If your child has been diagnosed with type 1 diabetes and attention deficit hyperactivity disorder, or ADHD, he or she is not alone. Some may think having ADHD means you can’t sit still in a classroom or pay attention when directions are given. Many times, the disorder may go undiagnosed, if it is the type that does not include hyperactivity or impulsivity. ADHD may impair a child’s ability to focus, retain information and plan and complete necessary daily tasks. This complicates diabetes self-management, increases parental and family angst and makes routines and schedules challenging and frustrating. The good news is that once ADHD is properly diagnosed in a youngster with type 1 diabetes, specific tips, tools and strategies can be implemented to make life a bit easier for family, teachers and, most importantly, the child.
What is ADHD?
According to the American Psychiatric Association, ADHD is one of the most common mental disorders affecting children. As a matter of fact, an estimated 5% of children and 2.5% of adults in the United States have ADHD, with symptoms including inattention, lack of focus and impulsivity (hasty acts that occur in the moment without thought).
Many students with ADHD often have weak executive functions (EF), which are a set of mental skills that can help a person focus, plan and complete important tasks. Suboptimal executive function may lead to problems with organizing ideas and time management, which require strong analytical skills and various levels of memory. Complicating the matter further, the parts of the brain that controls EF are not fully developed until our mid-20s, therefore making diabetes management more difficult.
These youngsters may be at risk for poor outcomes at school, leading to increased feelings of frustration and isolation. ADHD with reduced executive functions is particularly challenging for children diagnosed with Type 1 diabetes and may affect emotional health as well as daily self-care behaviors.
Additionally, it may be difficult to recognize the signs and symptoms of ADHD if your blood glucose levels have been fluctuating out of range. A high or low blood glucose level makes it difficult to think clearly and understand directions. A dual diagnosis of ADHD and diabetes may explain why your child may feel unfocused and super disorganized.
Signs and symptoms of ADHD in children
• Difficulty paying close attention to details or makes careless mistakes in school or job tasks.
• Difficulty staying focused on tasks or activities, such as during lectures, conversations or reading long documents.
• The appearance of not listening when spoken to (i.e., seems to be elsewhere).
• Inability to follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
• Problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
• Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
• Often loses things such as school papers, books, keys, wallet, cell phone and eyeglasses.
• Being easily distracted.
• Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.
Source: American Psychiatric Association
Parents with type 1 diabetes
In a recent study, Jianguang Ji, MD, PhD, of the Center for Primary Health Care Research at Lund University in Sweden, identified adults with type 1 diabetes and their children to determine whether parental type 1 diabetes is associated with increased risk for ADHD in children. The risk for ADHD was 29% higher in children who had a parent with type 1 diabetes compared to those without a parental diagnosis.
Boys had a higher incidence of ADHD compared with girls, and incidence of ADHD was higher in those with a family history of ADHD.
This study pointed to a significant link between parents who have type 1 diabetes and ADHD in their children. The researchers noted that more studies are needed to figure out the cause of these findings.
Let’s get organized
It’s essential to set up an organized and time-managed environment for your child that encourages a sense of accomplishment and successful diabetes management. Getting started can be daunting, but a few rules of thumb to follow can set your child on the right path.
Daily routines — the technology connection
Technology is a required life-saving tool for children with diabetes. Insulin pumps, continuous glucose monitors (CGM), meters and sensors are essential for blood glucose management and communication with caregivers and health-care providers. Technology can also be an asset for children with Type 1 diabetes and ADHD who commonly struggle with time management, organization and task completion. Basic routines are essential to help students stay focused on tasks related to diabetes, school and extracurricular activities.
A young person with Type 1 diabetes may benefit from using an electronic timer or cell phone reminder to check his or her CGM, glucose meter or other blood glucose-monitoring device. Alerts on a phone can be used to help him or her remember to check blood glucose and share the data or results with parents or caregivers and confidently move on to the tasks at hand in the classroom. The routine aspect of using these types of reminders may help the child move forward and feel a sense of accomplishment.
A child with type 1 diabetes and his or her caregivers cannot completely shut off technology because much of daily diabetes care revolves around using essential devices. Routines can support these technologies, and set up a road map for success and reduce the possibility of overuse. For example, continuous blood glucose monitoring communicates essential data and blood glucose trends. While blood glucose numbers can be unpredictable, the timing of additional checks (such as using a monitor before lunch, after recess or during sporting events) may become necessary. Once this information is shared, it may be determined that blood glucose is out of an acceptable range and may need to be treated and rechecked. The idea is that the routine and reminders are necessary to assist a child who may suffer from ADHD and needs additional assistance with focus and time management.
What’s their style?
You need to first recognize your child’s organizational style and set up systems that work for him or her. Ask your child, “What system is going to work for you so you will remember to check your blood sugar after or before dinner?” Perhaps he or she would prefer reminders written on his or her bedroom mirror rather than hung in the kitchen. Or he or she likes fun accessories and is happy to set reminders on a cool watch. You’d be surprised how creative kids can be when they are simply asked.
Clear is king!
If your child doesn’t see it, it doesn’t exist. Clear folders, containers and binders, even backpacks, give your child a natural way to receive visual reminders of priorities and the physical locations of resources. Clear containers with diabetes and school supplies are easily identifiable. The goal is to be able to access things easily, and clear takes the guesswork out of what’s inside.
If it takes more than two steps…
…your child will most likely not do it. Think streamlined. If your child has to reach high up or move several items out of the way in the refrigerator to find what he or she needs, then the likelihood of him or her doing so is slim. Place your child’s essentials in their “prime real estate” — between their shoulders and knees — for easy access. Your child will find it easier to check his or her blood glucose or eat a snack when a visual cue is right in front of them.
Think air space.
If you have the wall space, hang a pegboard on which you can keep all your child’s diabetes and school supplies. This is an ideal solution for the child who forgets things when they’re out of sight. Use it in the kitchen for grab-and-go snacks or in the bedroom for a diabetes supply pouch. Being easy to see and readily accessible make for easy to do.
Simplify where the supplies are kept.
We can’t stress this enough. If you store your child’s supplies in a drawer, be sure to keep absolutely everything related to his or her daily care in there. This includes an extra meter, testing items, even batteries. The less places you and your child need to look for things, the more likely you will be able to find them quickly, efficiently and without fuss.
Grooming items, such as a toothbrush, are typically kept in the same place, on the sink or counter in the bathroom. Keep blood glucose checking supplies nearby so your child will be reminded to check blood glucose at the same time. This is called “checking in pairs,” and is a great way to set up a natural routine for self-care. This strategy sets up a positive affirmation for any child or adult who may have previously skipped this important step in his or her own self-care and fosters independence in children.
Set up a launch pad.
This is a designated place in your home to keep the belongings that go back and forth to school every day. A launch pad takes the stress of “I can’t find my notebook” or “where are my gym sneakers” out of the equation. Remember to pick a location heavily trafficked by your child. It could be your front door, mud room or even outside his or her bedroom. Backpacks, completed homework, library books, instruments, daily diabetes supplies, glucose tablets — everything for school should all be stored here.
Use a planner.
Whether your student uses a paper planner such as Order Out of Chaos’ Academic Planner: A Tool for Time Management or an electronic calendar, make sure it is set up as a grid system so he or she can see the week at a glance. The planner should include all class assignments, after-school activities and reminders for diabetes maintenance and check-ins. Using a visual tool will take the guesswork out of not only what needs to be done, but also when. Extra bonus? It promotes a wonderful independence in your child.
Most people think checklists are the way to go to remind us to do things. We feel checklists eventually become clutter and much prefer directions. For a child with ADHD, directions can be more helpful in getting him or her to remember and complete tasks. For example, let’s say one checklist item is “check your school tote bag for diabetes supplies every night.” Instead of writing that, give your child step-by-step instructions that go something like this: juice box (to treat a low blood sugar) in the pantry, juice box in the tote bag, tote bag in the launching pad.
Take the remembering out of remembering.
If your child is going to be spending time with another caregiver (such as a grandparent or babysitter), create a sheet with instructions for his or her necessary diabetes care. No need to reinvent the wheel for basic diabetes terms and education — check out The Smart Sitters Guide for T1D Caregivers by Omnipod.
Don’t rely on your child’s memory to communicate necessary instructions, especially if he or she is feeling unwell. The Smart Sitters Guide, along with your individualized instructions about your child (including an emergency contact list), will detail how to check blood glucose, dose insulin if necessary, ensure enough carb grams and what to do in case of emergency, especially for hypoglycemia and hyperglycemia.
Also, program an emergency contact number in your child’s cell phone. For phones with a passcode, use a picture of emergency contacts on an index card as the wallpaper so if your child is forgetful, he or she doesn’t have to remember.
Once ADHD is properly diagnosed and acknowledged, you and your child with diabetes can take a number of concrete steps to help navigate this challenging dual diagnosis. By using several targeted strategies, improvement in ADHD-related issues may help your student feel more confident and lead to improved diabetes self-management behaviors.
Want to learn more about caring for a child with Type 1 diabetes? Read “Type 1 Diabetes and Sleepovers or Field Trips,” “Writing a Section 504 Plan for Diabetes,” and “Top 10 Tips for Better Blood Glucose Control.”