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Overcoming Executive Function Deficits With Students With ADHD

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Overcoming Executive Function Deficits With Students With ADHD

Joseph Johnsonab; Robert Reida
a
University of Nebraska-Lincoln, b University of Nebraska-Omaha,

Online publication date: 18 January 2011

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ADHD', Theory Into Practice, 50: 1, 61 — 67
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 Theory Into Practice, 50:61–67, 2011
Copyright © The College of Education and Human Ecology, The Ohio State University
ISSN: 0040-5841 print/1543-0421 online
DOI: 10.1080/00405841.2011.534942
Joseph Johnson
Robert Reid
Overcoming Executive Function
Deficits With Students With ADHD
Downloaded By: [Pennsylvania State University] At: 20:18 26 January 2011
Academic problems are common among stu-
dents with attention deficit hyperactivity disorder
(ADHD). One reason for academic problems
is the difficulties in executive functions (EF)
that are necessary for complex goal-oriented
behaviors. Students with ADHD often exhibit EF
deficits and as a result have difficulties with tasks
that require planning, organizing, maintaining
effort, and monitoring activities. This article
outlines how teachers can help students with
ADHD overcome EF difficulties and improve
their academic performance.
Joseph Johnson is a doctoral student in Special Ed-
ucation at the University of Nebraska–Lincoln and
Lecturer in Special Education at the University of
Nebraska–Omaha; Robert Reid is a professor of Spe-
cial Education at the University of Nebraska–Lincoln.
Correspondence should be addressed to Robert
Reid, 213L Barkley Memorial Center, Special Edu-
cation, University of Nebraska, Lincoln, NE 68583.
E-mail: rreid2@unl.edu
A TTENTION DEFICIT HYPERACTIVITY dis-
order (ADHD) is the most commonly diag-
nosed childhood disorder, with an estimated 3–
7% prevalence rate (American Psychiatric Asso-
ciation [APA], 2000). Students with ADHD often
experience serious academic difficulties. Their
skill levels are around two thirds of a standard
deviation below their peers in reading, mathemat-
ics, and spelling (Frazier, Youngstrom, Glutting,
& Watkins, 2007). They often have other school-
related difficulties that affect learning, includ-
ing problems with organization, attending class
unprepared, writing down assignments, bringing
necessary materials home to complete assign-
ments, turning in class assignments on time
(Gureasko-Moore, DuPaul, & White, 2007), and
are inconsistent and careless in their schoolwork
(Hinshaw, 2002). Around 50% of students with
ADHD qualify for special education services
(Barkley, 2006; Reid, Maag, Vasa, & Wright,
1994). These students most often receive services
under the learning disabled, emotionally dis-
turbed, or other health impaired categories (Sch-
noes, Reid, Wagner, & Marder, 2006). Although
the exact cause of the academic difficulties asso-
61
 Current Perspectives on Learning Disabilities and ADHD
ciated with ADHD is not known, evidence points
to problems with executive functions (EFs) as a
contributing factor.
EFs are cognitive processes necessary for
complex goal-directed behavior (Loring, 1999).
EFs include metacognitive knowledge regarding
strategies and tasks, attention and memory sys-
tems that support these processes (e.g., working
memory), and self-regulatory processes such as
planning and self-monitoring (Meltzer, 2007).
Students with ADHD often have EF deficits (Bie-
derman et al., 2004). This is a serious concern
because EFs involve planning, organizing, main-
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taining effort, and monitoring activities (Meltzer,
2007), all of which are necessary for academic
success. Not surprisingly, EF deficits can nega-
tively affect academic performance (Clark, Prior,
& Kinsella, 2002). EF deficits are a primary char-
acteristic of ADHD in current theoretical models
(e.g., Barkley, 2006) and there is good reason to
suspect that EF deficits play a significant role in
the academic problems of students with ADHD.
In this article, we discuss three EF problems
directly related to academic success: (a) adopting
a planful, strategic approach to academic tasks;
(b) goal setting; and (c) persistence or maintain-
ing effort on a task. In the following sections, we
describe the problems experienced in these areas,
and how teachers can effectively address the EF
deficits.
Developing and Deploying Strategies
Problems with organization and adopting a
thoughtful reflective approach toward tasks are
symptomatic of ADHD (APA, 2000). Because of
problems with impulsivity, students with ADHD
rarely take the time to plan an activity. They
seldom analyze a task to determine the behav-
iors needed to complete the task, and also may
be unable to effectively combine the behaviors
needed to accomplish a task (Barkley, 2006). For
example, Jacobson and Reid (2010) asked high
school students with ADHD to plan and write
an essay. Even when the students were explicitly
cued to plan their essays, and were provided with
a paper and pencil to use to plan, the students
62
instead immediately began to write their essays.
None of the students engaged in any planning
whatsoever. Students with ADHD also have dif-
ficulty developing an effective strategy to attack
a task. Kliegel, Ropeter, and Mackinlay (2006)
asked 20 children with ADHD to develop a plan
to complete some computer games, to review
and remember their plans, and then implement
the plans after a short break. All of the students
with ADHD claimed to have developed a plan
to complete the computer games; however, only
three students were able to develop an effective
plan, and only six students actually followed the
plans they developed. Thus, even when students
with ADHD have formulated a plan, they may
not actually use the plan. This impaired ability to
plan and develop effective strategies for academic
tasks contributes to students’ academic difficul-
ties.
Just as they are inefficient planners, students
with ADHD are inefficient strategy users; they
have difficulty selecting effective strategies and
applying strategies to various tasks. Students with
ADHD are less inclined to use strategies sponta-
neously when given a task (Hamlett, Pellegrini, &
Conners, 1987). For example, in a recall memory
game, students with ADHD were asked to study
some cards for a few moments and then tested
to see how well they recalled the location of
matching cards. Students with ADHD not only
performed poorly in their recall efforts, their
attempts to explain the game to an imaginary
peer showed a lack of strategy use. Students
with ADHD also tend to avoid strategies that
are effortful (O’Neill & Douglas, 1991). When
given a choice of strategies, they will most often
choose the strategy that is the easiest, but that
may also be the least effective. For example,
when asked to remember and summarize a story,
students with ADHD tend to choose skimming
as their strategy as opposed to a more effort-
ful but effective approach such as rereading or
taking notes (O’Neill & Douglas, 1991). When
tasks call for pronounced and continued strategic
processing, the deficit in strategy use for ADHD
students becomes even more obvious (O’Neill
& Douglas, 1996). For example, when asked
to memorize word lists, students with ADHD
 Johnson and Reid Overcoming Executive Function Deficits With Students With ADHD
often chose single-word repetition, which does
not require a great deal of cognitive effort but
which is not as effective for memorizing many
different words, rather than the more elaborative
rehearsal-style strategies such as grouping similar
words into sets and repeating the sets. Even in
tasks that feature an obvious strategy for optimal
success, these students struggle. Kofman, Larson,
and Mostofsky (2008) found that students with
ADHD had great difficulty discovering an obvi-
ous strategy for maximizing points on a copying
task consisting of high- and low-value items. In
that instance, the students could have scored the
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most points simply by focusing on the high-
point problems, but the students with ADHD did
not discover that simple strategy on their own.
Clearly, students with ADHD have problems with
strategy use.
Teachers can help students with ADHD over-
come their deficits with planning and strategy
use by providing direct instruction in planning
and using strategies. Many strategies actually
combine planning and task-related strategies, and
all strategies provide step-by-step algorithms for
accomplishing academic tasks (Reid & Liene-
mann, 2006b). Effective strategy instruction for
students with ADHD should: (a) directly and
explicitly teach the steps in the strategy, (b) pro-
vide students with information on the value of
the strategy (e.g., why use the strategy, how
the strategy helps), and (c) continue until the
student has mastered the strategy and can use it
independently. A study by Reid and Lienemann
(2006a) demonstrates how these steps can be
accomplished in practice. The study involved el-
ementary students with ADHD who were taught
the POW C WWW, What D 2, How D 2
strategy for narrative writing. POW–(Pick your
ideas, Organize your thoughts, and Write and say
more) serves as a planning strategy, used before
beginning to write. WWW, What D 2, How D 2
(Who, Where, When, What do the main charac-
ters do? What happens next? How does the story
end? and How do the characters feel?) is used
to help students organize their story and ensures
that the students include all of the parts of a story.
In the initial lesson, the instructor introduced
the strategy and explained how it could help the
students improve their ability to write stories.
Each part of the strategy was explained so the
students could understand what it involved. Stu-
dents practiced saying the steps and what was
involved at each step. The instructor informed
the students that they were expected to memorize
the steps of the strategy and that they would
be quizzed on the steps in the next lesson.
To help them learn the steps of the strategy,
students were given a prompt that listed the
steps and what was involved at each step. In
subsequent lessons, the instructor continued to
discuss the strategy with the students, reviewing
the steps and requiring the students to verbally
demonstrate that they knew the strategy steps
and what each step required. To provide stu-
dents with an understanding of the value of the
strategy, the instructor explicitly remarked how
using the strategy helps to write a good story.
For example, the instructor commented on how
using the WWW, What D 2, How D 2 ensures
that all the parts of a story will be included. More
general information would also be included; for
example, the instructor noted that planning the
story in advance makes it easier to write a
good story. In subsequent lessons, the instructor
worked collaboratively with students to practice
using the strategy to write a story. The instructor
provided support and feedback as needed. This
practice continued until students were able to
use the strategy independently. After instruction,
students were able to independently plan and
write stories that, compared to baseline, were
longer, more complete, and of higher quality. Ef-
fects were maintained over a 3-week maintenance
period; however, long-term maintenance was not
assessed. The results of this study suggest that
when students with ADHD are taught planning
skills and strategies, and provided proper support
and guidance, they can use a plan effectively and
use strategies. This, in turn, can improve their
academic performance.
Goal Setting
Problems with goal related behaviors are com-
monly associated with ADHD (Barkley, 2006).
63
 Current Perspectives on Learning Disabilities and ADHD
Students with ADHD may be unaware of the
goal associated with an academic task or may
also have difficulty remembering goals (Barkley,
2006). Further complicating their difficulties with
goal setting is the fact that, rather than focusing
on task-specific goals, students with ADHD may
have an orientation toward maladaptive goals
that can serve to inhibit performance. Some stu-
dents with ADHD actually exhibit performance-
avoidance goals, namely to avoid demonstrating
incompetence (Barron, Evans, Baranik, Serpell,
& Buvinger, 2006). If students’ goals are to avoid
showing what they do not know or cannot do,
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they are not concerned with accomplishing tasks.
Rather, they are concerned with avoiding being
judged for their perceived lack of ability. This is
a serious problem for students with ADHD, be-
cause goals serve important functions. Goals help
to guide behaviors, provide feedback on progress,
and enhance motivation (Schunk, 1990). Without
a specific and appropriate goal in place, students
with ADHD will struggle to direct their behaviors
in an appropriate and productive manner. Ad-
ditionally, there is evidence showing that goal-
setting can improve the academic productivity of
students with ADHD (Konrad, Fowler, Walker,
Test, & Wood, 2007).
Goal setting can be taught in much the same
manner as teaching a strategy. Teachers need to
explain the importance of setting goals, require
that the students set goals, and provide students
with the means to monitor their progress toward
their goal. When instructing students on how
to set goals, teachers should remember that the
most effective goals are those that are specific,
proximal, and moderately challenging (Bandura,
1988). A specific goal is to get 10 math prob-
lems solved correctly in 5 minutes, as opposed
to doing a good job on the math problems.
Specificity is required to determine objectively
when a goal is met. A proximal goal is one that
can be accomplished in a reasonably short time,
such as a day or two, rather than a week or a
month. Proximal goals are critical for students
with ADHD, as these students often need more
frequent reinforcement. A moderately challeng-
ing goal is one that provides sufficient challenge
to a student so that it cannot be achieved too
64
easily. An easy goal does not serve to maintain
a student’s motivation.
One way educators can foster goal-setting
practices is by incorporating goal-setting into
task assignments. For example, Lienemann and
Reid (2008) used goal-setting as a component
of essay writing. The instructor discussed the
importance of including all the parts of an es-
say. Students were encouraged to set a goal of
including all eight parts in their essays. Students
were provided a graph numbered from 0 to 8.
The instructor explained that after each essay
the students wrote they would count up the
number of essay parts included and color in
the graph. The graph allowed students to chart
their progress toward their goals. In practice, this
graphic feedback proved extremely motivating to
students who took great pride in including all
essay parts. A more elaborate example is a study,
involving five 6th-grade students with ADHD,
that included defining target behaviors, setting
goals, and negotiating reinforcement for attaining
goals (Barry & Messer, 2003). The students set
goals for their academic work and behaviors, and
then monitored them at set intervals during the
day. The students were rewarded for accurate
self-assessment and for reaching their goals. All
of the students improved the percentage of work
completed and the percent correct. The interven-
tion took only 20 minutes to initially introduce,
and then a few minutes each day for providing
feedback and checking the accuracy of the self-
assessment.
Persistence
Students with ADHD often struggle with
sticking to it. They lack persistence and quit
significantly more often than their non-ADHD
peers, especially when they encounter difficulties
with a task. For example, when students with
ADHD were asked to do simple word-finding
puzzles, some of which were solvable and some
of which were not, the students with ADHD gave
up much more often than those without ADHD,
regardless of the difficulty of the puzzle (Milich
& Greenwell, 1991; Milich & Okazaki, 1991).
 Johnson and Reid Overcoming Executive Function Deficits With Students With ADHD
This finding suggests that a task posing even a
small amount of challenge may cause a child
with ADHD to quit. In part, this may be due to
problems with regulation of emotion caused by
frustration (Walcott & Landau, 2004). Students
with ADHD report less mood repair when they
experience frustration (i.e., they did not attempt
to overcome their feelings of frustration), which
makes it more likely for them to give up on a
task when they began to feel frustrated (Scime
& Norvilitis, 2006). One source of frustration
is lack of progress monitoring (Barkley, 2006).
Students with ADHD are often unaware of their
Downloaded By: [Pennsylvania State University] At: 20:18 26 January 2011
progress (or lack of progress) on a task. This,
in turn, can lead to unrealistic appraisals (either
positive or negative) of their performance that
result in frustration that can negatively affect
persistence.
There are several effective methods to help
students with ADHD persist at academic tasks.
First, teachers can help reduce frustration by
ensuring that students have sufficient instruction
and opportunities for practice to enable them
to successfully master the skills needed to per-
form a task. Along with this, teachers should
work to instill a can do attitude. That is, the
teacher should stress that if students work hard
and apply the skills they have been taught,
they will be successful. Enhanced self-efficacy
could help improve persistence. Another way
to promote persistence is by teaching students
self-monitoring strategies that can increase their
academic performance (Reid, Trout, & Schartz,
2005). Self-monitoring involves self-assessing
academic performance or behavior (e.g., number
of correct answers, whether the student was
attending to task) and self-recording the results
(Reid, 1996). For example, Reid and Lienemann
(2006a) used self-monitoring to help students in-
crease the length of their stories. The teacher first
discussed how longer stories are more interesting,
then showed students a graph of the number
of words in stories they had previously written
and explained that after each story the students
wrote, they would count up the number of words
written (self-assessment) and graph the results
(self-recording). This process allowed students to
compare current and past performances and pro-
vided feedback on improvement. Self-monitoring
proved highly motivating to the students and
helped to improve the length of their stories.
Self-monitoring can also be combined with
goal setting. Ajibola and Clement (1995) asked
six students with ADHD to participate in a tutor-
ing class as employees. As part of the tutoring
class, the students set goals for the number of
reading problems they hoped to complete, and
self-monitored the number of reading problems
they completed. Each time they answered a read-
ing question, they would give themselves one
point. At the end of the tutoring session each
day, they received a tangible reward for reaching
their goal. This intervention led to significant
improvement in academic performance.
Conclusions
Students with ADHD often display EF deficits
that negatively impact their strategic planning,
goal-setting, and persistence. Deficits in these
areas can be detrimental to academic success.
Educators should approach instruction for stu-
dents with ADHD with these deficits in mind.
We recommend teaching students with ADHD
specific academic strategies, including planning
and organization strategies. Strategies should be:
(a) linked directly to the curriculum, (b) taught
systematically and explicitly, and (c) supported
through the use of scaffolding and collaborative
practice (Meltzer, Pollica, & Barzillai, 2007).
Goal-setting should be explicitly incorporated
into academic activities. Teachers should directly
note the goals for some tasks (e.g., writing a story
with all the parts, or remembering the main idea
of a chapter) and help students set their own
goals for others (e.g., get 80% correct on the
weekly spelling test). Teachers should also help
students monitor performance and make progress
toward goals salient (e.g., progress charts). Ide-
ally, making goal setting an integral part of
all assignments can help students with ADHD
make setting goals habitual. Finally, using self-
monitoring or other techniques that help to make
students aware of their performance can help
these students become more persistent on their
65
 Current Perspectives on Learning Disabilities and ADHD
academic tasks. Note that self-monitoring can
easily and effectively be combined with goal
setting. None of these techniques used to address
these problems requires significant extra effort on
the part of educators, and all of these techniques
can also be helpful for other students with or
without learning problems.
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