3 Specific Rules for Managing ADHD

The CDC reports that 6.4 million children in the United States have been diagnosed with ADHD. As the prevalence of the diagnosis continues to rise, it’s important to have tools and strategies at the ready for managing ADHD in school.

Here are three classroom rules that are easy to implement and follow…

The following is based on the new release: Managing ADHD in School by PESI author Dr. Russell Barkley.

The CDC reports that 6.4 million children in the United States have been diagnosed with ADHD. As the prevalence of the diagnosis continues to rise, it’s important to have tools and strategies at the ready for managing ADHD in school.

Here are three classroom rules that are easy to implement and follow:

1. Rules and instructions provided to children with ADHD must be clear, brief, and often delivered through more visible and external modes of presentation than is required for the management of children without ADHD.

Stating directions clearly, having the child repeat them out loud, having the child utter them softly to themselves while following through on the instruction, and displaying sets of rules or rule-prompts (e.g., stop signs, big eyes, big ears for “stop, look and listen” reminders) prominently throughout the classroom are essential to proper management of ADHD children. Relying on the child’s recollection of the rules as well as upon purely verbal reminders is often ineffective.

2. Represent time and time period externally (physically).

Children with ADHD are less capable of using their sense of time to manage their current behavior and get work done in time, over time, and on time. When short time intervals of an hour or less are required to do work, then represent that time period using a clock, kitchen timer, counting device or other external means to show the child how much time they have and how quickly it is passing. A spring-loaded kitchen cooking-time placed on the child’s desk can serve this purpose. For longer time periods, break the work down into shorter periods with smaller work quotas, and allow the child to take frequent breaks between these shorter work periods.

3. Anticipation is the key with children with ADHD.

This means that teachers must be more mindful of planning ahead in managing children with this disorder, particularly during phases of transition across activities or classes, to ensure that the children are cognizant of the shift in rules (and consequences) that is about to occur. It is useful for teachers to take a moment to prompt a child to recall the rules of conduct in the upcoming situation, repeat them orally, and recall what the rewards and punishments will be in the impending situation before entering that activity or situation.

Think aloud, think ahead is the important message to educators here. By themselves, such cognitive self-instructions are unlikely to be of lasting benefit, but when combined with contingency management procedures they can be of considerable aid to the classroom management of ADHD children.

Russell A. Barkley, Ph.D., is a Clinical Professor of Psychiatry at the Medical University of South Carolina. He served as the Director of Psychology at the University of Massachusetts Medical School for more than 15 years (1985-2000) and established the research clinics for both child and adult Attention Deficit Hyperactivity Disorders.

Get the tools and strategies you need to help your youngest clients enjoy childhood to the fullest. Featuring Drs. Russell Barkley, Temple Grandin, Tina Payne Bryson and more. Limited capacity! Register now.

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Does Sugar Mimic or Increase ADHD Symptoms?

Have a cranky, irritable, and unmotivated child or teen that cannot concentrate well? Perhaps sugar-loaded foods are to blame!

The following is based on the new release: ADHD: Non-Medication Treatments and Skills for Children and Teens A Workbook for Clinicians and Parents: 162 Tools, Techniques, Activities & Handouts by PESI author Debra Burdick, LCSWR, BCN.

Have a cranky, irritable, and unmotivated child or teen that cannot concentrate well? Perhaps sugar-loaded foods are to blame! Eating foods high in sugar results in a surge of sugar in the bloodstream followed by a dumping of energy a short time later.

Your hyperactive client may be sensitive to the effects of sugar, and they may become extremely hyper when they have it. But as their body adjusts to a sudden increase in blood sugar, it will trigger an increase in insulin which will rapidly lower the sugar level in the blood. As the blood sugar level decreases, it can worsen the already low brain arousal level of the ADHD child or teen and aggravate behavioral problems.

Studies are contradictory about the effects of sugar on hyperactivity and behavior, and many indicate no change in symptoms (Wolriach, ML, 1994). Yet many of my clients have discovered that sugar was a culprit in making symptoms worse.

Discover if sugar is impacting your client’s ADHD symptoms by downloading and completing the following worksheets with your client. You’ll find skill building and integration thoughts below.

Worksheet Downloads

Handout 19.1.1. | Food Diary 

Handout 19.1.2. | Food Symptom Diary Example

Handout 19.1.3 | Food Symptom Diary

SKILL BUILDING: Find out how much sugar your client consumes. Help them keep track by using a Food Diary (Handout 19.1.1.) to write down everything they eat for 1-2 days. Review it with them to see what food choices they are making and how much sugar they are eating. Teach them to look at food labels, and show them where the sugar content is listed. Discuss with parents, older children and teens the effects of sugar on the symptoms of ADHD.

Explain that sugar affects some people with ADHD by increasing hyperactivity, poor concentration and irritability. If they consume a lot of sugar, use the Food Symptom Diary (Handout 19.1.3) to determine if sugar is increasing and/or decreasing their ADHD symptoms. You can see a completed example of the food symptom diary using Handout 19.1.2.

Explain that the glycemic index (GI) is a scale that indicates how fast the body will convert a particular food to glucose (sugar). The higher the number, the faster the rise in blood sugar will be. A low GI value is 55 or less, medium is 56 – 69 and high is 70 or more. Encourage them to serve foods that have a low glycemic index.

For example: One 20-ounce bottle of a popular orange soda contains 83 grams of sugar. That translates to 21 teaspoons of sugar. They might replace that with a flavored water such as 0 calorie SoBe® LifeWater Fuji Apple Pear which is sweetened with a stevia extract and has 0 grams of sugar. (At the time of this writing stevia has been found to be safe and non-toxic, but as always, encourage clients to consult with their doctors before use.)


  • How much sugar is the client consuming?
  • How much impact is sugar having on the client’s ADHD symptoms?
  • Were they able to complete the Food Diary?
  • Did they discover a pattern of increased ADHD symptoms following consumption of sugar when they completed the Food/ Symptom Diary?
  • Are they finding ways to decrease sugar intake?

Get over 100 more tools, techniques, activities and handouts in the new ADHD Non-Medication Treatment & Skills for Children and Teens workbook.


Learn more from Debra! 

Reference: Wolraich, M.L., Lindgren, S.D., Stumbo, P.J., Stegink, L.D., Appelbaum, M.I., & Kiritsy, M.C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330(5), 301–7.

The Timing Therapy Exercise Every Therapist Needs

Give us four minutes, and we’ll show you how you can see up to 30% gains in the executive-function skills of your clients with ADHD.

Timing and synchronization are crucial to our brain’s ability to function. Our brain has a master clock and circuitry devoted to keeping cells and signals synchronized. When the timing of this circuitry is imprecise, brain processes can suffer and we experience a degradation of motor skills, senses, cognitive skills, emotional regulation and other functions.

Timing therapy is an approach to re-syncing the brain’s timing circuits. Research has shown that when we regularly practice timing precision, we can repair out-of-sync timing circuitry in the brain, which in turn increases brain and body functionality in a significant way.

Key elements of timing therapy include:

The beat: It should match the natural rhythm of the activity.

The tempo: A comfortable clapping speed for most people is about 54 beats per minute (BPM). However, a typical child with ADHD will be more comfortable at a slightly higher tempo (try 63 BPM).

Precision: Keeping an imprecise beat or not caring about the beat will not produce desired results.

Feedback: The most powerful forms of timing therapy provide sensory feedback on how well the beat is being maintained.

Much of the research in timing therapy has been done in conjunction with the Interactive Metronome. Studies show that children with ADHD who did 15 hours of tapping and clapping exercises using the Interactive Metronome made 30% gains in their executive-function skills. This includes attention skills, working memory, motivation ability to plan and problem-solve, as well as the ability to stay organized.

Want to implement timing therapy with your clients and see similar results, but don’t have the funding to purchase equipment? Teresa Garland, MOT, OTR has a method for you. By combining a metronome and a ball, you can get the same sensory feedback for under $2.

Master the simple method in under four minutes.



This blog is based on the writing of Teresa Garland, MOT, OTR. Check out her award winning book Self-Regulation Interventions and Strategies: Keeping the Body, Mind & Emotions on Task in Children with Autism, ADHD or Sensory Disorders.