Attention Deficit/Hyperactivity Disorder (ADHD) is a neurological disorder that affects approximately 8% of children and 5% of adults in the United States. It involves developmentally inappropriate behaviors in two domains: attention and hyperactivity-impulsivity.
A common myth about ADHD is that all forms of attention are affected. However, this is not the case. The human brain has six types of attention, but only one is affected in ADHD: persistence. Individuals with ADHD struggle with persisting in the completion of goals and tasks. If persons with ADHD begin a task, they have more difficulty than others in resisting responding to distracting stimuli, and if they are distracted, they have difficulty re-engaging in the original task. Related to persistence difficulties is an impaired working memory system, a very common and substantial executive dysfunction in people with ADHD.
Working memory is the ability to hold information in mind in order to plan steps, in sequence, for accomplishing a goal. For example, when you think about the ingredients and steps involved in making a recipe, yo are using working memory to guide your behaviors of taking out everything and completing each step to produce the desired meal. If ADHD affects the ability to hold in mind information needed to complete a goal, it makes sense why they struggle in persisting with tasks and goals.
In the domain of hyperactivity-impulsivity, persons with ADHD have impaired verbal, motor, cognitive, and emotional inhibition, meaning that they are less able to stop inappropriate words, motor activity, decision making, and emotional expressions.
They are more likely to make impulsive decisions because they have difficulty delaying gratification. In other words, they have less consideration of future consequences and are more motivated by immediate consequences. They may display excessive and irrelevant physical and verbal behaviors that impede task completion. In children, this may manifest as fidgeting, squirming, running around, climbing on things, and touching others or things. Teenagers more likely report feeling restless and having the need to be busy instead of showing the excessive physical movement that children often display. Persons with ADHD also appear to be emotionally impulsive in that they struggle with regulating positive and negative emotions. They are often easily frustrated, impatient, and quick to get angry which can negatively affect social relationships.
ADHD is a pervasive and persistent disorder that begins in childhood and affects major areas of life activities such as academic success, social relationships, family functioning, and job performance. If untreated, ADHD can be associated with anxiety, depression, academic failure, social rejection, substance use, delinquency, and other mental health and social issues.
Here are the 10 Strategies for Managing Children and Teens with ADHD:
1. Reduce the Time Interval Between Actions and Consequences
Because children and teens with ADHD have difficulty delaying gratification, it is helpful to reduce the amount of time between their actions and the consequences. If necessary, break time-consuming tasks (a book report or chores, as examples) into smaller pieces, and reward each step of the way.
2. Make Important Information Physical
Because ADHD involves significant impairment in working memory, we should not rely on a child or teen successfully using working memory to meet goals. By representing information physically, or external to the child’s or teen’s working memory, we significantly improve his or her chances of succeeding and demonstrating what he or she knows. For example, have the child or teen put important information on any physical means such as sticky notes, signs, note cards, etc.
3. Make Mental Tasks Physical
Children and teens with ADHD often struggle with tasks like mental arithmetic, listening to stories, and comprehending what they’ve read because these tasks all require the ability to hold information in mind while manipulating it to solve problems (a.k.a. working memory), and we know that working memory is very often a core deficit in ADHD. Adults should allow them to use physical means to solve problems such as writing down information they’ve read onto index cards or drawing number lines for addition problems.
4. Plan on Using External Motivators
Have you ever wondered why a child or teen with ADHD can play video games for hours on end but can’t complete a 5-minute chore? Blame an impairment in another executive function: internal self-motivation. Tasks without built-in rewards (such as homework and chores) require us to use our internal self-motivation to complete these task and then wait longer periods of time for future rewards (such as good grades in school and having a clean home). On the other hand, video games have immediate consequences and do not require internal self-motivation. To help children and teens with ADHD complete these non-rewarding tasks, adults can add external motivation such as privileges, money, or other rewards.
5. Increase Accountability to Others
Because children and teens with ADHD have weak internal self-motivation to work independently without supervision, you should make them accountable to you more frequently. You can do this by breaking tasks into shorter work intervals and making sure to check in on them during breaks. When you check in, go over the next set of goals for the upcoming work period, and check back with the child or teen at the end of each work period to review his or her progress. Provide praise for reaching goals. If he or she was unsuccessful, then the work interval was likely too long.
6. Use Rewards Before Punishments
If you are frequently punishing the misbehaviors of a child or teen with ADHD and are confused as to why his or her misbehaviors persist, it’s because you haven’t provided incentives for positive behaviors. It is much more effective to consider the positive opposite of the misbehavior and then provide rewards when this positive behavior occurs. For example, if you want to see less yelling, you should spend your efforts rewarding the child or teen when he or she uses a calm voice to express feelings.
7. Keep Explanations Brief
Adults often talk a lot when addressing the behaviors of children and teens with ADHD. Do you find yourself saying, “You should complete your homework. You need to learn it. Homework is important to your learning….” etc. etc. etc.? Speaking to them more will not make them any more able to complete tasks. ADHD is not a deficit in knowing what to do but is a deficit in actually being able to do it. It is more effective to briefly discuss behaviors with children and teens who have ADHD. Not only is it a waste of time to further explain what they already know (what they are supposed to do), but talking more equals a longer delay in consequences. For children and teens with ADHD, consequences need to be more immediate.
8. Anticipate and Prepare for Problem Situations
It is much more effective when adults are proactive instead of reactive. Being proactive involves thinking about problems beforehand, anticipating when they are about to occur, having a plan for both positive and negative behaviors, and sharing this plan with the child or teen with ADHD. Think about what situations trigger misbehaviors, consider the positive opposites, come up with a reward plan for positive behaviors, and have mild punishments planned for misbehaviors. Prior to entering into the situations in which you expect misbehaviors, discuss your plan briefly with the child or teen so that he or she knows what to expect for positive behaviors and misbehaviors.
9. Keep a Sense of Priorities
It’s often difficult for children and teens with ADHD to complete tasks, so it’s helpful for adults to keep in mind which tasks are priorities in the long run and which can be put on hold. Making their beds in the morning is not as important as completing homework assignments and making prosocial choices when with others. For a few weeks, avoid the low-priority tasks and focus your efforts on helping these children and teens show success in high-priority tasks which have more of an effect on their lives.
10. Keep a Disability Perspective
Remember that ADHD is a neurological disorder that causes a delay in a person’s ability for self-control. If you can keep this in mind, you will more likely respond to him or her with patience and offer guidance instead of criticism. A good rule of thumb is Dr. Barkley’s “30% Rule”: reduce the person’s age by 30% to find his or her age of self-regulation. You should lower your expectations to this age and not compare the child or teen to same-aged peers.