1011 Parkside Commons, Unit 101, Greensboro, GA 30642

Front Desk: (706) 454-1210

Lake Oconee Pediatrics

SINCE 2006 | THE LAKE AREA'S 24-HOUR PEDIATRICIAN

ADHD PATIENT INSTRUCTIONS

Guide for Attention and School Problems

Contrary to popular opinion, pediatricians and other physicians do not routinely “throw every child on medicine” when school problems are noted.  Attention Deficit Hyperactivity Disorder (ADHD) is a serious diagnosis that we make only after very careful history taking and consideration of other possible diagnoses. And even then, medication is rarely our first treatment step.  The following is a list of recommendations for children who have trouble concentrating or finishing their schoolwork.  


  • Establish a consistent, predictable routine with clearly defined, realistic expectations or rules.
  • Rules should be limited to only those which are essential.
  • The consequence of rule infraction should be immediate and short-lived.
  • Minimize discussion or "moralizing" of broken rules. There hsould be negotiating. Management should be "cut and dry" and with as little emotional reaction as possible.
  • Announce consequences of undesired behavior in advance.
  • Praise, often and immediately for even slight progress.
  • Use touch to establish contact for communication.
  • Communicate in simple, short sentences.  Avoid multi-stepped directions or give the steps to the child privately at a pace he can handle, with minimum distractions.
  • Avoid constant nagging.
  • Provide outlets and setting for the release of excess energy.
  • For younger children, allow only a few toys out at a time and limit the number of friends visiting at any one time.
  • Intervene before the child becomes overly excited.
  • Lastly, remember to praise often and immediately, even for minor progress.\


When studying at home or school:

  • Good study habits are essential.  Do not attempt “cramming” with a child who has attention problems.  Daily brief reinforcement of material will ensure mastery.
  • Use “quiet” décor, dull lights and subdued colors.
  • Provide non-moveable furniture whenever possible.
  • If the routine must be altered, discuss and clarify the changes in advance in order to allow time for the child to adapt. Try to be physically close to the child when changes are implemented, to be available for immediate feedback. Do not allow the child to become fatigued.  Whatever internal control he/she has developed will likely break down under conditions of fatigue or exhaustion.
  • Develop a special signal that will remind the child when his/her attention is wandering, when he/she is off task.
  • Avoid, whenever possible, environments which nurture disorganization or in which children with high activity levels are not tolerated. This is especially important when the child has been working hard or is tired.  These environments may include assemblies, formal gatherings, cafeterias, buses, parties and supermarkets.  If these situations cannot be avoided, provide structure and control by remaining in close proximity to the child and utilizing management methods discussed above.
  • School worksheets can be cut into several sections or the child can be instructed to bring his/her paper to the teacher/parent when a certain point is reached.  Worksheets should be highly structured with minimal extraneous (distracting) information.
  • The child should be allowed and assisted to make check lists which break down larger, more complicated tasks into their smallest components.  Praise when items are completed and checked off.
  • Avoid tedious repetition for the sake of repetition.  Once the child has mastered a concept, take a short break and then move on.
  • Use as much one-on-one or small group instruction as possible.
  • Intersperse short concentrated work periods (in general, these children tolerate only 10-20 minutes in one place, on one activity at any given time) with short bursts of less demanding, preferably physical activity.  This will help to relieve tension and frustration and may be utilized in a reward system for completed work to provide motivation.  Such motivators might include allowing the child to erase the blackboard, open windows, run an errand or spend 5 minutes at a preferred activity (coloring, etc).
  • Provide a quiet workspace at home which is free from distractions. In the classroom, preferential seating should be provided. The student should be seated near the teacher, where his/her attention can be more easily captured and held.  Proximity to the teacher also allows for clarification of directions, frequent learning checks, and reinforcement of on-task behaviors. A preferred seat is the front corner desk, away from the window and door.  There, visual distractions such as classroom activities and other students can be kept behind the distractible child and the number of stimuli between him/her and the task at hand (the teacher, the blackboard, the page) can be limited.
  • Use a cubicle or study carrel whenever possible to minimize distractions.
  • Some children with attention deficits might benefit from a behavior modification (or cognitive training) program in which they are rewarded for increasing their on-task time.  Determine a reasonable time span for the student and assign a quantity of work that can be successfully completed in that time.  A timer might be used to help the student keep track of the time, or it might be effective to set the timer to ring at certain intervals, with points earned for being on-task when the bell rings. Grades could include bonus points, or rewards given for starting or finishing the task within the specified time limit.  These kinds of programs are most effective if the child actively participated in planning the tasks and rewards.