By Scott Ryan, licensed marriage and family therapist at CHOC’s Intensive Outpatient Program
Children with attention-deficit/hyperactivity disorder (ADHD) have more challenges in achieving success at school. The core symptoms of ADHD, such as difficulty paying attention, increased impulsivity and avoidance of tasks that require sustained attention interfere with learning and performance.
As a caregiver of a child with ADHD, it can be difficult to support your child in an effective manner when they may not appear to be motivated or are easily distracted. With an understanding of your child’s deficits, you can more effectively use strategies that will support them from elementary school to college.
Here are some statistics about the impact of ADHD on a child’s educational performance:
- On average, students with ADHD have GPAs that are 25% lower than non-ADHD children.
- 32.2% of students with the combined type of ADHD drop out of high school compared to 15% of teens with no psychiatric disorder.
- According to a 2013 study, 50% of youth with ADHD attend vocational or junior colleges vs. 18% of non-ADHD children.
- Children who are treated for ADHD are at decreased risk of lower GPAs, lower standardized test scores and lower risk of grade retention.
What are some of the features of ADHD that get in the way of my child’s school success?
When most people think of someone with ADHD, they consider that the person might be hyperactive, fidgety, or maybe spacy and have trouble paying attention. Superficially that is accurate, however, there are many other facets to ADHD which make succeeding in school challenging.
Children with ADHD may have poor executive functioning skills that may result in:
- Reduced self-awareness. Kids may be less likely to understand the impact of their actions on others around them.
- More limited working memory. Imagine that each of us has a large fruit bowl that can contain four oranges (oranges represent ongoing thoughts) at one time that help us decide what needs to be done. Now imagine how much harder it would be if your fruit bowl was much smaller and could contain only two oranges. If someone gives you an additional orange (a direction, a task or a distracting comment) then one of the other oranges falls out of the bowl, making it harder to follow instructions or get things done.
- Less emotional control. Kids with ADHD may be more likely to feel and act on emotions with less time to pause and reflect before making a decision.
- Decreased self-motivation. A child with ADHD does not attend to rewards and consequences in the same way as a non-ADHD child. The sense of reward is diminished because the link is not as robust, so activities that require sustained attention might be both more punishing (it takes more effort) and less rewarding (the rewards don’t increase motivation as much as non-ADHD child).
- Poor planning. Children with ADHD are less likely to link current actions with future outcomes, as they don’t readily see the benefit of sacrificing current rewards for future rewards, they typically are not good at planning for the future. In terms of schoolwork, this might mean increased procrastination, underestimation of the time needed to complete work as well as difficulty breaking large assignments into more achievable steps.
Additionally, children with ADHD may experience the following challenges at school:
- Forgetting assignments, losing things needed to complete work or forgetting to turn in completed work.
- Having an impaired sense of time. ADHD children often are less able to accurately gauge the passing of time.
- Have difficulty switching from one task to another.
- Be easily distracted by things going around them or simply the thoughts in their head.
- May have the desire or need for interaction or feedback that is not typically permitted in the school classroom, such as frequent individual participation or physical activity.
- A low frustration tolerance. Related to emotional regulation, ADHD children may have a short fuse, give up more easily and want to quit trying.
This is not a complete list and one can easily see how a child with ADHD is not just hyperactive or inattentive but struggles with a variety of factors that interfere with school success.
What can I do as a caregiver to help my child with ADHD?
Work with your school
- Meet with your child’s teacher early in the school year and describe your child’s challenges. Adopt a cooperative stance; you are on the same team. The teacher likely wants what is best for your child and has the experience and understanding to support them. Describe your child in specific terms, what exactly they have difficulty with and what they respond positively to. Do they need to be seated toward the front of the class? Can your child use fidget items in the classroom?
- Ask for a student study team in writing (schools will have their own name for this meeting) if your child needs additional support in the classroom setting. Once it is established that your child does have additional needs, then the next steps might be to call for either a 504 plan or (Individualized Education Plan) IEP. Although professionals may often recommend demanding an IEP, California Education Code places 504 plans and IEPs on equal footing, meaning that your child will receive accommodations that will support their education regardless if they qualified for an IEP or a 504 plan. The benefit of having any of these plans is that it will follow your child to the next grade level or another school, meaning that in principle, any teacher or school will need to follow the established plan to support your child.
- Check in with your child’s teacher regularly to get feedback about their performance, and then you can problem solve with them before it is too late to make changes.
Create a routine
Setting expectations for your child with ADHD can decrease the potential for arguments and frustration after school and teach your child valuable organization skills that will support them throughout the school.
- Arrange for a family meeting with your child and establish a workable routine. Avoid identifying all the problematic study behaviors you may have observed the previous year, rather focus on the need/importance for having dedicated blocks of time to take care of their responsibilities.
- Teach your child to use a daily planner. Many schools require their use, so your job as a caregiver might be to emphasize its use by asking to see it every day, having your child write-in other time constraints (sports, planned activities, etc.) to promote its use.
- Offer your child several options for time and place for completing schoolwork. Traditionally there are three time slots that work best: right after school, after a 30-minute break from school, or before dinner. Have them choose one time slot to start and commit to it. Ideally where they do the homework is a place that is quiet and free of distractions, so work with your child to establish the permitted places to do the work.
- Engage your child in a discussion about the order in which they prioritize their tasks. Don’t tell them what to do, have them consider if it is better to start with easy or hard work, math, or English, etc. You want to teach them how to prioritize tasks so when they are in high school or college, they have the necessary organizational skills to be successful. On the other hand, they initially may need support figuring-out what works best for them (when they complete tasks, the order they do things, etc.) so providing gentle feedback will be helpful, such as “I noticed you are more alert earlier in the afternoon, so maybe that it is a better time to do….”.
- Help your child to break down longer/larger activities into smaller chunks. Help your child list the order of these chunks and complete one chunk rather than avoid starting the big project because it feels overwhelming.
- Put the routine in writing or picture/calendar format. This will serve as a reminder of what they have agreed to and support their orientation toward the time.
Establish a reward system
Children with ADHD are typically less responsive to rewards and have greater difficulty delaying gratification. Whereas a child who does not exhibit ADHD symptoms may be motivated to complete tasks simply to hear caregiver’s praise, a child with ADHD may need bigger and more frequent rewards to overcome their executive functioning deficits. Due to the child’s difficulty forecasting future results, they are more likely to go toward the more immediately gratifying tasks (playing, watching TV) rather than choose a task that may or may not be naturally gratifying. Here are some tips:
- Increase how often you provide praise. Try to give positive feedback when your child remains on task, remains seated, and is attending to their work. Catch them being good and let them know you notice. Many, not all, children with ADHD will feel reinforced by receiving praise; they just need it more frequently! If praise is not sufficient for your child, then it is time to incentivize their schoolwork.
- Create achievable goals. If they are completing homework only one day a week, then completing homework three days a week might be realistic to start, even if your goal is for them to complete it entirely. Work with them to create a reward menu that is both meaningful to them (will motivate them to do the work) and reasonable to you (buying a $40 video game every week may be hard to sustain in the long run).
- Set-up both immediate rewards and long-term rewards. It may be possible that your child will work for praise daily and can earn a bigger reward at the end of the week. Make sure that the big reward is defined in advance and that it is clear to both of you that if they do this, they will get that. And always follow through! If they earned the reward, you give them the reward every time. If they engage in an unwanted behavior then you might give them a consequence, but do not take away their earned reward, that will only serve to weaken the link between their effort and rewards.
- Provide frequent breaks. Frequently children with ADHD are more hyperactive, need more activity in general and may require more effort to sustain attention, so they need breaks from their work. The trick is to make the breaks long enough that they feel refreshed though not so long that they become distracted by other activities. Breaks from three to 10 minutes are recommended.
- Incorporate downtime activities or physical activities into their schedule to break up the amount of time dedicated to non-preferred tasks (i.e.: doing homework). Physical activities are beneficial to all children, though especially children with ADHD who then experience enhanced focus after exercise.
Help with transitions to different tasks
Shifting from one task to another can be especially difficult for a child with ADHD due to their executive functioning deficits. They may not have been closely attending to the directions, so they may not be alerted to the fact that they have a new direction. At times, some children with ADHD may exhibit hyper-focus, and be very focused on their task to the exclusion of the environment, or in other words, they didn’t hear you or the teacher because they were so engaged in what they were doing.
A child with ADHD may also take longer to shift focus to a new task on an emotional basis, meaning that they haven’t oriented to the reasons they need to shift their focus, what are the rewards/consequences involved, how much time do they need to complete the task, etc. Here are some tips to improve their transitions to new tasks.
- Provide your child with a prompt in advance of a transition, such as in 5 minutes we will start doing…”.
- Understand that transitioning from a pleasant task to a harder task may take more prompts and reinforcement.
- Limit the time between tasks as a child might become easily distracted or consider brief, time-limited breaks.
- Use checklists or other visual aids to support the transition between tasks. This will orient the child to the structure while also providing visual cues that they are accomplishing things and that there is an end to the tasks.
- Using timers or digital reminders might be helpful as well as using music to signify transitions to soothe a child’s emotions.
- Keep instructions short and to the point. A general rule is 10 words or less. Avoid over talking at them; they are likely to either lose attention or become confused with additional instructions.
- Check for understanding. Ask them to repeat what the instructions are to confirm that they know what they are supposed to do.
Children with ADHD are sometimes considered as “difficult to parent” children. This makes sense as they may not follow directions as quickly or easily as children who do not present with ADHD symptoms, they might need more frequent rewards, they may be impulsive and need lots of redirection. The recommendations above will likely serve you well in parenting a child with ADHD, and remember that despite these tips, it can be difficult to manage your child’s ADHD symptoms by yourself. There are many online support groups that offer current information about ADHD and tips about parenting your child with ADHD. https://chadd.org/ and https://www.additudemag.com/ are two of the most popular ones.
Additionally, it is often helpful to have a mental health provider who specializes in the management of ADHD symptoms on your team to recommend behavioral support strategies, such as LMFTs, MSWs and psychologists. These experts can help you set up effective interventions and create realistic expectations for your child’s performance. Finally, although not the focus of this article, medication treatment through your child’s pediatrician or a child psychiatrist is often beneficial in tandem with behavioral interventions.
Children with ADHD are intelligent, but their ADHD symptoms may make school challenging for them
Children with ADHD are as intelligent as other children, yet they may struggle in school due to the symptoms of ADHD. Poor executive functioning causes children with ADHD to be less organized, poorer at planning ahead, have less perseverance, not respond as well to rewards, be less motivated and have a more limited working memory. These school performance barriers can be overcome by following a routine, increasing rewards, and providing more frequent breaks. Parents can invite teachers to collaborate with them to develop routines and strategies that will support their child in the classroom and request a higher level of intervention represented by a 504 plan or an individualized education program (IEP). Finally, it is often helpful to have a neutral party that knows how to work with children with ADHD to support your establishment of routines and rewards, typically mental health therapists.
I hope this article was helpful to you! While children with ADHD can present with parenting challenges, they can also be a bundle of fun! Talkative, curious, engaged, willing, and wanting to do things and generally full of life. How exciting! Helping your child with ADHD succeed in school will increase their sense of mastery and competence and the support you provide doesn’t have to be a hair-pulling experience for you. Hopefully, these strategies will make both of you feel successful as they positively impact your child’s academic performance.
For more health and wellness resources from the pediatric experts at CHOC, sign up for the Kids Health newsletter.
How to prevent and treat respiratory illnesses this season
Unfortunately, many kids get infected with respiratory illnesses in the fall and winter seasons. CHOC experts highly encourage all eligible members of households to receive their annual flu shots. Other preventative measures like good hygiene and staying home when sick can help protect families from illness. The following articles and guides provide more information.
The mental health team at CHOC curated the following resources on mental health topics common to kids and teens, such as depression, anxiety, suicide prevention and more.