Introduction

In this series, which talks about "A Gentle World from the Perspective of Children with Developmental Disabilities," I would like to put a question to you all about what adults can do for children with developmental disorder tendencies. Through this inquiry, I hope to deepen our understanding of these children by introducing various perspectives, mainly focusing on children. In the previous episode, I explained two definitions of developmental disorders and my valuable memories of one boy with developmental disorders.

In this episode, I would like to share my thoughts on children with ADHD tendencies based on my research and experiences as a school counselor. First, I will explain ADHD characteristics and secondary symptoms. Based on that understanding, I will then introduce a case study of one child with ADHD tendencies, focusing on how he was at daycare center and elementary school.

Through discussing the actual situations of children with ADHD and the feelings and thoughts of their parents and teachers, I hope to give the readers some fresh insights.

ADHD characteristics and secondary symptoms

According to DSM-5 (American Psychiatric Association, 2013), a manual for the assessment and diagnosis of mental disorders, about five percent of children have ADHD, with a boy-to-girl ratio of 2:1. ADHD symptoms usually start before age 12, including inattention, hyperactivity, and impulsivity. The symptoms should remain visible for at least six months in more than two environments, usually at home, childcare facilities, elementary school, or after-school activities.

ADHD has two core symptoms of "inattention" and "hyperactivity/impulsivity." More precisely, the following behavior patterns are typically observed:
Inattention: Being forgetful, being easily distracted, making careless mistakes, etc.
Hyperactivity/impulsivity: Not being able to sit still, interrupting and calling out answers before the question is finished, not being able to wait in line or take turns, etc.

As children get older, the frequency of hyperactive or impulsive symptoms often decreases, while inattentive symptoms are likely to remain unchanged (Biederman, Mick, & Faraone, 2000). Unfortunately, these ADHD symptoms are often maintained as difficulties invisible to others.

In addition to such characteristics, the onset of secondary symptoms will further exacerbate the feeling of difficulties. Considering these ADHD characteristics as core symptoms, secondary symptoms are acquired disorders due to environmental factors. Secondary symptoms of ADHD can be roughly classified into "secondary problems" and "secondary disorders." For example, secondary problems include physical (school absenteeism and social recluse), mental (depressive state), and behavioral (abusive language and violent behavior) problems. In contrast, secondary disorders include internalizing problems (depression) and externalizing problems (oppositional defiant disorders) (Saito & Aoki, 2010).

It is pointed out that the accumulation of failed experiences and lowered self-esteem are effect factors that bring about secondary symptoms (Sato & Akasaka, 2008). In addition, these effect factors emerge due to others' lack of understanding regarding ADHD children and intolerant attitudes such as repeated reprimanding. Therefore, to guard against the onset of secondary symptoms and help ADHD children live more comfortably, adults must fully understand ADHD characteristics.

Having said this, how can we adults understand children with ADHD characteristics? In the next section, I will introduce the case study of Yuki-kun (tentative name) during preschool and elementary school years.

Yuki-kun at daycare center

Yuki-kun is currently a second-grader in elementary school. When he was in daycare center, he often had difficulties staying still and participating in group activities with peers (he was diagnosed with ADHD when he was four years old). He is continually active and curious. If he finds something interesting, he immediately approaches it, speaking loudly, touching and moving it. Supervising and supporting teachers at the daycare center worked together to motivate Yuki-kun to join in group activities by constantly talking to him and repetitively encouraging him. Then he would somehow join in from the middle of the activity.

Yuki-kun at elementary school

After entering elementary school, at the beginning of the first semester, Yuki-kun tried hard to sit still in class. Because some other children with special needs were in the same class, the learning support teacher could give attention to Yuki-kun for only a few hours per day. Gradually, Yuki-kun stopped taking part in group activities, but instead walked around the room during class, created things with erasers or bits of paper or drew pictures. Nevertheless, it was not that he was indifferent. If he understood what he had learned, he would speak up in class. However, he often called out the answers loudly before listening to the whole question and would be reprimanded by his teacher.

Furthermore, he was having more trouble with his peers and was frequently late for school. His teacher has now started reporting on Yuki-kun's situation to his mother.

Situations through the eyes of Yuki-kun

Imagine what Yuki-kun feels and think when he gets reprimanded by teachers. He might feel irritated, saying, "I'm watching/doing this now!" However, when he notices what he had missed, he probably thinks, "Oh, I did it again!" and "I actually wanted to do it...."

As he grows, how would Yuki-kun feel when the teacher reprimands him? With repeated reprimands, he would feel, "Again! How annoying...." and show a defiant attitude. This may lead to an oppositional defiant disorder (ODD), a typical symptom of certain children with ADHD, becoming easily offended, upset, and disobedient. Teachers are trying to support Yuki-kun, teaching the rules of school life and encouraging him to participate more in activities, but the more teachers interact, the more he feels, "They're always picking on me," "Why only me??"

In fact, when I had interviews with high school and university students with ADHD characteristics, many of them said, "I used to be scolded by teachers all the time, ever since I was little." This indicates how much children with ADHD characteristics are reprimanded in their daily lives; so much they feel "anywhere and anytime" whenever they are at home, childcare facilities, elementary school, or after-school activities.

Situations from the standpoint of parents

From the standpoints of parents, how do they feel about their ADHD children? Unfortunately, a lot of parents seem to have a difficult time at home as well. I will explain the case of Yuki-kun's family. Yuki-kun often plays video games for a long time and cannot easily switch to other activities. His mother is busy with a young baby brother born in the previous year. His father lives separately due to his work relocation and is not involved in child-rearing. His paternal grandfather is strict regarding education, and maintains that his mother's "inadequate parenting" is responsible for Yuki-kun's current situation.

Furthermore, school teachers repeatedly report to her that Yuki-kun will not participate in group activities, causes trouble in class, does not complete homework assignments, and is often late for school. Under such circumstances, how would you feel as a parent? If it were me, I would not know what to do.

As Yuki-kun cannot sustain his efforts because of his ADHD characteristics, he has difficulty staying focused and his "failed experiences" keep piling up. Under such a situation, how can he maintain his self-esteem, which may affect the onset of secondary symptoms? I think it must be very difficult for him to improve this situation on his own. If we adults do nothing, a negative cycle may result.

Yuki-kun's self-esteem will be damaged due to others' lack of understanding and repeated reprimands. As a result, teachers and parents feel irritated and reprimand him further, worsening Yuki-kun's self-esteem.

Situations from the standpoint of teachers

Next, how do school teachers perceive the situation surrounding Yuki-kun? Teachers feel they want to help Yuki-kun so he can participate in more activities as this may help him build a good relationship with his peers. On the other hand, they also think they need support from parents as well so that he can take part in activities that he can do.

The teachers' feelings seem to divide in two directions: for the sake of Yuki-kun, or for the benefit of the entire class. If teachers place more weight on the benefits of the entire class, they may encounter numerous difficulties in treating Yuki-kun, repeatedly reprimanding him but finding no improvement. As a result, they will lose confidence and feel lost, regardless of their years of experience as a teacher (Sunami, 2022).

Understanding of Yuki-kun with ADHD tendencies

Finally, how should we adults understand children with ADHD characteristics, such as Yuki-kun, in order to get involved with him in a better way?

As mentioned above, ADHD has two categories of symptoms: inattention and hyperactivity/impulsivity--children with ADHD display either one symptom or both. In the case of Yuki-kun, he seems to have trouble in listening to teachers' instructions, staying focused, or paying attention (most probably because he easily gets distracted by something else he is interested in). Such behaviors are attributable to "inattention," one of the ADHD characteristics. Because of inattentive symptoms, Yuki-kun cannot listen to teachers' explanations sufficiently and, thus, cannot understand what to do next. In addition, to perform a task, it is necessary to understand and remember what to do and concentrate on it without being distracted by something (Barkley, 1997).

Therefore, Yuki-kun has difficulty in completing a task due to inattention and impulsive symptoms.

Because of these characteristics, children with ADHD tendencies are likely to be considered a "child who dislikes making an effort," no matter how strongly they desire recognition for their efforts. Nevertheless, based on my experiences as a counselor, I am sure that deep down in their hearts, every ADHD child wants to make friends, be accepted by others and enjoy their school life.

Through my experiences, my perspective of children with ADHD tendencies gradually changed from "children with problems" to "children suffering from difficulties in keeping up their efforts and find themselves in unsuccessful outcomes as a result due to ADHD characteristics." ADHD children are making efforts as much as they can. With such feelings in mind, I now see an "innocent child trying his/her very best" and can accept him/her with a warm feeling as a precious student, even when the situation could be troublesome for adults.

References:

• 1) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. text revision DSM-5 (5th ed.)
• 2) Biederman, J., Mick, E., Faraone, S. V. (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry, 157(5), 816-818.
• 3) Kazuhiko Saito & Momoko Aoki. (2010). The comorbidity of ADHD as secondary symptoms. Japanese Journal of Psychiatric Treatment, 25, 787-792.
• 4) Masae Sato & Emi Akasaka. (2008). Self-esteem and factors affecting it in children with attention deficit/hyperactivity disorder. Japanese journal of learning disabilities, 17(2), 141-151.
• 5) Naomi Sunami. (2022). The expertise of teachers instructing children with developmental disorders. Gakubunsha.
• 6) Barkley, R. A. (1997). ADHD and the nature of self-control. Guilford press.
• 7) Naomi Sunami. (2022). Interpersonal interactions that nurture a sense of belonging and self-esteem among children with developmental disorder tendencies. IMAIBOOKS.
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