ADHD in children and teenagers: the strategies that work at home

1. Before you start

You repeat the same instruction four times. The school bag is ready, but the water bottle is still on the table. Homework that should take twenty minutes takes an hour and a half, with two meltdowns along the way. Mornings are a race, evenings a negotiation. And the most baffling part: your child knows perfectly well what needs to be done. They can explain it to you. They do not do it.

This resource is written for that situation. It concerns children of roughly 6 to 18 years old in whom attention-deficit/hyperactivity disorder — ADHD — is diagnosed or suspected. It is written for parents, not for professionals: what it describes is put in place in a kitchen, a hallway, a bedroom, on a Sunday evening.

2. Understanding ADHD

What ADHD is not

It is not a failure of parenting. Parents of children with ADHD often raise other children without particular difficulty, using the same principles.

It is not a lack of willpower. A child who stays focused for three hours on a video game and not six minutes on a page of exercises is not choosing: they are showing exactly the profile of the condition, whose hallmark is an attention that depends heavily on immediate interest and novelty.

It is not an excess of energy. A number of the children concerned are not restless at all: they daydream, lose their belongings, drop out halfway through an instruction. They are the least often spotted, and often the latest diagnosed, because they disturb no one.

It is neither a recent invention nor a rare condition: it affects around 5% of school-age children worldwide, with figures that are stable from country to country when the same criteria are used. And it is not a question of intelligence: ADHD is found at every level of intellectual ability, and the gap between what a child understands and what they manage to do is precisely what makes the condition so baffling to those around them.

The mechanism: a problem of execution

ADHD is not a deficit of knowledge, it is a deficit of execution. The mechanisms involved have a name: the executive functions. They are what allow us to hold on to an intention long enough to carry it out, resist a distraction, start an uninteresting task, stop in time, and give weight to a distant consequence.

Three practical consequences follow, and they govern everything else in this resource.

The future barely motivates. A reward announced for Saturday has almost no influence on behaviour on Tuesday. "If you carry on, you won't go to the party on Sunday" has virtually no effect on what is happening right now. This is not carelessness: it is a real difference in the way this brain weighs a delayed consequence. Anything meant to have an effect must therefore arrive fast.

Inhibition is expensive. Where another child holds back an impulsive response without thinking about it, this one has to make a conscious effort — and that effort runs out over the day. Hence the catastrophic late afternoons after a decent morning, and the Saturdays that go better than the Thursdays.

Working memory is short. "Go up, put on your pyjamas, brush your teeth and come back down with your school bag" contains four instructions. Halfway up the stairs, one is left, rarely the most important. This is not bad faith.

How the diagnosis is made

The clinicians' reference manual, the DSM-5-TR of the American Psychiatric Association, describes ADHD around two sets of symptoms: inattention on one side, hyperactivity and impulsivity on the other. What follows is a restatement in everyday language, not the official list — that one is assessed in consultation.

On the inattention side: careless mistakes, attention that drifts, instructions that seem not to be heard, tasks started and not finished, disorganisation, avoidance of anything requiring sustained mental effort, lost objects, easy distraction, everyday forgetfulness.

On the hyperactivity and impulsivity side: constant movement, leaving one's seat, running or climbing at the wrong moment, difficulty staying still, talking a great deal, answering before the question is finished, interrupting, being unable to wait one's turn.

To retain the diagnosis, a clinician checks several conditions, and this is where reading a list becomes misleading. There must be a sufficient number of symptoms (at least six in one of the two sets before the age of 17, five after), a presence before the age of 12, a manifestation in at least two settings — home and school, typically —, a real impact on school, social or family life, and the absence of another explanation: a sleep disorder, anxiety, depression, learning difficulties, a difficult family situation, or a simple mismatch between the child and their environment.

That last point matters most. Many children tick boxes without having ADHD, and the clinician's role is precisely to rule out the other explanations before concluding.

Three presentations, one household

A predominantly inattentive presentation is distinguished from a predominantly hyperactive-impulsive one, and from a combined presentation, the most frequent in clinical practice. The distinction matters for follow-up; it changes little in the strategies described here, except on one point: with an inattentive child who is not restless, the classic mistake is to underestimate the difficulty because it makes no noise.

---