists that can complete a formal assessment, including: a child or adult psychiatrist a paediatrician (a specialist in children's health) a learning disability specialist, social worker or occupational therapist with expertise in ADHD Who the child/young person is referred to depends on their age and what is available in your local area. To make an accurate assessment for diagnosis the specialist will do a range of tests which may include: a physical examination, which can help rule out other possible causes for the symptoms a QB Test to determine prominent characteristics a series of interviews with you or your child interviews or reports from other significant people, such as parents/carers and teachers. The school may also complete a QB Check and provide these result for the specialist Diagnosis: Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, the child must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness. To be diagnosed with ADHD, the child/young person must also have: been displaying symptoms continuously for at least six months started to show symptoms before the age of 12 been showing symptoms in at least two different settings for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or parental control symptoms that make their lives considerably more difficult on a social, academic or occupational level symptoms that aren't just part of a developmental disorder or difficult phase, and aren't better accounted for by another condition 6

7 Ten Point Observation List on ADHD Behaviour 1. Eye contact: Avoidance of eye contact is ADHD/ASD behaviour they may look as if they are ignoring you but some children find making eye contact really difficult. 2. Fidgeting: Not standing or sitting still or fiddling with something whilst you are talking with them, i.e. pens, books, or something on your desk. This behaviour does not mean they are not taking in what you are saying to them; they will be. If unsure, ask them to repeat back what you have just said to ensure their understanding. 3. Wandering: Avoidance of work-adhd behaviour, possibly they don t know what to do or what you want from them, so rather than fail, they just won t do it. If I don t do it then I can t get it wrong. Sometimes children with ADHD prefer to be told off than to get work wrong and be perceived as stupid. Getting started or completing a task may be due to the inability to direct their focus and not because they just can t be bothered or are lazy. 4. Inappropriate behaviour: ADHD children have difficulty with understanding inappropriate behaviour i.e. burping in class and other uncontrollable noises, they see these things as being funny and socially acceptable; we on the other hand see it as unacceptable. They also tend to make remarks that are inappropriate to the situation i.e. Sir, why have you got a hole in your sock? They say what they see; they have difficulty reading social cues. 5. Consequences: Children with ADHD make no connection between behaviour and consequences. If you point out a behaviour issue to a child they may acknowledge it and be very sorry for what he/she has done, but five minutes later they may do the very same thing again. Lack of executive functioning (analysing, problem solving and understanding sequence of actions and consequences) results in impulsive and unconsidered behaviours. 6. Daydreaming: is an ADHD characteristic, not paying attention or being distracted by other events that are going on outside/inside. It is not that the child is not paying attention: it is more likely the child is paying too much attention to everything and not focusing on just one thing. 7. Negative self-esteem: Personal experience of not being able to understand instructions clearly, forget instructions or information, impulsive words and actions all have social consequences. Children with ADHD can easily become frustrated at their own inability to understand and communicate with others. This results in feelings of isolation and exclusion from recognition, praise, reward and affection from adults and peers. This in turn creates anxiety which exacerbates ADHD characteristics. Inevitably this causes behavioural problems for children with ADHD who act out unable to articulate what they feel. I can t do that before they even try (fear of getting it wrong.) 7

8 8. Being the class clown: trying to make people laugh and cause disruption (possibility due to work avoidance) I can t do it so the class won t be able to do it either. OR I will gain the esteem and friendship of my peers by making them laugh (as I will not be able to gain the esteem and friendship from my teacher so I will behave in a way that meets my instinctive need for relationship and a sense of belonging. 9. Waiting turns: Children with ADHD find waiting turns, either in lines or in group work difficult; they act and speak without thinking ( in the head out the mouth ) this is the impulsivity of ADHD. They may be clumsy or accident prone; they may break things and accidentally hurt others. 10. Rule breaking: Children with ADHD will test out rules and structure: they need to know that they are there. They are not being defiant! They need boundaries and they need to know how far they can go. These children struggle in understanding boundaries as they have poor social observations. How do we as professionals experience children with ADHD? He disrupts my lesson Children with ADHD are often academically gifted but underachieve as their ADHD impacts on their Attainment. Key to minimising the risk of disruption of lessons is time resourced induction and relationship building with the teacher. A well planned fun induction at the start of term and getting the child to tell you about themselves and how their ADHD affects them is critical in establishing the teaching and learning relationship between you and the child. It will be easier to understand his/her behaviour in the context of his/her intention rather than his/her action: that is to say the quality of the relationship and the unconditional positive regard will motivate the child to win the approval of the powerful adult by responding to the need for approval and praise. He prevents other children from learning Many schools make use of circle or PSHE time as an ideal forum where children can learn how their behaviour impacts on their peers and help children develop an awareness of consequences but also empathy as they gain an insight into how their actions/behaviour make another child feel or indeed a teacher. This will allow pre-determined strategies to be implemented and considered fair amongst all children. 8

9 QB Check for Schools: 9

10 For more information about QB Check visit:

What other condition/disorders could it be? As stated in the overview document two thirds of those with ADHD will also have another condition and one third will have two or more.

11 What other condition/disorders could it be? As stated in the overview document two thirds of those with ADHD will also have another condition and one third will have two or more. This is termed a Co-morbid Condition. It maybe that you identify these more easily but as educators we must be aware that these maybe masking the underlying ADHD, for example, dyslexia. ADHD is a spectrum disorder and so just because you have met one child with ADHD, you haven t met them all. Observe each child for the characteristics and behaviours they are showing and remain objective. Some examples of comorbid conditions The more common are: Anxiety Disorder which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness Oppositional Defiant Disorder (ODD) this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers Conduct Disorder this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals Depression Sleep Problems finding it difficult to get to sleep at night, and having irregular sleeping patterns 11

12 Autism Spectrum Disorder this affects social interaction, communication, interests and behaviour Epilepsy a condition that affects the brain and causes repeated fits or seizures Tourette s Syndrome a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics Learning Difficulties such as dyslexia, Sensory Processing, Speech and Language It is useful to the clinician diagnosing that you portray all the evidence for any of the conditions that you observe which might be affecting academic progress and social, emotional development. Questions we should ask ourselves in support of ADHD Do I use good eye contact and good body messages? Do I start each day as a new day? Do I give short breaks to prevent stress and frustration? Do I give coping strategies when needed, children with ADHD need them? Do I get into arguments with children with ADHD in the classroom? Do I arrange my classroom to avoid confrontational routes? Do I always keep channels open for communication/ Do I always try for a win- win situation? Do I give clear directions or instructions? Do I expect a child with ADHD to be totally silent? Do I expect a child with ADHD to not fidget? Do I allow the child with ADHD to make it right and not hold over to tomorrow what has happened today? Do I reward only for task completion? What about reward for effort and progress? Do I offer opportunities for genuine choices, either or is not always a genuine choice? Do I make sure behaviour demands are differentiated? Do I give instructions in a clear and non-confusing manner? Do I use non-verbal communication, a nod, a thumbs up or a smile to reinforce spoken instructions? Do I give a structured environment where there is a dependable routine? Do I give lots of descriptive praise? Do I use a calming and informative voice so as not to confuse or threaten? Do I make changes using small well planned steps? Do I reward for self-management not just for perfection? Do I give the child with ADHD short work periods with short term goals? 12

#BornToBeAdhd The self-esteem and mental health of a child with ADHD or any disorder will be fragile as they may have experienced many negative situations both at home and at school.

13 #BornToBeAdhd The self-esteem and mental health of a child with ADHD or any disorder will be fragile as they may have experienced many negative situations both at home and at school. Role models play an important part in any child/young person s life and so part of any intervention should be to let them know and understand that It s the different which makes the difference. Research with your child/young person celebrities from a range of disciplines and discuss with them why they think that person has been so successful. This will help them to set goals and realise that this is a disorder which can give them the advantage if channelled early #BornToBeAdhd #BornToBeMe For further information and support please contact your ADHD Friendly Schools Advisor and visit the website: 13

ADHD and social skills M. T. LAX-PERICALL CONSULTANT IN CHILD AND ADOLESCENT PSYCHIATRY PRIORY HOSPITAL ROEHAMPTON

ADHD and social skills M. T. LAX-PERICALL CONSULTANT IN CHILD AND ADOLESCENT PSYCHIATRY PRIORY HOSPITAL ROEHAMPTON ADHD (DSM-5) persistent pattern of inattention and/or hyperactivity-impulsivity that interferes