Developmental Age in ADHD

I've been asked what the single best parenting tip I've gotten as the parent of a child with ADHD is. After a lot of consideration, I've decided that it involves setting expectations. When we re-frame things that are appropriate for their developmental age, it alleviates so many fights and frustrations. These expectations can vary if they're on medication at the time, how much sleep they've had, and more.

What is developmental age?

Kids with ADHD have a delay in brain development that affects the ways they organize, process, and act upon information.

Chronologic age

We typically measure a child's age by how long it's been since they were born. This is their chronologic age.

We assume that kids will be able to understand more complex ideas and master new tasks as they get older. There are certain milestones that are associated with various ages, such as a social smile by 2 months or walking by 15 months of age.

Developmental age

Your pediatrician will ask developmental questions at routine well visits to be sure your baby is on track.

These questions help us to identify if your child is developing at a normal rate or if there is a delay. At some ages there are specific standardized developmental screening tools to be administered.

As long as a child meets expectations, their developmental age and chronological age match. If they are delayed, we can give a developmental age to help identify their stage of development.

We know that ADHD is one cause of delay of areas of the brain that are important in executive functioning. At this time there are no standard screening tool recommended at all well visits to assess this development. It is important to bring up any concerns from home or school with your physician.

What are executive functioning skills?

Executive functions are the things we use to help us use and act upon information.

Understood is a great resource for many things related to learning, attention, and behavior. They have a great page about what executive functioning problems look like at different ages - from preschool to high school.

But my child's smart, not delayed!

Being delayed in executive functioning areas of the brain is not the same as being academically delayed or having a low IQ. Parts of our brains grow at different rates.

Even your child that excels in certain areas can be delayed in others.

A child who can do math several grades ahead of classmates might not be able to remember something as simple as turning the homework in the next day.

Another child who reads grade levels ahead might not be able understand why a certain behavior is considered undesirable.

A child who is gifted in the arts can struggle significantly remembering all the things that must happen to get ready to leave the house in the morning on time.

It's easy to get angry at kids for having missing assignments, when they forget to brush their teeth, or when they're always running late. It can be difficult to help kids understand why they cannot blurt out answers or tell others what to do or how to do it.

Negative feedback leads to increasing problems

Unfortunately, kids with ADHD often hear negative feedback when they fail to do what's expected, which can lead to rejection sensitivity.

Kids often develop unproductive ways to buffer the negativity that follows their failures. They can act out, become the "class clown," decide to stop trying because of the fear of failure, and more.

Setting expectations

I'm asked all the time how to set expectations with kids, especially those with ADHD.

It's understandably difficult to parent when your child, who otherwise looks and acts like kids of the same age, doesn't have the same abilities in areas of focus, organizing, prioritizing, completing tasks, and self care issues.

Visible differences are easy to spot

When kids look different due to a genetic or physical condition, it's easy to see what accommodations are needed.

If a child has an obvious trait that makes it difficult to do a task, we modify our expectations. A wheelchair bound child would never be expected to run upstairs to grab something.

Invisible differences still exist

For those who look "normal" but are neurodevelopmentally different, it's easy to fall into the trap of setting an expectation based on the typical expectation for their age, not their level of development.

A child who has problems with working memory might also struggle to run upstairs to grab something. It's not a form of defiance when they go upstairs and forget what they're supposed to be getting or when they don't return because they get distracted by something else.

Many kids are simply not there yet.

They can't act their age because that part of their brain is not at that stage.

Most will get there, but it takes them longer.

Set appropriate expectations, and when they struggle, show patience and help them learn. This is much more effective than setting the bar too high, resulting in punishments and anger.

Delays of executive functioning

Dr. Richard Barkley has shown that kids tend to develop executive functioning skills about 30% slower than neurotypical peers. This adds up to about 3-5 years at most ages.

This might mean that your 12 year old might struggle doing what another 12 year old has already mastered. They might only be able to handle things expected of an 8 year old.

Set expectations according to skills, not age

The single tip that helps de-stress parenting more than any other that I've heard is to adjust expectations by skill.

Chronologic age is less important when deciding what a child is capable of and what they're ready to learn.

This doesn't mean letting them get by with anything...

As a child grows, you will watch their successes and failures.

You learn what they can and cannot handle. Help them with the things they cannot do while letting them do as much as they can.

Set expectations and supports

One child can be expected to get dressed and brush teeth without reminders.

Another child of the same age will need a chart listing all the routine things that need to be done.

And yet another child of the same age may need reminders to look at the chart.

All of these same age kids can be smart and have good intentions, but they need different levels of reminders.

Recommended Video

I recommend this video to parents often. It shows very clearly what it means to parent a child who is delayed in executive functioning. Parents of kids with ADHD will most likely identify with it.