directions twice, rechecking work; see
Test-Taking Strategies by Kesselman-Turkel & Peterson).
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Cite instances in which instant gratification was delayed in favor of achieving meaningful long-term goals. (40, 41)
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Teach the client mediational and self-control strategies (e.g. “stop, look, listen, and think”) to delay the need for instant gratification and inhibit impulses to achieve more meaningful, long-term goals (or supplement with “Problem Solving Exercise” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce).
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Assist the parents in increasing structure to help the client learn to delay gratification for longer-term goals (e.g. completing homework or chores before playing basketball).
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Identify what social skills were implemented to reduce anxiety and build confidence in social interactions. (42, 43, 44)
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Use instruction, modeling, and role-playing to build the client's general social and/or communication skills.
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Work with the parents and assign exercises that facilitate the client's use of social skills in various everyday situations.
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Assign the client to read about general social and/or communication skills in books or treatment manuals on building social skills (e.g. Your Perfect Right by Alberti & Emmons; Conversationally Speaking by Garner); or supplement with “Social Skills Exercise” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce.
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Identify and implement effective problem-solving strategies. (45, 46)
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Teach the client effective problem-solving skills (e.g. identifying the problem, brainstorming alternative solutions, selecting an option, implementing a course of action, and evaluating the results).
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Use role-playing and modeling to teach the client how to implement effective problem-solving techniques in his/her/their daily life; work with the parents and assign exercises that facilitate the client's use of problem solving in various everyday situations.
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Cite which constructive coping strategies were implemented when the negative emotions associated with failure were a potential trigger for addiction. (47, 48)
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Review specific instances of failure to learn and the negative emotions associated with the experience; focus on how addictive behavior was used to escape from negative emotions.
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Role-play and model constructive alternative coping behaviors to use in failure-to-learn situations (e.g. cognitive focusing, deep breathing, make lists, reduce distractions, shorten learning sessions, repeat instructions verbally).
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Report instances when relaxation techniques reduced tension and frustration while increasing focus in a learning situation. (49, 50)
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Using techniques like progressive relaxation, guided imagery, or biofeedback, teach the client how to relax completely; assign him/her/them to relax twice per day for 10 to 20 min per session.
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Encourage the client to incorporate relaxation skills as a coping and focusing mechanism when feeling tense and frustrated by a learning situation or urge to use substances; review implementation; reinforce success and problem-solve obstacles.
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Develop and implement an exercise program that includes exercising at a training heart rate for at least 20 min at least three times per week. (51)
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Help the client develop an exercise program; increase the exercise by 10% each week until the client is exercising at a training heart rate for at least 20 min, at least three times a week.
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Develop an aftercare program that includes regular attendance at recovery group meetings, getting a sponsor, and continuing the therapy necessary to bring ADHD and addiction under control. (52)
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Help the client to develop an aftercare program that includes regular attendance at recovery group meetings, getting a sponsor, and continuing the therapy necessary to bring ADHD and addictive behavior under control (or supplement with “Aftercare Plan Components” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
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Complete a survey to assess the degree of satisfaction with treatment. (53)
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Administer a survey to assess the client's degree of satisfaction with treatment.
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DIAGNOSTIC SUGGESTIONS
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ICD-10-CM
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DSM-5 Disorder, Condition, or Problem
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F90.2
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Attention-deficit/hyperactivity disorder, combined presentation
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F90.0
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Attention-deficit/hyperactivity disorder, predominately inattentive presentation
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F90.1
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Attention-deficit/hyperactivity disorder, predominately hyperactive/impulsive presentation
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F90.9
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Unspecified attention-deficit/hyperactivity disorder
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F90.8
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Other specified attention-deficit/hyperactivity disorder
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F91.1
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Conduct disorder, childhood-onset type
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F91.2
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Conduct disorder, adolescent-onset type
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F91.3
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Oppositional defiant disorder
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F91.9
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Unspecified disruptive, impulse control, and conduct disorder
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F91.8
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Other specified disruptive, impulse control, and conduct disorder
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F31.xx
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Bipolar I disorder
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Note
1 Indicates that the Objective/Intervention is consistent with those found in evidence-based treatments.
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) – ADULT
BEHAVIORAL DEFINITIONS
1 Childhood history of Attention Deficit/Hyperactivity Disorder (ADHD) – primarily inattentive, primarily hyperactive/combined that was diagnosed during childhood or based on a history of symptoms meeting criteria.
2 Often
