Attention Deficit/“Goal-Getting” Disorder
High school ADHD, revisited.
Posted Apr 23, 2019
The older children grow, the broader the impact of ADHD. ADHD relates to executive function, a developmental path that matures into our 20s and supports self-management, planning and judgment. With aging, more overt behavioral symptoms of ADHD tend to improve yet ADHD-related impairments often increase. That’s because aspects of executive function like organization and time management become more central to their lives. By high school, core impairments around ADHD often impact not only goal setting but also “goal-getting” behaviors like persistence, planning, and foresight.
To properly support teens with ADHD, we need to reframe their challenges. Even when appearing unmotivated, they rarely are—they simply do not yet have the skills to identify and stick to goals. Additionally, schools today frequently demand early independence and self-advocacy, though these are late-developing skills for many students even without ADHD. Although those goals are worthy targets, someone with ADHD struggles even more than peers to support themselves in this way.
A “sink or swim” approach to teen ADHD—the assumption that someone who cares enough will push through and figure it all out—misses the reality of how ADHD impairs executive function. ADHD is a disorder of planning. Even someone who cares greatly about achieving goals requires compassionate support and direct instruction to thrive and become a strong and consistent self-advocate.
The Nuances of Motivation
Motivation itself is not as straightforward a concept as it seems for anyone, and with ADHD it becomes even more complicated. That’s because motivation involves both an intrinsic belief that our effort matters and the use of neurologically-based skills to achieve goals. ADHD can undermine both aspects of development.
The first part of motivation is how we more traditionally label it, the perspective we take toward challenges. This relates more recently to Dr. Carol Dweck’s idea of mindset—the belief that strong effort and learning from mistakes are how we progress. That mindset can be hard to maintain when someone grows up with deficits in executive function.
ADHD has been described as not a disorder of “not knowing what to do” but instead a disorder of “not doing what you know.” Even in early childhood, and certainly by high school, many children have spent years seeing exactly what they should be doing but falling short. And that experience, quite directly, undermines this aspect of motivation–as they continually fail to achieve goals, they lose faith in themselves.
Second, a specific cognitive skill set is needed for sustained goal setting and persistence. These are the actual mental abilities required to solve problems, persist when something gets difficult, and target long-term goals by establishing realistic steps and following through to fruition. These abilities are impaired by ADHD—because they all relate to executive function.
Even with a strong mindset, ADHD causes people to drift away from their plans. They know exactly what they should be doing, or hope to accomplish, but not how to make that happen. That is why ADHD affects not only academics but also relationships, sports, hobbies, and even physical health. Sticking to objectives requires specific cognitive skills that are undermined by ADHD.
Overcoming the effects of ADHD requires understanding this neurological disconnect. Quite commonly, ADHD symptoms get mislabeled as poor effort. Students with ADHD require meticulous support until they learn how to overcome these ADHD-related struggles and begin to show their true capacities instead.
Simply throwing a student into the proverbial deep end, expecting them to figure out how to persist through their ADHD, is not how most students learn to swim. At first, most teens with ADHD do not know how or when to self-advocate and call for help. They cannot identify the need to study, nor do they know how to study well. It is an all-too-common pitfall to assume that someone with impaired planning skills because of ADHD can plan their way around ADHD.
ADHD as Life Management Disorder
Success with ADHD requires seeing it not as an attention disorder but as a goal management disorder. Children, particularly those with ADHD, benefit from direct instruction whenever encountering a new topic or skill set in life. A foundation of mastery, whether around math and reading or around time management and organization, allows them to eventually take the lead. Structure created and maintained by adults, from parents and teachers to therapists and tutors, allows children to pick up stronger skills that one day will allow them to meet their potential.
Sometimes people voice concerns that adult supports become a “crutch” that children overly rely on, but this rarely happens. Our kids want to be autonomous and on their own—even when it doesn’t seem so in the short term. They learn directly from plans we develop and reinforce, whether for setting daily routines, managing a project, or organizing a research paper. Once they have the skills, they will show us and move themselves towards more independence.
The art of managing teen ADHD is getting “buy in,” while still sustaining routines and setting limits in age appropriate ways. We allow teens to explore and learn from mistakes up to a point, yet they rely on us for direction because we adults are the ones with mature executive function. Collaborate, offer choice, allow for independence—and at the same time set boundaries about what is acceptable in any situation. It can be a difficult balance to find with adolescents, as this is a dynamic, individualized process, not a clearly defined algorithm to follow.
Again, see ADHD first as a planning disorder. Some people learn to swim by being thrown in the deep end—most of us learn better by receiving instruction, using kick boards and floats initially, and being supervised closely until we’re strong on our own. The same applies for anyone with ADHD. Start strong, fade supports, and wait until you are confident your teen can swim in the stream of life on their own.
Do Nots of High School ADHD
- Do not provide only “open-ended” supports. Open-ended supports rely on goal-oriented behavior. An awful lot of planning and coordination is required to take advantage of offers like, “after-school help is available if you need it.” ADHD symptoms like distractibility, poor time management, and impulsiveness get in the way, as do other executive function-related planning abilities. Once a student shows their ability to access supports, let them run (or swim) with it; before that time, adults should initiate and schedule supports as needed.
- Do not presume a struggling student lacks motivation. It takes strong executive function to create and follow through with a plan when a problem arises, such as when a low grade is received in a class or on a project. Allow for learning from mistakes but also keep track of when to step in with compassion and direct supports. Forgetfulness is an ADHD symptom, not a sign that someone should care more about their school work; the solution to not handing in homework, for example, is most often a routine created and monitored by an adult for a stretch of time.
- Do not fall into the “gifted trap” by letting students coast. Some teens get good grades despite their ADHD, since ADHD primarily affects whatever tasks someone finds difficult. When academics come easily, it is easy to allow students to drift without strong academic skills. A student isn’t thriving if his or her grades could be even better except for careless mistakes and mismanagement due to ADHD. Equally important, as academic content and expectations expand, teens with ADHD eventually hit an academic wall when poor study habits and academic skills persist.
- Do not assume someone with ADHD will figure out how to manage their own ADHD—that’s the bottom line. When someone has a planning disorder, learning to swim on their own is not the most likely outcome. When a pattern of difficulty persists, collaborate and show them what works instead of hoping they figure it out on their own.
To-Do’s of High School ADHD
- Do collaborate whenever possible. Let teens take the lead in discovering what works for them through encouragement and discussion (which may need to be prompted by adults) — while also stepping in if some aspect of their plan is not specific enough or likely to work.
- Do teach teens how to organize their school work and time proactively. Expect them to make plans by prompting them (OK, but what time will you do your homework on Saturday?), and then support those plans. Keep a posted family calendar visible that you monitor together and show them how to break projects into day by day parts when they are assigned. Encourage them, over time, to write everything down (never keep track of scheduling or a to-do list in your head), and to use reminders consistently.
- Do create strong study habits. Make sure students have a specific plan at the start of any new class and when problems arise. Simple guidance in the fall can change the whole school year, for example: In Spanish, when you get a new worksheet, make flashcards and study them each night. Again, support and problem solve how to sustain that plan.
- Do teach writing skills directly. Research suggests that nearly half of students with ADHD could also meet criteria for a writing disorder. Narrative writing itself is an executive function-based task. Teaching students to organize their thoughts and outline is vital for those with ADHD.
- Do look for opportunities to support activities outside of school. Some students find activities they love and become engaged on their own, but since ADHD affects anything that requires persistence, planning, and long-term effort, many teens with ADHD give up on their extracurriculars too soon. Again, create practice routines and ask teens to commit to activities for longer stretches of time before giving up, to demonstrate the value of persisting and mastering something.
- Do look for opportunities to establish healthy lifestyle habits. ADHD has increasingly been shown to undermine health directly, since it gets in the way of sleep, exercise, nutrition, and screen time management. Set reasonable expectations, such as a “technology bedtime” (all phones to the charging station by a certain time) or setting a family expectation that everyone maintains some form of physical activity.