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>.

Montessori and ADHD

 “The first essential for the child’s development is concentration. The child who concentrates is immensely happy."

“To let the child do as he likes when he has not yet developed any powers of control is to betray the idea of freedom.”

Maria Montessori 

The relationship between ADHD and the Montessori classroom is a tricky one.  Montessori is neither a panacea for children with ADHD, nor an environment that they should avoid altogether.  ADHD is not caused nor cured by diet, the frenetic pace of our culture, television, or poor parenting.  (See my comment about the first article below, and the author's repsonse)  Those issues can certainly affect the severity of ADHD symptoms and a child's ability to develop coping mechanisms, but ADHD stems from structural differences in the brain, is highly heritable, and was first identified in this country before the Civil War.  I am sure that Dr. Montessori met and observed some children who might have been identified as "mentally defective," but may actually have been living with ADHD.

The traditional Montessori classroom, when properly designed and maintained, can be beneficial to a child with ADHD.  Particularly in Children's House, the environment is structured to develop control and concentration.  (I have used some traditional Montessori activities, such as "walking the line" with some of my younger non-Montessori ADHD clients to a good effect) The child has freedom within the structure of the classroom, and can spend a long period of time on activities of choice.  The child learns how to remember and apply multi-step directions when they choose a work, take it off the shelf and carry it to a work area, complete the work, pick it up, and put it away - all of which must be done in a specific fashion.  All of those skills are important for children with ADHD to learn and practice.  Some children with ADHD require years of practice before those skills are mastered.   Children with ADHD will be done a disservice in the classroom when the teacher does not recognize that the child may not be capable of fully implementing these skills without the help of the teacher or a classmate.  Likewise, it will not help the child if the requirements to operated within the defined behavioral parameters of the classroom are ignored.  For the ADHD child to be successful, both the teacher and the parents must be willing to ask the child to perform at the highest level of capability, while providing assistance so that the child will still be successful.  In some schools this balance may be difficult.  More on that in a minute.

Older children must also learn and practice the skills of moving from one work to another in a timely fashion so that they complete enough work each day to make adequate academic progress.  For children with the executive function issues around ADHD, that can be a daunting challenge.  Activation (starting a task - particularly one perceived as difficult), perserverance, and organization all take a hit in the ADHD brain.  Since children in Montessori school often see their worth in the amount of work they complete, continued failure in this area can lead to discouragement and even depression.  A child in a Montessori classroom who is either spending the day wandering around the room with no substantive tasks completed, or a child who is just sitting complacently without showing willingness to attempt anything independently are both illustrations of this problem.  A child who begins to exhibit behavior that seems angry or defiant may also have arrived at the same place.  Again, the teacher who understands how ADHD truly impacts issues around work completion will be able to identify a discouraged or anxious child and will modify the child's environment accordingly, without labeling the child as "lazy", "oppositional", or "unmotivated".  The parents will also need to do their part to listen to teacher concerns as soon as they are voiced, and provide their child with the appropriate assistance at home.  This assistance may need to go beyond medication to things such as creating a structured schedule to help continue the "Montessori Day" into the home, learning all that they can about ADHD and how it affects their child, and agreeing to participate in the extra help that might be offered at and outside of school.

The challenge for many Montessori schools at the present time - particularly public Montessori schools - involves the ability to accommodate children with ADHD within the parameters of shrinking staffs and increasing demands for children to meet benchmarks on a yearly basis.  Even with two adults, it is a challenge to meet the needs of 25+ children on a truly individual basis.  In addition, the degree to which the plan of work may be modified for a child when the school has target standards to meet is limited.  In a traditional Montessori environment, where learning takes place in a three year cycle, children can often take time to practice and master classroom skills that require growth of executive functions. I'm not speaking of skills doing math or writing a paragraph or answering comprehension questions; rather I'm speaking of the skills required to develop a plan of work, do the work completely and properly, ask for help when needed, and do it all in a timely fashion.  Often once they have developed some mastery of those executive functions, learning is accelerated in subsequent years. Children in many types of public schools no longer have the luxury of time to develop executive function skills according to their own developmental timetable, and teachers certainly do not have time to teach them.  Standards are expected to be met on a yearly basis.

So if your child has ADHD, or you suspect they do, you must consider the following things before enrolling your child in any particular Montessori school, whether it's public or private:

• How much bandwidth do you as a parent have for assisting your child at home?  Are you prepared to continue the "Montessori Day" with the appropriate amount of structure in your home to help your ADHD child?  Are you willing to use agencies and providers to help with ADHD outside of school if it becomes necessary?  
• Are you willing to adopt and support the philosophy and structure of the school, even when you child is not always successful meeting the school's expectations?
• Does your child become discouraged easily?  Learning how to behave independently can be difficult work for a Montessori child.  How much comfort do you have with your child trying and being unsuccessful?  Independence often results in "skinned knees."
• Does your child tend to misbehave or "shut down" in an environment with lots of choice and stimulation?
• How well to the teachers understand the Montessori theories of developing control and concentration and how do they apply those theories in their classrooms?
• How well does the staff at the school truly understand ADHD beyond a child's difficulty sitting still or paying attention?  Do they understand what executive functions are and how they impact a child in the classroom?  Do they know and use positive interventions for children with ADHD?
• What is the school's philosophy about grade-level benchmarks and testing?  What is your philosophy?  If your child shows a slow rate of gain academically in one particular year while they are developing skills for staying productively on task,  how will the school react?  How will you react?  
• Will there be continual pressure for your child to perform independently yet be "on grade level?"

If any of those things are concerns for you, your child might not thrive in that particular Montessori environment, or might not be a good fit for Montessori at all.  For two other perspectives, I offer the articles below.

 http://www.huffingtonpost.com/laura-flores-shaw/after-ritalin-whats-next_b_1271750.html

http://tracylynnconway.hubpages.com/hub/adhdandmontessori

5 Things ADHDers Can Do in 2014

I have never been big on New Year's Resolutions that require learning difficult new habits.  In particular this is because January and February have traditionally been the months when I've had the lowest amounts of energy and motivation.  New diet and/or exercise program = epic fail.  However, I love lists of things that you can do that are (or at least are pretty close to) One and Done.  Here's that type of list for you.  If you or someone in your family is diagnosed with ADHD or ADD, here are some things to do in the new year.

1.  Subscribe to CHADD.  http://www.chadd.org/. CHADD stands for Children and Adults with Attention Deficit/Hyperactivity Disorder.  They are the largest organization of their kind, and they have a phenomenal amount of information on their site including articles, webinars, research studies, and information about local groups.  Your $53 membership also includes "Attention" magazine and access to all the previous issues online.  It's a great way to educate yourself and your family.

2.  Watch these two videos: "ADD and Loving It" and "ADD and Mastering It."  Available at TotallyADD.com.  I think these videos are the best at providing a thorough and funny view of ADHD.  They are good for ages 10 and up.  Our understanding of ADHD in our house took a major turn after my husband and I watched them.

3.  If you are a parent of a child with ADHD, consider whether or not you might have ADHD and whether or not you need treatment and/or coaching.  This is very important for two reasons.  First, the ADHD symptoms in your children are affected, both positively and negatively, by your parenting behavior.  If your home is in chaos, you cannot expect your ADHD child to be organized and on top of things at school.  It's really not very fair, and it just plain old isn't going to happen.  More importantly, your attempts to overcome your own struggles with an ADHD brain are going to be a powerful example to your child.  If your child has ADHD, there's almost an even chance that one of their biological parents does too.  So take a look in the mirror.  Go see your Doctor or a Psychologist and have a screening done.

4.  Consider getting a smartphone or an iTouch for everyone in your house who is in 6th grade or higher,  and learn how to use it one app at a time.   The apps and features on these things can be harnessed to make up for what the ADHD brain lacks - multiple times over.  Alarms, digital calendars, task lists, homework apps, grocery store lists and apps, mindfulness training, exercise routines - the list is endless.  Please DON'T start with Facebook or Angry Birds because you probably won't move on to the more important tasks.  There are several good articles out right now about using smartphones with ADHD.  http://www.additudemag.com/adhd/article/5329.html, http://www.healthline.com/health-slideshow/top-adhd-android-iphone-apps and http://www.danarayburn.com/managing-add-adhd/using-the-iphone-to-manage-adult-add-adhd%E2%80%A8/ for a few examples.

5.  Read ADD-Friendly Ways to Organize Your Life by Judith Kohlberg.  Before you run out and buy 18 plastic bins next week to "finally organize that junk room!" or clean out the car "so it STAYS that way!", buy this book and read it.  An easy read with lots and lots of practical suggestions for many different types of things.  It also does a great job explaining why certain types of organizational solutions = epic fail for ADHDers.  The other ADHD members of your family will thank you for not trying to impose a system that will spell a lack of success for them.

Hopefully you will find these items relatively quick and somewhat painless.  You don't have to do all of them and you don't have to do them in any particular order.  As my friend the FlyLady says, "Just jump in where you are!"

Happy New Year!