Handling Slips

This final chapter of the workbook covers strategies for preventing relapse for adult clients with ADHD. The chapter reviews all of the skills that were taught in the treatment program. Clients identify which skills were helpful and which were not. The chapter includes a troubleshooting worksheet. There is also a worksheet that clients can use after treatment has ended to review which things are going well and which skills need more practice in order to maintain treatment gains.

Modifying Your Environment

This chapter focuses on how adult clients with ADHD can identify and minimize distractions in their work environment to create a situation that is more conducive to concentration. Clients are urged to find one place where they can do important tasks without distractions. Information is presented about the importance of keeping track of important personal objects such as keys, wallet, and phone. Suggestions are made about how to set up effective systems for this. Clients can use reminders such as alarms to check in with themselves to see if they are on track or have gotten distracted.

Gauging Your Attention Span and Distractibility Delay

This chapter contains instructions that adult clients with ADHD can use to gauge their attention span and use the “distractibility delay” technique. The first step is for clients to gauge the length of time that they can reasonably expect themselves to work on a boring or difficult task. The second step is to break tasks down into smaller “chunks” that will likely take that amount of time. The “distractibility delay” skill involves committing to keep working on a task for a certain period of time. During that time, the client writes down distractions but does not act on them. After the agreed-upon period of time, the client can decide if they are tasks that need to be done immediately, tasks that can go onto the task list, or tasks that are pure distractions and can be discarded.

Organizational Systems

The main goal of this chapter is for the adult client with ADHD to learn strategies for developing organizational systems. Information is presented on how to develop a system for sorting mail, reducing the chance that important mail or bills will be misplaced. Having an organizational system in place will decrease difficulties related to poor organization such as feeling overwhelmed or out of control, paying late fees, and missing out on opportunities because of missed deadlines or lost paperwork.The chapter also covers how to develop systems for other items that might be problematic, including papers, electronic files, emails, and household items. Clients are encouraged to develop organizational systems that are both simple and effective.

Application of Skills to Procrastination (optional)

This chapter, which is optional, covers how clients with ADHD can use the skills they have learned to deal with the problem of procrastination. Many individuals with ADHD have struggled with procrastination for quite some time, and we therefore discuss the attractive aspects of procrastination. Clients are given instructions on how you can identify the negative consequences of procrastination. An exercise is presented that involves writing out pros and cons of procrastination using a specific example. The chapter explains how previously taught skills of problem solving and adaptive thinking can be applied to procrastination with the help of a thought record.

Adaptive Thinking

This chapter continues the discussion of the cognitive component of ADHD. The primary goal is for clients to learn how to develop alternative thoughts to replace their negative and/or unhelpful thoughts. The process, called adaptive thinking, involves observing one’s thoughts, labeling them as inaccurate or unhelpful, and then coming up with more accurate or helpful thoughts. We discuss ways to formulate helpful rational responses to use in place of negative automatic thoughts. The chapter includes instructions regarding how to review thought records. We use a coaching metaphor to explain helpful and unhelpful styles of coaching yourself/talking to yourself about situations.

Problem Solving and Managing Overwhelming Tasks

This chapter contains information about how adult clients with ADHD can learn to manage overwhelming tasks, those that remain on the task list for many days or weeks without getting completed. A five-step problem-solving strategy is outlined to arrive at a solution to a problem. The five steps are articulating the problem, listing solutions, listing the pros and cons of the solutions, rating each solution, and implementing the best solution. Instructions are given for breaking down large tasks into smaller, more manageable chunks to increase the likelihood of task completion. The client is urged to continue practicing these skills regularly so that they become habits.

Information About Adult ADHD

This introductory chapter provides psychoeducation about ADHD and how it manifests in adults. The symptoms of ADHD are described. The cognitive-behavioral model of adult ADHD is presented. The chapter explains why adults sometimes need additional therapy, even if they have been treated with medication for ADHD. Attention is paid to debunking some myths about ADHD, such that individuals with ADHD are lazy or unintelligent.

Organization of Multiple Tasks

The main focus of this chapter is to teach the adult client with ADHD how to organize multiple tasks. This chapter describes how the client can select an effective calendar and task list system to use. Advice is given on how to manage multiple tasks. Information is provided about how to prioritize tasks using an “A,” “B,” and “C” rating system. The importance of sticking with a system is emphasized.

The Foundation

This chapter provides basic information about setting goals for treatment. It focuses on helping the client with adult ADHD to come up with goals for therapy that are both specific and within his or her control. The modular structure of this treatment program is explained. The chapter covers the foundational skills that will allow the client to get started with a task list and calendar system. There is a discussion of how to identify and try to resolve potential pitfalls or challenges that may arise during treatment. The chapter concludes with a discussion of motivation for change.