Students with ADHD have significant difficulty with self-control which impacts their functional performance in the classroom. Many find it impossible to sit still, constantly moving, and are often out of their seats. Many speak without thinking, blurt out the answers, and frequently interrupt. They often start work without reading the directions, appear to rush through work “carelessly” and hand in schoolwork without checking it. These students may snatch a toy that another child is playing with, struggle with being patient, and have intense reactions to seemingly minor events.

Children with ADHD have significant difficulty controlling their immediate responses to situations. Students with ADHD have poor impulse control. They act before they think and have a compromised ability to modify behavior based on future outcomes and consequences. Because of this, they are often seen as aggressive, disrespectful, or defiant. Too often the child’s inability to incidentally learn a skill that may come naturally to most is viewed as a moral defect rather than a skill deficit.

Teachers and caregivers spent a significant amount of time redirecting these students.

If a child would only respond to these daily, repetitive prompts with one simple word.

HOW?

What would be your answer? Looking back, my answer (although not asked) has been nothing more than a compassionate restate of the expectation of “ what to do”.

“ Next time, just don’t interrupt while the teacher is talking.” Unfortunately, this is not a solution.

ADHD is a disorder of performance, not knowledge. Research suggests that students with ADHD can often verbalize the rules but have difficulty internalizing them and translating them into thoughtful behavior. They know what to do, they just don’t know how to do it.

Teachers, therapists, and parents teach. We give strategies, teach solutions, and practice till automation. Yet, many do not offer these students any solutions to something they struggle with almost every single waking hour of their lives.

Research in the past decade has illuminated for us the reason why individuals with ADHD have poor self-control and what can be effectively done about it. This post will provide the reader with evidenced-based strategies and answers we need to start giving our students. The school-based therapist can support classroom function by teaching students HOW to control themselves and providing caregivers with strategies to facilitate self-control.

Self-Control and ADHD

Self-control is defined as the self-initiated regulation of conflicting impulses in the service of future goals. Self-control requires without debate the ability to regulate and inhibit responses (impulse control) and the ability to imagine/anticipate or prioritize the future. Self-control requires executive functions including response inhibition, prioritization, goal-related persistence, and time awareness ( being able to see and anticipate the future).

Individuals with ADHD have neurochemical and structural differences in the development of brain areas that are responsible for executive function and self-regulation. Executive functions are supported by evidence to be delayed in children with ADHD. Approx 30% delayed compared to age-matched peers. In addition, contemporary research supports that lower levels of dopamine, a neurotransmitter in the brain, lead them to respond immediately and reflexively to their environment. Therefore the lack of self-control frequently seen in students with ADHD is due to neurochemically impaired response inhibition and difficulty regulating their behavior with future consequences in mind.

The Process Model of Self-Control – Impulse Generation

Impulses are rapid, unplanned reactions to internal or external stimuli without regard to the negative consequences of the reaction. Impulsive behavior is NOT regulated, it is an automatic, default response to stimuli. Human beings all have the same automatic default response, we will do things that feel good right away. Have an itch, the default is to scratch it.

In the Process Model of Self Control, Duckworth, Gendler, and Gross, 2014, define both the stages by which impulses are generated and the strategies by which they can be regulated. Impulse generation is described as a repetitive cycle, beginning with the situation and ending with the response. The authors’ title this “The situation- attention- appraisal- response cycle”. A response or lack of response brings the individual back to the situation.

Depicted below is the default pleasure-oriented response to a cookie, if you like cookies. Standing in a kitchen with cookies represents the situation, we attend to the stimulus (I see a cookie ) then we appraise the stimulus (yummy cookie), and finally the immediate satisfaction response (eat the cookie). There is no self-regulation in this rapid impulse cycle, we just mindlessly eat that yummy cookie.

The dynamics of impulse generation are similar no matter whether impulses are attentional, emotional, or behavioral in nature.

In the second example below, a student is sitting at his desk listening to the teacher’s lesson. He has an idea to tell his friend (attention), it’s an awesome idea (appraisal), and he calls out to his friend (response). Never once does he consider that he is interrupting his teacher in a room full of students trying to learn and he just kissed his recess goodbye.

Controlling Impulses

But what if you’re on a low-sugar diet or you’re trying to follow the classroom expectations of raising your hand before speaking?

When our automatic response is to default to pleasurable or immediate satisfaction now vs doing it for a future goal, effort must be exerted to regulate and stop the automatic response. Using self-control to modify your response requires effort, so much so that research refers to it as “effortful control”. Effortful self-control is a forceful struggle between lower-level impulses and higher-level cognitive control processes.

Many people struggle with self-control. Baumeister 2015 proposes that every act of self-control depletes and progressively exhausts a finite store of intrapsychic strength. Self-control is limited, as long as we remain in the situation, attend to the stimulus and have the same appraisal our ability to control our response will progressively weaken as we go around the cycle until we default and eat the cookie or call out because we can’t hold it any longer.

Requiring students to control their responses without support earlier in the impulse cycle is not sustainable or effective. Willpower is not a sustainable source. Nearly every diet uses proactive strategies due to the fragility of human willpower and self-control. Expecting students with ADHD to “control themselves” in the heat of the moment, requires voluntary suppression of the undesirable impulse and requires moderate effort. This is the “try harder” and as evidenced by recent research the least effective way to control impulses.

Impulse Control Strategies for Students with ADHD That Work!

Using the Process Model of Self Control, Duckworth, Gendler, and Gross, 2014, provide clear prescriptive recommendations as to when and how self-control is more effectively deployed. As a rule, earlier in the cycle is best.

With this framework, we can scaffold proactive strategies that work beyond sheer grit suppression of impulses. Using the process model of self-control, self-control strategies can be organized by considering the timeline of the developing tempting impulse.

Situational Selection Strategies for Students with ADHD

At the beginning of the cycle, we can influence self-control by selecting situations (physical and social environments) that facilitate self-control. In our example, keeping the tempting cookies out of the house.

In the classroom, teachers use situational strategies all day long. We strategically select seats, time lessons for certain points of the day, and strategically group students for partner work. Most teachers intrinsically appreciate the power of the context upon our impulses.

Situational strategies are antecedent based, proactive, and heavily supported by evidence. Situation strategies are most effective because they modify impulses earlier in the process of generation when they are weaker.

Set Up For Success

The most effective recommendations for improving performance in students with ADHD involve manipulating the context in a manner that decreases impulsivity. Most accommodations on IEPs and 504 plans are situational strategies. Teachers, caregivers, and parents can select situations that support self-control and anticipate situations that might make self-control more challenging for the learner.

Evidence supports that students with ADHD tend to perform better in situations that :

Structured with explicit expectations and immediate accountability.
Highly stimulating, novel, and challenging.
Situations that have built-in rewards and frequent feedback.
Situations with lots of movement or freedom to move.
Situations where there is little pressure to wait for things
Situations that provide frequent breaks for self-regulation
Environments with less visual clutter and distractions.

Scaffolding Situational Strategies

School-based therapists can explicitly teach the child and caregivers HOW to set themselves up for success. We can explicitly help the student determine supportive situations, scaffolding with a child when and why a situation will increase his or her ability to control impulses with the same kindness as we would explain how to conjugate a verb. We can teach a child how to purposefully change their circumstances to their advantage and promote self-efficacy.

Design Student Offices

Independent work is a perfect time to practice this strategy. From a young age, students can experiment with different methods of decreasing impulsivity and increasing goal-related performance. We trial different situational strategies and rate them on how they helped.

OT for ADHD Impulse Control Strategies Design Office

Inexpensive ( or made from cardboard boxes) study corrals make incredible offices for children. They can decrease distractions, contain schedules, visuals, and cues, and be individualized. We can teach children to discover what helps them as individual learners and remove the negative stigma. We all learn best differently.

Situational Modification Strategies for Students with ADHD

Most children have very little control over selecting their environment. They are born into a family, placed in a school, placed in a classroom, placed on a team, and taken to a babysitter. When we can’t select the environment, we can learn to proactively modify aspects of the environment to facilitate improved self-control.

Out of Sight out of Mind

Teach students how to identify temptations on their own, and take the necessary action to eliminate them. Rather than reduce distractions for them, slowly get the child involved in the process. Rather than taking away that toy that they are playing with, scaffold with powerful questions about what items the learner may need to be out of sight to reduce distraction. You can create a distraction inventory where students rate things that distract them and are hard to resist.

Do you need a clear desk? Try it and report back if it made it easier for you to learn?

Where do you work best? Maybe the front is not the best for this child when assigning seats.

Harness the Power of Friction

Evidence supports that many of us truly overestimate the role of willpower(self-control). Researcher Wendy Wood, the author of, Good Habits, Bad Habits: The Science of Making Positive Changes That Stick, found that conscious willpower is not the driving force behind sustained behavior change. The most essential force is building self-reinforcing habits.

Wood’s research explains how our environments shape our habits. If we want to break a bad habit, we need to modify our environment to add friction. When something becomes more difficult to do, we tend to do it less often.

The most successful people do not necessarily have more self-control, they seem to understand the influence of situations and choose ones in which it’s easier to repeat desired actions. Will less “friction” in their lives they are not tempted to act in counterproductive ways.

We can teach our highly impulsive students to harness the power of friction. Teach the student how to increase the friction to the behaviors they do not want to engage in. Friction can be in the form of distance, visibility, and access. Anything you can add to make it more inconvenient, less visible, less attractive, and less satisfying. This space will give the student a chance to think, breaking the automated impulse cycle.

The inverse is also true. We can reduce the friction around doing things they want to do. When we make it harder to do things we shouldn’t be doing in a setting, it decreases the effort needed for self-control. When we make it obvious, clear, and super easy to do the things we should be doing, it decreases the effort needed for self-control. Remember the default mode prefers less resistance.

Examples of modifying friction to decrease impulsivity:

I am going to sit further away from my best friend so I am not tempted to talk to her during class.
I will put my homework on the table and my video game in the drawer until I finish the homework.
I am going to leave my flute out on the table so I remember to practice it.
I am going to turn off the notifications on my phone and place a long password instead of Face ID to slow myself down from checking my phone impulsively.
I am going to put my backpack in front of the front door so I have to move it to leave, that way I won’t forget it.
I am going to pack my homework into my folder as soon as it is assigned so I don’t forget it later.

Preview and Review

Research supports that children are able to control impulses better when they are reminded of the rules frequently and explicitly. Before beginning a task, review the expectations explicitly. Understand that “make good choices” is not explicit. Be explicit about how exactly your student is to behave. Review expectations often and prompt the child to tell you what is expected in the given situation.

Externalize Reminders

It’s hard to stay on track if you don’t remember the rules, and students with ADHD have trouble keeping directions in mind and generalizing one set of rules to a different situation. While discrete and frequent reminders of the rules are a must, creating externalized rules ( cards or signs with pictures or words) for different situations can provide an external representation of the process minimizing impulse generation.

Provide visual reminders of how to avoid impulsive behavior. For example, stick a small card on the student’s desk that says STOP THINK DO. Counting 3 seconds before responding can begin to create the gap between stimulus and response. Children can practice this for about five seconds before responding to your questions.

OT for ADHD Impulse Control Strategies Stop Think Go

Provide visual reminders of the expected behavior or future goal to keep it salient and obvious.

Have a secret signal. Decide on a gesture or signal that will convey to the student that he is interrupting and needs to stop.

Attentional Deployment Strategies

In situations we cannot select or change, students can learn how to use attentional deployment strategies to direct their focus to features of the situation that facilitate rather than undermine self-control. When on that diet we look away from the cookies, distract ourselves and bring water bottles everywhere to keep our hands and mouths busy to avoid snacking.

Develop Self Awareness and Self Monitoring

It is difficult for children to practice impulse control if they aren’t aware of their thoughts, feelings, and actions. They must be able to identify what they are experiencing and what they’re feeling. Depending on the age and skill level we can explicitly teach what impulse control is and what it feels like with impulse control games and experiments. We can talk about what it feels like to stop yourself and think.

Games that teach self-control.

Red Light Green Light- kids move on the green light and stop on the red light. Don’t get caught moving on the red light
Simon Says- The child only performs the action when the leader says ” Simon Says”
Freeze Dance: Dance until the music stops

Stroop Test: For the fluent reader the best activity to help students feel what impulse control feels like is the Stroop Test. Students have to read a list of words by saying the color of the word ( not the word). Try it. We then discuss what it felt like to stop yourself. The struggle is real. Note: The Stroop effect will not be present in a non-fluent reader.

OT for ADHD Impulse Control Strategies Stroop Effect

Impulse Control Test: A fun way to bring self-awareness to the importance of controlling our impulses and reading directions is to take a trick quiz that prompts you to read all the directions. The last direction changes the whole test.

Cognitive Change Strategies

When attending to temptation is unavoidable, we can use these strategies to diminish our undesired impulses and amplify our desired ones.

If -Then Scripts

We can facilitate impulse control by helping the student make if-then plans that connect a certain triggering situation with a concrete behavior. For example, ” If my neighbor talks to me doing quiet time I will ignore them by not looking at them or answering them”. Or “When the bell rings I will count to five before getting up. ” Repeated practices strengthen the association between the specific situational cues and the intended response forming a habit. Forming if-then plans can help to outsource behavioral control to the environment to prevent willpower depletion as the student is on automatic pilot when in habit mode.

OT for ADHD Impulse Control Strategies Anchor Habits

Gift for your Future Self

Teaching students to consider their future self is an effective strategy. Removing ourselves, and becoming the third-party observer allows for greater impulse control. Teach the student to stop and think about what my future self wants me to do right now. Lead the student to visualize what their future self may experience.

For example: If I lay my clothes out tonight, my future self in the morning will thank me. If I don’t my future self will be stressed out and look sloppy. Be sure to thank yourself in the morning, out loud! That reinforcement is just the right amount of silly to make a lasting impression.

Self-Talk Out Loud

Students with ADHD do not have well-developed self-talk. Encouraging them to “Think Out Loud” when they are problem-solving, will slow them down before they respond impulsively.

Implications for School-based Therapists

Completing tasks that have a self control element requires higher levels of effort, difficulty and fatigue then ones that don’t. For students with ADHD, controlling their impulses is a daily strenuous battle that is is often misunderstood as aggression, disrespect and defiance.

Duckworth, Gendler and Gross, 2014, present the process model of self control that illuminates why situational strategies are superior in effectiveness to response modulation strategies. Sheer grit and will power is now understood as a finite resources. This is crucial for all individuals with ADHD, who are born with an inherent difficulty with regulating and inhibiting responses.

School based therapists can provide explicit and scaffolded instruction to students with ADHD and their caregivers to support situation selection and modification strategies that decrease the effort needed for impulse control. We can teach students how to use attentional deployment strategies to direct our focus to features of the situation that facilitate rather than undermine self control. And we can use teach cognitive change strategies to diminish our undesired impulses and amplify our desired ones.

School based therapists can sustainably improve classroom function by helping the student develop self-reinforcing habits to hack faulty impulse control. Kids who stay out of trouble aren’t necessarily blessed with greater strength of self control, they are simply better at anticipating and avoiding situations that trigger impulsive behavior. And that’s extremely good news for our students with ADHD and the people who care for them. ❤️

Evidence Base

Barratt, E.S. (1994). Impulsiveness and Aggression. In Monahan, J. and H. J. Steadman (Eds.), Violence and Mental Disorder: Developments in Risk Assessment (pp. 61-79). University of Chicago Press, Chicago, IL.

Duckworth AL, Gendler TS, Gross JJ. Situational Strategies for Self-Control. Perspect Psychol Sci. 2016 Jan;11(1):35-55. doi: 10.1177/1745691615623247. PMID: 26817725; PMCID: PMC4736542 LINK

Baumiester, Yielding to Temptation: Self-Control Failure, Impulsive Purchasing, and Consumer Behavior

Wood, W. (2019). Good Habits, Bad Habits: The Science of Making Positive Changes That Stick. New York, NY: Farrar, Straus and Giroux