Huntington Learning Center helps expand your child's academic skills with individualized tutoring & test prep. It also connects you to the latest news, tips and academic resources. Find posts and update on ADHD.
In previous posts, I’ve talked about things parents can to do get reluctant teens to attend therapy sessions and what to look for when searching for a therapist. An additional consideration for parents of teens with ADHD is how involved they should be in their child’s treatment once their child is attending sessions with a qualified clinician.
When a younger child is receiving therapy for ADHD, there’s no question that parents should be highly involved in their treatment. In fact, all evidence-based treatments for ADHD require parents to learn skills and strategies to support their child at home. But when it comes to teenagers, being involved in treatment can feel like more of a gray area for parents. After all, your teenager isn’t a child anymore, and parents want to grant their teen a certain level of independence. Some parents also feel like it would be intrusive to be involved in their teenager’s therapy sessions. They want their teen to have a relationship with their therapist that represents a “safe space” where they don’t have to worry about what their parents think.
While parent involvement in therapy for teens with ADHD isn’t as black and white as it is for children with ADHD, in almost all cases, parents should still be moderately involved in their treatment – that is, not quite as involved as they would be if their teenager were still a child, but not as hands-off as they would be if their teen were already an adult. Why?
Treatment for teens with ADHD often includes strategies for creating additional structure and organization in their lives. This involves creating and sticking to routines that work at key times of the day, using tools for organizing and prioritizing their homework, strategies for organizing their possessions, and time management skills. Teens with ADHD are not typically capable of using these skills on their own – at least, not right away. They need help from their parents in order to practice these skills until they eventually become habits.
Therapists only see the teen once a week for about an hour. In order to make progress, teens need to practice their skills between sessions, and the therapist needs help from parents to hold the teen accountable.
Many parents of teens with ADHD are highly involved in their day-to-day lives, in an effort to help them compensate for their ADHD symptoms. Ideally, parents will be able to scale back their involvement over time as the teen improves their own skills and becomes more independent. Knowing when and how to pull back as a parent is hard. Part of a teen’s therapy involves coaching their parents on how to best support the teen as they grow and change.
While parents should be involved in their teen’s therapy, they don’t usually need to attend every session. It’s often important for the teen to have individual sessions with the therapist when they can discuss all the complicated and messy emotions and social situations that come up during adolescence. In general, it’s common for parents to either regularly join for a few minutes toward the end of a session, or to attend occasional scheduled parent-teen sessions that occur in place of the regularly scheduled teen-only sessions.
When it comes to concerns that the teen won’t fully open up to the therapist if they know that the therapist is also talking to their parents, more often than not, this isn’t much of a problem. Teens can have a great open and supportive relationship with their therapist even if their parents are involved in some of the sessions. Therapists who work with teens are adept at laying clear boundaries, letting the teen know that they won’t share anything with their parents without the teen’s permission (with a handful of exceptions, of course – like if they express intent to harm themselves or someone else), and as long as the therapist demonstrates that they will stick to these boundaries, then teens come to trust the therapist in return.
When it comes to finding a therapist who is a good fit for your teen, make sure to look for someone who connects with both you and your teenager. The results you see from therapy will so much greater when you are both involved.
When your teenager is struggling, you naturally want to do everything that you can to help them. For many teens with ADHD, that means working with a therapist as part of their treatment plan. But what can do you do as a parent if you know that your teen needs therapy, but they refuse to attend sessions? How can you get them the help they need if you can’t even get them into the therapist’s office in the first place?
It’s very common for teenagers with ADHD (and teenagers without ADHD for that matter) to be resistant to the idea of working with a therapist. There isn’t usually one single factor driving the resistance, and the underlying reasons vary from teen to teen, but there are usually some similar themes. For starters, some teens are generally opposed to anything that they perceive as being their parents’ idea. They want to be in control of their own decisions, and they certainly don’t want to do something just because their parents tell them it’s in their best interest. For teens with ADHD who have a history of Oppositional Defiant Disorder, this reason alone may be why they are refusing treatment. Other teens don’t want to meet with a therapist because they have misconceptions about what therapy is, or they view therapy as a sign that there is “something wrong with them.” While this line of reasoning may not be accurate, it can be hard for parents to convince their teen to change their point of view. Lastly, there are some teens who worry that the therapist won’t be able to help them and sessions will be a waste of time, and others who fear feeling uncomfortable in sessions if they are asked to discuss things they would rather avoid.
So, as a parent, what should you do? With any one of the scenarios above, how do you convince your teen to go to therapy? And if you succeed in getting them to see a therapist, how do you make sure that your teen will cooperate once they are in the session? There is no easy one-size-fits-all solution here, but there are a few strategies that may help.
Approach the situation from the teen’s point of view. When it comes to getting your teen to go to therapy sessions, talking to them about the reasons why you think they need treatment is not going to work. Instead, look at the situation from the teenager’s point of view. Think about the things that are most important to them, and which of those things may not be going very well right now. Maybe they can’t participate in extracurricular activities because of poor grades, are struggling with friendships, are worried that they won’t get into college, or are tired of arguing with their parents all the time. Whatever it is, talk to them about how therapy can help improve these aspects of their lives.
Engage a respected peer or adult. Often teenagers are simply not in a mental space where they are able or willing to hear what their parents are saying to them. No matter what their parents say, they refuse to listen. To really get through to your teen, they may need to hear about the benefits of therapy from a respected peer or adult in their life. Ideally, this person will have had experience with therapy themselves and can talk about their experience. Sometimes it just takes the right messenger to get a teenager to listen.
Provide incentives. If all else fails, consider providing incentives or rewards for your teen if they attend therapy sessions. Remember that the primary goal at this stage is to get your teen into treatment. If incentives, either in the form of privileges (e.g. a later curfew on the weekends) or tangible rewards (e.g. gift cards or money toward a big-ticket item that they would like to buy), do the trick, then it may be a short-term solution that ultimately gets them one step closer to accepting the help that they need.
When you succeed in getting your child to attend therapy sessions, try not to worry too much about how they behave once they are actually in the room. It can be frustrating to think that your teen may be “wasting” valuable time and money by not giving 100%, but as a parent, there really isn’t much you can do to control what your teen does during therapy sessions. Fortunately, good therapists who have experience with adolescents can form close bonds with even the most resistant teens. The best thing you can do as a parent is research therapists ahead of time and find one who seems like they will be a good fit for your teen. If, after a couple of months, the therapist and teen tell you that your teen isn’t participating in sessions, then it may be time to look for a new therapist. In the meantime, do what you can to get your teenager into the therapist’s office, and then let the therapist take the lead from there.
ADHD medication can be an important part of a comprehensive treatment plan for kids with ADHD. When a child or teen responds well to medication, the positive impact on almost every aspect of their life is profound. They do better in school, with friends, and at home, and their self-esteem often greatly improves. However, many parents are understandably reluctant to have their child take medication for ADHD. One of the biggest worries is that ADHD medication will lead to addiction down the line.
Fortunately, there’s been a great deal of research examining the effects of ADHD medication on future drug addiction. Numerous studies funded by the National Institute of Mental Health and the National Institute on Drug Abuse have found that ADHD treatment with stimulant medications does not lead to drug abuse during adolescence or adulthood. In fact, 11 studies showed either no increased risk or a decreased risk for substance use problems in individuals who were treated with stimulant medication. One study showed a slightly increased risk for later substance abuse only when ADHD medication was started earlier in childhood (although there are a number of additional factors that may have contributed to this finding beyond the use of ADHD medication).
While research suggests that taking medication to treat ADHD in childhood or adolescence may protect against substance use problems during the teen and adult years, some studies suggest that treatment response to the medication may also be an important factor. Specifically, the kids and teens who had the best medication response (meaning their ADHD symptoms were well managed by their ADHD medication) are the least likely to go on to develop substance abuse problems.
Overall, studies suggest that ADHD medication treatment may protect against later substance abuse – especially when a child or teen’s ADHD symptoms are well managed by their medication. This finding is extremely important because teens and adults with ADHD (when compared to teens and adults without ADHD) are at higher risk for substance abuse problems overall. While the exact reasons for this risk are unknown, there are several factors that probably contribute. Specifically, the impulsivity associated with ADHD likely puts individuals at increased risk, as does higher rates of a family history of substance abuse, and the possibility that teens and adults whose mental health symptoms aren’t well managed with medication or behavioral treatment are essentially self-medicating with alcohol, marijuana, or illicit drugs at teens or adults.
Effective treatment with ADHD medication is just one of the many routes parents can take to help protect their child from future substance use problems. Effective academic and social supports for kids with ADHD may buffer against future drug abuse, as can strong and supportive family relationships. So, if you are leery of having your child take ADHD medication, or if your child simply doesn’t respond to or tolerate ADHD medication, then it’s especially important that they receive extra behavioral supports and treatment to help minimize the impact of their ADHD symptoms on their current functioning and future development.
Helping kids with ADHD understand themselves and their ADHD symptoms isn’t easy. Many kids with ADHD have very little insight into their own behavior. They don’t realize that they’re daydreaming, acting impulsively, or moving around more than other kids. In fact, they often don’t notice that they’re doing anything out of the ordinary until they get called out on it by a parent, teacher, or classmate who is frustrated by their behavior. They may feel like they are different from other kids or start to believe that they are a “bad kid” who “can’t do anything right,” but they often struggle to understand why they feel this way. Age-appropriate books with characters who have ADHD symptoms can be a great resource when it comes to helping kids with ADHD understand their own experiences. These books can spark “aha” moments for kids and serve as excellent conversation starters for meaningful discussions between parents and kids.
Here are five books that I recommend for kids with ADHD who are newly diagnosed, or those who have known about their ADHD for a while but are struggling to understand their differences.
Marvin's Monster Diary: ADHD Attacks! (But I Rock It, Big Time) by Raun Melmed, Annette Sexton, and Jeff Harvey For 3rd, 4th, and 5th grade kids who love The Diary of a Wimpy Kid series, Marvin’s Monster Diary: ADHD Attacks is sure to be a hit! Marvin is a monster who is distractible, impulsive, and energetic. He’s constantly getting into trouble at home and at school. Overall, things don’t go well for Marvin until he learns some special tricks that ultimately help him keep his ADHD symptoms in check. For a child with ADHD, this book will help validate their experiences and emotions and will get them thinking about mindfulness strategies that they can use to help make their days better. It’s not likely that a child will read this book and suddenly start using the strategies on their own, so the author has included a parent guide so parents can help their kids use the strategies at home.
Get Ready for Jetty!: My Journal About ADHD and Me by Jeanne Kraus Elementary school girls with ADHD will relate to Jetty, a 4th grader who is newly diagnosed with ADHD. Written in journal form, this book takes kids through Jetty’s journey of struggling in school and with friends, getting tested and diagnosed with ADHD, and working with her teachers, parents, and doctor to feel better. This easy to read and engaging book will be embraced by even the most reluctant readers.
All Dogs Have ADHD by Kathy Hoopman All Dogs Have ADHD pairs photos of energetic, distractible, funny, and adorable dogs with easy to understand descriptions of ADHD traits. The book’s simple format is great for kids with ADHD who don’t usually enjoy reading. The humor and joy conveyed in the photos help highlight the positive side of ADHD, and kids who love dogs will enjoy seeing the similarities between themselves and their favorite pets.
Shelley the Hyperactive Turtle by Deborah Moss and Carol Schwartz For young kids with ADHD (around ages 4-6), Shelley the Hyperactive Turtle is a great resource. It can be extremely difficult to explain the concept of hyperactivity to very young kids. Kids with ADHD will see themselves in Shelley, and the book can start some great conversations between kids and parents. If a child is taking medication for ADHD, they’ll also relate to the part of the story where Shelley goes to the doctor and gets medicine for ADHD too.
Mrs. Gorski I Think I Have the Wiggle Fidgets (The Adventures of Everyday Geniuses) by Barbara Esham and Mike Gordon This book does a nice job of emphasizing the inattentive symptoms of ADHD – being easily distracted. having trouble focusing, and making mistakes – as well as some of the hyperactive and impulsive symptoms. The main character, David, has a hard time staying in his seat during class and is often getting in trouble for not paying attention or for making “careless” mistakes. Kids with ADHD will relate to the feelings of embarrassment and frustration that David feels when he can’t control his ADHD symptoms. They will also experience a sense of hope and determination when they see David triumph over his ADHD and find strategies that work for him.
In my previous post I discussed the reasons why so many kids with ADHD struggle to successfully transition from one activity to another throughout the day. The good news is that while transitions are much more difficult for kids with ADHD than kids without ADHD, with some targeted support and accommodations, transitioning between activities can become much easier.
Provide a 5-minute warning. 5 minutes (or more) before the end of an activity, let the child know that the transition will be happening soon. Make sure the child heard you by making eye contact before giving the warning and asking the child to verbally repeat the number of minutes that are left in the activity.
Break the transition down into small manageable steps. If the transition requires the child to complete more than 2 steps (e.g., put your materials in your desk, put your completed work in the bin on the teacher’s desk, get your backpack, and line up by the door), then give the child instructions that break the instructions down into just two steps at a time. For example, “Put your materials away and then put your completed work on my desk. Nice job! Now go get your backpack and line up at the door.” If the transition is one that happens routinely, then post the steps on the wall, create a checklist, or give the child the instructions 2 at a time until the steps become a habit.
The fewer steps a child needs to follow during a transition time, the more smoothly things will go. Think about your most difficult transition times and consider whether there are any steps that can be removed or completed ahead of time. For example, when it comes to transitioning from play time to homework time, making sure the child’s homework station is organized, well stocked with supplies, and has his or her backpack (and daily materials) sitting nearby can actually take care of many little steps that get in the way of getting started on homework.
Give instructions slowly. For kids with ADHD who process information more slowly, make sure you provide the instructions with enough time (about 10 seconds) in between for the child to start following through. Often instructions are given rapid-fire during transitions because everyone is in a hurry. But, this fast pace ultimately just slows things down when a child can’t process the information quickly enough to be able to follow through.
Allow extra time. Most kids with ADHD cannot transition between activities quickly, and when you try to rush them they only seem to move more slowly. Instead, allow extra time either by giving the child with ADHD a head start on the transition activities, or by building in an extra few minutes for everyone during the transition time. At home this may mean allowing an extra 5 or 10 minutes in the morning to transition from finishing breakfast to getting out the door, for example.
Stay calm. Kids with ADHD often struggle to manage their emotions during transitions – and so do their parents and teachers who worry about being late or feel frustrated because the child is not doing what they want them to do. When a child’s emotions are escalating, help the child calm down by staying calm yourself. Practice deep breathing and/or walk away and come back in a few minutes when you’re feeling more calm and clear headed. Rather than spending too much time during the transition talking to the child about why he or she is upset, instead focus on problem solving. Is the child overwhelmed? Help him or her complete one or two tasks to provide support as he or she gets started on the new activity. Is the child frustrated because he or she didn’t want to stop playing video games? Give the child a few minutes alone to calm down before he or she starts the next activity. It can be helpful to have conversations with kids about why they are so upset or frustrated, just save these conversations for a less stressful time when they aren’t transitioning between two activities.
Use praise and rewards. Think about the behaviors you want to see from the child and provide specific praise to keep him or her motivated. For example, “Great job following my instructions right away.” “I like how you stayed calm even though you were disappointed that you didn’t finish the assignment before the time was up.” For kids who need extra incentives to stay on track, consider providing small rewards for successful transitions.
Stick to a routine whenever possible. Surprises and changes in schedules will always be a part of life but sticking to a routine as much as possible will go a long way in helping your child transition between activities smoothly. Many kids with ADHD benefit from having the routine or schedule posted on the wall, especially if they are prompted to look at it throughout the day.
Kids with ADHD will always face some challenges navigating transitions throughout the day. But with the proper support they can be successful and transition from one activity to the next smoothly most of the time.
But outside of these recommended toys, what should you be thinking about when evaluating toys and gifts for your child with ADHD? Try this simple checklist to help you make great decisions.
Does it play to their strengths and help them feel a sense of accomplishment? Between school and homework, kids with ADHD spend a lot of time involved in activities that play to their weaknesses instead of their strengths. During their downtime, look for activities that will play to their strengths, whether it’s their artistic, musical, athletic, or social abilities, and allow them to shine. Also, look for gifts that are age appropriate and within their ability level. It’s great if a toy or activity challenges your child and stretches their skills. Just avoid gifts that are likely to be too difficult and lead to the frustration and meltdowns that can quickly derail playtime for kids with ADHD.
Does it allow for creative play? Kids with ADHD thrive when they can play “outside the box” and create moments that fit with how they prefer to interact with their world. So toys and games that don’t “fit a mold” or have strict rules about how they are played tend to be favorites among the ADHD kid set. These toys and games allow them to express themselves through their play and bring their version of the world to life.
Does it keep them busy and engaged? There is a reason fidget toys are so popular with all kids, but especially kids with ADHD. It keeps them busy. They help channel that nervous, hyperactive energy so kids can feel calm and have more space for creative thinking. There are many hands-on toys available that allow kids to focus and calm their mind. For kids who aren’t very active, but need an engaging activity to quiet their thoughts, detailed coloring books for kids (and adults) paired with a big set of colored pencils can make a great gift.
Is it active? Is it outdoors? Most kids with ADHD have more than enough energy to burn. When they don’t have any opportunity to be active, their ADHD symptoms become worse, and everyone in the family suffers. So, games that involve running, jumping, stretching, reaching (Twister anyone?)– anything active – will be a good fit for your child with ADHD. Outdoor games are also great for kids with ADHD, getting them away from screens and using up some of that energy. Just be wary of games that require a tremendous amount of of coordination or hours of practice to master. These games can frustrate some kids with ADHD and will be anything but fun.
Is it fast-paced? Kids with ADHD are most focused and engaged when they are participating in a faced paced activity. Fast paced, shorter games leave little space for kids’ minds to wander, setting children with ADHD up for success and fun!
With so much to choose from this holiday season, finding the right gift for a child with ADHD can feel overwhelming. But with a little thoughtfulness and consideration of your child’s strengths and their ADHD needs, you can find the perfect gift that will bring hours of fun.
For many kids with ADHD the most difficult times of the day are those that happen when they are transitioning from one activity to another. At school, it may be when they are ending an academic period and getting ready to head to art class or to lunch. Or it may be during more subtle transitions, like when they are moving from circle time on the rug to classwork at their desk. At home, challenging transitions come up when a child needs to settle down for homework time after playing video games, or when they need to transition into their bedtime routine.
Transitions are so much a part of our daily lives that they aren’t something we spend much time thinking about. In general, we tend to assume that transitioning between activities is something that is easy for kids, and it should go smoothly most of the time. In reality, transitioning between activities is anything but simple, especially for kids with ADHD. Why? Transitions tap into several cognitive skills simultaneously – and these happen to be the very cognitive skills (or executive functioning skills) that are areas of weakness for kids with ADHD.
Let’s look at the different steps required for successful transitions and the cognitive skills associated with each step.
Stopping an activity. Before a child can transition to a new activity they first need to stop the activity they’re doing already. This may seem simple enough, especially if the activity isn’t particularly enjoyable. However, for kids with ADHD stopping or inhibiting an ongoing behavior can be very challenging. This is because the same cognitive skills that are used to “put on the breaks” and stop an impulsive behavior like calling out in class or grabbing something they want out of their friend’s hands, are the very same skills that they need to use when abruptly stopping an activity. Putting on the breaks more difficult at certain times than at others. It’s particularly challenging when a child with ADHD is hyper-focused on an activity, when the activity is something that’s particularly rewarding (like screen time), or when the upcoming activity is something they would prefer to avoid (like a writing assignment or bedtime).
Starting a new activity. After a child with ADHD has successfully stopped his or her previous activity, he or she is now faced with the task of initiating a new one. This can be something fairly simple, like lining up by the classroom door, or something more complicated, like starting homework. Either way, it requires the child to tap into his or her cognitive skills related to initiating a new activity. For many kids with ADHD – particularly those with the inattentive subtype - initiating a new activity can be overwhelming and exhausting. Not surprisingly, the less rewarding the new activity, the harder it is for a kid with ADHD to muster up the mental resources needed to get started on the new task.
Following multi-step instructions (quickly). Starting a new activity often involves following multiple steps in a specific order. If the transition isn’t routine, these steps can be a lot for a child with ADHD to process - especially if the instructions are presented verbally and very quickly. Why? Most kids with ADHD have weaknesses in either working memory (the ability to hold information in your short- term memory, and then manipulate this information in your mind) or processing speed (the ability to process information quickly). Some kids with ADHD have weaknesses in both areas. As a result, they may not have fully processed the necessary instructions making it nearly impossible for them to transition successfully.
Managing a chaotic environment. Transition points are often the most chaotic times of the day. Imagine 25 kids shuffling papers, chatting with their neighbors, racing to their cubbies, grabbing all their things and lining up at the door for lunch. Now imagine trying to block out this noise while you struggle to stop your activity and follow a sequence of steps that you’ve only half-processed. When you look at from this perspective it’s easier to see why kids with ADHD literally get lost in the shuffle and struggle to follow through.
Coping flexibly with changes in a routine. Not all transitions are planned. Things come up at school and at home that require kids to be flexible and adjust to a new routine on the fly. For kids with ADHD who struggle with cognitive flexibility, quickly wrapping their head around even small changes can be a big challenge.
Managing frustration and emotions. Lastly, but perhaps most importantly, dealing with transitions requires managing emotions and dealing frustration. Kids may feel upset because they don’t want to stop the fun activity that they’ve been doing. Or they may feel frustrated because they didn’t have enough time to finish everything they’d hoped to accomplish. They may feel overwhelmed by all of the noise and activity in the room or feel a sense of dread about the upcoming activity. Regulating emotions and tolerating frustration are areas of weakness for most kids with ADHD. Compared to other kids their same age, it’s not uncommon for kids with ADHD to have emotion regulation skills that are about 2 years behind. This means that at times of transition, the expectations placed on a child’s emotional capacity may exceed their actual ability level.
Understanding the underlying challenges that make it difficult for kids with ADHD to navigate transitions throughout the day is the first step in ultimately making transitions easier for the child (as well as their parents and teachers). In my next post I’ll provide concrete steps you can take to provide the support a child with ADHD needs to transition between activities successfully.
When I’m planning a classroom visit parents will often tell me that I’ll have no problem figuring out which desk belongs to their child – it’s the one overflowing with papers, books, pencils, and countless random items. Problems with organization can seem like they aren’t as impairing as other ADHD-related difficulties, like impulsivity or difficulty staying focused, but in fact, studies show that the kids with ADHD who struggle the most academically are those who have the greatest difficulty with organization. When children are disorganized, it’s harder for them to find their materials and get started right away, they have a harder time blocking out the visual clutter so they can stay on task, and their self-esteem can suffer if they are frequently criticized for their messy work area by parents and teachers and are teased by peers who label them as the messy student in the classroom.
While it may appear that a disorganized child with ADHD is careless or sloppy, often these students care very much about their materials and wish they could have a neat desk like their classmates. The problem is that the executive functioning skills required for organization are underdeveloped, making it almost impossible for them to maintain an organized desk and work area on their own. For kids with ADHD, getting organized and staying organized requires structure and support from their teacher and repeated practice of organizational skills and strategies.
Here is a simple 5 step process that will help the student get the support that they need:
Do an initial desk clean out with the child. At a time when there are no other students in the classroom, do a complete desk clean out with the student. Everything should come out of the desk, and only the absolute minimum number of items should go back in. Fewer materials in the desk means there will be less to keep track of an organize on a day-to-day basis.
Create an itemized checklist and tape it to the top of the desk. Make a checklist that includes every item the student needs to keep in the desk. The rule should be that if an item is not on the checklist, then it does not belong in the desk. If the student wants to put something in the desk that is not on the list, then he or she needs to ask permission and either update the list (if it’s a permanent addition) or take the item back home with at the end of the day so it doesn’t create clutter.
Schedule a daily desk check-in. At the end of each day, review the desk checklist with the student. Make sure only checklist items are in the desk and clear out any clutter that may have accumulated throughout the day. Over time you can have the student go through the checklist alone and call you over when he or she is ready for you to review his or her progress. Alternatively, if there is a kind, organized student in the classroom, you can have that student be a peer helper who is responsible for helping the student go through the checklist and clear out the clutter.
Provide praise and rewards. Remember that keeping a desk organized is an extremely challenging task for many students with ADHD. Provide a lot of praise when you complete the daily check-ins, and when the desk is looking particularly neat, snap a picture to share with the student’s parents so the student can receive praise at home as well. Some kids may need to receive rewards as well to stay motivated. You can provide rewards either by adding a daily “desk organization” goal to his or her daily report card, or by providing small stickers or incentives at the end of each day.
Review and update the desk checklist with the student monthly. As the curriculum changes throughout the year the student may need to add or remove items from the desk checklist. Review the checklist with the student and ask if there are items on the list that he or she is no longer using, or if there are things he or she needs regularly that aren’t in the desk or on the list. Actively engaging the student in this process will help him or her feel a sense of ownership over his or her organization and will help him or her develop valuable skills that he or she will be able to use independently in the future.
While it’s unlikely that a child with ADHD will go from being highly disorganized to the neatest student in the classroom overnight, with a few supportive strategies and daily practice the student can keep his or her materials reasonably organized and will no longer stand out as having a desk that’s the messiest one in the room.
Transitioning smoothly from one activity or setting to another can be very challenging for students with ADHD. Somewhat surprisingly, difficulty managing transitions is actually one of the least talked about problems associated with ADHD, yet it is at these times of the day that students with ADHD are typically the most disruptive or emotional.
Fortunately, there are some fairly simple strategies that help make transitions infinitely easier for students with ADHD.
Identify trigger points. Most students with ADHD who struggle with transitions have a few points in their day that are the most difficult for them to manage. Start by thinking of the most challenging of these times and consider the factors that may be most triggering. Is there something about the other students in the mix at that particular time - maybe someone who the student gets particularly silly and excitable around, or someone who always seems to push his or her buttons? Is there a consistent time of day when the student struggles the most with transitions? Is there something about the activity being transitioning to or from that may make the transition harder for the student? Having a clear understanding of the factors that make a transition particularly difficult for a student will help you see the situation from his or her perspective and troubleshoot more effectively.
Make simple adjustments. Whenever possible, make simple adjustments to minimize triggers. For example, if a student consistently seems to have difficulty with a particular classmate at a given transition, make sure these students are not in the same group or area of the room at this time. If the difficult transition comes as lunchtime is approaching, consider whether the student is overly hungry and may need a mid-morning snack to help them make it all the way through until lunch. It may seem simple, but sometimes this is all it takes to smooth out a rough point in the day.
Consider medication effects. When a student with ADHD seems to handle transitions fine in the morning, but can’t manage them well in the afternoon it’s important to consider the possibility that his or her medication is not as effective as it should be throughout the entire school day. When a medication wears off too quickly, the effects are often most obvious during transitions when emotions and disruptive behaviors are at their peak. In these cases, a medication adjustment may be needed to ensure that the medication is providing the proper support all day long.
Announce schedule changes well in advance. Kids with ADHD rely on their daily routine to help regulate their behavior and emotions. Abrupt changes in their schedule or routine are often accompanied by abrupt change in their emotions and behaviors. Making sure the student is aware of the change well in advance will help him or her stay calm and regulated.
Make them a “helper.” Students with ADHD often do best during transitions when they are engaged in structured tasks. Since transitions are often a relatively chaotic time in the classroom, placing students in the role of classroom helper can add some structure and focus to this otherwise unstructured time. The tasks can be simple, like making sure all of the desk chairs are pushed in as everyone lines up, or counting the student in the line to make sure everyone is accounted for. Just remember to praise the student and thank him or her for the help, so he or she will feel confident and motivated to keep helping day after day.
Helping kids with ADHD manage transitions calmly and independently requires some initial planning and problem solving, but once a new routine is in place the student will thrive and problematic transitions will be a thing of the past!
Neurofeedback (also known as EEG biofeedback) is marketed as an alternative treatment for ADHD. Parents who are looking for a medication-free treatment option often hear about neurofeedback and wonder if it can help their child. However, neurofeedback can be expensive, costing between $3,000 - $6,000 for a course of treatment and is often not covered by insurance. It is also time intensive, requiring weekly sessions for a few months or longer. So, before signing your child up for sessions, learn what neurofeedback entails and what the research says about its effectiveness.
What is Neurofeedback? Neurofeedback is based on the premise that the brain emits different patterns of brain-waves depending on whether a person is in a focused state or a distracted state. The goal of neurofeedback is to train the brain to produce and sustain more brain-waves associated with focus and concentration and fewer brain-waves associated with distraction or daydreaming. Neurofeedback treatment begins with brain mapping. The patient wears a cap lined with electrodes and is instructed to perform cognitive tasks (like simple math or reading). During these tasks a computer program reads the signals transmitted by the electrodes and identifies areas where the brain appears to be underactive or overactive. These areas of brain-wave underactivity or overactivity become the targets of the tailored neurofeedback treatment plan. During weekly treatment sessions the patient wears an electrode cap while playing a video game filled with challenging cognitive tasks. Brain-wave activity is measured, and if the electrode signals indicate that a child or teen has lost focus then the game stops. The game resumes when “focused” brain-wave activity picks up again. The patients goal is to keep the game running without interruption by staying engaged and encouraging sustained “focused” brain-wave activity.
What the Research Says
Unbiased research published by scientists without affiliations with the neurofeedback programs themselves provides the most reliable source of information about the treatment’s effectiveness. Locating results from these studies can be challenging, since the findings are published in academic journals and aren’t always described on the neurofeedback websites that appear in a Google search. A number of randomized controlled trials comparing neurofeedback to ADHD medication treatment and/or a control condition have been published. Some of these studies show that neurofeedback leads to changes in brain-wave patterns and improved performance on computer tasks. However, in studies where medication was included as a comparison treatment, the medication group always outperformed the neurofeedback group. When these studies examined the impact of neurofeedback on the child “real-world” ADHD symptoms at school or at home (rated by teachers and parents), there were no effects or very limited effects on symptoms. In addition, clinical scientists are concerned that there may be a placebo effect. In a recently published meta-analysis researchers combined and analyzed the data from 13 randomized controlled studies of neurofeedback. The results showed that when studies compared neurofeedback to a “sham” or placebo neurofeedback condition, there were no differences in computer task performance or ADHD symptoms between the placebo group and the actual neurofeedback group.1
Being an Educated Consumer
The current research suggests that parents should be cautious about enrolling their children in neurofeedback for ADHD. Of course, there are children who have received neurofeedback whose parents report an improvement in ADHD symptoms, and there are also many children whose parents say they saw no change in symptoms. It is possible that some children do in fact see some benefit. If ADHD medication is not effective or if symptoms that persist even after other evidence-based treatments have been tried, then neurofeedback may be an alternative treatment to explore for your child.
If you choose to seek out neurofeedback treatment, remember that the goal of treatment should be to see “real world” improvement in ADHD symptoms at school and at home and not only improvement on a handful of computer tasks or a change in brain-wave patterns. Ask the neurofeedback practitioner how they will monitor real world symptom improvement. Will they be obtaining rating scales from parents and teachers at regular intervals? Also ask how soon should you expect to see improvement, and at what point should you stop the treatment if there is no observable change in ADHD symptoms or behavior.
Neurofeedback requires a significant investment of time and money. Before enrolling, make sure you have explored evidence-based behavioral treatments and medication options first. Also, consider your child’s specific challenges and look for interventions with proven track records that target the areas where your child needs help the most. These can be academic interventions, social interventions, programs that help kids learn to manage their emotions, or behavioral treatments that target ADHD symptoms specifically. Targeted interventions with a history of proven outcomes are most likely to lead to real-world results for your child or teen with ADHD.
1 Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., Santosh, P., Simonoff, E., Stevenson, J., Stringaris, A., Sonuga-Barke, E., on behalf of the European ADHD Guidelines Group (EAGG) (2016). Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes from Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry, 55(6), 444-455.