What Do We Want From Children With ADHD: Keeping A Moving Target In Mind

Dr. Sam Goldstein

A number of years ago I completed an informal survey with elementary school teachers. I asked a simple, open-ended question. What do you want or need from children with ADHD in your classroom? I left it to each teacher to individually interpret the meaning of the question in considering his or her response. I asked this question to identify not only the mindset of elementary school teachers who work with children experiencing ADHD, but the beliefs, attitudes and ideas these teachers held as to what would lead to improved performance, behavior and functioning in the classroom. Not surprisingly, I received a diversity of responses. Responses ranged from teachers commenting that they needed these children to take their medication each day on time, to commenting on general issues of success in the classroom, and focusing on specific competencies related to behavior and work completion. Though there were a number of common themes – observations related to work completion, general behavior, social interaction and rule compliance, I attempted to filter relevant responses to identify the most basic issue for teachers who had children with ADHD in their classrooms. After grouping and re-grouping teachers? comments, I decided that teachers wanted three things from children with ADHD. They wanted these children to START, STOP and FINISH in concert with other children in the classroom. They wanted the child with ADHD to begin a task when everyone else began and to continue until finished. They were not as concerned about the quality of the performance so long as the performance reflected a basic level of competence. This theme of START, STOP, FINISH appeared to emerge in other areas of school as well, including non-academic activities. I have used this basic foundational model – START, STOP, FINISH over the past fifteen years in my workshops with teachers to provide a basic foundation for their mindsets when working in the classroom with children who experience ADHD.

At a recent conference, a parent inquired whether there is a mantra or underlying key point to consider before beginning to discuss specific goals for children with ADHD. When I answered START, STOP, FINISH this parent commented that this particular point focused almost exclusively on outcome. This clever observation made me think about whether there was an additional point or mantra I needed to consider to help parents and professionals understand and work successfully with children experiencing ADHD. I began listening carefully to parents? comments and observations at workshops, as well as in my clinical practice. As a neuropsychologist, I evaluate three to four children each week and supervise the work of one or two post doctoral residents as well. We evaluate over 500 children each year at our clinic. These children present not just with ADHD but often with a complex set of genetic and traumatic problems. For example, I evaluate a large number of children suffering from traumatic brain injury. I began gathering parents? observations and comments. As I did with the educators? data many years before, I tried to group these, searching for common themes. Just when I thought I would be unsuccessful, I came upon the proverbial pot of gold at the end of the rainbow. There was an underlying point, mantra or foundational goal which all of us attempt to instill in children with ADHD. There is a core agenda in all of the work we do with these children. Whether at home, in the classroom or on the playground, our intention is to help children with ADHD behave more CONSISTENTLY, PREDICTABLY and INDEPENDENTLY in all of their activities. CONSISTENT, PREDICTABLE, INDEPENDENT. One might consider these the calling cards of functional human beings, children or adults. Consider the significant adversity the symptoms of ADHD pose and consequent impairment in all arenas of life and you too will quickly realize that the core impairment for children and, for that matter, adults with ADHD is their inability to behave consistently and predictably in a functional manner.

Teachers, parents, coaches or, for that matter, any adult interacting with a child experiencing ADHD in which there is a specific behavior to be learned or goal to be reached, quickly become frustrated by their lack of ability to predict the child?s behavior. Children with ADHD are inconsistent. They know what to do, but do not consistently, predictably, or for that matter, independently do what they know. As you consider treatment, family or educational plans for a child with ADHD, I urge you to think about this issue carefully. By starting with a basic underlying goal of helping these children behave consistently, predictably and independently, everyone starts on the same page. This goal acknowledges that in many situations we do not need to teach these children what to do, but rather we must engineer the environment and provide experiences and consequences to assist them in behaving consistently; to allow them to call upon and utilize the skills and resources they may possess predictably; and finally to help them negotiate every day life at a maturity level leading to functional, independent behavior by the adolescent years.

I believe this basic goal to help children with ADHD become CONSISTENT, PREDICTABLE and INDEPENDENT in their daily behavior is a critical and consistent goal regardless of whether we are discussing medication treatment, behavior management, educational intervention or social skills training. In all of these areas, once children with ADHD achieve understanding and competence, we must then focus upon helping them consistently, predictably and independently do what they know.

Twelve years ago in our book, Why Won?t My Child Pay Attention?, Dr. Michael Goldstein and I concluded the volume with a ?Checklist for Success.? I believe it is worth re-visiting this checklist, to incorporate an understanding of the basic issues related to consistency, predictability and independence in everything we do to help children with ADHD.

  • Educate yourself. The more you understand your child and yourself, the more success you will have and the more functional your child will become. Knowledge is your most effective intervention. Incorporate the goal of consistency into everything you do. Ask yourself if your behavior in any situation or problem with your child will over time facilitate consistent, predictable and independent functioning.
  • Effective management strategies at home. Even when taking medication for ADHD, children with ADHD still struggle with a variety of self-regulatory problems. By creating a consistent set of discipline and behavior management strategies, those to deal with the incompetence of ADHD and those to deal with the non-compliant patterns of behavior that at times all children develop, you will be best prepared to help your child.
  • Parental unity. You, as well as all adults who interact with your child on a regular basis, must be on the same page of the game plan. You all must apply consequences fairly and routinely. Opportunities to improve functional behavior must be provided in all settings.
  • Positive parent-child relationships. Seek out and participate in activities that you both enjoy on a daily basis. Don?t give up your relationship with your child. Instead, create what may be an effective behavior management program with a human touch.
  • Family stability. Children with ADHD are often a barometer for family problems. Deal with all family problems as they occur and try to avoid crises.
  • Good friends. Social success is a very positive resilience factor for all children, even those with ADHD. Finding good friends may be harder to achieve, and may require some support and engineering on your part.
  • School success. Be patient, persistent and proud when representing your child?s needs at school. Remember the school is a service organization. It is the school?s responsibility to provide your child with an appropriate education.
  • Do no ignore problems such as learning disability or mood irregularity. These problems are more likely to progress to more serious psychiatric impairments in children with ADHD.
  • Medication. Medication treatment for ADHD is by far the most effective intervention for symptom reduction.
  • Keep a balanced view. We now recognize that a treatment plan must incorporate equal amounts of effort focused on reducing symptoms and improving daily behavior and instilling resilient qualities in your child. Dr. Robert Brooks and I have written extensively about these qualities on our web pages and in our books.