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Section 4
Behavior Therapy for ADHD

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In the last section, we discussed three examples of combining education and counseling. The three examples of combining education with counseling were 1. the "no-fault" notion about cause, 2. the Symptom Rating Scale, and 3. self-esteem reevaluation.

In this section... we will be discussing counseling for children with ADHD. I have found that there are three types of counseling that may be beneficial for children with ADHD. The three types of counseling for children with ADHD are individual counseling, self-control training, and social skills training. Let’s look at each type of counseling a bit more closely.

Three Types of Counseling

♦ Type #1 - Individual Counseling
The first type of counseling is individual counseling. There is some controversy about the use of counseling with ADHD children. Do you agree? Here are my thoughts. As you know, the very symptoms that make children ADHD also make them poor candidates for counseling. The ideal therapy candidate is not usually thought of as someone with a short attention span, a tendency to blame others for their problems, and no desire to see a therapist.

Yet as you know, a therapist may serve several functions to the ADHD child. The several functions of the therapist are support, education, and mediation. For a child with ADHD, having a counselor who can listen sympathetically and point out the child’s good qualities is obviously a great source of support. As you know, the counselor can educate the ADHD child about his or her disorder, which is often better than having the parents try to explain the disorder. The counselor may also be able to help mediate disputes between the ADHD child and his or her parents.

There are three factors to consider in determining if a child with ADHD would benefit from individual therapy.
--1. First, consider the age of the ADHD child. Clearly, a 12-year-old is much more likely to benefit than a six-year-old.
--2. Second, consider the chemistry between the ADHD child and the therapist. Does the ADHD child get along with the therapist? Are you overlooking this obvious point of chemistry with a current client? Are you currently treating a child that you should refer?
--3. Third, consider how defensive the ADHD child is about discussing his or her problems. If he’s not willing to talk about his problems in individual therapy, group therapy might be considered.

Think of your ADHD client. Is individual counseling going to benefit him or her according to the three factors of determining if a child with ADHD would benefit from individual therapy?

♦ Type #2 - Self-Control Training
Joel, age 12, was diagnosed with ADHD. Joel tried to talk to his peers during class when they were supposed to be working on homework, when the teacher was talking, and even when they were taking tests. Sound familiar? For Joel, it seemed the second type of counseling for children with ADHD, self-control training, would be appropriate. The ADHD child’s difficulties with self-control result from a lack of internal language that a normal child uses to talk to himself.

As you know, this internal language that normal children use is what helps them anticipate the consequences of their actions. With Joel I used a technique called the "Internal Dialogue" technique.

♦ Technique: 'Internal Dialogue'
To do the "Internal Dialogue" technique:
-- Step 1 - I first asked Joel to say aloud, "If I talk to the kid next to me in class, I won’t finish my work, may get a detention, and may have to stay after school." This sentence helped Joel establish the consequences for his actions in the classroom situation.
-- Step 2 - Second, I asked Joel to whisper the same sentence, "If I talk to the kid next to me in class, I won’t finish my work, may get a detention, and may have to stay after school."
-- Step 3 - Third, I asked Joel to say the sentence silently to himself. We repeated these three steps a few times. Then I encouraged Joel to actually think of this sentence "If I talk to the kid next to me in class, I won’t finish my work, may get a detention, and may have to stay after school." in the classroom.

These three steps helped Joel stop and think in the classroom instead of acting impulsively. Would the "Internal Dialogue" technique be beneficial to your client with ADHD?

♦ Type #3 - Social Skills Training
In addition to individual counseling and self-control training, the third type of counseling for children with ADHD is social skills training. As you know, social skills deficits can result in widespread problems, including poor school performance and social aggression or withdrawal. Social skills training is based on the assumption that adjustment problems are related to deficiencies in social abilities. As you know, correcting or learning these social skills will result in fewer serious problems. Social skills often seem problematic for children with ADHD. These skills include following directions, sharing, compromising, and joining a conversation.

In social skills training, I have found the most straightforward treatment is done in three steps.
--Step 1 - First, tell the child what to do in situations identified as problematic. For Joel, one situation he had problems with was hitting other children. During school one day, a classmate had hit Joel on the back. In retaliation, Joel stabbed him with a pencil.
--Step 2 - After identifying the problematic situation, second, show the child with ADHD how to handle the situation. I suggested to Joel that a more appropriate response may have been to walk away.
--Step 3 - Third, have the ADHD child practice the skill before using it in real life. For this step, Joel and I did a role-playing exercise. I pretended to tap him on the back, and he walked away. For the ADHD child in a social skills training group, it is usually helpful if the parents and teachers are informed of the skills being learned so that they can help reinforce the new skills.

Often, children with ADHD don’t remember to try to do things differently in a social situation. Having an adult present who can signal them when it’s time to try something new can help a lot. Make sense? In Joel’s case, I told his teacher what role-playing Joel and I had practiced so that she might be able to give helpful reminders.

Social skills training is sometimes seen as a difficult undertaking with results that are hard to come by. Even with successful social skills training, spontaneous, "uncovered" social interactions may still too often be negative. However, as you know, social skills are critically important for the ADHD child’s future. Social skills training can provide at least a little guidance.

In this section... we have discussed three types of counseling that may be beneficial for children with ADHD. The three types of counseling are individual counseling, self-control training, and social skills training.

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