ADD/ADHD

ADD/ADHD in children becomes ADD/ADHD in adults as we know that people do not grow out of this condition.  I have been treating ADD/ADHD in both adults and children for over 15 years.  I work closely with Parents, Teachers , Physicians or other providers to help create a supportive structure for children and adolescents to learn to be more effective in managing their performance.  Adults also benefit from skills based training and Cognitive Behavioral Therapy to learn more effective ways to both improve performance and cope with the emotional stress of being an ADD/ADHD person.   The article below was originally published by CHADD and addresses typical aspects of ADD in both children and adults.  For more on Adult ADD please see the link in the links section to the lecture by Dr. Barkley.

Five years ago, most parents and teachers of students with ADHD didn’t have a clue that a child’s academic success was contingent upon strong executive skills. However, today’s savvy parents and educators realize that deficits in critical cognitive skills known as executive functions are slower to mature in many children with ADHD. Researchers vary widely in reports about the frequency of these deficits in students with ADHD: some report 30-50 percent of children and others, including Drs. Barkley and Brown, believe that by definition, 100% of people with ADHD also experience these deficits. Practically speaking, problems with the “brain’s CEO” contribute to several academic problems: disorganization, difficulty getting started and finishing work, forgetting homework, plus difficulty memorizing facts, writing essays or reports, working complex math problems, completing long-term projects, being on time, controlling emotions, and planning for the future.

Before we understood the role of executive functions, parents and teachers were often baffled when students, even those who were intellectually gifted, teetered on the brink of school failure. Unfortunately, to the uninformed, deficits in executive skills often appeared to be a simple matter of “laziness or lack of motivation”. When a student had trouble getting started and finishing an essay or math work, it was easy to assume that the student chose not to do the task.

According to Dr. Russell Barkley, a leading researcher, students with ADHD experience roughly a thirty percent developmental delay in organizational and social skills. Practically speaking, our children appear less mature and responsible than their peers. For example, a twelve year old’s executive skills are often more like those of an eight-year-old. To ensure academic success for these students, parents and teachers must provide more supervision and monitoring than is normally expected for this age group. I like to refer to this as providing “developmentally appropriate supervision.”

Although scientists have not yet agreed on the exact elements of executive function, two ADHD researchers, Dr. Barkley and Dr. Tom Brown, have given us insightful working descriptions. Dr. Barkley describes executive function as those “actions we perform to ourselves and direct at ourselves so as to accomplish self-control, goal-directed behavior, and the maximization of future outcomes.”  Through use of a metaphor, Dr. Brown gives us a helpful visual image by comparing executive function to the conductor’s role in an orchestra. The conductor organizes various instruments to begin playing singularly or in combination, integrates the music by bringing in and fading certain actions, and controls the pace and intensity of the music.

Although our son Alex successfully struggled through the early school years, he finally hit the proverbial “ADHD brick wall” in middle school. Belatedly I realized that the demands for executive skills increase exponentially in middle school (working independently, organizing oneself, getting started, remembering multiple assignments). As a former teacher and school psychologist, I’m also embarrassed to say I failed for many years to recognize that a high IQ score alone was not enough to make good grades. It wasn’t until Dr. Barkley identified the central role executive function plays in school success, that I finally understood why school was so difficult for my son.  Teachers would say, “Alex is very bright; he could make better grades if he would just try harder.” In truth, our children often do try harder, but even then, cannot make good grades without proper treatment and academic supports.

 

Components of Executive Function

Based upon material from Barkley and Brown, I have outlined five general components of executive function that impact school performance:

1.    Working memory and recall (holding facts in mind while manipulating information; accessing facts stored in long-term memory.)

2.    Activation, arousal, and effort (getting started; paying attention; finishing work)

3.    Controlling emotions (ability to tolerate frustration; thinking before acting or speaking)

4.   Internalizing language (using “self-talk” to control one’s behavior and direct future actions)

5.   Taking an issue apart, analyzing the pieces, reconstituting and organizing it

into new ideas (complex problem solving).

 

Let’s take a more in-depth look at just one element of executive functions – deficits in working memory and recall—and their impact on school work.

Poor Working Memory and Recall

Deficits in working memory and recall negatively affect these students in several areas:

1. The “here and now”: Our children have limited working memory capacity that often impacts their behavior at home and in the classroom:

-       remembering and following instructions.

-       memorizing math facts, spelling words, and dates.

-       performing mental computation such as math in one’s head.

-       completing complex math problems (algebra)

-       remembering one part of an assignment while working on another segment.

-       paraphrasing or summarizing.

-       organizing and writing essays.

2. Sense of past events: Because our students have difficulty recalling the past, they have limited hindsight; in other words, they don’t learn easily from past behavior. This may help explain why our children often repeat misbehavior.

3. Sense of time: Many students with ADHD also have difficulty holding events in mind and  using their sense of time to prepare for upcoming events and the future. Consequently, they have difficulty judging the passage of time accurately. Practically speaking, they don’t accurately estimate how much time it will take to finish a task, thus they may not allow enough time to complete the work.

4. Sense of self-awareness: As a result of their diminished self-awareness, these students don’t easily examine or change their own behavior. Perhaps this explains why they often are unaware of behaviors that may alienate friends.

5. Sense of the future: Most students with a working memory deficit focus on the here and now and are less likely to talk about time or plan for the future. Thus, they have limited foresight; in other words, they have difficulty projecting lessons learned in the past, forward into the future. Not surprisingly, they have difficulty preparing for the future.

Common Academic Problems Linked to ADHD and Executive Function Deficits

Many students with ADHD have impaired working memory and some also have slow processing speed, which are critical elements of executive function.  Not surprisingly, these skills are critical for writing essays and working math problems.

A research study by Mayes and Calhoun has identified written expression as the most common learning problem among students with ADHD (65 percent). Consequently, writing essays, drafting book reports or answering questions on tests or homework is often very challenging. For example, when writing essays, students often have difficulty holding ideas in mind, acting upon and organizing the ideas, quickly retrieving grammar, spelling and punctuation rules from long-term memory, manipulating all this information, remembering ideas to write down, organizing the material in a logical sequence, and then reviewing and correcting errors.

Since learning is relatively easy for most of us, sometimes we forget just how complex seemingly simple tasks such as memorizing multiplication tables or working a math problem really are. For example, when a student works on a math problem, he must fluidly move back and forth between analytical skills and several levels of memory (working, short-term, and long-term memory).   With word problems, he must hold several numbers and questions in mind while he decides how to work a problem.  Next he must delve into long-term memory to find the correct math rule to use for the problem. Then he must hold important facts in mind while he applies the rules and shifts information back and forth between working and short-term memory to work the problem and determine the answer.

To further complicate matters, other serious conditions may co-occur with ADHD.  According to a landmark National Institute of Mental Health study on ADHD (known as the MTA), two-thirds of children with ADHD have at least one other coexisting problem, such as depression or anxiety. Accommodating students with complex cases of ADHD is critical! These children are at greater risk than their peers for a multitude of school problems, for example, failing a grade, skipping school, being suspended or expelled, and sometimes, dropping out of school and not going to college.

 

Favorite School Success Strategies

Over the years I have identified several teaching strategies and accommodations that work well for students with ADHD. So here are just a few of my favorite tips:

General Teaching Strategies

  • Make the learning process as concrete and visual as possible.

Written expression

o   Dictate information to a “scribe” or parents.

o   Use graphic organizers to provide visual prompts.

o   Use “post-it” notes to brainstorm essay ideas.

Math

o   Use a peer tutor.

o   Use paired learning (teacher explains problem, students make up their own examples, swap problems, and discuss answers).

(After barely passing high school and college algebra, my son made an A in calculus plus had a 100 average on tests when the professor used this strategy.)

Memory

o   Use mnemonics (memory tricks), such as acronyms or acrostics, e.g., HOMES to remember names of the Great Lakes.

o   Use “visual posting” of key information on strips of poster board.

  • Modify teaching methods.

o   Use an overhead projector to demonstrate how to write an essay. (Parents may simply write on paper or a computer to model this skill.)

o   Use color to highlight important information.

o   Use graphic organizers to help students organize their thoughts.

  • Modify assignments – reduce written work.

o   Shorten assignments.

o   Check time spent on homework, and reduce it if appropriate (when total homework takes longer than roughly 10 minutes per grade as recommended in a PTA/NEA Policy, e.g. 7thgrader = 70 minutes).

o   Write answers only, not the questions (photocopy questions).

  • Modify testing and grading.

o   Give extended time on tests.

o   Divide long-term projects into segments with separate due dates and grades.

o   Average two grades on essays– one for content and one for grammar.

  • Modify level of support and supervision.

o   Appoint “row captains” to check to see that homework assignments are written down and later turned in to the teacher.

o   Increase the amount of supervision and monitoring for these students, if they are struggling.

  • Use technology.

o   Use a computer as often as possible.

o   Use software to help teach skills.

 

Office Locations

15 Altarinda Road, Suite 203, Orinda, CA 94563

1350A Solano Avenue, Suite 3, Albany, CA 94706
Phone/Fax for Orinda and Albany: (925) 215-5646

Email:howard@howardsattler.com