UCalgary podcasts feature interviews with experts from our community on the COVID-19 situation.
Episode 27: Kids living with ADHD
June 10, 2020
For kids with ADHD, coping with daily routines and social interactions can be challenging at the best of times. The social isolation and loss of routine over the past few months has added a whole new layer of complexity. Dr. Emma Climie (MSc ’08, PhD ‘12), an associate professor in the Werklund School of Education, talks about some of the issues faced by kids with ADHD and their parents, strategies for managing things like learning, sleep and physical activity, and what a return to school might look like.
Emma Climie (EC): We do know that there's lots of ways that we can harness the creativity and the energy that kids with ADHD have. They're often ones to come up with very out-of-the-box ways to solve problems, or to come up with unique situations or stories. They're very creative.
Deborah Yedlin (DY): That was Emma Climie, an associate professor in the Werklund School of Education, and this is UCalgary COVIDcast. I'm Deborah Yedlin, and thanks for joining us. For kids with ADHD, coping with daily routines and social interactions can be challenging at the best of times. The social isolation and loss of routine over the last few months has added a whole new layer of complexity for kids with ADHD and their parents. Today on COVIDcast we're talking with Dr. Emma Climie, an associate professor in the Werklund School of Education and an adjunct associate professor in the Department of Psychology. EC is the director of the Strengths in ADHD research lab and the lead researcher for the Carlson Family Research Award in ADHD. EC joins us today to share some insights into how kids with ADHD and their parents can cope in a time when routines are disrupted and people are staying at home. EC, thanks for joining us.
EC: Thanks for having me.
DY: So tell me, how has the pandemic affected kids with ADHD? Their routines are off. They're out of school. They don't have the supports. How does this manifest and how has it affected these kids?
EC: How hasn't it affected these kids? I mean, it does boil down to that whole loss of routine. So we're missing the structure of school, that home and school routine where you have some time at home, some time at school. Even extracurricular activities where they just got to go and either burn off some energy, or hang out with some friends, or do some activities that they're interested in, that's all out the window now. They're kind of stuck at home. We have more limits in terms of their mobility, how much they can get outside, how many friends they can see. And kind of coupled in with that, as well, there's more of that increased screen time, just because we're now doing school via online means, which works for some kids and doesn't work as well for others.
DY: So let's go into that. That's one of the themes we keep hearing about over and over again is that increased screen time is a need right now because of school, but for kids with ADHD, is there something... I mean, that's a different aspect of their... It's not as interactive. Just tell me what that means for them in terms of their learning and their ability to sit still, even, and engage with the screen?
EC: I know. I think we're all getting into that Zoom tiredness. We're all tired of sitting in the sessions and the meetings because you just don't get that same feedback as when you're in a live class or a one-on-one situation. So it's the situation now where the teacher's trying to teach in a class that's online, and so they've got 15, 20, 30 kids sitting there in front of them and it's much more difficult to keep them engaged or entertained, and even to kind of get some of that information across, especially for those kids that have ADHD where the dog walks by them or they're sitting by the window and something happens outside. There's so many other things that are going on that for kids with ADHD, sitting in a big Zoom meeting, they're likely not going to get as much out of it as other kids in their class, and that will have an impact on their learning.
DY: So is there a strategy that the parents can help the kids implement when they are on Zoom? Or is there something that the teachers could do differently? I mean, they don't have the support in the classrooms either, obviously, when they're at home. So is there anything that can make this situation a little bit easier on them?
EC: Yeah. And I think a big thing is the parents talking with the teachers, and whether that's just via email and just having a conversation about what the teachers are going through that day in terms of the curriculum or whatever topic they're talking about so that the parents have a little bit of awareness of what's going on. But it's also a little bit with that teacher's responsibility to make sure that they're checking in with that child. If they are not paying attention in Zoom, then making sure that there's a way that they can try and redirect their focus. But also it might be a situation in which that teacher can maybe spend 10 minutes later in the day in that one-on-one session with that child, just to help reinforce some of those things that are going on in the classroom, help with their learning, help answer questions. And again, that one-on-one situation might be an environment in which that child is able to learn a little bit better rather than being one in a class of 20 in a big session.
DY: What about, can parents help the children maybe break down, let's say you have an hour long class. Does it help to break it down into, let's say, 10 minute increments, watch the clock? If you sat for 10 minutes, you can sit for another 10. Do you know what I mean? Is there some way to sort of incentivize them to break it down so they're not feeling like it's this huge amount of time, but it's smaller increments?
EC: Absolutely. Yeah. With all kids, but particularly kids with ADHD, we think about their learning in bursts. So it's that whole idea that they have periods of time where they can focus and they can sit, but that's maybe 10 minutes, 15 minutes, and then they need to get up or move or change activities. So, when teachers are planning their days, they don't sit kids in desks for six hours, so you can't expect them to be doing that at home either. You can't sit them down with the computer and say, "Here it is. Off you go." They need to have those breaks, as well. So, yeah. Maybe it is doing a short activity and saying, "Here's some of your math work that you need to do. You have 10 minutes and we get this amount done, and then we can take a break and do something else." So even just planning and scheduling things with that idea of those learning bursts, and being able to capitalize on when those kids are able to learn, but also reflecting on when do we need to take breaks? When do we need to step back?
DY: Are there behavioral changes or patterns that manifest on Zoom that are a bit different in terms of how... When you're in a classroom, you can participate. On a Zoom class it's a little harder. And so the ADHD kids like to be involved. It's harder when they're doing it on the computer and on a Zoom format. What can they do to make sure that they're still feeling part of that classroom experience and being able to contribute and just not talk over everyone?
EC: Yeah. And that's a difficult question just because there's 20 kids who all want to have their voices heard. So some of that comes down to how the classroom has been structured or how the teacher's structuring things. Maybe it's having small groups. So having breakout groups in the session so that kids are in smaller groups and they can actually have that opportunity to talk to one another, and so it's not just the teacher lecturing and the kids listening. Having that opportunity for the kids to be able to talk to one another and even kind of taking it outside the classroom. Having opportunities for kids to FaceTime with one another, or to have opportunities to chat with their peers about things that aren't school related. So having that opportunity to be a kid and connect with others, especially when we think about that in the teenage years, those peer relations are a critical factor.
DY: Absolutely. And I guess the other thing is if you have some children, sometimes the social interaction is a little awkward for kids with ADHD. So I'm curious as to, does this situation that we're in make it worse? What are you observing in these kinds of kids that do have challenges on the social side to begin with?
EC: It's really hit or miss. For some kids, they are able to connect with peers over Internet or via FaceTime and things like that, so they're usually short conversations. So for the most part, kids are able to focus. They have a quick conversation and then they're done and they move on. There's not that lingering hanging around that sometimes can get kids with ADHD into a bit of trouble. So sometimes it's just that in and out sharing the information, having that connection is a really nice thing. But on the flip side, they also don't have that opportunity to practice and build that social capacity. A lot of those kids have difficulties, and schools and parents spend a lot of time helping those kids develop those social skills, and now they don't really have the chance to practice them because they're at home and they're maybe with parents, they're with siblings, but they don't have that same kind of interaction. So it'll be interesting to see what happens when the schools all come back together and it's going to be stressful for everybody. But how is that going to manage for those with ADHD?
DY: So what about parents? What kinds of suggestions can you offer parents whose kids may be ADHD and are dealing with this new environment, whether they're in school or not?
EC: Yeah. So for parents, they obviously are dealing with a lot of things themselves, just managing the new situation, having to be the homeschool teacher, dealing with working from home. So there's a lot of things that are going on for parents, as well. So it's also being able to take a step back and reflect on the time that we're in right now and prioritizing things that are most important. So obviously school needs to come into play there, especially for the older grades, but also being able to reflect on, how do we help teach some of those skills that they learn in the classroom in more practical ways? So for example, in grade five, if they're learning fractions, maybe that's when we get out the cookies, and we start making cookies, and we talk about a half cup and full cup. And what does that look like? So you've got a real life application of some of those math skills. If they're practicing their handwriting, maybe they're doing that by writing a letter to their grandparents. Maybe they're practicing their typing skills through communication with somebody else. Maybe if they're doing their reading, maybe they read to the dog. Maybe they read to grandparents via FaceTime. So you can get a lot of those academic skills in without necessarily sitting down at a desk and having kids work. How can you bring in some of those skills in that practical, real life circumstance? Sometimes kids don't even realize that they're practicing their skills, that they're learning those things because they're enjoying the process of going through it.
DY: And I guess if you really want to have fun with the baking and the fractions, you all of a sudden lose your cups and you have to have them figure it out with tablespoons.
EC: Yeah, you can do that.
DY: And you get another math lesson. How do you make that conversion?
EC: Yeah. And Legos are actually a really great one because they're set up for fractions, right? So if you are doing fractions, Lego is the one to do.
DY: Oh, tell me more about that.
EC: Well, it's just the way that they're set up, right? The main sized blocks have eight. And so if you're taking half, then you know that there's four, and so you have that smaller block and it's four dots, and then a quarter as the two dots. So you can work your way up looking at sort of a half and half. You put it together and you make a whole. So they often use Lego when you're looking at fractions, which is obviously something that a lot of families have at home, as well.
DY: We have a lot of Lego in our house. We never used it for math lessons. A missed opportunity for us, now, because our kids are in their twenties. But that's a great tip. I guess one of the questions is, too, is that there might be a downside to this. Well, there's a bunch of downsides, obviously, but you've had kids isolated, ADHD, at home. It's a different dynamic. What happens when they get into that big classroom again and the school does open up? What kind of impact do you think the switch from being so isolated to being back in that environment? Do you think there could be some behavioral challenges? Is there something that teachers need to do differently? Parents need to think about an advance?
EC: Yeah. I think that it's going to be a big adjustment for everybody, and part of that is that we don't even know what school in September is going to look like. So it's not like we can even start preparing kids for this is how the new school situation is going to look like. So I think that can be a little bit anxiety producing for kids just because these kids really do thrive on structure. So knowing what is coming up and coming next is helpful for them, and unfortunately we just don't have those answers right now. So when they get back into the classroom, whatever that looks like, it's going to be new routine. It's going to be a new teacher most likely. It's going to be a new set of peers in the classroom. So, you kind of take that whole anxiety and transition period from just moving from one grade to the next, and now you put in the fact that they haven't been in school for six months. So it's definitely going to be a slow easing back into things and trying to figure out what that's going to look like, and I think that's where taking care of social emotional wellbeing and mental health is going to be a really important factor.
DY: So let's talk about the mental health. How might the mental health of kids with ADHD be affected by this pandemic?
EC: Well, we know that kids with ADHD are already at higher risk for mental health concerns, especially when we look at anxiety and depression. Anywhere from 15 to 50% of kids with ADHD may have some indication of anxiety or depression, as well. So we know that they're an at-risk group to begin with. And the situation that we're in right now with this pandemic, there's a greater mental health impact across everybody right now. So that would lead us to believe that kids with ADHD are probably going to be impacted through mental health means, as well. So I think that's also one of the things to really keep in mind for both parents and teachers as we move back into schools. How do we provide that support to their mental health? How do we talk about what you're feeling and what you're thinking? How do we support kids with anxiety about coming into contact with other people now after they've just spent six months at home? How do we-
DY: Saying don't go near anybody, yeah.
EC: Yeah. Don't go near anyone. Don't touch anyone. Now suddenly you're back in the classroom and the desks might all look different. So, yeah. It's going to be a challenging situation for them, and I think just making sure that parents and teachers are aware of what depression looks like in these kids, or in all kids, but particularly those with ADHD.
DY: So that's what I wanted to ask you was what should parents and teachers be looking for? Or siblings? Sometimes the siblings are a little bit more attuned than the parents are for whatever reason, and so what should we all be looking for?
EC: So often we start to see decreases in things that they previously enjoyed. So that's usually a big indicator is that losing interest in favorite activities, things that they used to have a lot of fun doing or engaging in, any kind of withdrawal from friends or family, particularly family, given that that's who they spent a lot of time with over the last little while. Any kind of changes in eating, sleeping, or interest in school. Obviously school is going to be a bit more difficult, but if suddenly they're refusing to go to school or refusing to participate in any kind of class activities, these are things we start to say, "What else is going on?" What is making them either more anxious, or more worried, or more withdrawn from what their regular life looked like?
DY: And then we often talk about exercise being really important in terms of, not just ADHD kids, but also mental health. So maybe you have some recommendations even though they may not have soccer practice, or basketball practice, or track practice, whatever activity they're doing. What else do you think parents can do to encourage some physical activity that doesn't look like they're nagging? It's really coming obviously from a good place, but that exercise piece to get those endorphins going is also helpful. So how do we make those suggestions in these times?
EC: Yeah, that's a tough one, as well. A lot of that seems to be a little bit weather dependent. I know that we always spend more time inside when it's not cooperative. But obviously now with some of the restrictions easing, we do have that opportunity to get outside. The playgrounds are starting to open up. The fields are starting to open up. So while we can't necessarily engage in sports or team activities, we do have that opportunity to get kids back outside again. But even just that whole idea of having active time with your family, it can be going for a hike. It could be going for a bike ride around your community, taking the dog for a walk, playing soccer in the backyard. So there's still lots of opportunities to move. It just may look a little bit different than when they can go out and play with their friends on the street.
DY: Yeah. And maybe it's just a chance to rediscover activity in a different way. That it's a little less structured. It's fun. It's just about being active and not having a goal to run something in a certain amount of time or whatever.
EC: Yeah. It's more just getting out and having fun, right? So here we're really looking for how do we get kids active, but keep it fun? So now that the restrictions are starting to ease a little bit, we can go to playgrounds. We can go into parks. Now there's that opportunity to get outside and be active a little bit more. Even just taking the bikes out around the block. You don't necessarily have to go far, but just getting kids out, being active, playing soccer in the backyard. Anywhere they just get the opportunity to move, I think, is a really important piece. And as well, even if you look online, there's a lot of kids workout videos or exercise movement videos online. GoNoodle is a really great one that my kids use, that it really focuses on dance and movement and music. It's quite engaging for the kids, and it's a 20 minutes opportunity for them to move and burn off some energy. There's also a lot of kids yoga videos, as well, if they just need that opportunity to calm their body and just take that time to breathe and to stretch themselves out without necessarily running around. So given the situation that we're in, a lot of places have put up videos and at-home things to do, so taking advantage of some of those would be a great opportunity.
DY: And I guess if your child is involved in sports at a higher level, you can always get in touch with your coach, get them to support you in terms of sending workouts that are possibly doable in this current environment. And I guess now that we're being able to go outside, maybe there's a few more options than there were two weeks ago.
EC: Yeah, absolutely. And quite a few places I know have been doing that. Some of the gymnastics centers is still having the training sessions. Some of the studios have gone online with things like martial arts, and even just sending home programs for training and things like that with other sports. So there's definitely opportunities for kids to do that. If they're still interested in their sports or they're still interested in getting back into their sports, there's those cross training activities that can be done at home for sure.
DY: So I want to talk a little bit about your research because you're the director of the Strengths in ADHD research lab. Tell us about some of your research and what you're finding. I'm curious just basically about the strengths in ADHD.
EC: So yeah, so the Strengths in ADHD is my research lab, and the premise of the work that we do is to really understand kids from a strengths-based perspective. So I have books and articles and an entire office full of all of the things that kids with ADHD have difficulties with. But what we're really interested in knowing is what do these kids do well? There's a lot of kids who are very successful in any number of different areas. So we're really interested in looking at kids who are doing well in some areas and then comparing them to kids who are maybe having a bit more difficulty, and looking to see where do those differences lie and what can we do for those kids that are having difficulty to help bring them up into that successful group? So we have a variety of different things that we're working on, some more focused on intervention and supports more so at the university level. We're really interested in stigma and mental health at this point, so looking to see perceptions of stigma and when kids may start to experience feelings of stigmatization. We're also interested in things like social cognitive development, which is, again, tying into those social skills. So how do kids interact with one another? How do they understand turn taking and perspective taking? How does that relate to things like empathy and sleep, and some more of those bigger constructs that are starting to be shown to be really important in working with kids with ADHD.
DY: And when you say strengths, are you identifying certain areas of strength in your research? Or is it too early to tell to be able to distill some of that?
EC: Yeah. So when we're looking at the results of some of the studies that we've done, it really varies depending on what we're looking at. So some of the things that we've found is that kids with ADHD really benefit from having social support. So that whole idea that parents are very important, but for kids who have somebody outside of their parents that they can go to, another adult, whether it's a teacher, a coach, a grandma, an aunt and uncle, somebody outside of their parent unit to talk to or to connect with, and they have that special connection with, that's a really important factor. It really helps to build resilience. It really helps to allow those kids to work through challenging situations when they have that extra person that they can go to. We also know that kids with ADHD, from an emotional perspective, they are very aware of the things that should be happening in certain situations. So the whole idea of knowing versus doing, they know what to do. They have a lot of knowledge when it comes to social interactions and how one should behave, but where they're really having the difficulty is actually carrying out some of those behaviors. So we're really focusing on how do we build their capacity in being able to appropriately interact without just saying, "This is what you're supposed to do." Because they know what they're supposed to do. It's just, they're having trouble implementing those skills.
DY: That gate isn't opening for them.
DY: So you have to help that.
EC: That impulsivity is still getting in the way. Cognitively they know what to do. They can answer all the questions about what should I have done and how should I handle this differently, but it's the actual doing of it. So, that's one of the things that we're working on right now.
DY: One of the things you mentioned just a couple seconds ago was sleep. What about sleep? Sometimes kids with ADHD have trouble sleeping. Is it worse now with the pandemic would you say? What do you suggest are some strategies to sort of help the sleep equation?
EC: Yeah. So kids with ADHD often do have difficulties with sleep. A lot of times that centers around an inability to fall asleep, just because their minds are continually racing, turning over, thinking about new things, and so they have a really difficult time calming down before they go to bed. So in the pandemic, that could be getting worse, particularly if a child has some anxiety that they're sort of ruminating on things that are going on and they aren't having that opportunity to help talk through things. So they may have things that they're thinking about that are impacting their sleep. But the other thing that is also maybe playing a role right now is that because we don't have the same kind of structure in our lives right now, that kids aren't necessarily going to bed at the same time because they don't have to get up at the same time in the morning. They don't have to be at school for 8:30 in the morning. Parents don't have to be at work in the same kind of way. So what we're seeing is that there's a little bit of that adjustment in terms of sleep schedule. So sometimes that means kids are going to bed later, getting up later. So their sleep routines are starting to get a little bit adjusted, which is fine, as long as they're still getting the same amount of sleep that they should be, right? Making sure that they're not missing out on sleep because they're staying up late and still getting up early. So one of the things that I suggest is making sure that parents keep with those good sleep routines. So that whole idea of sleep hygiene, making sure that there's wind down time before bed, making sure that they're not got screens in their rooms or that they don't have screens right before bed, and that there's some kind of soothing activity, reading a book or just kind of listening to music or something before bed to really help with settling them before they actually go to bed. If it turns out they're going to bed at 10:00 and getting up at 8:00 as opposed to going to bed at 8:00 and getting up at 6:00, then that's fine. But it's really about that sleep hygiene.
DY: What about, I just was wondering, you mentioned a little bit earlier on too about university students. University students are, and it sort of again, affected with this a bit differently. They're older. But a student with, let's say, who has ADHD working on a thesis. Not in that structure, can't go to the library, can't go to the lab. What would you suggest they do in terms of setting themselves up for success to get the work that they need done?
EC: Yeah. This is going to be a challenge as we move into the fall semester with online classes and working with students with ADHD. As you said, even graduate students who are trying to meet deadlines and get thesis complete over the summer. So the things that I've suggested to my students whether they have ADHD or not, is really focusing on setting a schedule, setting a goal, and treating your work as if it is a job. So you're getting up. You're working from 9:00 to 4:00 on a day, and you're taking your hour lunch break. But the rest of that time, you're trying to be productive. Maybe it's not sitting there for eight hours in front of the computer. Maybe that's working for 20 minutes and then getting up and having a five minute break and coming back. But that whole idea of trying to keep some routine so that it's not just, "Oh, I'll do it tomorrow. I'll do it tomorrow. I'll do it tomorrow." But trying to keep the same kind of semblance of weekdays and weekends.
DY: Yeah, because everything, when you have longer term projects, there's a tendency to procrastinate for anybody. But for kids and adults with ADHD, that is an issue. So do you have any advice as far as not procrastinating and just making sure that that deadline doesn't show up all of a sudden, and then the panic starts?
EC: Yeah. So obviously planning things out to begin with is a good way to start. So having a calendar or having a reminder so that you know two weeks from now this is what's due. And then even putting a reminder that's one week from now, this is when something is due so that you have those consistent reminders of something coming up so you don't just suddenly discover that it's due the next day. And also trying to break things down into smaller chunks. So rather than saying, "Oh, I have to write this whole term paper in two weeks time," maybe start with, "Okay, I'm going to write two pages of the background section. I'm going to write this section of the background section." Or I'm going to write, "This part I'm really interested in, so I'm going to spend the next two days getting this section written." And really trying to break it down so that it's individual pieces that are happening rather than the whole project. And then once you finish an individual section, then you can take a break, or reward yourself, or go outside, or whatever it is that's motivating for you. But trying to break things down into smaller chunks helps to make it seem a little bit more manageable.
DY: And it also sounds like some people look at things and say it has to go A to Z in that order. But you're saying no, not necessarily. Pick out the pieces that are going to make you feel like you've accomplished something and then build on those.
DY: That's good advice.
EC: So, yeah. Start with something that is easy to knock off so you feel like you've got something done. So once you've got the first thing done, then you've got a little bit of momentum to move on to the next thing. But if you start with something that's really difficult and you know it's going to be hard, you'll spend the whole day sitting there staring at a blank screen before you actually get anything done. So get started. Whatever you can do to get the ball rolling is a good place to start.
DY: I think Ernest Hemingway said he tried to write at least a sentence every day.
DY: Obviously he wrote more than that. But I think that was the whole idea. Just start. And when you start, you can keep moving from there.
EC: And there's different ways to start, right? So it doesn't necessarily have to be sitting at a computer typing things out. So there's a lot of speech-to-text software programs now that you can lie on the couch and dictate out whatever it is that you're trying to write, or the emails that you need to send. You'd still probably need to go back and do some editing and make sure that they're... Obviously the way we speak and the way that you write looks a little bit different. But if it's sitting in front of a computer that's difficult, try to change the modality so that there's different ways to work.
DY: One of the things we have read about is that having ADHD is potentially something that gives you superpowers because you can do things a little differently. You can maybe a few things at the same time. Just curious as to what your thoughts are on some of that conversation, some of that information we've been seeing.
EC: I mean, kids with ADHD are multitaskers, right? They've got so many things going on at different times. They may have a bit of trouble finishing everything, but they've got lots of motivation to start. So we do know that there's lots of ways that we can harness the creativity and the energy that kids with ADHD have. They're often ones to come up with very out-of-the-box ways to solve problems, or to come up with unique situations or stories. They're very creative in terms of how things come together, so that's one of the reasons why my research has focused on strengths rather than just continually looking at things they're having difficulty with. We know these little kids are great. We know they grow up into very successful adults and it's just kind of helping support them to make that transition.
DY: I think that's a great place to end our conversation. But before you go, I'd like to know if you can offer us some website information where people can go for more resources and to get some support if they need it.
EC: Absolutely. So there's two really great ADHD resources in Canada. We have the Canadian ADHD Resource Alliance, so CADDRA. They have a ton of resources for parents, for teachers and as well for things specifically related to COVID and working with kids at home in the pandemic. There's also the Centre for ADHD Awareness. So, CADDAC is more of a parent focused organization, and again, a ton of resources on there as well. So CADDRA is www.caddra.ca. C-A-D-D-R-A. And CADDAC is www.caddac.ca.
DY: Well, that's great. Thank you so much for joining us today. It was a great conversation. Before we go, I'd like to remind our community that mental health supports continue to be available. For all Calgarians looking for mental health support and resources, please reach out to 211 via phone or text. For students, support can be accessed through Student Wellness Services. For after hours support, or if you're in crisis, call Wood's Homes Community Support or the Distress Centre. For staff, faculty and post-doctoral scholars, supports are available through Staff Wellness. Additionally, Homewood Health is available and provide 24/7 mental health and crisis support. For domestic violence support, visit ucalgary.ca/sexualviolencesupport. For drug and alcohol harm reduction support, visit the Wellness Services website at ucalgary.ca/wellness-services. This has been UCalgary COVIDcast. To subscribe or to listen to past episodes, or to get more online resources for coping with the coronavirus pandemic, visit ucalgary.ca/covidsupport. Thanks to Dr. Emma Climie for taking the time to chat with us today. I'm Deborah Yedlin. Thanks for listening.