By Mark Bertin , M.D.
He’s failing two classes again. The teacher keeps telling me he isn’t handing in his homework. I go through his bag and there are blank worksheets. He thinks they might be work he didn’t finish in class, but he says he doesn’t remember. I have no way of knowing. There’s a missing piece of communication somewhere. Who am I supposed to ask?
For most children, school requires more executive function skills than other parts of their life. For starters, they must control their activity level enough to sit still, and they must deal with their impulses while listening and waiting their turn. They need to focus on their teacher, blocking out distractions in the room—as well as internal distractions, like thoughts of the new toy waiting at home.
They must find the ability to organize and process what they’ve heard, as well as to retrieve it, paraphrase it, and get it down on paper. And then as they get older, they are expected to keep track of assignments and books independently, manage their time, and plan ahead. It is no wonder many people in the field consider executive function deficits to be a learning disability on their own.
When ADHD is first identified, intervention often focuses on behavior management at school and at home. Initial interventions may be directed at impulsivity, fidgeting, daydreaming, and class disruptions. Children, especially those with hyperactivity or impulsivity, must be able to sit, focus, and control their impulses enough to participate.
They need to interact with peers and teachers appropriately. But then there are the equally pressing and less obvious issues such as scattered organizational skills, poor time management, and working memory deficits. Again, it’s not only the most obtrusive ADHD symptoms that matter.
ADHD isn’t an excuse for school problems or misbehavior, but it can be an explanation. Children with ADHD do not know how to keep track of their work, organize their time, or maintain effort. The overriding question should never be Why doesn’t he work harder? but, Since he doesn’t have this skill yet, what can we do to help?
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Mark Bertin is a board certified developmental behavioral pediatrician and author.
The above is an excerpt from his book The Family ADHD Solution Copyright 2011 Palgrave Macmillan.
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