School for School Counselors Podcast

What Schools Get Wrong About ADHD

• School for School Counselors • Episode 144

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We’ve got to stop calling it "defiance" when it’s actually dysregulation.

In this episode, we’re pulling back the curtain on what ADHD really is- and why the strategies we often use in schools aren’t cutting it. You’ll learn:

  • Why ADHD isn’t a behavior problem (and what it actually is)
  • The critical difference between knowing and doing
  • Why worksheets, clip charts, and “just try harder” don’t work
  • What school counselors can do instead to actually help

If you’ve ever had a student who “knows the rules” but can’t seem to follow them, this one’s for you.

And if you’re tired of seeing kids punished for things they haven’t learned how to manage yet?

You’re in the right place... Let's go!


Resources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Barkley, R. A. (1997). ADHD and the nature of self-control. New York, NY: Guilford Press.

Barkley, R. A. (2011). Executive functions: What they are, how they work, and why they evolved. New York, NY: Guilford Press.

Brown, T. E. (2013). A new understanding of ADHD in children and adults: Executive function impairments. Routledge.

Centers for Disease Control and Prevention. (2022). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), 27250.

Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D. E. E. A., ... & Rapoport, J. L. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the national academy of sciences, 104(49), 19649-19654.


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Speaker 1:

Let me tell you about a student named Mason. Mason is a fourth grader. He is very smart and hilarious, he cracks the best jokes and he loves talking about rocks all the different kinds of rocks, you name it. He knows about them. Just an overall delightful student, except for one problem.

Speaker 1:

Every week there's a new behavior slip, he's out of his seat, he forgets his homework or he talks non-stop in the classroom. Then the teacher comes to you and says hey, we got a problem with Mason and I think he might have ODD because he just does not seem to care about the classroom rules. But here's the thing that that teacher wasn't seeing Mason actually does care. Mason actually does care and he is trying really hard. But his problem isn't motivation, it's regulation. And in Mason's case, like so many other students on our campuses, what looks like defiance is really dysregulation. By mid-year Mason's grades are dropping. He's getting pulled from his specials classes. He's spending lunch in the office almost every week and something has to change. And when mom comes up to the campus to have a meeting, she says with her eyes full of tears he used to love school, but now he cries when it's time to go. Now Mason is a compilation of a lot of students that I've had over the years, but I'll bet as you're listening, the story reminds you of one of your own students. These kinds of situations hit hard because it's not just an issue of misunderstanding kids. Kids like Mason get trained in school to believe that they are the problem, and that's not okay with me. So today I'm really focusing on how we conceptualize and understand ADHD in our schools, Because if you've ever wondered why there's a student that knows better but still struggles to follow the expectation, or if you've ever felt stuck between what the classroom is expecting and what you know that student is capable of, this episode is going to be for you. Hey, welcome back to the School for School Counselors podcast. I'm Steph Johnson, a full-time school counselor, just like you, on a mission to make school counseling feel more sustainable and more enjoyable. I want your career to be rewarding. I want you to feel capable and confident every day you walk through those doors and not only work hard but enjoy the journey along the way. So let's just lay down the gauntlet at the get-go here and start with the most important thought first and I normally don't do it this way, but I need to make sure this is crystal clear ADHD is not a behavior disorder.

Speaker 1:

Adhd is a disorder of executive functioning, and that is a super important distinction. Executive function is like the brain's air traffic control system it helps us pay attention to the right things at the right time. It helps us tune out the distractions that might divert our attention. It helps us manage our impulses, start, maintain and finish tasks, regulate our emotions, organize our materials and even shift from one task to the next one. In kids with ADHD, that system doesn't develop at the same pace or in the same ways as neurotypical kids. So when you have a student that's blurting out answers every 30 seconds or leaving their seats 10 times in a class, or forgetting their folder for the third time that week, it's not because they're trying to push anybody's buttons. It's because the mental system that helps them regulate when and how to do those things is impaired. When and how to do those things is impaired. It's like trying to drive your car with GPS, but the GPS keeps cutting in and out. You know the destination you're headed toward, but you're constantly missing the turns, and then you get disoriented, you get frustrated and you might even give up on the trip altogether. That's what ADHD feels like for students in school and unfortunately, even though it's pretty prevalent, it's also still very widely misunderstood on our campuses, even when the adults on those campuses are the most well-meaning, empathetic people in the world. When we mistake dysregulation for defiance, we tend to respond with discipline instead of support, and then we end up chasing compliance instead of teaching capacity. That's a very important distinction.

Speaker 1:

According to the Centers for Disease Control, about one in 10 children in the US have been diagnosed with ADHD. I've seen numbers as high as 14%, and if you work on a campus that's a Title I campus or a campus with limited access to pediatric care, the actual number is probably higher. And when we're talking about girls, they are historically underdiagnosed. What that means to you as a school counselor is that many of the kids that you've been asked to see for things like anxiety or behavior or apathy may actually be walking around with undiagnosed ADHD, and the longer we miss that, the more shame they begin to internalize, because they begin to decide that that they're the problem and y'all. That's why our work matters.

Speaker 1:

In the DSM-5, which is the Diagnosis Manual for Mental Health Concerns, adhd is categorized into three presentations. One is the type of presentation that we normally see and can identify pretty quickly, and those are students who are predominantly hyperactive or impulsive. These are the kids that are constantly moving and fidgeting and squirming around. They're leaving their seat when they're supposed to be seated. They talk excessively. Sometimes they get so excited they start blurting out answers and they have difficulty waiting their turn. They're often interrupting others. That's what we generally conceptualize when we think about ADHD.

Speaker 1:

But there are other presentations too. One of them is predominantly inattentive. One of them is predominantly inattentive. These kiddos often fail to give close attention to the details. They have difficulty sustaining attention in tasks. They kind of wander off a little bit. They don't seem to listen. When we're speaking to them directly, it's almost like they're in another place. When we're speaking to them directly, it's almost like they're in another place. They're easily distracted and often forgetful in their daily activities. This is a type that we often see in these undiagnosed girls, because they are compliant, complacent and they're able to do just enough to get by. So they never really sound out the alarm bells for teachers.

Speaker 1:

And then the third classification of ADHD in the DSM-5 is a combined presentation, that's when students meet the criteria for both kinds the hyperactive, impulsive and inattentive and they meet those criteria for six months. Now there are other constraints to the diagnosis of ADHD as well, and we're not going to get into those because as school counselors, we don't diagnose students and we shouldn't be attempting to do that. But it's important to note that this kind of diagnostic criteria helps standardized identification. People often want a label to the situations they're seeing, right, but we also know, especially in our line of work, that students' symptoms can also be heavily influenced by context, environment and co-occurring conditions. That's why our observations and collaborative abilities as school counselors are so important to our schools.

Speaker 1:

Studies suggest that children with ADHD may experience up to a 30 percent delay in the development of the prefrontal cortex and if you remember from all your counseling courses, that's the part of the brain that is responsible for these executive functions that we've been talking about. That means a 10 year old might be functioning more like a 7 or 8-year-old when it comes to organization, impulse control and time management. Let's put that in perspective for a minute. 10 years old is the start of the fifth grade. 7 years old is the start of the second grade. If we take a student with second grade organizational skills or impulse control skills and put them in a fifth grade environment, they're gonna have some significant challenges right and when we're asking them to sit still, take notes, complete multi-step tasks and even manage their materials independently. If we do that without scaffolding, we are setting them up to fail, and I would bet that's a lot of what you're seeing with a lot of your so-called behavior problems on your campus right now.

Speaker 1:

So let's talk about how students perform in school versus what they know they're supposed to be doing, because that's one of the biggest misconceptions that you're going to find on a school campus that ADHD is about not knowing what to do. And the reality is that's just not true. It's not about not understanding the expectation. True, it's not about not understanding the expectation. It's about legitimately not being able to perform to that expectation. Dr Russell Barkley says ADHD is not a disorder of not knowing what to do. It's a disorder of not doing what you know. Think about that for a minute. What you know. Think about that for a minute Because that reframes almost every ADHD conversation that's happening in schools right now.

Speaker 1:

We have to understand that ADHD is a performance disorder, not a knowledge problem and not a behavior problem, and once we understand that that it is a performance disorder. We stop asking things like why are they doing this? I already told them what to do. And we start thinking what's getting in the way of them doing that right now? And what's usually missing is working memory inhibition or emotional regulation. It's not about motivation, friend. It's about timing and pressure and capacity, and it's a lot like the stories we often tell our students in our school counseling offices when we're explaining how the brain works and about how fight, flight and freeze work.

Speaker 1:

We've probably all shown our students the hand model of the brain, all shown our students the hand model of the brain, and we've probably all asked if I walked out in the hallway right now and saw a tiger or a bear getting ready to come after me, what would I do? Right, I know, I know you've had these conversations with your students, but turn it around on yourself. If I asked you to do a math problem while you're being chased by a bear, you might know how to do that math problem, but your brain isn't built to access that skill in a moment of high stress, and that's what ADHD feels like. If that classroom gets too fast or too loud or too unstructured, students cannot access the skills they need and really that kind of speaks to where things fall apart in schools. Because as adults we tend to assume that once we've taught the skill to the student, once we've explained the rule, handed out the worksheet, reviewed the poster even talked about coping skills or provided a worksheet about organization that students should now be able to demonstrate that behavior on demand. But when executive functioning is involved, that's not how learning works.

Speaker 1:

Putting a kid in a counseling small group and talking about setting goals is not the same as remembering how to set those goals in the middle of sixth period, especially when that class is going bonkers. It's the same with our behavior charts, our sticker charts, our token economies or our calm down corners. We're giving zero instruction regarding those and we're expecting kids to catch on, but without coaching or guided practice. These tools don't teach regulation Really, they just track dysregulation. And if we're getting real about this, they can also cause a lot of harm. Because if I'm a student with ADHD and I keep getting the same organization worksheet or I'm being admonished about, why didn't you go to the calm down corner? Why didn't you use your coping skills? What I start internalizing is I'm the problem. I already know what to do, but I keep messing it up. Something is wrong with me and over time that turns into shame and y'all.

Speaker 1:

We cannot shame kids into better executive functioning, we just can't do it. But we can scaffold them into it and lucky for us. This is where school counselors can really shine, because if ADHD students don't need the what to do as much as they need the how to do it, we can walk in and model how to use a checklist in the real environment. We can push into that classroom to support. We can assist the student in practicing emotional regulation before the blow-up happens. Or we can implement and support visual prompts or specific language or consistency in approach long enough that they can build the habit in all their classrooms.

Speaker 1:

Let me see if I can explain what I mean. Say we have a student who could explain the entire process for turning in their homework. This may or may not be my own child. She knows exactly where to turn this paper into. She can tell me exactly when she's supposed to go, where it's supposed to be turned in and how she's supposed to make it happen. She even had a reminder note taped to her folder, but every day, day after day, that paper stayed in her backpack because she just could not plan it out to make it happen. So we had to practice, we had to act out how that was going to go down. I had to really work on the praise part of the equation instead of the pressure, and we had to loop the teacher in so everybody was having the same conversation and after a couple weeks of doing that, not only has she turned in that one paper, but she was turning in all of her work, not because she finally cared more about it, but because she got a bridge from knowing to doing, but because she got a bridge from knowing to doing.

Speaker 1:

And that is what school counselors are best at. We should not be the perpetual behavior managers on campus. We're not the SEL worksheet team, but we are connectors and we can connect between understanding and application. And we can connect between understanding and application and we can connect between student need and the capacity of the adult in the room. So if you've ever had a student that seemed like they should know better, stop and ask do they actually have the skills to do better or are they stuck in that gap between knowledge and execution? And if it's a gap, then your job is not to remind and nag. It's to support and model and coach.

Speaker 1:

In our School for School Counselors Mastermind, that's exactly what we're working on right now. We're working on building Tier 2 interventions that go beyond behavior plans, collaborating with teachers in a way that does not alienate them and creating systems that support skill building, not just the tracking of the symptoms. Building, not just the tracking of the symptoms. We just held our ADHD supports and solutions masterclass and that replay is already in our mastermind classroom.

Speaker 1:

So if that's what you're needing, come join us, because I don't want you to have to figure this out alone. For your sake and for your students, this is too important to let it go. Hey, I'm so glad that you joined me in this episode. In the next one, I'm going to be talking about ADHD through a completely different lens and it might actually change the way you approach behavior. We're going to be talking about how this one thing hijacks behavior and how to help students that live in a perpetual fight-flight-freeze loop. You are not going to want to miss it and spoiler it's related to ADHD. If you enjoyed this episode, make sure you hit subscribe in your podcast player so you can get the next episode, lickety split, and until then, I hope you have the best week. Take care.

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Steph Johnson

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