Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by elevated levels of inattention, overactivity and impulsivity that impair the affected individuals’ social, academic, and occupational functioning (1). It has been the subject of intense research interest in efforts to better understand and manage the disorder (2). Much of this research has focused on the challenges and difficulties experienced by those with ADHD. Very little attention has been given to the hopes, dreams, and aspirations of those with ADHD.

This impairment-based research emphasis, although driven by the forward goal of improving the lives of those with ADHD, may lead to negative self-perception/lowered self-esteem and reduced expectations of what can be achieved, in the minds of individuals with ADHD, and those with whom they interact. The problems posed by such deficit models are being recognized amid calls to focus on the resources an individual with ADHD is able to recruit (3, 4). Hoogman and colleagues (5) suggest increased knowledge about the positive aspects of ADHD “may aid in treatment and coping with ADHD, reduce stigmatization and increase the quality of life of patients” (p. 81).

To date few researchers have heeded these calls. A review of the literature does show a number of studies have assessed creativity in children and adults with ADHD (5), while the business sector has considered the potential advantages of ADHD symptoms for entrepreneurship (6–8). A small number of studies have focused on the characteristics of successful adults with ADHD (9, 10). In studies of children with ADHD, resilience and protective factors have been considered (11). However, largely absent from this body of research are the perspectives of the children themselves (12). Giving voices to children with ADHD can facilitate understanding of their lived experiences and desires, rather than what others in their lives want for them. In the current study, we begin to address these research gaps by examining the wishes of elementary-age children with ADHD.

A common approach to collecting such information from children is the Three Wishes task. This is a minimally structured technique, used by many clinicians, to elicit information on an individuals’ desires, hopes, goals and concerns in an unbiased manner. While the exact phrasing of the question varies across studies, children are asked to express three wishes, without reference to the likelihood or probability of their occurrence. The technique is seen as providing “ecologically, psychologically and developmentally meaningful data” (p. 914) (13).

When used in research, children’s wishes are recorded and later coded into previously determined categories, the number and nature of which varies depending on the study purpose. A number of studies have focused on the wishes and desires of typically developing children; however, this approach has also been used to study the wishes of children and adolescents facing a range of challenges, including physical illness (14, 15), behavioral and psychological difficulties (16, 17), intellectual disability (18), and disadvantage/abuse (19–21). The Three Wishes task has not previously been used in research studies to assess and document the desires and motivation of children with ADHD.

In child and adolescent populations, the Three Wishes task demonstrates developmental effects (15, 16, 21–26). Typically, younger children make more material wishes (16, 21, 23, 27) while the wishes of older children are less materialistic and immediate, and more abstract and inclusive of others (16, 22, 23, 26). However, within elementary school-aged populations (26, 28) and within adolescent populations (29, 30), the focus of children’s wishes is similar. A number of studies have also identified sex differences in the wishes of children and adolescents. Boys’ wishes are more likely to be associated with pleasure (31), money, power, sport, personal achievement, and possessions (16, 19, 22, 24, 28, 29), social roles (21) and welfare (31, 32). The wishes of girls have been described as more likely to be associated with intimacy, pets, and caring about others (19, 22), family welfare (31), social and family relationships (16, 21), fulfillment of others (29), personal attributes and skills (28), and to be more realistic (17). However, not all studies with this age group report sex differences (25, 26).

There is some evidence that the wishes of children and adolescents experiencing adversity mirror their difficulties. Martinson and Liu (15) reported the wishes of children and adolescents with cancer reflected the impact of their illness on their lives. In comparing the wishes of child psychiatric patients and their peers, Winkley (17) observed those seen by a psychiatrist were more likely to describe wishes that reflected “real problems,” relating to specific difficulties in their lives. Reviewing the wishes of school children with and without learning or emotional problems, Guarnaccia and Vane (16) concluded children experiencing difficulties were “more concerned with personal possessions and relief from the pressures of school than ‘non-problem children”’ (p. 130). Amongst persons with an intellectual disability, Dykens et al. (18) reported associations between participant responses and psychiatric status or CBCL maladaptive behavior. In contrast to these results, Nereo and Hinton (14) found school aged boys with Duchenne’s muscular dystrophy did not make more health-related wishes than their peers or siblings.

In the current study, children meeting the diagnostic criteria for ADHD [as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM)] were asked a standard question about their wishes at the end of a semi-structured interview. Specifically, they were asked “If you had three wishes and could change three things about your life, what would you change?” The children’s responses were recorded by the interviewing clinician. This data was subsequently extracted for coding, including identification of the motivation behind the children’s wishes, using a version of Maslow’s Hierarchy of Needs. According to Maslow’s theory of human motivation, unmet needs generate wants, desires, and goals that motivate individuals to take actions to obtain them. Maslow’s original hierarchy incorporated five levels; from the essential physiological and safety needs, to higher level needs of love and belonging, esteem, and self-actualization after basic needs are met. Medcalf and colleagues (33) previously used this hierarchy to categorize children’s wishes and dreams for the world. We extended Maslow’s hierarchy for the current study to include the additional motivational categories of avoidance, altruism, and materialistic/hedonistic wants. Many of the categories used in other studies examining children’s wishes are comparable with this extended hierarchy. Other theories of motivation were considered, but not selected given their focus on specific aspects of motivation such as achievement (34), behavioral learning (35), arousal (36), and intrinsic vs extrinsic motivation (37).

In analyzing the wishes of children with ADHD, our goal is to provide insight into their inner worlds through identifying their hopes and desires. We also hope that the information gathered will help us better understand what motivates their behavior. Beyond anecdotal testimonies and clinical observations, we know very little about what motivates children with ADHD (38–40). Such knowledge would help in supporting children with ADHD to thrive and reach their goals. The current study is not designed to evaluate the nature of the wishes of children with ADHD against those of their typically developing peers. Nevertheless, the coding scheme was developed to ensure comparability with those used in previous studies, including those examining typically developing children. We also consider the relationship between age, sex, and socioeconomic status (SES), and the underlying motivations of children’s wishes in the context of existing research with the Three Wishes task. Based on previous studies, we expect to find some differences in the wishes of boys and girls with ADHD. Given the age range of the participants, 6–12 years, marked developmental shifts in the children’s wishes are not expected. While ADHD can create difficulties for the affected child, we do not make specific predictions regarding the degree to which this will be reflected in the children’s wishes.

Ethical approval for the study was obtained from the Okinawa Institute of Science and Technology (OIST) Graduate University Human Subjects Research Review Committee. Participating parents, teachers and children were volunteers and provided written consent.

The current study sought to identify the desires and motivations of children with ADHD through analysis of their wishes. The children were asked to share three wishes about things they would like to change in their lives. Study findings highlight the typicality of the self-reported needs, desires and hopes of elementary age children with ADHD. This is the first study to use the Three Wishes task to better understand the inner worlds of children with ADHD.

Consistent with the instruction to report how they would like to change their lives, the beneficiary of the recorded wishes was overwhelmingly the children themselves. For the most part the wishes reported involved immediate fulfillment rather than being future focused. Some children’s wishes, especially those of younger children, involved fantasy. Overall, their wishes appear to be developmentally appropriate (49) and consistent with previous reports of wishes made by typically developing children of similar ages.

As the participating children were all diagnosed with ADHD, their wishes were also coded for whether or not they referenced related difficulties or challenges (15–18). The number of such wishes was low, just over twelve percent summed across all problem categories, including ADHD. The proportion of children making ADHD related wishes was small (2.3%). Amongst “other” problem related wishes (reported by 20% of children), problems with social interactions were the most commonly identified issues. This finding is consistent with research showing elevated rates of social interaction difficulties in children with ADHD (50, 51), and speaks to the desire of children with ADHD to have better interpersonal relationships. Importantly, the wishes of 80% of the children did not include any reference to their difficulties; concerns over their problems do not occupy the everyday thinking of most children with ADHD in this study.

Children’s wishes did not seem to be strongly influenced by their living circumstances. A small number of wishes were related to them living in a foreign country. Only one wish was unequivocally linked to the COVID-19 pandemic. This was a little surprising as a number of children participated in the study after the pandemic began. Given the emerging reports of the negative impact of the pandemic on the mental health of children of this age (52), we did expect to see more wishes in this category. The current result may reflect less life disruption from the pandemic in Japan compared with many parts of the world. It is also possible that the children in the current study are, by and large, coping well in their lives, including with COVID-19 restrictions.

An important focus of the current study was identifying the motivation underlying the children’s wishes. This was achieved by coding the wishes using an extended version of Maslow’s Hierarchy of Needs. This approach has been used previously to analyze the “dreams for the world” of elementary school aged children (33). Changes were made to the original Maslow categories to address the age of the participating children and our interest in their wishes and desires, not just their perceived needs. Almost half of all the children’s recorded wishes were for material benefit/gain or hedonistic/pleasurable activities, which is highly consistent with the children’s ages and previous research. While presented toward the bottom of the hierarchy, this is not meant to imply these are lower ranked or less important wishes. Rather these are simply things the children desire. The next most frequently identified motivation involved affiliation or belonging, with almost 20% of the children’s wishes falling into this category, highlighting the children’s desire for social connections. This is an important finding, children with ADHD tend to experience interpersonal difficulties and receive frequent negative feedback. Our results suggest positive attention and enjoyable time with others, as well as tangible rewards and pleasurable activities, can serve as strong motivators for children with ADHD.

Though fewer in number, several of the children’s wishes reflect their desire to improve their abilities or skills. Some of the children’s wishes also involved the betterment of others and society more generally. This latter result is interesting given the children’s age and that they were asked how they would like to change their own lives. Few physiological and safety needs were identified in the children’s wishes, suggesting that the children’s basic needs were being met. The percentage of avoidance wishes was small and reflected the children’s desire to avoid school and homework.

Previous research has identified developmental or age effects, differences between boys and girls, and the impact of psychiatric/learning difficulties on children’s wishes. Consistent with findings with typically developing children, younger children in the current study were more likely than older children to offer wishes that involved fantasy and to make materialistic or hedonistic wishes. Older children, on the other hand, were more likely to make wishes reflecting affiliative and altruistic concerns. In contrast to previous studies, no statistically significant differences between the wishes of boys and girls, or those from different socioeconomic levels, were identified. A review of the most frequently appearing nouns in the wishes of boys and girls identified substantial overlap, but also some notable differences. Videogames and cars were referenced only by boys, while words related to pets and family appeared more frequently among girls.

The Three Wishes task appears to be a useful method for eliciting the hopes and desires of children with ADHD. Participants enjoyed the task and were able to articulate their wishes, with only a small percentage of children being unable to provide any wishes or offering a non-specific desire for more wishes. Given the age range of our sample, this highlights the value of the task for younger children. In the current study we did not specify the time frame for the children’s wishes. In future studies, it would be interesting to ask about children’s wishes for the future, and for others. This would provide more information on children’s career plans and goal setting, and their ability to consider the needs of others. It might also provide a format to elicit information regarding the children’s attitude toward their ADHD. Understanding the perspectives, desires, and goals of children with ADHD, through their words, can help facilitate treatment planning and help them thrive (4, 12, 53, 54).

In interpreting the current data, it is important to acknowledge any study limitations. The wishes of children with ADHD were not directly compared with those of typically developing children, though this was not the study aim. The children in the study were volunteers and as such may be more representative of community samples of children with ADHD than those presenting to specialty clinics, i.e., levels of comorbidity are low and the proportion prescribed medication for symptom management is below that reported in many studies. For several families this was a first assessment for ADHD, likely contributing to lower reported medication use. Thus, the study sample may have influenced the nature of their wishes and should be kept in mind if generalizing the findings to other groups of children with ADHD. That said, all children did meet DSM criteria for ADHD. The reported findings are influenced by the coding scheme utilized. The scheme included elements common to previous studies to facilitate comparisons with this earlier literature. We also included study unique codes (e.g., those related to ADHD and COVID-19). We used word cloud methodology to visualize the content of the children’s wishes, in this case the 50 most frequently appearing nouns. This offers insight into the subject of the children’s wishes but does not represent a thematic analysis. The latter might be considered for future studies using this methodology. In the current study, an a priori coding scheme was used to organize their wishes, thus we opted not to identify themes from children’s actual recorded wishes.

The results of the current study offer some important insights as to how we might better support children with ADHD. In clinical practice, it will be important to ask children about their wants, desires, and goals, rather than focusing exclusively on what parents want for their children. Understanding children’s desires may help in motivating them to make behavior changes. This includes attending to positively defined goals, e.g., addressing what children want from their relationships with others, rather than focusing on reducing their social difficulties. We suggest that a goal, rather than impairment, focused approach might serve to motivate and engage children with ADHD in the treatment process. We recommend empirical testing of this proposal.

The Three Wishes task can be effectively used with children with ADHD to obtain information regarding their hopes and desires. Our findings indicate the wishes of children with ADHD are developmentally appropriate, focusing as they do, on immediacy and material possessions, with some age effects evident in the degree to which they incorporate fantasy and are hedonistic versus affiliative and altruistic. Clearly, the presence of ADHD does not define, or limit, the hopes, and desires of children. This study serves as a timely reminder of the value of including children’s voices in research and clinical practice.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by OIST Graduate University Human Subjects Research Review Committee. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

EF, RU, and GT conceived and designed the study. MF collected the data. RU and MT performed the coding. EF and RU organized the data, performed the statistical analysis, and prepared the data for visualization. All authors contributed to manuscript preparation and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.