Written on 25-10-2017

We all know them – kids with ADHD who are bright, energetic, and creative – yet struggle in school. They don’t enjoy learning. They prefer easier work. They give up easily. By all accounts, they lack motivation.

But why? Is it due to a bad attitude? Is it laziness? No, it’s in the wiring!

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Is there anything we can do to help?

Fortunately, yes!

Studies of kids with ADHD have identified interventions that can increase motivation and enhance school success for kids with ADHD.

Point of Performance Supports: Leveling the Playing Field

Point of performance supports are small changes we can make in a setting or task that can make big differences for kids with ADHD. Such supports might include supplying noise-cancelling headphones, preparing organized work spaces, or providing checklists for complex assignments.

The great thing about point of performance supports is that they can have immediate pay-offs. They can reduce the frustration and increase success for kids with ADHD. However, point of performance supports rely on others to make that success possible. The kids still have the same challenges in unsupported situations. Point of performance supports alone are not enough in the long run.

Meds: Ramping Up the Supply of Dopamine

Stimulant medications have been found to increase the availability of dopamine in the reward circuits of kids with ADHD. This can help them get past the distractions of the moment and work toward future goals, at least during the time the medications are in effect. In the school setting, kids with ADHD tend to improve academic performance when taking appropriate medications. For some kids, booster doses may be needed after school to help them maintain focus and persistence during homework/study time.

Many studies have found ADHD medications to be safe and effective, yet medications are not a panacea. It may take considerable trial-and-error to find the “right” medication. Some kids do not respond well to ADHD medications. Others may find that effectiveness of the medication changes over time. Parents often struggle with decisions about medication.

Behavior Modification: Leveraging the Here and Now

Kids with ADHD seem to be stuck in the present moment. Their need for immediate payoffs makes behavior modification—the carefully planned use of rewards and consequences – a powerful intervention for kids with ADHD. Behavior modification can be helpful in increasing desired behaviors, like time-on-task, and in reducing problem behaviors, like missing assignments.

However, the motivation created by behavior modification may only last as long as rewards are provided. Rewards and consequences are not really effective in helping kids with ADHD develop the kind of long-term, internal motivation that is needed for real academic success.

SO – point-of-performance supports, medication, and behavior modification seem to be helpful for kids with ADHD in specific situations for the short term, but they rely heavily on someone or something outside the kids, and they don’t really promote long-term motivation.

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我們都會認識一些患有專注不足及過度活躍症（ADHD）的孩子，他們聰明、有活力並別具創意，但卻在學業上遇到困難重重。他們不喜歡學習，寧願做簡單的工作，又容易放棄。總的而言，就是缺乏動力。

為甚麼會這樣呢？ 是因為他們態度不好？ 還是過於懶惰？不，一切問題都出在大腦迴路上！

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有幫助ADHD孩子的辦法嗎？

幸好答案是肯定的。

有關ADHD兒童的研究發現，一些介入療法可以增加ADHD孩子的學習動機，提升他們在學校的表現。

適量的調適：降低客觀環境的挑戰

適量的調適是指對環境及任務作出細微的改動。對於ADHD孩子而言，這些小改動的作用可以很大。適量的調適可以是提供降噪音耳機、準備一個井井有條的工作空間及為複雜的任務提供清單等。

適量的調適的一大好處是能讓ADHD孩子立刻體驗到成效，減少挫敗感而增加成功的機會。不過，這個方法必需依賴他人的幫助，故在缺乏幫助的情況下，ADHD孩子還是會面對同樣的挑戰。從長遠而言，單靠適量的調適並不足夠。

藥物治療︰提升多巴胺的供應

研究發現，刺激性藥物可以提升ADHD孩子獎勵回路的多巴胺，讓他們至少能在藥物生效期間擺脫干擾，為未來目標而努力。在上學期間適當使用藥物，一般能有助提升孩子的學習表現。而放學後，部分孩子或會需要再服用藥物，讓他們維持專注，以便完成功課或進行課後溫習。

雖然有大量研究指出， ADHD藥物既安全亦有效，但它始終不是萬能的。要找到“合適”的藥物或需一定的試驗時間；藥物治療的效果並不是人人理想；藥效也可能會隨着時間的增長而改變。而作爲家長，就是否讓孩子接受藥物治療，往往會感到難以抉擇。

行為矯正：把握當下

ADHD孩子似乎較局限於眼前， 他們對即時獎賞的渴求，令行爲矯正成爲一個非常有效的干預方法。只要小心計劃目標及利用獎賞，ADHD孩子都會欣然接受。行為矯正可讓孩子培養更多適當的行為，如合理運用學習時間；同時減少問題行為，如做漏功課。

然而，一旦沒有了獎勵，孩子很可能便會失去動力。長遠而言，獎勵並非真正有效的方法。要在學業上取得真正的成功，需要有內在的動機和長遠的動力。

在短期且特定的情況下，適量的調適、藥物治療及行為矯正三種方法似乎都能幫助ADHD孩子。但這些方法都極度依賴他人及外物，無法真正孕育出個人的動機和長遠的動力。