ADHD attention frustrated student attention deficit hyperactivity disorder
(Illustration by Chen from Pixabay)

AFTER DINNER, some 200,000 Massachusetts teenagers retreat to their bedrooms. Nominally, they’re doing homework. In practice, many are waging—and losing—a private war of attention. Even when they turn their phones off or leave them in the kitchen, the homework itself often lives on a laptop, where a single click offers instant distraction and relief.

We recently launched a consulting business to coach high schoolers struggling with getting homework done. The fancy, sometimes broader name for the skill we try to help them develop is executive function.

We’ve worked with dozens of teens over the past six months. Many try in good faith.  They trudge upstairs after dinner.  They stare at Google Classroom, click into math or history, maybe start a problem or two. Then they promise themselves they’ll start “for real” in 10 minutes, and click elsewhere. The evening dissolves into self-reproach.  Now it’s 9 pm.  Oops, now it’s 11.  

What we’ve learned in helping kids with attention deficit hyperactivity disorder, or ADHD, is that they need more than “strategies.”  Teachers and counselors have already explained these – here is how to get organized, how to prioritize, here are some tricks to help you focus. It is not leading to behavior change.

There is no one-size-fits-all plan that will work with all students.  Most of our students arrive having already tried these things.  

What’s needed is a wholesale rethinking of our approach to ADHD, one that is guided by evidence and a better understanding of the dynamic nature of attention problems. Getting the diagnosis right will allow us to stop spinning our wheels and develop the best plan for each student dealing with these challenges.

ADHD is a complex, multi-dimensional problem.  You need a spirited trial-and-error, equally multifaceted plan to address it.  It’s a chronic condition that is always changing, often in reaction to changed circumstances: fall to wintertime blahs, loss or gain of friends, a particularly inspiring or boring teacher, sports participation.  

The chronic nature means it’s unlikely that an ADHD teen will ever transform into someone like his or her super-organized friend or sibling. What’s more plausible is that an hour a week of well-considered, evidence-based, trial-and-error coaching can help unlock perhaps 10 additional individual hours of effort. That could mean the world to the mental health and school trajectory of a struggling 15-year-old.

When it comes to how adults respond to a teen with ADHD, parent reaction varies.  Some feel sympathy, others fury.  Some parents (moms more than dads) blame themselves.

At high schools, many veteran teachers shrug.  It’s always been like this – some teens just can’t or won’t get their work done – but it’s way worse now in the smartphone era. Solving the 8 am to 3 pm smartphone issues with school cellphone bans, however, doesn’t do anything for the 3 pm to 3 am problem.

What precisely is behind all this? As journalist Paul Tough  wrote last year in The New York Times Magazine, experts argue vigorously about ADHD. What is it? Are we over- or underdiagnosing it? How should we treat it?

In 2024, Tough wrote, 11.4 percent of all US children had been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. Among adolescents, the figure was even higher — 15.5 percent — while a stunning 23 percent of all 17-year-old boys had an ADHD diagnosis.

Our take: It’s over-diagnosed in affluent communities, where some families simply see a path to advantaging their teen over their friends, with extra time on SAT and so forth. Meanwhile, it’s under-appreciated in high-poverty schools, where there’s less belief that many teens are trying in good faith to get their work done, but stuck.

Families desperate for answers often marshal everything they can to address the problem. The cavalry sometimes succeeds: medication, therapy, IEPs and 504 plans, executive-function coaching. Often it doesn’t.

Take Alan, a 16-year-old with two D’s and an F. His mom had already tried the obvious fixes. She sat him at the kitchen table to do homework—he’d start, then toggle to Discord within five minutes. She hired therapists—he felt better after sessions, but turned in zero additional assignments (and sometimes used therapeutic language to deflect Mom). The school offered daily check-ins. Alan BS’d his way through them.

We tried all sorts of strategies with him. Clear task list with time estimates? First night: 8 out of 10 level of impact. Two weeks later: it had slipped to 4 out of 10. Pomodoro technique – the celebrated 25 minutes on, 5-minute break tactic?  Failed for him.  App blockers? Alan circumvented them in minutes. Hard start time? Somehow 4:30 pm became 5:15 pm became “after this YouTube video.”

What worked? A coach adopting a Sherlock Holmes mentality when navigating the school’s online platform (it might take 22 clicks to find what was actually due tomorrow); detailed nightly plans his mom enforced; body-doubling for math, where Alan dictated answers, first to the coach and eventually to the computer; chunking big research paper assignments into smaller pieces with micro-deadlines; live editing sessions, where a coach would hover over Alan a little bit, kind of like a personal trainer at the gym (“OK, now hold this plank for 60 seconds”). 

What were Alan’s final semester grades? In chemistry, he went from an F to a B. In pre-calculus, from a D+ to an A, and in history, from a D to a B. When all was said and done, four strategies failed, five worked – for Alan. The next kid will need different ones.

And that’s the problem. Schools, parents, and even some clinicians use the strep throat framework. Positive strep test? Amoxicillin.  Or, to borrow another medical analogy: broken ankle?  A cast, followed by eight weeks of PT. These solutions work reliably.

ADHD doesn’t operate that way. That’s why everyone gets frustrated. We should treat it more like diabetes: a complicated, chronic condition that requires constant monitoring and adjusting of treatment, as warranted.    

Even when you think you’ve cracked the code, conditions change, and the treatment needs to also. The sport season that was a motivating force ends. The friend group shifts. The science teacher who motivated kids goes on leave, and the sub is a dud.

What are the policy implications of all this?

1. ADHD exposes the failure of one-shot systems.

The problem with our approach to ADHD is the same as the problem with how we deal with many learning disabilities that call for an individualized education program.  IEPs aren’t built for trial and error. Moreover, they often have a legal compliance vibe. Many veteran teachers are forced to sit through meetings where, in their heart of hearts, they don’t think the plan has any chance to succeed – it’s full of jargon and nominal accommodations like “preferential seating.”   

We could learn from how we handle other chronic conditions like diabetes, where success means continuous monitoring and adaptation. What if IEP teams reconvened quarterly, not annually, explicitly to test and adjust interventions?  This won’t make a difference if the special ed services amount to no more than bureaucratic compliance. In that scenario, it’s just more worthless meetings, annoying for all involved.  But this is an essential idea if the services are delivered in good faith, because only trial and error is likely to stumble on the set of things that work for that particular teen at that moment in their lives.  

2. ADHD has an evidence vacuum.

When it comes to treating ADHD, we have passionate practitioners—therapists, coaches, teachers, pediatricians—but little shared measurement of whether interventions actually improve a student’s ability to plan, start, and finish tasks.  

Massachusetts is home to many world-class social scientists.  MIT’s Blueprint Labs  uses data to better understand policies in education and other areas.  There are many other similar research centers. The state could fund randomized controlled trials with real outcome metrics: tasks started on time, assignments submitted, credits earned. Publish all results, good or bad. The goal isn’t crowning one method—it’s building a testing infrastructure and evidence base that separates what works from what merely sounds helpful.

3. ADHD magnifies a brutal equity gap.

Trial and error costs money. What works is relentless tinkering—come up with a strategy the teen is willing to try, do it, measure it, adjust—until some combo clicks. Our small firm mostly serves wealthy families who can afford multiple attempts until something clicks. Families relying on services in public schools often get one shot, maybe two, before the system gives up on their teen.

Massachusetts already knows how to democratize boutique interventions.  For example, the 2006 Rosie D. settlement—a class-action lawsuit over inadequate mental health services—transformed home-based therapy for Medicaid-eligible children from a luxury into a statewide benefit.  We should do the same for executive function support—making the trial-and-error coaching process accessible to every family, not just those who can pay.  

Mike Goldstein is co-author of I’ll Do It Later: Surviving School (and Renewing the Love) with Your ADHD Son, and co-founder of Reset Teen Coaching in Boston.