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ADHD and High School Planning: What It Takes to Thrive

A fundamental flaw in understanding ADHD undermines academic success

The statement "he's fifteen and should take responsibility for his school work" doesn't always hold water. It doesn't have anything to do with "should." Either he can or he can't keep track of it. You can "should" him and yourself and his school all you want, but the only real solution creates an appropriate support system in the short term, and teaches required skills over time.
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James is a fourteen year old who looks like any other kid his age, slouched in his chair and mumbling one word answers to questions about his life. The only difference is James has ADHD. Despite all the help he is getting from his teachers and elsewhere, James continues to do poorly in school. His parents aren't happy with his performance, and he doesn't appear to care about academics at all.

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James takes medication daily and everyone agrees he now has little difficulty focusing. He's stopped talking out of turn and his grades have improved, but not enough. His test scores are all over the place, from 55 to 95 and then back down to 75, reflecting what he actually knows only inconsistently. He rarely gets his homework in on time, if at all. All his teachers have offered to stay after school to help him keep up, but he just leaves at the end of the day. There are complaints that he seems unmotivated, disengaged, or lazy. What's gone wrong?

High schools approach academic support for children differently than primary and middle schools do at lower grade levels. Kids, both with and without ADHD, are expected to take responsibility for their education. They are supposed to manage their schedules on their own, handle intense homework loads (and hand everything in on time), and coordinate time around all their after-school activities. The pressure can be intense, but most kids without ADHD sort it out, make a plan, and thrive.

Yet even without ADHD, teens don't have the brain of an adult. The average teen is still developing their executive function abilities - the mental capacity to regulate emotions and behaviors, organize, plan, manage time, and a host of other related tasks. A burst of neurological growth starts in adolescence and progresses through the mid to late twenties. In one way, adolescence is about surviving impulsive decisions and scattered thinking and then to become an older, wiser grown up - as reflected by these changes within the brain.

As parents we allow teens to grow and become individuals, hand them responsibilities and let them fail at times, but we also must keep an eye on the bigger picture. Executive function relates to concepts such as ‘wisdom' and ‘maturity,' and does not plateau in its development until near age thirty. This cognitive progression leads to a decrease in risky behaviors and a better ability to monitor our behavior and to plan for the future. Any individual may have more or fewer of these skills, but from a neurological perspective the expectation that most teens will make rational, long-sighted choices does not make sense. (It's one reason to insist kids wait until they are older to consider something like a tattoo.)

While most teens struggle with executive function, those with ADHD fall even further behind. Their capacity to organize and plan lags by several years. Because of their neurology they struggle with staying on task, transitioning from activities, keeping track of lists, handing things in, and managing their time. The ability to connect immediate behaviors (I don't feel like going for extra help today) to future consequences may not exist yet.

This attribution to ‘effort' or ‘motivation' is the fundamental flaw undermining many academic plans for teens with ADHD. These issues have little, if anything, to do with motivation. Even with lots of effort if a teen does not possess age-appropriate executive functioning the essentials for school success are not going to be found without the involvement of responsible, caring adults.

Visiting a teacher for after-school support requires the ability to remember the possibility exists, to keep track of time, to put aside the current activity, and to maintain attention from point A to point B. It requires recognizing a need for help, making a plan, and then sticking with the plan over the long haul. As teens fall further behind the stress increases and at the same time more and more school work accumulates, further taxing their limited executive function skills. For someone with ADHD, it may be too much to ask.

Someone who looks and acts like a teen-ager may have the executive function and self-monitoring skills of a child years younger. A fifteen year old with frontal lobes going on ten has the capacity of a ten year old to manage his workload and responsibilities. Establishing a school plan for a ninth grader with ADHD is a set up for failure when relying entirely on that teenager for planning and communication. Superficially, it might not seem to make any sense that high school teachers must communicate with parents about school work, but for certain students that intervention is a vital part of short-term planning. Parents stay in the loop, aware within days if work falls behind.

The statement "he's fifteen and should take responsibility for his school work" doesn't always hold water. It doesn't have anything to do with "should." Either he can or he can't keep track of it. You can "should" him and yourself and his school all you want, but the only real solution creates an appropriate support system in the short term, and teaches required skills over time.

Teens require an opportunity to collaborate, to feel like they are individuals and are being heard, and they may rebel when too much is dictated about their lives. If a particular teen can handle their schoolwork, you can run with it, let him take responsibility and prosper. If he can't stay on top of things because of ADHD and executive function, then he can't.

What helped James get back on track? Offering controlled options, such as posing the question, "Which teacher would you like to work with?" instead of "Would you like to work with a teacher?" Moving some organizational help outside of regular school hours, with a tutor, because he didn't want to feel different during the school day. Making an end-of-day resource room part of his schedule, instead of voluntary. Giving direct instruction in organizational skills, instead of an open-ended study hall. His parents and teachers established a safety net that kept James on target, with a goal of handing him back responsibilities at a rate he could manage on his own.

Some children do lose motivation because they have been struggling for so many years. However, as motivation typically builds from success and a sense of mastery, the initial step to improved motivation is putting the right plan in place. The long term goal of independence doesn't change, but without the support network kids become overwhelmed.

As always, the bottom line is a compassionate and objective view of someone's real skills. We must seek a clear understanding of our teens' capacity to manage their lives, instead of leaving them to flail when they fall behind. We may have an entirely different picture of what a teenager ‘should' or ‘shouldn't' be doing in life, but reality may be different. Just because a student has entered high school doesn't mean they are ready to thrive on their own.

Mark Bertin, M.D.,is a developmental behavioral pediatrician, an assistant professor of pediatrics at New York Medical College, and the author of The Family ADHD Solution.

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