Table 5 Practice recommendations for children and adolescents with comorbid ADHD and ASD: educational interventions

1. School staff should receive specific training to understand how ADHD and ASD impact on the way that children learn in the classroom and interact with their peers.

2. Specific learning difficulties such as dyslexia, dyscalculia, dysgraphia, and language and communication deficits should be addressed as early as possible with referral to allied health professionals (e.g. speech and language therapists, occupational therapists) so that appropriate interventions can be introduced before they significantly impact on learning, social functioning and/or development.

3. Anxiety may be the principal barrier to social inclusion and learning. Some children may feel isolated and deeply distressed in school leading to school refusal. When this happens, it is important that educational services develop comprehensive coordinated support plans to help the child and prevent school refusals in advance.

4. Knowledge and understanding about the social and sensory needs of individual pupils will enable staff to make the necessary adjustments (e.g. avoidance of congested spaces, loud noises) to reduce stress and promote learning and engagement.

5. Health and well-being topics should be included within the curriculum to avert later risk (e.g. unplanned pregnancy, STDs, substance misuse and mental health difficulties).

6. School staff may not fully appreciate the ‘achievement gap’ between chronological age and developmental age especially for children in mainstream school education. This needs to be clearly addressed in the child’s Education, Health and Care plan (EHCP), or equivalent, to ensure that curricular demands are appropriate. The EHCP should be developed and regularly updated with input from all those involved in the child’s care, including parents/carers.

7. Proactive individual planning regarding the transition from primary to secondary education should be made with the student, the school and others involved in the student’s care (if appropriate) in order to minimise the potential negative impact of this event and feelings of stress.

8. A personalised education plan [PEP] should be developed (see Table 6 for suggested topics) and shared with the healthcare team for inclusion in the individual’s care plan. The care plan should be shared with all relevant parties, with appropriate consent.