Russell A. Barkley, Ph.D. • 8/20/2018 • Be the First to Comment
ADHD is far more than just a problem with attention, hyperactivity, or impulsiveness. It is a disorder of the brain’s executive system – a system essential for effective functioning in school and in most other important domains of life. ADHD disrupts the normal development of the brain’s executive functions and impacts self-regulation. Over 90 percent of children and teens with ADHD will experience classroom behavioral and emotional problems, peer relationship problems in the school, low academic achievement, or various adverse consequences associated with these difficulties.
Here are 10 specific rules to managing children and teens with ADHD that can be applied in school, to help teachers and clinicians increase the success of children and teens with ADHD.
Stating directions clearly, having the child repeat them out loud, having the child utter them softly to themselves while following through on the instruction, and displaying sets of rules or rule-prompts (e.g., stop signs, big eyes, big ears for “stop, look, and listen” reminders) prominently throughout the classroom are essential to proper management of ADHD children. Relying on the child’s recollection of the rules as well as upon purely verbal reminders is often ineffective.
Children with ADHD are less capable of using their sense of time to manage their current behavior and get work done in time, over time, and on time. When short time intervals of an hour or less are required to do work, then represent that time period using a clock, kitchen timer, counting device or other external means to show the child how much time they have and how quickly it is passing. For longer time periods, break the work down into shorter periods with smaller work quotas and allow the child to take frequent breaks between these shorter work periods.
Delays in consequences greatly degrade their efficacy for children with ADHD. The timing and strategic application of consequences with children with ADHD must be more systematic and are far more crucial to their management than in children without ADHD. This is not just true for rewards, but is especially so for punishment, which can be kept mild and still effective by delivering it as quickly upon the misbehavior as possible. Swift, not harsh, justice is the essence of effective punishment.
Behavioral tracking, or the ongoing adherence to rules after the rule has been stated and compliance initiated, appears to be problematic for children with ADHD. Frequent feedback or consequences for rule adherence seem helpful in maintaining appropriate degrees of tracking to rules over time.
The relative insensitivity of children with ADHD to response consequences dictates that those chosen for inclusion in a behavior management program must have sufficient reinforcement value or magnitude to motivate children with ADHD to perform the desired behaviors. Suffice it to say, then, that mere occasional praise or reprimands are simply not enough to effectively manage children with ADHD.
This means that punishment must remain within a relative balance with rewards or it is unlikely to succeed. It is therefore imperative that powerful reinforcement programs be established first and instituted over 1–2 weeks before implementing punishment in order for the punishment, sparingly used, to be maximally effective.
Often children with ADHD will not improve with the use of response cost or time-out if the availability of reinforcement is low in the classroom and hence removal from it is unlikely to be punitive. “Positives before negatives” is the order of the day with children with ADHD. When punishment fails, this is the first area that clinicians, consultations, or educators should explore for problems before instituting higher magnitude or more frequent punishment programs.
This means that even though a particular reinforcer seems to be effective for the moment in motivating child compliance, it is likely that it will lose its reinforcement value more rapidly than normal. Reward menus in classes, such as those used to back up token systems, must therefore be changed periodically, say every 2–3 weeks, to maintain the power or efficacy of the program in motivating appropriate child behavior. Failure to do so is likely to result in the loss of power of the reward program and the premature abandonment of token technologies based on the false assumption that they simply will not work any longer.
Token systems can be maintained over an entire school year with minimal loss of power in the program provided that the reinforcers are changed frequently to accommodate to this problem of habituation. Such rewards can be returned later to the program once they have been set aside for a while, often with the result that their reinforcement value appears to have been improved by their absence or unavailability.
This means that teachers must be more mindful of planning ahead in managing children with this disorder, particularly during phases of transition across activities or classes, to ensure that the children are cognizant of the shift in rules (and consequences) that is about to occur. It is useful for teachers to take a moment to prompt a child to recall the rules of conduct in the upcoming situation, repeat them orally, and recall what the rewards and punishments will be in the impending situation before entering that activity or situation.
Think aloud, think ahead is the important message to educators here. By themselves, such cognitive self-instructions are unlikely to be of lasting benefit, but when combined with contingency management procedures they can be of considerable aid to the classroom management of ADHD children.
The weaknesses in executive functioning associated with ADHD result in a child whose behavior is less regulated by internal information (mental representations) and less monitored via self-awareness than is the case with children without ADHD.
Addressing such weaknesses requires that the child with ADHD be provided with more external cues about performance demands at key “points of performance” in the school, be monitored more closely by teachers, and be provided with consequences more often across the school day for behavioral control and goal attainment.
One common scenario is that a student responds initially to a well-tailored program, but then over time, the response deteriorates; in other cases, a behavioral program may fail to modify the behavior at all. These outcomes do not mean behavioral programs do not work. Instead, such difficulties signal that the program needs to be modified. It is likely that one of a number of common problems (e.g., rewards lose their value, programs are not implemented consistently, or the program is not based on a functional analysis of the factors related to the problem behavior) occurred.
For more evidence-based methods, read Managing ADHD in school by Russell Barkley, Ph.D. In the book, Dr. Barkley, internationally respected expert on ADHD, draws on his 40 years of clinical work with thousands of students, teachers and schools to create a definitive resource for the most effective methods in overcoming impairments for children and teens with ADHD.