October is ADHD Awareness Month

How is ADHD currently treated and managed?

My first response to that as a parent is ‘not well enough’, but that needs some qualifying.

Firstly, medication can be considered. There are plenty of different medications that aim to treat the symptoms of ADHD. Paradoxically, they are all stimulant medications that increase the levels of certain neurotransmitters within the brain. This might sound odd, to stimulate a child that’s already hyperactive, but the effectiveness of these medications point to the fact that ADHD brains respond in a different way than ‘normal’ (or ‘neurotypical’) brains.

These powerful stimulant drugs, many of which are similar to amphetamines, have considerable side effects. They reduce a child’s appetite, at a time when they need to be eating well to maintain their growth. They can have an effect on organs such as the heart and liver, cause trouble with sleep, resulting in nausea, or headaches and even increase the incidence of suicidal thoughts.

Yet despite these problems, most children with ADHD will take these drugs, because the risks of not being able to learn or stay safe outweigh the risk of the side effects.

I was reluctant for my son to start taking such powerful medication at such a young age (he was 8) but I could see the distress that his inability to control his behaviour was causing him, as well as his failure to make the most of school, and learning – I could see, as a pharmacist as well as a Mum, that he would benefit from taking them.

Although not every child will need to take stimulants, it can be very helpful. While they don’t change the ADHD brain, it’s an accepted fact that taking medication improves the symptoms – they increase an ADHD child’s ability to focus, and control their inherent impulsiveness, allowing them to cope better with the structure of the school day, or social etiquette requires. It’s misleading to say that children will ‘grow out’ of ADHD, they will always have a brain that reacts differently; but they do develop ways to manage its impact and medication can support a child while they develop such strategies.

Even with the support of medication, schools are currently not well set up to cope with the needs and preferences of ADHD children.

School classes require children from a very young age to sit still for extended periods and to work with a large group of other children in a room full of colourful distractions. Everyone is expected to learn in the same way at the same time and it can be a real challenge for those whose brains don’t work the same way, be that due to ADHD, autism spectrum disorder, hearing or visually impaired or with processing differences such as dyslexia.

I might actually go as far as to suggest that the way traditional classes are currently taught actually suits very few of the children they have in them!

My daughter is training to be an educational psychologist, and currently working in a large comprehensive secondary school, with a high number of ADHD students, both diagnosed and undiagnosed. She agrees that much of the school day is set up to be reliant on sitting still and focused for extended periods of time – a challenge that many children, ADHD or not, find hard.

Like me, she also feels that while a ‘label’ of ADHD can be a form of shorthand to help explain to staff what additional support a child might need, it can also lead to expectations of lower achievement by teachers, which is surely detrimental. 

How can we improve things for ADHD children?

MEDICATION

Medication management is a key part – if it’s deemed necessary to take medication, finding the right meds to control impulsiveness with a minimum of side effects is important. Equally important is to constantly reassess the need to continue them and to ensure they are at maximum effectiveness as the child grows both in size (which might necessitate a change of dose) and maturity.

Most ADHD drugs are available as slow-release versions to get around the need to take them, more than once a day, but such an early start time for most school-aged children means that they may start to wear off just after lunch. If so, it may be worth considering a small ‘top up’ dose to help in the afternoon.

BEHAVIOURAL MANAGEMENT

Medication alone isn’t enough. Behavioural management is just as important, to develop and strengthen better responses to challenges that neurotypical children cope with more easily.

Children with ADHD annoy themselves. They sense that their brain is working differently and they are aware of and distracted by external stimuli, a constant bombardment of sensory input that takes them away from what they’re meant to be focusing on. Even if they are ‘trying’, it’s very hard for them to stay on task, especially in an environment with high input from other people – the noise, light, sensations, and movement all around combine to pull attention from doing their work.

They simply can’t help it.

And that’s without the internal drive to move – the hyperactivity component of ADHD that causes them to move, fidget, talk or otherwise act compulsively.

Behavioural management might be as simple as allowing an ADHD child to have a ‘fiddle toy’ to expend the urge to physically move. It might involve seating that child at the front of the class so that fewer distractions (including other pupils!) are visible, or allowing them to work in a smaller group where possible. It should always involve explaining their limitations to teachers and others involved in working with them in order to improve understanding of what support they need in order to learn best.

Focusing on the quality of work produced over the quantity is useful feedback, as is appreciation and respect for the sheer effort it takes for that child to stay on track in class. I know from my own son that ADHD children lack self-esteem and confidence, as they are often criticised. Improving positive feedback encourages them to keep trying, instead of becoming disheartened. It’s useful to emphasise that this feedback works best when it’s in the moment, as the very nature of the ADHD brain favours immediate over delayed reward.

SUPPORTIVE TALK THERAPY

The third component of good management for ADHD children is that recommended by NICE – supportive talk therapy.

ADHD children are impulsive because the centre in their brain that controls behaviour (their prefrontal cortex) is less strongly linked to other areas than in neurotypical brains. Talk therapy aimed at developing better impulse control and better behaviour, can, if it’s the right type of talk therapy, improve confidence and self-esteem. Traditionally, ‘cognitive behavioural therapy’ or CBT has been used, but there are limits to how effective it can be when working with ADHD children.

This, for me, is where hypnotherapy can be really helpful.

SOLUTION FOCUSED HYPNOTHERAPY AND ADHD

The solution-focused therapy that I practice in my clinic is, as it sounds, more focused on finding solutions to the issues faced by my clients now than at looking too hard at the historical or biological reasons for them.

This is extra valuable for those with ADHD as they know all too well the reasons and causes of their unwanted behaviours; what they want are ways to change them and to be and feel more productive. Solution-focused hypnotherapy (SFH) uses an understanding of how the brain works to explain to the client why their brain seems to be ‘misbehaving’, and uses a solid, evidence-backed basis of neuroscience to help them develop new ways of thinking and behaving. SFH actually strengthens the connections between that prefrontal cortex and the rest of the brain, improving communication between all areas, and effectively teaching it how to put the brakes on unwanted patterns of behaviour.

Anxiety is very common among ADHD diagnosed children (and adults) and can impact severely on their ability to attend school or work, to enjoy social experiences and hobbies or to maintain friendships. Learning through SFH how to effectively reduce the level of anxiety means that they are better able to learn, play and go on to develop healthy ways to deal with stressful situations.

Similarly, sleep dysfunction is common with ADHD, as their busy brain struggles to switch off appropriately. Using guided relaxation audio at night can really help to structure a better night’s sleep, and practising trance (hypnosis) as part of sessions with me teaches my clients how to do that effectively.

Supporting Parents

Sometimes, children are too young to be able to make the most of talk therapies and often, it can be useful to work with their parents instead. As any parent knows, having children can be challenging, and having those with additional needs even more so! Helping to support parents so that they themselves are in the best frame of mind to cope with the added demands of working with their children and with the education system is another way that I use SFH.

What are the benefits of solution-focused hypnotherapy for those with ADHD?

Arguably the most important thing that SFH does is to focus on a clients’ strengths and abilities, helping them to recognise the areas where they are achieving, and to promote an awareness of their innate skills.

It’s interesting to think that ADHD might not necessarily be a disadvantage. As the consultant I mentioned in my previous blog said, it’s entirely possible that mankind saw ADHD as an evolutionary advantage, instead of detrimental. Our ancestors lived very differently from how we now do, and a heightened awareness of changes in their surroundings could well have conferred an advantage to a caveman with ADHD.

As a therapist, I try to pass that empowerment and positivity that this point of view confers onto my ADHD clients. Being able to see the differences in how their brain connects as a resource, to learn how to use that and to make the most of the ways that their fast processing power and multitasking ability translates into daily life can change their outlook on how they see themselves.

Developing a new sense of identity that differs from the underachieving, hopeless lack expectation they may feel at school can be life-changing.

Feedback from my clients says that learning from me how their brain works made them understand that they are not broken, just wired a little differently. They learn that they can train their brain to work more productively for them, so that they can think calmly and rationally. SFH gives them not just coping strategies, but long term resilience so that they can cope well with whatever life throws their way.

As one client recently put it – I no longer need to struggle silently. I can be me.

About the Author: Claire Noyelle practices from her tranquil garden therapy room at her home in Bearsted, Maidstone East, in the heart of the garden county of Kent. Claire is a member of the Association for Solution Focused Hypnotherapists, National Council for Hypnotherapy and the Complementary and Natural Healthcare Council and a member of both the General Pharmaceutical Council and the Royal Pharmaceutical Society.

If you would like to explore how hypnotherapy can help with managing ADHD, get in touch to book your FREE initial consultation with your local Inspired to Change hypnotherapist. Inspired to Change Hypnotherapists are based across the UK.

Inspired to Change Hypnotherapists are all recognised by the National Council for Hypnotherapy, the UK’s leading not-for-profit hypnotherapy professional association.

To find out how you can train as a solution focused hypnotherapist click here for our hypnotherapy school information