Attention Deficit Hyperactivity Disorder (ADHD)

What Is ADHD?

ADHD is a common neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. It is recognised by the NHS and NICE (National Institute for Health and Care Excellence) guideline NG87, last updated in 2024.

ADHD is now understood to be a lifelong condition. Research shows that ADHD persists into adulthood for the majority of people diagnosed in childhood, though presentations may change over time. Adults often develop coping strategies, but the underlying executive function difficulties remain.

ADHD occurs on a spectrum and pupils may present with one of three presentations:

• Predominantly inattentive presentation: difficulty sustaining attention, easily distracted, forgetful, struggles with organisation
• Predominantly hyperactive-impulsive presentation: fidgeting, restlessness, difficulty staying seated, interrupting, acting without thinking
• Combined presentation: significant symptoms of both inattention and hyperactivity-impulsivity

Note that these presentations can change over time. For example, hyperactivity often becomes less obvious in adolescence, but inattention and impulsivity may remain or become more prominent.

Executive Function and Emotional Regulation

While many people focus on the hyperactivity aspects of ADHD, the condition fundamentally affects executive functions, the brain's management system. Executive function difficulties include:

• Working memory: holding and manipulating information in mind (e.g., remembering multi-step instructions)
• Organisation and planning: structuring tasks, breaking down goals, keeping track of materials
• Time management: estimating how long tasks will take, meeting deadlines, understanding time passing
• Prioritising: deciding what to do first, distinguishing urgent from important
• Task initiation: getting started on tasks, especially ones that are uninteresting or complex
• Emotional regulation: managing frustration, disappointment and excitement; controlling impulses

Research increasingly recognises emotional dysregulation as a core feature of ADHD, not just a secondary consequence. Pupils with ADHD may experience emotions more intensely, struggle to manage strong feelings, and have difficulty calming down once upset.

ADHD Strengths

While ADHD presents challenges, it is essential to recognise the strengths that often accompany the condition:

• Creativity: thinking in unconventional ways, making novel connections, innovative problem-solving
• Hyperfocus: intense concentration on tasks that are interesting or engaging
• Energy and enthusiasm: passion, drive, and infectious excitement about topics of interest
• Spontaneity: willingness to try new things, adaptability in dynamic situations
• Out-of-the-box thinking: ability to see solutions others might miss
• Resilience: many young people with ADHD develop remarkable persistence in the face of repeated challenges

Medication Context

Some pupils with ADHD may be prescribed medication (most commonly methylphenidate, such as Ritalin or Concerta, or lisdexamfetamine, such as Elvanse). Medication can help with attention, impulse control, and hyperactivity, but does not work for everyone and is not a cure.

Teachers and support staff should be aware that:

• Medication may wear off during the school day or take time to become effective in the morning
• Side effects can include reduced appetite, difficulty sleeping, or mood changes
• A pupil's needs may change if medication is adjusted or stopped
• Medication works best when combined with environmental adjustments and support strategies
• Not all pupils with ADHD take medication, and this is a family decision made with medical professionals

Strengths-Based Strategies for Teachers

Contemporary best practice focuses on working with ADHD brains, not against them. Strategies should reduce barriers, build on strengths, and support executive function.

Environmental Adjustments

• Provide a structured, predictable environment with clear routines
• Minimise distractions: seat the pupil away from windows, doors, and high-traffic areas
• Allow movement: fidget tools, standing desks, movement breaks
• Use visual supports: schedules, checklists, timers, colour-coding

Supporting Attention and Working Memory

• Break tasks into small, manageable steps and present one step at a time
• Give clear, concise instructions with visual or written backup
• Ask the pupil to repeat back instructions to check understanding
• Use timers to create urgency and make time visible
• Visit regularly to keep the pupil on task or help them return to it without judgement
• Provide checklists so pupils can track their own progress

Building on Interests and Strengths

• Incorporate topics of interest wherever possible to harness hyperfocus
• Offer choices to increase engagement and autonomy
• Celebrate creativity and out-of-the-box thinking
• Provide opportunities for active, hands-on learning
• Recognise effort, not just outcomes

Supporting Emotional Regulation

• Stay calm and avoid raising your voice, even when behaviour is challenging
• Give the pupil time and space to calm down if they are becoming excitable, frustrated or overwhelmed
• Teach and practise calming strategies when the pupil is regulated
• Use a calm, neutral tone when redirecting behaviour
• Avoid power struggles: state what you need and give the pupil time to comply
• Repair relationships after incidents: 'We're okay. Let's try again.'

Boundaries and Consistency

• Set clear, consistent boundaries and apply them fairly
• Reward short chunks of work or positive behaviour immediately (ADHD brains struggle with delayed rewards)
• Use specific, descriptive praise: 'I noticed you started your work straight away. Well done.'
• Do not be drawn into arguments; restate your expectation calmly
• Focus on what you want the pupil to do, not what you want them to stop doing

How Teaching Assistants Can Help

• Visit the pupil regularly to refocus on the task without judgement or criticism
• Break tasks into smaller, achievable chunks and celebrate each step completed
• Re-explain and reinforce teacher instructions in simple, clear language
• Provide visual or written reminders of instructions and steps
• Use timers and checklists to support time management and task completion
• Remind the pupil of their personal targets and strengths
• Offer movement breaks or sensory tools to support regulation
• Notice early signs of frustration or dysregulation and intervene early
• Implement and administer agreed reward systems within lessons
• Report back to teaching staff about patterns, triggers, and successes

Further Information and Resources

• NICE guideline NG87: Attention deficit hyperactivity disorder (2024)
• ADHD Foundation: neurodiversity charity with resources for schools
• ADDISS: National Attention Deficit Disorder Information and Support Service
• NHS ADHD Taskforce resources and guidance
• Young Minds: mental health support for children and young people with ADHD