Inattentive ADHD Can Be Overlooked in the classroom as it is Less VISIBLE than COMBINED or Hyperactive/ Impulsive ADHD
Around 5% of children are affected by ADHD, at a ratio of 2:1 girls to boys according to the DSM-5.1 Girls are more likely to present with Predominantly Inattentive ADHD (ADHD PI) whereby the child is not as likely to be a disruptive influence in the classroom as a child with Predominantly Hyperactive/Impulsive ADHD (ADHD PH/I), or classic ADHD, may be.
The signs of ADHD PI are much harder to spot because generally these children are trying to ‘fit in’ with their peers, not wishing to draw attention to themselves as they feel like they are not achieving as well as they could do. I’ve heard children as young as 8 say that they don’t want to be ‘found out’ because people think they’re bright, but really they feel stupid because they keep making mistakes and feel like they need to try harder.
I wrote in my article about growing up with Inattentive ADHD that I felt invisible and in some ways that was what I was aiming for when I was younger, I didn’t want to stand out. I coasted through school managing to do fairly well but I could have achieved more if someone had been able to explain to me that my brain worked differently to my peers and that trying to be like them wasn’t going to solve all of my problems.
Medication could have helped with some of my symptoms, helping me to focus in lessons, and extra time in exams may have helped, but I think, more importantly, understanding why I couldn’t seem to do things like everyone else would have made a huge difference. I wasn’t just lazy or stupid, I was trying as hard as I could and every failure felt enormous, even if it was getting 9/10 on a maths test. Support from a teacher or another professional would have meant learning techniques and strategies to manage my time, organise my things and how to manage my emotions and build up my self-esteem.
So what can teachers, Teaching ASSISTANTs and support staff look out for?
The most obvious indicators are probably those to do with poor time management skills, both the passage of time and the ability to estimate how long something will take are hugely affected by ADHD PI and this leads to difficulties in homework, coursework, completing work in lessons and going to and from lessons.
An ADHD PI child:
- May find it difficult to hand in homework on time or complete work within deadlines, particularly if given a broad topic and a long time-frame.
- May take time to get started with work or spend too long writing the title and date, eg. when writing a newspaper article the child spends 15 minutes writing the heading, rubbing it out and rewriting it several times trying to get it to ‘look right’, then, upon realising that the lesson is almost over, they rush to write more content, making mistakes and inevitably not completing the work.
- May wish to stay in the classroom to finish work rather than go out to play at break or lunch times. It is incredibly difficult to stop something part way through, as motivation is difficult it is important to let the child continue working where possible as they may not be able to get back to that point in their thoughts at another time.
- May ask to go to the toilet during lessons as they have forgotten to go at break/lunch times.
- May arrive at lessons late, may be the last to pack away their things at the end of lessons in order to move to the next lesson/break/lunch.
Planning and organising skills are also impaired with ADHD PI, this means that the child may find it difficult to picture what items they need for the day ahead, or for the next lesson so may arrive without important equipment.
An ADHD PI child:
- May frequently need to borrow items of stationary, may leave their glasses, books or PE kit at home or in their locker, or may lose items, including lunch money.
- May appear unkempt or may have difficulty in remembering to wash hands, brush teeth or hair before school.
- May forget which lesson they are supposed to go to, may particularly have problems if the lessons change classrooms on a rota or temporarily.
- May not hand letters to parents/carers at home or bring them back signed, often these disappear to the bottom of the school bag.
Engagement and motivation are difficult to maintain with ADHD PI. If a subject is of interest the child may be able to hyper-focus, this is often seen with computer games or TV programs but can be reflected in schoolwork.
An ADHD PI child:
- May produce very little work some lessons and suddenly produce excellent pieces of work, particularly if a free choice of topic. For example, a book review based on own choice may include illustrations, character detail and obvious enthusiasm whereas a book review based on a given book may be brief, flat and possibly inaccurate if the child has been expected to read it in their own time.
- May find it incredibly difficult to get started on work that is not engaging, or is open-ended. Shorter tasks are easier to tackle as they have a more immediate reward/definite end.
- May make careless mistakes. Usually these mistakes can be verbally corrected easily with the child, showing understanding of the concepts, they have just been noted down incorrectly.
- May produce varying degrees of handwriting quality. Often handwriting quality will deteriorate as the length of work increases.
Emotional regulation can be impaired with ADHD PI, often feelings seem amplified and can consume the thoughts of a child, causing them to dwell on them and be unable to move on. This affects concentration and focus in the classroom, particularly if something has happened just before a lesson.
An ADHD PI child:
- May become very upset at failure or being told off. May smile or smirk when being told off as a nervous response to prevent crying in front of others – this often provokes authority figure to feel more frustrated and feel as though they are not being taken seriously.
- May miss pertinent details in instructions but find it difficult to ask for help or clarification. Could be unable to voice concerns which may lead to no work being done at all, or misinterpreted instructions being followed leading to work which does not fit the brief.
- May be very self-conscious and feel that everyone is looking at them, particularly if someone has pointed out a mark on their clothes or a leaf in their hair etc. The child may be consumed by this thought and find it difficult to concentrate until they can try to fix the problem
- May be eager to please, but disappointed with mistakes. Will only offer answers in class if interested in subject and feels that they are definitely correct. Will feel humiliated and embarrassed they have got something wrong, particularly in front of other children.
- May be very anxious whilst waiting for test results and feel that they have let parents/carers/teachers down if they have done badly.
- May find friendships difficult, often falling out with friends because of amplified feelings of hurt. Generally children with ADHD PI are loyal and caring and can feel betrayed if a friend does not act in the way that the child perceives they should.
This is difficult to judge and often changes over time as a child learns to ‘assimilate’ with other children or to hide their feelings. Some older children learn to ‘look like they are listening’ even when distracted as they fear being told off.
An ADHD PI child:
- May often sit quietly, often seems lost in own thoughts or seems to stare at a fixed point.
- May sometimes not respond when spoken to because their mind is focused on something else, this may be the work that the child is doing and should not be seen as a sign of disrespect or a deliberate act.
- May doodle in the margins of workbooks or rearrange stationary on the desk to try to stop their mind from wandering while the teacher is talking.
- May be noticeably distracted by things happening outside a window or by noises in the classroom, may seem overly interested in what other people are doing, particularly if they are doing different work, or, for example, if the teacher is setting up for the next lesson while students are expected to carry on with their work.
- Older children may come across as disinterested in their progress, may seem not to take their work seriously as they try to hide feelings of disappointment.
May Have Some Hyperactive/Impulsive Symptoms
It is likely that a child diagnosed with ADHD PI will still have one or two hyperactive or impulsive symptoms which may be ‘visible’ but infrequently as often the child does not want to draw attention to themselves. These symptoms however will be very difficult to suppress so may cause some disruption.
An ADHD PI child:
- May find it difficult to pause a conversation that was occurring before the lesson started to carry it on at a more appropriate time, this may result in the child passing notes or whispering to their neighbour to finish the conversation, despite knowing that they will get into trouble. The child will be embarrassed and upset if caught out, but still find it difficult to stop until the conversation has reached a natural pause or end. This is akin to ‘getting it our of their system’.
- May occasionally shout out answers, or speak over the teach if overexcited, may then feel self-conscious afterwards.
- May be thought of as ‘cheeky’ when in fact it is just impulsiveness.
- May let arguments become physical, though this is fairly rare unless the other party exacerbates this.
- May do things without thinking them through which could cause an accident or damage to property.
- May be restless and tap/jiggle feet or hands when sitting trying to listen. This may annoy other children and will usually be occurring subconsciously.
May have previously considered other conditions
I’ve added this one as the symptoms can sometimes look like other conditions, in particular autism. I’ve spoken to a couple of teachers who have said that they had wondered if the child in question had an Autistic Spectrum Condition but it didn’t seem to ‘fit’ so they decided that the child was just a bit ‘quirky’. They were surprised when the child was diagnosed with ADHD PI as the child ‘seemed quite calm’.
Siblings/Cousins/Parents have ADHD
A bit obvious you would think but it’s definitely something that you should consider. If you’ve taught a boy with ADHD H/I (it wouldn’t have been labelled that at the time, just ADHD) and his little sister comes through the school there’s an increased likelihood that she will have ADHD as well. Look for family links before you dismiss the possibility.
Over the 15 years since training as a Special Needs Teaching Assistant, through my own diagnosis and that of my children, I am saddened that there still seems to be a lack of information and training given for identifying the inattentive symptoms of ADHD, particularly when they appear without the more visible signs of hyperactivity and impulsivity.
I have met teachers who are dismissive of the suggestion of ADHD PI because they don’t ‘see’ any problems and are often quite fond of the child in question. The old phrases still pop up ‘she’s really bright so there’s nothing wrong with her’, ‘she just takes a while to get going’, ‘she’s doing fine with her grades, so there’s no concerns’ and of course ‘she’s just a bit of a daydreamer, she’s not hyper or anything, she’s just a bit ditzy’.
If you work with children please look for the signs of ADHD PI in the children you work with, chances are that as you read this someone came to mind, don’t dismiss that thought, hang on to it. Start watching for these signs as there are children who are struggling silently, wondering what is wrong with them when other children seem to find it easy.
If you suspect that a child might have ADHD PI please don’t keep it to yourself, talk to the relevant people at your school who can talk to the parents and to the SENCO and start the ball rolling on diagnosis. If you’re wrong then there’s nothing lost, but if you are right then you are giving that child the best chance of support.
Please share this so that others can know what to look for, if there is anything that I’ve missed please add it to the comments so that I can include it. If you want to share your own experiences I’d love to hear about those too. Thank you so much for reading and for passing it on.