Setting Target Goals for managing ADHD symptoms

The ADHD goal-setting process goes beyond the simple desire of “improving symptoms” and establishes observable, measurable objectives that are meaningful for the individual.

For example, to achieve the desire of “being less forgetful,” an appropriate goal would be to “leave the house for school/work every morning for 1 week while remembering all necessary items (eg, backpack, jacket, lunch).”

Also, the target outcomes may change with the progression of ADHD over time. For example, the focus for children tends to be on academic and social outcomes. In adolescents, desired outcomes may shift to target impulsive behaviors and social outcomes. In adults, goals may be related to stability of employment, financial challenges, or sustaining a relationship.

Setting goals for ADHD begins with a thorough interview process to understand what desired behaviors and outcomes each patient and his or her family value most. The process of developing desired target outcomes requires input from patients, caregivers, and teachers and/or other school personnel. 38

When formulating target goals, the involved parties should endeavor to set SMART goals that are Specific, Measurable, Attainable, Realistic, and Timely. 38,62,63

• Specific—Develop specific goals that are clearly stated and/or written.
• Measurable—A goal is measurable if one can clearly determine whether progress is being made toward reaching the goal.
• Attainable—Patients and/or their caregivers should all agree that the goal is worthy of pursuing.
• Realistic—Ensure that the goals are attainable.
• Timely—A timely goal is one that can be achieved in a period that is meaningful, and not too far in the future.

The following tips can help individuals get started with ADHD goal setting:

• Identify motivations—What does the patient really want to work on? It is difficult to strive for goals unless the motivation is present, so the patient or caregiver should choose something that he or she truly wants to achieve. 38,59
• Prioritize goals—The patient or caregiver should rank-order the goals, choosing what is most important or what makes sense chronologically, keeping motivation in mind. 38,59
• Reduce expectations—Try not to set expectations too high. If the patient or caregiver reaches too high and comes up short, there may be disappointment. However, if expectations are lowered and the goal is reached, the patient and/or caregiver may be happier. Perspective is important. 38,54
• Take small steps—Break down goals into smaller, more manageable steps. Even the largest, most overwhelming changes are made only one step at a time. 38,54
• Begin with a quick success—Choose a goal that can be accomplished quickly. This quick success can help feed the cycle of success. Try not to tackle the toughest goal first. Instead, “practice” first on some of the easier goals to help build self-confidence. 38,59

Establishing at least three to six target goals serves as an excellent guide for the health care provider designing the comprehensive management plan, as the plan can be individualized in accordance with the goals. As the patient’s goals change over time, adjustments can be made to the management plan. 38

Sample academic and social goals are shown in Table 8. In order to meet the SMART goal criteria previously outlined, each target needs to be tailored to individual patients. 59,64

X = the variable tailored to individual patients.

Once the ADHD goals have been established, the following tips can help individuals realize and sustain their goals:

• Develop an action plan—List the steps necessary to reach a goal and include a timeline. Build flexibility into the action plan. Have a plan B, and a plan C, if necessary. 38
• Evaluate progress regularly—Keep track of the progress being made, and provide rewards early and often when improvements are seen. Do not save all the rewards for when the entire goal is reached, but spread out praise and positive reinforcement all along the way. 38