This directive necessitates others to construct a management system that manipulates consequences so that they are immediate. The person diagnosed with ADHD can achieve, but only one small step at a time. As soon as the support system is revoked, the individual will fall back into the short sightedness of ADHD. He or she will operate only for immediate gratifications and longer-term safety and adjustment will be compromised. So let’s examine this view and identify some of its problems.
First, we expect that people subjected to “contingency management” will fall back to old behaviors when the system is revoked. When people learn to do behavior under conditions of coercion, they are not as likely to do those behaviors when the coercion is withdrawn. Whether the manager doles out rewards or punishments, the system induces pressure, and the behaviors are unlikely when the prodding stops. There is nothing unique about the failures of the ADHD population when “point of performance” intervention ceases.
Second, what is the basis for asserting that individuals diagnosed with ADHD cannot see the future? Perhaps we are simply confusing their pattern of being less attentive to what others want with this supposed disability. People diagnosed with ADHD show behaviors that eventuate into impressive longer-term achievement without “point of performance” intervention quite often (e.g., learning guitar and auto mechanics), and they often show punctuality and time management when the goal is something desired (e.g., planning and coordinating with friends). They might not be doing their homework or chores, but their behavior is very different for activities that they initiate and enjoy.
People diagnosed with ADHD might be able to see the future just fine. But they might not be reinforced to do the behaviors that other value. People often avoid when activities are associated with negativity, and frequently, they continue to do behaviors that lead to future problems when the activities are pleasurable (e.g., over eating, smoking, not exercising, etc.). It seems incongruous that a child with ADHD can scheme and sneak to not get caught, but not see the future enough to recognize the problems associated with not doing homework.
Conclusion: It is not that people diagnosed with ADHD require “point of performance” intervention; it is that once we start that kind of treatment, we must continue to use it. This is true for most people, and it says nothing about whether people diagnosed with ADHD are unique in this regard. Moreover, when we assume that people diagnosed with ADHD need “point of performance” intervention, we are essentially dooming them to that limitation. If we do not socialize them to do actions and achievements valued by others without contingency management, we cannot expect them to behave in that way.