Monday, February 10, 2014

Teachers (and Parents) - This is Why Your ADHD Student Isn't Working - Part 2 of 4.

"It is less painful to be told that one is lazy than that one is incapable.  In short, laziness serves as a screen to hide the child's lack of faith in himself, prohibiting him from making attempts to cope with the problems confronting him."
 - Alfred Adler [1]
........."what distinguishes someone with ADHD from someone without it is that they appear to be less mature (are age inappropriate) in their ability to engage in self-regulation toward specific goals and the future more generally. If one is to help someone with ADHD, they must be helped to either overcome these delays or at least compensate for them (make accommodations to them) if they are to be more effective or successful in managing themselves, getting to their tasks and goals, and preparing for their future more generally. 
-       Dr. Russell Barkley [2]
“Organizing is what you do before you do something, so that when you do it, it is not all mixed up.”
-       A. A. Milne

     Here’s the second part of our four part series on why kids with ADHD don’t always work.  Last week we talked about not understanding or hearing directions, and some ways to help with that.  This week we are talking about “getting going.”
Problem #2 - They know what they are supposed to do, but don't know how get started, or get stuck and don’t know how to get started again.
      Lets say an assignment says the following:  “Writing Journal: Free Choice.  Write at least three paragraphs.”  A child in 3rd or 4th grade who is neurotypical and has average writing skills can say to themselves, “First I have to figure out what to write about.  Then I have to figure out my topic sentence.  Then I have to figure out what I’m going to put in each paragraph.  Then I have to write it.  Then I’m going to edit it.”  They may not complete all the steps correctly, but they remember what the steps are, and can use self-talk and planning to make it through from start to finish.  If they get stuck, they can re-start by thinking, “What am I supposed to do now?” and then appropriately answer that question. Following through on procedures and planning in the previous example requires three Executive Functions – working memory, appropriate internal self-talk, and decision-making.  
For this particular task, there’s a big obstacle right off the bat – deciding what to write about.  For ADHD children this decision can be difficult to make on their own.  First of all, there may be so many competing ideas it may be hard to narrow down the choices.  Secondly, there may be reluctance to make a decision because there is difficulty forecasting whether or not it’s a good decision.  i.e.:  “If I write about going with my dog to the park yesterday, will there be enough for three paragraphs?”  Children may react to this challenge in two different ways.  The first reaction might be to just try and start writing something without thinking anything through first.  The second might be to avoid starting the task altogether.  Either way, it could be a recipe for getting stuck.
  •  Write Down Procedures  - There’s an organizational method that’s popular with a lot of ADHD adults called Getting Things Done, or GTD.  A man named David Allen developed it about ten years ago.  (Wiki - GTD)  One of the tenets of GTD is that anything with more than two steps is defined as a Project.  Project steps should be written down, so that focusing on what needs to be done is not hampered by recall – unless the recall has become automatic.  By this definition, a long division problem for a 4th grader might be a Project.  Yes, I know the procedures for doing a long division problem are in the workbook or textbook.  But they might be in the middle of a block of text, may be overly complicated, or the steps may be interrupted by text.  The child who is stuck may need graphic procedures that are simple and no more than five steps.  One way to figure out what an individual child needs is to have them write their own procedure.  That way they can list the items they are most likely to forget, put things on the list that have the most meaning to them, and describe the procedure in the way that they like to remember it.  We can all describe how to do a load of laundry, but the method we use and how we describe it can vary from person to person.
  • ·      Help Narrow Down Choice When Possible  - Children love free choice, don’t they?  Weellll yes, but sometimes for some of us it can get overwhelming.  If you offer free choice to your class, provide two or three suggestions.  So the instructions above might be modified to read: “Writing Journal: Free Choice.  You might want to write about how your family celebrates Martin Luther King Day or whether or not you think we should have to make up snow days, but you can write about anything you would like.  Write at least three paragraphs.” 
  • ·      Focus on What’s Next – Getting stuck can sometimes lead to confusion and/or anxiety for an ADHD child.  One way to reduce confusion and anxiety is to focus on the Next Action.  This happens to be another tenet of GTD.  When a child is stuck, a helpful question might be, “What is the very next thing you need to do?”  For a large project, that next thing may need to be broken down into even smaller pieces.  For example, if the next part of the project is to create a poster, that activity may need to become a sub-project with an end date of it’s own.  After a procedure is written down for that part of the project, the very next thing might be “Get a sheet of poster board.”  When the child stalls, they can be brought back to the very Next Action.
  • ·      Practice Appropriate Self-Talk  - Children and adults can learn how to practice appropriate self-talk.  It’s actually a part of something called Cognitive Behavioral Therapy or CBT.  (CBT and ADHD) Adults can practice this individually with children, a small group, or the entire class.  “Let’s suppose you are doing your work and you get stuck.  An adult might not be able to help you for a little while.  What are some things you can say to yourself that will be helpful?”  Some children will come up with answers like, “I can move onto something else while I’m waiting”, or “I can ask another child”.  You can also offer alternatives such as, “What’s the very next thing I need to do?” or “If I try again I might be able to figure it out” or “If I need to ask for help it’s OK”.  In a group you might want to hand out index cards and ask children to write one or two of their favorite solutions so they can tape them on their desk or table.  Make sure you write the solutions somewhere so that children can copy them and don’t have to rely on memory or auditory skills.  This is also an activity that you might ask your school counselor to do with some or all of your children.  CBT is actually a good technique for children who are dealing with any type of negative self-talk whether it relates to depression, anxiety, or other issues. 
All three of these solutions will benefit other children in your classroom – not just those with ADHD.  For example, writing down new procedures and practicing positive self-talk are just good habits that help most people.  Once again you are engaged in Universal Design of Instruction.  

You can follow me on Twitter @pam327 or on Facebook at Pamela Mecca Seymour, LPC

[1] Adler, Alfred, and Heinz Ludwig Ansbacher. The Individual Psychology of Alfred Adler, a Systematic Presentation in Selections from His Writings. Ed. and Annotated by Heinz L. Ansbacher and Rowena R. Ansbacher. New York: Harper Torch, 1964. Print.

[2]  Barkley, Russell A., PhD. N.d. MS. The Important Role of Executive Functioning and Self - Regulation in ADHD. Web. 1 Feb. 2014. <>.
Montessori, Maria. The Absorbent Mind. New York: Henry Holt, 1995. Print.

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