Middle childhood

Middle childhood is widely recognised as ages between 6-12 years and the developmental stage between early childhood and adolescence (Harold & Hay, 2005; Healthy People, 2020; National Research Council, 1984). Children in this period go through many physical, social, cognitive, emotional and behavioural changes which come with its many challenges. Developing cognitive abilities mean children can handle more complex intellectual problem solving and understand social relationships (Capital Health Network, 2020). Many of the challenges children in this age group face are in relation to social development and experiences. Peer acceptance and bullying is a significant issue as children are developing relationships with their peers and starting to spend less time with their parents. In these relationships children are making social comparisons that contribute to their emotional regulation and self-esteem. Social media also provides a platform for bullying online, especially as the usage is high. Ofcom (2022) found that children were more likely to be bullied online (84%) than in person (61%). Further significant difficulties for children in middle childhood are learning difficulties that interfere with their abilities to develop at the typical rate and the transition from primary school into high school.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder that begins in early childhood, starting before 12 and sometimes noticeable as early as age 3 (Mayo Clinic, 2022). In 2013-14, ADHD was found to be the most common mental health disorders for children at 8.2%, and the most common with boys at 11% (Australian Institute of Health and Welfare, 2022). More than 3 in 4 children with ADHD will continue to experience symptoms into adulthood (Healthdirect, 2020c). There are 3 types of ADHD; Inattentive, Hyperactive-impulsive and combined (Healthdirect, 2020c; Mayo Clinic, 2022). Researchers acknowledge that ADHD affects the brain’s executive functioning and the ability to self-regulate and practice self-control with thoughts, words, actions and emotions (Berk, 2012; Healthdirect, 2020c). Whilst ADHD does not cause other psychological or developmental problems, children are more likely to or often have other conditions with ADHD. These include mild delays in language, social development and motor skills, oppositional defiant disorder, conduct disorder, disruptive mood dysregulation disorder, learning disabilities, anxiety disorders, depression, autism and Tourette syndrome (Mayo Clinic, 2022). Children with ADHD tend to have low frustration tolerance, mood swings and difficulties controlling their emotions (CHADD, 2017). The development of ADHD may be as a result of genetics, environmental factors, and problems with the central nervous system during fundamental stages of development.

Evidence of Symptoms 

Generally, ADHD symptoms appear in early childhood. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013b), before age 12, various symptoms are required to be present. It can be difficult to distinguish these symptoms, such as excessive motor activity during toddler years, as this is typical behaviour of children under four (CHADD, 2017). Under the DSM-5 criteria, clinicians can also diagnose the severity of the disorder as mild, moderate or severe.

Through observations at school and home, symptoms of ADHD can be identified. It is common for children to lose interest in activities, become inattentive and be full of energy at times, however, symptoms of ADHD are persistent and do not match up with where the child should be developmentally. Children with inattention may show the following signs: have trouble staying focused on tasks, fail to pay close attention to details and often make careless mistakes in schoolwork, appear not to listen even when spoken to directly, struggle to follow through with instructions, fail to finish tasks or chores, easily distracted, forget to do daily tasks, has difficulties organizing activities and tasks, and avoids tasks that require mental focus. Children with hyperactivity and impulsivity may have the following symptoms: difficulty staying seated in class and other situations, constantly on the go, fidgeting, tapping hands and feet or squirming in a chair, difficulty engaging in an activity quietly, talks excessively, interrupts people, and has difficulty waiting. Some children will show a combination of these symptoms (Healthdirect, 2020c; Mayo Clinic, 2022). In addition to this, children with ADHD may also struggle with self-esteem, have poor relationships and low achievement in schoolwork.  Symptoms may lessen with age as individuals develop strategies to overcome these and have access to the appropriate medication.

Impact on the Individual and Interactions

Children with ADHD are at a greater risk of significant issues in adolescence and adulthood. This can include the impact it has on relationships with others, whether it be family, peers and the wider community. Children with ADHD tend to show more signs of depression than their peers and are at an increased risk of developing depression in adolescence and adulthood (Evans et al., 2019).

At school it can have an impact on developing friendships with others as they may get distracted easily when a peer is talking to them or talk over them. It can affect their relationships with teachers as they may be inattentive and do not follow instructions. Furthermore, the symptoms listed above can have a lasting effect on their learning if the suitable interventions are not implemented at school. Children in middle childhood with inattentive or combined ADHD demonstrate lower achievement than their peers (Evans et al., 2019). Research shows that these children do poorly on tasks requiring sustained attention, fail to manage frustration and intense emotion, find it hard to ignore irrelevant information and have difficulty with memory, planning, reasoning and problem solving in academic and social situations (Berk, 2012). Disruptive behaviours, such as, being unable to play quietly and independently, struggling to wait for a turn during conversation or activity and difficulty sitting still, also affect a student’s social, emotional and academic development and functioning. According to Dunn and Bennett (2002), children with ADHD may not process and receive sensory information correctly and therefore have issues with responding appropriately at home, school and social settings. Additionally, this disorder may impact functional and motor achievement, behavioural development and their ability to learn (Shimizu et al., 2014).

Suggested Interventions

As ADHD is present in childhood, guidance counsellors have the opportunity and responsibility to support these children and develop methods to manage their symptoms at school and provide parents with education and strategies to support them outside of school and into adulthood. Before implementing the relevant interventions, it is crucial for a guidance counsellor or educator to understand what skills need developing for the child coping with ADHD as children exhibit different symptoms. Developing an Individual Support Plan (ISP) through assessments, is a useful way to gather information on a student concerning their individual preferences, goals, needs and abilities. For the best results, guidance counsellors should work directly with parents to practice consistency and routine to best support the child.

Research suggests that a combination of medication and behavioural treatment has the best results for improved behaviour both at home and school over having just one treatment (CHADD 2017; The A.D.D. Resource Center, 2017).  Behavioural interventions include the following strategies: positive reinforcement, being consistent, being taught problem-solving skills, self-advocacy skills and communication. Behavioural interventions can also include adjustments in the classroom/school environment depending on the symptoms of the child. This could be seating the child away from corridors or the like as they may be distracted, providing opportunity to take breaks or movement throughout the day, and breaking up long tasks into smaller segments (The A.D.D. Resource Center, 2017). Children should also be involved with planning. Guidance counsellors should work with parents and teachers to guide, support and teach strategies.