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Dr. Richard Gallagher Talks About Organization and ADHD

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On October 4, 2010, Dr. Richard Gallagher gave the first in a series of parenting talks, at the Dalton School on Manhattan's Upper East Side. His presentation was based on groundbreaking research undertaken over the past 10 years by the NYU Child Study Center (CSC) under the direction of lead investigator Dr. Howard Abikoff. One aspect of the talk focused on recently analyzed results from a study conducted in conjunction with Duke University.

This study has shown conclusively that children with ADHD and organizational skills deficits can learn to overcome those deficits to a significant degree; they can be systematically taught organizational, time management, and planning, or OTMP skills, through techniques developed over the course of the study.

Many kids who are bright and otherwise capable, but were floundering in their studies due to difficulties with OTMP skills have made remarkable gains through the training they received as study participants. In January, the CSC began offering the training as part of our patient care services to children who have demonstrable organizational skills deficits related to ADHD (read more). At Dalton, Dr. Gallagher outlined techniques that can benefit all kids and be taught by parents at home.

You can see a video of Dr. Gallagher's full presentation above. Below is a transcript of the question and answer portion of his talk. You can also send your parenting questions to csc.parentinginstitute@nyumc.org. Dr. Gallagher will do his best to respond to every question.

Q: There are a lot of first-grade parents in the audience, and I would like to know how this information translates to younger kids. (The study was conducted with kids in grades three through five. Other sections of the research have worked to understand the challenges of students in grades six through eight as well.)

Dr. Gallagher: We decided not to start doing this work before third grade because, first, teachers said children at this age didn't have a lot of independent responsibilities for organization. Secondly we didn't think children in grades prior to third would generally be effective at developing these routines on their own.

That doesn't mean children in Kindergarten, first, and second grade can't begin this process. We have not tested this out, but I think of it like language development. We don't wait for children to say words before we talk with them. We spend a lot of time talking to children who have no idea what we're saying because they're too young. By talking to them, we are helping them understand language and how it works.

Parents can get involved with this organizational process with younger children by highlighting how it is done, not just showing, but actually talking it out. For example, one could say, "Here is what I am doing to get your backpack ready. I am thinking about the weather outside. I heard the forecast and it is going to rain, so I am going to put an umbrella into your backpack."

You can prompt your child, "If you are going to a friend's house for a play-date, what do you think you need to take with you?" The child responds, "Well I don't know, maybe we will play football." Then you can suggest, "Why don't you bring a football?"

It's important to think about time in a similar way. Say, "I know we have to get downtown, I know it is this time of day, I know the 6 train is going to be crowded, so we better give ourselves this much time. We want to get there by seven o'clock, so we'd better leave by 6:30."

I do not believe you have to be highly organized yourself to be able to help your kids. If you saw my office you would know that I am not very talented at this, but I can help out a fifth grader. I am smarter than a fifth grader in this regard, and with regard to younger kids, you can be smarter as well.

Q: I noticed the organizational skills research shows mastering one skill before moving on to the next. With all the things kids have to do, I wasn't sure how that would work.

Dr. G: We have found that without taking that step, kids who are struggling truly do get overwhelmed. The kids we've seen, especially those in fifth grade and certainly the middle school kids, have heard it over and over - people asking them, "Why don't you just get yourself better organized? Why don't you keep track of your papers? Why don't you write things down?"

These kids have been highly unsuccessful. When we tell them we're going to help them get organized, their reaction is, "Are you kidding me?" We try to make it as playful and rewarding as possible, while taking on this serious problem.

Many of these kids are flunking out. We are working with eighth graders who have never been organized, and they are in the process of saying, "I guess I am not going to do well at school. I am just going to get by."

We found that if they learn one organizational skill at a time and see that it's successful, they are encouraged. It is motivating to them to go on to the next step and take on some of these onerous tasks.

Also, some of the tasks we teach kids are boring and slow. It takes time to write things out. It takes time to use a calendar. It is boring to sit down and figure out what items you need to put in your backpack.

The kids have to be willing to do this, and we find the best way is one step at a time. Be patient as you're teaching these skills, and recognize that things will improve.

Q: How do you get kids to do the important first steps, such as writing everything down?

Dr. G: A lot of it is cueing kids, trying to get teachers to remind kids. If your kid is really struggling, talk with the teacher and say, "I understand that this may not be a problem for every student, but could you provide my student with a quiet reminder to write things down? Could you check at the end of class? Please have my child show it to you."

Then when your child comes home, you can get involved with praising him or her and sometimes making this something that gets a reward for follow-through. We use a lot of positive reinforcement. We find that is very important as well.

Q: How much time should we spend as parents?

Dr. G: It depends on what you want to get organized and how skilled your kids are. We do promise kids: It's really slow in the beginning, but if you keep doing this, it will get faster and faster.

For third grade I would think about how much homework they have. It may take 5 or 10 minutes to get organized in the beginning. After a while we find it just takes a few minutes - if the kids are ready to sit down and think about their homework, how long it will take, and what they need.

As they get older, it will take more time. Although, even with middle school kids, we found that it can be done in a few minutes. Certain things will require more time, such as weeding out the binder, making the plan for the book report or studying for a test.

How long does it take you to think about your own office, or your own briefcase? Use those estimates and then expand, because kids are slower.

Q: Because children generally don't have a great sense of time, what is the best way to get a child to leave home to go to an activity, whether it be school or camp, and be on time?

Dr. G: What is very helpful, and you see a lot of preschool teachers do this, is giving kids warnings: "It's almost time for clean up." They will give the warnings five minutes ahead of when the actual getting ready should start. They will count things down: "We have another minute to go, and now it is time to clean up."

We can do the same thing with older children to plant the idea of a change. Usually kids are involved in something they are really enjoying. They engage in a lot of magical thinking, "I just have to think about getting down to Grandma's; that is how long it takes." Kids don't really know how long things take.

If it is something unimportant and you can work it out without being cruel, a child could miss part of an activity. You can say, "Well remember I gave you this idea, I gave you a choice. I said you could start getting ready to leave. You didn't do that, and that's okay, but now you see it results in you missing some of this activity." You can say this without being cruel; you don't want to rub their noses in it. This enables the natural consequences to play themselves out, and kids can learn that way.

Q: You mentioned boys are generally less organized than girls. Where is the line between developmental boyishness and a true problem?

Dr. G: If most of the other boys are not having a problem, then I would say it is a concern.

Many of my colleagues are postdoctoral women who are really powerful and smart, and when we brainstormed, they often came up with really elaborate ideas for developing organizational skills. I would say, "Now wait a minute, we are talking about boys. They are not going to do this."

Ask around, "How are your boys doing with their organization?" You can ask a teacher if you don't want to talk to friends about it. A teacher would give you a sense of where kids stand.

We do have an assessment procedure, which actually was the beginning of this work (financial disclosure, we get royalties from this method). In the beginning we didn't know how to measure or pinpoint kids with this problem. We developed a scale that is based on parent and teacher ratings. We now have norms that tell us which kids are falling into the problematic range.

Q: Do you discourage the use of electronic organizers all together?

Dr. G: Yes, they get lost. The children I work with have a lot of important abilities, I am really not trying to malign people who have Attention Deficit Hyperactivity Disorder. But if you talk to a fair number of parents of teens who have ADHD, you will find that they have lost many phones each year.

The other part of electronic organizers is that "To Do" lists are not always well connected to the calendar. We would like to see something where when a child enters in homework, a reminder pops up saying there is a book report due in a week, and that they should be working on part of it. But it would be important that it wasn't nagging, because then they will ignore it.

This series of six parenting talks by Dr. Richard Gallagher is possible thanks to the generosity of Sarah and David Fiszel, who, through their gift, wanted to bring valuable parenting advice from Dr. Gallagher and the NYU Child Study Center to a broader audience.

The Fiszels' support enables these talks to reach hundreds of parents who attend the live presentations at area schools. Their donation has also made it possible to feature video of each talk on the CSC's Web site, www.aboutourkids.org, which will help us to reach thousands more parents and caregivers across the country.

Dr. Gallagher is an associate professor of Child and Adolescent Psychiatry and director of special projects at the CSC's Institute for Attention Deficit Hyperactivity and Behavior Disorders. He is an expert in the treatment of selective mutism as well as organizational skills deficits.