For Physicians

School

The preschool age and environment are the perfect time and place to recognize ADHD impairments and begin to understand and support these children. Not allowing the child with ADHD to remain at preschool is a disservice to the child as well as the staff who should take the opportunity to learn about ADHD as they will undoubtedly have more children with ADHD cross their path in the future.

Behaviour Management

Behavioural therapy is the most effective if done as uniformly as possible between home and school. The implementation of behavioural support and strategies can occur even before an ADHD diagnosis, since these techniques are beneficial for all children. The key to ADHD behaviour management is consistency and immediacy through clear, calm positive communication. Children with ADHD are often subjected to an abundance of scolding, nagging and general negative interaction with adults and even other children. This takes a huge toll on their self-image and wellbeing.
Since ADHD is a very individual disorder which presents in a variety of ways, across a range of severities and commonly with coexisting disorders, finding the exact right behavioural plan may take some time. The help of an expert in the field of ADHD may even be required to get the process on the right track. However, here are some basic principles on ADHD behavioural techniques that often work in the home and school setting.

Behavioural Management Techniques for Home and School

1. Set up a limited number of rules focusing on a few hard and fast concepts such as we do not hurt people, we stay safe.
2. Structure the environment and set up consistent routines; consistency helps the formation of habits decreasing the load on executive functioning skills.
3. Pay attention to the child when they are doing what you want then to do and ignore nuisance behaviours or minimize your interactions around them.
4. Use positive consequences like praise, or small rewards like: additional time doing an activity they love, a sticker or star, or points toward a larger reward when the child is doing what you want them to do.
5. Be immediate and very specific when giving positive feedback on appropriate behaviour so they know exactly what they did right.
6. Give brief, simple instructions, without too many steps informing them of what you want them to do and not what you don’t want them to do.
7. Have them report back to you when they have completed the first step or two so you can praise and then share the next step or two in the sequence.
8. Provide visual prompts like picture charts as reminders.
9. Decrease distractions.
10. Be proactive: anticipate times and places when their self-regulation will be challenged and set up accommodations and strategies to help them cope.
11. Use parent/teacher social coaching to help the child acquire and practice social skills.

There are a variety of medical professionals that may assess/diagnose (and treat) ADHD:

Questions to ask your healthcare provider:

• What is the current wait time?
• Do they provide long term follow-up care?
• Is a full screening for other potential medical disorders part of the assessment process?
• Are there additional cost associated with the ADHD assessment

PHYSICIANS, PEDIATRICIANS, PSYCHIATRISTS, NEUROLOGISTS

The assessment and diagnosis of ADHD by a medical professional is generally covered by your provincial health care plan, however, always ask if any additional fees will be charged.

The potential diagnosis of ADHD should include;

• A medical history
• As psychiatric medical history
• Screening to rule out any possible physical disorders
• Vision and hearing test

PSYCHOLOGIST

Psychologists may assess and diagnose ADHD, but they cannot prescribe medication. Psychologists are not covered by provincial health care plans, but may be partially covered by private health coverage. Speak to the psychologist prior to contacting your private insurance provider.

Psychoeducational assessments are different from an ADHD assessment.

Children who are struggling academically may seek a psychoeducational assessment to assess whether any coexisting learning disabilities (LDs) may exist along with ADHD. A complete assessment of a child’s learning strengths and needs is essential for a student who continues to be impaired at school. Psycho-educational assessments cost approximately $2,000-$4,000

Important Things to Know About the Health Care Professional that you choose:

• Their expertise in the area of ADHD
• Their accreditation and registration (pertinent to a psychologist’s ability to diagnosis)
• What is the current wait time?
• Do they provide long term follow-up care?
• Is a full screening for other potential medical disorders part of the assessment process?

For more information about ADHD assessments please contact our Resource Navigator at info@caddac.ca

Common symptoms of ADHD in Preschool

While many behaviours such as: inattention, distractibility, being fidgety, tantrums and oppositional behaviour are common for preschool children these behaviours in a child with ADHD are more extreme. They are more frequent and more intense. Most often young children with ADHD will stand out in a group of children and appear to function as a younger child.

However, each child with ADHD will be unique; they will present with a different group of ADHD symptoms, on a spectrum from very mild to very severe. Symptom levels can vary throughout the day and from day to day but will always become more apparent when the environment and tasks before the child challenge their impaired skills.

Questions to Ask Yourself

1. Are the child’s behaviours similar to other children their age?
2. Would their behaviours appear to mimic those of a younger child?
3. Do the behaviours change in different settings? (symptoms will increase when placed in an environment that challenges their impairments)
4. Is the expected behaviour that you are NOT seeing something that would be developmentally appropriate for their age?

Treatment of ADHD in Children under 6 yrs

ADHD should be treated using a “multimodal‘ approach”. Simply put, this means using more than one type of treatment to manage ADHD symptoms. Examples of ADHD treatments are listed below

Psycho Education

Educating parents, individuals, and any other adults who routinely interact with the child about ADHD is the first and most important component of an ADHD treatment plan. Studies have shown that providing education on ADHD greatly increases the chance that treatment will continue long term. The more a family understands about ADHD and how it affects their child, the better they will be at making informed choices and implementing strategies and accommodations in the home. insert link to events page – parenting programs

Classroom/school Accommodations

It is important to seek classroom accommodations for your ADHD child, please refer to our section on education (insert link)

Behavior Therapy

Guidelines on ADHD for preschools developed by the American Academy of Pediatrics (AAP) state that behaviour therapy should be the first line of treatment for children four and five years of age. However, the guidelines go on to state that if behavioural therapy is not accessible, has not worked, or if symptoms are severe enough that the child or family are at risk of harm, medication can and should be considered. Insert link to“Understanding early childhood ADHD”

Exercise

Exercise produces several hormones that can benefit brain functioning and help improve focus.

http://add.about.com/od/treatmentoptions/a/ratey.htm
http://www.everydayhealth.com/add-adhd/can-you-exercise-away-adhd-symptoms.aspx

Mindfulness

Mindfulness can assist with better awareness of attention, manage stress, be less reactive to impulsive thoughts and be less judgmental of ADHD symptoms.

http://www.psychologytoday.com/blog/here-there-and-everywhere/201206/adhd-mindfulness-interview-lidia-zylowska-md

Sleep

Sleep plays a major role in our health and development. For example, sleep is important for learning, attention, and memory, academic achievement, and even physical growth1, 2. As such, it is important for children to get age-appropriate quality and quantity of sleep! According to the National Sleep Foundation, school aged children (6-13 years old) should receive between 9 and 11 hours of sleep each night3. Children who sleep less or who have poor quality sleep (e.g., up and down throughout the night) will not be able to perform their best during the day, especially in school.

PDF on ADHD and Sleep

Alternative Treatments

Access the Canadian Paediatric Society’s article on Alternative ADHD Therapies by clicking here.

Access a comprehensive article reviewing the evidence on Cognitive Training (brain training games) and brain training strategies by clicking here.

Medication Management – if required

It not usually recommended that children under the age of 6yr take ADHD medication, however in certain instances it may be required. Please speak with a knowledgeable ADHD physician to see if ADHD medication is right for your child.

In uncomplicated cases of ADHD, medication management is fairly straight forward and effective with minimal side effects. ADHD medication has been around for more than fifty years and there are thousands of published research papers on their safety and efficacy. There are two types of medications used to manage ADHD medication. For more information on medication please speak with a medical professional

1. Stimulant medication.
2. Non-stimulant medication

Please refer to the charts below for information on specific medications

• Medications access by province - https://www.caddra.ca/provincial-and-federal-public-formulary-overview/
• Medication charts - https://www.caddra.ca/wp-content/uploads/Final-Laminate-Card-2019_9-1.pdf