Your questions answered: Part two | ADHD in children: What to look for and what to do next

Dr Heidi Phillips, and Charlotte Jarvis, Practice Manager at Oxford ADHD & Autism Centre recently presented on the key signs of ADHD in children, how it can present differently depending on age and gender, and what steps parents and carers can take if they have concerns.

Within the session, they covered:

• Common signs of ADHD in children and how they may show up differently in boys and girls

• How ADHD can affect learning, friendships, and emotions

• When to seek professional advice and what the assessment process involves

• Practical strategies to support your child at home and at school

After the presentation, Dr Heidi covered a wide range of questions, and this post is the second in a series covering the most frequently asked questions. If you have not yet had an opportunity to watch the webinar, you can access the replay.

Questions answered in this post

• What should I do if I think a young child might have ADHD or autism?

• Is it better to wait for an ADHD assessment until they are six years old? My child is five and a half.

• Does a school need to make reasonable adjustments even if symptoms or behaviours are not present during the school day?

• If you are home educated, unable to attend school, or do not have school reports, parents, or other informants available, how is the information needed for an ADHD or autism assessment gathered?

I see a lot of parents coming through with concerns about ADHD because they've heard about ADHD, they've read about ADHD, they think some of the symptoms fit. But when I read the information, I'm sort of looking at it thinking, but that is more autism.

So, remember that with ADHD, the main signs tend to fall into inattention, hyperactivity and impulsivity. All children can be distracted or energetic at some times, but those with ADHD have persistence and it is seen as an impairment.

With autism, parents often notice differences in social communication, especially with friendships and relationships, and how a child experiences and responds to the world around them. They might find it hard to engage in social communication, or they might be very, very good at social communication and not really pick up on social cues. They might struggle with ping-pong conversations and have very strong interests, prefer routines and predictability, or become really distressed with change.

Autism overlaps with ADHD, but it's also different from ADHD. The advice for somebody who's a mum or a parent of a young toddler, what are the difficulties rather than what are the labels? And then how can you help with those difficulties? For autistic children, it might be sensory overwhelm as 93% of autistic children experience sensory overwhelm. Thinking about all the senses, how can you take away the sensory overwhelm?

We tend to do autism and ADHD assessments for those six years and older because other things that can impact behaviour that need to be investigated first.

I don't think there is a cut off age and I do think it depends on the route that you are going down. If you are fortunate enough to be able to go down a private route, then perhaps you would be able to get an assessment sooner rather than later. If you're on an NHS or right to choose route, then you have a waiting list. Therefore, with the latter two, referring in at 5 and a half years old might mean realistically it is a few years until they are seen, so that would be fine.

If you're talking about having an assessment within the next couple of months, I will be thinking, have we excluded everything else first? Because remember, it's not about do they have difficulty paying attention or is their behaviour poor. Have we got all the other information? What about hearing, vision, or any other conditions that could be occurring?

Do also established whether they have a language disorder. Do they understand speech and language? Do they have a receptive language difficulty, or an expressive language difficulty that means they do not really understand what it is you are asking, or they are processing the information slowly?

I would want to make sure that if I was pursuing an assessment, I have got all that other information from those other areas first.

I guess that is the question: If the child does not have any difficulties at school, then what adjustments are you wanting school to make?

I think my first approach is to sit down and, if possible, have a chat with my child, depending on their age. In primary school, I recognised difficulties for my daughter with social communication and friendship issues but the first I was aware of it was a handwritten note. Reading what she had written, I thought, she is quite impacted, there is stuff going on that I did not know about.

I went to see her amazing SENCO, showed her the note, and we sat down and talked about it. What she did not need was an assessment for autism at that point, she needed to be included.

The reasonable adjustments school made were to make her a library monitor. At break times, she would go into the library and rearrange all the books. They also let her go into the specialist teaching facility with the younger children, where she helped.

She had a role, she fitted in, and she felt important. The fact that she did not have friends of her own age was not a reasonable adjustment, and she still does not have a diagnosis, she has support, not necessarily ADHD support, but it was the support she needed for the difficulty she had.

We have to think about the assessment in the context of what is in front of us. No one is an island, so the person seeking the ADHD assessment is likely interacting with other people and having other relationships. There might be work, college, or extracurricular activities. There are going to be people and situations in other parts of their lives that can act as informants and show the “pervasively”.

The persistence is about what they remember from childhood and what information they were told about from childhood. For example, I remember my mum telling me that I had about half a dozen children from the neighbourhood round in the house. I had taken them upstairs, stood on the toilet, opened the bathroom cabinet, and handed out all the medication to my friends. We all ended up at A&E and had to be treated.

Another time, I put all my school uniform on a little bonfire in the back garden. Another time, I painted the inside of the house windows with emulsion paint. These are stories I was told about my childhood that might suggest unusual behaviours that most neurotypical children might not describe.