ADHD Support Revolution: Rethinking Interventions for Success

Understanding ADHD Urgency

Hello school counselor . How are you doing over there ? I hope you're doing great . I'm so excited to be back with you for another episode of the School for School Counselors podcast . I'm Steph Johnson , your host , and I just look forward to this each and every week , having some time to consult with you a little bit to discuss all things school counseling , because I'm a full-time school counselor , just like you . We are in these trenches together and I consider it an honor to bring you information each and every week .

Have you ever had kids on your campus that you knew had attention deficit , hyperactivity disorder , adhd ? But for some reason , the interventions that you provide them or the things that you try to teach them to do just don't seem to work . Have you ever been there ? Chances are , if you're a school counselor , you've been there more than once and I can't attest to that . Sometimes helping these kiddos shine in school can feel really complicated and really difficult , just because impulsivity comes into play and it's hard to really help kiddos get the upper hand on that . In a lot of times we provide interventions that we're told are going to work great and then sometimes they don't work so well . We just chalk it up to well , that didn't work , for that kiddo got to find something else , without really diving into the why of why it may not have worked .

As I was walking through the literature for our podcast episode last week about dialectical behavior therapy and how that can be implemented in schools , i ran across an interesting sentence . It was in one of the journal articles that I was reading and it was talking about positive and negative urgency in students with ADHD . Have you ever heard of positive and negative urgency ? I hadn't , so I went in and started doing a little excavating , a little researching and a little unearthing . What I discovered is that some of us many of us have been looking at ADHD all wrong . We're going to dive into ADHD . This week . We're going to be talking about positive and negative urgency for students and what that means in our school counseling interventions .

But before we do that , as always , we want to hop into the reviews for the School for School Counselors podcast . There's only one problem This week we don't have any new reviews . You guys , how did this happen ? I have no idea how we've gotten here , but here we are . We have no new reviews for the podcast and we love reading your reviews . We love it so much . It's what keeps us going to continue putting this out week after week , because it's not just me sitting here behind the mic . I have a team of folks that are helping us get this out and it really helps motivate and inspire us in our work . If you have a minute , if you're feeling generous , would you hop on over to Apple podcasts and leave us a written review about how you feel about the School for School Counselors podcast ? Let us know if you're picking up what we're laying down over here . Let us know if we're handing you the right things , because one of our number one goals is not to sound like every other podcast out there . The only way we know if we're hitting the mark is if you let us know about it .

Let's hop into ADHD . Let's talk about what negative and positive urgency actually is . This idea of urgency plays a significant role in how students with ADHD navigate their daily lives . It's how they make decisions , it's how they engage in behavior and it also is tied into their emotional well-being . So it's really important for us to be able to understand the differences between negative and positive urgency so that we can give the targeted strategy students need to effectively address what it is they're lacking . We want to be able to be that environment for all of our students that makes them feel supported , that makes them feel understood and like they can be successful , because at the end of the day , that's 100% the goal of the school counselor . I'll give you an example , kind of , of what I'm talking about , and it's just an amalgam put together of a lot of kids that I've known over the years .

But let's think about a student that just really wants to shut down in class , and they do it in one of two ways . Number one they get frustrated and angry . They like to shout , yell , throw things in the floor , maybe turn over a desk here in there every now and again , or they like to lay their head down , maybe pull their hood or their hat over their heads and just sit there and refuse to do anything . If you have those kiddos on your campus , you know what I'm talking about , right , and so typically , when we go in to intervene with these kiddos , what do we do ? We walk in and we talk to them about how they're feeling , right , maybe about their triggers . We talk to them about coping skills and how to implement coping skills in the classroom . Hopefully we've got some time to practice those , really try to ingrain those skills for the student . And then usually , if we're at a lower level , we look at implementing some kind of a behavior chart , right , because we want to really encourage these students to do their best job . And sort of general thinking is , if we can get them to really reflect , really have their finger on how they're doing , that that's going to encourage them to do better , right ? Well , listen , as we walk through this , you may determine that that's not the course of action that you want to take at all . But let's jump back .

So ADHD , we know , is inattention , impulsivity and typically hyperactivity . So what does urgency have to do with all this ? Emergency is talking about a heightened sense of time pressure that folks with ADHD experience all right . So their perception of time is being influenced and it impacts their ability to manage their tasks and to manage their emotions effectively . They feel all of this pressure pushing down on them . Everything's going hyperdrive in their mind And so , to their understanding , time is clipping along pretty quick and they don't even have time to think and react .

There are two aspects to this urgency . One is negative urgency , and that's when students start making impulsive decisions when they're in a negative emotional state . So we're talking about when students are frustrated , when they're angry , when they're sad , they start making these impulsive decisions , and they're making these decisions in an effort to get rid of the negative feeling . Right , they make rash decisions , they don't think through all the way to the consequences , and so we start to see difficulties with emotional regulation . We start to see this affect their relationships And then we start to see them have some academic challenges , right , because they're just constantly making these impulsive decisions when they don't feel good . On the other hand , we could also be looking at some positive urgency with students . This is when they're still making those impulsive decisions , but they're doing it during a positive emotional state .

So these are kiddos that are looking for gratification , right , and feedback . Sometimes they're looking for intense feedback to match their own intensity , but it's when they're feeling excited , when they're feeling super happy , when they're feeling very invested in what they're doing , they start impulsively seeking these kinds of gratification , and that can also lead to things like risk taking behaviors , impulsivity , and they also sometimes have trouble delaying gratification . This kind of sensation seeking behavior can also pose some challenges in the academic realm , because they're not able to sit and really focus on what they need to be learning , they're not able to be able to send some of those skills into some longer-term retrieval And socially with their peers and their classmates , they may start to struggle too . Even though they're happy , even though they're invested , they're still struggling with focus , with self-control , and then that's going to bleed over into the classroom environment And eventually it's going to start affecting their sense of well-being . So , negative urgency and positive urgency Both ways in which students with ADHD make impulsive decisions one , though , is during a negative emotional state and one is during a positive It's almost like and this is the way I tell myself about this in my brain .

I don't think it's a thousand percent accurate , but I do think it's helpful . In conceptualizing this . It's kind of like the happy versus the angry ADHD student , if that makes any sense . Now , i don't know that positive urgency is necessarily always correlated with happiness per se , but it's just a way to kind of frame this out in your mind a little bit . So , as school counselors , it's really important for us to understand the distinctions between negative urgency and positive urgency , because each one of those , as you've already heard a little bit have different impacts on student behavior , and so they need different kinds of interventions . So if we can look at a student and identify what sense of urgency they're operating from , we're able to give them a more targeted strategy . We're able to better help them regulate their emotions and guide them towards more healthy decision-making tailored to their specific needs .

So first let's talk negative urgency . These are the kids that usually pop up on our radar as needing intervention a little bit more quickly . So just to recap there , these guys are acting impulsively when they're experiencing negative emotions , when they're getting frustrated , when they're disappointed , when they're angry . They're finding it hard to manage their emotions and they're engaging in impulsive , sometimes destructive behaviors . This might look like outbursts , this might look like difficulty following directions . This might look like engaging in just outright disruptive behaviors , throwing materials , lashing out verbally at peers or at teachers . And it's unfortunate , because students who are struggling in this realm are not only disrupting the classroom learning environment , but they're putting a strain on their relationships right with other kids . They essentially can sometimes make a pariah out of themselves in the classroom environment and they're not learning what they need to learn when they're in the classroom .

There is a profound connection between negative urgency and difficulties with emotional regulation , because when students are faced with these negative emotional states , their urgency level skyrockets I mean it just blasts off into the stratosphere and they feel compelled to find immediate relief for this sense of urgency . It overrides their ability to think through the situation . They cannot see consequences , they cannot see impacts of their actions . All they can do is seek the relief from this negative urgency . And it's important to say here too that this is not a lack of self control . This is not a need for more discipline . This is simply the student displaying a heightened emotional response to a negative stimuli .

How often when you see students with these types of behaviors , have they quickly been labeled as defiant versus dysregulated ? This is really important to think about , because when we get students who are crumpling papers , when we have students who are storming out of the classroom and eloping , when we have students who are throwing things , often they're immediately labeled by someone on campus as defiant . When we talked about this quite a bit back in episode 41 , in an episode titled Stop Talking About ODD I digress , but really the point is let's not jump to a label of defiance . Let's look at them through a lens of dysregulation , let's exhaust those possibilities , let's support them through that and then , if those are not fruitful , if they're not willing to engage in those strategies , then we can start looking toward other explanations .

Managing Urgency in ADHD

So what do we do for kids who are exhibiting negative urgency ? Ask school counselors what can we do ? Number one teaching mindfulness or a personal time out , or teaching them to take a break . This is going to be extraordinarily helpful for students in negative urgency . The thing is , you're going to have to teach them how to do those things . Not only are you going to have to teach maybe , some mindfulness techniques , but you're going to have to teach them how to take a break , because when students get in that heightened state and they can't think through the next best thing to do , they're just reacting . They're just seeking that immediate relief from that negative feeling . They're going to have to call upon times when you explicitly worked with them , explicitly practiced , explicitly reviewed how it went when they took a break . You're going to have to invest a lot of time in teaching some of your students how to take a break . They don't instinctively understand what that is .

Second , we can provide coping strategies and we teach those day in and day out , right morning through the afternoon , about regulating emotions effectively in the moment and out of the moment right . So continue teaching those coping strategies . Third , we can do a little cognitive restructuring . We can do that through some cognitive behavior techniques or through some dialectical behavior therapy techniques , and again you can go back to the last episode if you want to catch up on those . But basically what we're trying to do is address those negative thought patterns . We're trying to address those impulsive behaviors and replace them with things that are more realistic or more positive . And then , last , we can provide some problem solving and decision making skills . How do you problem solve ? What are the steps in making the next decision ? Those are all very important and I think sometimes we think we should just be able to tell students how to do it , particularly if they're at the secondary level . But they often do not have the first clue about how to go about that in an effective way . It's up to us to teach them .

So for negative urgency , taking a break , coping strategies , cognitive restructuring and then teaching problem solving . So then let's look at positive urgency . Positive urgency , remember , is acting impulsively when experiencing those positive emotions Excitement , joy , elation And students feel that sense of positive urgency because they want immediate gratification , they want that sensation that they're seeking , and so they find it hard to back off . This may look like them blurting out answers in class when they've been asked to raise their hand . That's a big one in a lot of classrooms , also engaging in off-task behaviors because they're looking for that attention and excitement that they feel like they have to have . They may struggle with staying focused on long-term goals , and so they can easily succumb to distractions . They again they're starting to make impulsive decisions because they can't think through to the end game .

Think about a student that you know that frequently interrupts class discussions . Think about students that you know that are frequently up and moving around the room for no apparent reason . Really , they're happy and excited to be in the classroom . They just don't know how to handle it . This is going to create challenges for the student . It's going to create challenges for their classmates . It's going to disrupt the flow of the classroom , right , and then nobody's able to focus and nobody's able to be productive . So being able to find these students that are dealing with positive urgency is super important , because it gives us an insight into what's going on with regard to their self-control and their ability to delay gratification . What are we going to do to help with positive urgency concerns ?

These are the kiddos that might respond well to reward systems , particularly ones that provide smaller and immediate gratification alongside of a long-term goal . These kids are not going to do well when they have to get 10 stickers in a week . You're going to have to give them some immediate gratification in that process . You might even have to start them with hey , buddy , you got one sticker , come on , let's do something cool And build them up , build their stamina for delayed gratification .

Another great thing that school counselors can do with kiddos in these situations is teaching impulse control , some techniques to really make themselves stop and think . And then one really important thing that I think we are really good at is helping foster environments that promote engagement and stimulation within appropriate boundaries . That is the one-two hit of engaging lessons and effective classroom management . Ever wonder why you have some kiddos that you know have ADHD concerns that perform perfectly in one class and can't seem to handle another ? Odds are it comes down to that beautiful marriage engaging lessons and effective classroom management .

So if we have students that are struggling like that , then it's up to us to try to push into that classroom and either explicitly teach or model what those components look like , understanding the difference between negative and positive urgency is crucial because we have to be able to recognize the differences in how these urgencies manifest , how they look different , what the behaviors become because of the urgencies . Then we can tailor our interventions and our support strategies to really address the students' specific challenges . It's no longer this one-size-fits-all approach for ADHD that hadn't been helping anybody . We got to get intentional and targeted about what we're doing . We can address that specific urgency type . We can help students navigate their emotions , tailor to their type of urgency and be able to help them make more thoughtful decisions , be more successful academically , feel better about themselves and experience better interpersonal relationships . We've got to get targeted and intentional with what we're doing .

I talked about this a little bit earlier , but let me circle back around and say how many times have we addressed negative urgency through positive urgency interventions ? That student who refuses to complete work , who likes to throw chairs , who likes to shout , who likes to elope . We talk to them about their feelings , we identify their triggers , we put them on a behavior plan , we chart their progress , we try to incentivize them in some way . Maybe we put them in a check-in-check-out system . The only components of that plan that are appropriate for negative urgency are talking about feelings and identifying triggers . Everything else is tailored to positive urgency .

If you implement a plan like that for a student with negative urgency I'm not saying it's not going to work , because all students are different , but the odds are not in your favor It might be a little bit more efficient and effective for everyone if you approach it in a different way . In negative urgency . We might be looking more toward a CPS model like the one that Ross Green teaches . If you've ever had the privilege of learning from Ross Green , that might be a great approach . Dialectical behavior skills , again , might be a great approach . Some of your cognitive behavior approaches could work well with negative urgency if they're presented in the right way and at the right time . So we've really got to be mindful and thoughtful with the way that we're doing this .

So let's make this all make sense , because I've been going on and on about negative and positive urgency And , to be honest with you , i debated about whether or not I was going to allow this podcast to go on this long . But I don't want to break this conversation in half , so bear with me for just another few minutes . Let me try to bring this all home . Let me try to wrap it all up with a bow and present it to you on a platter , about what we can do with regard to negative and positive urgency in ADHD . Number one what can school counselors do ? We've got to understand the differences between positive and negative urgency . Number two helping establish supportive and structured environments . Not only is the structured , consistent and predictable for students , it may include some advocacy on behalf of students with folks that don't understand ADHD , some of your teachers that feel like they should just be able to sit down and behave and listen Right . How many times have you heard that You may be doing some advocacy to establish those supportive and structured environments ? You may have to teach your teachers about ADHD , about positive and negative urgency . And then you've got to have an environment where students feel comfortable expressing their emotions or seeking help when it's needed , and that's not just you as the school counselor . That can happen in the classroom as well .

So , first , understanding the differences between positive and negative urgency . Second , establishing that supportive and structured environment from all aspects . Third , we're going to educate students on emotional regulation strategies . We don't just tell them y'all , we practice with them , we focus on it , we recap , we revisit all the time . Fourth , working with students to develop coping mechanisms for managing negative emotions and for making thoughtful decisions in those moments . Fifth , we can collaborate with teachers and parents . Again , we've got to make sure that we are consistently supporting students and that those in the classroom with them understand the different types of urgency . And then , last , we can implement behavior management techniques . There's a lot going on here . Then there's a lot going on here .

This feels like a good time to mention one more time . We have a mastermind book study on DBT skills in schools because , as I mentioned earlier , dbt skills can be highly effective in addressing both positive and negative urgency in students with ADHD . Our last conversation talked about some of the main components of DBT and you can go back and listen if you want more information , but basically they're emphasizing four key areas mindfulness , distress tolerance , emotion regulation and interpersonal effectiveness . Holy moly , that sounds custom made for these ADHD situations , doesn't it ? I mean , it just sounds stinking perfect .

Mindfulness is going to address both the positive and the negative urgency . It's going to allow students to have an awareness in the present moment , of the moment , without judgment . Kids are going to be able to observe their emotions , to observe their thoughts and not immediately act upon them . It's something that takes practice and stamina right that it can be accomplished through time , patience and good guidance . Distress tolerance , again , is going to help both kinds of urgency , negative and positive . These skills are going to help students tolerate those emotions and situations without getting impulsive or without engaging in harmful behaviors .

Students who have a negative urgency remember that comes from those negative feelings combined with that sense of time urgency are going to really benefit from distress tolerance skills because they're going to learn alternative ways of coping with their negative emotions . For positive urgency kiddos , distress tolerance skills are going to help them manage that urge for instant gratification . They're going to be able to tolerate the discomfort of delayed rewards . It's going to be super important . And if they can withstand that urge for that immediate satisfaction they're going to be able to make more informed decisions . The third component of DBT Emotion Regulation are particularly relevant for addressing negative urgency . Identifying and labeling their emotions , understanding the functions of them and implementing good coping strategies are going to help them respond to those negative emotions that are driving that urgency in a more adaptive manner . And last , for DBT teaching , interpersonal effectiveness is going to help both sides in all social contexts right , they're going to be able to manage conflicts or express their needs in healthy ways . Y'all it's just beautiful .

If you are interested in hopping into our study , it has already started , but it is not too far gone that you couldn't participate , particularly if you're listening to this episode close to the date of release . We're heading on toward chapter two , so you're not that far behind . We would love to have you come join us . If you're listening to this very far afterward . Please know that we're archiving all of these book study conversations in our library of all the things grad school forgot . So they're not leaving . They're still a chance to hop in and soak up all the goodness of dialectical behavior therapy skills in the school setting .

You can learn more about the School for School Counselors Mastermind on our website , schoolforschoolcounselorscom slash mastermind . It's all there for you And please hop in our Facebook group . Let us know if you have any questions . We want to make sure it's right for you before you hop in . But I promise you learning about DBT skills is only going to benefit your school counseling practice .

Improving ADHD Support in Schools

All right , this episode went on a little long , but I hope that you got a lot of really great information . I hope it validated for you some things that you've seen with some of your students in addressing attention deficit hyperactivity disorder and that you really feel like you have a new and more promising direction when working with your students , when working within these situations . Go , give it some thinking , go reflect , maybe write some things down and then come join us in the School for School Counselors Mastermind . We'd love to take this conversation further as we geek out on all things school counseling . I'll be back soon with another episode of the School for School Counselors podcast . In the meantime , i hope you have the best week And if you're starting your summer break , enjoy it . Y'all take care .