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 3^rd or 4^th 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.

Solutions:

•  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 4^th 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

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[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. <http://www.russellbarkley.org/factsheets/ADHD_EF_and_SR.pdf>.

Montessori, Maria. The Absorbent Mind. New York: Henry Holt, 1995. Print.

Teachers (and Parents) - This is Why Your ADHD Student Isn't Working - Part 1 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**
........."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**

Lack of effort can be one of the most frustrating things in the relationship between a teacher and student.  When a child tries to complete a task or skill, they are providing the teacher with information that indicates how much they do and don't understand.  Absent effort, the teacher is left guessing how much the child knows.  Moreover, when a child is not making any effort, it leaves the teacher feeling like he/she is working their tail off for a child who doesn't really care.  Sometimes it's hard not to take that personally.  However, when you are talking about children with ADHD, coming at it from their point of view and understanding their brain wiring can bring about an "AHA!" moment.  Things aren't always what they seem.  

The solutions that I detail below can be used with the entire class.  Very often they model good communication skills and ways to build good working relationships, thereby providing benefit to the group as a whole in addition to the students that are specifically targeted.  When a teacher provides accommodations to the group as a whole, it is known as Universal Design for Instruction (UDI).

Problem #1 - They don't know what it is that they are supposed to do.

I know you repeated the directions for the assignment more than once.  "They were looking right at me when I was talking!" Yep, and they still may not have gotten what you were saying.  Children with ADHD subconsciously learn how to look like they are attending, even when they are not.  It's a defense mechanism that often comes from hearing things like, "Look at me so I know that you are paying attention," or "Why weren't you listening?", etc.  When a neurotypical person is in a room with lots of low-level background noise, say a classroom or a cocktail party, or a dinner with different conversations happening at a large table, they can "screen" the background noise out and attend to the person right in front of them.  Most ADHD children (and adults) have a very hard time doing that.  Everything seems like it's at the same volume, and the brain seems to want to try to pay attention to everything all at once.  If the room is loud, it can actually be distressing.  Pulling a complete and accurate set of directions out of that sea of competing noises and interests can be very, very, difficult.  In addition, if the child has other things on their mind, (sick pet, Mom's gonna be mad at me because I didn't get my work done today, there was an argument at home last night, etc.) it's difficult to keep the brain from wandering.  All of this is not willful.  It's a lack of Executive Function (EF) that is a result of structural differences in the brain.  If you want to get an idea of what this is like, try the simulation on this link.  http://www.pbs.org/wgbh/misunderstoodminds/experiences/attexp2a.html

Solutions: 

• Check Back - When I'm working with a child who has trouble attending, I stop every so often and ask them to tell me what I've just said.  Usually I phrase it using a question something like, "Can you tell me what you just heard so that I know I said everything I want you to know?" or, "Can you tell me what I just said so that I know that I said it correctly?"  Notice that you are assuming they tried to listen, and that you are taking responsibility for what you said, not asking them to take responsibility for what they heard.  (Even though that's the point of your question) If you are working with a group, assign one or two people to be "check-back" people.  Assign that role to a child with ADHD.  Their job is to help make sure you described the directions completely and accurately.  It gives them practice attending, a chance to contribute, and you have the opportunity to make sure they "got it".

• Do not assume the child will ask for help from you or another child - Even as early as Kindergarten and First Grade, an ADHD child will begin to understand that adults and other children are critical of those who repeatedly miss what it is they are supposed to do.  Therefore, it's often easier to either try to "muddle through" or cop a refusing attitude than it is to ask for help.  Teachers therefore need to be proactive in making sure that the ADHD child really knows what they have to do.  When the child asks for help, even if the directions have been repeated several times and written down, the teacher should reinforce that request with a positive response.  All too often I have heard responses such as, "I have already given those directions several times.  I'm not giving them again."  If asking to repeat directions several times becomes a habit, the adult should meet one-on-one with the child to try and come up with an alternate system.

• Keep the directions clear and simple - I'm going to come back to this point again and again, because it's REALLY important.  Children with ADHD often have EF development which lags 2-3 years behind their chronological age.  Following that logic, if your class is 5th grade, the directions for your children with ADHD have to be in a form that a 2nd or 3rd grader can use to be successful.  You need to remember to include things that other children may take for granted.  For example, if the work involves measuring, the directions for children all the way up through 5th grade should say, "Get a ruler", or "Make sure you have a ruler". 

• Document the directions - Once you have done that, you still need to document the directions.  If you are going to write them on the board, they should stay there until the assignment or work is due.  Better to put them on a website or in email, or Edmodo, etc.  When I get done meeting with a client in high school or middle school that has a phone, I send a text with the week's "homework".  There are appropriate ways for you to do something similar.  Try not to put the directions in paragraph form.  A numbered list or a list with bullets is going to be more effective. 

The next post will talk about the problem of not knowing HOW to get started on a particular task.

You can follow me on FB at "Pamela Mecca Seymour, LPC" or Twitter @pam327.


**The quotes above come from the following works:

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.

Barkley, Russell A., PhD. N.d. MS. The Important Role of Executive Functioning and Self - Regulation in ADHD. Web. 1 Feb. 2014. <http://www.russellbarkley.org/factsheets/ADHD_EF_and_SR.pdf>.