One of the key aims of the Connections in Mind Foundation (www.cimfoundation.org.uk) is to influence policy and to increase awareness of Executive Functions (EFs) at a national level. As part of this strategy we have established a working group of psychologists, teachers and coaches who feel passionate about this mission. One of the goals of the working group is to increase the training teachers receive when they are qualifying with regard to what executive functions are, the relationship between executive function learning and mental health, and related neurodevelopmental conditions such as ADHD.
As the group work towards this goal, an opportunity arose to contribute to the All-Party Parliamentary Group (APPG) for Attention Deficit Hyperactivity Disorder (ADHD). This initiative was the result of many years of work by the devoted and inspirational Michelle Beckett from ADHD Action (http://www.adhdaction.org).
The aim of the All-party Parliamentary Group is to raise awareness of the condition, as well as to understand how ADHD impacts children and consider how best to equip parents and teachers to identify and support them. As a trustee of the Connections in Mind Foundation and clinical psychologist with 20+ years of working with children and families with ADHD, I was asked to attend.
It was a bright autumn day and the queue to enter Westminster was a long one, but I soon began to talk to a mother, coach and young person standing behind me also attending the event. It became clear to me before I even walked into the room that this was going to be a well-attended event full of passionate individuals from all walks of life who had been affected by the condition.
I had been asked to give a five-minute presentation, with the invitation to cite scientific evidence for the causes and incidents of ADHD and its potential impact on mental health and well being. How is it possible, I wondered, to succinctly summarise a vast array of data with a meaningful message in five minutes? I chose to focus on three key myths about ADHD and offer three key solutions.
Misconceptions about ADHD:
The first myth that needs busting before all else is that ADHD is a behavioural disorder, as some still believe. It is, in fact, one of a number of neurodevelopmental disorders where a child’s brain is developing differently to the majority of the population’s. Research has clearly demonstrated that people with ADHD have distinct structural, chemical and functional characteristics of their brains that emerge as they grow up. ADHD is strongly heritable and while no one likes the idea of medicating children and young people, a meta-analysis published in 2013 shows clearly that core symptoms of ADHD are most effectively treated with medical intervention.
The second myth is that we don’t know what to do about the epidemic of mental health problems in young people and how to manage the behavioural crisis in schools resulting in startlingly high levels of exclusion. On the contrary, we have the answer staring us in the face. A very high proportion of children who present with mental health difficulties or cause disruption at school have a neurodevelopmental condition, such as ADHD (one to three children in every classroom), which is currently under-recognised and under-diagnosed.
The third myth is that effective assessment and intervention in ADHD is prohibitively expensive and hard to implement. We do know how to assess and intervene in a cost-effective manner. The knowledge, expertise and evidence are there. We just need to know how and where to implement change.
There are three key solutions that are effective, easy to implement and would make a real difference to young people with ADHD.
Firstly, we can equip teachers with the knowledge to recognise ADHD in all children. Teachers are dedicated and hard-working individuals who are currently in the dark. They are given the task of teaching large groups of children, all of whom are different, but a proportion of whom stand out and are struggling. Teachers know ‘one size fits all’ does not work in education but they don’t have the skills to identify what is really going on. This is particularly a problem for girls with ADHD who are systematically under-diagnosed and for children with ADHD in the context of high ability who underachieve but go unnoticed as they perform at an average level, despite their enormous potential. We just need to train teachers on what to look for to identify ADHD. If you know what you’re looking for, it’s easy to identify.
Solution number two is to set up affordable but effective screening systems for ADHD for children who are underachieving at school or have mental health or behavioural problems. We are past the age of believing that children are inherently lazy or naughty. Behaviour is a communication that tells us that a child is struggling. We have a duty to investigate the why and act.
Solution number three is to train all teachers in the small but effective strategies for how to manage all children’s behaviour and to help them engage in learning in the classroom. Some of the most effective interventions in education have come about from relatively small changes in our perceptions and beliefs. Take the work around mindsets, for example. The intervention is small but powerful, as it is meaningful and integrated throughout a child’s life. It’s a change in the way behaviour is perceived by both the adult and child, and a change in how we communicate about success and respond to behaviour.
The current work around executive functions (EFs) and metacognition is another example of this kind of approach. Programmes exist that embed an awareness of EF skills in the curriculum, offering both teachers and children an understanding of the processes of learning that are getting in the way of performance. This demystifies children’s performance, reduces teacher and student stress and empowers them both to know how to change. In the UK, the Connections in Mind Foundation has been working with schools to train teachers on how to do this by adopting the Activated Learning approach. Laurie Faith (creator of Activated Learning) reminds us that this kind of intervention is ‘necessary for some and good for all’. With these types of approaches, we are handing children the key to their own success that will serve them now and for many years to come.
The point is that none of these solutions and approaches are expensive, onerous or difficult to implement. This is not about changing the entire education system; it’s about knowing what makes a difference for children.
Passionate contribution from all
After my short presentation, Kit Messenger, former head teacher and head of education at Genius Within, spoke passionately about her experience as a teacher, echoing much of what I had said and reinforcing the negative impact in schools where there are cases of undiagnosed ADHD in children. She was followed by Stephanie Camilleri, lawyer, school governor and legal advocate for cases involving ADHD and schools, who talked about her work as a legal advocate as well as her experience of children with ADHD struggling within the school system. The floor then opened for questions and answers, chaired by Alex Sobel, along with Angela Rayner, shadow education secretary.
Passionate personal stories were recounted from parents, young people, professionals, lawyers, police officers and teachers. The strength of feeling was overwhelming. Of the very many important points and messages, what stands out for me are the following: the importance of remembering gender imbalance in diagnoses (girls are systematically under-diagnosed); the potential racial biases in diagnoses (young black boys are more likely to be seen as badly behaved); emotional regulation as a key symptom of ADHD, including heightened anxiety; that it is a child’s human right to have breaks in their school day (a point made with force by a young man who had consistently been held in at break time at school before getting his diagnosis); and that medication does work for some (as illustrated during a Q & A session with a psychiatrist and her 12-year-old patient).
One mother also pointed out that parents need support at home on being educated on what EFs are and how they impact on home life; there are currently no programmes showing them how. This is something that spoke volumes to us because, over the last few years, we have created a course called Connected Minds Parenting (www.connectedmindsparenting.co.uk) to do just this.
As a person waiting to take office who has the understanding and experience that inspires action, Angela Rayner gave us hope for change. Angela is current and cutting edge as a strong female MP, both as a teenage mother and as a person with a self-disclosed diagnosis of ADHD, which she referred to as her ‘super-power’. She confirmed what we all know and fear, which is that there is a mighty discrepancy between the way we treat children with physical disabilities and those with neurodisabilities. Her child with visual impairment is well looked after by the NHS. Her child with ADHD has been sanctioned and labeled as naughty and his needs neglected, both before and since being diagnosed. If there is anyone who can champion the cause of the campaign, it’s Angela.
What the future holds
The Connections in Mind Foundation is devoted to helping all children flourish by increasing awareness of and intervention in to developing executive function skills. While the foundation works hard on its mission, the seeds have already been planted that an executive function approach is an inexpensive, effective and accessible way in which we can support children both with and without ADHD, because at times we all struggle with our executive function skills. There is a lot of work to do, but the foundations have been laid, the motivation is there and the future looks bright. There can be no more excuses. This is not about money or a significant overhaul of our education system – it’s about the motivation to equip everyone in society with the knowledge needed to support all children.
by Dr Bettina Hohnen