“Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
When I begin therapy with a client who has been diagnosed with an attention deficit type of disorder, I start with a pretty simple premise. Therapy is fun! You ‘get’ to come with me and have therapy for about 45 minutes. For our first session, I meet with the child and the parents together. During this initial session I learn about the child and their family, as well as the symptoms they note. During that first session, I learn about who lives in the home(s) the child lives in, the history of symptoms, what are current symptoms, and what are the child’s strengths and skills. I also learn if there is a history of abuse in the family. Following that first session, I explain to their parents that going forward our session will be around 45 minutes, after which I check in with the parents and talk about some of our goals we set with the child.
Attention is short, so I vary the activities based on the needs of the client. I usually start with a check in of what has been going well, and what they feel could have gone better. Once I have been updated on their goals from the previous week, we begin our therapy specific for this session.
I give my clients a choice about what they would like to do-I usually have some sort of game and some sort of activity. I allow the participant to choose which they would like to do first. Once they choose, we move forward with their choice.
For games, the first time we play I introduce the game and explain the rules that are specific to therapy. Once we have played at a previous session, I ask them if they like the rules. I give them the option to change some of the rules, which also allows me to realize which parts of the game resonate with them.
One game I find particularly effective is Uno. There are several ways that I utilize the game. One way to play is to assign each color an emotion. An example is:
red=anger, green=happy, blue=sad, and yellow=scared
When I play the game using these emotions, I have my client identify an emotion each time they place a card that is one of those colors. I encourage them to tell me about a time they felt the emotion that is assigned to that color of card. I also like to make a special rule, where if I play a ‘special’ card (Draw 2, Wild, Reverse, Skip), I get to ask them a question of my choosing.
Another option is to use each color to notice a sense. For example:
Blue=something they see
Red=something they hear
Yellow=something they can touch
Green=something they smell….I have also switched this up with something they are looking forward to
By allowing the participants to choose rules, I help them maintain some control of the session. We work on mindfulness, so we are working on what they see, hear, and touch. By talking about what they are looking forward to, this allows us an opportunity to plan for things which may be difficult for them. For example, if they are looking forward to fireworks on the 4th of July, we can talk about what to do if they want to set off fireworks and they are either told no, or told that they have to wait. We can plan for ways to help them be patient and avoid conflict. This also allows me to see their own insight into struggles they may predict having.
Social skills and learning to de-escalate are pretty common issues with people I meet with. Helping them identify tough social situations has been helpful in helping them identify alternatives to how they typically act in those situations.
There are some specific, concrete skills that we work on. One of them is to work on de-escalating. De-escalating means helping my clients and their families learn to bring down the level of emotion that they are feeling. Here are a couple of de-escalation techniques that I find helpful:
1. Deep breathing (in for 4, count to 4, out for 6)
2. Mindfulness-find an object in the room, what color is it? What do you see when you look at it? What do you smell, hear, see, touch?
3. For some clients, I teach a sequence of skills. For example:
a. Pick a color
b. Count how many things you can see that are that color
c. Count to that number, then count backwards from that number
d. Take that many deep breaths
At all times, I work on LISTENing-clients who have a diagnoses of attention issues frequently are used to having people irritated with them, and sometimes they have not been listened to like they’d like. Many times, those with attention issues recognize that transitions are tough for them.
I talk with my clients about how transitions are going for them.
Specifically, we come up with concrete ideas for how to help with transitions-
1. Getting ready for school–
What will help them wake up?
Setting an alarm?
When do they lose track of time?
What meds do they take, if they do take meds? When are the meds helpful, when do they not need them?
2. Homework time
Most kids with attention issues perform better with structure and breaks. Once school gets out for the day, some parents are tempted to have their children complete their homework right away. My guess is, they are thinking that their children will enjoy being ‘free’ from responsibilities for the rest of the evenings, or some families have multiple other tasks to complete after the homework task is finished, including sports practices, dinner, baths, etc.
My suggestion is to give kids a break from structured activity after school. How long this break is can be determined by both the parents and the child, depending on the needs of the family. Some families choose to have snack time, then free time, and to start homework after dinner. Some children are in a child care setting which encourages homework time, or where homework may be more difficult to complete. Other families prefer to set a timer, and once the timer goes off, homework time starts. This allows the break to be for a specific amount of time.
The timer can also be helpful in morning routines. One family I worked with had a lot of frustration around the length of time their son was showering in the morning before school. They had tried a few things, including prompting him about when it was time to move on to shampoo, soap, etc. This had not proven successful for them.
What worked for them was setting a timer for his shower. Once the timer went off, he turned the shower off. This allowed him to determine when to transition from rinsing, to soap and shampoo, to rinsing again, to being done with his shower. It allowed him some control, and allowed other family members who were also trying to get ready to focus on their own set of tasks to get out the door in the morning. If the timer went off and he had not completed the tasks of soaping and shampooing, then he did not do those things that morning. This routine worked for the family and the child, as the child learned to utilize the time he had fairly quickly.
Bedtime can be another tough transition for those with a diagnoses of an attention issue. Again, structure helps. Having a set bedtime, with predictable events before bedtime, seems to help in this area. For instance, some families choose to either read to or allow their children to read prior to bedtime. This calming down time can help with the transition from being awake to being asleep. I would encourage families to stop screen time prior to bedtime as well. For my own children, who love video games, we had an end time of 8pm both during the week on school nights and on weekend nights. Their friends knew they would have to stop playing at 8pm if they were at our house as well. This rule lasted until they were around 11 or 12 years old, and worked for our family. For some children, they may need to have their screen time end prior to that, depending on how screens affect their child’s ability to fall asleep.
These are some specific concrete ideas that have been useful for me as a therapist working with children with a diagnosis of ADHD.
Originally published at medium.com