Dr. Ashley Major – ADHD Expert Interview Series 

Dr. Ashley Major, C. Psych. (Supervised Practice) specializes in the assessment and treatment of children, adolescents, and families. Dr. Major completed both her Doctorate and Masters degrees in School and Clinical Child Psychology at the University of Toronto. She earned her Bachelor of Arts (Honours) in Psychology at Western University. Dr. Major completed her pre-doctoral residency at the IWK Health Centre in Halifax, Nova Scotia, where she received extensive training in community mental health, health psychology, and preschool assessment. She has also trained in hospital, community-based, and residential treatment settings, and has worked extensively in schools in the Toronto area. Dr. Major’s dissertation research examined self-perceptions in ADHD and was among the first to demonstrate that self-efficacy beliefs (confidence in one’s ability to complete a task) are one of the strongest predictors of classroom engagement and success in adolescents with ADHD. Dr. Major has published articles related to ADHD in peer-reviewed journals and has presented her research at national and international conferences. Dr. Major presently works in private practices in Vaughan and Toronto, where she continues to support children and families in enhancing their overall well-being and quality of life.

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder (brain-based) that affects 5 to 12% of school-age children. This means that, in a class of 25 to 30 children, it is likely that at least one or two students will have ADHD. Children who are affected can have trouble paying attention, sitting still, and/or controlling their impulses.

If left untreated, the symptoms of ADHD can create a number of challenges in a child’s life, such as academic under achievement, trouble making friends, and difficulties at home. Fortunately, however, we have learned a lot about ADHD and there are many interventions that can help children with ADHD succeed (see below).

What Causes ADHD?

We do not yet have a full picture of what causes ADHD. Most of the evidence to date suggests that genetics plays an important role, as ADHD tends to run in families. Researchers have also found subtle differences between children with ADHD and children without ADHD in certain parts of the brain, such as the regions that control concentration, motor activity, and impulse control. There are also differences in how certain parts of the brain communicate with each other. Other factors that may increase the risk of a child developing ADHD include: low birth weight and complications during pregnancy, at birth, or shortly after birth; head injury; and exposure to toxic chemicals in the environment.

ADHD Myths

There are also many myths about what causes ADHD. It is important to know that ADHD is NOT caused by: poor parenting (although a mismatch between parenting style and the child’s needs can make symptoms of ADHD worse); diet (e.g., sugar, caffeine, food additives and preservatives); laziness; or watching too much television.

How To Know If Your Child Lacks ‘Typical’ Attention Skills

Knowing whether your child lacks the typical level of focus for his/her age can be aided by having a sense of what is considered an age-appropriate attention span at each stage of development. As with many abilities, a child’s capacity to focus strengthens with age. So 1 to 2 year olds can be expected to attend to a single toy/activity for about 1 to 2 minutes before they lose focus. Three to 4 year olds can usually pay attention to one task for approximately 8 to 10 minutes and are able to shift their focus back and forth between the task and an adult who is speaking to them. Five to 6 year olds can often focus on one task for about 10 to 15 minutes and are usually able to filter out small distractions in the environment. Children ages 6 to 7 years may be able to sustain attention for as long as 30 minutes and have more control over resisting distractions.

It is important to keep in mind that these are general guidelines and that children’s attention skills can vary widely even within a certain age-range. Furthermore, a child’s capacity to pay attention can be affected by many other factors, including fatigue, hunger, interest, and task difficulty. Just because a child has trouble paying attention for an age-appropriate length of time, does not mean that they have ADHD. There are specific criteria that must be met, as described below.

‘RED FLAGS’ That May Suggest Your Child Has ADHD

 Potential ‘red flags’ for ADHD can look different at each developmental stage. Here’s what to look out for in preschoolers, school-age kids, and adolescents:

Preschool children with ADHD usually stand out from their non-ADHD peers in their behaviour and abilities. For instance, they may be:

• unable to sit through games, stories, and circle time
• constantly asking questions but racing off before the answer is given
• constantly running and on the go
• does not seem to listen when spoken to directly
• seemingly unaware of routines, rules, and expectations
• frequently moving from one activity to the next
• contributing information or answering questions in a way that might be off-topic
• difficulty sitting still
• unable to play or engage in leisure activities quietly
• banging into objects and people, climbing and jumping off furniture
• can be intrusive in play and may grab, hit, or push others
• difficulties waiting for their turn
• difficulties waiting in line
• challenges with social skills, such as sharing and respecting personal space
• difficulty adapting to the play of others
• trouble following through with teacher requests
• difficulty with transitions

School-age children with ADHD can often be spotted with the following behaviours:

• generally act much younger than their age (socially immature)
• often act as the “class clown”
• easily distracted by sounds or objects in their environment
• often wandering and chatting with peers
• fidgeting with items and objects
• difficulty getting started on their work and staying focused
• poor follow-through with tasks and requests
• often requires frequent reminders to stay on task
• talk excessively when they are not supposed to
• shouts out in class
• acting before thinking about the consequences
• takes longer to get through school-work due to distractibility and/or daydreaming
• rushes through work, making careless mistakes
• tendency to give up easily when things are effortful or uninteresting
• difficulty initiating and sustaining friendships
• often interrupts or intrudes on others
• losing track of personal belongings and materials needed for a task
• is forgetful
• desk is poorly organized
• often show great difficulty in or even avoid written work, so they write little or nothing down on paper

It is important to note that the behaviours listed above are not specific to ADHD and that many children (and adults) can show some or all of these at some point in their lives. Furthermore, attention problems can sometimes be the result of other issues, such as anxiety, language delays, learning disabilities, sleep problems, or stressful life events. Therefore, a thorough assessment by a psychologist or medical professional is essential in ruling out other concerns and establishing whether a child has ADHD.

At What Point Do You Feel Parents Should Seek Professional Help?

Parents might consider seeking professional help if their child is presenting with many of the above behaviours and if these behaviours are:

• present in more than one setting, (school, home, extracurricular)
• persistent over time (evident in the child’s early history to some degree)
• interfering with their child’s ability to learn, make friends, or complete household responsibilities
• not due to other problems or conditions (anxiety, language delays, learning disabilities, sleep problems, or stressful life events)

If you suspect that your child has ADHD, talk to your family doctor or pediatrician about an assessment. Your doctor may complete the assessment him/herself or may refer you to a psychologist or psychiatrist for the assessment. A “gold standard” assessment for ADHD includes interviews with parents and other informants, such as teacher, parent and teacher questionnaires, and ideally, observation of the child in more than one setting (clinic and school).

Is ADHD Something Children Can Grow Out Of?

Although ADHD is usually first identified in childhood, it is considered a chronic and life-long condition. Research has found that between 60% and 80% of children diagnosed with ADHD will still have symptoms of the disorder in adolescence and beyond. These symptoms can continue to interfere with their academic, social, and home functioning.

Although symptoms of ADHD have been found to persist over time, they can change in presentation as children develop. For instance, it is common for the overt hyperactive/impulsive symptoms that often occur in the preschool and school-age years to lessen gradually as children enter adolescence. Instead, adolescents can experience their hyperactivity internally and report feelings of “inner restlessness” and fidgeting. Similarly, impulsivity that appears as poor self-control and behavioural reactions in preschool and early school-aged children can be displayed as verbal outbursts and poor decision-making in adolescents and adults. In contrast, symptoms of inattention (such as forgetfulness, disorganization, and difficulty concentrating) tend to change less over time and are persistent throughout development.

How Can Parents & Teachers Work Together For School Success?

Because ADHD can affect children both at home and at school, clear and frequent communication between home and school is essential. It is important that both parents and teachers understand the unique demands and needs associated with each context and how there can be variability in symptoms. Parents are a great resource for teachers regarding the student’s interests and educational history. Similarly, teachers can provide parents with updates on the child’s progress and strategies being used in the classroom (for example, teaching the student how to use a homework planner).

There are a number of ways for teachers and parents to communicate with each other, including phone calls, newsletters, log books, notes, informal visits, conferences, and report cards. There is evidence to suggest that Daily Report Cards, which are a type of communication log, can help the student, parents, and teacher monitor progress towards goals, and goal attainment can be reinforced.

Research and Resources

Research has also shown that students with ADHD benefit when parents and teachers understand and are educated about the disorder. Having knowledge about why children with ADHD might struggle academically, behavioural, and socially is critical in creating an empathetic and supportive approach toward children that encourages skill building. Communication that is positive and that involves the planning and monitoring of interventions across both settings is also important in helping students with ADHD achieve educational success.

There are a number of resources to help parents learn more about ADHD. Click Here for a complete list of RESOURCES.

Please remember that you are not alone if you are learning to cope or currently cope with a child with ADHD. There are professionals, resources and programs that can help assist you with the challenge. Parenting is a journey and your path will look different then the person next to you. Don’t compare or judge. Travel your path the best you know how!

For more information please contact Dr. Major at the Clinic On Dupont.