A spotlight on ADHD in the Early Years

The article is written by Kerry Murphy, an ADHD and autistic writer and consultant who prescribes to identity-first language - ‘autistic person’ as opposed to ‘person with autism’. This article uses the term ‘ADHD’er’ to honour identity-first language and draws upon lived experience frameworks as well as a growing evidence base.

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The term Attention “Deficit” Hyperactivity “Disorder” (ADHD) is probably quite familiar to you as an educator. It is a neurotype that has gained much controversial media attention in recent years despite being historically associated with boisterous and mischievous boys. ADHD is often described as paradoxical, meaning it can be misinterpreted and contradictory. The research on ADHD is also quite narrow, often focusing on deficits and delays or simply …. strategies to make someone ‘less ADHD’ and more compliant.

So, while ADHD is trending as a topic in education and wider society, it felt apt to write about our growing understanding of the ADHD experience and to consider children with emerging traits of ADHD.

It is important to state that a diagnosis of ADHD rarely happens in early childhood, but it does tend to be identified before the age of 12. There are many reasons for this, including the importance of giving children time to mature. There are also difficulties in accessing assessments due to waiting times. This becomes especially difficult if the child does not “fit” into the outdated archetype of ADHD, and we know it disproportionately impacts children based on their gender and racialised identity. 

The purpose of this article is not to suggest that educators should diagnose ADHD; rather, it aims to raise awareness of often overlooked traits and to provide ideas.

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ADHD – is it all in a name?

If you conduct an internet search for ‘ADHD’, you’ll likely find a mixture of results, mostly from medical websites. You'll also find that the predominant descriptions focus on symptoms like, 

• Having a short attention span, 
• Constant fidgeting or restlessness, 
• Impulsive behaviours. 

ADHD is also often misrepresented as a behavioural disorder instead of a neurological difference. Is it any wonder that upon discovering that a child is ADHD, we might feel apprehensive about how they threaten our orderly practices and environments? We have been primed to focus purely on how ADHD will present us with a problem. 

Even the name Attention Deficit Hyperactivity Disorder encourages us to think about it negatively. 
Dr. Edward Hallowell and Dr. John Ratey ‍

But the issue with this dominant narrative is that you are only getting part of the story, and traditional research mostly fails to acknowledge the balanced and holistic profile of ADHD. Luckily, research increasingly accounts for lived experience which is beginning to challenge these outdated notions and ideas.

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A more holistic definition of ADHD

While we have a medicalised definition of ADHD, there is also growing advocacy to:

1. Change the name because it does not feel like an accurate portrayal (Dr. Edward Hallowell and Dr. John Ratey, 2019)
2. Provide a definition that better encompasses the key experiences currently absent from the diagnostic criteria. 

ADHD is a neurological difference, meaning that the architecture and pathways of the brain differ from typically developing people. Our brains work and perceive the world in different ways. We are not, contrary to belief, just badly behaved.

As mentioned earlier, ADHD is also considered paradoxical because traits and difficulties can seem ever-changing or contradictory—the goalposts of what an ADHD’er can and can’t do move often. For example, a child may develop an interest and become highly motivated to only play with that thing or in that way, only to forget about it entirely a few days later. This does not devalue that experience, rather, it demonstrates that ADHD’ers can be inquisitive and drawn to new and novel experiences.  

Some researchers have suggested that key characteristics of ADHD include:

• Divergent thinking skills
• Variable attention
• Emotional sensitivity 
• Interest-based motivations that can lead to intense interests 
• An aversion to things that feel mundane

See the work of Sedgwick et al., (2019)

We will unpick two of these areas in more detail: variable attention and emotional sensitivity. 

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Variable attention in ADHD

It is difficult to dispute the idea that there is an attention deficit in ADHD given that it features in the very name. Still, it has become increasingly obvious that there is no absence of attention. On the contrary, ADHD’ers often report abundant attention but a struggle to regulate and allocate it - hence variable attention. 

If a child is engaged in something of interest, you will likely find that they can enter what is sometimes referred to as “hyperfocus” or a flow state. There can be a complete immersion into the task or experience.

An early years environment can often be compatible with this way of being because we empower children to engage in long, uninterrupted periods of pure play. But there can also be many incoming cognitive and sensory demands, along with the requirement to switch attention across tasks.

A day spent at nursery or with a childminder, even when playing can become taxing if there are many transitions, routines, demands and expectations. In addition, exhaustion can follow from a period of hyperfocus, along with the sensory pain of pulling yourself out of a flow state.  

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Early Years strategies for variable attention

• Use visual routines to map out a child’s day so they know what to expect and when. Highlight the points where they can play uninterrupted and points in the day that might feel a bit trickier to manage.
• Break information down so children have time to process and to latch onto key information. Otherwise they may become overwhelmed or miss important information.
• Plan for the seven types of rest (physical, mental, emotional, sensory, creative, social, and spiritual) after periods of play so that the child can engage in co and self-regulation.
• Adapt expectations on attention and read cues of disengagement rather than misbehaviours.

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Emotional sensitivity in ADHD

One of the most overlooked but widely reported traits of ADHD is emotional sensitivity, dysregulation and rejection sensitivity dysphoria (RSD). In short – emotions run high in ADHD and the dance between emotions can be quite rapid, going from euphoria to joy to despair within a short space of time.

This area requires more research, but there is recognition that momentary emotions can take up a lot of space due to differences in neural pathways, making our minds and bodies full to the brim with all the feelings (see Brown, 2023).

In addition, ADHD’ers are considered particularly sensitive to real or perceived rejection, which can create overwhelming emotional states including sadness, anger and anxiety. As someone who is ADHD with significant issues with RSD, I can confirm that it is one of the more unpleasant experiences and can interfere a lot in my daily life. I have spoken extensively with other ADHD’ers who work in early education, and a key reflection has been that emotional sensitivity and RSD were present in our childhoods. We wish we had knowing adults who could have helped us figure it out. 

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Early Years strategies for emotional sensitivity

• Affirm children’s feelings. If a child feels something, then it is real to them. It can be really unhelpful to a child to be told “Don’t be silly”, “It is okay” and to “Calm down”. Sometimes the best way to support a feeling is to acknowledge that it is there – “I hear you”, “I am sorry you feel this way” and “Can you say more or show me?”
• The fear of rejection can often make children feel as though they are not liked. Take time to “hold them in mind” letting them know what you like about them, reassuring them and providing genuine praise or feedback.
• Spend time teaching children about interoception (how feelings feel in the body) and energy states. Some ADHD’ers seem to feel everything, making distinguishing feelings, emotions, and sensations difficult. They may also find it difficult to find the words to name emotions (referred to as alexithymia). The work of Kelly Mahler is essential in developing an interoceptive-informed curriculum.
• Use emotional literacy to address social and emotional experiences, for example, stories about navigating conflicts in friendships. Homemade books can be especially useful for working through emotional sensitivity.
• Do remember that emotional sensitivity is not a bad thing. It can also mean that children are quite attuned to the emotional climate and feelings of others. Steer clear of telling children they are too sensitive or overthinking. The world needs more sensitive souls. 

Kerry’s top tips for supporting ADHD’ers in the Early Years

• Where possible, incorporate children’s interests and make time for uninterrupted play. It can also be useful to have a project-based curriculum meaning children can move between intense interests with ease.
• Reduce cognitive demands where possible, taking away some of the overload that can happen to children with intense energy levels in their brains and bodies. ADHD is often associated with external hyperactivity - think of your jumping beans or leaping frogs. However, some ADHD’ers experience hyperactivity internally, for example, racing or busy thoughts.
• Make space for play and learning to be active. A moving child is a learning child. No child, including those who are ADHD was born to stay still or only receive an education from the neck-up. In fact, while fidgeting is considered a sign of poor attention and usually poor sitting, it is often the brain and body's way of seeking stimulation to maintain attention. 
  The body needs to move to think, and so when we ask children to remain still, we are technically asking them to stop maintaining attention. Fidgeting helps us to focus, but it can also be a sign that what we are doing isn’t stimulating enough, and we might need to shift tasks for re-engagement.
• Ensure a good balance of affirmations, positive feedback and encouragement. ADHD’ers often get lots of negative feedback because we tend not to “fit in” to neuronormative spaces, which can impact self-esteem. This does not mean to say we can never address challenges with a child, but it is important to remember that this can feel heavier for children with emotional sensitivity. 

Hopefully, across this article, you will have gained some insights into ADHD and the lesser-understood traits that resonate with you but haven’t quite known how to place. Not all children who express these traits will be ADHD, but the recommendations should be useful regardless.

It is also important to reiterate that ADHD is under-researched, especially that of lived experience, so we hope to see a clearer representation of it over time. The descriptions in this article are informed by lived experience and research combined, and any advice taken from this article should be in tune with your personalised knowledge of the child.