Is ADHD Complex?

ps://www.rawpixel.com/image/680803/doctors-with-tablet
Answers to some of your questions about ADHD
and how it may affect your child and family

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 The following Complex Attention and Hyperactivity Disorders Service (CAHDS) Clinicians
have contributed to this booklet:
Nathan Adey Clinical Nurse Specialist
Lee-Ann Bamess Senior Speech Pathologist
Dr Parma Barbaro Clinical Psychologist
Stephanie Curtis Senior Speech Pathologist
Dr Stephen Edwards Senior Social Worker
Robin Elliot Clinical Nurse Specialist
Jessica Green Senior Occupational Therapist
Dr Chloe Groznik Clinical Psychologist
Dr Ben Pearcy Research Co-ordinator
Dr Pradeep Rao Consultant Child and Adolescent Psychiatrist
Claire Tan Educational & Developmental Psychologist
Dr Prue Watson Clinical Neuropsychologist Registrar

Acknowledgements
Complex Attention and Hyperactivity Disorders Service (CAHDS) would like to thank the
families and children who have accessed CAHDS services, either through the Parent
Information Sessions or the CAHDS assessment process. Their feedback and involvement
in the service has helped develop this resource.
CAHDS would like to acknowledge Ms Shenae Chapple, Child and Adolescent Health
Service (CAHS) Consumer Representative, Ms Ana Ristoska, Mr Ben Rushton,
Mrs Emma Rushton & Ms Ulrika Thor, CAHDS consumers, for reviewing the manuscript
for applicability to the consumers of the service and also to the wider community.

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About the Service
The Complex Attention and Hyperactivity Disorders Service
(CAHDS)
The Complex Attention and Hyperactivity Disorders Service (CAHDS) is a state wide
service that works with children, young people (under 18 years old) and families. Children
and young people accessing CAHDS must have a diagnosis of ADHD and currently being
treated by a Paediatrician or Child Psychiatrist. We work with children and young people
who have not responded to typical ADHD interventions, and are continuing to experience
persistent problems with symptoms or functioning. This can manifest in their behaviour and
adversely affect their developmental progress and mental health. CAHDS is a free service
funded through the Department of Health WA.

What happens at CAHDS?

CAHDS provides a specialised assessment and recommendations for future management
such as other services to work with in partnership with your referrer. CAHDS also provides
targeted group treatment programs to children and families accessing our service. We do
not offer ongoing individual treatment or pharmacological intervention.
CAHDS assessment involves a comprehensive multidisciplinary assessment. Our
clinicians work collaboratively with your child and family to understand your child’s
abilities and challenges and identify co-morbid issues that may occur with ADHD. Our
assessment may include detailed psychosocial, speech pathology, occupational therapy,
neuropsychology and psychiatric assessments.
We provide information sessions on ADHD and related issues, including the Therapeutic
Crisis Intervention for Families (TCI-F) program, to families and schools. These sessions
occur several times throughout the year, and are available for free. You do not have to be
currently engaged in our service to attend the information sessions.

CAHDS Contact Details:

Perth Children’s Hospital
Level 2, Clinic K
15 Hospital Avenue
NEDLANDS WA 6009
(Locked Bag 2010 NEDLANDS WA 6909)
Phone: 6456 0214
Email: CAMHS.CAHDS@health.wa.gov.au
Scan QR code to email CAHDS from your phone:
1. Open camera on your phone
2. Tap QR code in the image
3. Write contact email to CAHDS

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 Foreword
Why have we written this booklet?
This booklet has been written by clinicians working in Complex Attention and Hyperactivity
Service (CAHDS) for families of children with ADHD. CAHDS is governed by Child and
Adolescent Mental Health Service (CAMHS) which is part of the Child and Adolescent
Health Service. CAHDS is an assessment service for children and young people
diagnosed with ADHD who are experiencing ongoing issues with the management of their
ADHD. CAHDS also provides a consultative service to other CAMHS teams for children
with attentional difficulties.
The CAHDS team is made up of:
 Clinical Psychologists
 Mental Health Nurses
 Clinical Neuropsychologists
 Occupational Therapists
 Speech Pathologists
 Social Workers
 Child and Adolescent Psychiatrists
 School Psychologists from the Department of Education.
Parent information sessions have been provided since 2015 as a means to increase
parents’ knowledge and understanding of issues that may impact on their understanding
of their child. As such, CAHDS developed Parent Information Sessions on various topics
related to ADHD. The information session topics were identified by parents who indicated
that they wanted more information on topics related to ADHD. This booklet collates the
information presented in the parent information sessions and it is the intention parents can
use this as a ready reference.

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The authors of this booklet have tried to include resources available nationwide. Some
resources may be specific to Western Australia. If you are accessing this booklet outside of
Western Australia, it is recommended that you check local resources with your respective
health.
The advice provided in this booklet is for general information only and detailed information
must be obtained from the treating doctor as well as the product information provided by
the company prior to commencing any medications.
This booklet is also available electronically on our website:
https://cahs.health.wa.gov.au/Our-services/Mental-Health/Specialist-services-and-day-
programs/Complex-Attention-and-Hyperactivity-Disorders-Service

Contents
1. Introduction to Attention-Deficit Hyperactivity Disorder (ADHD)
Dr Pradeep Rao, Dr Parma Barbaro and Dr Ben Pearcry....................................6

2. U
 nderstanding your child’s behaviour
Nathan Adey and Dr Parma Barbaro....................................................................9

3. E
 xecutive functioning and ADHD
Dr Chloe Groznik, Dr Prue Watson, Claire Tan and Dr Parma Barbaro................ 16

4. Communication and ADHD

Lee-Ann Bamess and Stephanie Curtis................................................................24

5. What is Sensory Processing

Jessica Green.......................................................................................................28

6. Sleep and ADHD

Dr Parma Barbaro, Dr Pradeep Rao and Dr Ben Pearcy.....................................35

7. Medications in ADHD
Dr Pradeep Rao....................................................................................................39

8. Family Self-Care and ADHD

Nathan Adey and Dr Parma Barbaro....................................................................44

References................................................................................................................51
Appendix 1. Recording sheet for identifying child’s needs.................................56
Notes.........................................................................................................................58

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 Chapter 1
Introduction to Attention-Deficit
Hyperactivity Disorder (ADHD)

What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common disorders in
children. It is understood to be a neurodevelopmental disorder (where the development
of the brain is affected) that is commonly subdivided into problems of attention, problems
of increased activity and problems of impulsivity. ADHD is often diagnosed in childhood
and can continue into adulthood. ADHD occurs in both girls and boys. ADHD is commonly
thought to affect at least 5 out of every 100 children, although this number can vary
between 2 and 10 out of every 100 children.

Examples of problems a child with ADHD may have in these areas include:
Attention
 Poor attention to details or making careless mistakes
 Appearing not to listen even when spoken to directly
 Losing things easily
 Easily distracted
 Easily forgetful
 Problems with finishing tasks or following through on instructions
 Problems with organising tasks or activities
 Problems holding attention, especially to everyday tasks
 Avoidance of tasks that require prolonged mental effort

Hyperactivity
 Fidgeting or squirming
 Difficulty sitting still
 Running about or climbing excessively
 Trouble playing quietly
 Appearing as if constantly ‘on the go’
 Talking excessively

Impulsivity
 Blurting out answers before questions have been completed
 Difficulty waiting their turn
 Interrupting conversations

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There are three sub-types of ADHD noted in the Diagnostic and Statistical Manual of
Mental Disorders:
 ADHD Inattentive sub-type
– Children with predominantly inattentive presentation display mostly the inattention
symptoms noted above.
 ADHD Hyperactive-Impulsive sub-type
– Children with predominantly hyperactive/impulsive presentation display mostly the
hyperactive/impulsive symptoms noted above.
 ADHD combined sub-type
– Children with predominantly combined presentation display both a mix of inattention and
hyperactive-impulsivity symptoms.

How is ADHD diagnosed?

The diagnosis of ADHD follows a thorough assessment usually by Paediatrician or a
Child and Adolescent Psychiatrist. This involves obtaining information about the child or
young person from different people (e.g., parents, teachers) who know the child or young
person well. This may include observations, questionnaires, school reports and specific
testing (e.g., cognitive testing). This process also helps to rule out other issues (e.g.,
developmental, medical, mental health) that may better explain the child’s difficulties. It is
important to have a detailed understanding of the child/young person before making any
decision about their diagnosis and treatment.

What causes ADHD?

There is no specific cause of ADHD. There are factors that may contribute to the develop-
ment of ADHD.

Some Risk Factors

 Family history of ADHD  Complications during birth

 Brain injuries  Low birth weight

 Mother’s mental illness  Oxygen deprivation at birth

N
 egative childhood experiences

E
 xposure during pregnancy to:
 (e.g., chaotic and conflictual family
– toxins (e.g., tobacco, alcohol, environment)
lead,drugs)
– mother’s stress
P
 sychological trauma following a

– viral infections
stressful event.

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 How is ADHD treated?
ADHD is usually treated using a combination of:
 Medication
 Psychological therapy including psychoeducation
– This can help address other issues the child/young person is experiencing such as
anxiety, depression, sleep, social skill difficulties, emotional regulation, and executive
functioning. It can also help the child/young person get a better understanding of their
difficulties and ADHD.
 Parent education
– This helps with increasing parental understanding of ADHD, confidence with their
ability to raise their ADHD child, and specific parenting strategies.
 Educational strategies
– This helps with addressing areas the child/young person is having difficulties with
at school. An Individual Education Plan (IEP) or Individual Behaviour Management
Plan (IBMP) can outline strategies to address specific areas the child/young person
has difficulty with at school (e.g., learning difficulties in the areas of spelling, reading,
writing, and comprehension, sensory difficulties, executive functioning, working memory,
processing speed, challenging behaviours).

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Chapter 2
Understanding your child’s behaviour

Children are often described in terms of their behaviour. This is particularly true when
describing children with ADHD.

Behaviour - what do we mean?

All behaviour has a reason. Children often use behaviour as a means of communication.
They may be trying to tell us they need to:
 get something they desire (e.g., food, activity, attention)
 get away from/avoid something (e.g., pain, noise, difficult task)
 express their emotions
Behaviour is often interpreted as positive or negative. Behaviour may be interpreted as
negative because:
 parents can feel helpless when trying to manage it
 it may have negative consequences for children (e.g., academically, socially)
 it may contribute to conflict within the family and damage family relationships
When describing behaviour, the setting and circumstances in which it occurs may often
be overlooked. This can be called the “function” of behaviour. Understanding the reason
behind the behaviour can help us support the child develop more appropriate behaviours
to have their needs met.

Getting needs met

Some behaviours are more effective than others in getting the child’s needs met,
particularly if the behaviour has been reinforced in the past.
Reinforcement can be:
 Negative: taking away something to increase a behaviour
– e.g., putting a child in timeout when they throw their book in anger when asked to
complete an assignment. In this example, the timeout gets the child out of completing
the assignment - something they were looking to avoid in the first place by throwing the
book. The act of putting the child in timeout has negatively reinforced the behaviour of
throwing the book in anger as it has helped them avoid a possible difficult assignment.
 Positive: adding something to increase behaviour
– e.g., giving a child a lolly because they are crying. This means they will be more likely to
have a tantrum to get a lolly.

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 The use of reinforcement is a powerful motivator to complete a task. Motivation to
complete a task/comply with an instruction can be
 Intrinsic: within the individual
– e.g., reading a book because you enjoy reading and are interested in the topic
 Extrinsic: outside the individual
– e.g., reading a book because you will get a canteen voucher from the teacher
Intrinsic motivators can be more effective and long-lasting but are more difficult to use as
a reward. Extrinsic motivators are easier to use as a reward but lose their effectiveness
over time. Extrinsic motivators need to be modified. They may lose their effectiveness
if they do not address the need or the need changes. Extrinsic motivators are useful to
initiate change in behaviour. They are more effective when intrinsic motivators are used
alongside.
 For example, a child who constantly interrupts a parent may temporarily stop
interrupting when given a small treat. However, going with the child to get the treat in
response to them not interrupting maybe more effective as you may be addressing the
underlying need of the child wanting to spend time with you.
It is therefore important to understand the need the child is trying to communicate with
their behaviour. Behaviour can often be a poor communicator of our needs or feelings.
Sometimes the need being communicated by a particular behaviour can be easily
identifiable whereas at other times this may not be as obvious.

The Iceberg:
 Often what we see externally is
the behaviour (the iceberg visible
on the surface).
 What we may not see are the Behaviours
underlying feelings and needs (the
ice hidden under the water).
 Children may sometimes engage
in extreme behaviours (e.g.,
impulsive outbursts, self-injury,
defiance, inability to regulate
emotions).
 These behaviours may be
the result of emotional and Feelings and needs
psychological factors (e.g. trauma
response; see below for more
information). In these cases the
feelings and needs in the lower
part of the iceberg need to be
acknowledged.
 Children displaying extreme behaviours often need assistance to express their hurt (big
feelings) as well trusting that others can help them with managing this hurt.

10
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Understanding the possible reasons for a particular behaviour can help with providing a
response that is attuned to the needs of the child.
Addressing the behaviour in isolation while not responding to the underlying needs and
feelings can lead to a child replacing one unwanted behaviour with another to have their
needs met. This can lead to increased parental frustration as parents will feel that they
have tried everything to manage the behaviour.
The following table illustrates the iceberg concept.

Response
Behaviour Need (possible) Feeling (possible)
to behaviour
Child is  Get out of  Embarrassment or  Send child out
‘surfing’ on top classroom/ shame as not as of class
of table when learning ‘smart’ as others or  Chastise child
teacher walks environment feeling judged by in front of class
into class room  To make people teacher or peers
laugh/like me  Lonely or disengaged
 Show the teacher from others; socially
they can’t control excluded from peers.
me  Disempowered
 Have some  Restless, under
sensory or stimulated,
movement input anxious

In the example above, the responses do not help the child get their needs met, and may
in fact, reinforce the feelings driving the behaviour (e.g., sending the child out of the class
may further increase their feelings of disengagement or reinforce the avoidant behaviour
and underlying sense of embarrassment).

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 What affects how children manage their feelings and
behaviour?
 Degree of Stress

Best Performance
High

Performance

Low Stress Level High

* graph based on Yerkes & Dodson (1908) Inverted U Theory

A certain degree of ‘stress’ is needed to motivate us to do something. Too little or too

much stress can lead to suboptimal performance, avoidance, or irrational or dysregulated
behaviour. In times of stress or excitement the ability to use coping strategies or previous
behaviours may be compromised. In these situations, it is important to consider what is
possible for a child to achieve at that point in time.
Trauma or negative experiences
 
A trauma response is not only triggered by abuse (physical, emotional, sexual, neglect).
Children, including those with ADHD, may also experience a trauma response related
to significant negative experiences (e.g., bullying, peer rejection, sense of failing). This
can affect their ability to manage feelings and behaviours. When a child faces a real or
perceived threat the stress response* is more readily activated.
*further details in family stress chapter
Expectations
 
A parent’s expectations of their child’s behaviour should take into consideration the
ability of the child (e.g., cognitive, physical, emotional and developmental) to meet
those expectations. For example, a child who is impulsive may not be able to inhibit
their responses, or a child who has attention issues may get distracted. If a child
does not have the skills to meet certain expectations, it is unlikely that sole use of
external incentives will help the child meet those expectations. The focus must be on
both building the child’s skills as well as using reinforcements appropriately. In some
instances a child may never be able to meet those expectations and accommodations
may be necessary.

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 Goal or need motivating the behaviour
 
Although a child’s behaviour can change, the goal or need of the behaviour usually fits
into one of four categories. The child may not be aware of their need or why they are
behaving in a certain way. To assist a child manage their behaviour, it is useful for adults
to be aware of the emotional response that is elicited in themselves when they are
faced with a child’s behaviour.

Emotional
Belief/ thought/ Child’s
Goal/Need response in
cognition/ feeling behaviour
parents

Attention/ I need to be in the Child repeatedly Annoyed

Attachment person’s mind/ interrupts parents
seeking interactions whilst on phone
because they are
thirsty, hungry, can’t
find something, can’t
get something to
work, starts arguing
with their brother

Power I need to be master Conflict with parent; Angry, provoked

of my own destiny/be arguments as if parental
able to make decisions authority is
about self threatened

Revenge I am hurting or Child says “I hate Deeply hurt

unlovable you”; “You’re fat/ a
bad cook”

Display of I am incapable or if I Child cannot make Despair, hopeless

inadequacy become capable you their bed despite (I give up)
will not like me or need being shown and
me assisted a number of
times how to do it.

* Based on Dreikurs (1948).

Appendix 1 has a suggested recording sheet that parents can use to help identify a child’s
need as outlined in the table above.

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 Willingness and Ability
When faced with behaviour that may be challenging or difficult consider what is
contributing to the behaviour: unwillingness or inability (or maybe both)?
If it is an unwillingness then we may need to address how to positively motivate the child
so that they will make an attempt. Consider what the behaviour is trying to tell us. If it is
inability, changing expectations or further skills training maybe necessary. The picture
below provides some examples.
Willing

Willing - Praise and reward the effort Willing - Praise and reward the effort
Able - If consistently achieved in Unable - If consistently not achievable
the future consider increasing the consider decreasing the expectation
expectation to keep them stimulated and/or teach the skills needed

Able Unable
Unwilling - Identify what will increase Unwilling - Identitfy what will increase
the motivation the motivation (intrinsic/extrinsic)
Able - Consider increasing the Unable - If not achievable consider
expectation to keep them stimulated descreasing the expectation and/or
and interested teach the skills needed.

Unwilling
*Matrix based on Paul Hersey and Ken Blanchard (1977) Willing and Able Matrix.

Consequences vs punishment
When encouraging a child to use alternative behaviours, using punishments may deter
them from doing what they were doing. It does not necessarily teach them an alternative
strategy to use in the future. It is important to remember if we are taking away a behaviour
used to communicate or meet a need we need to teach a new way of communicating or
getting the need met.
As children develop, they will test boundaries and their thoughts/beliefs about themselves
and the world. When testing these boundaries their behaviour may not be appropriate or
acceptable within a setting. However, it maybe developmentally appropriate for the child
(e.g., a two year old having a tantrum when they don’t get what they want; an adolescent
not complying with an instruction). As significant adults in their life we can teach and guide
them to use socially acceptable and effective communication to get their needs met.

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Additional resources to assist with understanding behaviour
Organisation: Department of Social Services (Raising Children)
Details: The Raising Children website provides ad-free parenting videos, articles
and apps backed by Australian experts in the field.
Contact: https://raisingchildren.net.au

Notes:

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 Chapter 3
Executive Functioning and ADHD

What is Executive Functioning?

Executive functioning may be understood as a set of mental skills that help us to plan,
stay focused without becoming distracted and flexibly solve problems so as to achieve
our goals. It involves skills such as working memory, mental flexibility, self-control and
organisation.
Working memory is our ability to hold and work around different pieces of information in
our short-term memory (e.g., remembering multiple instructions from parents to go to your
room, change your shirt and come back to set the table for dinner).
Mental flexibility is being able to switch our attention or apply different rules when
situations change (e.g. if we are missing a recipe ingredient, we can substitute it or ask our
neighbour).
Self-control is being able to hold back impulses and prioritise what is most important (e.g.,
not yelling in a library when we are angry that someone bumped into us).
Executive functioning skills are essential for achievement in school, managing big feelings,
developing positive behaviours, maintaining healthy and meaningful relationships, and
being successful in work environments.

Development of Executive Functioning

The building blocks for these skills begin in early childhood, and these skills can continue
to develop well into early adulthood. The developmental pathway can be different for
males and females. Some males may continue to develop their executive functioning
control until 30 years old. Females tend to develop their executive functioning control
earlier than this (at approximately 20-25 years).
The development of executive functioning skills is enhanced by:
 Supportive families and teachers
 Fun activities that improve social skills
 Safe home and school learning environments
Stressful events such as abuse and neglect can disrupt the brain development and place
children at a disadvantage with the development of these skills.

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Impact of ADHD on Executive Functioning
Children with ADHD have a higher likelihood than other children to have difficulties with
executive functioning. ADHD is a neurodevelopmental disorder that affects a person’s
ability to sustain their attention to manipulate different pieces of information; selectively
tune out distractions to focus on their goals; and hold back impulses.
Children with ADHD may be slower in the development of their executive functions. This
can vary up to 30% and up to 6 years behind their peers in some cases. This means
that they are often thinking or behaving in ways that are younger than same aged peers,
which can lead to difficulties with their learning, relationships with friends and adults, and
the way they manage feelings. They may then be mistakenly labelled as ‘lazy’, ‘rude’ and
‘defiant’; which further maintains their difficulties. Children with ADHD can sometimes also
have other difficulties such as language disorders, anxiety, specific reading disorder (e.g.,
dyslexia), fine-motor difficulties and sensory processing differences, which further impact
on their executive functioning. These difficulties highlight the importance of supporting
children with ADHD and managing expectations of them across the lifespan.

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 While it is hard to clearly separate the different constructs of executive function in real-
life situations, here are some examples of the areas of executive dysfunction common in
children with ADHD: Jayden, Sophia and Isabella are fictional characters used to illustrate
areas of executive dysfunction.

Area of executive
Example Impact
dysfunction

Organisation and Jayden has started high Learning: It is difficult for Jayden to
Task Initiation school this year. After dinner, hold different information from different
he knows it is time to do subjects in mind. He often misses key
some homework but there are information due to the limited size
so many different subjects, of his working memory. He may mix
projects, homework, tests and up the sequence of learning, or even
exams (organisation). appear to ‘make up stories’ to fill the
gaps of what he has missed.
Jayden cannot get his head
around what task to start with Social: He is unable to keep up with
(initiation), or the different the pace of learning in high school, is
steps to complete each task labelled by teachers and families as a
(organisation). ‘day-dreamer’, ‘lazy’, ‘lost cause’. He
no longer enjoys going to school, and
Defeated, he stares blankly at
starts losing interests even in subjects
his bedroom wall. One hour
he used to enjoy. He sits alone at
later, he still hasn’t started
lunch and isn’t interested in playing
on anything (initiation).
sports or talking with his peers.
His mother walks past his
bedroom and yells at him to Emotional: Jayden becomes sadder
“Jayden, stop daydreaming! and more withdrawn, he starts to think
I can’t believe you haven’t “What’s the point of even trying when
started on anything in the I’m going to get it wrong anyway?”
past hour!”

Self-awareness/ Sophia calls out her answer Learning: Sophia may miss key
Impulse Control and before her teacher has information when learning as she has
Working Memory finished reading the story not listened to the full story (working
to the entire class (impulse memory).
control).
Social: Teacher sees her as ‘rude’ for
Her teacher singles her out interrupting; and other children are
before the class, stating annoyed with Sophia for frequently
“Sophia, it is very rude yelling out. She gets sent to ‘time out’.
of you to interrupt when I She may also be gradually ostracised
am speaking. Go to ‘Time by other students.
Out’ now”. Everyone turns
Emotional: Sophia doesn’t understand
to Sophia and are either
why she is being sent to ‘Time Out’
frowning or shaking their
and feels confused, ashamed and
heads at her. Sophia still
angry.
isn’t quite sure why they are
annoyed with her… (self-
awareness)

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 Area of executive
Example Impact
dysfunction

Emotional Control / Isabella is playing a game Learning: Isabella may miss out on
Mental Flexibility of Uno with her family on fun activities that she may perceive
Sunday night. Everyone is to be ‘unfair’. This may lead to her
laughing and having fun. missing out on fun activities which are
essential for life.
It is her turn, and this is the
third time in a row that she Social: Families and friends may be
has to ‘draw two’. Suddenly, more reluctant to engage Isabella
Isabella jumps out of her in spontaneous games for fear of
seat and shouts “This is not her emotional outbursts, and her
fair!” bursting into tears and opportunities to practice turn taking,
pushes all the cards to the managing wins and losses are limited
floor (emotional control / (mental flexibility).
mental flexibility). The game
Emotional: Isabella continues to have
stops and Isabella’s father
great difficulty managing emotions,
takes an hour to calm her
where she has frequent outbursts,
down.
tantrums. Even when she is happy, it
can lead to excessive ‘silly’ behaviours

What now?
Given the impact of ADHD and executive dysfunction on learning, behaviours, feelings
and relationships, it is crucial for adults at home and in school to identify these areas of
difficulties early on. This will allow for and provide appropriate supports to be provided for
their difficulties, particularly when children and adolescents are developing these abilities.
Parents and carers also play a big role in advocating for their child in school settings. Often
children with ADHD and executive functioning difficulties are at risk of being mislabeled
as “badly behaved” or “difficult”, when they have genuine difficulties that impact on their
learning, behaviours and relationships. When mislabeled, this can put them at further risk
of disengagement from school, risky behaviours and mixing with antisocial peers. Regular,
open and calm communication between families and schools can support the child by
identifying problems early on and jointly problem solving these difficulties.

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 Strategies to assist with Executive Functioning
Early identification of these difficulties and advocating for your child’s needs can promote
the use of appropriate supports and strategies to strengthen their executive functioning
over time. Parents and teachers play a very important role in supporting the development
of these skills, first by helping children complete tasks they find difficult (scaffolding), then
slowly stepping back to allow children to practice and learn from their mistakes. Children
build their self-confidence and ability by repeatedly experiencing success with each
practice5.

Here are some common strategies to consider

1. Take a few deep breaths or a few minutes away from a potentially heated
situation!
Have a mantra in mind before speaking with your child. For example “My child isn’t
giving me a difficult time, they are having a difficult time.” or “They need my help, how
can I best respond?”
Your child (*remember they have difficulties managing feelings!) will also need your help
to take a few deep breaths together, have a cuddle, a hot drink, or a reassurance from
you that “It’s ok, we can work through this”.
2. Guide your child from complete dependence on adults to gradual independence:
When working through a complex task, it can be helpful to first show them what to do,
then telling them what to do, then asking them to do it, until they are able to take over
that role on their own. As with learning any new skills, this takes time and repeated
practice. Supportive adults modelling appropriate self-talk and behaviours can help
children build their inner self-talk in positive ways. Using visual supports or writing steps
down can help your child remember how to complete a task independently.
Praise your child’s effort regardless of outcome. Affirming their successes can also
encourage them to develop resilience and a positive self-image.
3. Modify your expectations, the task and/or the environment
Identify the best way your child learns (e.g., time of day, sitting positions, sensory
preferences, visual or verbal learners) and consider when may be the best time to do
what. For example, children with ADHD tend to be exhausted after school as they have

20
 had to work a lot harder than other children to stay seated, attend to information, work
out what they have to do in class and interact socially with their peers. Asking them to
do their homework the moment they get home may just be “too much” for them. Having
a set (but flexible when required) routine after school such as exercise, healthy snacks
or a warm shower may help them “re-set” their emotions and complete home tasks.
Just like we all have good and bad days, their performance and attention will vary
depending on their mood and energy levels. Have in place other activities or plans when
things may not be possible on one day. Encourage them to express how they feel and
when they feel overwhelmed.
When they are calm and rested, help them identify which task needs to be prioritised
and use visual aids like a checklist, or a calendar. Speak slowly using simple language,
writing key points down so that they can refer back to a static reminder if they miss any
key steps. They may also need reminders, not because they were not listening, but
because they have limited working memory storage. Allow regular rest periods for them
to review their work, and pre-warn them before transitioning to the next task.
If the work is too difficult for your child, consider meeting with their teacher to discuss
possible ways to modify the tasks so that they can be assessed for their learning, at
an appropriate level for your child (e.g., if they have marked difficulties with writing
an essay, can they demonstrate their learning through dot points instead of an essay,
multiple choice options, or “hands on” demonstration of a skill). It may take several
trials and errors to find the appropriate modifications; be patient and validate everyone’s
efforts. With repeated successes, consider gradually increasing task complexity to
support their independence, confidence and abilities.
4. Teach your child effective ways to learn
Consider teaching them strategies that place less demand on their working memory,
and maximise their learning such as:
  Chunking
e.g., If you had to dial the number 135610, if you remember it as 1 3 5 6 1 0, that is six
chunks of information, which fills your working memory. If you chunk the number into
13 56 10, that is three chunks of information, which is much easier to remember.
  Mnemonics
Teach Child to use mnemonics to help them remember new information,
e.g. VIBGYOR- for the colours of the rainbow/ light spectrum (Violet, Indigo, Blue,
Green, Yellow, Orange, Red).
Creating a story to remember words/item for a shopping list: Cornflakes, banana, milk,
toothpaste.
“In the morning I get up and eat my cornflakes with banana and have a cup of milk.
Then I clean my teeth”.
Mindmaps
 
e.g., A diagram used to visually organise information and show relationships between
information.
Brain storming
 
e.g., Writing down all possible ideas related to a topic.

21
 Try to link new learning to previous learning. Structure new situations as much as
5. 
possible (e.g., teacher can provide a handout of key points before the lesson), and give
small amounts of new information at a time.
Teach them new ways to manage big feelings such as asking for help from a helpful
6. 
adult or peer; taking a deep breath or a sip of water and telling themselves “this looks
hard, but I’ve done this before and I can do this again” before starting a task. Consider
mental health input (e.g., psychology, OT) if their feelings start to impact significantly on
their daily activities.
7. L
 earning continues at home! In many ways, parents are better placed than teachers
to teach functional strategies with their children. Daily activities (chores, setting the
table, cleaning room etc.) require executive functioning. On the days you can’t spend
individual time with your child, include them in your own daily routine.
Have fun! There are some family activities that can promote executive function
8. 
including board games, sports, music and dance.
The Center on the Developing Child, Harvard University has a working paper
“Enhancing and Practicing Executive Function Skills with Children from Infancy to
Adolescence” (https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-
content/uploads/2015/05/Enhancing-and-Practicing-Executive-Function-Skills-with-
Children-from-Infancy-to-Adolescence-1.pdf) that suggests some activities according
to chronological age. Keep in mind that children with ADHD may be slower in their
development of these skills.
Speak with your child’s doctor and/or teacher about your concerns if these
9. 
difficulties remain or worsen even after a prolonged period of regular intensive
support (e.g., 12 months). Your professional may discuss if there is a need for further
assessments.
10. Self-care: “Put your own oxygen mask on first before helping someone else”. Parents
of children with ADHD experience a great deal of stress doing their best for their
families and children. Self-care is not selfish, and is of benefit to you and your
child. Take some time out of your day to do something kind and nurturing for yourself,
be it yoga, writing, joining a support group, catching up with a friend over coffee, or
speaking with a mental health professional can help you clear your mind, reset and
better support and advocate for your child.

22
Key Takeaways
Executive functioning involves working memory, mental flexibility, self-control and
organisation.
Given the impact of ADHD and executive dysfunction on learning, behaviours, feelings and
relationships, early identification and support is crucial. Parents and teachers play a very
important role in supporting the development of these skills. Be wary of quick fixes, and
things that may sound too good to be true or interventions that are not based on evidence.
When supporting your child, consider changing your expectations, the task and/or the
environment, and teach them new ways to manage big feelings.
Helpful strategies to enhance learning are:
 Using visual supports
 Simple language
 Chunking
 Mnemonics
 Mindmaps
 Brainstorming
Take some time out of your day to do something kind and nurturing for yourself.

Additional resources to assist with Executive Functioning

1. Center on the Developing Child, Harvard University, https://developingchild.harvard.edu/
guide/a-guide-to-executive-function/
2. InBrief: Executive Function: Skills for Life and Learning https://www.youtube.com/
watch?v=efCq_vHUMqs&feature=emb_title
3. Executive Function 101 Prepared by the National Center for Learning Disabilities
https://www.edrevsf.org/wp-content/uploads/2019/01/executivefunction101ebook_344.
pdf
4. Helping Children with Executive Functioning Problems to Manage Physical
Impulsiveness http://www.ldonline.org/article/29048
5. Helping Children with Executive Functioning Issues Manage Behaviours http://www.
ldonline.org/article/29121
6. Helping Children with Executive Functioning Problems Turn In Their Homework http://
www.ldonline.org/article/29043

23
 Chapter 4
Communication and ADHD

“he will only do homework when in the mood”

“he has difficulties understanding
what he’s reading”
“struggles academically, has always been behind”

“he forgets information he

has learnt”

“he gets stuck thinking of words”

“he sometimes forgets what he started off saying”
“gets confused when
there are too many
instructions”

These are examples of common comments made by parents of children with a diagnosis
of ADHD. The comments are generally related to difficulties with communication skills.
We all use communication skills to provide information, to pass on our thoughts and ideas
to others, to give instructions and to make comments. We also ask questions to find out
about what we don’t know or to check that we have understood something correctly. We
have all had experiences when communication breaks down, where we are misunderstood
or haven’t fully understood what others are saying. When communication breaks down it
is frustrating or embarrassing for the person giving information and the person trying to
understand the information.

24
Receptive and expressive language
The skills needed to give information to others are known as expressive language
skills. First words usually emerge around a child’s first birthday and language develops
from there. Not only do they learn words, but also learn to use grammar and sentence
structure to put words in the correct order and the correct form to make the meaning clear.
As children’s language develops, their vocabulary keeps on expanding. A child’s speech
sounds also need to develop accurately for their speech to be clear and for their messages
to be easily understood. Speech impairments refer to the actual speech sound production
and are separate to language development.
The skills needed to understand information are known as receptive language skills.
Children develop their understanding of concepts such as size and directions from very
early on. At first, understanding information is about what is happening right there and then
but as children develop language and thinking skills they start to link new information to
their past experiences. They add information to categories and start to think about, and
problem solve, using old and new information. Children learn to work out what information
may have been implied without having been said specifically, this is known as making
inferences. Children also use their understanding of what was said to predict what might
happen next or what has caused something to happen. Children need to understand
language to be able to follow instructions and to be able to answer questions.

Literacy
Communication is not only about using and understanding spoken words. When children
start school they start to read and write. Reading is the ability to understand written
information whereas writing is the ability to express thoughts, ideas and the knowledge
they have on certain topics. Again it is the ability to give or understand information.

Non-verbal communication
Communication is also much more than just the words being used. We use facial expressions,
tone of voice, gestures and eye-contact to communicate so much more than what is said just
using words. That is why when writing text messages we use capitals to emphasise a point we
are making and sometimes we use emojis to let others know how we’re feeling.

Social communication
We use communication skills in all we do, to think, to learn and to socialise. The
communication skills used to interact with others are known as social communication
skills. These are the skills we use to develop and maintain friendships and to stay socially
connected with others. We use them to negotiate, to be assertive and to make friends and
keep friends. These skills let others know that we are interested in them and want to make
a connection with them.
To be part of society and feel connected with others, we develop and then build our
relationships. We have relationships within our families, our friendship groups, our
classmates, teammates and when we grow up in our workplaces and many other
roles. We are connected with many people by the way we communicate with them and
that includes social media and using technologies to communicate when we cannot
communicate face-to-face.

25
 Communication Difficulties, ADHD and other Mental Health
Issues
Many children and young people diagnosed with ADHD and other emotional, behavioural
and mental health needs, experience difficulties communicating with others and
connecting with others socially. Developmental language difficulties and learning difficulties
are common with a diagnosis of ADHD but are often undiagnosed. Language difficulties
are often ‘hidden’ as the child or young person may seem to be variable in the way they
understand information and appear to be able to communicate in some situations but
often not as well as their peers. Language difficulties often affect academic achievement.
Learning difficulties or learning disorders may also occur.

Developmental Language Disorder

Formal assessment by a speech pathologist is required to diagnose Developmental
Language Disorder (DLD). Over 80% of children with an identified behavioural or
emotional disorder have an unidentified communication difficulty (prior to being specifically
assessed by a speech pathologist). The focus of children with behavioural difficulties is
often on their externalising behaviours rather than the underlying cause for their difficulties.

Behaviours linked to communication difficulties

Symptoms of language impairment can often be mistaken for inappropriate or even
‘bad’ behaviour (see also Chapter 2 for further information on behaviour). Children and
young people with ADHD are often seen to be ‘non-compliant’, but this may reflect a
lack of understanding of expectations. Children with ADHD are frequently reported to be
rude. This can often be a response to frustration, embarrassment or low self-esteem.
Others may try to hide their difficulties by being the class clown. Inattentiveness may be
due to difficulties with attention, but can also be due to the child switching off or tuning

26
out because they are unable to follow and understand what is being discussed in the
classroom. Lack of motivation to complete set classroom tasks or homework is also
common for individuals with ADHD but again may be affected by a difficulty understanding
task explanations or a difficulty expressing what they know. These difficulties are often
made worse when literacy difficulties are also present. Language difficulties, cognitive
weaknesses and attention difficulties can have a significant impact on a child’s learning in
the early school years. This can result in significant gaps in learning.

Identification of communication difficulties in older children

and adolescents
Some children are not diagnosed with a Developmental Language Disorder until later in
primary school or even high school. Difficulties became more apparent as the gap between
them and their peers widens and also the language demands in the classroom with regard
to their learning increase. Often the language demands in social life increase as the rules
in games and social exchanges become more complex, more subtle and may frequently
change. The topics discussed become broader as children’s experiences and awareness
and understanding of topics widen and they read information for themselves in books and
on the internet as well as access documentaries and visual information online.
Unfortunately, children with Developmental Language Disorder are at increased risk of
failing academically as well as being diagnosed with mental health problems. Anxiety,
depression, low self-esteem and being targets for bullies are known to occur. Young
people with a Developmental Language Disorder are also over-represented in the youth
justice system. Decreased academic achievement can result in reduced education, training
and future employment options.

What now?
So is it all bad news? No! Children and young people with communication difficulties will
and do progress through childhood, through school and also through life in general. What
is of significant help, is that their difficulties are identified and recognised as early as
possible (but it’s never too late) and they have consistent, ongoing and appropriate support
for their needs provided to them.
Some key points to consider:
 Vocabulary may need to be explained (don’t take for granted that they have full
understanding of the vocabulary used when a new topic is introduced at school).
 Instructions and important information may need to be repeated or supported with visual
resources. Check to make sure they have understood what you expect of them.
 They may need assistance to help plan their written work and how to write down what
they know in meaningful chunks.
 They may take longer to become independent in doing school work or they may never
be fully independent, but this does not mean that they cannot learn and develop skills
and knowledge.
 High school students may be able to access assistive technology, such as computers
to help them read and write. They may also be able to access increased reading time
when sitting exams.

27
 Chapter 5
What is Sensory Processing?

Sensory processing refers to the ability to ‘take in’ and make sense of information from
the environment around us. This process starts in our senses, where information from
our environment is captured – for example noises, movement and smells. Our brain then
organises and responds to this information to help us learn, talk, move, think, attend and
behave. The way we see and perceive the world is unique – we all feel sensations at
different intensities. These preferences can lead us to developing habits around preferred
foods, learning styles and sleeping preferences. There are some sensations we like and
seek out, and others we dislike and avoid. There are seven senses involved in sensory
processing – five are external senses and two are internal:
External Internal
 Auditory: Noise heard from our ears. Proprioceptive: Information on our body
 
 Olfactory: Smells from our nose. position which is received from joints
 Visual: Light, colours, contrasts seen muscles and bones (deep pressure
with eyes. touch).
 Tactile: Light touch, temperature and Vestibular: Body movement information
 
pain felt on our skin. received from our inner ears.
 Taste: Tastes from our tongue.

Sensory Input Modulation Reaction

 Sight, sound,  Registers information  Person makes
taste, touch,  Organisers information a meaningful
smell, movement,  Filters out relevant motor, language,
body awareness information behavioural or
emotional response
 Integrates information
 Stores information

28
Responding to our Senses
People have different limits for noticing and responding to different sensations. We all
have different thresholds for sensations, and different ways in which we respond to these
thresholds.
People with a high threshold for sensations will only feel a little when given lots of input
– for example they may prefer strong tasting foods as other foods taste bland. We
often refer to people having high thresholds as ‘big cup’ people, where they need lots of
information to fill their cup before they begin to notice.
There are two types of ways we can respond to having a high threshold for
sensations:
Sensation Seeking: Children who are sensation seekers are active and continuously
 
engaged in their environments. Their seeking behaviours interfere with their everyday
performance, as they often fidget, are constantly on the move, and like to be noisy.
These children have a high threshold to sensory information and actively engage in
behaviours to meet this threshold.
Low Registration: Children who have poor registration may act as if they are
 
overly tired all the time or have trouble getting up in the morning. They can appear
uninterested in activities and will often have low motivation to problem solve or
change environments for their benefit. These people have a high threshold to sensory
information, but do not actively self-regulate and are passive in their reactions.
There are two types of ways we can respond to having a low threshold for
sensations:
People with a low threshold have a smaller cup for sensations, which makes a little feel
like a lot of input. For example, they may prefer quiet spaces to loud environments. This
can often lead to sensory overload.
 Sensory Avoiding: People who are sensory avoiders experience an overload of
stimulation, and this can be uncomfortable for them. They develop strategies to avoid
this, such as withdrawal, or they may develop daily rituals, which cannot be changed, or
they may appear stubborn and controlling. These children actively engage in behaviours
to avoid going over their low threshold.
Sensory Sensitivity: Children who have sensitivity to stimuli appear as distractible,
 
and have difficulty filtering input from their environment. They have difficulty maintaining
attention, and can become upset with their own difficulty keeping on task, or with
others who interrupt them. These children are passive in their response to sensation
preferences, which may often lead them to feeling overwhelmed by their environment
but not engaging in behaviours to help them feel better.

Sensory Processing and ADHD

Attentional difficulties relating to ADHD can impact on how we process the information
we receive from our senses. These attentional differences can impact any part of the
processing sequence shown in the diagram on page 1. These differences may be hard
for the child to manage or control, which at times can lead to emotional dysregulation, or
inattentive periods. Children with ADHD can have differences in all four of the sensory

29
 based responses listed above, but are most likely to have differences in sensory seeking
type behaviours (e.g. fidgeting, humming, and moving). Some of the sensory processing
difficulties that are common in children with ADHD and sensory processing difficulties are:
  Difficulties filtering auditory input, e.g. when requiring to focus on verbal instructions
– the child may instead focus on the overhead fan hum or bird noises outside. Some
children may hum or talk to try and drown out background noise.
Lack of spatial awareness, e.g. bumping into objects within their environment which
 
they may have seen but not registered (e.g. chairs, desks, tripping on flooring changes).
Movement seeking, e.g. fidgeting and swinging legs while working. This might help the
 
child to focus on their work instead of thinking about their uncomfortable and restless
muscles.
It is important to note here that people who do not have ADHD can also experience similar
difficulties at times, but may be able to recover and regain their focus quickly. For a child
with ADHD and sensory processing difficulties, the ability to recover and regain control
of what sensations they are focusing on can often be difficult. In some situations this
may be an easy process, but rarely consistent or predictable. These inconsistencies can
become frustrating and overwhelming, and often impact on how children socialise, react
emotionally, learn and behave.

Strategies to assist with Sensory Processing

Developing an understanding of sensory preferences and problem solving
Supporting your child to identify specific sensations and environments that bother or
distract them is a great skill to begin with when targeting sensory processing. Looking at
each environment individually is important as a noise may be distracting in one specific
environment, but not as distracting in another. An Occupational Therapist can support

30
you in developing this awareness by completing a sensory assessment. It is important
to consider where and when your child consistently feels calm, their preferred learning
strategies, and activities that always help them to calm down when dysregulated or
overwhelmed. Sometimes it can also be helpful to think of your own sensory preferences
as a parent or child support. This will help develop understanding of how spaces you share
with the child can be set up to meet both of your needs. This will help keep you both calm
while engaging in activities and interacting. Here’s an example:

Supporting Sensory
Breakfast Challenging Sensory input
input
Ben (child)  Movement e.g. leg swing  Noise
 Fiddling  Visually distracting
 Strong sweet tastes environments
 Bright lights

Jenny (Mother)  Natural light  Strong smells

 Morning news on via TV  Hearing spoon scraping, loud
chewing
Breakfast environment to compliment both preferences:
Movement: Trial “move n sit” cushion to move on for Ben – this won’t make too much
noise.
Tactile: Tape textures under the table at Ben’s spot e.g. bubble paper, give him a
textured placemat that is not too bright in colour.
Incorporate cold, sweet foods into Ben’s breakfast – Cold foods have lower levels
of smell (mother dislikes smells). E.g. Strawberry smoothie – this also eliminates cutlery
which makes scraping noise.
Seating: Sit Ben away from the natural light source, preferably facing the opposite
direction so it is not so bright. Mother can face light.
News: Listen to the news via a less visual source e.g. radio or phone (with screen not
showing). Prepare Ben for the news and give time limits to when this is listened to so he
knows there is an end point. Trial headphones for short periods of meal (e.g. mother to
listen to radio, or Ben to use while mother is hearing news).

31
 Practical strategies for teachers and parents
Carers, family members and educational supports can help a child problem solve ways
to increase or decrease exposure to certain sensory sensations throughout their day.
It is recommended that a ‘just right’ challenge is achieved, as usually we are unable to
completely eliminate sensory challenges, but by adding in some coping strategies or
elements to our environment we might make it easier for the child to engage and remain
calm. Some examples of practical strategies for the 4 sensory responses are listed below:
Sensory Seeking: Incorporate movement breaks with rhythmical, predictable movement
or heavy work into your day. Add tactile and movement opportunities to the child’s learning
space - e.g. turf or bubble wrap under the table, theraband on chair legs to swing legs off.
Low Registration: Increase visual cue intensity (e.g. coloured, bolded, larger lettering),
add texture to objects to increase awareness (e.g. textured pencils), vary seating
positioning throughout the day (e.g. desk sitting, to floor laying, to completing work on the
wall while sitting on gym ball).
Sensory Avoidant: Prepare the child for unenjoyable activities and ensure there is a time
limit or end point identified. Allow the child to access resources to limit sensation exposure
if required - e.g. noise cancelling headphones, gloves in art based activities, shoes on
grass or sand.
Sensory Sensitivity: Use deep pressure rather than light touch (e.g. head massage
prior to hair brushing or tight clothes instead of loose), place belongings in cupboards or
drawers and only have essential items on their desk, introduce new sensations gradually.

32
What if nothing works?
1. Incorporate general regulating strategies into your day: Deep pressure can
support everyone to reach their optimum level of focus - whether we are under or over
stimulated. Deep breathing can also support regulation - when we focus on breathing
into our belly and making our out-breath longer than our in-breath; it can help us feel
calmer by slowing our heart rate and providing us with internal deep pressure. Because
of this, these activities are great for the whole class or family to engage in together each
day. This will help your child maintain baseline functioning for as much of their day as
possible. Completing these types of activities for a longer time period in the morning is
recommended, as well as a few shorter breaks throughout the day.
2. Goal setting: it is recommended that you try working towards smaller; specific SMART
(Specific, Measurable, Achievable, Relevant, Time-bound) based goals (e.g., start
with wearing socks and shoes to school instead of all day, or remaining seated for 10
minutes instead of for a whole meal). A useful tool that may help you to break bigger
goals down, and identify tools to overcome the sensory challenges is the ‘Bridging
the Gap’ goal setting visual - this is available online. The child, parent and any other
supports can all be allocated tasks or responsibilities to work on which will help to
achieve each small goal.
3. Shift your focus: If your child is finding it challenging to implement their calming
tools and strategies relating to sensory preferences, shift your focus to modifying the
environment and task around the child:
a. M  odify the environment - e.g. Close the blinds, remove posters, replace chairs with
gym balls to sit on. Complete the task in a different space more suited to the child
(e.g. quieter).
b. T  ask modifications - e.g. Change the time of day the task is completed, change the
way the instructions are given (from verbal to visual), change the length of time given
to complete the task (to be longer and include breaks).
4) Empower the child: If your child is finding it challenging to self-regulate when
overwhelmed by environments or tasks, empower them to ask for and accept help from
those around them. Build on your child’s awareness of body clues - for children who
are more visual, pictorial thermometers or speedometers are great tools to help them
learn to tune into their body ‘speed’ or energy levels. Support your child to link these
differences to certain sensations and activities. Help your child to develop assertiveness
and communication strategies to let people around them know how they are feeling –
e.g. role play conversations in advance, or create cue cards they can hand to people
when they are feeling under or overstimulated. Letting others know what is making them
feel dysregulated will help the child to be supported appropriately.

33
 Additional resources to assist with Sensory Processing
1. Occupational Therapy - Occupational therapists can support children to better
understand their sensory profile and implement strategies into their day that support
regulation. Children can access Occupational therapy through the following:
a. Self-referral to your local child development service for assistance with sensory
processing difficulties here (Perth WA only): https://ww2.health.wa.gov.au/About-us/
Child-and-Adolescent-Health-Service/Child-and-Adolescent-Community-Health/Child-
development-service
b. Medicare rebates may be available through (with referral from a GP): Chronic
Disease Management (CDM) and Mental health care plans (only eligible for BAMHs
endorsed occupational therapists)
c. Via the National Disability Insurance Scheme (NDIS), if eligible.
d. Via private health benefit funds
e. You can find a list of government, non-government and private occupational
therapists in WA here: https://dotwa.org.au/
f. You can find a list of Better Access to Mental Health (BAMH) endorsed OTs here:
https://www.otaus.com.au/find-an-ot
2. Informative workshops and websites cover useful information and strategies about
managing sensory processing difficulties:
a. CAHDS Sensory Processing Parent Information Session
b. Traffic Jam in my brain seminar – www.sensorytools.net
c. How Does Your Engine run Program – www.alertprogram.com/
d. SPD Australia - https://spdaustralia.com.au/spd-foundation/
3) Helpful books and therapy program can provide assistance to parents and teachers
with the management of sensory processing:
a. The Out of Sync Child & The Out of Sync Child has Fun – Carol Stock Kranowitz
b. Raising a Sensory Smart Child, the Definitive Handbook for Helping Your Child with
Sensory Processing Issues – Lindsey Biel and Nancy Peske
c. Sense-ational Mealtimes – Gillian Griffiths and Denise Stapleton
d. Sensational Kids – Lucy Jane Miller
4) Tools and resources to support sensory needs can be purchased from the following:
a. Calming Kids(Perth Based) - www.calmingkids.com.au
b. Skill Builders(Perth based) - www.skillbuilders.com.au/products
c. Sensory Tools – www.sensorytools.net
d. My Diffability Australia – www.mydiffability.com.au
e. The Therapy Store – www.thetherapystore.com.au
f. Sensory Calm – www.sensorycalm.com.au
g. Calming Moments – www.calmingmoments.com.au

34
Chapter 6
Sleep and ADHD

Why is sleep important?

Sleep is important as it gives your body and mind time to rest after a busy day. It helps a
child’s body to recharge so that they have enough energy to complete tasks, think clearly,
concentrate and stay alert.

ADHD and Sleep:

Many children and young people with ADHD have difficulty with sleep. They can have
trouble with
 getting to sleep
 staying asleep
 daytime sleepiness
 be restless sleepers
– get woken by noises
– toss and turn
– wake up tired not looking rested creating a sleep debt as they are not sleeping
enough - this can look like sleep deprivation

Teenagers and sleep

Being a teenager can also make it more difficult to sleep. Teenagers need more sleep but
they may have poor sleep habits. Activities that teenagers do during the day can affect
their sleep.
 Teenagers often go to bed later and wake up late. This can lead to sleep reversal
(e.g., sleeping during the day and staying up all night).
 Drinking energy drinks which contain a lot of caffeine.
 Using electronics and talking to friends late at night.
 Sleep habits
Problems with sleep can make ADHD symptoms worse. It can even make children without
ADHD look like they have ADHD. Poor sleep can make it even more difficult for children
and young people with ADHD to:
 concentrate
 cope with day to day tasks
 be calm

35
  have stable mood
 complete school work
 problem-solve
 stay on task
 remember things.

Common reasons children have trouble falling asleep:

 Difficulty settling down at night – physical (need to move; get energy bursts) and mental
restlessness (busy brain they can’t shut off)
 Mental health issues such as depression, anxiety, trauma
 Recent use of electronic devices
 Fear of going to sleep
 Not wanting to go to bed (e.g., fear, pain)
 Sensory (e.g., too hot)
 Nightmares
 Toileting issues (e.g., bed wetting)
 Medication side effects
 Sleep disorders such as sleep apnoea (which can include loud snoring, choking/gasping
noises) restless leg syndrome, narcolepsy, periodic limb movement disorder

Strategies to assist with sleep problems and ADHD

Difficulties with sleep can have a negative impact on good health and development so
establishing a good sleep routine is an important key to wellbeing. These strategies are
known to be effective.
Behavioural sleep strategies
Going to bed
 Practise good “sleep hygiene”
– Go to bed and wake up at the same time
– No screens an hour before bed
– Have a warm shower or bath before bed
  This can help increase your sleepiness as body temperature drops when you sleep,
– Use bedroom only for sleeping. If possible, have play and homework areas in other
parts of the house
– Have a consistent and clear bed time routine (e.g., quiet time before bed)
 Ensure the child has what they need (e.g., a drink; gone to toilet)
 Reinforce positive behaviours (e.g., putting pyjamas on; reading before bed)
 Reduce attention to behaviours children use to avoid sleep (e.g., frequently getting out
of bed; calling out)
 Monitor sleep (e.g., use a sleep diary) to see if there is any patterns that might explain
sleep problems

36
 Manage the sleep environment (e.g., quiet and uncluttered sleep area)
 Alter environment to help sleep
 If your child needs a night light or uses a lamp use warm’ white light, rather than a ‘cold’
or bright ‘blue’ light
 No non-age appropriate naps during the day. It is better to be active during the day even
if your child is tired. This will help with sleeping at night
 If your child is still awake after one hour suggest getting up for a short while to read to
re-set sleep
 Try relaxation strategies to help your child settle
https://raisingchildren.net.au/toddlers/parenting-in-pictures/sleep-relaxation
Staying asleep
 Make sure the room is dark and quiet
– Some children may need a night light to help them sleep
 Don’t keep checking the time as this may make children worry more that they are not
asleep

37
 Medication for sleep
Medications for sleep should only be used when the above strategies have been tried
and are ineffective. Sleep difficulties in children with ADHD may be due to the effect of the
disorder itself, a side effect of stimulant medications or due to another co-occurring mental
disorder such as anxiety or depression.
A thorough evaluation of any sleep difficulties can be undertaken by your doctor. They will
usually look for primary sleep disorders (where the sleep difficulties are inherent and not
due to another condition) and medical conditions that may be resulting in sleep difficulties.
As part of this evaluation your child may be referred for a specialist evaluation in a sleep
clinic and may need to undergo a sleep study.
In most instances, the sleep difficulty in ADHD is usually due to the condition itself or
a side effect of stimulant medications. If the reason is thought to be a side effect of the
medications, your doctor will consider if the medication is still the best one for your child.
After a thorough evaluation, your doctor may decide that all other methods (sleep hygiene
described above, altering of medications etc) have failed and that your child may need a
medication to assist with their sleep.
Melatonin is the most common medication used to assist with difficulty falling asleep when
this is a side effect of stimulant medications. It is available in a prescribed formulation
(Circadin) or as over the counter supplements. Over the counter formulations are difficult
to assess/ advice for effectiveness as they are not usually standardised.
Usually if all other methods described have failed, your child may need the prescribed
formulation. Circadin is available as a 2mg tablet and the usual recommended dose is 1
tablet at night an hour before bedtime. The dosage can be increased to up to 3 tablets
(6mg) at night although it is unclear if higher doses are more beneficial. The tablet should
not be chewed or crushed. Precautions should be taken in case of drowsiness during the
day, if that occurs.
Clonidine is a medication that may be used to assist with sleep difficulties. It is also
beneficial for symptoms of ADHD.
Medications such as Zopiclone are not recommended for use in children. It would be highly
unusual for medications such as Diazepam to be used in children for sleep difficulties and
must only be done under the advice of a qualified healthcare professional.

What to do if sleep problems persist?

 Remember that it is important to treat and address other issues that may be impacting
on sleep (e.g., low mood; anxiety)
 You may be referred by your doctor to a sleep clinic for further assessment and
evaluation.

38
Chapter 7
Medications in ADHD

Medications for the treatment of ADHD were discovered by chance in the 1930’s by a
psychiatrist Charles Bradley from Rhode Island, USA. He administered amphetamines
to ‘problem children’ in the hospital who suffered from headaches due to a medical
procedure. The procedure was conducted on them to understand the cause of their
behaviour difficulties. While the intent of the amphetamines was to help reduce the
headaches, he noted unexpected improvements in their behaviour, school performance,
and social and emotional interactions. This chance discovery was ignored for more than
25 years before amphetamines began to be regularly used for ADHD.
Medications to treat ADHD have become increasingly common over the years and have
been well researched in this time. Interestingly, while most medications for psychiatric
disorders in children were initially developed for adults and then subsequently used in
children (many without specific research done in children), medications for ADHD were
first developed for children and have been extensively researched in this age group.
The most well-known of these studies is called the MTA (Multimodal Treatment of
ADHD) study conducted in several hospitals in USA and Canada in the 1990’s (The
MTA Cooperative, 1999). The original study compared treatment with medication
(Methylphenidate- commonly known as Ritalin) and treatment with behaviour therapy
and a combination of the two over a 14 month period. This study found that medication
treatment alone and combination treatment with medications and behaviour therapy were
both significantly better than treatment with behaviour therapy alone (Further information
available here; MTA, 2009). In the longer term, (over 6-8 years), the advantage conferred
by medications was not significant, suggesting that the use of medications in the long term
must be reviewed periodically.
While the results of the study were favourable for medications in general, they may not
hold true for every child. Every child with suspected symptoms of ADHD must be evaluated
by a qualified professional (a Paediatrician or a Child and Adolescent Psychiatrist) to
determine the best treatment for them. Whether a child with ADHD will benefit from
medications depends on a number of factors such as accurate diagnosis, other diagnoses
that may exist alongside ADHD, any medical conditions in the child or family and allergies,
to name a few. Combining medications with behaviour therapies is likely to result in greater
improvement in academic performance, emotional symptoms and social relationships and
must always be considered in the treatment of ADHD (National Institute for Health Care
Excellence [NICE], 2018).

39
 Medications for ADHD
Medications used for the treatment of ADHD can be grouped into two broad categories:
Stimulant medications and non-stimulant medications. We will only discuss the current
medications available in Australia.
Stimulant medications include methylphenidate, dexamphetamine and
lisdexamphetamine. Short acting forms of medications usually work for about 3-4 hours
per dose. The long acting forms of medications work for approximately 8-12 hours per
dose. These are general parameters and they vary between children and depend on the
exact medication (brand) being used.
Methylphenidate - In Australia, this is marketed in short acting forms (Ritalin and Artige-
10mg per tablet) and long acting forms (Concerta and Ritalin LA). Concerta is available as
tablets in strengths of 18mg, 27mg, 36mg and 54mg. Ritalin LA is available as capsules in
strengths of 10mg, 20mg, 30mg, 40mg and 60mg.
Dexamphetamine - In Australia, this is available in the short acting form as a 5mg tablet.
Lisdexamphetamine - In Australia, this is available as Vyvanse capsules in strengths of
20mg, 30mg, 40mg, 50mg and 70mg. This is a long acting medication to be taken once
a day. It is an inactive component that is gradually converted to dexamphetamine in the
body.
Points to note:
 Stimulant medications are considered the first choice medications for the treatment of
ADHD
 They have been available for decades and are all approved for the treatment of ADHD
in children
 They benefit about 70-80% of children with ADHD

40
 They work by increasing the levels of dopamine and norepinephrine in certain areas of
the brain. This is believed to improve the functioning of those brain areas resulting in
improvement in symptoms of ADHD.
 Some children respond well to methylphenidate and others to dexamphetamine.
It is difficult to know which medication a child will respond to but most doctors use
methylphenidate as the first choice medication for treatment of ADHD.
Non stimulant medications include Atomoxetine, Clonidine and Guanfacine. These
medications are generally thought to be effective over a prolonged period of time (up to
24 hours), other than Clonidine which is effective for 4-6 hours. Clomipramine and other
medications in its class were previously used for treatment for ADHD but are no longer
routinely recommended due to their significant side effects.
Atomoxetine is marketed as Strattera and is available as capsules in strengths of 10mg,
18mg, 25mg, 40mg, 60mg, 80mg and 100mg. Atomoxetine is also believed to increase
the levels of dopamine in certain brain areas but does this in a different way to stimulant
medications.
Clonidine (often marketed as Catapres) is available as tablets in strengths of 100
micrograms and 150 micrograms. It is essentially a medication used for high blood
pressure but has also been shown to be effective in ADHD. It is only available in its short
acting version and the extended release form of Clonidine is not available in Australia.
Guanfacine is chemically related to Clonidine but is used specifically for the treatment of
ADHD and is marketed as Intuniv tablets in strengths of 1mg, 2mg, 3mg and 4mg.
Clonidine and Guanfacine work on different receptors called alpha-2 receptors in the brain.
Non stimulant medications are usually used when either stimulant medication does not
work or when there are significant side effects with stimulant medications. Non stimulant
medications also have side effects and these will need to be carefully considered before
starting medications.
Points to note:
 Whatever the choice of medication, most doctors will start at a low dose and gradually
increase the dose of medications.
 The dose of the medication does not depend on weight, gender or age but on how
well your child responds to the medications. This depends on how the medication is
absorbed and processed by the body and differs for each child.
 Careful monitoring is required and doctors will consider a number of issues before
starting medications.
 While it is not necessary for every child, in some situations your doctor may require
blood tests and an ECG (heart tracing) prior to starting medications.
 For appropriate dose adjustment, your doctor will need to know whether there have
been improvements in all areas including at home and school. Reports from the school
teacher are usually beneficial when considering making dose adjustments.
 Your doctor will monitor your child’s height, weight, pulse and blood pressure on a
regular basis while your child is taking medications.

41
 Side effects of medications
Side effects vary depending on the type of medications. Not all side effects are discussed
here. Please discuss with your doctor if you observe any symptoms that you consider
to be a side effect of your medications. The product information sheet that comes with
your medication is a very useful source of information and you should keep it handy for
reference.

Stimulant medications
Decreased appetite - This is a common side effect of all stimulant medications. Your child
will likely graze on foods during the day while under the effect of stimulant medication.
Encouraging a good breakfast before the morning dose of the medication and a good
dinner at the end of the day will ensure that they get a reasonable intake of calories and
nutrients during the day. If your child is losing weight consistently while on stimulant
medications, your doctor may suggest ‘medication breaks’- i.e., only taking the medication
on school days. If their appetite is significantly decreased, your doctor may suggest a
different medication.
Trouble sleeping - This is a common side effect of all stimulant medications. This is
usually seen as trouble falling asleep on time or less commonly, trouble due to frequent
waking up at night. Your doctor will likely advise not to take the medication after 2 – 3pm.
If you forget a dose and remember it after this time, it is usually best to avoid taking the
medication that day and returning to your child’s regular schedule the next day.
Feeling anxious or nervous - This is another common side effect but usually only
lasts for a few weeks while the body is getting used to the medication. If this persists or
is severe, your doctor may need to adjust the dose of the medication or occasionally,
discontinue the medication.
Effect on growth - The medication may result in slowing down of your child’s growth
(height and weight). As mentioned above, your doctor will monitor this by checking your
child’s height and weight regularly. Your doctor may advise medication breaks. If this
persists, they may change the medication.
Change in mood/emotional dysregulation/aggression - As noted above, some level
of anxiety is common when a medication is started and usually settles down with time.
However, occasionally, some children experience significant mood swings and aggression
when on the medications. If this happens, your doctor will usually adjust the dose of the
medication but if it persists or is significant, the medication may need to be changed.
Other common side effects include nausea, cough or sore throat, dizziness and a high
pulse rate.
Other side effects include abnormal blood pressure, tics, blurred vision, muscle cramps,
amongst others.
Rare but serious adverse effects
 Psychotic symptoms
 Suicidal ideations
 Seizures
If your child experiences any of the above, you must seek immediate medical attention.

42
Non stimulant medications
Atomoxetine may lead to:
 Suicidal ideations - this will require close monitoring. Immediate medical attention will
need to be sought if this occurs
 Jaundice or liver damage
 Constipation - eating a high fibre diet and drinking plenty of fluids is advised
 Other side effects include poor appetite, sleep disturbances, dizziness and fatigue.
It may also cause increased anger or aggression.
 If you notice a rash with Atomoxetine, you must stop taking Atomoxetine and seek
medical attention immediately.
Clonidine
 Excessive sleepiness and fatigue
 Dizziness
 Dry mouth
 Lowering of heart rate or blood pressure- which may lead to fainting. The medication
must not be stopped suddenly or it could lead to a rebound increase in blood pressure
which may be fatal.
 Constipation
 Low mood
Guanfacine
 Excessive sleepiness - this is less common than for Clonidine but may still be
experienced
 Difficulty sleeping
 Low heart rate or blood pressure – which may lead to fainting
 Weight gain
 Low mood

Conclusion
This is a brief overview of the medications for ADHD available in Australia. Further details
about ADHD medication can be obtained from the TGA website (https://www.ebs.tga.
gov.au/). Always consult your treating doctor before starting, changing or stopping any
medications.

43
 Chapter 8
Family Self-Care and ADHD

Why family self-care?

Family stress can preoccupy parents and wear down their patience. Stressful family
environments can put family members at greater risk of physical and mental health
problems. Parents often report certain times of the day or tasks that they find their stress
levels increase (e.g., getting ready for school, shopping, bedtime). However, once the
specific task or time is over parents’ stress levels will tend to decrease. This may not be
the case for parents and families of children with ADHD who often feel stressed throughout
the day.
ADHD affects many aspects of a child’s life (e.g., social, emotional, behavioural and
learning difficulties). A child with ADHD will face many developmental challenges
associated with their ADHD. In addition, many children with ADHD also have other
mental health/ learning and developmental difficulties (e.g., depression, anxiety, learning
difficulties, oppositional defiant disorder, conduct disorder, language difficulties, motor
difficulties, tic disorders and executive functioning difficulties).
Caring for a child with ADHD places extra demands on parents above and beyond typical
parenting demands (e.g., increased demands on finance, social and emotional resources,
time). Children with ADHD also require ongoing support to address their challenges. These
increased demands place additional stress on families and family relationships. This can
compromise the coping and emotional well-being of family members and lead to increased
mental health issues within the family. Parents may also find it difficult to manage their
child’s ADHD while trying to manage their own mental health and emotional well-being.
Having ADHD not only affects the child/young person with ADHD but the whole family.
It is important to take time to address family and individual stress to be more effective in
parenting and caring for a child’s needs. When individuals are struggling to manage their
own emotional needs they cannot care for their child as effectively as they would like.

What happens when we feel stressed?

When we experience stress our sympathetic nervous system (survival brain) takes over
to keep us “safe from a perceived threat”. When this happens, our body experiences a
physiological change as the ‘survival brain’ is activated to prepare the body to respond to
a perceived threat. This is known as the fight, flight, freeze, faint response. When we are
stressed our thinking abilities reduce. This limits our ability to problem-solve and regulate
our emotions.

44
How our body reacts to stress is specific to each person. Everyone responds and
experiences stress differently. Some common body responses are outlined in the figures
below.

1 Feel dizzy or lightheaded as breathing 5 Adrenaline released to tell other body

becomes shallow and quicker so we organs (e.g, heart) to get ready to fight
can get more oxygen into our big or flight
muscles to fight or flight
6 Hands get cold as blood is going to
2 Racing Thoughts – Makes it hard to major muscles
focus on anything other than that you
are in danger 7 Body starts to sweat as this cools body
if having to run away
3 Dry mouth as the body stops producing
saliva to digest food as it prepares for
8 feeling of needing to go to the toilet as
fight or flight body getting rid of extra “weight” to help
you run/get out of danger faster
4 Heart beats faster to get more blood
to larger muscles 9 Muscles get tense as blood builds up
and ready to run from danger

1
2 1
2
3
3

4 4

7 5 5
6 8 7
8

9
9

45
 It is important to be aware of how your body responds to stress (physiologically,
emotionally and cognitively). Increased awareness and early identification of your own
stress reaction will help with how to address it before it becomes overwhelming.
Stress can be brief or ongoing. Chronic stress has a damaging effect on a person’s sleep,
physical and emotional well-being. Often chronic stress is unrecognised by the individual
and may only be recognised when a person seeks medical or psychological treatment.
Others may notice changes in a person’s behaviour, mood and usual functioning before an
individual notices that they are overwhelmed.

Strategies to assist with Family Self-Care

There are a number of strategies that might assist with managing family stress and
enhancing family self-care. These strategies can be used to prevent our stress level from
increasing.

Preventative stress management: managing daily stress

Be aware of the cumulative effects of the daily stressors of caring for a child with ADHD.
A holistic approach that considers your needs (e.g., physical, cognitive, spiritual and
emotional needs) can assist in managing daily stress and your emotional well-being.
Having a balanced lifestyle that includes hobbies, socialising, and work in conjunction
with caring for your child can help maintain a healthy lifestyle. This can be achieved by
engaging in stress prevention strategies such as:
 regular exercise
 regular and sufficient sleep
 balanced diet
 engagement in pleasurable activities and interests
 membership to groups
 maintaining relationships/nurture social networks
 formal relaxation (e.g., yoga, meditation, mindfulness, progressive muscle relaxation,
guided visualisation)
 positive self-talk or supportive mantras
 scheduling of pleasurable activities and interests outside of parenting duties (e.g.,
going to work, catch up with friends, shopping, exercise, date nights, attending sporting
events, religious events)
 Scheduling parenting/family duties (e.g., family appointments, school meetings)
Effective stress prevention involves giving yourself permission to consider your own
emotional well-being before you manage others’ needs.
The principles of The Act Belong Commit campaign (https://www.actbelongcommit.org.au/)
can assist with maintaining emotional well-being. Individuals are encouraged to engage
in the three domains of: Act, Belong, and Commit to improve their mental health and
wellbeing. Evidence shows that these three domains contribute to positive mental health.
(https://www.actbelongcommit.org.au/assets/resources/factsheets/the_evidence_for_act-
belong-commit.pdf)

46
Stress management strategies
Successful stress management incorporates strategies that address a person’s
physiological and emotional responses to stress. These management strategies can
include using the preventative strategies and principles (listed previous page) as well
additional strategies such as:
 Develop a coping plan prior to a difficult situation that identifies helpful strategies and
thoughts.
 Use supportive networks to discuss stressful situations and experiences.
– This is not about others solving the problem. It is about externalising emotions and
problems to help process them. When stressful situations are discussed they can be
processed more effectively as it moves from the “survival brain” into the cognitive/
thinking/problem-solving brain.
 Access helplines (e.g., Parenting Helpline; Mensline; Crisiscare; LifeLine)
 Acknowledge stress and limitations that may make it difficult to manage stress or a
situation effectively at a particular time.
– This may require ‘parking’ the problem, taking time away to do pleasurable and
relaxing activities and then going back to address the problem with your ‘thinking
brain’ rather than ‘survival brain’.
 Keep perspective and ‘pick your battles’.
– Look at the bigger picture. Is the situation/issue worth the increased attention it is
receiving or can it be ‘let go.’
 Review expectations for the parent and child
– Are they realistic and developmentally appropriate for both the child and parent rather
than idealised views of how things should be.

47
 Managing stress effectively allows for better management of stressful and difficult
situations, and support of others. However, over-reliance on specific activities that help
assist in short-term management of stress can be unhelpful. This can include:

Strategy Why it is not helpful

Busying self/avoidance Does not address or delays addressing the issue to
Wishful thinking that the issue help you accept or make sense of the situation. This
will go away. can lead to overthinking and make an issue bigger
than it is.

Substance/alcohol use Can lead to masking stress. When the effects of

these substances wear off the stress and the cause
of the stress will return. Substance over-use can lead
to further health issues.

Eating more or less Can lead to masking of stress. When the effects wear
off the stress and the cause of the stress will return.
Over - or under - eating can lead to further health
issues.
The body will sometimes crave high caloric foods
as it is burning through energy due to the increase
stress. This food may not be adequate to provide the
nutritional needs for optimal emotional well-being.

Drinking coffee/ This can give the impression of increased energy

caffeine drinks but is in fact mimicking the physiological response of
stress (e.g., increased heart rate; physical arousal
level) rather than increasing problem-solving and
cognitive abilities.

Overexercising Exercising in moderation helps to regulate some of

the physiological needs. Over-exercising can lead to
a reliance on the endorphins released for short-term
relief. The underlying reasons for stress are not being
addressed.

Social withdrawal This limits our ability to belong and connect with
others. This lessens the opportunity to access
support and problem-solve. Being connected with
others helps put things into perspective.

48
Seeking psychological intervention for stress
You may need to access psychological treatment for stress when your usual strategies to
manage stress are ineffective and you are feeling overwhelmed. This could be accessed via:
 GP (via the Medicare Better Access Initiative)
 Employee Assistance Programs (if available)
 Community Health and Well-being services (e.g., Women’s Health Services; “The
Blokes Book” resource)
 Telephone Help Lines (e.g., Mensline Australia; Crisiscare; Lifeline; BeyondBlue )
 Private mental health professional (e.g., clinical psychologist, social worker, counsellor,
and psychiatrist)
Treatment can assist in:
 reducing how long the stress lasts
 managing stress more effectively
 preventing increased stress in future.
 managing your stress effectively to assist you to help your child.

Additional resources to assist with Family Self-Care

Organisation: Wanslea
Details: Wanslea Children and Family services provide assistance in caring for your child
and family
Contact: Phone: (08) 9245 2441
Fax: (08) 9245 2481
Email: support@wanslea.asn.au
Website: https://www.wanslea.asn.au/children-and-family/

Organisation: Communicare
Details: Communicare provides low cost support services to families and individuals
Contact: Refer to website for contact details of Communicare offices and programs
across WA
Website: https://www.communicare.org.au/

Organisation: Centre for Clinical Interventions (CCI):

Details: CCI provide psychological therapy, research, professional training, and free
resources for a variety of mental health disorders including eating disorders, anxiety
related disorders, depression, and bipolar disorder
Contact: Phone: (08) 9227 4399
Fax: (08) 9328 5911
Email: info.cci@health.wa.gov.au
Website: https://www.cci.health.wa.gov.au/

49
 Mensline Australia: 1300 78 99 78

The Bloke’s Book: www.menshealthwa.org.au/wp-content/uploads/2016/10/The-Blokes-

Book-2016.pdf

Kids Helpline: 1800 55 1800

Lifeline: 13 11 14

Crisis Care: (08) 922 3111

1800 199 008 (country free call)

Beyondblue: 1300 22 4636 https://www.beyondblue.org.au

Notes:

50
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Notes:

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 Appendix 1
Recording sheet for identifying
child’s needs

Date/Time What they did My response/What I did

56
 Category it fits in
How I was feeling/My
(attention, power,
feeling response to what Other comments
revenge, display of
they did
inadequacy

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 Notes:

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Notes:

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