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Section 25
The Journey: A Group Intervention Technique for Children with ADHD

Question 25 | Test | Table of Contents

Rational Emotive Behavior Therapy (REBT; Ellis & MacLaren) provides a theory for developing a group guidance unit that helps students learn how ADHD affects learning behaviors and classroom performance. It offers a rationale for increasing student awareness and the value of practicing school success skills. The theory assumes that an ADHD student cannot exhibit a behavior that has not been learned. REBT emphasizes behavioral change and self-regulation along with the examination and possible modification of thoughts, beliefs, feelings, and expectations. It is an approach that supports recent treatment interventions for children with ADHD (Ellis & Wilde; Schweibert et at.). It is assumed that, while the primary symptoms of the disorder are difficult to ameliorate, it may be possible to help children develop competencies that lower the risk of serious secondary difficulties (Braswell). According to Myrick, this approach also lends itself to brief counseling that is so often used in schools.

The Journey: A Group Counseling Intervention
What follows is a description of a small group counseling intervention that has been used with ADHD students. The intervention focuses on increased understanding of the disorder and how it impacts school performance. It was assumed that students needed to face their disorders and recognize that it is part of who they are. Further, the disorder by itself wilt not keep them from their personal, academic, or career goals. To the contrary, many individuals who have ADHD have made valuable and significant contributions to society. The secret to success is being able to manage one’s thoughts, feelings, and behaviors. The intervention consisted of six small group sessions designed for about six students per group. Each session had a specific objective related to thoughts, behaviors, and skills that focused on school and personal achievement and began with a review of the previous session and a check on application of skills. Sessions ended with tasks for practice and an encouraging summary statement. The unit culminated with snacks, juice, and talk about the group experience as well as a review of plans for utilizing strategies. The sessions were based on the theme of a journey that students might imagine they were taking. Of course, the journey required preparation and the ability to recognize certain road signs and to manage the vehicle in such a way that the students would arrive safely at their final destination. Because the students had ADHD, they would be a different kind of traveler and, at times, take a different route than others, although they would eventually arrive at the same destination. The metaphor of a journey provided opportunities to construct group activities that were fun and enabled participants to reflect on goals and goal setting, the influence of personal characteristics on achieving goals, and personal management skills. As they considered skills needed to move them along on their imaginary journey, they also thought about how the skills were related to the academic, personal, social, and career goals shared by all students their age.

Preparing for the Journey
The therapist begins the unit by telling students that they have been selected for the group because j they have been identified as different kind of learners: They have ADHD. They are asked, "What do you know about ADHD?" Discussion and clarification help the students identify ADHD symptoms and how the symptoms are manifested in school, which often makes them learn in different ways than others. They are, in one sense, a different traveler in the education world. It is explained that sometimes they take the same road as others while learning things and then, at other times, they will go another way, perhaps taking some detours, even though everyone is trying to get to the same place. The therapist leads the participants through a series of structured learning activities. Special efforts are made to focus on what students experience (their feelings) and how those feelings are related to behaviors (their actions). Students discuss what they believe to be true about themselves and others, and how they can manage their thoughts, feelings, and behaviors. Once introductory activities are completed, the journey begins.

Session One: Our Journey. Participants begin their journey as they explore a variety of paths to reach a single destination in Map Quest; they talk about goals and places to go. As they discover the link between an objective and school success, students realize that not all students must take the same journey through school; however, they can each achieve success and arrive at the same destination. Summary statements include: "Having ADHD doesn’t mean you can’t be successful as a student; however, it does mean that you might have to find some ways to get there (success) that will be a little different than the routes others take. You will need to learn to be a different kind of traveler and do some things to help yourself become successful. If you do, you will have more control over where you are going and how you will get there."

Session Two: Pack It Up. Students experience the "messy bag." The therapist begins the session by rummaging through a bag or backpack, throwing things left and right and creating havoc. It is a demonstration of the chaos that comes from being cluttered and disorganized. Students explore their own bags and the need for organization. Being orderly will probably remain a difficult task to learn, but students may have more insight as to why others are continually trying to organize them. Organizational skills are introduced, demonstrated, and practiced. The session closes with a brief summary statement: "Keeping things organized is important. It is one way for you to help yourself on your journey to school success."

Session Three: Stop Lights and Traffic Cops. Students embark on an imaginary "car ride" to heighten their awareness of the need to attend and pay attention to the signs around them. As they pretend to drive a car, signs are flashed in front of them, and they have to navigate obstacles in the room. They then play the "paying attention" game. A participant wins the game by keeping his or her eyes focused on an object, a book, or perhaps a person who is walking around the room such as a teacher might do for various time intervals. Time intervals are increased from a few seconds until a one-minute interval is reached. The therapist summarizes by saying, "Having ADHD makes paying attention and listening more difficult, but it can be done. Learning and remembering strategies like we practiced today help us notice important things along the way and let us take control during our journey."

Session Four: Using Road Signs as a Guide. Students identify familiar road signs (cards) that cue behavior on the road before they identify signs in their classroom that may help to cue behavior or remember something. Students each develop their own cue to support increased success in the classroom. Summarizing remarks include, "Students with ADHD can be successful in school and get things done —using cues and reminders in your classroom and making up your own are ways to do it."

Session Five: Road Holes and Detours. Students imagine things that could go wrong on a road trip, including obstacles to getting to their destination (construction, detours, holes in the road, etc). Students generate school situations (many times generated by their own behavior) that create obstacles to success in school. The therapist teaches and demonstrates selected cognitive behavioral strategies before giving students an opportunity for practice. The therapist closes with, "We know there will be holes in the road for ADHD students. There are holes in the road for all students, but your map is marked and you can expect them. You are learning ways to get around obstacles and difficult situations at school and go on with your journey."

Session Six: Roadside Help and Being Your Own Mechanic. Students explore the idea of breaking down on the road and becoming their own mechanic. Previously learned skills and attitudes are reviewed as tools they will need to get back on the road. Sometimes one has to ask for assistance from someone else when necessary tools are not in the toolbox. However, most of the time, students will have the tools they need to stay or get back on track. Knowing that they can fix things and be their own mechanic is an empowering experience. They are more responsible for managing their own vehicle. The topic of medication is introduced. Doctors and parents usually determine if medication is an appropriate intervention. If students have been prescribed medication, they are encouraged to help themselves by taking the medication, as if it were a tool, and working on the self-management strategies.

The final session summary includes, "We know that all students can be successful in school and that not everyone must be the same kind of traveler or learner. During our sessions we have learned about ADHD and some of the skills and attitudes that will help us in our travels as we journey through school. We have talked about the value of being organized, using cues and strategies to help us remember things, paying attention, and thinking before we act. We also practiced some skills and tried using them in school and at home. With the right kind of attitudes and skills, we can reach our destination — school success." It was found that therapists enjoyed delivering this intervention to students. The intervention provided the teachers who participated with some direction, was helpful in their work, and was perceived as impacting student awareness and perception of self in regard to ADHD.
- Webb, Linda D and Robert D Myrick; A Group Counseling Intervention for Children with Attention Deficit/Hyperactivity Disorder; Professional School Counseling; Dec2003, Vol. 7 Issue 2, p108

Personal Reflection Exercise #11
The preceding section contained information about "the journey" group intervention technique for children with ADHD.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Moderators of long-term treatment outcome when comparing
two group interventions for adolescents with ADHD:
who benefits more from DBT-based skills training?

- Meyer, J., Zetterqvist, V., Unenge Hallerbäck, M., Ramklint, M., & Isaksson, J. (2022). Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training?. BMC psychiatry, 22(1), 767. https://doi.org/10.1186/s12888-022-04435-8


Peer-Reviewed Journal Article References:
Leijten, P., Wijngaards-de Meij, L., Weeland, J., Menting, A., Orobio de Castro, B., Overbeek, G., & Matthys, W. (2021). Parenting group composition does not impact program effects on children’s conduct problems. Journal of Family Psychology, 35(5), 709–714.

Shahidullah, J. D., Carlson, J. S., Haggerty, D., & Lancaster, B. M. (2018). Integrated care models for ADHD in children and adolescents: A systematic review. Families, Systems, & Health, 36(2), 233–247.

Smith, Z. R., Eadeh, H.-M., Breaux, R. P., & Langberg, J. M. (2019). Sleepy, sluggish, worried, or down? The distinction between self-reported sluggish cognitive tempo, daytime sleepiness, and internalizing symptoms in youth with attention-deficit/hyperactivity disorder. Psychological Assessment, 31(3), 365–375.

Weyers, L., Zemp, M., & Alpers, G. W. (2019). Impaired interparental relationships in families of children with attention-deficit/hyperactivity disorder (ADHD): A meta-analysis. Zeitschrift für Psychologie, 227(1), 31–41.

QUESTION 25
According to Webb, what is a group intervention exercise that can help ADHD children gain insight into the need for organization? To select and enter your answer go to Test.

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