On the last track, 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.
On this track... 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
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
--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
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
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
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.
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.
On this track... 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.
On the next track, we will be discussing marital therapy for the parents
of a child with ADHD. The four steps of marital therapy are evaluation,
cognitive therapy, negotiation training, and getting it together.
Peer-Reviewed Journal Article References:
Bloh, C. (2010). Assessing self-control training in children with attention deficit hyperactivity disorder. The Behavior Analyst Today, 10(3-4), 357–363.
Curtis, D. F. (2014). Structured dyadic behavior therapy processes for ADHD intervention. Psychotherapy, 51(1), 110–116.
Langberg, J. M., Dvorsky, M. R., Molitor, S. J., Bourchtein, E., Eddy, L. D., Smith, Z. R., Oddo, L. E., & Eadeh, H. (Jan 2018). Overcoming the research-to-practice gap: A randomized trial with two brief homework and organization interventions for students with ADHD as implemented by school mental health providers. Journal of Consulting and Clinical Psychology, 86(1), 39-55.
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