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Home > Knowledge & support > Guide for parents and carers > Managing your child’s type 1 diabetes > Managing type 1 diabetes in children with neurodiversity > Looking after a child with ADHD and type 1 diabetes
ADHD stands for Attention Deficit Hyperactivity Disorder. It’s a disorder that is defined by the way that people behave. For example, some people might have difficulty paying attention (inattention) or might struggle to sit still for extended periods of time (hyperactivity).
Most people with ADHD have a combination of both inattention and hyperactivity difficulties (known as combined type ADHD), but some people have one aspect that is dominant (either inattentive or hyperactive type ADHD).
ADHD can make type 1 harder to manage. In turn, unstable blood glucose can contribute to harder to manage ADHD. ADHD affects people differently, but some of the main issues that might affect your child’s type 1 management are:
Find out more about how these issues can affect type 1 management.
Studies have found that ADHD rates in people living with type 1 diabetes are higher in both adults and children than in the general population. There isn’t enough research at the moment to explain why this is.
ADHD may be underdiagnosed in people living with type 1, because some of the signs of ADHD might be attributed to type 1 diabetes and the effects of high and low blood sugars on executive function (a set of mental skills). For example, most people with type 1 will demonstrate some level of executive dysfunction when having a hypo.
When assessing a child for ADHD it is important that the assessor understands the complexity of type 1 so that the diagnosis is appropriate.
It is important that your child’s clinic know that your child has ADHD. This will allow them to try and make clinic as engaging as possible and allow for tools such as fidget spinners or other sensory comforts.
“Part of living with ADHD can be characterised as the gap between thought, intention and action. For example, a child with ADHD and type 1 can think: ‘I need to do X’ and fully intend to do X, while in the moment be unable to do X and then get distracted and do Y instead.This can cause frustration for Healthcare Professionals who may mistake this gap for a lack of motivation or worse, simple laziness. These attitudes can lead to feelings of shame and self-judgement in children with ADHD. It can also put them off going to their type 1 appointments. For both parents and children, it can be frustrating to feel judged for things like low time in range which has been caused by ADHD.” – Jacq Allen, Psychologist: Children’s Diabetes Team
“Part of living with ADHD can be characterised as the gap between thought, intention and action. For example, a child with ADHD and type 1 can think: ‘I need to do X’ and fully intend to do X, while in the moment be unable to do X and then get distracted and do Y instead.
This can cause frustration for Healthcare Professionals who may mistake this gap for a lack of motivation or worse, simple laziness. These attitudes can lead to feelings of shame and self-judgement in children with ADHD. It can also put them off going to their type 1 appointments. For both parents and children, it can be frustrating to feel judged for things like low time in range which has been caused by ADHD.” – Jacq Allen, Psychologist: Children’s Diabetes Team
It’s also important that your child’s Diabetes Healthcare Team know that your child might interrupt or be distracted because of ADHD rather than ‘not behaving’.
You may want to ask for shorter appointments so that your child child is not asked to focus beyond what they are capable of.
You can ask for an email after the appointment, which outlines what you talked about at the appointment. This can help if your child is not able to process information in the moment.
Involving your child in preparing for an appointment is important.
Using a special notebook or their phone, your child can write down or voice record any questions they have before their appointment, if they might forget them later on.
You can also write a list of things you want to talk about and email it to your Diabetes Healthcare Team in advance. This can help direct the conversation while keeping your child on track.
Type 1 technology like continuous glucose monitors, insulin pumps and hybrid closed loop systems can help children with ADHD manage their type 1. Alarms on their tech and reminders on their phones can help a child with ADHD if they’re struggling with organisation and focus.
It’s important to re member that children with ADHD may also resist, ignore or be distracted away from alarms and reminders. Talk regularly with your child about what is working for them and be open to changing how you manage their type 1 when needed.
Children with ADHD can struggle to follow instructions. As well as making type 1 management more difficult, this can be distressing for them and even lead to meltdowns.
Breaking instructions or tasks down into smaller chunks over much smaller periods of time can help.
Using different ways of showing your child how to manage their type 1 can also be useful. For example, being shown by their Diabetes Healthcare Team how an insulin pump works rather than being told.
Your child can also take a video of pump settings or practice on a dummy pump to help them process instructions and what they need to do.
Pathological demand avoidance (PDA) is when someone is unable to perform an immediate demand. For example, ‘check your blood glucose now’. It is often seen in children and adults with ADHD.
If your child experiences PDA, change how you ask them to do something. This gives your child the best chance of being able to do what you’re asking. For example, instead of saying ‘change your pump now please’, give the child a choice, such as ‘do you want to change your pump now or after dinner?’ This can reduce the feeling of immediate demand and also help the child feel more in control of their type 1 management.
Speak to your Diabetes Healthcare Team about your child’s ADHD and what support they can offer.
You can find more information about managing ADHD at ADHD UK and Additude magazine.
This content was created by Dr Jacq Allan, Psychologist: Children’s Diabetes Team. It has been reviewed by ADHD UK. It does not constitute medical advice. Always speak to your child’s Diabetes Healthcare Team if you need support with their T1D care.
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