The Point of Performance for children with ADHD – Home Edition!

Do you feel like you tell your child with ADHD the same thing over and over but they never learn or remember? Are you facing the same battles day in and day out? Have you have tried everything you can think of to change their behaviour, but it seems, no matter how many times you plan, discuss or provide consequences their ‘behaviour’ never changes?

What is the Point of Performance?

In our house, we have a snack cupboard. It was originally part of my pantry, and then it moved into a cupboard next to the pantry, then it moved to the cupboard above the bench. Now, it is a cupboard up above the range hood, as high in the kitchen as I can make it. The contents of this snack cupboard are only for lunchboxes when the kids go to school. It’s out of bounds for the kids when they’re at home, because we always have other snacks available.

My 11-year-old son with ADHD is the reason that the contents of this cupboard has needed to move so many times. When he was younger and could reach the pantry, he would constantly help himself to the lunchbox snacks. No matter how many times we went over the rules and imposed consequences for taking snacks, he never learned. So, the snack cupboard was moved into another cupboard next to the pantry. But he found it… the same day.  So, we moved the cupboard up higher, which worked for a couple of weeks, until he discovered where the cupboard was. When I wasn’t in the kitchen, he would climb onto the bench, open the cupboard and help himself. Later, when I’d go to pack the kids’ lunchboxes for school, we’d have no snacks left. After many weeks of frustration and imposed consequences (no snacks, chores to pay to replace the snacks, only fruit in lunch boxes for snacks) it didn’t change. Nothing worked. Until I found out about the Point of Performance.

Dr. Russell Barkley is a Clinical Professor of Psychiatry who first introduced me to the idea of the Point of Performance in his book –  Executive Functions: What they are, How they work and Why they Evolved (2012). He states that the point of performance is the “critical place and time for performing a behaviour or task in the natural setting where the behaviour takes place like home or school.” In lay terms, this means it is the actual place, at the exact time, the child is doing something.

So, some examples of the point of performance for my kids are:

Brushing their teeth before bed – In the bathroom at 7:25pm

Eating dinner – at our dining table in the dining room at 6:30pm.

Homework – at the desk in the study at 4pm (before COVID-19!)

From the example of my son sneaking the snacks from the out-of-bounds cupboard, the point of performance is right now, in the kitchen, standing on the bench, multiple times a day.

So, now that we now about the point of performance, why does it matter?

Well, according to Dr. Russell Barkley, it is vital that for children with ADHD, any teaching, consequences and rewards – in fact any behavioural modification at all – needs to take place at the point of performance. It needs to happen instantly. That is, it needs to happen in the location, at the time the child is performing the action for it to be effective.

It is well documented that children with ADHD struggle with the passage of time. Rather than seeing time as past, present and future they live in the present with little hindsight or forethought. Edward Hallowell calls this “now” or “not now” brains. The now, is well… now. And the “not now” is everything else. The past, the future, even five minutes ago. If it isn’t happening now, it isn’t happening ever. This is why providing feedback and consequences or teaching at the point of performance is necessary for a child with ADHD. A child with ADHD really can’t process the questions “How many times do I have to tell you not to…?” You could tell your child a million times to do something, but if it isn’t at the point of performance – that is, in the moment where and when it’s happening – their brain isn’t going to identify that teaching and information as necessary for the “now”.

I’m pretty sure I can tell what you’re thinking, because I thought the exact same thing when I first read about this: “I can’t be everywhere at once!” I get it, I really do. I already constantly watch my kids as much as I can, and yet my son purposefully waited until I wasn’t around to sneak snacks from our out-of-bounds cupboard! While it would be ideal to be at the point of performance all the time, you don’t have to be for this to be effective.

According to Dr. Russell Barkley it is just as useful to externalise important information and motivation at the point of performance. What does this mean?

  1. We need to put in view (externalise) what the child needs to know (important information) where they need to know it (the point of performance)
  2. We also need to put in view or remind our child (externalise) why it’s important that they need to do something (motivation) where they need to know it (the point of performance).

What does this look like in real life?

Let’s go back to the example of my son sneaking into the lunchbox snacks cupboard. Because I knew I couldn’t possibly be in the kitchen every waking moment, I externalised the important information at the point of performance.

I put up a sign on the cupboard that looks like this. This is an external reminder (a sign) at the point of performance (the cupboard), reminding him not to take food out of the cupboard.  

Another issue we always had was the kids leaving their clothes all over the floor in the bathroom despite having three laundry baskets right in front of them. So, I made a visual for the bathroom to assist them with planning and organisation of where to put the clothes.

It is at the point of performance (in the bathroom), where they typically remove their clothing. It is a physical reminder, so they don’t have to remember which basket to put their clothes in.

We also have visuals above our bins in the kitchen. We have three bins – one for landfill, one for recycling, and one for Redcycling (for soft plastics such a chip packets). It was always very difficult for our children to remember which bin was for which type of rubbish. So, we now have pictures above the bins with examples of each type of rubbish, so they can independently sort it – at the Point of Performance.

My children also have an external reminder of how to clean their room using simple steps. Please feel free to download it here!

This is another example of an external reminder (chart with pictures) at the point of performance (their bedrooms). It is there for when they need to clean their room without me having to stand and give orders!

It can also be used as reminders of social expectations.

For example, my daughter with ADHD struggles to share and be kind during play with her younger sister. She likes to be in control of play and if that control is threatened, she often acts out.

By having a visual reminder at the point of performance (in the play area in their bedroom), it can be a help her to be kind during play.

So, how does the point of performance actually help the child with ADHD?

Part of the reason that children with ADHD don’t appear to listen, learn from their mistakes, or even be able to do something one day and not the next, is because of two main issues: Impulsivity and working memory deficits.

Impulsivity is a deficit of inhibiting actions prior to thinking about the consequences. Children with ADHD struggle to stop and think before they act; this is impulsivity. I love what Dr. Edward Hallowell says, “They have a race car engine, with bicycle breaks”. You can think of impulsivity as a deficit in forethought: they have difficulty predicting future consequences from past actions. Therefore, it seems as though children with ADHD do not learn from their mistakes, they seem to just keep repeating them.

Working Memory deficits are extremely common in children with ADHD. Working memory is an executive function (mental process), that we can think of as the mind’s Post-it Note. It holds a little bit of important information (the memory) so that we can do something with it (the working part). The Post-it Note is only small, and is only designed to hold a small amount of information. This is known as its capacity. In children with ADHD, their capacity is smaller than their neurotypical counterparts. This is why many parents, carers and teachers report that the child with ADHD may appear to be listening but only follows one instruction at a time, or even has just stood and listened to the instructions but almost immediately forgot what was said.

You can see why the strategy of externalising important information and motivation at the point of performance is so powerful. It acts as the child’s Post-it Note to support working memory deficits and gives them a powerful visual reminder to help stop curb some of their impulsivity.

I hope that you’re able to get as much out of the point of performance strategy for the home as I have. However, there are two main things to remember as you give this a go:

  1. Of course, this strategy isn’t 100% full proof. My son still sometimes completely ignores the external reminder and just takes snacks out of the cupboard because he wants to. This is a choice he makes, and we continue to reinforce the consequences for his poor choices.
  2. Children with ADHD need things to be novel, exciting and interesting. If you find that an external reminder (such as a chart) isn’t working anymore, shake it up! The laundry basket reminder that I shared with you is actually the second chart I’ve used there. The first chart had pictures of clothes as examples and that worked really well for a while, but then it became part of the furniture and was ignored. So, I came up with the monster chart. We have some fun with it, because if I see clothes on the floor in the bathroom, I now say, “The monster wants to eat your clothes, guys!” and they laugh and go and sort their washing! And it doesn’t have to be a printed chart! It could be an ornament or a picture! Anything to provide them with an external reminder at their point of performance.

I’d really like to help you implement the point of performance into your lives. Please comment below what specific issues you might be having and I will make some external reminders for your point of performance, so we can get ADHD Done Differently.

Next blog: look out for how the point of performance can be used for helping children with ADHD during school activities and learning tasks!!

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