Working with Individuals with ADHD: Proactive and Positive Tools for Parents and Teachers

1. PROVIDE A “UNIVERSAL DESIGN FOR LEARNING:” The National Center on UDL defines Universal Design for Learning as, “not a single, one-size-fits-all solution but rather flexible approaches that can be customized and adjusted for individual needs.” Teachers should provide an environment that provides flexible learning approaches, accommodating for different learning needs. Universal Design for Learning or Differentiated Instruction is founded on the idea that people perform best when able to express ideas in their own learning style or “learning language”. Most children with ADHD benefit from a multi-sensory instructional approach. They also tend to be kinesthetic learners and learn best with manipulatives, hands-on activities, projects, acting-out concepts, and meaningful movement.

2. ABBREVIATE VERBAL INSTRUCTIONS: Give instructions in small chunks; minimize words and resist the urge to try and gain the child’s attention with lots of words or explanation; use no more than 3-step directions; provide visuals or mnemonics if needed to help with focus, memory, and follow-thru. Hold up fingers (1,2,3) as you give each instruction. This creates a multi-sensory memory trigger, ensuring greater recall and focus. Be sure to repeat the abbreviated instructions more than once. Use eye contact often to ensure focus and retention of what you are saying.

3. CHECK FOR UNDERSTANDING: Ask for instructions to be repeated and check for understanding. Have child hold up fingers (1,2,3) as s/he repeats instructions. Ask for eye contact. Have them repeat the instructions more than once. Ask, “What are you doing first? Then what? What’s last?”

4. BREAK TASKS INTO SMALL CHUNKS: This is one of the most powerful interventions for children with ADHD. This technique helps curtail anticipatory frustration and defeatist attitude when the child feels overwhelmed with the emotional response, “No way I can do all that!” Break tasks into small achievable amounts and reward or provide scheduled movement when each section is completed; ie, do one row of math, then take an agreed-upon “break” (sharpen 4 pencils, run an errand, get a drink of water); provide praise and “successful completion” for this one row; do a second row and provide an immediate scheduled movement break; provide praise, repeat. Utilize a timer to “ground” and focus the child on the task and to provide for a “delay of gratification” (“I know that my break is coming in 4 minutes. I can stay focused for that long! I can finish this row!”)

5. PROVIDE SCHEDULED MOVEMENT: Children with ADHD need to move and purposeful movement actually helps with focus. Allow acceptable and agreed-up-on escape valves. This serves many purposes:

1. Provides a socially appropriate avenue for the movement their brains need.

2. Teaches self-management and modulation.

3. Gives a positive alternative to “losing it” and possibly looking socially stigmatized.

4. Allows for endings and new beginnings.

6. REDUCE WORK AMOUNT: Children with ADHD will shut down and check out if they feel overwhelmed by a large amount of work at home or school. Often children can demonstrate knowledge of a concept without having to complete large assignments. This is a quality vs. quantity approach. The primary goal is for the child to demonstrate they understand what we taught. This goes back to UDL (tip #1). Some children may be able to best demonstrate mastery of a concept by acting it out, making a poster or through verbal explanation vs. completing several pages of worksheets. Maintain this philosophy with homework!

7. ELIMINATE TIMED TESTS: There is little educational value with timed tests. They don’t provide children an authentic opportunity to adequately showcase their knowledge. They may also exacerbate performance anxiety, adding to the tendency to “check out.” Anxiety affects the memory portions of the brain and shuts down executive functions, which will foil their ability to demonstrate true knowledge.

8. STRUCTURE THE ENVIRONMENT: Provide a consistent structure and routine and stick to it.

Prepare child in advance for any changes in the expected routine. Structure the external environment to provide support for what they struggle to structure internally on their own. Explicitly teach organizational skills. Use color-coding for subjects. Make lists that they can go back and refer to. Post rules and review often. Teach the skill of using an agenda or calendar.

9. REDUCE DISTRACTIONS: Use headphones to muffle ambient and distracting sounds if not stigmatizing and tolerated by classmates. Use visual dividers when working at desk. Use proximity control by placing the child’s work area close to the teacher.

10. TEACH TRANSITIONS: Prepare and teach how to properly and efficiently transition from task to task and between different environments. Transitions and unannounced changes are very difficult for individuals with ADHD. They often become disordered around them. Take special care to prepare for transitions well in advance. Announce what is going to happen, then give repeat reminders as the time approaches.

11. FOCUS ON POSITIVE RELATIONSHIPS: Interact positively 3-5 times for every negative or corrective interaction. Remember that what you pay attention to and notice will be reinforced and strengthened. Pay attention to the GOOD stuff!

12. GIVE CUES AND PROMPTS: Make it a habit to provide consistent reminders of expected behavior in advance of activities (e.g., remember to raise your hand if you have a question or point to add to our discussion). Give positive feedback often and be specific (e.g.,”I really noticed how often your remembered to raise your hand today.”)

13. UTILIZE REINFORCEMENT PLANS: Choose 3 positive behaviors (opposite of the 3 most challenging behaviors currently being displayed.) If the child is currently blurting out, the new positive replacement behavior for the chart should be “Use the class attention signal or Raise hand.” Systematically “watch” for these 3 positive behaviors during a pre-set interval of time (ie, each hour, every 30 min, each subject area, etc). The child earns a point for each of the 3 behaviors displayed during that time interval. Never take away points or give negative marks on this chart. The research is unequivocal that the greatest success comes from focusing on positive replacement behaviors vs correcting and punishing negative behaviors. Treat each time interval as a new positive beginning!

14. ADOPT A STRENGTH-BASED APPROACH: Individuals with ADHD are notoriously creative, empathic, intuitive, full of positive energy and have the ability to “hyperfocus” (on desired activities)! Encourage participation in activities that breed success. Try pairing more undesirable tasks with the desired topic.

15. MAKE TASKS INTRINSICALLY REWARDING: Link activities to something the individual intrinsically finds rewarding or interesting. Given that dopamine is the “reward neurotransmitter” and individuals with ADHD have a lower level of dopamine, it naturally follows that they will subsequently find normal day-to-day activities LESS “rewarding” which can exacerbate the inattentiveness symptom. Find a way to link everyday activities such as home routines or schoolwork to something that the individual finds rewarding. Some examples of famous individuals with ADHD: Michael Phelps probably would have welcomed his teachers finding ways to incorporate the topic of swimming into academic tasks he found “unrewarding”. Whoopi Goldberg and Jim Carey certainly would have earned high marks if allowed to “perform” or utilize their natural kinesthetic and comic tendencies in lieu of a research paper.

16. CAPITALIZE ON SUCCESS: Transform tasks that aren’t internally rewarding approachable, doable and infused with a motivating factor. It is of utmost importance that stress be minimized. When a child is feeling unsuccessful and stressed, cortisol (stress hormone) kills memory cells. Learning is now extremely compromised. Ensure that the child is experiencing mastery instead of failure and frustration, excitement instead of boredom or fear. Remember that there is NOTHING rewarding about failure. Remember that our goal when working with children is to help them find mastery and success and we are merely guides. “Seek out and underscore success as much as possible. These kids live with so much failure; they need all the positive handling they can get. This point cannot be overemphasized: these children need and benefit from praise. They love encouragement. They drink it up and grow from it. And without it, they shrink and wither. Often the most devastating aspect of ADHD is not the ADHD itself, but the secondary damage done to self-esteem. So water these children well with encouragement and praise.” –Dr. Ned Hallowell

©Heather M. Goodwin, MA, HHP Heights of Health Holistic Therapy Services