ADHD and school: how it works

Johan hears every noise. He struggles to concentrate at school and quickly loses sight of the essentials when doing his homework. Hanna also finds it difficult to concentrate: she often can't remember what her teacher explains to her. Other things, however, she remembers perfectly.

Johan and Hanna, who have their say in this dossier, have ADHD. Attention deficit hyperactivity disorder is the most common developmental disorder in childhood. Oskar Jenni, paediatrician and co-head of the Department of Developmental Paediatrics at the University Children's Hospital Zurich, describes children and adolescents affected by ADHD as having inadequate attention and perseverance in relation to their age and abilities, and emphasises: «ADHD is not a mental disorder, but a developmental disorder.» According to international studies, around three to five per cent of children are affected.

Girls and women have ADHD just as often, it is just less recognised in them.

In the past, a distinction was made between ADHD and ADD - the version without hyperactivity disorder - but doctors and researchers now work with the generic term ADHD. «In most cases, we are dealing with mixed forms anyway, and it is difficult to differentiate between the various symptoms,» says René Kindli. He is a paediatrician in Mauren (FL) and has been dealing with ADHD in his practice for many years.

The three symptoms of the disorder are inattention, impulsivity and hyperactivity or a combination of these. The manifestation and severity are also very individual and vary greatly, ranging from barely perceptible to very severe symptoms.

Dreamy girls, hyperactive boys

ADHD often becomes apparent when children start school - when the demands placed on them are suddenly significantly higher and they are unable to cope with them due to their symptoms. In people without a hyperactivity component, on the other hand, ADHD is often only noticed in upper school or adulthood. Although they often appear dreamy and absent-minded, their behaviour is not off-putting, meaning that no action is initially required.

The stimulus filter does not work with ADHD, so too many stimuli enter unfiltered.

René Kindli, paediatrician

The dreamy form is more common in girls and women, the hyperactive form in boys. Until a few years ago, it was thought that ADHD affected three times as many boys as girls. Today it is clear that girls and women have ADHD just as often, it is just less recognised in them.

As different as the symptoms of ADHD may be, all those affected have one thing in common: special learning needs. But what exactly are the challenges? What does good teaching look like for children with ADHD? How can parents and teachers provide them with targeted support? To clarify these questions, we spoke to experts and in this dossier we also give affected families a chance to have their say.

ADHD: A neurobiological peculiarity

In order to explain what a child with ADHD needs to learn, it is worth first explaining how their brain works. According to experts such as René Kindli, attention deficit hyperactivity disorder is a neurobiological peculiarity, a developmental disorder of the brain. This persists throughout life and is mainly due to genetic predisposition. ADHD brains do not work worse - just differently.

It is not a question of not wanting to, but of not being able to.

Stefanie Rietzler, psychologist

The main regions of the brain affected are those that play a role in controlling behaviour and attention. In people with ADHD, communication from nerve cell to nerve cell in the brain is impaired. The messenger substance dopamine does not remain in the synaptic cleft long enough to have an effect on the neighbouring nerve cells. As a result, information is not transmitted well and neuronal communication is disrupted. «The stimulus filter doesn't work either, so too many stimuli enter unfiltered,» says paediatrician René Kindli.

Directing attention

The result: at school, children with ADHD are magically attracted to everything that is colourful, loud, new and interesting to them or that moves: the whispering in the back pew, a bird perching on a branch outside the window. They also quickly drift off into daydreams and forget their work assignments, say Stefanie Rietzler and Fabian Grolimund. The two psychologists and learning coaches run further training courses on ADHD at their Zurich Academy for Learning Coaching and have written a comprehensive guide for parents.

Paradoxically, children with ADHD can also stay on task for hours on end - for example when playing Lego, programming or gaming, in short, when they are intrinsically motivated. «Outsiders often say: "This child can't have ADHD!», says Stefanie Rietzler. «We then explain that ADHD is actually an attention-deficit disorder.»

These children find it difficult to consciously focus on what is expected from the outside. It is much more likely that the maths problem that the teacher is explaining is suddenly replaced by thoughts of the exciting radio play from the previous evening. «It's therefore not about not wanting to, but about not being able to,» emphasises Rietzler.

Due to the constant demand to concentrate and stay focussed, school is particularly stressful for these children - which quickly leads to fatigue. «Many parents say that the week is already over for their child on Wednesday because they always have to pull themselves together so much at school,» says the psychologist.

Disruptive factor impulsivity

The aspect of inattention plays the biggest role in the affected child's school performance; however, the child often suffers from this in silence. The aspect of impulsivity, on the other hand, is also clearly felt by classmates and teachers. Those who are unable to stick to the rules in class, constantly intervene and are unable to control their emotions are a source of offence to others. Hyperactivity and the associated strong urge to move also lead to unrest in the classroom.

At home, homework is often a big topic of contention for a child with ADHD.

What's more, ADHD is often accompanied by learning disorders - in reading, spelling or maths, for example - which makes everyday school life even more challenging for these children. «Pupils with ADHD often have the impression that they can't do anything and are doing everything wrong anyway,» says Stefanie Rietzler. This can lead to these children losing all motivation, slipping into the role of class clown or refusing to participate altogether.

At home, on the other hand, homework is often a major source of contention: children and young people don't start it or don't stick to it - which leads to many conflicts with their parents. «They feel like assistant teachers who constantly have to make sure that their children don't fall behind,» observes Fabian Grolimund. In the long term, there is a risk that their relationship with the child will suffer.

ADHD diagnosis and initial measures

To put it simply, people with ADHD are inattentive, impulsive or fidgety. To a certain extent, these behaviours are not unusual for childhood. The question of when a disorder can be diagnosed is therefore crucial. In order to avoid incorrectly categorising children, experts have agreed on certain criteria that must be met for an ADHD diagnosis.

Trained specialists such as child and adolescent psychiatrists or paediatricians examine this thoroughly. They also look at the patient and family history and rule out other disorders that could trigger ADHD-like symptoms.

If ADHD children feel valued by the teacher, they make an enormous effort.

René Kindli, paediatrician

Depending on the severity of the ADHD, the measures that a child needs to get through school well are then derived. Do just a few clearly formulated work strategies help? Does it make sense to compensate for disadvantages at school? Do they need medication?

«In some cases, regular exercise and clear, structured lessons are enough to help,» says paediatrician René Kindli. However, ADHD children are simply overwhelmed by some modern approaches, such as working with weekly schedules, which require a lot of self-organisation - «because they have no structure in their heads».

Instead of a vague «work on all three pages by Friday» assignment, a concrete «work on problems five to ten by tomorrow» would help them. Above all, however, these pupils need a great deal of understanding: empathetic teachers who recognise when a child is drifting off and intervene in good time without embarrassing them - for example, by gently touching them and reminding them to pay attention again.

Three points to learn better

Rietzler and Grolimund focus on three points so that children and young people affected by ADHD can cope better at school.

1. Adapt the environment to the child as far as possible - in other words, don't give too much homework, work with hearing protection, create a place for the child near the teacher and much more.
2. Develop strategies that help those affected to control themselves better. «However, you shouldn't overburden the child here,» warns Grolimund, «so don't practise five points at the same time, but limit yourself to one aspect.» For example: How do I manage to write down my homework every day?
3. Accept that the child has certain strengths and weaknesses and should not be made into a different person.

«It's a really bad feeling when children realise: "The adults would rather have me differently,» says Grolimund. That's why it's extremely important that parents tell their children: «You're OK!» and trust that the child will go their own way.

At school, on the other hand, children should realise: «I am welcome here.» As soon as they have the opposite feeling, the problems often intensify massively - those affected often devalue themselves, pretend to be disinterested in school topics, go into resistance or develop exam and school anxiety.

I am often surprised at how little children and young people know about their diagnosis and what is happening in their brains.

Alice Caduff Scheuner, remedial teacher

Children with ADHD are extreme relationship people

In general, research also shows that people with ADHD are extremely relational people. Applied to school, this means: «If ADHD children feel valued by the teacher, they make an enormous effort,» says paediatrician Kindli. «If, on the other hand, they feel that the teacher doesn't like them, they switch off.»

«They react much more sensitively to praise and criticism and how we communicate with them,» Stefanie Rietzler also points out. Targeted feedback is therefore important - for example, when the teacher realises that a child has mastered a situation well («That was a tricky worksheet, but you stuck with it!»).

Fabian Grolimund agrees that more encouragement makes sense, but less criticism would be even more important: «Many children with ADHD are under constant attack. If you made a list of what they hear every day, it would make you sick.»

Handing over responsibility

Alice Caduff Scheuner is a special needs teacher and ADHD coach and works in integrative support at a secondary school in Thun BE. She teaches in teams, in small groups and coaches young people affected by ADHD on a one-to-one basis. Together with those affected, she checks: Have work assignments been understood? What is needed so that the young people can organise themselves better? And she always answers the question: «Why am I actually behaving like this?»

«I'm often surprised at how little children and young people know about their diagnosis,» says the curative educator. «An important part of my work is therefore to show them what is happening in their brains. We also look at their self-image.»

Together with pupils, she looks for individual solutions - such as how to ensure that the tablet is charged in the school bag every morning. Alice Caduff Scheuner does not provide any ready-made recipes, but works out strategies together with the young people. «It's about handing over responsibility to those affected,» says the curative educator. «To let them feel it: My self-efficacy is great!» This strengthens their self-esteem and breaks the vicious circle of incorrect behaviour. «Because children and young people want one thing above all else: not to stand out, but to be like everyone else.»

Right to compensation for disadvantages with ADHD

In the experience of the curative educator, teachers are generally better equipped to deal with children and young people with ADHD. Stefanie Rietzler and Fabian Grolimund have also noticed this. How children with ADHD are supported at school and when they receive what support varies from canton to canton.

To ensure that those affected by ADHD are not disadvantaged in education despite their symptoms and their effects, they have the right to compensation for disadvantages, for example. This requires a medical diagnosis and a medical certificate.

Interestingly, the weaknesses of people with ADHD are often also their strengths.

Fabian Grolimund, psychologist

Disadvantage compensation is intended to ensure that those affected have the same conditions as their fellow pupils. For example, this measure helps to extend exam times, provide a quieter learning environment or allow breaks during exams. «In the end, however, the overall school package remains difficult,» says Fabian Grolimund, «because the demands of school and the symptoms of ADHD simply don't fit together very well.»

When medication makes sense

If the level of suffering becomes too high, many sufferers opt for medication. In most cases, methylphenidate (MPH) is used - both for hyperactive and dreamy children. In addition to Ritalin, there are a total of ten drugs containing this active ingredient in Switzerland. If the side effects are too severe - in the form of loss of appetite, sleeping difficulties or depressive moods - it is possible to switch to another active ingredient.

«These medications can often be helpful for affected children and young people,» says curative teacher Caduff Scheuner. «Many are like a new person, can suddenly concentrate and experience this as a great relief.» However, medication alone is not a solution; additional help such as coaching or therapeutic support is always needed.

Those affected usually take the medication throughout their school years. «However, if the environment between the child and teacher is suitable or if there is developmental progress, the dosage can be adjusted,» says paediatrician Kindli. «Overall, the main aim of the medication is to give the child good self-confidence and a sense of achievement.»

In fact, the drugs influence the levels of certain neurotransmitters in the brain, particularly dopamine and noradrenaline. These neurotransmitters play an important role in attention, impulse control and the regulation of behaviour. The drugs therefore have a stimulating effect and promote concentration and performance.

However, when prescribing ADHD medication, it is important that parents consult ADHD specialists and that this medication is only prescribed if a diagnosis has actually been made, emphasised Susanne Walitza in an interview with this magazine. She is a professor at the Department of Child and Adolescent Psychiatry and Psychotherapy at the University of Zurich and treats many children with ADHD. Oskar Jenni also believes that the use of medication is primarily indicated for severe disorders and high levels of suffering. According to the developmental paediatrician, in mild cases it is important to adapt the environment to the child.

Promoting talent

All of the experts emphasise how important it is to move away from a purely deficit-oriented approach and focus more on children's strengths - regardless of whether they are mild or severe. René Kindli, for example, always writes «promoting strengths» as a treatment recommendation in his diagnostic report. This is precisely because school is often very deficit-orientated. That's why children with ADHD need even more support for their talents outside of school.

«Children with ADHD are often very sporty,» says the paediatrician, adding that they should do several sports. However, parents often think: «Our son doesn't have time for training, he has to study for school.» «Wrong!» says Kindli. «The tougher it is at school, the more other experiences of success it needs!»

«Interestingly, the weaknesses of people with ADHD are often also their strengths,» observes Fabian Grolimund. Hyperfocus - being able to spend hours on topics that interest them. Physical activity - which can often be channelled into a sport. The strong sense of justice - which allows you to think outside the box or swim against the tide. «These are all extremely enriching,» says Grolimund. It is therefore crucial for people with ADHD to know themselves well. To know: In which areas do I get help, where do I delegate better? But also: What am I really good at?

However, research has so far barely considered the strengths of people with ADHD. Grolimund and Rietzler have therefore developed a strengths questionnaire for parents of children with ADHD. «Parents are often delighted to tell us that they weren't even aware of many of their child's strengths,» says Stefanie Rietzler, «and that their perspective suddenly shifts completely.»

For example, the daughter may not be good at maths, but is a great sales talent at the flea market or skilled in handicrafts. The son may have difficulties with dictation, but has a strong social streak, is very affectionate with younger children or is very creative.

«Realising that there is much more to life than the logical-mathematical or linguistic areas that are so strongly focused on at school is worth a lot,» says Rietzler. Individual strengths should therefore be given much more space in everyday life. After all, they are essential sources of a child's self-confidence - especially when there is little sense of achievement at school. And they often form the basis for later professional success.