Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.
The management of ADHD primarily targets the alleviation of a child's problems in the classroom and at home. However, a child's difficulties can extend beyond these two settings. For example, poor self-esteem and unfulfilling peer relationships can be very painful. Some children feel alienated from their peers, as though they are social outcasts. Therefore, regardless of how well they manage at home or at school, they may still have emotional and social difficulties. While medication, education, and behavioral plans address the core symptoms of ADHD, they do not adequately address children's sense of personal mastery and competence. This is where individual therapy comes in.
The goal of individual therapy varies according to each child. One rather universal goal is for the child to recognize, and accept ADHD-related symptoms and behaviors. Acceptance does not mean to ignore, or excuse away unacceptable behavior. Acceptance means to avoid judging oneself for having the symptoms of a disorder. Acceptance also means taking responsibly for implementing strategies to improve behavior. During this process, individual therapy can help to restore self-worth and self-confidence. Self-worth refers to a sense of being valued, supported, and competent. Self-worth reflects respect for self, and others. These are the ingredients all children need to maximize their potential.
When shopping for a therapist, begin by asking around for recommendations. You are looking for a therapist with specific experience working with ADHD children. You should use the same diligence and care as when you shopped for your child's pediatrician. Many, if not most ADHD specialists work from a model called cognitive behavioral therapy. We discuss this approach in the next section.
Cognitive Behavioral Therapy for ADHD
Cognitive behavioral therapy (CBT) is a particular type of psychotherapy. As the name implies, this type of therapy focuses on thoughts and behavior. CBT therapists pay special attention to thoughts and behaviors that interfere with school, family, and social functioning. The basic premise of CBT is that by changing our thoughts, we can change our mood and behavior. This premise has been heavily supported by an enormous amount of research.
Not surprisingly, people with ADHD can develop some faulty ideas and beliefs. Sometimes they misinterpret the motivations of others. For instance, a child who feels like an outcast might hear some kids laughing. Instead of thinking, "I wonder what's so funny," they immediately think, "Those kids are laughing at me." A CBT therapist helps a child to identify these sorts of patterns and tendencies. Once identified, these faulty ideas and beliefs can be examined and evaluated for accuracy and helpfulness. Then, they can be replaced with more accurate thoughts, and more healthy behaviors.
Psychotherapy for ADHD can have one, or several areas of focus:
Understanding and accepting the diagnosis of ADHD;
Accurately appraising one's own strengths and weaknesses;
Learning to set realistic, attainable goals;
Learning and practicing new skills; and,
Prioritizing goals and behaviors.
When other disorders co-occur with ADHD (e.g., depression, anxiety, etc.) the CBT therapist will develop a treatment plan to simultaneously address both disorders.