August 16, 2022

Drbodyscience

Genuine Education

8 Principles for Supporting Students with ADHD

15 min read
8 Principles for Supporting Students with ADHD

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I still remember the feeling I used to get when looking at the paperwork for my students who had ADHD, the forms listing the accommodations I would need to make for them—usually extended time on tests and maybe preferential seating. 

The feeling could be best described as uncertain. I understood what these small changes looked like in practice—seat this student near the front of the room and give him more time to work on tests. But I knew almost nothing about the mechanics behind why the changes were supposed to make a difference. I signed the papers, returned them to the office, and made a mental note that if any of these students ever showed signs of struggle, it was probably because of the ADHD.

And they did struggle. The preferential seating and extra time wasn’t often enough to help them turn in completed work on time, keep track of their things, and stay focused on class activities. Knowing as little as I did about ADHD, I figured that was the best we were going to get.

As uncomfortable as it makes me to say this, I will also admit that part of me wondered why these students couldn’t just power through, find the motivation, try harder. Disorganization got the better of me sometimes too, and when that happened, I would just tidy things up, declutter, reset my priorities, and get back on track. It wasn’t that hard. I also wondered whether parents were to blame, if a lack of structure, too much TV or video games, or some other oversight at home might be the true cause of students’ difficulties.

Suffice it to say I really, REALLY didn’t understand ADHD. 

It turns out my lack of knowledge wasn’t unique. A number of studies have shown that many teachers don’t know enough to effectively meet the needs of students with ADHD (Alkahtani, 2013, Poznanski et al., 2018). While a growing number of teachers can recognize behaviors that might suggest ADHD in a child, knowledge drops off significantly when it comes to treatments and interventions that can help—the less training and knowledge a teacher has about ADHD, the less confident they feel about working with students who have it (Flanigan & Climie, 2018). This may explain the heartbreaking statistic that teachers tend to form fewer close relationships with students who have ADHD (Ewe, 2019).

Regardless of the subject area or age you teach, you’re likely to have at least a few students with ADHD in your classroom every school year, so a good working knowledge of it should be part of any teacher’s professional training. In the nine years I have been sharing resources on this website, I have only ever done one piece on ADHD, a 2017 interview with Seth Perler, who shared a great set of systems that help students who struggle with executive function. But that’s it, so it’s time to dig a little deeper. 

A Solid Place to Start: Russell Barkley

Setting out to find good resources, I kept landing on the name Russell Barkley, an ADHD researcher who has been called a pioneer, a leading expert, and the gold standard in ADHD research. In all the places where his work appears—speaking on YouTube, as a guest on multiple podcasts, and as the author of many articles and books on ADHD—what is most striking are the number of comments from adults with ADHD who are relieved to finally find some validation, to hear clear explanations for why their brains work the way they do.

Although Barkley has been criticized for sounding negative and bleak when he speaks about the condition, using language that many would characterize as deficit thinking, his work has helped many people understand the workings of ADHD, how it affects those who have it, and how to best manage it. With that in mind, he seems like a good place to start; for suggestions on where to keep learning, I’ll provide a list of resources at the end of this post.

Most of Barkley’s work is directed at parents of children with ADHD and adults who also carry the diagnosis, but he has also written the highest-rated book for teachers on the subject, Managing ADHD in School: The Best Evidence-Based Methods for Teachers (Bookshop.org | Amazon). 

This slim book is not meant to be comprehensive or in-depth. Barkley states outright that he’s not going to spend time on narrative prose and extensive research citations; his goal is to simply explain ADHD so that busy teachers can understand it, and tell them what they can do to help students who have it. His message is “Trust me, I know this stuff. Do this, not that.” And while this obviously leaves him open to criticism, the book certainly delivers on its promises, and it’s a great starting point for any teacher who wants a crash course on ADHD.

As Barkley is fully retired now, he declined to be interviewed here, so this is basically my own personal book report: I learned so many things from the book that would have helped immensely in my own work with students with ADHD, so I’m going to  summarize what I think are the most important takeaways here. I strongly suggest you get a copy for yourself.

Although I’m doing my best to share this information accurately, there’s a chance I’ll get something wrong; if you see something that needs correcting, please let us know in the comments. 

What do teachers need to understand about ADHD?

Before we get into classroom practices, I’m going to summarize a few key facts about ADHD that every teacher should know. Most of these happen to be things I personally didn’t know—in fact, some are the exact opposite of beliefs I held—so I can only assume other teachers might also need this overview.  

  • ADHD is a neurodevelopmental condition that impacts a person’s executive function. This shows up as a difficulty with persisting toward goals and resisting distractions, holding information in working memory, and planning and problem solving. It also increases impulsivity, making immediate consequences more valuable than long-term ones, and interferes with inhibition, which results in quicker displays of emotion and other conduct that is generally discouraged in social settings. Unfortunately, all of these are often categorized as misbehavior or “poor choices” in the classroom, and if teachers don’t understand how ADHD works, they can spend years responding in ways that will do little to address the underlying causes. 
  • The cause of ADHD is largely genetic. In the book, Barkley asserts that “no compelling evidence indicates that social factors, such as parenting or educational environment, have been found to cause ADHD.” Research has also ruled out diet, TV or media consumption, or videogame play as contributing factors (p. 15-16). With this information in mind, we can stop looking for outside factors to blame and get down to the business of helping these students do better in school. Knowing this should also put an end to attempts to “motivate” students with ADHD by giving them pep talks, angry reprimands, or guilt trips.
  • Roughly ten percent of your students are likely to have ADHD. Numbers for this are hard to pin down exactly: The National Institute of Mental Health puts the total number of children and adolescents diagnosed with ADHD at about 11%, the CDC at 9.4%, and Barkley at 5 to 8%. Regardless of the source, the numbers continue to rise every year, and boys have a higher rate of diagnosis than girls. More important than an exact number is this: Every year, you should expect to have at least a few students in your classroom who have ADHD.
  • Rates of diagnosis do not necessarily reflect the actual number of students with ADHD. Barkley says diagnoses tend to occur more in communities with more resources, and overdiagnosis is more frequent “in upper income neighborhoods where a premium is placed on academic excellence or acceleration” (p. 8). By contrast, students may be underdiagnosed in communities with fewer resources for diagnosis and treatment. Apart from just being good general knowledge to have, this may inform the research and action you take depending on the community where you teach: Perhaps more of your students actually need to be referred for diagnosis and treatment; by contrast, you may be working with students who are receiving treatment for a misdiagnosis.
  • ADHD is linked to a host of serious problems. People with ADHD have a greater risk of relationship problems (including social problems in school and both personal and professional adult relationships), employment issues, depression, anxiety, eating disorders, addiction, auto accidents, and suicide. These statistics shocked me, and they underscore how important it is for educators, who work with these students for hours every day, to learn as much as we can about how to better support them in school. 
  • Medication can help. Although public opinion on medication is mixed, much of the research shows that ADHD medication, when combined with interventions and supports like the ones listed below, has a high rate of success for improving academic performance. It has also been shown to lower other risk factors, like suicide (Liang et al., 2018), addiction (Sherman, 2022), and auto accidents (Chang et al., 2017).
  • Research continues to evolve. What was known about ADHD twenty or even ten years ago has been enriched by a growing body of research on diagnosis, causes, interventions, and medication. So when you come across information that doesn’t quite fit with your current understanding of ADHD, keep an open mind.

8 Principles for Helping Students with ADHD Succeed in the Classroom

Barkley packs tons of strategies and advice into his book; here I’ve attempted to condense them into eight general principles. Just like with so many strategies designed to help specific populations, these are also likely to help many of your students be more successful, regardless of whether they have identified difficulties with executive function.

1. Be proactive (rather than reactive).

Throughout the book, Barkley urges teachers to plan ahead with systems and strategies that can solve common ADHD-related challenges. Instead of waiting for problems to arise and then dealing with them, which is more likely to be done under duress, it’s far more effective to anticipate challenges and set up a plan for preventing them. 

For example, students with ADHD often struggle with transitions, so one strategy is to always pause a few minutes before a transition to verbally remind students of the procedures and rules around the upcoming transition.

2. Make the internal external.

Because ADHD affects working memory, a person with ADHD has a harder time keeping things like instructions for a task in their mind. “Even if they try to hold such information in mind … any distractions will disrupt and degrade this special type of memory. The mental chalkboard of working memory is wiped clean by the distraction. …having gone ‘off-task,’ the child is far less likely to reengage the original and now uncompleted goal or task” (p. 3-4). 

Working memory can be boosted when we make the internal external: taking information that might typically be a mental process (like remembering the steps for turning in an assignment) and making it visible. Here are some examples:

  • Color-coded folders help students keep materials organized and find what they need more easily.
  • Visual timers that students can easily see keep them aware of how much time is left for a task.  
  • Written rules and instructions posted close to where a task is going to be completed (Barkley calls this the “point of performance”) offer support right when students need it.
  • Daily behavior report cards can work well to remind students of expectations and get immediate feedback on how well they are meeting them.
  • Notetaking helps students record what they are learning to make it more concrete.

3. Break large tasks into smaller ones.

Because ADHD makes it harder for students to manage long, complex tasks, it helps if teachers can guide students in breaking these tasks into smaller steps. 

4. Maximize the effectiveness of incentives.


Author’s note: If you listen to the podcast version of this post, you’ll notice that this item is somewhat different from that version. The original primarily used the term “consequences” and came across very punishment-heavy; this did not accurately represent Barkley’s recommendations. The written version is the more updated one and is the best representation of this principle.


Internal motivation is harder to sustain for students with ADHD due to reduced working memory and increased impulsivity, so external incentives are a powerful tool for sustaining motivation. He recommends these guidelines:

  • Positive reinforcements must significantly outweigh negative ones. In fact, Barkley recommends that any program of reinforcements have only powerful, positive incentives for 1 to 2 weeks before ever introducing negative ones.
  • Incentives need to be delivered with more immediacy and frequency than for students without ADHD. 
  • Incentives may need to be “richer” than what you might typically use for other students. If a consequence (positive or negative) doesn’t seem to be motivating a student with ADHD, it’s probably because it doesn’t mean much to the student and should be replaced with something the student values more. 
  • With the above in mind, incentives also need to be varied or rotated more often for students with ADHD, as they lose their potency more quickly over time. 

In the book, Barkley regularly uses the word “punishment” to describe negative consequences for undesirable behavior. Although he doesn’t advocate for anything harsh, the term is still troubling to me after the book so clearly establishes that the behavior of someone with ADHD is caused by the way their brain is wired, not bad choices. So I would advise teachers reading his book to extract the valuable information he shares about consequences, while keeping in mind that we are not trying to cause shame or pain to students for their behavior; the goal is to create a system of incentives and reinforcements that prompt students to refocus and make adjustments.

5. Prepare for restlessness. 

To work with—rather than against—these students’ greater need for movement, keep a supply of stress balls, fidget toys, balance balls, or wobble chairs for them to use. You can also provide standing desks and other seating options so that student can to choose what works best for them, and plan frequent physical exercise breaks to give all students a chance to stretch and burn off some energy between activities that require more stillness.

6. Alternate low-appeal with high-appeal activities.

“Too many boring topics or activities back to back can lead a child with ADHD to lose focus,” Barkley says (p. 37). This loss of focus can lead to the student becoming distracted and possibly disruptive to the class, so mix the more engaging, high-interest activities in between those that require more effort to maintain focus. 

7. Use technology as a support.

Technology has been shown to be especially effective for students who have ADHD. Barkley cites research showing that students with ADHD “pay more attention to computer software learning programs and learn more from the practice with them than they do when working on worksheets” (p. 36). 

He also recommends teaching these students keyboarding skills as early as possible. “Students with ADHD have a high occurrence of fine motor coordination problems…give them alternative means of expressing themselves in print” (p. 38).

8. Monitor and modify interventions regularly.

“One common scenario,” Barkley writes, “is that a student responds initially to a well-tailored program, but then over time, the response deteriorates” (p. 28). This doesn’t mean the interventions didn’t work; it might mean they need to be modified or the implementation needs to be checked for fidelity.

A Lingering Question: Public Accountability?

As much as I want to wholeheartedly recommend the book, one repeated suggestion concerned me. In a few places, Barkley advocates for “public accountability” for student behavior (p. 28, p. 61), but at other times offers more discreet methods of accountability for older students (p. 62). 

Public behavior charts and systems have gotten a lot of pushback in the teaching world over the past 5 to 10 years, and I agree with the criticism: The shame these can cause is not worth any benefit they may offer. I worry that some readers will come away from this book thinking that public shaming is an effective strategy for supporting students with ADHD, even though Barkley doesn’t necessarily advocate for this. My best guess is that the recommendation should be interpreted to mean that the accountability system should be visible to the student, but not necessarily on display for the whole class to see. 

With this in mind, a good rule of thumb for any time you see a recommendation in an education book, or on a website like mine, that feels off in some way or seems to go against your better judgment, listen to your gut. 

I’ll end this piece as I began it, with an admission of bare minimum knowledge on the subject of ADHD. As much as I have tried to accurately represent the recommendations and knowledge Barkley shares, there’s a very good chance I got some stuff wrong, and this book is just a starting point, but it would have been incredibly helpful to me as a teacher, so I hope it helps you as well. If you have personal experience with ADHD, professional expertise, or links to other good resources, I urge you to share these in the comments below so we can build on what’s here.


Learn More

This piece only scratches the surface of what the medical and educational communities are learning about ADHD. It is meant to serve as a jumping-off point so that teachers can be equipped with strategies that will be the most helpful to students with ADHD. To continue learning, try the resources listed below:

  • CHADD.org, or Children and Adults with Attention-Deficit/Hyperactivity Disorder, is an organization dedicated to improving the lives of people affected by ADHD. Their website houses loads of fantastic resources, plus an online teacher training course if you want to go in depth.
  • ADDitude describes itself as “the leading media network for parents and adults living with ADHD.” This is a website you’ll need to set aside time for, because it’s packed full of interesting articles, tools, and other resources to help anyone learn more about living with ADHD.
  • Want more from Russell Barkley? Listen to this recent interview from the Ologies podcast, where he provides an in-depth overview of ADHD and how it impacts those who have it.
  • The work of Edward Hallowell is worth considering for a more asset-based view of ADHD. Learn about his advocacy for replacing the term ADHD with the more neutral term VAST and this summary of his public “debate” with Russell Barkley. And for short bursts of learning, follow him on TikTok.
  • While you’re on TikTok, also check out Sasha Hamdani, a psychiatrist and ADHD specialist whose following has grown exponentially in the last year for her helpful and humorous videos. You can also find her on Instagram.

References

Alkahtani, K. D. F. (2013). Teachers’ Knowledge and Misconceptions of Attention Deficit/Hyperactivity Disorder. Psychology, 04(12), 963–969. https://doi.org/10.4236/psych.2013.412139

Barkley, R. (2016). Managing ADHD in School: The Best Evidence-Based Methods for Teachers. Pesi Publishing & Media.

Centers for Disease Control and Prevention. (2021, September 23). Data and statistics about ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/data.html

Chang, Z., Quinn, P. D., Hur, K., Gibbons, R. D., Sjölander, A., Larsson, H., & D’Onofrio, B. M. (2017). Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry, 74(6), 597. https://doi.org/10.1001/jamapsychiatry.2017.0659

Ewe, L. P. (2019). ADHD symptoms and the teacher–student relationship: a systematic literature review. Emotional and Behavioural Difficulties, 24(2), 136–155. https://doi.org/10.1080/13632752.2019.1597562

Flanigan, L., & Climie, E. (2018). Teachers’ Knowledge of ADHD: Review and Recommendations. Emerging Perspectives: Interdisciplinary Graduate Research in Education and Psychology, 2(1), 1–13. https://jmss.org/index.php/ep/article/view/42922

Liang, S. H.-Y., Yang, Y.-H., Kuo, T.-Y., Liao, Y.-T., Lin, T.-C., Lee, Y., McIntyre, R. S., Kelsen, B. A., Wang, T.-N., & Chen, V. C.-H. (2018). Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study. Research in Developmental Disabilities, 72, 96–105. https://doi.org/10.1016/j.ridd.2017.10.023

National Institute of Mental Health. (n.d.). NIMH» Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved April 14, 2022, from https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd

Poznanski, B., Hart, K. C., & Cramer, E. (2018). Are Teachers Ready? Preservice Teacher Knowledge of Classroom Management and ADHD. School Mental Health, 10(3), 301–313. https://doi.org/10.1007/s12310-018-9259-2

Sherman, C. (2022, March 31). The Truth About ADHD and Addiction. ADDitude. https://www.additudemag.com/the-truth-about-adhd-and-addiction/


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