K: ADHD

MODULE K: UNDERSTANDING ATTENTION-DEFICIT HYPERACTIVITY DISORDER[1]

IN THIS MODULE:

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It is normal for children to sometimes have a hard time sitting still, paying attention, or controlling impulses.  As children mature, they typically get better at maintaining their attention.  What makes children with attention-deficit/hyperactivity disorder (ADHD) different from others is a matter of degree, where these abilities are behind their age peers.  Just as other children get better at managing impulses, attention, and physical movement as they grow up, kids with ADHD also get better over time, but they may lag behind their age peers.  There isn’t a “cure” for ADHD, only treatments.  Scouting can be a part of a youth’s life that supports appropriate development and helps the Scout become more effective at what he or she wishes to do.

What we think of as ADHD has three major attributes: inattentiveness, impulsiveness, and hyperactivity.  Each person’s challenge is different because these attributes have a different severity for each person and come in different combinations from one person to the next.   The total impact on someone’s life can vary a great deal from one person to another because the combined effects of different symptoms can be greater than the effect of each one alone.  For youth with ADHD, the problems are frequent and pervasive enough that they impact many aspects of daily life – school, home, Scouts, faith congregation, and community.

It is not our place as adults in Scouting to try to diagnose a Scout as having ADHD.  It is better to focus on behaviors and recognize when the behavior patterns point us to ways we can help the Scout and his family.  Since about 10% of the school population is affected by ADHD, it is a near certainty that there are some of these kids in every traditional Scouting unit.

Remember, Scouting does not have to be an all or nothing proposition. Depending upon the needs of the Scout and the intensity of symptoms, it may be appropriate for the Scout participate part-time, in just some of the unit’s activities, or to participate for only part of an event. Allowing this flexibility gives a Scout a chance to benefit from Scouting in the short run, while in the long run growing into a successful, continuing, and expanding involvement in the Scouting program. The approach works best when the family and unit leadership function as partners and communicate well.

Working with Scouts who have ADHD can be frustrating at times, but the rewards for both the Scout and the leader can be great.  It is often a trial and error process. Thank you for taking the steps that will allow more youth to participate in Scouting and benefit from the best the program has to offer.

COMMUNICATION

If you have not already done so, we strongly encourage you to stop and read Module F before continuing on with this module.  Module F tells you how to use a Joining Conference to begin the relationship with a Scout and his family.  It also explains the importance of ongoing communication with the family as the Scout moves through the program.  We do want to emphasize that in regard to ADHD it is important for all of us; adults in Scouting, family members, teachers, medical professionals, and therapists to think of ourselves as part of a team that supports this Scout.

TYPICAL STRUGGLES & BEHAVIORS

A person with ADHD (inattentive presentation) has many, but not all of these struggles:

  • Forgetful in daily activities
  • Easily distracted
  • Misplaces things
  • Avoids or dislikes tasks requiring sustained mental effort
  • Has difficulty with organization
  • Struggles to follow multi-step instructions
  • Has difficulty sustaining attention
  • Misses details – makes careless mistakes
  • Does not appear to be listening

A person with ADHD (hyperactive-impulsive presentation) has many, but not all of these behaviors:

  • Interrupts and/or intrudes often
  • Gets up from seat at inappropriate times
  • Fidgets and squirms frequently
  • Excessive running and climbing in young children; restlessness in older youth and adults
  • Moves and acts continuously, without pauses or breaks
  • Has difficulty engaging in activities quietly
  • Talks excessively
  • Blurts out answers before questions are finished
  • Has difficulty waiting and taking turns

EXECUTIVE FUNCTIONING

While most people know that the effects of ADHD can interfere with learning and self-control, they don’t know that people with ADHD often struggle with analyzing, planning, organizing, scheduling, keeping track of time and progress, and completing tasks. These kinds of skills are called “executive functioning” and are skills one needs to be productive[2].  While all children develop these skills gradually over time, this is another area where Scouts with ADHD are probably behind their age peers.

In the context of ADHD, the key elements of executive function are:

  • Self-awareness – knowing your feelings, thoughts, and actions; also recognizing how others see you
  • Self-restraint – controlling one’s self-directed attention and impulsivity
  • Holding thoughts to guide memory
  • Retaining directions and sequences
  • Awareness and regulation of emotions
  • Self-motivation
  • Planning and problem solving

While these executive functions are important for everyone, in Scouting they align with our “Be Prepared” motto, and our goal of building future leaders. Executive function skills are necessary for work and play.  They allow us to reach out, coordinate, and complete projects both jointly and independently.

You can support executive function skills in those with ADHD by:

Using Flexible Accountability – ADHD is not about the capacity to understand, it is about timing, sequence, and focus.  Use teachable moments, not punishment

Writing it Down – Use and encourage the Scout to use signs, lists, note cards, journals, charts and checklists – anything that makes information visual helps to build memory skills.

Making Time External – “Time blindness” adversely impacts planning, organizing, and self-regulation – use of clocks, timers, counters, verbal notice of time remaining or time elapsed supports independence and accountability

Making Motivation External – External forms of motivation – tokens, charts, and rewards – can be useful to establish a sense of self-motivation by reinforcing long-term goals with short term-rewards

Making Learning Hands-On – Doing is better than listening to instructions – physical activity helps to get knowledge into memory

Stopping to Refuel – Self-regulation and other executive skills can be depleted quickly. Frequent short breaks of 3-5 minutes, involving physical activity, hydration, and redirection can help internalize executive function skills

Model /Teach Pep Talks – Positive self -talk can help build self-regulatory skills – internalized “you can do this” statements aid in visualizing future rewards, as well as reviewing steps needed to achieve goals

Being Adaptable and Supportive – Making changes that will allow Scouts to show what they know – then help them understand what went right, what went wrong, and why

BEST PRACTICES FOR SCOUT LEADERS

Many ideas that work well for Scouts with ADHD will benefit your other Scouts too.

Take time to learn what triggers difficult behavior in them and what the Scout’s warning signs are.  If there is already a system that the family home or school use to help the Scout manage behavior, be consistent, and use the same system within the Scouting program.

Monitor the tone of the group and the interactions of individual Scouts. Make adjustments to the activity as needed.  In particular, be willing to take breaks.

Give advance explanation for activities.  Explain the overall goals, sequence of events, timetables, and give clear expectations whenever possible.  Teach youth leaders to do likewise.

Review directions with the Scout one-on-one or better yet, one on two.  Have the Scout’s buddy listen to the directions also.  This way the buddy can repeat instructions to keep everyone on track.

Use chunking to break tasks down into achievable smaller segments.

Encourage the Scout to repeat or restate the directions back to you.  Encourage the Scout to ask questions.  Mark off on a list or chart to visually show personal progress, even on small-scale multi-step tasks.

Stick to plans and routines as much as possible. Model and encourage youth leadership to do the same.

Prepare for transitions between tasks and activities. Give early warnings of change. A ten, five, and two-minute sequence is usually sufficient.  Stick to the timetable and be clear as to what is to follow.  If you have to change the plan, give advance notice as soon as practical.

Consider using a buffer activity like a water break, bathroom break, washing hands, or a quick game to divide larger activities at a transition.

Scouts with ADHD often have difficulty with unstructured time. It may be helpful if they can be given specific meaningful tasks during those times. Plan in advance to have some things available to do.

Be on the lookout to give genuine compliments, even for small things. Ignore minor inappropriate behaviors that are not disruptive or dangerous.

Make a plan with the Scout, so you can discreetly communicate that you are getting concerned about a behavior before it becomes a problem. This gives the Scout a way to self-regulate and develop self-control without being called out in front of the group or embarrassed. The agreed upon signal might be moving closer to the Scout, a gesture like tugging on your ear, or a noise like a pretend cough. Part of the plan can be an understanding that the Scout is allowed to break off from the activity for a while to regroup (self-removal) or is allowed to do a subtle physical activity, like pace in the back of the room.

Some Scouts may benefit from the use of a discreet fidget tool[3]. Directing them to use the tool in their pocket for a few moments, may be enough of a pause to enable them to return to the task at hand. It should be noted that these items are not toys and should only be used to relieve tension or anxiety often occurring in activities or long projects requiring sustained concentration.

Technology can be a useful[4]. Consider letting the Scout use a smartphone or other devices to make notes of step by step directions, set timers, receive reminders, and receive redirections (the vibrate setting can serve as an inconspicuous method to help a Scout get back on track). Noise canceling earphones or background music may be helpful to focus some Scouts. Scouts can be encouraged or redirected by a text message from the Scout leader.

Allow for frequent breaks and opportunities for purposeful movement. Be cautious of prolonged unstructured physical activity, this can easily lead to deteriorating behaviors and exhaustion. Scouts who have ADHD have as much difficulty regulating play as they do work.

IMPULSIVENESS AND ATTITUDE ADJUSTMENT

OK, this section title is a bit misleading, because the attitude that needs adjusting is probably yours and not the Scout’s. Do not take challenges personally – keep cool!  It is vital that the adults keep calm and carry on.  Some Scout leaders and Scout units place a strong emphasis on getting their Scouts to be respectful of adults and well-behaved.  With this viewpoint, it is easy to see the behaviors of ADHD through a lens of morality and judge the Scouts as disrespectful and disobedient.  This regrettably can lead to “disciplinary” actions that do not serve the aims of Scouting. The Corrective Action and Addressing Conflict and Self Removal sections of Module F have great advice on handling poor behavior.  If you have not read them, then do so before reading more here.

Scouts and Scouters with ADHD often possess great attributes, which when harnessed can be invaluable. Their energetic, clever, excited, happy-go-lucky, creative, enthusiastic, inquisitive, and spontaneous nature can be fun and make significant contributions to the success of your unit. The key to success in dealing with ADHD behaviors, as with many others, is to turn challenges into opportunities. Planning, observation, intervention, and redirection are important tools to support behavioral changes. 

While we want to embrace the positive behaviors, there will be some impulsive behaviors that are safety hazards and will have to be addressed.  Realistically, the leaders on an outdoor activity may need to keep a closer watch on things with a Scout with ADHD than would otherwise be needed.  It’s a little late to interrupt climbing to the top of a tree or running headlong through rough terrain after it has already happened. There are things you can watch for proactively, before trouble starts. Sometimes our Scouts with ADHD can unknowingly serve as the early warning system that it is time to change the pace of an activity for the whole group of Scouts.

Watch for these things for either an individual or the group as a whole:

  • Concentration – lost interest or hyper-focused
  • Distracted – focused on things other than the given task
  • Being Distracting – increased interrupting, walking about
  • Procrastination or Difficulty Getting Started – may indicate directions were not understood or remembered
  • Frustration – whining or destroying work may indicate the need for a break, review of the task, or breaking it into smaller segments
  • Fidgety Behaviors- may need a short break with physical activity or redirection. There is some evidence that physical exercise helps people with ADHD settle down.
  • Increased Impulsive/Aggressive Behaviors – poking, prodding, and invasion of others’ personal space most likely requires intervention or change of activity.

If a situation calls for immediate action and consequences are necessary, they should be prompt, proportional, and not reactive on the part of leadership. It is important to minimize the theatrics of the situation. Use a calm voice, limit verbal interactions, avoid yelling and public humiliation.  Cooling off time and spaces (self-removal) can be useful options.  The aim is to address the behavior and have the Scout rejoin the activity as soon as possible. This might happen during the current activity or may have to wait till the next event, depending upon the seriousness of the behavior and how long the Scout needs to regain control. 

ABOUT MEDICATION

BSA Risk Management has a guidance document on Medication Use in Scouting (BSA 680-036), which is a general document for all medications.  While medications are often part of an ADHD treatment plan, medication use can be complicated and we need to explain some details in this module.  If you have not experienced ADHD yourself or with a family member you may assume that medication will “fix” ADHD by itself, which is not true, and unfairly judge a parent if medications are not provided. It is not a Scout leader’s role to suggest or require specific treatment options, medications, and or diets.  With children, doctors may advise families to give the ADHD medications at some times of day and not at others, or to recommend periodic breaks from medication.  The benefits of using the medication are balanced against the overall health of the child.

Per BSA 680-036, “Parents are cautioned against using a BSA event as a “drug holiday” by suspending administration of medications taken regularly by their youth member unless there are specific instructions from a health-care provider.”  Unit leaders, families, and Scouts with ADHD need to communicate in advance about medication needs, including a need for a break.  Families should not surprise leaders by sending a usually-medicated Scout on an event without medication without prior notice.  Scout leaders need a chance to consider the length of the event and the activities that are planned in order to assess the risk to the Scout with ADHD and to others on an outing.  Leaders should look for accommodations like providing some extra supervision or the Scout participating for only part of the event.  If there is a situation where a Scout cannot be safely accommodated at an event unless medicated, the leaders need to explain it to the family in advance so they understand why and can consult their doctor.  Leaders also need to be sure that they make such decisions in the best interests of their Scouts and not primarily for convenience.

Revised 22 April 2020

[1] The Boy Scouts of America would like to thank the CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), chadd.org for reviewing the contents of this module for accuracy and usefulness.

[2] As a side note, executive functioning struggles are also a common feature of anxiety disorders, psychosis, some learning disorders, and autism spectrum disorders.  Some people have these struggles without having ADHD.

[3] Examples of fidget tools are a soft squeeze ball filled with sand or a couple of loose marbles contained in netting or small cloth sack.

[4] Youth protection rules for technology use would still apply. No inappropriate photo taking or recording. Text and email communications with the Scout must copy a parent or guardian as well.