Students with ADHD are tricky. Many appear to have the skills to do what is expected of them yet have so much trouble DOING what is expected of them. This is the hallmark of the ADHD condition. 

Being able to decipher between “ can’t do” and “won’t do” when it comes to classroom expectations is a slippery slope. Although it may be clear that the expected behaviors are not performed, it is often unclear whether the student does or does not have the skills to meet the expectations.

Performance difficulties seen in students with ADHD are often misunderstood as motivation deficits or worse as willful noncompliance resulting in damaging secondary complications. 

This post seeks to objectively clarify the difference between ” can’t do”, classroom challenges that are based on not having the skills/ability to perform and “won’t do” , classroom challenges that are based on lacking motivation or refusing to demonstrate/ utilize the skills or behaviors they already possess. Determining the “why” the student is having difficulty meeting classroom expectations is an essential first step in identifying and developing interventions that will appropriately target the student’s challenges.

Skill Based vs Performance Based

Students with ADHD may exhibit difficulties meeting expectations that are either skill-based or performance-based. In other words, either the skill may not be in the student’s repertoire (skill based) or the student may have acquired the skill but it is not performing it (performance based).

Many school-based professionals commonly make the mistake of confusing performance based difficulties as “won’t do’s”. Performance based difficulties are frequently misinterpreted as difficulty with motivation or worse, willful non-compliance.

Imagine this scenario.

A friend asks “ Can you ski? ”You answer “Yes” because you have gone skiing a two or three times”. Yes, you can ski. 

The friend then invites you to go on a helicopter to ski a Double Black Diamond this weekend. 

Do you go?

Not a chance. Why?

Even though you know how to ski, there is a vast difference between the performance expectations on a bunny hill then that of a double black diamond.

When a student has a ” skill deficit” they have not yet acquired the prerequisite skills to meet the academic, behavioral, social, or emotional demands of the environment. If a student does not have the required skills to meet the expectations, this is obviously a “can’t do” problem.  We would need to teach them the skills first. 

However, a child might appear to have the basic components of the skills but they do not possess the skill at the level of mastery required for the task in this time frame and under these circumstances creating a “performance deficit”.

There are different levels of skill performance that exist on a continuum in all physical, cognitive, and psychosocial skill sets, outlined below.

Novice: 

• Requires cognitive effort to complete the task
• Vulnerable to distraction
• Makes frequent errors
• Completes task slowly 
• Requires assistance 

Intermediate

• More independent but requires some cognitive effort to complete the task
• Performance is inconsistent
• May hesitate between steps
• Make fewer errors than a novice, fluency increasing
• Require supervision with instant feedback on performance 

Mastery 

• Independently with minimal if any cognitive effort to complete the task
• Fluent, does not hesitate between steps 
• Makes few to no errors
• Can multitask while doing the task

As you can see, a performance deficit, like your novice skiing ability, would still be considered a “can’t do”. We would still need to teach the child how to exhibit the expected behavior in this time frame and under these exact circumstances. Performance deficits are commonly misinterpreted as motivation deficits or willful noncompliance because the student is observed to perform the skill in one setting but not in another.

A Performance Deficit is Not a Motivation Deficit.

Some research states that you can determine between a skill deficit (can’t do) and motivation deficit (won’t do) by offering a highly tangible prize or providing strong incentives to perform the desired behavior.

What if you were highly motivated to ski the double black diamond.? I am going to give you a million dollars to ski it.  Would you, a novice skier, skiing twice at 15, now have the ability to ski the double black diamond?

Absolutely not. You might try, a million dollars is a strong incentive.

We can not improve your ability to ski with motivation alone. You do not have the adequate level of skills required to perform in that context, even though, yes, you can ski on a bunny hill. 

A performance deficit is not at all the same thing as a motivation deficit. While this example is painfully obvious, I see well intentioned teachers and therapists attempting to purely motivate novice students to enhance their classroom performance. You can not enhance the performance of a skill that does not exist.

Positive behavioral interventions including behavior contracts and reward systems are designed to enhance the performance of existing skills. Performance enhancement systems will not work if the child has not reached the level of performance required for the task. Increasing motivation and volition alone will not sustainably improve skill-based or performance-based difficulties meeting expectations. It will, however, set the child up for failure, shame, self-doubt, poor self-esteem, and poor self-efficacy.

Inconsistent Performance

Very often, we see students with inconsistent performance in handwriting legibility in the classroom environment. The student can form every single letter correctly, and at times they can write legibly but at other times, it is totally and completely a sloppy, illegible mess. 

Often, teachers, parents, and therapists judge this inconsistency as poor motivation or non-compliance. “They need to put more effort into their work” “They need to try harder“, or “They need to slow down and stop making careless errors”. However you want to wrap it up, the child’s motivation mistakenly becomes the problem and the solution.

To effectively decipher between skill-based, performance-based, and motivation-based classroom difficulties we need to consider the following questions.

1. What is the expected behavior?
2. Do they have all the skills required to meet the expectation?
3. Can they do it at the performance level required? 
4. Can they perform the skills across multiple settings and persons? 
5. Can they perform the skills without support or assistance? 
6. Can they perform the skill fluently, within the time frame provided?

Reteaching this child how to form letters would not improve their classroom performance, the student already knows ” how” to form the letters. The student has the basic components of the skill but requires more practice to move onto the automated mastery level of letter formation that some of the different handwriting tasks require. Copying a spelling word on a worksheet is the bunny hill compared to the black diamond requirements of writing a paragraph. 

Interventions for Performance-Based Difficulties

Performance-based difficulties require different interventions than skill-based or motivation-based difficulties. The below interventions are evidenced based and highly effective for students with ADHD.

1. Clarifying Expectations 

Students with ADHD struggle with the “where and when ” of performance. They have the knowledge, the disorder impacts performance. Students with ADHD may need performance supports to help clarify exactly how, where and when they need to do the thing that they need to do. 

• Provide visual models of the directions to refer back to support working memory 
• Provide finished product examples to objectify subjective expectations,  for example, a picture of what an organized desk looks like.
• Check for understanding when giving directions

Remove Extraneous Barriers that Impede Performance

A novice level student is prone to distraction, they take more time to complete tasks and need assistance. There are so many distractions in the school environment that make tasks harder to complete and the cognitive effort required is greater for students when the task is unfamiliar.

• Decreasing extraneous steps to the task. Simplify what is presented at one time.
• Decreasing physical distance during task completion, for example, having all supplies at the desk.
• Provide a quiet work environment or sound-blocking headphones.
• Cognitive offload steps to the environment

Scaffolding Supports to Increase Self Efficacy

Scaffolding is a teaching method that provides structured “assists” that can help an individual attain a new skill that may be just outside of their performance level.  The therapist/teacher provides external feedback at the point of performance and continually adjusts the level of help in response to the learner’s level of performance, lessening the level of support until mastery. In the classroom, scaffolding can include modeling a skill, providing hints or cues, and adapting materials or activities (Copple & Bredekamp, 2009).

Scaffolded Supports for Performance Challenges include:

• Explicitly teach the skill and expose students to options for increasing efficiency.
• Work with the student to determine a path to accomplish the task. 
• Modeling key skills while engaging with the student in the task.
• Demonstrate the task and prompt for self-monitoring toward completion
• Gaining and maintaining the learner’s interest in the task.
• Making the task simple.
• Emphasizing certain aspects that will help with the solution.
• Provide support for the child’s level of frustration.
• Use physical and visual elements, manipulatives, and visual aids together.
• Use mind maps, graphic organizers, and anchor charts to help students draw relationships between abstract concepts.
• Modeling in front of the class, since images and gestures will help paint a whole picture of the lesson.

Embed Prompts Within the Environment

Executive functions such as time management, prioritization, and organization are commonly underdeveloped in students with ADHD. The prompt is not to gain a reward or improve motivation, it is simply to remind the student to exhibit the behavior. And that can be extremely powerful. 

• Visual supports and visual schedules are examples of environmental prompts. Are there enough in the classroom environment to support the student? See how to measure up with this tool. 
• Strong classroom routines and procedures help support performance problems. Does the student require support to complete the classroom routines/ Can you support them? Use this tool to determine what supports are needed in the classroom routines. 

Summary 

ADHD is a disorder of occupational performance. The difficulty we see in the school setting is confusing as the student appears to have the knowledge or skill acquisition but it is unable to perform the skills in context. Performance difficulties ( can’t do) are commonly misinterpreted as willful noncompliance (won’t do) because the student is observed to perform the skill in one setting but not in another. Do not make this mistake.

Determine if the student has acquired the prerequisite skills to meet the academic, behavioral, social, or emotional demands of the environment in this time frame and under these exact circumstances.  

Performance enhancement systems like reward systems will not work if the child has not reached the level of performance required for the task. Therapists and teachers can effectively improve the classroom performance of students with ADHD by clarifying expectations, removing extraneous barriers, embedding prompts into the environment, and providing graded scaffolds to increase self-efficacy. 

Resources and Evidence  

Scott Bellini, Jessica K. Peters, Social Skills Training for Youth with Autism Spectrum Disorders, Child and Adolescent Psychiatric Clinics of North America, Volume 17, Issue 4, 2008, Pages 857-873, ISSN 1056-4993, https://doi.org/10.1016/j.chc.2008.06.008.

Toglia, J., Rodger, S., & Polatajko, H. (2012). Anatomy of cognitive strategies: A therapist’s primer for enabling occupational performance. Canadian Journal of Occupational Therapy, 79(4), 225-236.

Cognitive Offloading: Structuring the Environment to Improve Children’s Working Memory Task Performance Ed D. J. Berry, Richard J. Allen, Mark Mon-Williams, Amanda H. Waterman First published: 04 August 2019 https://doi.org/10.1111/cogs.12770

Barkley, R. (2016). Managing ADHD in School The Best Evidence-Based Methods for Teachers. Eau Claire, WI: PESI Publishing & Media.

Bryan, T. (1991). Assessment of social cognition: Review of research in learning disabilities. In H. L. Swanson (Ed.), Handbook on the Assessment of Learning Disabilities: Theory, Research, and Practice (pp. 285-311). Austin, TX: Proed.

U.S. Department of Education. (2008). Teaching Children with Attention Deficit Hyperactivity Disorder: Instructional Strategies and Practices. U.S. Department of Education. Retrieved from: http://www2.ed.gov/rschstat/research/pubs/adhd/adhd-teaching_pg3.html

Teach ADHD. (2013). Rethinking ADHD in the Classroom. Retrieved from: http://www.teachadhd.ca/abcs-of-adhd/Pages/Rethinking-ADHD-in-the-Classroom.aspx