ADHD is grossly misunderstood as a “behavioral condition,” one where individuals simply need to “try harder” or “behave better.” This view not only misrepresents the condition but also leads to ineffective interventions that fail to support the core challenges individuals with ADHD face.
ADHD isn’t about willpower or behavior, it’s a neurodevelopmental difference that fundamentally impacts what we call functional cognition, the ability to actually use all that cognitive potential everyone’s always talking about. By understanding ADHD as a difference in functional cognition, we move beyond surface-level fixes and focus on evidence-based strategies that empower our students.
In this post, we’ll explore why traditional interventions fall short, and how to easily transform your support for students with ADHD.
What is Functional Cognition?
Functional cognition is the bridge between thinking and doing.
The American Occupational Therapy Association (AOTA) defines functional cognition as “how an individual utilizes and integrates his or her thinking and processing skills to accomplish everyday activities.”
In the school setting, functional cognition is how a student applies attention, memory, organization, and flexibility while doing real-life activities like writing an essay, following classroom routines, managing materials, or asking for help.
It’s not just about whether a student has a cognitive skill, it’s about whether they can use it when it matters.
Functional cognition looks at how executive functions show up in action. For example, a student might score well on a working memory test, but still forget instructions halfway through a writing task. That’s a functional cognition challenge (not carelessness).
How ADHD Impacts Functional Cognition
Students with ADHD often struggle not with isolated cognitive skills, but with using those skills consistently in context.
The issue isn’t about knowing what to do, it’s about actually doing what you know.
Students with ADHD often know the rules: raise your hand, don’t interrupt, check your work, turn in homework, but struggle to apply them consistently. This gap between ability and execution, along with high situational variability (able to do it here but not there), is a key red flag for functional cognition difficulties.
The Discrepancy Gap
The IQ-achievement discrepancy model has long been used to determine if a student qualifies for special education due to a learning disability (Iris Center). It looks for a significant gap, typically two standard deviations between a student’s cognitive ability (measured by IQ tests like the WISC-V) and their academic achievement (measured by tools like the Woodcock-Johnson). In other words, it identifies students who have the cognitive capacity to learn but aren’t learning at the expected rate.
Students with ADHD often show a similar gap. They have the cognitive capacity, yet they struggle to apply those abilities functionally in the classroom. Just like students with learning disabilities, they experience a disconnect between potential and performance.
But here’s the problem: while a child with dyslexia isn’t blamed for struggling to read, a child with ADHD is often told they “just need to try harder.” Their challenges are mislabeled as behavior problems. They’re seen as lazy or unmotivated, not because they lack ability, but because they can’t consistently show it.
We don’t tell a child with dyslexia to “just read.” So why do we keep telling kids with ADHD to “just focus“?
Why Traditional Interventions Fall Short
Many of our commonly used interventions (behavioral, sensory, and skill-building) miss the mark because they aren’t embedded in real school tasks. They happen too far from the point of performance, making it hard for students to apply what they’ve practiced when it really counts.
ADHD is a contextual disability. The physical, social, and attitudinal environment directly affects how symptoms show up. Context is everything.
- Knowledge-based interventions assume the student doesn’t know the skill. The issue isn’t knowledge, it’s execution.
- Cognitive skill-building (like computerized attention or memory training) may improve performance in isolated tasks, but lacks evidence for far transfer.
- Behavioral interventions target external behaviors and produce only short term compliance. Nothing is learned and will damage self-efficacy.
- Sensory strategies can support regulation but don’t address the executive processes behind performance breakdowns leading to kids who do not apply the strategies they learn.
Interventions That Address Functional Cognition
Interventions that target functional cognition bridge the gap between knowing what to do and actually doing it. To truly support students with ADHD, these interventions focus on how thinking skills (executive function skills) are used in real-life school tasks, like writing, organizing, transitioning, or managing homework.
These are not isolated skill drills. They are real-time, real-task supports that improve participation through environmental scaffolds and task-specific strategies.
Examples:
- Task initiation supports: visual start-up routines for independent work
- Environmental scaffolds: timers, visual schedules, strategic seating
- Cognitive strategy instruction: writing strategy cards for planning and revising
- Cueing systems for transitions and multi-step directions
- Metacognitive performance-based reflection tools (e.g., “What helped me get started?”)
These interventions are grounded in occupation-based practice, helping students learn to adapt, compensate, and function in their real school contexts.
Evidence Supporting Cognitive and MetaCognitive Interventions
Cognitive and metacognitive strategy instruction gets to the heart of ADHD challenges by teaching individuals to reflect on, monitor, and adapt their cognitive processes within the context of meaningful activities. It focuses on how we do things, creating strategies that work with the ADHD brain.
Recent research underscores the effectiveness of cognitive and metacognitive strategies in improving academic and social outcomes for individuals with ADHD. (Levanon-Erez et al.,2019, Grinblat & Rosenblum,2023, Kastner et al.,2022).
Evidenced based frameworks of cognitive strategy instruction include:
- MultiContext (MC) Approach: Integrates metacognitive and cognitive strategy interventions to promote strategy generalization and self-monitoring across tasks.(Toglia, 2025)
- Self-Regulated Strategy Development (SRSD): Combines explicit strategy instruction with self-monitoring and goal-setting, emphasizing the transfer of learned strategies across contexts.(Harris,2024)
- Cognitive Orientation to Occupational Performance (CO-OP): is a client-centered, performance-based approach that uses cognitive strategies to enable skill acquisition and improve occupational performance. (Polatajko, 2004)
Those Immature Visuals Started It
One key pillar of the EASE Framework I developed to support learners with ADHD is scaffolding, and visual supports play a major role in that. But over time, I noticed that while visuals are incredibly effective, they’re often overly juvenile looking. Even my third graders cringe.
What began as a mission to create more modern age-appropriate visuals quickly evolved into something deeper, a way to apply cognitive and metacognitive strategies that truly supported student performance. A tangle , physical cue co-created with students to support performance.
The STRAT Deck, is a cognitive strategy resource used to guide students in developing and maintaining personalized strategies for school. (maintenance is everything.) The Deck helps students track what works, reflect on their successes, and make adjustments, building not just participation, but self-awareness and ownership along the way.
The STRAT Deck has four steps .
Four Steps to Build a Strat Deck
Joe, a 4th grader with AD/HD-C, knows he’s supposed to raise his hand before speaking, yet he keeps interrupting. He is not intentionally misbehaving, instead it is impulsivity and working memory challenges that are creating a mismatch between ability and execution. Joe knows the rule but struggles to consistently follow it.
Step One: Strat Exploration/ Selection :
Together with his teacher, we briefly (5 minutes) discuss the problem and validate how difficult it is for Joe. Joe feels his interrupting is because he will lose his thought if he waits. Using the pictured Strat 4 That chart , we collaborate on possible strategies to help him not interrupt without losing his thought.
Step Two: Test Drive:
Together we create a strategy called “Pencil Park Ideas” where he writes his thoughts down before saying it out loud. We provide a visual and a notepad. He agrees to test the strategy and report back on its effectiveness.
Step Three: Analyze & Adjust:
Two days later , Joe reports immediate success with the strategy and shares the self monitoring data. We notice that just having it on his desk served as an immediate visual reminder, and that the teachers prompting immediately shifted from promoting Joe to try harder not to interrupt to supporting Joe’s’s effort using a strategy to control impulses.
Step Four: Foster & Deck:
Joe “fostered” the strategy by naming it and creating a physical representation of it to add to his strategy deck. This aides in maintenance and generalization. Joe’s success led to the creation of multiple strategies for his deck to cover different problem as they arose. Both Joe and his teacher felt empowered rather than frustrated. The teacher then started used the T chart regularly with her entire class.
The Strat Deck empowered Joe and his teacher to pause, get curious, collaborate, and develop strategies that bridge the gap between knowing and doing. Instead of being told to try harder, Joe was given the permission and support to use that effort to approach a problem differently.
Empowering Students Through Functional Cognition
ADHD is not a behavioral problem , it’s a neurodevelopmental difference that affects the brain’s ability to regulate functional cognition. The core challenge isn’t knowing what to do, but consistently doing what you know in real-world situations.
Cognitive strategy instruction targets the gap between thinking and doing by building self-awareness, teaching adaptive strategies, and supporting carryover across environments.
When we stop treating ADHD as a behavior problem and start addressing its true nature, we give students and teachers the tools they need for greater understanding, acceptance, and meaningful accountability. Students with ADHD don’t need to try harder, they need to try differently.
To learn more about STRAT DECK and explore various Strat Deck resources click here.
Visit this link to explore the Full EASE framework, for supporting students with ADHD and earn AOTA certified continuing education.
References
American Occupational Therapy Association. (n.d.). Functional cognition. https://www.aota.org/practice/clinical-topics/functional-cognition
IRIS Center. (n.d.). RTI (Part 1): An overview. Vanderbilt University, Peabody College. https://iris.peabody.vanderbilt.edu/module/rti01/cresource/q1/p02/
Toglia, J., & Foster, E.R. , 2025, The Multicontext Approach for Cognitive Rehabilitation. In M.N. Ikiugu, S.D. Taff, S. Kantartzis, & N. Pollard (Eds.), Routledge Companion to Occupational Therapy: Theories, Concepts and Models. Taylor & Francis.
Harris, K.R., 2024. The Self-Regulated Strategy Development Instructional Model: Efficacious Theoretical Integration, Scaling Up, Challenges, and Future Research. Educ Psychol Rev 36, 104 (2024). https://doi.org/10.1007/s10648-024-09921-x
Madieu E, Gagné-Trudel S, Therriault PY, Cantin N. Effectiveness of CO-OP Approach for Children With Neurodevelopmental Disorders: A Systematic Review. Arch Rehabil Res Clin Transl. 2023 Feb 23;5(2):100260. doi: 10.1016/j.arrct.2023.100260. PMID: 37312979; PMCID: PMC10258384.
Scammell EM, Bates SV, Houldin A, Polatajko HJ. The Cognitive Orientation to daily Occupational Performance (CO-OP): A scoping review. Can J Occup Ther. 2016 Oct;83(4):216-225. doi: 10.1177/0008417416651277. Epub 2016 Jun 14. PMID: 27301479.
Dietrich E, Lebrault H, Chevignard M, Martini R. CO-OP Approach With Children and Youth With Executive Function Deficits After Acquired Brain Injury: A Qualitative Study of Care Partners’ Involvement. Am J Occup Ther. 2024 Sep 1;78(5):7805205050. doi: 10.5014/ajot.2024.050586. PMID: 39133618.
Levanon-Erez N, Kampf-Sherf O, Maeir A. Occupational therapy metacognitive intervention for adolescents with ADHD: Teen Cognitive-Functional (Cog-Fun) feasibility study. British Journal of Occupational Therapy. 2019;82(10):618-629. doi:10.1177/0308022619860978.
Libby Kastner, Yifat Velder-Shukrun, Omer Bonne, Ruthi Traub Bar-Ilan, Adina Maeir; Pilot Study of the Cognitive–Functional Intervention for Adults (Cog-Fun A): A Metacognitive–Functional Tool for Adults With Attention Deficit Hyperactivity Disorder. Am J Occup TherMarch/April 2022, Vol. 76(2), 7602205070. doi: https://doi.org/10.5014/ajot.2022.046417
Grinblat N, Rosenblum S. Work-MAP Telehealth Metacognitive Work-Performance Intervention for Adults With ADHD: Randomized Controlled Trial. OTJR (Thorofare N J). 2023 Jul;43(3):435-445. doi: 10.1177/15394492231159902. Epub 2023 Mar 27. PMID: 36971429; PMCID: PMC10336612.