You can’t manage ADHD with drugs alone. Anyone who has ever parented one of the 6 million children in the United States age 4-17 diagnosed with the condition knows that. But with school now back in session, frustrated parents and their children may be asking what more can be done to manage ADHD and its symptoms. Because taking drugs isn’t enough, and may not even be the right way to go.
ADHD is complicated. It makes learning difficult. That’s why children with ADHD need a great deal of support from their parents, teachers, and school counselors. A school counselor, in particular, can play a special role in helping students with ADHD by serving as an intermediary between parents and teachers.
With so many children experiencing ADHD, it becomes crucial to offer them some sort of support system that goes beyond purchasing a prescription and hoping for the best. Here, school counselors can fulfill an important function, by serving as the pipeline for communication between parents and teachers. School counselors can also be an important resource for all those who work with children with ADHD, both in and out of the classroom. While most children are diagnosed with the combined form of ADHD, the presentation of symptoms can change over time. The school counselor can offer strategies to cope with changing behaviors as these changes arise.
In order to manage ADHD, however, it is important to gain an understanding of the skills a student with ADHD must develop. The aim of any therapies for ADHD must have, as their ultimate goal, improved impulse control, time management, and the ability to focus or concentrate on tasks. If students fail to develop these critical skills, they will remain in perpetual frustration, become worn out from trying so hard, develop poor self-esteem, and suffer from acute embarrassment, as well.
One practical way to help students with ADHD develop these skills is to provide them with a dependable structure. A student who struggles with forgetfulness, for instance, should be made to do homework at the same time every day. Over time, the student internalizes that homework is always done at 4 PM, so that when 4 PM rolls around, the student knows just what to do and never forgets. A student who tends to forgetfulness can also be instructed to store his schoolbooks in one designated space. Since the item is always placed in the same spot, there will never be a time when the child cannot find the item. These are meaningful methods for developing time management and organizational skills to really address and manage ADHD.
But let’s say there is to be a school field trip at 4 PM on a certain date. That can throw the student with ADHD for a loop, since 4 PM is homework time. The student should be prepared well in advance of any such changes in schedule or routine. Talking about how and when the child will get dressed, do homework, and eat on that day is going to be a necessary conversation that may have to be reviewed several times over several days or weeks. Students with ADHD need lots of help and much spatience in learning to organize their time.
As for developing a student’s powers of concentration and focus, ADHD expert Dr. Edward Hallowell believes that staying focused for shorter periods of time is the right way to go. “Kids with ADHD must learn to manage large projects. Break down large topics or tasks into small, manageable bits. For example, a book report might be subdivided into eight steps, or a science project outlined in a dozen doable steps. This helps the child with ADHD not feel overwhelmed.”
Strategies to Manage ADHD
These coping tips and tricks help students manage ADHD symptoms by teaching them strategies that have been proven to work, based on evidence. Such strategies are called evidence-based interventions (EBIs). An example of an EBI would be helping the parents of the student with ADHD to develop and put into place a system of organization to assist the student in carrying out more homework assignments and chores and getting them done on time. Parents might use calendars, charts, notebook or computer, and class syllabi to make it work.
Anil Chacko, a professor for Counseling@NYU’s online master’s in school counseling program from NYU Steinhardt, describes some strategies that school counselors can use when working with students who have ADHD. “School counselors should utilize methods that support students’ time management, planning, and organization,” Chacko says, citing the work of Joshua Langberg at Virginia Commonwealth University (VCU) and Howard Abikoff at New York University’s (NYU) School of Medicine, leading scholars in the field of ADHD in children and adolescents. “I would also encourage school counselors to work directly with parents to create a school-home note system to support cross-setting changes.”
Dr. Langberg developed and published the successful Homework, Organization, and Planning Skills (HOPS) intervention. HOPS is about teaching kids to use physical organization tools, for instance book bags, binders, and lockers, and homework management tools such as writing down assignments and recording them accurately, entering test dates on a calendar, and in general, planning things out.
Dr. Abikoff researches interventions and training in children with ADHD, for instance Organizational Skills Training (OST). OST targets specific organizational skills goals. Here is a description of the OST program from program’s creators:
OST is a 20-session, twice-weekly, clinic-based program, which focused on building organizational skills in four areas:
- Tracking Assignments: Teaching students a system for consistently recording assignments and due dates in a specially designed planner.
- Managing Materials: Providing students with methods for storing and organizing their papers and materials through the use of an accordion binder system, materials checklists included in their planner, systems for organizing their desks, and by developing prominently visible checklists for backpacks and other tools for material transfer, as well as other related strategies.
- Time Management: Helping students become more aware of their use of time and how to plan ahead to structure their time effectively through the use of an afternoon scheduling component in their planners; helping students improve their time estimation skills and their awareness of how much time they need to complete tasks; teaching students to work efficiently by minimizing distractions in their work spaces.
- Task Planning: Showing students how to break larger projects and goals into steps and create schedules for task completion through the use of task-planning pages in their planners.
OST students are taught that each OTMP (organization, time management, and planning) problem area is the result of a brain “glitch.” Each glitch is depicted as a naughty character who likes to watch children make mistakes due to organizational problems. This concept helps motivate the students and makes the program “lighthearted and fun.” The concept of glitches is also meant to make the issues encountered by students with ADHD less personal. Kids come to understand that it’s not they who fail, but the symptoms of ADHD getting in the way of their academic and social success.
Each organizational skill is taught using the same basic method:
1) The new skill is discussed, defined, and explained. A rationale is given for the importance of the skill. The child hears about the settings in which the skill might be used.
2) The skill is demonstrated
3) The skill is practiced by the child under the guidance of an instructor and feedback is given. The skill is practiced many times. The student is taught to identify situations in which the skill should be used.
Studies as recent as this one from 2016, have found that early behavioral therapy (HOPS, OST, and the like), begun before any other interventions, such as medication, had “four fewer rules violations an hour at school than the medication-first group.” That’s not to say that behavioral therapy takes the place of medication. Medication has proven benefits for children with ADHD. What we should take away from the research is that 1) We shouldn’t begin with medication and 2) Teaching children to develop their OTMP skills even before they reach school age, can really make a difference. In terms of cost, by the way, behavior-first therapy is estimated to cost an annual $700 less per year when compared to medication-first treatment.
Strategies for Teachers
Besides using EBIs like OST and HOPS in their work with children, school counselors can also train teachers to support children who are coping with ADHD in the classroom. A school counselor might, for instance, suggest the teacher give out points or tokens for good behavior. Here are some other practical tips from the National Resource Center (NRC) on ADHD:
For the easily distracted student (predominantly inattentive)
- Seat the student close to the teacher’s desk and away from distractions such as windows or school corridors
- Split long assignments into smaller segments
- Offer more breaks during class time
For the students that fidgets and squirms (predominantly hyperactive/impulsive)
- Seat the student where the fidgeting and squirming will be least likely to disturb classmates, for instance along the side of the classroom
- Offer opportunities throughout the day that allow the fidgety student to move, for instance, handing out work sheets.
More Tips to Manage ADHD
Scott Ertl, M.Ed., was an elementary school counselor for 18 years before he became the CEO of BouncyBands, a device to help fidgety students cope in the classroom. Here are Ertl’s top 5 tips for helping students with ADHD succeed in the classroom:
1) The child or teacher, depending on the child’s maturity, should clean out the child’s desk every Friday afternoon so the week starts off as organized and prepared as possible.
2) Allow movement. Let the child earn the ability to deliver a book to the media center, a note to the front office, or a message to a teacher when their work is completed correctly. Bouncy Bands, yoga balls, and standing desks in class are also great ways to allow movement throughout the day. Kids need appropriate ways to release their extra energy without distracting others.
3) Set them up for success. Give them advance notice that you are going to call on them to answer a question in class so they are ready. This works much better than catching them off task as a way to shame them into paying attention.
4) Have specific goals on their desk to accomplish, like: Check over my work when completed, Make sure all of my homework is written down before leaving class, and Raise my hand to ask for help when unsure of what to do in class.
5) Communicate. Give specific feedback during the day when these goals are being accomplished to recognize their improvements. Use them as model in class to encourage other students to improve those behaviors as well.
Teachers who must manage ADHD in the classroom may also want to try using sentences that suggest an order of action, for instance, “First read all the questions, then answer them,” or, “First put your crayons away, then take out your geography book.” In addition, enlisting a student’s help can increase self-worth and help refocus the child’s energy. Teachers and parents should always watch for good behavior and give praise whenever and wherever it happens!
How Can Parents Manage ADHD?
Here are some things parents can do at home to help their children who struggle with ADHD:
- Use a system to acknowledge and reward good behavior, for instance, a chart with stickers
- Stick to a home routine with as little deviation as possible (e.g. homework, dinner, bedtime, and etc., are at the same time each day)
- Create written to-do lists for chores so that the child can cross things off the list as they are done
- Practice at home, OTMP strategies learned at therapy sessions
Professor Chacko encourages parents to educate themselves. If you have a child with ADHD, seek out information on behavior parent training programs in your area. Some consider these programs to be the most important and most effective means to manage ADHD behaviors both in and out of the classroom. Parents, along with teachers and school counselors, should also be aware that ADHD often coexists (see: Comorbidity and ADHD: It’s Not Just About ADHD) with learning disabilities and difficulties. “The challenges these children face may be more than just ‘ADHD,’” says Chacko.
What do you do at home to help support your child with ADHD?