Current research by the Council for Exceptional Children indicates that nearly 10 percent of school-aged children struggle with Attention Deficit Disorder (ADD). Both in the home and at school there are many easily recognizable signs.
Inattention
Impulsiveness
Hyperactivity – mental or physical
Disorganization
Unfinished assignments
Careless errors
Weak short term and working memory – not taking in or holding on to information(see footnote1)
Seemingly unmotivated or caring to do what’s asked
Other behaviors detrimental to one’s self and others
Medication has been known to help, but with or without medication, adapting the environment, adjusting parenting and teaching style, and changing expectations based on the strengths and weaknesses of a child with ADD can turn a losing year into a winning one.
Before we consider the long list of possible accommodation options parents and teachers can make to the needs of young people with ADD, it is important to understand why such accommodations are needed and the lifelong negative effects on kids whose ADD is not addressed proactively .
Understanding the ADD brain.
Persons with ADD have been found to have a unique and special nervous system that regulates attention, emotions and motivation in different ways than the nervous system in those without the condition. It is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules. Despite ADD’s association with learning disabilities, most people with an ADD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. In his book A Different Perspective Thom Hartmann describes ADD not as a “disorder” at all but as a different state of mind that’s best suited in settings that require one to attend simultaneously and respond quickly to a myriad of aspects in one’s total environment. That’s very a very different setting from the typical classroom and job today that require us to narrow our focus to single tasks and tune out all other environmental stimuli.
Unlike in kids with Attention Deficit Hyperactive Disorder (ADHD), the ADD nervous system is not overtly physically hyperactive. They are hyperactive internally. They don’t have a shortage of attention. They pay too much attention to practically everything. Most people with unmedicated ADD are attending to multiple things at once with four or five things going on in their minds at any time, making it easy to become overwhelmed and difficult to sort, organize or prioritize competing input when pressed to focus narrowly. The hallmark of the ADD nervous system is not attention deficit, but inconsistent attention. This contributes to memory problems arising from trouble controlling attention when distracted.
Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick to it until it’s completed:
1) importance to self
2) importance to important others
3) rewards and punishments.
The ADD nervous system isn’t able to use the idea of importance or rewards and punishments to start or do tasks dependably. They know what’s important, they like rewards, and they don’t like punishment but for them, the things that motivate the rest of the world are not motivational. They have never been able to use the idea of importance or rewards to start and do a task.
This is why parents and teachers become so frustrated with their inability to help ADD children master their behavior. Everything that works so well with other children gets either no or inconsistent results. We know that if they get engaged with a task, these children can do it and do it well. We’ve all seen how they can “get in the zone” and be right on track, but neither they nor us can ever be sure whether their abilities will show up when they need them. These inconsistencies that come and go throughout the day are a defining trait of ADD. It makes their behavior mystifying and frustrating … and they are just as mystified as we are.
The inability to use importance and rewards to get motivated has a lifelong impact on the child. How are they to choose between multiple options? How can they make major decisions when neither importance nor rewards and punishment are helpful in motivating them to do what needs to be done? While the ADD nervous system works perfectly well by its own set of rules unfortunately it doesn’t work well by the rules generally accepted in our culture. They are disorganized, because just about every organizational system is built on two things — prioritization and time management — two things the ADD nervous system doesn’t do well. They have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.
This means they aren’t built to fit in with the standard school system, or later as adults into standard jobs, that are built on repeating what someone else thinks is important and relevant. Just look at this chart adapted from The Motivation Breakthrough by education specialist Richard Lavoie, M.A., M.Ed., to see how dramatic this mismatch in school expectations is.
| Classroom Expectations | ADD Brain |
| “Wait until you are called on.” | Reacts to rather than ignore things around them in the moment, otherwise labeled as impulsiveness. |
| “Don’t interrupt.” | |
| “Keep your hands to yourself.” | |
| “Stay in line.” | |
| “Take your time.” | |
| “Read the directions carefully.” | |
| “Sit still.” | Active, better known as hyperactivity |
| “No pencil tapping.” | |
| “Stay in your seat.” | |
| “Play/talk/work quietly.” | |
| “Stop fidgeting.” | |
| “Keep your desk/book bag orderly.” | Non-linear vs linear thinking that makes systematically organizing details difficult |
| “File your homework.” | |
| “Where’s your pen/pencil/ruler/glasses?” | |
| “Drill, drill, drill!” | Low frustration level from having to reign in the desire to attend, act and respond to the moment to the internal and external environment |
| “If at first you don’t succeed…” | |
| “Be patient.” | |
| “How many times have I told you…” | Reacting to each moment as new instead of remembering and drawing upon past experience |
| “Don’t you remember what happened last time?” | |
| “Follow the rules!” | |
| “Arrive on time.” | Fully engaged in a flow of experience in which time intervals are irrelevant. Particularly when in the zone, in which there is no perceived time. |
| “Adhere carefully to due dates.” | |
| “Estimate how long it will take you to…” | |
| “Figure it out yourself.” | Difficulty with linear sequencing, prioritizing, analyzing, synthesizing |
| “How would you solve this problem?” | |
| “What’s your solution?” | |
| “Don’t forget to…” | Fully engaged now |
| “Always remember to…” | |
| “Memorize this.” | |
| “The due date was…” | |
| “Come prepared.” | |
| “Watch those careless mistakes.” | Inconsistent attention to one thing while attending to many |
| “Listen closely.” | |
| “Pay attention.” | |
| “Follow the main idea.” | |
| “You should have finished that by now.” | Ready to move on |
| “You seem to be able to do it when you want to.” | |
| “Great start, but then you fell apart.” | |
| “Unacceptable handwriting.” |
The implications of this mismatch are vast. It means the first thing parents, teachers and others need to stop trying to turn ADD people into neurotypical people. The goal should be to intervene as early as possible, before the ADD child has become frustrated and demoralized by struggling in a neurotypical world where the deck is stacked against them.
This list of accommodations offers alternatives that take the ADD nervous system into account. Here’s what can happen if we don’t.
The Risks of Not Accommodating the ADD Nervous System
Studies are showing that all the risks parents worry about are more likely to occur in unaccommodated AAD children: a 250% greater risk of doing poorly in school; a 50% chance of being held back a grade, a 50% chance of developing depression, anxiety, obsessive-compulsive disorder (OCD), or some other emotional problem. Because the skills that child with ADD lack are precisely the skills needed to do well in school, they are likely to develop a negative attitude toward school and learning. If they are continually blamed, reprimanded, and censured for behavior that is beyond their control, they are likely to become angry, resentful, and frustrated resulting in discipline problems, low self-esteem, and difficulty with peers. As time passes there is a statistically greater risk of substance use, car accidents, problems with the law and diminished likelihood of going to and then graduate college. In untreated ADD, adults find it affects job performance, lifetime earnings, marital satisfaction, and likelihood of divorce.
This is because without treatment or accommodations kids with ADD will struggle with developing what’s called Executive Function: the process by which we consciously control of what we think and do. It allows us to guide our own behavior from moment to moment, enabling us to:
- Make choices and decisions and act on them
- Control impulses, inhibiting actions that won’t serve us
- Regulate our emotions
- Resist distractions and control attention
- Adapt flexibly to a changing situation
- Identify a problem and work to solve them.
- Develop plans and carry them out
- Self-monitor and evaluate the outcome of our thoughts and actions
Often in early grades ADD students can do OK, even very well. They are smart and children of young age are not expected to have much executive function. The demands on behavior and self-management are limited. But as they near junior high and high school, expectations become higher while the tasks become more complex and require longer sustained linear concentration. For example students are expected to:
- process incoming information while listening to a teacher’s explanation
- identify the relevant pieces of information
- inhibit irrelevant thoughts and ignore distractions
- hold the information in mind while linking it to what she already knows about the topic
- stay focused on a task
Like all children those with ADD are developing executive function but theirs is non-linear in nature. Linear executive function is a slower, step-by-step process that considers and organizes details one by one in order. Non-linear executive function is quick, jumping from one thing to another, not attending to or landing on details individually but putting things together instinctively. Often linear thinkers are unable to explain how they reached a particular conclusion. They just did. So as ADD children move into higher grades they may have problems with the many linear tasks expected of them:
- managing their time
- organizing their materials
- holding directions in mind, especially if the directions are complex or multi-step
- multi-tasking (trying to organize and complete several tasks within a specific time frame)
- resisting or delaying impulses (for example, they tend to blurt out answers rather than raising their hand to be called on)
- monitoring how their actions affect others in a social context
- study skills
- planning
- setting goals
- self-monitoring
- integrating information and encoding it so he or she can remember and retrieve it later on
- integrating skills such as reading a book in order to write a book report
- applying established knowledge to new situations such as applying math facts to word problems
We may see then struggling to:
- Identify the problem or task they are assigned, knowing what the finished a task should look like and figuring out how to complete it.
- planning, executing, and monitoring projects or assignments
- getting started on assignments, despite interest in the work
- setting goals and carrying out steps to achieve goals
- monitoring school work (for example, checking for errors)
Without these skills ADD kids and no treatment or accommodations for their neurological system they can begin to fall behind and can’t always catch up. Self-esteem plummets and depression or angry outbursts may become common. But children who receive appropriate treatment can usually learn to slow down and focus enough to participate in therapy and learn critical skills and coping strategies to manage ADD into adulthood. They begin to do better at school and at home, feel less frustrated and become more confident. Most gradually overcome sadness, anxiety, or other emotional problems they may have been experiencing.
Even with this knowledge in mind, parents and teachers may understandably prefer that their ADD child do the activities on the accommodation this list for him- or herself like other children do. In considering these accommodations, some parents and teachers may also be resistant to making these changes for practical reasons. Doing them consistently is time consuming and tedious. But with such accommodations we can help entrain the desired behaviors in our kids so they can to do well. It is well worth the effort for the future of the child.
The List of Possible Accommodations
This comprehensive list is culled from A.D.D. Warehouse (with permission) and other sources, including my over 20 years of experience working with children with ADD. It is organized by the issues they are intended to help. I like to see the child be involved in selecting the ones he/she thinks would be helpful in concert with his or her parents and teacher. Choosing and structuring such accommodations can be included in an IEP or 504 plan. Section 504 of the Rehabilitation Act of 1973 requires schools to make such accommodations when needed.
For inattention
- Seat child in quiet area, near good role model, study buddy or best of all right front facing the teacher where he cannot be distracted by what is happening in the classroom
- Increase distance between desks
- Allow extra time to complete assigned work
- Shorten assignments or work periods to coincide with span of attention; use a timer
- Break long assignments into smaller parts so child can see end to work
- Assist child in setting short term goals
- Give assignments one at a time to avoid work overload
- Require fewer correct responses for grade
- Reduce amount of homework
- Instruct child in self-monitoring using cueing. Since this is difficult adults need to provide reminders
- Pair written instructions with oral instructions
- Provide peer assistance in note taking
- Give clear, concise instructions – check to see if he has them and have him repeat them to the teacher or perhaps to the class
- Vary voice tone, cadence, facial expressions and movements frequently and unexpectedly to draw attention to your words
- Establish a private fun and clever signal to cue child to stay on task when he or she is doing other than school work like drawing, talking or reading instead.
Impulsiveness (as in doing what comes to mind instead of what he/we has outlined for himself to do
- Supervise closely during transition times
- Use “prudent” reprimands for misbehavior like drawing instead of working, talking during study time (i.e. avoiding lecturing or criticism)
- Attend to positive behavior with compliments etc.
- Acknowledge positive behavior of nearby students
- Seat child near the teacher
- Set up a behavior contract. Often the items in this contract have to be cued by adults in the moment for right at the time now.
- Instruct child in self-monitoring of behavior. Again this is difficult for the child with ADD so at least initially this too needs to be cued by adults. Invite child to notice what he/she is doing and if it is what they need to be doing.
- Call on only when hand is raised in appropriate manner
- Praise when hand raised to ask or answer questions
Hyper Activity
Note: the ADD’s child’s “hyper activity” may be mental not necessarily physical – an ever active mind – and may be reported as a sense of boredom.)
- Allow child reset their mind by psychical movement, i.e. to stand at times
- Provide opportunity for “seat breaks” where child can do tasks for the teacher or others.
- Provide short break between assignment periods
- Supervise closely during transition times
- Remind child to check over work product if performance is rushed and careless
- Give extra time to complete tasks (especially for students with slow motor tempo) Assistance will most likely be needed for the child to stay on task.
Mood
Note: Self Disappointment is usually obvious but to preserve some sense of self-esteem the child may have a propensity to blame others, find excuses real or imagined or and make up stories to avoid facing what a significant problem he or she has.
- Provide reassurance and encouragement
- Frequently compliment positive behavior and work product.
- Speak softly in non-threatening manner if child shows nervousness. This means being able to
recognize their individual signs of nervousness. - Reinforce frequently when signs of frustration are noticed
- Look for signs of stress build up and provide encouragement or reduced work load to alleviate
pressure and avoid repeated failure - Teach the child to recognize the bodily symptoms that their stress is rising
- Help them identify stress triggers and help them use stress reducers, coping and problem-
solving skills - Review instructions when giving new assignments to make sure child comprehends directions
- Look for opportunities for child to display leadership role in class
- Conference frequently with parents to learn about the child’s interests and achievements
outside of school in order to tailor engaging teaching examples and projects. - Send positive notes home
- Make time to talk alone with student
- Spend more time talking to students who seem pent up, display anger easily or are easily
- Provide training in anger control: encourage child to walk away; use calming strategies; tell
nearby adult if getting angry. This may be better done in counseling instead of burdening the
teacher. Due to low self-esteem some ADD children are more pent up than blowing up.
Academic Skills
- If reading is weak: avoid dull, tedious materials, provide additional reading time; use “previewing” strategies; select text with less on a page; shorten amount of required reading; avoid oral reading
- If oral expression is weak: accept all oral responses; substitute display for oral report; encourage child to tell about new ideas or experiences; pick topics easy for child to talk about
- If written language is weak: accept non-written forms for reports (i.e. displays, oral, projects); accept use of typewriter, word processor, tape recorder; do not assign large quantity of written work; test with multiple choice or fill-in questions
- If math is weak: allow use of calculator; use graph paper to space numbers; provide additional math time; provide immediate correctness feedback and instruction via modeling of the correct computational procedure
Organization and Planning`
- Encourage child to have a notebook with dividers and folders for work
- Provide child with homework assignment book
- Provide organization rules i.e. like with like, a place for everything and everything in its place.
- Ask for parental help in showing child how to do this, maybe even repeatedly, and encouraging and overseeing use of these tools
- Supervise writing down of homework assignments
- Send daily/weekly progress reports home
- Regularly check desk and notebooks for neatness, reinforce the rules by demonstrating, encourage neatness rather than penalizing sloppiness
- Allow child to have extra set of books at home
- Give assignments one at a time
- Assist child in setting short term goals
- Allow child to tape record assignments or homework
Compliance
- Praise compliant behavior
- Provide immediate feedback
- Ignore minor misbehavior
- Use teacher attention to reinforce positive behavior
- Use “prudent” reprimands for misbehavior (i.e. avoid lecturing or criticism)
- Acknowledge positive behavior of nearby student
- Supervise child closely during transition times
- Seat child near teacher
- Set up behavior contract
- Implement classroom behavior management system
- Instruct child in self-monitoring of behavior – demonstrate, model and cue self-monitoring
Working Memory
Remember: A child with ADD can only hold a certain amount of information in working memory before experiencing cognitive overload. There is already too much going on in their minds.
In school:
- Put homework assignments in writing
- Find out what the child heard
- Make time at the end of class for students to write down homework and make sure child is doing it in their homework notebook.
- Make eye contact before giving a classroom assignment
- Keep homework assignments on school website up-to-date so child and parents know what is to be done
- Speak slowly and provide information in small units suitable for student’s short-term memory.
- Make lecture interactive and invite students to share a summary of key points
- Make handing in homework the routine “ticket to start the class or to get out of class” at the end of the day. Stand by the door and collect it as they come in or leave
- Talk with child about what to do if they forget
- Use an analog clock or even a time to help with time management.
- Call close attention to due dates, post them, refer to them often, send home reminder notes, send individual or group emails
At home:
- Assign a designated place for child to put important stuff. Make sure he puts his things in this place. Reward for following through
- Call close attention to due dates, post them, refer to them often. Have the child look up home reminder notes and individual or group emails sent by the teacher. Ask them what the teacher said
- Create a reminder checklist of what goes into the back pack to go to school. Post it prominently and watch the child go through it preferably at night before bed
- Make and use to-do-lists yourself for child to see you using
- Brainstorm with child what would help him or her remember important things, i.e. smart phone reminders, pinning list to back pack zipper, ask friends what they do
- Get permission for child to email assignments to the teacher
- Reward for remembering. Have child create a reward menu.
- Set up a homework routine. Doing homework requires a lot of working memory so teach the child the elements it involves: knowing the assignment, recording the assignment, bringing it home, doing the home work, putting it in the book bag, taking it to school, turning it in
- Have the child record morning routines and listen to his own voice as a reminder each morning
- Rehearse with child what you expect him to remember right before the situation
- Use texts, IM’s or email reminders to your child’s smart phone during the day
- Keep distractions to a minimum when you want child’s attention to say something important, i.e. no TV, video games
- Follow through. Children with weak working memory will indicate that they did something — put their homework in their backpack, say — when you ask, but will proceed to forget. Until the child gets used to taking action when prompted, check on him to make sure he did what he told you
Motivation
General
- Level the neurologic playing field with medication so that the child has the attention span, impulse control, and ability to be calm on the inside. It is thought that for most this requires two different medications. 1) Stimulants have been found to improve day-to-day performance and help to get things done. 2) Since those are not effective at calming the internal hyperarousal that many with ADD have, the majority evidently benefit from adding an alpha agonist medication. Consult a pediatrician experienced in treating ADD as to what, if any, medication will be best for your child.
- Medication is usually not enough. A child can take the right medication at the right dose, but nothing will change if the ADD child is still expected to approach tasks with neurotypical strategies. The second piece of improving motivation is to work with the child to identify when he or she gets in “the zone.” Theirs is an interest-based motivation system. This is why procrastination is such an issue when the child is required to do dull, boring or uninteresting tasks. So usually getting in “the zone” involves being interested, challenged or intrigued in what they are doing, especially if it is urgent.
Classroom
- Make classroom work stimulating and interesting to what you know about the child
- Avoid rout, boring routine, repetitive assignments
- Use attention-grabbing audio video aids, role-playing projects, etc. to add interest and hold attention
- Break learning into smaller bites
- Have classroom or small group discussions that involve thinking about interesting aspects of the coursework
Home and School
- Stay on top of problems. Don’t let the child dig a huge failure hole for themselves by not noticing they’ve been failing a class for a month or missing their homework for days, etc.
- Ask what do you think you could you do to avoid this problem?
- Ask what could I do that would help you avoid this problem?
- Reduce stress in the child’s environment. Teach the child to recognize their physical symptoms of stress. Show them how to use simple stress reducers
- Notice when your child gets in the “zone.” What was the trigger? Structure other activities to have this quality.
- Challenge the child with bets and dares, i.e. “I was going to suggest … but I’m not sure if you can do that.” “I bet you can’t do this by the time I …..”
- Set a timer and challenge the child to see if he or she can get started in the next minute.
- Ask intriguing questions to make tasks interesting, i.e. how long would it take you to take out the trash? A minute, five minutes, an hour?” “Why do you think we study this?” “Do you think a smart squirrel could do this?”
- Build in competition, i.e. who can get this done first? Be sure the challenging task is a simple not a complex one involving sustained attention.
- Point out that we don’t need to be interested or want to do something. Do it because you can.
- Create fake urgency. “Oops, if you want to go with us we’ve only got___ minutes.” “If you don’t want to stay after school you’ve got ______.” Don’t renege, however, if the child dawdles around. Simply say, “Maybe next time.” with no emotion, no blame.
- Invite the child to visualize a picture the end result of what they’re doing. How will they feel?
- Pre-empt “You know I can’t make you do this. How will be feel about yourself is you don’t? If you do?” “I know you will hate this, but it’s time to get up.”
- Cue the child to Step Back/Slow Down. Use SSTA: Stop-Slow Down-Think-Act. Teach Slow Down Strategies.
- Teach and reinforce the pitfalls of negative self-talk.
- Avoid all negative attributions like “You’ll never get in college.” “You’re going to end up working in McDonald’s.” “You’re not stupid so stop being stupid.” What’s wrong with you anyway?” I know you can do this.”
- Show plenty of affection at times unrelated to failure or accomplishment
- Spend time together doing things the child enjoys and does well.
