ADHD Counseling Best Practice
Below find a review of ADHD counseling best practice which include the following:
- Self-esteem
- Cognitive-Behavioral Therapy
- Behavioral Therapy and Parent Training
- Organizational and Planning Skills
- Coping Skills- Emotional Awareness and Self-control
- Social and Social Thinking Skills
- Executive Skills
- Lifestyle Strategies
- Sensory Integration, Proprioception, Fine Motor Intervention
- Comorbid Anxiety, Depression, Dyslexia, Dysgraphia, CAPD
- New FDA Approved Device eTNS System
- Video Games
Self-esteem ADHD Counseling Best Practice
Studies show that the greatest risk ADHD poses to someone with ADHD is the development of a low self-esteem. Our self-esteem gives us confidence to persevere and cope with disappointments and frustration. Psychoeducation means we can teach the mechanics and meaning of ADHD, review an individuals profile of strengths and weaknesses, and explain that ADHD does not mean you are lazy, crazy, or stupid. People with ADHD often excel in thinking outside the box, creative and artistic endeavors, inventions, and business entrepreneurship.
Recently I worked with a little boy who drew this picture. Up to this point he stated that he saw himself as half-good and half-bad. His teacher said she could always tell at the start of the day if he was going to have a good day or a bad day. So I initiated conversation with him about his inherent goodness, his challenges and efforts, created a graph to visually represent the amount or ratio of time he was good. He made this dragon-graph 1-5 scale as a morning check-in so he could easily indicate his readiness to be a good and calm learner. If he wasn’t at a 1 or 2, he could take a little time to draw and settle down to be ready. Two weeks later, his teacher reported he had been great, having some near-perfect five-star days. His parent reported great improvement at home. Our thoughts about ourselves can greatly influence how we conduct ourselves.
Cognitive-Behavioral Therapy
Often called CBT for short, this type of ADHD counseling best practice involves building awareness of self-defeating and destructive thought patterns. This can help build self-awareness, abate procrastination (“I can do this later”), assist with attitude and emotional control, and maintain a positive self-esteem despite struggles setbacks and negative feedback from caregivers. There are categories of thinking errors that can be learned, and practice replacing negative or irrational thoughts can happen in the office and at home. These categories include such illogical automatic thought patterns as psychic predicting (I know what is going to happen, and it’s going to be bad), overgeneralization (I never do anything right), and extremism or polarized thinking (If it’s not perfect it’s terrible).
Behavioral Therapy and Parent Training
Yep, you guessed it. The success of behavioral therapy is largely dependent on what parents and teachers do either before or after target behaviors occur. This means parents or teachers are given training in how to train behavior! Expected behaviors are written down, checklists may be used, rewards identified as well as consequences. Charts may be used to track progress or token economies such as a credit system may be implemented. People with ADHD commonly get more negative feedback than their neurotypical peers, so special attention is placed on rewards and encouraging words. Parents can ask questions and review responses to new ideas tried for fine-tuning and replacements for what doesn’t work. In my 30 years of researching and providing ADHD counseling best practice, behavioral therapy can be one of the fastest and largest treatment effects. Why? Because we are working to create motivation and encourage effort. When someone is very motivated, they can at least for a short while overcome whatever obstacles and do well. With repeated practice the skills used for success become stronger and more automatic.
Organization and Planning Skills
ADHD counseling best practice will usually place some attention on developing better organization and planning. This may include getting one planner that includes all assignments and events and when they are due, or using a smart phone, and planning when items will be worked on and finished with automated reminders. In addition, setting a timer to go off every 15-30 minutes may be used for a self check-in to notice if one is on track and working as intended or distracted, building greater self-awareness and attention. A parent can assist by working with a student to review assignments and tasks, have the student estimate how long each will take, setting a timer, and recording how long each task actually takes, building time management and task monitor skills. A general rule of thumb is plan to do the worst first and save the best or easiest for last. This is because willpower and persistence fade over time. Breaks can be planned and timed, rewards for completion identified. The study space should remain the same place because people with ADHD tend to be stimulus bound- the environment triggers certain behavioral sets. Distractors such as video games and social media can be removed. A student can experiment with which sort of lighting is preferred, type of body position; chair, beanbag with a clipboard, laying on stomach. Working with background sounds such as classical music or silence can be tried as well as scents that help with calm or alertness. Backpacks and study areas can be organized. Often people with ADHD start well with a new plan but they fall off after a week or two. A coach can be utilized who may call or text a few times weekly to help monitor and keep a person on track as intended.
Coping Skills for Emotions
Having ADHD can be stressful. Often people with ADHD can be quite sensitive to setbacks and criticism. ADHD counseling best practice can include teaching emotional recognition and management skills. We can make a plan for recovering from a bad moment so it doesn’t turn into a tantrum or bad day. Tools for fixing unwanted feelings can be assembled in a menu or toolbox by categories such as thinking tools (It’s not a big problem it’s a little problem, it’s okay I CAN handle this, everybody makes mistakes), social tools, activity tools, relaxation tools, and inappropriate tools- things the person may do sometimes that don’t fix the problem or make things worse. We may choose from menus what our stress triggers are and stress signs, meaning how do we know when a stress response is beginning before it escalates and is too late. I like to use 1-5 scales to identify these domains in gradations, and help notice when we are at a 2 or 3 because once we get to a 5 the fight or flight response is triggered, our thinking gets impaired, and we probably will need some recovery time before we can go back and reason through the triggering problem.
Social and Social Thinking Skills
Sometimes someone with ADHD has difficulty socializing and behaving in a group in expected ways. This can result in others being surprised and confused by unexpected behavior, resulting in weird and uncomfortable thoughts, then others may not be very nice or exclude the person who fails to behave in expected ways. Many of the rules and expectations for social behavior are “hidden rules,” not written or normally explicitly taught, which we can explain, illustrate, and practice. It can be for some people with ADHD as if they have a learning disability in social skills. They may exhibit some but not all traits of Autism. Basically social skills mean you learn to monitor others for how they are thinking and feeling about you, and you modify your behavior to keep others having good thoughts and feelings about you. I learned some of this language from Michelle Garcia-Winner, she has great instructional materials and curricula on her website socialthinking.com. It is my belief that having friends with age-peers involving face-to-face interactions, and feeling like we are part of a group, even if it’s small, is key to having good mental health. No friends, no group = no mental health. And sorry but no, I don’t believe online friends count. Better than nothing, but not enough. Sometimes I have greater success teaching social thinking concepts using a comic book format filling in each progressive box starting with a problem, an unexpected behavior, or an expected behavior, using thought bubbles and speech bubbles and prompting my person to predict how others will think and feel based on their behavior, the consequences they experience, and how they feel about the consequences. I call these success stories and sometimes start a binder to keep genuine success stories where obstacles are overcome for later review to emphasize the success and progress.
Executive Skills
ADHD best counseling practice may also place some focus on identifying underdeveloped executive skills. These are the thinking skills involved in organizing behavior in the pursuit of a goal. Like the conductor of the orchestra of your behavior. Executive skills, or sometimes called executive functions, can include the following:
- inhibition or impulse control
- attention
- working (short-term) memory
- planning
- organization
- metacognition- the ability to think about what you are thinking about
- task initiation
- flexibility
- time management
- perseverance
Identified underdeveloped executive skills can be either compensated or remediated. For example, poor working memory can be supported with a checklist of tasks to complete before, say, leaving for school, this would be a compensatory strategy. A remediation approach would involve short daily sessions exercising and building short-term memory. Research strongly supports these skills are not fixed, they can be fixed, or improved, resulting in much greater academic achievement results.
Lifestyle Strategies
Lifestyle strategies for ADHD and related conditions consist of habits or everyday proactive practices that put us in a better place to begin with for dealing with demands and stress. The three main pillars of our health are sleep hygiene, diet, and exercise. Think of a stool with three legs. Knock one out and the whole thing falls. Did you know that clinical trials have demonstrated that 25 minutes of aerobic exercise three times per week are equally effective for treating anxiety and depression symptoms as any pill you can take? Plus the side effects are more energy, feelings of well-being, physical health, improved brain function, and longer life. A healthy diet means avoiding processed foods, regular meals and snacks, fruits and vegetables. Organic please, studies show that as many as 46 different pesticides can be on fruits and vegetables you buy at the grocery store, which have been directly linked to the formation of ADHD. Supplements like fish oil, B vitamins, and magnesium can help. Sleep hygiene means going to bed and waking the same time every day. Additional practices shown to help manage ADHD symptoms include meditation, yoga, getting out in nature. Socializing, play, and the pursuit of a hobby or passion such as music can also improve quality of life and overall well-being.
Sensory Integration, Proprioception, Fine Motor Intervention
While there are some things a counselor can advise parents and educators to do to help with these problems, the best therapy if these issues are prominent is occupational therapy. People with ADHD can have sensory hyper or hypo sensitivities to sound, light, textures, touch, tastes, or smells. We can make accommodations like noise-cancelling headphones for sound sensitivity. Sensory integration means the brain’s ability to receive sensory inputs and organize them into meaningful categories and packets. Poor sensory integration can result in a person becoming easily overwhelmed and very disorganized in stimulating environments such as a classroom for of people. It may also mean difficulties with balance, fine motor control, trunk strength. One accommodation would be to program some heavy work activities into the daily schedule. Proprioception is how we know where are bodies are located in relation to objects and people, and if we are safely positioned. Signs of difficulties include dragging a hand on the wall when walking down a hall, stepping on the heels or toes of others, falling out of chairs, constantly touching everything around, rolling around on the floor instead of sitting upright and still. A weighted vest or blanket may be used to provide more sensory input so the brain gets enough to know it is safely and comfortably positioned. Sensory Screener https://sensorykids.ie/en/sensory-integration/sensory-integration-screening-questionnare/
Comorbid Anxiety, Depression, Dyslexia, Dysgraphia, CAPD
Because these can often present along with ADHD, ADHD best counseling practice should involve some awareness and evaluation for the presence and treatment of these conditions. If signs are present a referral for more formal evaluation and intervention may be in order. Of course if you tended to be impulsive and distractable, making silly errors, and being criticized or laughed at, you would be more prone to developing anxiety or depression. Some signs of dyslexia would be refusal to read out loud, poor progress in reading, headaches, car sickness, very slow reading speed, inconsistent spelling patterns, and left-right confusion. Like ADHD it could be important to point out that being dyslexic does not mean you are stupid. Dysgraphia means having difficulty with letter formation and written expression. Poor legibility, very large letters, words run together without consistent and proper spacing, failing to complete written assignments would be signs. Occupational therapists also can help develop fine motor skills, the Handwriting Without Tears curriculum can be implemented, and typing or talk-to-text can be allowed. CAPD or central auditory processing deficit means having difficulty discriminating speech sounds into meaning in the presence of background sounds. Speech therapists can assist with this and there are programs to develop this ability such as Fast Forward.
New FDA Approved Device eTNS System
Available by prescription only, this device provides low level electrical stimulation via electrodes attached to the forehead during sleep stimulating the trigeminal nerve. Intended for children aged 7-12, a clinical trial of four weeks yielded a significant reduction in ADHD symptoms. More than half of the children experienced some side effects such as fatigue, headache, increased appetite, some weight gain, and increased heart rate. See the link to an article with more information at the end of this article.
Video Games
ADHD best counseling practice would be remiss to dodge this problem. I say problem because frankly, the majority of problems and conflicts reported in my private practice revolve around video games. I could write a book about this issue and have made a documentary about the impact of digital culture on human development you can see on Amazon or your Amazon Prime account or participate in a video course. I’ll keep it short here. It appears that people with ADHD are especially susceptible to the distraction of video games and digital media distractions. In addition more prone to becoming addicted. This means they are foregoing socialization, chores, work or school work, sneaking devices and off-limits access, disrupting family relationships and often becoming aggressive, abusive, self-harming, or making suicidal gestures efforts and statements all to get access, or, in addiction language, use. So do I think this is potentially a risky problem, yes. Sometimes this becomes the only reinforcer someone will work for, or they simply demand to have it and refuse to do anything to earn it. Counseling can help navigate these stormy waters. Video games are often used as a way to encourage desired behaviors, I think they do disrupt social opportunities and development, the ability to delay gratification, and weaken attention span. At some point parents may find themselves asking if they should just take them away completely and end the recurring conflicts, but they have become dependent on them sometimes as well and they fear how a child or teen will respond if they do.
https://www.verywellmind.com/types-of-therapy-for-adhd-5272434
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014388/
Link to article about eTNS
https://www.apa.org/monitor/2019/07-08/adhd-children
I hope you enjoyed this article about ADHD counseling best practices. Questions or comments? Feel free to email me.
Brad Mason, LPC, LPA, LSSP
Brad@intensivecareforyou.com