What Teachers Need to Know
“But he’s not even sorry” !
When a child does something wrong, for example, breaks a rule, says something inappropriate, hurts anothers’ feelings, or even physically hurts another child, many concerned teachers and caregivers report that it appears as if the child with ADHD lacks “ remorse “ for their actions. The child appears to “ not care” and lacks empathy for others. Lack of remorse and empathy are serious implications and, in the case of a developing child with ADHD, a dangerous misunderstanding of what is really going on.
It is vital to understand that the child is not lacking empathy or remorse; instead, they are having difficulty understanding their action from someone else’s point of view. This can include the point of view of their peer, parent, or teacher.
Children with ADHD often demonstrate a significant developmental delay in the underlying executive function and self-regulation skills that impacts their ability to navigate the social domain of their school day.
Perspective-taking is a developmental skill that requires adequate development of core executive functions, particularly inhibition, working memory, and cognitive flexibility. When these executive functions are delayed (Barkley estimates at about 30% behind peers), a student will have extreme difficulty understanding the impact their actions have on others, considering different perspectives of the same event, and applying past social consequences to the present context.
While most neurotypical children begin learning to take perspective intuitively by early elementary school, students with ADHD may need explicit guidance and tools well beyond what is developmentally expected of their age level.
This post will provide the reader with an evidenced-based understanding of the impact ADHD can have on developing social skills. We will provide actionable classroom tools and additional resources for the school-based professional to empower authentic and meaningful performance in the social context of the school environment.
Social Skills Difficulties in Children With ADHD are Diverse
The dynamic performance deficits caused by ADHD and its possible comorbidities, age/stage presentation, and contextual dependence leave teachers and school admin with no singular intervention for ADHD. No two children with ADHD are alike.
Many students with ADHD, particularly those with impulsive/hyperactive and combined presentation) struggle to regulate and inhibit behavior. As a result, they may unintentionally interrupt or offend others, tend to go off-topic, get stuck on high-interest topics, or invade another’s personal space. Inattentiveness and impulsivity can lead to the child missing non-verbal social cues or other’s feelings/emotions.
Other students with ADHD may have difficulty with emotional regulation. As a result, they often appear over-sensitive and emotional. They may have difficulty managing their emotions when interacting with their peers, appear prone to meltdowns, and have intense difficulty with perceived rejection.
And some children with ADHD have poorly developed cognitive flexibility and perspective-taking for their developmental age. They have difficulty thinking about others’ thoughts and understanding how they come across to others. These students may lack awareness of unspoken social rules, struggle to take another’s perspective, and be inflexible thinkers. They may struggle to see another person’s point of view, misinterpret comments that were intended to be humorous or rude, and struggle to negotiate situations or resolve conflict.
Social skill difficulties evoke highly negative responses from peers, which leads to high levels of peer rejection which causes a downward spiral. Peer rejection leads to missed opportunities to practice and learn social skills. Worse, many students are never provided an explicit understanding of why they struggle socially, which leads to poor self-esteem and self-efficacy.
Fifty-six percent of children with ADHD have no reciprocated friendships, which is almost twice the number of typical children (Hoza et al., 2005). If not resolved, peer rejection and poor friendship quality will persist and amplify over time. Constant social difficulties and peer rejection have been associated with adverse outcomes later in life (Mrug et al., 2012).
The Impact of Poor Executive Function on Social Skills
To understand why children with ADHD experience difficulties in their social relationships, it is important to understand the cognitive mechanisms involved in social skill development. ADHD is a neurodevelopmental disorder that impacts executive function and self-regulation. Developmental delays or uneven development of the executive function and attentional domains are responsible for the social difficulties seen in ADHD.
All social interactions require executive function and self-regulation. Many social interactions require some form of prediction or inference about the situation. They require the child to be able to infer how their actions affect others. Perspective taking implies putting into practice skills such as considering different points of view, attending to relevant aspects of the context or ( surrounding environment and people), making decisions, inferring mental states, and predicting behaviors. (Birth 2016) Taking another’s perspective requires the mental processes of inhibitory control, working memory, cognitive flexibility, and attention, which are the core brain-based impact of ADHD.
Imagine a block pyramid; at the base, is response inhibition and working memory, which together support cognitive flexibility. Without these blocks, our ability to understand another’s perspective will be inadequately supported.
The development of the following executive functions impacts social skill development.
Attention Regulation enables the child to pay focused attention to accurately receive the verbal and non-verbal messages of others and recognize their own thoughts and feelings.
Response Inhibition– enables the child to inhibit a response so they can delay their initial reaction. It is the stop-and-think executive function. It is needed to filter and focus on relevant information and inhibit intrusive internal or external stimuli so that they can weigh options and choose an appropriate response.
Working Memory enables the individual to keep in mind and process different information simultaneously, sense the hypothetical future, and allows children to integrate past and present experiences.
Cognitive Flexibility enables the child to adapt their thoughts and behaviors in response to a change in the task, consider other perspectives, and transition between activities. It allows us to shift back and forth to account for opposing views of a situation so that we can understand that another person may have a different perspective.
We tend to see problems with social skills amplify around the middle of second grade. Most typically developing children have acquired adequate inhibitory control, working memory, and cognitive flexibility by then.
Why “Social Skills Training” Doesn’t Work For Students with ADHD
Social skill training does not improve social skill performance for students with ADHD. A meta-analysis found that social skills training for youth with ADHD did not improve teacher-assessed social skills (11 studies, over 1,200 youths), general behavior (8 studies, over 1,000 youths), or school performance and grades (5 studies, over 600 youths) (Storebo et al., 2019).
This is because ADHD is a disorder of performance. The challenge is doing what we know. While many students with ADHD can verbally explain what is expected of them in school, that knowledge does not support their performance. The lack of efficiency of fluency in the performance of the skills impairs the students’ social relationships.
In addition, practitioners need to be aware that promoting masking and forced compliance to fit into a restricted view of neurotypical norms is extremely harmful to a developing child. Rigid social skills training has been evidenced to lead to anxiety, incessant self-consciousness, self-doubt, self-shame, and hypervigilance in social interactions in neurodivergent children. (2021 Roberts). There are multiple ways for children to improve their performance in school-based social interactions and models available that support social-emotional development while respecting authenticity and diversity.
Below are actionable, evidence-based strategies for supporting the development of the underlying executive functions and self-regulation skills needed to support the development of perspective-taking in students with ADHD. These strategies intentionally empower the authentic individual child’s meaningful performance in social interactions without encouraging blind compliance.
Improving School-Social Interactions in Students with ADHD
School-based professionals, including teachers and related service providers, can greatly reduce the negative impact ADHD has on social skills development by providing early support. I use the acronym EASE when working to facilitate functional classroom performance in children with ADHD. EASE stands for Educate, Accommodate, Scaffold, and Empower.
Educate Adult Caregivers to Reframe
Caregiver education is the most important, evidenced-based best practice one can provide on behalf of a child with ADHD. Caregivers need to understand what they are seeing is not willful misconduct, lack of remorse, or lack of empathy. Understanding that the child is demonstrating difficulty in learning how to take another’s perspective helps the adult shift paradigms to support the development of the underlying self-regulation and executive function skills needed for social performance in context. Changing how adults interact with the student immediately helps ameliorate the negative impact of weak skills.
Skill Deficit vs. Performance Deficit Confusion
“ They can’t do it, or they won’t do it” is the question most caregivers become stuck on. While many students with ADHD can verbally explain what is expected of them in the social domain and easily attune with adults in a 1:1 setting, that knowledge does not support performance which is the crux of ADHD. Practice with point-of-performance feedback and reflection helps improve the performance of the skills that people “ know.”
School-based professionals can help teachers and caregivers develop the capacity to “think like a sports coach.” Before a child plays any sport, they are taught how to play the game and learn the skills needed to play it. They then practice performing those skills with their coach’s point of performance feedback. Coaches don’t simply say, “Go play baseball.” They break down each step and practice it again and again with tips for improving. Before every game, even the coaches of professional athletes review the pre-game strategy. They use signals and plays during the game and do a post-game debrief. Providing explicit instruction and feedback before, during the point of performance, and shortly after improves performance.
Educate The Entire Team
At the 2022 International Conference on ADHD, Ryan Wexelblatt, LCSW ADHD-CCSP of ADHD Dude, stated, “Recess can be the hardest subject for a student with ADHD.” This sentence illustrated a vitally important and often unknown barrier in most school settings.
Recess is an unpredictable, unstructured group setting where our students typically need the most support. Yet the adults monitoring these time periods may completely lack the information, education, and actionable strategies to support this student. They may not be aware of the student’s IEP, diagnosis, or 504 modifications and accommodations that are in place to help the student be successful. The adults in these situations may not be legally( HIPAA) allowed to have access to this information as sometimes recess is monitored by volunteer parents in the community.
Teams need to be aware of exactly who constitutes a caregiver in this student’s life. School based caregivers include classroom teachers, special area teachers, including PE, art, library music ect.., related service providers ,coaches, permanent substitutes and recess, lunch and bus monitors. It is vital for school support teams to determine who the adults are in the students’ school setting and get legal clearance for providing them with the information needed to support the child at the point of performance.
Children as young as six typically have a minimum of 4 consistently different “ teachers” during one school day. This would include the classroom teacher, two special area teachers and a lunch and recess monitor. Add speech, resource room, OT, and an afterschool sport and this child is expected to socially shift for 8 different adults in one school day. Educate the ENTIRE TEAM.
Accommodations /Modifications to the Context
Our behaviors are a reflection of our environment. When we change our environment, we change our behavior. Providing contextual accommodations to support underlying weaknesses in executive functions can minimize the impact of ADHD on social performance. Accommodations to reduce cognitive demands and stress will immediately improve the student’s capacity for performance.
Accommodations are primary interventions for ADHD. Providers must be mindful to frequently review accommodations for fidelity and efficacy with a coordinating plan that supports the improved performance of the underlying skill.
Support Working Memory and Inhibitory Control
Provide externalized environmental supports for working memory and inhibitory control.
- Provide increased availability of adult supervision, support, and cueing in environments that will require greater impulse control from students.
- Improve the availability of working memory by decreasing extraneous cognitive load (see this post), and decreasing choices and steps.
- Support inhibitory control with external representations (signs) of the rules across different school social environments and contexts.
- Provide increased supervision in open-ended, unstructured, and unpredictable environments.
- Support the student’s performance with pretaught inconspicuous gestures or cues.
Provide Environmental Support for Cognitive Flexibility
Situations with high uncertainty or ambiguity produce significant stress and make it much harder for the student to cope with anything unexpected. Often the student will predict their own idea of what’s coming up next, an idea that favors the outcomes they want. For example, they might tell themselves, “snack is next” after math. When snack is not next, this student melts down for what appears to be “no reason.”
Provide environmental support for cognitive flexibility, especially during transitions.
- Visual Schedule of the Day– it is important for students with difficulty with cognitive flexibility to know what activity or situation is coming up next.
- Reduce Novelty: Pre-teaching and walk-throughs of new events and settings reduce novelty, increasing the child’s ability to cope with change.
- Post Changes In Advance -Ensure that the child is cognizant of the shift in rules that is about to occur prior to transition.
- Prepare kids for transitions: Children with poor cognitive flexibility find transitions difficult. Transition times are often when natural socialization occurs during the school day. The stress level of the transition will impede performance during this social moment.
- Allow extra time for transitions
- Use a visual countdown timer
- Provide transition aid (object)
- Assign the student the job of letting the class know its time to transition( stop, prepare, go)
Scaffold Executive Function Development
Scaffolding improvement in the underlying executive functions that may be interfering with social performance is a three-part process. Below we provide evidence-based, actionable “pre-game, game time, and post-game huddle” strategies to empower the school-based professional with the tools they need to support authentic social skill development.
“Pre-Game” -Direct Intervention for Underlying Skills
Develop Fluency In Interoceptive and emotional awareness
Many students with ADHD may have decreased interoceptive awareness due to inattention to their own inner experiences. Facilitating an understanding of sensations and the associated emotions is essential in developing self-regulatory strategies and self-awareness. Many students with ADHD will “ forget” to eat, use the bathroom, and drink water until those cues reach an emergency level intensity. Listening to our body’s cues will improve self-awareness and is often the missing link in most emotional vocabulary programs. Without being able to identify one’s inner sensations, emotions, and thoughts and understanding how our internal characteristics influence actions, a student can not be expected to predict how others feel.
- Direct instruction and experiments of feeling our internal feelings. Ie. Hot vs. cold
- Direct instruction of corresponding physical feelings(sensations) that may be associated with emotions/feelings. Ie. A grumbling stomach, a shaky body equal hungry.
- I use the Interoception Curriculum by https://www.kelly-mahler.com/. She has an incredible wealth of neurodiversity-affirming interoceptive resources to use with children. My students love the interoceptive experiments, and I have found them easy to implement install groups and the whole class setting.
DEVELOP fluency in contextual Awareness
Hyperactivity and inattention can lead a student to have difficulty attending to the relevant aspects of the environments around them. This causes students to miss situational cues.
Ari Tuckerman said, ” ADHD is a disorder of converting intention into action.” I often see children with ADHD as completely misunderstood by those around them despite the most honest of intentions. I’ve seen them try to do something nice and helpful but get in trouble for doing it at the wrong time. Confirm that the student has developed an authentic, individualized understanding of what is expected in the school context and why. What might these expectations mean to them?
Out Of Context: Develop an understanding of why peers and adults act the way they do in various school settings and situations. Some of the school rules are silly if taken out of context. For example, raising your hand to speak, walking in lines, and asking to use the bathroom. Doing those same actions at home would be kinda silly? Social expectations are contextually dependent. Ensure that students understand what words or actions in different contexts might be expected to produce: negative feedback or positive feedback from a peer or adult?
What if Everybody Did That? There is an illustrated children’s book, What if Everybody Did That, with illustrations of situations that are not may not be that big of a deal if done by one person but illustrate what it looks like when done by many. Same action, different context. Plenty of expectations in school are based on this one-to-many context. This helps make the why behind some of the ” expected” behaviors more visual.
Develop Fluency in Cognitive Flexibility
Due to lagging response inhibition and working memory development, students may have significant difficulty with cognitive flexibility. They may need direct instruction and guided practice to develop the ability to revise plans in the face of obstacles, setbacks, new information, or mistakes.
Often children will report that no one wanted to play with them, but the actual scenario was that no one wanted to play the game the child wanted to play, and the child did not want to play the game the others were playing. While we can see this is vastly different, without cognitive flexibility, the child processes it as a painful personal exclusion.
- Surprise Card: Change, as they say, is life’s only certain. Surprises or changes will come up despite plans and schedules. School-based therapists can identify and practice methods of coping with surprises in a smaller structured setting with games and the surprise card. We can flip the script and have the child change a game rule and hand over the surprise card to the therapist that copes. The surprise card can then be used in the whole class environment when changes happen.
- Develop Self-Talk Plays – Students with ADHD can be terrible at self-talk. Help the student develop self-talk default strategies for managing change in situations. I have succeeded with key phrases( mini mantras) and self-advocacy scripts such as ” I feel, and I need.” A common default strategy that most people learn and never seem to forget is ” What do you do if you are on fire? “STOP, DROP, and ROLL. When I wait in line, I say,” This too shall pass,” to remind myself that it feels way longer than it is. Help develop mini mantras and self-advocacy scripts with your students.
- Reset and Return: Predetermine a space or person that the child can go to in a more unstructured setting to self-regulate as they are practicing and learning new skills. We need to expect inconsistent performance as children learn. Safe Spots can be a quiet location or pre-identified adult. They can take a minute to calm down, and or talk to an adult.
- Walk through: Present and review expectations to reduce ambiguity. Provide and review clear and specific expectations prior to the social setting. Explicitly review what to expect in a social situation, including possible changes, unexpected situations, and past events that may be similar.
- Competence Anchor: Students with ADHD struggle to link past and present situations. Detect what’s similar about a context from something in the past to help the student conceptualize what worked for them in a similar situation. What have you done in the past that is kind of like this? Highlight similarities
- “Normalize” Errors: Mistakes are really hard to tolerate if your awareness of the past and future is impaired. Time is always NOW for students with ADHD. If they feel as if they or their peer ” always” make mistakes, it is because “always,” in their mind, consists of only right now. As much as possible, normalize mistakes, teach error factor and prepare children for the possibility of anticipated mistakes ( like the weather report or a bad call in a sports game).
Develop Fluency in Perspective Taking
Inferring mental states and predicting behaviors can be complex for a child with ADHD. Explicit teaching of the nuances of others’ possible behavior can help develop an understanding (skill development), but that understanding may not improve performance in different contexts ( environments and social settings) without practice and feedback.
Read the Room: Practice looking in on a real setting as an onlooker and reading the room and the people in it. Is this a quiet, calm environment or a loud, active environment? Are people serious or carefree and silly? What might they be thinking? How would the student feel in this environment? What actions may lead to negative reactions? What actions may lead to positive reactions?
Trying on Someone Else’s Shoes: Predict putting someone else’s shoes on to imagine how they might feel in a context (physical sensations and emotions). Improving the ability of the student to understand “why” a behavior was “unexpected” or may make someone feel/express a corresponding emotion. To understand how their actions may be perceived by those around them regardless of their intention.
Game Time: Support at the Point of Performance
Think Out Loud
Teachers, parents, and caregivers can be encouraged to model and scaffold out loud your sensations and feelings and self-regulation strategies as you naturally do things during the day. Taking the time to model self-regulation is highly effective as students are co-regulating off of you, like it or not. If you have a big feeling, own it and problem-solve it out loud.
“Wow, that landscaper is loud; I am finding it hard to concentrate and starting to feel irritated. I’m going to shut the window until the landscaper is done”.
All day long, teachers model flexibility. Most became field experts in flexibility during COVID. Change is hard, but the only certainty in life is change. Cancellations, technology down, fire drills, field trips, new students, a permission slip that needs to go home now after you have already packed them up. Say “Plot Twist,” and then think out loud about how you’re coping with the change. You’re doing it automatically but making it loud and explicit sticks to the friends who are not paying attention to it incidentally.
What we pay attention to grows. I notice slips to provide positive performance feedback that sticks. Teachers can notice and reflect when the student exhibits emotional and interoceptive awareness and ask them, “ How exactly did they do it?” Teachers can notice signs of flexibility during a more structured time and praise it. No lead in the yellow pencil, so they used orange for the sun, awesome flexible thinking!
Noticing the moments that children are successful, no matter how small, can powerfully offset the negative a child with ADHD is accustomed to hearing. Imagine the repair to self-image as these are collected over time. 💕
Teachers, therapists, and caregivers can ask curious questions to inspire students to reflect on their performance, how it feels, and whether the situation met their expectations without judgment. We can encourage the generalization of strategies that worked in one setting to another. Students with fluency-based instructional needs, in particular, require generalization support. It is essential that such opportunities are meaningful and realistic. If generalization is not connected to the natural environment, results will be limited, and long-term effects may fail ( Bullis 2001)
Avoid Defense Trigger
Children with ADHD are often in trouble for reasons they can not fully understand. Teachers can decrease the need for unnecessary defense by avoiding the word “why.” “Why did you do that?” is processed differently than ” How did doing that work out for you? “. Why immediately puts them in defense mode and will switch that learning brain off. Instead, evidence supports using curious language, using how and what.
Use Curious Language
Curious questions inspire the growth and development of executive function and self-regulation. There are no wrong answers to curious questions. They all have an ” I wonder?” tone about them. Even if you think you know the answer. No one is naturally better at this than teachers.
- How did that go? What did it feel like to do something another way? Where did you feel it?
- How did you find that your ( insert strategy name) worked out for you?
- Would you try it again?
- In what situation would you try it?
- What happened?
- What were you trying to accomplish?
- What are you thinking about?
- What are you noticing?
- What could you do to solve this problem?
- What do you imagine you can try next?
- What have you already tried?
- How would you like this situation to turn out?
“Students with ADHD often struggle with perspective-taking skills, creating major barriers to communication and closeness. These barriers often lead to those nearest to the individual feeling, whether real or perceived, a lack of empathy from the individual.”(Pineda 2018) It is vital to understand that the child is not lacking empathy or remorse, but instead, they are having difficulty with executive function and self-regulation development to be able to understand their action from someone else’s point of view.
School-based professionals, including teachers and related service providers, can greatly reduce the negative impact ADHD has on social skill development and performance by providing early support. When working to facilitate functional classroom performance in children with ADHD, we can Educate, Accommodate, Scaffold, and Empower (EASE).
We can Educate all caregivers to reframe inconsistent performance as the learning challenge it really is. We can ensure to collaborate and provide specific resources to those who support our students during unstructured times such as recess.
We can provide contextual Accommodations for working memory, response inhibition, and cognitive flexibility that influence the environment for improved performance.
We can strategically Scaffold improved learning and performance of interoceptive awareness, emotional awareness, cognitive flexibility, and perspective-taking with direct teaching, strategy selection, and explicit feedback at the point of performance. We can use our “coaching skills to prepare our students with effective knowledge of the game and help to authentically select and design plays (strategies) to reach their goals. We can provide point-of-performance feedback while they practice social skills in the natural classroom setting.
Using non-judgmental post-game debriefs, school-based professionals can Empower generalization and gradually reduce support. We can empower the child with ADHD to develop individualized authentic, and meaningful strategies to improve performance and self-efficacy in the social context of the school environment.
Below are currently my favorite resources. Follow along because this section will grow.
Resources and Tools
Visit TPT to download the complete guide to supporting social skill development in children with ADHD.
Interoception Curriculum- Kelly Mahler has an array of resources that truly promote the generalization of interoception from school to home.
Caroline Mcguire ” Why Will No One Play with Me” is a book that truly teaches parents how to coach social skills with their unique child. She has a social-emotional executive skill assessment that is worth the book purchase alone. Her website has resources and courses for educators. Link to the questionnaire.
ADHD Dude- Parents of ADHD middle School/Teens Ryan has an amazing following and a wealth of free information on YouTube aimed at parents but teachers can definitely learn and use his strategies.
Read the Evidence – References
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