One of the key ingredients to any treatment plan for ADHD - both in children and adults - is instituting behavioral strategies. In school, this strategies, or accommodations, can include preferential seating. At home, it might mean using a token economy to reinforce positive behaviors. these types of techniques have been found to be effective, either along with medication or alone. However, some people see these types of strategies as a crutch - something you depend on to help focus attention and improve behaviors - and believe that these strategies stop children from learning the proper behaviors.
Most children with ADHD also have executive function deficits. Executive functioning skills are those brain processes that are involved in planning, organization, self-regulation, time-management and memory retrieval. It also helps you use information you learned previously with your current task. Studies have shown that children with ADHD have delays in executive functioning - sometimes by up to 30 percent, which means that a 12 year old with ADHD would have the executive functioning skills typical of an eight year old. These deficits in executive functioning can continue throughout your life.
According to Russell Barkley, in the article, "The Important Role of Executive Functioning and Self-Regulation in ADHD," accommodations and behavioral strategies help because they provide external cues when the internal systems aren't working properly. Alarms, to-do lists and calendars are commonly used by both children and adults with ADHD to help them stay on track. These strategies take the place of missing, internal time-management and organization skills. Likewise, token economies help to curb impulsive behaviors and provide an external motivation to compensate for different executive functions.
Just as ADHD is unique in each person, executive functioning deficits can show up differently as well. Screening tests can help determine which areas are difficult for you, or your child, such as:
- Planning projects
- Retaining information and then recalling it to use it in another task
- Memorizing information
- Initiating tasks and activities
- Estimating time needed to complete a task or project
Accommodations, when properly matched to executive functioning deficits, are much more effective than using across the board accommodations. A mental health provider can screen (using several testing and screening tools) for specific executive functioning deficits and offer suggestions for accommodations that might be effective. You can also use the "trial and error" approach - using different accommodations and behavioral strategies to find out which work best for your child.
Some common strategies for coping with executive functioning problems include:
- Breaking tasks down into small steps
- Using external organizers such a alarms, electronic calendars, watches
- Plan transitional times to provide more structure
- Request written instructions rather than being given oral instructions
- Create and use to-do lists
- Use visual calendars for long-term projects
- Schedule time each week to organize work areas
- Use checklists for assignments and daily tasks
- Token economies or charts to encourage positive behaviors
Remember, though, what works for you, or your child, might not be the same strategies that are most effective for someone else. Try different things to find what works best.