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Everybody can have difficulty sitting still, paying attention or controlling impulsive behavior once in a while. For some people, however, the problems are so pervasive and persistent that they interfere with every aspect of their life: home, academic, social and work.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 11 percent of school-age children. Symptoms continue into adulthood in more than three-quarters of cases. ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity.

Individuals with ADHD can be very successful in life. However, without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries and job failure. Early identification and treatment are extremely important.

Medical science first documented children exhibiting inattentiveness, impulsivity and hyperactivity in 1902. Since that time, the disorder has been given numerous names, including minimal brain dysfunction, hyperkinetic reaction of childhood, and attention-deficit disorder with or without hyperactivity. With the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) classification system, the disorder has been renamed attention-deficit/hyperactivity disorder or ADHD. The current name reflects the importance of the inattention aspect of the disorder as well as the other characteristics of the disorder such as hyperactivity and impulsivity.
Symptoms
Typically, ADHD symptoms arise in early childhood. According to the DSM-5, several symptoms are required to be present before the age of 12. Many parents report excessive motor activity during the toddler years, but ADHD symptoms can be hard to distinguish from the impulsivity, inattentiveness and active behavior that is typical for kids under the age of four. In making the diagnosis, children should have six or more symptoms of the disorder present; adolescents 17 and older and adults should have at least five of the symptoms present. The DSM-5 lists three presentations of ADHD-Predominantly Inattentive, Hyperactive-Impulsive and Combined. The symptoms for each are adapted and summarized below.
ADHD predominantly inattentive presentation

Fails to give close attention to details or makes careless mistakes

Has difficulty sustaining attention

Does not appear to listen

Struggles to follow through with instructions

Has difficulty with organization

Avoids or dislikes tasks requiring sustained mental effort

Loses things

Is easily distracted

Is forgetful in daily activities

ADHD predominantly hyperactive-impulsive presentation

Fidgets with hands or feet or squirms in chair

Has difficulty remaining seated

Runs about or climbs excessively in children; extreme restlessness in adults

Difficulty engaging in activities quietly

Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor

Talks excessively

Blurts out answers before questions have been completed

Difficulty waiting or taking turns

Interrupts or intrudes upon others

ADHD combined presentation

The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.

These symptoms can change over time, so children may fit different presentations as they get older.
Confusing labels for ADHD
In 1994, the name of the disorder was changed in a way that is confusing for many people. Since that time all forms of attention deficit disorder are officially called "Attention-Deficit/Hyperactivity Disorder," regardless of whether the individual has symptoms of hyperactivity or not. Even though these are the official labels, a lot of professionals and lay people still use both terms: ADD and ADHD. Some use those terms to designate the old subtypes; others use ADD just as a shorter way to refer to any presentation.
Severity of symptoms
As ADHD symptoms affect each person to varying degrees, the DSM-5 now requires professionals diagnosing ADHD to include the severity of the disorder. How severe the disorder is can change with the presentation during a person's lifetime. Clinicians can designate the severity of ADHD as "mild," "moderate" or "severe" under the criteria in the DSM-5.

Mild: Few symptoms beyond the required number for diagnosis are present, and symptoms result in minor impairment in social, school or work settings.
Moderate: Symptoms or functional impairment between "mild" and "severe" are present.
Severe: Many symptoms are present beyond the number needed to make a diagnosis; several symptoms are particularly severe; or symptoms result in marked impairment in social, school or work settings.

As individuals age, their symptoms may lessen, change or take different forms. Adults who retain some of the symptoms of childhood ADHD, but not all, can be diagnosed as having ADHD in partial remission.
ADHD throughout the lifespan
Children with ADHD often experience delays in independent functioning and may behave younger than their peers. Many children affected by ADHD can also have mild delays in language, motor skills or social development that are not part of ADHD but often co-occur. They tend to have low frustration tolerance, difficulty controlling their emotions and often experience mood swings.

Children with ADHD are at risk for potentially serious problems in adolescence and adulthood: academic failure or delays, driving problems, difficulties with peers and social situations, risky sexual behavior, and substance abuse. There may be more severe negative behaviors with co-existing conditions such as oppositional defiant disorder or conduct disorder. Adolescent girls with ADHD are also more prone to eating disorders than boys. As noted above, ADHD persists from childhood to adolescence in the vast majority of cases (50-80 percent), although the hyperactivity may lessen over time.

Teens with ADHD present a special challenge. During these years, academic and life demands increase. At the same time, these kids face typical adolescent issues such as emerging sexuality, establishing independence, dealing with peer pressure and the challenges of driving.

More than 75 percent of children with ADHD continue to experience significant symptoms in adulthood. In early adulthood, ADHD may be associated with depression, mood or conduct disorders and substance abuse. Adults with ADHD often cope with difficulties at work and in their personal and family lives related to ADHD symptoms. Many have inconsistent performance at work or in their careers; have difficulties with day-to-day responsibilities; experience relationship problems; and may have chronic feelings of frustration, guilt or blame.

Individuals with ADHD may also have difficulties with maintaining attention, executive function and working memory. Recently, deficits in executive function have emerged as key factors affecting academic and career success. Executive function is the brain's ability to prioritize and manage thoughts and actions. This ability permits individuals to consider the long-term consequences of their actions and guide their behavior across time more effectively. Individuals who have issues with executive functioning may have difficulties completing tasks or may forget important things.
Co-occurring Disorders
More than two-thirds of children with ADHD have at least one other co-existing condition. Any disorder can co-exist with ADHD, but certain disorders seem to occur more often. These disorders include oppositional defiant and conduct disorders, anxiety, depression, tic disorders or Tourette syndrome, substance abuse, sleep disorders and learning disabilities. When co-existing conditions are present, academic and behavioral problems, as well as emotional issues, may be more complex.

These co-occurring disorders can continue throughout a person's life. A thorough diagnosis and treatment plan that takes into account all of the symptoms present is essential.
Causes
Despite multiple studies, researchers have yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. More than 20 genetic studies have shown evidence that ADHD is strongly inherited. Yet ADHD is a complex disorder, which is the result of multiple interacting genes.

Other factors in the environment may increase the likelihood of having ADHD:

exposure to lead or pesticides in early childhood

premature birth or low birth weight

brain injury

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

Previously, scientists believed that maternal stress and smoking during pregnancy could increase the risk for ADHD, but emerging evidence is starting to question this belief. However, further research is needed to determine if there is a link or not.

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:

watching too much television

eating sugar

family stress (poverty, family conflict)

traumatic experiences

ADHD symptoms, themselves, may contribute to family conflict. Even though family stress does not cause ADHD, it can change the way the ADHD presents itself and result in additional problems such as antisocial behavior.

Problems in parenting or parenting styles may make ADHD better or worse, but these do not cause the disorder. ADHD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved.

For more information on the following topics:

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About ADHD - Symptoms, Causes and Treatment - CHADD

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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting up to 11 percent of school-age children and many adults.

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ADHD symptom tests, ADD medication & treatment, behavior & discipline, school & learning essentials, organization and more information for families and individuals living with attention...

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ADHD is a common condition that makes it hard to focus, keep still, and think before acting. Some people with ADHD mainly have trouble with focus. (This is also known as ADD.) ADHD can also impact other skills, including managing emotions.

It's not clear exactly how many people in the United States have ADHD. But estimates are between 5 and 11 percent.

ADHD doesn't just go away as people get older. Most of the time, hyperactivity and impulsivity lessen or disappear by the teen years or a little longer. But trouble with focus usually continues. Some people aren't diagnosed with ADHD until after high school or as adults.

No matter when people are diagnosed with ADHD, there are treatments that can make symptoms more manageable. And there are supports that can make things easier at school and at work.

People with ADHD have trouble with executive function, which is the "management system" of the brain. Because of that, people with ADHD often struggle with:

Managing time

Getting and staying organized

Setting priorities

Planning

Managing emotions

Paying attention and remembering things

Shifting focus from one thing to another

Getting started on and finishing tasks

Thinking before saying or doing things

There's one confusing sign of ADHD. People who have trouble focusing most of the time can often "hyperfocus" on tasks or activities they find really interesting.

Signs of ADHD can pop up at any age. Kids can show signs as young as preschool. But many don't show signs until later on, as school gets harder and they have more to juggle. Some people don't realize that what they experience is ADHD until they're in college or working.

The research shows that brain development is very similar. But the areas involved in executive function take longer to develop in people with ADHD. That's why kids with ADHD may act one to three years younger than other kids their age. Research also shows some differences in how the brain functions.

These differences have nothing to do with intelligence. People with ADHD are just as smart as people who don't have it.

Researchers are also looking at the role of genetics. ADHD tends to run in families. A child with ADHD has a one in four chance of having at least one parent who has it. And there's a strong likelihood that another close family member also has ADHD.

There are no tests for ADHD. Instead, evaluators use a variety of tools to determine if a child has ADHD. One is a questionnaire about behavior. Another is a clinical interview.

Here are some types of professionals who may diagnose ADHD:

General health care providers, including pediatricians

Psychiatrists

Developmental pediatricians

Neuropsychologists

Psychiatric nurse practitioners

Clinical psychologists

There are a few types of treatment for ADHD. They include:

Behavior therapy: This type of therapy involves creating a rewards system for changing a child's behavior. It's different from cognitive behavioral therapy (CBT), which helps people look at their thoughts, emotions, and behaviors, and make positive changes. CBT may be helpful to some people with ADHD, but it's not a treatment for ADHD.

Alternative treatments: There's no shortage of companies that claim to have an all-natural fix to ADHD. Most have no evidence to back up their claims. Learn more about alternative treatments for ADHD.

ADHD doesn't go away. But with the right treatments and supports in school, at home, and at work, people with ADHD can thrive.

Understood is not affiliated with any pharmaceutical company.

Key takeaways

ADHD is a biological condition that can impact focus, organization, and self-control.

ADHD is not a problem of laziness or willpower.

With the right support, people with ADHD can thrive.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Thomas E. Brown, PhD has written many books on ADHD, including "Smart but Stuck: Emotions in Teens and Adults with ADHD." He's the director of the Brown Clinic for Attention and Related Disorders.

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What is ADHD? Use this ADHD guide to understand attention-deficit hyperactivity disorder and how people with ADHD (or ADD) can thrive.

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Attention-deficit/hyperactivity disorder (previously known as attention deficit disorder or ADD) is a neurobehavioral disorder characterized by core symptoms of inattentiveness, distractibility, hyperactivity, and impulsivity. ADHD is thought to be the most common childhood mental health disorder, with estimates of its prevalence in children ranging from 5 to 11 percent. ADHD in adulthood is thought to be less common, with approximately 2 to 5 percent of adults diagnosed.

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Getting a diagnosis is the first step in helping your child live an everyday life. I have experience with this clinic. They diagnosed my own child with ADHD, and I can attest that they are professional, thorough, and loving with your babies.

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Dr. Hufstedler - Psychological testing specializing in Autism Spectrum Disorder. New Patient openings are available weekly so families do not have to wait!

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Medication isn't always necessary to manage ADHD, but it can be helpful for some. If you're considering it, Dothan Behavioral has experienced doctors specializing in ADHD treatments and can guide you through your options to find what works best for your child.

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DBMC Trusted Behavioral Health - Dothan Behavioral Medicine Clinic

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Dothan Behavioral Medicine Clinic is the Trusted Choice in Behavioral Health serving the south alabama and Wiregrass for 20 years.

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If you do choose not to medicate for ADHD, there are several therapists in Panama City who are trained in CBT or cognitive behavioral therapy, which is the suggested type of therapy for ADHD students.

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Cognitive Behavioral (CBT) Therapists in Panama City, FL

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Find the Right Cognitive Behavioral (CBT) Therapist in Panama City, FL - Coleen L Hernandez, LMHC, MS; Morgan Baeder, LCSW; Linda Ebert, LCSW; Cathy Supon Connor, LCSW; Erin Bruner, LCSW; Catie Myers, LMFT, LMHC, LMFT, LMHC; Neda Koehnemann, PhD; Nancy Rawson, LMHC

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Being involved with the school your child attends is very important. Open communication about your child's disability can make a difference in their academic success. Bay District School is a wonderful school district that is prepared to help your child succeed. They are equipped with counselors who can get accommodations on a 504 or IEP, whichever is needed, and they will walk you through every step.

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Our goal is to help all Bay District students reach their highest academic potential. Learn about our specialized programs and services and discover how they can best help your child.

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Because hyperactivity is a symptom of ADHD, seating can be difficult. Flexible seating is an effective way to allow students with ADHD to listen to their bodies and still focus on what the teacher is saying.

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5 low-cost ways to create a sensory-friendly chair

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Learn simple and affordable ways to create a sensory-friendly chair for kids with sensory processing challenges or ADHD. Improve focus and comfort for your child with these five low-cost DIY sensory chair ideas.

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Brain breaks are great for ADHD students because they give them a chance to burn off extra energy and refocus. Taking short breaks helps them reset, feel less restless, and stay on track when it's time to get back to work.

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When you're creating a lesson plan or reviewing student work, do you often need a break? Do you take a walk or listen to your favorite song to get your mind refocused? Your students need these "brain breaks," too.

In the classroom, brain breaks are quick, structured breaks using physical movement, mindfulness exercises, or sensory activities. Brain breaks can be done individually (like deep breathing) or as a whole class (like a round of Simon Says). No matter what the form, brain breaks take only a few minutes of instructional time. They give your students a brief rest from what they're doing to help their brains shift focus and return ready to work and learn.

You can use different types of brain breaks depending on what a student needs at a given time. Remember that different brains need different kinds of breaks. For example, although it may seem counterintuitive, students who struggle with focus, attention, and hyperactivity may need more energizing breaks. Other students may need to quiet their minds. Here's a look at three examples of brain breaks.

Mindfulness brain break: Watch how students at the Momentous School take a break with "flower and candle" breathing. (If students are wearing masks in school, this brain break can be a good one to try at home.)

Sensory brain break: See the sensory path special education teacher Holly Barker Clay created to provide her students with a self-directed brain break.

Download: Brain breaks bank

Looking for brain break ideas? Check out this printable list of brain breaks organized by type and time of day. It was created by Understood Teacher Fellow TJ Thornton.

Create a list of brain breaks. Make sure to include independent, whole class, and self-directed breaks. Collect tools students can use for these breaks, like stress balls.

You may have planned for an energizing break. But if your students are overly energetic, you may switch to a calming break instead.

If a few students are having trouble with the brain break, use a prompt to get them back on track or model the activity by doing it near the students.

Some students will need modifications. For instance, students who have motor skills challenges may not be able to hop on one foot. Instead, have them jump on two feet, working their way toward hopping.

Some students might feel uncomfortable participating in group brain breaks. Decide on a nonverbal signal that students can use to subtly let you know they're opting out.

4. Talk about the experience. If this is the first time your students used a brain break, encourage them to talk about how the break helped. Explain that you'll introduce different kinds of brain breaks over time so they can learn the types of breaks that are most helpful for them. You can also talk about how students might take these breaks on their own, like when they're getting frustrated or distracted. Have self-directed activities available, such as sensory tools and a timer, so students can take individual breaks without disturbing others. You can even make self-directed brain break activity cards.

Understand: Why this strategy works

Students who learn and think differently sometimes get tired easily, have a low tolerance for frustration, or have trouble figuring out how to approach their work. Switching up what they're doing for a few minutes can help break those patterns. Research shows that brain breaks can serve that purpose and help refresh the mind.

For many students, movement is an ideal brain break. That's because exercise increases blood flow to the brain, which helps with focus and attention. In fact, research has shown that students learn more quickly after they've exercised. In one study, students learned vocabulary words 20 percent faster after exercising. Exercise also reduces stress and anxiety, making it easier to focus on important tasks.

Relaxing brain breaks have similar benefits. They help calm students and allow their minds to settle enough to shift focus. For students who get overexcited or who have a hard time self-regulating, relaxing brain breaks may be more beneficial than energizing ones. After these quieter breaks, students are able to return to work because they've given the overworked areas of the brain time to recharge.

Brain breaks benefit not only students but teachers, too. They help improve the pacing of your lesson while keeping you and your students refreshed, focused, and engaged.

Adapt: Use for distance learning

Build brain breaks into your distance learning lesson plans, including your synchronous online lessons. For example, breathing exercises may help students who are anxious about live video lessons.

Brain breaks can give students a chance to socialize during distance learning. You can use a fun discussion-based brain break in the middle of the lesson to get students engaged.

Encourage families to have their kids take breaks while they learn at home. To do this, you can add brain breaks to assignment directions. Give families the printable list of brain breaks or links to your students' favorite breaks on sites like GoNoodle.

Research behind this strategy

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Brain breaks: An evidence-based behavior strategy

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Brain breaks give students a chance to shift their focus and return ready to work and learn.

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The read-aloud accommodation was a game changer for my child with ADHD. This accommodation allows the students to go into a one-on-one or small group setting and read their test questions aloud.

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ERIC - EJ1091667 - Is Reading Tests Aloud an Accommodation for Youth with or at Risk for ADHD?, Remedial and Special Education, 2016

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In this study, we intend to determine if reading tests aloud provides a differential boost to youth with elevated symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) relative to same-aged peers. Participants were 36 youth, 44% with or at risk for ADHD, who participated in a week long summer camp. Over the course of the week, youth attended five 45-min classroom periods followed by 10-min tests. Participants were randomized into one of two conditions (i.e., read aloud and silent) that alternated across 5 days. Results indicate that reading tests aloud in small groups significantly improved the testing performance of youth with or at risk for ADHD and provided a differential boost relative to youth without ADHD. Implications for special education practice and future research are discussed.

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Extended time is a great accommodation for ADHD students because it takes the pressure off, giving them the space to focus without rushing. It lets them go at their own pace, making it easier to stay on task and catch mistakes they might otherwise miss.

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Have you ever been so immersed in something that you completely lost track of time? Maybe hours passed but it felt like minutes. This experience is often called time blindness, or challenges with time perception. Time blindness is common for people with ADHD.

Losing track of time can be fun. But it can also be frustrating if it happens a lot - or if it gets in the way of your goals. Learn more about ADHD and time blindness and strategies to work with it.

What is time blindness?

Time blindness is a term coined by Dr. Russell Barkley, a psychologist and ADHD-focused researcher. It's not meant to be a negative or demeaning term. Time blindness refers to an experience, common among people with ADHD, of not having a clear sense of time.

Dr. Barkley has also described time blindness as temporal myopia. This means nearsightedness when it comes to time. The farther away something is, the harder it is to get a clear picture of timing.

Brain differences in people with ADHD can make it harder to have an accurate sense of time. Some research points to executive function challenges. Other research suggests that time blindness is also related to differences in the cerebellum. This is the part of our brain that plays a role in how we perceive the passage of time.

Whatever the reasons, it's clear that people with ADHD don't struggle with time perception on purpose. It's not about just "trying harder." Coping with time blindness takes a combination of self-compassion, strategy, and effort.

How time blindness may show up in your life

Time perception challenges can show up in the lives of kids and adults with ADHD in lots of ways. Here are examples.

Productivity and task-switching: When you struggle with time, it's hard to get a series of tasks done in a way that others might call "productive." And it can take a lot of time and effort to switch from one daily task to another - like going from showering to breakfast to school or work. (A 10-minute shower could easily turn into 30 minutes.)

Relationships: Time blindness can make you seem out of rhythm with people who have a strong internal sense of clock time. You might be late often - or even too early. On the other hand, you may find it easy to connect with other people and go with the flow, without watching the clock.

Deadlines: You might wait until the last minute to work on something. That's because your sense of time may not kick in until it feels urgent. Or you may have trouble estimating how long something will take.

Being in the moment: Time blindness can make it easier to be fully present in the moment. That can make it hard to switch from one task to another. But the ability to "live in the moment" is a strength that lots of people strive for.

Strategies to cope with time blindness

There are tools that can help keep time perception challenges from getting in the way of goals and activities. Here are a few to try.

Visual reminders: Put clocks everywhere - in the kitchen, on your wrist, and in the car. Place a calendar with upcoming deadlines for the next month somewhere very visible.

Break down tasks: Many everyday tasks have multiple steps. One example is going grocery shopping. Break it down to include time to make a list, get ready, travel to the store, do the actual shopping, and get back home. This will give a more realistic time estimation for the whole task.

The Pomodoro technique: For tasks that need focus,try setting a timer for 15 minutes at a time. This is more manageable than focusing for a full hour. Then take a five-minute break before setting the timer again.

If 15 minutes seems too long, start with two minutes, and work upwards. (There are lots of free Pomodoro apps for both iOS and Android.)

Honest communication: Ask others for help, and be open about your challenges. For example, a person struggling with lateness might say to a friend, "It's not that I don't care. It's just that I don't have a strong sense of time. How about next time I text you when I leave the house, so you'll know when to meet me?"

Most importantly, practice self-compassion if you experience time blindness. Remember that it's a brain difference, and there are tools that can help you work with it.

Find out what else is under the surface when it comes to ADHD.Download this ADHD iceberg infographic to learn more.

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What is ADHD time blindness? Why do people with ADHD struggle with time perception? Time blindness means not having a clear sense of time. Get examples of time blindness and ways to help.

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Structure helps ADHD kids by providing a clear routine that reduces uncertainty, making it easier for them to focus, stay organized, and manage their time effectively

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Children With ADHD and Routines: Building Healthy Structures

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Discover the benefits of routines for children with ADHD. Learn how to create effective daily structures for improved behaviour and focus.

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Positive reinforcement works well for ADHD kids because it helps them stay motivated by focusing on what they’re doing right and making them feel good about their progress.

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Do rewards and punishments - standards in every neurotypical parenting arsenal - actually inspire better behavior in children with ADHD? What about positive reinforcement? The answers to these questions from parents and educators, like most things ADHD-related, are nuanced.

Science suggests that children with attention deficit hyperactivity disorder (ADHD) differ from their neurotypical peers in their responses to positive reinforcement and punishment. The central differences: Children with ADHD are not effectively motivated by promises (of privileges to be earned or lost); and positive reinforcement is particularly powerful, but also ephemeral, in ADHD brains. Researchers have made these conclusions after studying children's performance on cognitive tasks and monitoring their physiological responses.

Altered sensitivity to rewards and punishments may be a core characteristic of ADHD. Prolific research on how changes at the brain's cellular level explain individuals' responses to rewards may offer compelling clues to the neurobiology of ADHD, and they may suggest effective approaches to behavior modification for children with ADHD.

Dopamine, Rewards, and the ADHD Brain

In primates and rats, dopamine neurons in the brain get a boost when they are given an unexpected reward. When a reward is expected, after repetition and training, these dopamine boosts occur when the brain receives cues that predict the reward. This anticipatory dopamine boost helps to propel the action that will unlock the reward.

Similarly, it is hypothesized that neurotypical brains experience a surge of dopamine when they predict a forthcoming reward. This provides immediate and continuous reinforcement at the cellular level even when the reward is delayed or discontinued.
[Get This Free Download: 50 Tips for How to Discipline a Child with ADHD]
In children with ADHD, it appears, this process is incomplete. When rewards are slowed or stopped, there is a delay in the dopamine signal of the ADHD brain, which has an increased preference for immediate rewards. When rewards are withheld or efforts go unrewarded, the result is poorer learning and performance.

Positive Reinforcement Fuels Learning

Few behavior-management programs take into consideration how children with ADHD respond differently to rewards and punishments, and how to modify reinforcement accordingly. It's well-established that positive reinforcement increases performance across a range of cognitive tasks. Studies show that under continuous positive reinforcement, children with and without ADHD learn tasks more quickly than they do with less frequent reinforcement. When offered only partial reinforcement, children with ADHD show poorer sustained attention and demonstrate less predictable responses to tasks, the research shows.

In the absence of reinforcement, children produce fewer correct responses; they don't learn tasks as quickly or as well. Children with ADHD who are struggling to learn a task under these circumstances may feel increased frustration and simply stop engaging. This behavior may look like poor motivation, but it is actually a neurological response to poor reinforcement from caregivers and educators. With partial reinforcement, a child with ADHD may learn a task or skill more slowly - but they retain more of their learning for a longer time than with constant reinforcement.

Several studies also show that children with ADHD are less able to adapt to demands when expectations change ; when expectations are very clear, they are better able to meet demands. It is critical for children with ADHD to fully understand rules and expectations, especially when they change. Frequent reminders from caregivers and teachers can help.
[Read: It's Not Bribery. It's Brain Chemistry.]
ADHD Brains Prefer Immediate Rewards

In one study, children with and without ADHD were asked at the beginning of a task to choose between a smaller immediate reward and a larger delayed reward.The reward alternatives were available throughout the task, and the amount of time that the children had to wait for the reward varied.

The children with ADHD tried to wait for the larger later reward, but in the end, they were more likely to choose the smaller immediate reward. This suggests that children with ADHD are more likely to seek immediate and available rewards, particularly when frustrated or distracted.

This also suggests that children with ADHD may become more upset when they don't receive anticipated rewards, and they may give up more easily when tasks are perceived as too difficult. Teachers and caregivers should pay particular attention when the child's task persistence drops away and he begins to respond impulsively or become emotional.

There is evidence that punishment can keep a child with ADHD on task in the short term. Studies also show that children with ADHD are more sensitive than their neurotypical peers to punishment.

Punishment, or the perception of punishment, used to motivate children to learn or stay on task, may carry serious long-term consequences if the child's emotion regulation skills are weak. In most scenarios, positive reinforcement is a more effective motivator than is punishment.

Reward and Punishment: Better Strategies for Children with ADHD

1. Make sure that waiting times are within a child's capacity so that they can be successful in their efforts to wait. Consider building up a child's stamina for waiting. Start small and gradually increase waiting times, acknowledging and praising efforts to wait. Introduce strategies to make waiting easier, such as self-praise.

2. Bolster executive functions during transitions. Children who have ADHD often fail to meet behavioral demands or expectations, especially when transitioning from one activity or setting to another - and when rules are not obvious. Make sure students know the rules in different classes or settings. Praise them when they get it right and calmly remind them when they forget. Alert them when expectations change; give them time to adapt.

3. Match homework demands to a child's capacity. Many kids with ADHD are distracted by more immediately rewarding activities, or when they find the work too difficult. When the work is challenging, reduce the amount and duration of time spent on it, keep levels of praise high, and reward effort.
The content for this article was derived with permission from "From Research to Clinical Practice: Applying What We Know About Altered Reinforcement Sensitivity to the Management of ADHD" presented by Gail Tripp, Ph.D., at the APSARD 2022 Annual Conference.
Positive Reinforcement: Next Steps

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Sources
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Carrots vs. Sticks: The Science of Reward and Punishment for Children with ADHD

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Do rewards and punishments - standards in every neurotypical parenting arsenal - actually inspire better behavior in children with ADHD? What about positive reinforcement? The answers to these questions from parents and educators, like most things ADHD-related, are nuanced.

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ADHD coaching can be a game-changer for your child because it gives them practical tools to stay on track, manage challenges, and feel more in control of their day-to-day life.

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ADHD coaching is a relatively new field that has become more prominent in recent years. Coaching is an intervention that complements medication and other non-pharmacologic alternatives. As a specialty within the broader field of coaching, ADHD coaching is a practical intervention that specifically targets the core impairments of ADHD such as planning, time management, goal…

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Educate yourself on your child's disability so you can advocate for them and help them learn how to advocate for themselves

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Cultivating Compassion for the ADHD Child | Dr. Francine Conway | TEDxAdelphiUniversity

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Understanding and Supporting Your Student With ADHD

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Ep #41: How I coach parents of kids with ADHD

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NCMH (National Centre for Mental Health)