Although the management of ADHD primarily targets the alleviation of children's problems in the classroom and at home, a child's difficulties often range well beyond these two settings. In fact, poor self-esteem and difficulty with peer relationships can cause even greater emotional pain for the child. While medication, environmental changes and educational interventions address the core symptoms of ADHD, they are not always sufficient to alleviate the damage done to the child's internal sense of mastery and competence.
Individual therapy can address children's unique response to the problems created by ADHD in their life, and focus on related emotional issues. Although such topics can be addressed in a group setting, depending on the child, a group might not be the best entry point into therapy. Even though individual work is more time consuming and costly, it is often highly beneficial.
The goals of individual therapy are to help the child learn to recognize ADHD related symptoms and behaviors, as well as to develop a realistic understanding of individual strengths and weaknesses. Individual therapy can also help restore a sense of self-esteem and self-worth. Feelings of self-esteem (a sense of self-respect, and being lovable) and a sense of personal worth (i.e., feeling loved, supported, and competent enough to manage oneself and one's environment) can greatly influence a child's ability to maximize his or her potential.
The first thing to consider when looking for an individual therapist for a child with ADHD is whether or not the therapist has experience with this population. Both children and the disorder itself present unique therapeutic challenges, so it is best to work with a specialist who is knowledgeable about children with ADHD. Next, consider the therapeutic orientation of the therapist. Given the physiological origins of the disorder and the subsequent disruptive behavior problems, problem-focused approaches are more likely to be helpful. A therapist trained in cognitive behavioral techniques will have the therapeutic tools most likely to be helpful to an child with ADHD.
Individual Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapists help children identify the symptoms created by their disorder, as well as the specific thoughts and behaviors that interfere with school, family and peer functioning. The theory behind CBT is that changing thoughts can lead to changes in mood and behavior. Once the target behaviors have been identified, the therapist will help the child develop a series of connected thoughts, a script, to begin using when problem situations arise. These scripts are usually accompanied by specific behaviors that gradually replace the problem ones. Once skilled in the use of these scripts, a child can demonstrate increasing behavioral control and have choices instead of showing only impulsive automatic responses to environmental events.
People with ADHD often have multiple cognitive distortions (i.e., erroneous ways of thinking) and misinterpretations. A cognitive behavioral therapist will help a child identify individual thinking patterns and tendencies. Once identified, these individual thoughts and cognitive processes can be examined and evaluated for accuracy and helpfulness. If these tendencies seem to contribute to the identified problems, they will become a focal point of therapy. Therefore, the therapeutic goals evolve as one goal is met and others are identified.
Areas of treatment focus include the development of skills in:
- Understanding and accepting the diagnosis of ADHD
- An honest appraisal of one's own strengths and weaknesses
- Setting up realistic, attainable goals
- Planning and strategizing skills, including how to prioritize goals and behaviors
A cognitive behavioral therapist will also be alert to the presence of co-occurring disorders (e.g., depression, anxiety, etc.) and develop a unique plan to address these specific issues as well.