Is the Problem Really ADHD?
Written by Harold Robert Meyer, MBA, BCC, SCAC and Susan Karyn Lasky, M.S., BCC, SCAC
There are many reasons why a child is disruptive or inattentive in class. However, many children who exhibit these behaviors have a form of Attention-Deficit/Hyperactivity Disorder. (ADD/ADHD).
ADHD is difficult to diagnose definitively. It is a highly hereditary neurobiological problem characterized by behavioral difficulties that may vary in intensity. Environment, attitude and internal motivation can influence behaviors.
Testing (a combination of neurological, psychological and educational testing, along with a detailed family history) is used to pinpoint ADHD as the probable issue. Testing should rule out other causes for ADHD-type behaviors. These include medical problems (thyroid, lead, intoxication, Lyme disease, diabetes/hypoglycemia, allergies, asthma, anemia, etc.), as well as visual or auditory problems and emotional/physical issues such as stress, abuse or neglect. A knowledgeable practitioner will make a differential diagnosis, determining whether the symptoms are due to ADHD, to one of the many behavior, mood or cognitive disorders that exhibit similar symptoms, or to a combination.
Few children have pure ADHD; high percentages have comorbid (co-existing) learning and/or communications disabilities. Children, particularly those who are not diagnosed until
they are older, may also exhibit affective and regulatory disorders (anxiety, depression, bipolar disorder) and/or disruptive behaviors (oppositional defiant disorder, conduct disorder, etc.). They may have developed drug dependency, often as an attempt to self-medicate.
Diagnostic Criteria for ADHD in Children
There are three predominant characteristics associated with ADHD: Hyperactivity, Impulsity and Inattention. However, a child may have ADHD, yet present as non-hyperactive.
There are three primary types of ADHD, each with a different set of diagnostic symptoms:
- Predominantly Hyperactive/Impulsive
- Predominantly Inattentive
- Combined type
All of these share the following criteria:
- Child must have at least six symptoms in a category, persisting for at least six months, to a degree that is maladaptive and inconsistent with developmental level.
- Some of the symptoms must be present before age seven.
- Some impairment from the symptoms must be present in two or more settings (home, school, play).
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.
- Symptoms are not better accounted for by another mental disorder.
Another type is Otherwise Specified ADHD, where the prominent symptoms of ADHD are exhibited, but not enough to meet the diagnostic criteria.
Predominantly Hyperactive/Impulsive Type:
- Fidgets with hands or feet, or squirms in seat
- Leaves seat in situations in which remaining seated is expected
- Moves excessively, or feels restless during situations in which such behavior is inappropriate
- Has difficulty engaging in leisure activities quietly
- Is “on the go” or acts as if “driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Has difficulty awaiting turns
- Interrupts or intrudes on others
Predominantly Inattentive Type:
- Fails to pay close attention to details or makes careless mistakes
- Has difficulty sustaining attention to tasks or leisure activities
- Does not seem to listen when spoken to directly
- Does not follow through on instructions, and fails to finish work
- Has difficulty organizing tasks and activities
- Avoids, dislikes or are reluctant to engage in tasks that require sustained mental effort
- Loses things necessary for tasks or activities
- Easily distracted by extraneous stimulus
- Forgetful in daily activities
- Meets criteria for both Impulsive-Hyperactive and Inattentive types of AD/HD.
Treatment for a child with ADHD can be very effective, especially when the diagnosis is made at an early age. Multi-modal treatment is recommended. This is a combination of individual and family therapy, behavior modification and, when appropriate, medication. Additional services are often helpful, such as socialization skills training, occupational therapy, organization, time management and study skills training. If there is a question as to whether a child has ADHD, it is important that they are tested, in order to receive appropriate services as soon as possible.
Children with ADHD are generally bright, although they may not show it. They are frustrated by their challenges and inconsistent behaviors. Older children may have learned to cover this up, often by manifesting negative attitudes and behaviors.
“If I can’t help it, I’ll join it,” “I’d rather be bad than appear stupid.”
However, they are not “bad” kids and want very much to be liked and appreciated. Many older children, upon being diagnosed, are thrilled to find that there is a reason for their lack of control and inability to focus— that the things they’ve always felt are wrong with them have a cause.
Motivating the child with ADHD is critical to his or her success. When motivated, challenged and interested, there is actually a change in their brain chemistry.
Parents of kids with ADHD are generally very frustrated. There is a pervasive attitude that, since the children misbehave, the parents are doing a terrible job of parenting. They are often criticized for not exerting enough discipline. Meanwhile, they may have relatives or spouses who criticize them for being too strict. There is often contention between spouses on how to handle the child. People often believe (especially fathers) that the child “Just needs to shape up.” What is often overlooked at home, as well as at school, is that the child CANNOT “just” shape up. These children have a very real neurological problem and need help to succeed.
The Teacher’s Role
Anything a teacher does to help their students with ADHD will benefit ALL students in the class. However, to successfully teach a child with ADHD, teachers must understand their “hidden” disability, along with its behaviors and challenges. They need to reach the student on a meaningful level, focus on the child’s strengths, inspire and motivate. This requires commitment and a great deal of energy.
There are many strategies, tips and techniques that are helpful to the classroom teacher. Here are a number of tips for effective classroom management:
105 Tips for Successful Teaching
- Set up an informal support group you can lean on. Having ADHD kids in the classroom can be exhausting. Ask for help from specialists (learning, psychological, medical). Involve the parents—how do they handle certain situations at home; what can they do at home to make your job easier. Involve other teachers in finding solutions to particular issues—t’s not a sign of weakness to reach out.
- Know—and accept—your limits. If you accept that it’s okay to get angry, tired, frustrated or even a little crazy, it’s easier to keep your overall sanity than if you think you have to be perfect.
- Avoid unfair expectations. Most kids with ADHD are smart, and because their behavior and performance is inconsistent, teachers often think the child’s problems are due to non-compliance or laziness, with the standard refrain being , “we know if you just tried harder you could do it.” But that’s not always so… sometimes the child who scored a 98 one day can’t perform better than a 65 on another day. “Can’t” NOT “won’t.” The same child who answers difficult questions may stumble on the easy ones. And they’re as frustrated about it as you are!
- Make sure you have his attention. Unless the child is paying attention, he can’t learn. So before beginning a lesson or assignment, establish eye contact with the child so you know he’s focused. ADHD kids frequently have difficulty distinguishing the key element (the teacher) from the background (other kids in the class, noise in the hall). Use frequent eye contact and an occasional touch on the shoulder to maintain or redirect the child’s attention.
- Seat the child near your desk and away from doors, windows, heater and air conditioning.
- Keep the classroom door closed, especially during tests.
- Minimize distractions in the classroom itself.
- Sit the child near a good role model, both for behavioral and organizational skills.
- Help the child to keep an uncluttered desk. Check that all necessary items (sharpened pencil, paper, etc.) are available. If the lesson begins and the child is still looking for her book, she won’t be able to catch up with the rest of the class.
- Set the child up for success, not failure. Break instructions into small steps and assign one task at a time. Pick one goal at a time.
- Spell it out—be precise in your directions. Don’t say, “get ready,” but break it down into several steps, such as “now sit in the chair with your feet on the floor…face the front of the room…have your work book and pen on the desk.” Pause between each instruction to give the child time to follow the step.
- Repeat directions. Write them down. Say them. Repeat them. Then have the child repeat the instructions back to you, while maintaining eye contact.
- Keep the child on task and redirect attention when necessary, which means supervising with greater frequency than normal.
- Disruptive/inattentive children need structure. They need their environment to structure for them externally what they can’t structure internally. ADHD children function best in a highly structured classroom with clearly established patterns and rules.
- Make lists and post the rules. It must be clear to the child what is expected. By providing rituals in the classroom, the kids then feel more comfortable taking risks from a secure base.
- Have as predictable a schedule as possible. Post it and refer to it often. If you are going to vary it, as most interesting teachers do, give lots of warning. Transitions and unannounced changes are hard for these kids.
- Have the children make their own schedules for afterschool, both to assist with learning the concept of time management and to avoid one of the hallmarks of ADHD—procrastination.
- Set limits and boundaries. There must be a defined system of acceptable and unacceptable behaviors, along with rewards and consequences (incentives, reinforcements). This is containing and soothing, NOT punitive. Be consistent and predictable. (Reward systems are discussed in more detail later on.)
- Take charge. Follow through with consequences (positive or negative) immediately. Avoid lawyer-like discussions of fairness. ADHD kids are notorious negotiators.
- Your goal is to help SHAPE behavior. You can’t be responsible for changing it. The child who hits won’t just stop hitting, because that is an impulsive, reactive act. Look for a gradual effect.
- Discipline means to teach —NOT to punish. ADHD children are impulsive, which means they’ll often do things which get them into trouble, even when they’re trying to behave well. They need your support.
- Never blame the child—criticize the behavior! ADHD kids, though they usually do not express or show it, feel badly enough about their behavior and lack of control. They frequently do things they didn’t plan or want to, due to impulsiveness. They know something is wrong and they cover up with false bravado. At a young age they begin to think they’re no good. By high school they’ve frequently “grown in” to the role they’ve been assigned as troublemaker. They need your support.
- Reprimand in private as much as possible.
- Give child a choice of behaving in the correct manner or, if continuing to misbehave, facing predetermined consequences – not punishment, but consequences logically related to behavior and made clear to the child in advance.
For example: If chair is continually tipped, it will be removed.
“It’s your choice if you prefer to stand through the lesson”…
If a favored toy is abused, the toy will immediately be given time out (put on a shelf)—
“Obviously you’ve decided not to play with this toy today, or you’d be gentle with it, so it’s your choice to put it away.”
- When you have a kid who is obstinate or has trouble making up his mind, give two choices, either of which which would be acceptable to you —”Do you want to put away the blocks first or would you prefer to put away the puzzles first?” The child gets to feel pride in being the one to make a decision, rather than being told what to do and you have made it clear what needs to be done.
- Provide the consequence of a choice so final behavior is the child’s decision—”Your pushing is upsetting both me and the other children. You can either play gently or go for time out —YOU DECIDE” This avoids having the teacher always being the taskmaster and disciplinarian and places the responsibility for acceptable behavior on the child.
- Present alternatives in a positive way. Instead of “If you don’t quiet down you’ll have to go to the principle’s office,” try “If you quiet down now we’ll have time for xxx.”
- Act quickly when giving a consequence, especially with younger children, so it’s clear punishment tied in to specific activity
- Try to be specific in defining behavior— NOT “Stop misbehaving, but “Stop pushing,” “Stop banging the book,” etc.
- Relate the criticism to the action—NOT the child. Instead of “You’re really creating disruptions in the class,” try “Your behavior (being specific if possible) is causing the other kids to get upset and making it difficult for me to teach.” It’s a subtle difference, but with one you’re condemning the child; with the other, the activity. This leaves the child free to improve, whereas the other makes him feel worthless.
- Never call the child good or bad, but address the behavior (not acceptable). Avoid accusations which make the child feel he or she is not good as a person, and put up their defenses: “You’re not trying” vs. “I feel upset when you don’t start to work on the questions.”
- Focus on actions, not motivations. Say, “It’s time to get started on your work.” NOT “Stop being so lazy.”
- Don’t praise with one hand and criticize with the other. It’s not positive to tell a child “You haven’t done anything wrong today,” even if you mean well by it. Say, “I’m really happy with the way you raised your hand, rather than interrupting the class.”
- Take advantage of a cooling down period. When you see the child has lost control, don’t confront the issue, but quietly go over and tell him to take some quiet time, then when ready, rejoin the group. You need to monitor the child, to help prevent negative behaviors by early intervention, to make the rules clear and to see the child experiences predetermined and clearly defined consequences.
- Choose the issues. Avoid confrontation on every wrong move. Ignore minor non-disruptive behavior and reinforce other children’s efforts for not attending to the ADHD child’s misbehavior (which to the child is reinforcement, albeit negative).
- Never confront the child or demand response when she’s out of control or her body language says NO. Give 10 minutes of quiet time and you’ll see PHYSICAL changes. Then you can discuss what happened from the perspective of being concerned and wanting to work with the child to avoid recurrence. Make the child feel good about herself, that you know she can do it, but you also understand how very hard it is for her, and what an accomplishment it will be.
- When a child is really disruptive, time-out doesn’t work and the child’s behavior is affecting the entire class, it may be advisable to bring in an authority figure. NEVER leave the child alone, but it may be necessary to remove them from class. Instead of having the child sit and do nothing, you or an administrator can offer them paper and pencil and give them a chance to work out what they’re feeling. (This way they aren’t sitting bored, and yet it isn’t a reward.) For younger children, just having an administrator write their name in an official-looking book may worry them enough to stop the behavior.
- Styles differ, but when kids are excited or distressed, calmness and predictability from the teacher is needed —a structure the child can depend on when they’re out of control, a model they can try to emulate.
- Children will test your limits. Try to be consistent, avoid anger or rejection (anger can be seen as negative reinforcement for unacceptable behavior).
- Be appreciative of the child’s struggles. It’s twice as difficult for a child with ADHD. Show that you respect his efforts and appreciate them. NEVER ridicule.
- Treat children as individuals, not as a typical this or that. Become a detective. Discover what the child responds to and what works for her, vs. what’s upsetting.
- Have high expectations, but express them in a gentle way, so kids feel elevated, not pushed.
- Make sure the child understands your expectations. DON’T ASSUME. Ask the child to repeat back to you. Ask them again tomorrow and again next week.
- Make sure the child knows how to meet your expectations. DON’T ASSUME that a student who continually makes noise when he stands up is doing it to annoy you or attract attention. They just might not know how to stand without scraping the chair against the floor. Demonstrate, have the child practice, then praise.
- Help the child get started on a task. The child may be trying, but doesn’t know how to get going. It’s not a case of noncompliance. Instead of criticizing for falling behind, try to establish support and involvement – “What can we do to make it easier to get started? Shall I review the assignment?
- Focus on learning, not rules. Allow more time for these children to complete projects. Allow aids, if needed, such as tape recorders or laptop computers.
- Build on strengths, rather than contribute to a child’s frustrations by focusing on his or her weaknesses. Example: If a child has difficulty in writing, you might ask him to answer a question verbally, but not write the answer on the blackboard.
- Reinforce that the child is competing only against herself, NOT others.
- Eliminate or reduce the frequency of timed tests. Teach test-taking skills.
- Go for quality, rather than quantity of homework.
- Separate out creativity and neatness into different activities. Have the student write a story for creative development; have her rewrite it neatly afterwards. Let the child dictate an essay into a cassette, then type it afterwards.
- Use computer software to help the child with organization, outlining and visualization of written projects.
- Break down large tasks into small tasks. This helps avoid tantrums due to frustration, real or anticipated. It also helps the child absorb what you’re trying to teach. An example is to give several target times, each 3-15 minutes, within an assignment (ie, do 4 math problems, break, 4 more, break or 1 essay, break then another). This helps those with trouble starting and those who tend to fizzle in the middle and have difficulty with completion.
- Target realistically for completion of work. Following through with consequences, give specifics as to when work must be completed if not done in class (recess, after school). Set appropriate goals that the child can (not “should”) meet. Start easy. Success is the best motivator, for both you and the child. Acknowledge each success. Encourage.
- Set time limits. This is helpful for drifters, but also for impulsive students who then must take needed extra time to look over their initial work which may be sloppily done, rather than just rushing though it to get it out of the way. If an ADHD child is the first one done with a test (often the case), give it back to him and ask him to review his answers.
- Try to give appropriate projects for the time of day. A good time for projects requiring concentration is in the morning when kids are fresh… and for those kids on medication, the medicine is working. Around lunchtime, play or low-key, calming activities work best. Be aware that, depending upon the type of medicine and dosage, medicine does “wear off” and during this period of the day the child may experience the most difficulty. Don’t make demands when the kids are going to be weaker. Work from strength.
- Allow the child time to be alone or away from classroom activities. Sometimes an ADHD child needs quiet space to pull herself back together when the distractions become to much. If other children want to know why she can do things they can’t, explain that “everyone in class is special, and this is something she needs that’s different from what you might need.”
- Allow the child to move. Let him leave the classroom for a 5 minutes, or walk around the room in between assignments or parts of a project.
- Allow time to exercise (everyone could benefit from a few neck or shoulder rolls, not just the ADHD children).
- Watch out for fatigue. ADHD children are often tired in the classroom. Not from lack of sleep, but from the effort it takes just to focus in and concentrate. Physical activity is often needed for the child to stay mentally alert. Otherwise, the longer the time slot, the increased inefficiency and disorganization. You’ll see the child yawn and stretch. It’s not rest time. It’s time to move!
- Memory is often a problem with these kids. Teach them little tricks, like mnemonics.
- Use outlines. Teach outlining. Teach underlining.
- Find little strategies to help the child feel successful.
- Encourage reading aloud at home. Read aloud in class as much as possible. Use story-telling. Help the child build the skill of staying on one topic.
- Repeat, repeat, repeat.
- Teach, don’t lecture.
- Use non-verbal communication. Sometimes it’s necessary to show the child what you want physically, as verbal commands, and especially verbal reprimands, are frequently ineffective.
- Help the children to listen better. Encourage them to write notes to themselves when they have questions, so they can listen without the distraction of having a question on their mind.
- Frequently compliment the student for on-task behavior. (And remember to call parents about good things too). Positive reinforcement is essential to helping the child develop self-esteem. These kids live with so much failure, they need all the positive handling they can get.
- Give the child frequent feedback on his or her work. Be honest but positive in approach: “You did a great job writing clearly… Next time, let’s work on staying within the margins” Monitor progress frequently; point out even small improvements, like in the frequency or duration of eye contact. THESE KIDS WANT TO DO WELL, BUT DON’T THINK THEY CAN Feedback should help the child develop self-observing behavior and be able to critique that behavior.
- Consider a daily progress report Have a brief exchange at the end of class in private.
- Give responsibility back to the child, when possible (ie, watering plants in the classroom, getting changed in gym on time).
- Involve the child. She needs to feel connected to you, her work, her classmates. Kids are often very intuitive and can tell you how they learn best, if you ask them. They are often too embarrassed to volunteer this information. And they certainly won’t volunteer when other kids are around.
- Involve the child in self-motivating behavior. Consider a point system, with rewards (predetermined) for desirable behavior. Motivational programs, using materials of high interest to the child, are very successful. They help the child stay focused on a goal, filtering that goal (acceptable behavior) out from others. Younger children might benefit from a posted award, such as stars or checkmarks on a corner of the blackboard for good behavior, being a good friend, etc.
- Encourage and reward responsible behavior with simple things, like letting the child be first on line, sending home a Responsible Behavior Certificate (or maybe a graded GOOD WORK to WOW, TERRIFIC), giving the child performing responsibility, like passing out papers or cleaning the blackboard. Note: You may want to include all children in this process, perhaps giving slips of paper to any child who does well (so as not to ignore the generally well behaved child either) and have a drawing at the end of the week for a “prize.”
- When offering a reward for certain behavior, set the reward in advance, so the child can strive towards it. Make it something age appropriate and desirable. It can be an object (a colorful pen for younger children, a low-cost CD or book for older kids. If it’s an object, you may want to have it on display. Smaller rewards along the way may be more successful in motivating a student than promising a big reward for completing a very big job. (One goal at a time…)
- When determining penalties for misbehavior, be careful. One school I know of would send the child home. One kid loved this and that was positive enforcement for misbehavior!
- Avoid giving rewards solely for academic performance —keep this non-competitive or the ADHD child will give up in frustration. Many ADHD children are perfectionists, and knowing they can’t be best, they’d rather not try at all. You can reward for getting homework done on time, reading the book, etc., so long as the reward is for effort, not expertise.
- In certain cases consider school to home charts, or even a combination homework/notebook (ADHD kids are notorious for losing things, including homework assignments). Charts should track behavior and school performance and be tied to predetermined and mutually agreed upon (by student, teacher and parent) behavior and consequence. The consequence, good or bad, should be administered at school, as that is immediate and related. Examples are a chance to be the class leader, messenger or whatever would give the child a sense of accomplishment and pride (motivation). If the child doesn’t do well, consequences may result in a loss of recess time, a particular play item (for younger children), etc.
Note: An older child may feel embarrassed showing pride in an accomplishment or reward. Don’t let that stop you!
- Keep the child stimulated by using challenging and interesting learning materials on level with the child’s learning ability, and switch approach when they begin to lose interest.
- Modulate your voice. Change tone, speed—even whisper. This captures the child’s attention, preventing your voice from being just more background noise.
- Make a game out of things. Motivation improves ADHD. Excitement about a subject changes the chemistry of the brain. That’s one reason a child who can’t seem to concentrate in class for more than five minutes can spend an hour constructing with Legos or building a model airplane.
- Be playful and have fun yourself! Kids hate being bored. Especially when so much of their “treatment” involves structure, schedules and predictability. They truly enjoy a bit of “silliness.”
- Early warning signs appear before the behavior goes. A child who is about to lose it will clue you in, if you’re a careful observer. It’s so much easier to stop unwanted behavior before it becomes full-blown. Have the child take a break to recharge. Separate him from the other kids for a little while by giving him a special task. Bring her back into the group dynamics by capturing her attention. Establish a private signal from the teacher to the child, to be used when the child is “tuning out” or acting impulsively. Perhaps it’s a hand signal, or a hand on the shoulder (acceptable physical contact sometimes calms the child, especially the younger child).
- Announce what you are going to say before you say it. Say it. Then repeat what you have said. After that, have the child repeat back what you’ve said.
- Don’t give the child too many choices. You’re the authority.
- Plan ahead. Anticipate problems (times when the medication wears off, unstructured activities, those times when you have no patience left, etc.) Have special resources available to see you through.
- Keep unfocused transition periods short, and monitor the ADHD child. Always explain the next activity in advance.
- Prepare for unstructured time. Warn them, help them think about what to do with the time and plan ahead.
- Encourage group participation. Separate clusters that feed on the negative aspects (ie, impulsivity).
- Work with the child to turn bossiness into leadership.
- Help them to understand social clues.
- Encourage a “study buddy” in each subject, with phone number.
- Meet with parents often. Avoid the pattern of just meeting around problems or crises. View the parent as a partner in educating the child. Try not to scare or depress parents; they’ve been through a lot. Stress the positive and what can be accomplished. Do not whitewash negative issues that should be brought to their attention.
- Cooperate with the child’s doctors, especially necessary in determining medicine dosage when that’s an issue. NEVER discuss the child’s medicine in front of the other children.
- Be on the lookout for sparkling moments. Highlight those times when the talents and gifts surface. Too often they’re blocked. This children are far more talented and gifted than they often seem.
- KEEP IT POSITIVE. Praise, stroke, approve, encourage, nourish. Focus on what you want the child to do, not just on what you want the child to STOP.
- Keep it honest. Kids know when we’re not being honest; praise with respect to actual accomplishment (however minor).
- Stick to it—your commitment will inspire the child.
- Remember, the kids are good kids. Children with ADHD don’t want to be disruptive or disliked by the other children. They need you to like them and understand they don’t mean to always behave the way they do. Help them to feel wonderful about attending and being part of the group, so they’ll want to do more. Motivation and respect work beautifully.
Add your own ideas here, and share them with a colleague:
Harold Meyer and Susan Lasky are both Board Certified and Senior Certified ADHD Coaches.
To contact the authors: firstname.lastname@example.org
ADD and ADHD are used interchangeably for Attention-Deficit/Hyperactivity Disorder.
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