As part of Head of School Renée Greenfield’s monthly blog posts, The Renée Sessions will feature periodic guest appearances by Carroll teachers and external partners, sharing their work, expertise, and insights.

More than half of Carroll’s student population has Attention Deficit Hyperactivity Disorder (ADHD) and/or executive function (EF) challenges, in addition to a language-based learning difference (LBLD). *see definitions below Often, it’s hard to tell which one is at play. Behaviors associated with ADHD can look a lot like an EF challenge and struggles with working memory—common for a student with dyslexia—can mimic symptoms of inattentive ADHD. How can parents and educators make sense of it all?

Clinical psychologist Dr. Sharon Saline, who workshopped with Carroll educators this fall and will present as part of our Community Speaker Series in February, answers a few of Renée’s questions.

Renée: The interplay between dyslexia, ADHD, and executive functioning (EF) skills is complex. How should parents and educators think about this constellation of characteristics and behaviors, and where can they start in addressing them? 

Dr. Sharon Saline: The challenge is that these diagnoses are deeply entwined. The co-occurrence of ADHD and dyslexia is around 50%. I start by teasing apart each component and then look at where the diagnoses—or symptoms—overlap.

Every human has strengths and challenges related to EF. For people with ADHD, those challenges are more severe and more frequent; for kids with dyslexia and ADHD, even more so. We also see kids who have dyslexia and EF challenges but not ADHD.

Part of the evaluation is to identify the student’s EF strengths and challenges so we can say, “Ok, you’re good with organization but struggle with time. Let’s work with time. How can we teach you what time looks like and feels like?” Maybe by using an analog clock and an alarm clock.

“How does your struggle with time affect your ability to read and write?” Students may perceive that they have all the time in the world to work on an essay in class, but they have much less time than they realize. We really want to look at how these EF challenges are manifesting in the classroom and at home.

Renée: You’ve previously talked about how kids who struggle with ADHD often think of time as either “now” or “not now.” This can certainly be frustrating for parents when giving multi-step directions, asking their child to do something now, like getting ready for school. How does this framing—that in the child’s mind there’s only “now” and “not now”—help parents to understand how to support their child?

SS: It’s important to understand that multi-step directions require good, solid working memory, which is remembering to remember and is deeply tied to emotional control. Many kids with ADHD have lower scores for working memory. When they’re giving multi-step directions, a child with ADHD can really only hold on to the first thing you say. For kids who are dyslexic and struggling to process language, even if they don’t have ADHD, multi-step directions are hard as well. They can’t hold all the steps in their brain and act. We have to break them down.

Renée: What should a parent be looking for if they suspect ADHD or EF issues may be at play for their child who already has dyslexia or an LBLD?

SS: ADHD can come in three forms—hyperactive, inattentive, and combined. And these characteristics need to be more severe than typically observed among a child’s peer group. Hyperactive ADHD can appear as aggressive or acting out behavior. Inattentive ADHD is often diagnosed later because it can hide. It may be talking out of turn in class, spaciness, or what I call ‘the drift.” Many children with ADHD miss the cues that are happening around them and have a hard time making friends. In general, you can look for fidgeting, restlessness, trouble motivating to complete a task a student doesn’t find interesting, or inconsistent motivation.

Renée: Am I correct in understanding that when you talk about motivation, it’s not so much motivation day to day, but motivation that’s topic-dependent. A student may be highly motivated if they’re working on car engines, but in another space, like a science class, you can see a very different level of motivation.

SS: Correct. This inconsistency in motivation is what Dr. Thomas Brown calls the central mystery of ADHD. And it’s why, in order to effectively address motivation, we have to work one at a time with its component parts:

• focus
• sustained attention
• task initiation
• time management
• organization
• prioritization 

To assess focus, parents can ask, “When and under what conditions is focusing easier for you, and for how long? When do you lose the ability to concentrate?” In general, interest fosters motivation. When something isn’t interesting, it’s harder to start it. So, we have to break those less interesting tasks down to help students feel a sense of success. No size is too small to start a task. Write your name on the top of the paper, for example. Then, let’s look at problem #1.

Parents can ask kids what’s easy, what’s hard, what’s medium and what order they like to complete work. Together, they can set up work periods that address how long the child can focus. Allow for a body break or a water break between work periods; have a reward that they’re looking forward to at the end of the task.

In terms of prioritization, think of having a list of multiple tasks to complete. For people with ADHD, overwhelm happens. The list looks like Mount Everest—there’s no trail marker, no guide, no map. Kids think, “I don’t know where to start so I’m just going to avoid it.” We want to help them prioritize tasks by thinking about urgency (when is something due?) and what’s the value of it (how important is it?).

The last thing we want to think about with motivation—and its interplay with ADHD, dyslexia, and EF—is this idea of metacognition: thinking about thinking. I call it self-awareness or self-evaluation. That is, “Am I making the progress I want? What do I need to help me?” We have to help kids zoom out and see what works for them so we can intervene more successfully.

Renée: How can parents support their older adolescent as they transition from high school to postsecondary settings?

SS: The most important thing you can do with your high school student is to really talk about what they see for themselves after high school. Don’t put pressure on them going to a top-tier school. Instead, ask, “What might interest you?” For kids with ADHD who often mature more slowly, they may not be able to have that conversation until senior year. Even then, they may need a year to mature, a gap year. What we want to do is help our kids make choices that fit who they are and not necessarily project what we need them to be able to do.

Renée: I agree, and I also think what you're offering there is relevant to kids moving from middle to high school.

SS: Often parents expect their kids to be at a place that they aren’t. We have to meet kids where they are and practice compassion—for your child and yourself. Parenting kids who struggle is challenging. If you have dyslexia or ADHD yourself, it can be even harder.

Renée: Yes, we find that many parents are forced to reopen whatever wounds or history they experienced, and that can be so painful. And then you see the same struggles in your own child and there’s so much blame and shame and guilt. You have to be able to manage your own emotions in order to help your child.

SS: Yes, parents can carry this invisible backpack of emotions that can be transferred to the child, so we really want parents to do some of their own work as well.

⭐️ Community Speaker Series

Watch a replay of a webinar with Dr. Sharon Saline and Carroll School to gain parenting tips and resources for children with dyslexia, ADHD, executive function challenges, and anxiety. Watch here.

*DEFINITIONS

Dyslexia: An unexpected difficulty in learning to read in an individual who has the intelligence to be a much better reader. 

Attention Deficit Hyperactivity Disorder (ADHD): A common neurobehavioral disorder that begins in childhood and is characterized by inattention, hyperactivity, and impulsivity. 

Executive Functioning (EF): Mental skills that we use every day to get things done, like goal-setting, prioritizing and organizing tasks, and managing our time. 

Working Memory: The retention of a small amount of information in a readily accessible form. It facilitates planning, comprehension, reasoning, and problem-solving.

Sharon Saline, Psy.D., clinical psychologist, specializes in working with kids, young adults, and families living with ADHD, learning disabilities, and mental health issues. The author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution Card Deck, she is a regular contributor to ADDitudemag.com and PsychologyToday.com. She is also a featured expert on MASS Appeal on WWLP-TV and a part-time lecturer at the Smith School for Social Work. Learn more at www.drsharonsaline.com.