Application of Skills to Procrastination (optional)

This chapter outlines an optional session for clients with ADHD that focuses on procrastination. It describes how the therapist can discuss the attractive aspects of procrastination and how the client can learn to identify the negative consequences of procrastination. An exercise is presented where the client goes over the pros and cons of procrastination using a specific example. The chapter includes a discussion of how previously taught skills of problem-solving, adaptive thinking, and cognitive restructuring can be applied to procrastination. A case vignette illustrates the process of identifying the long-term and short-term effects of procrastination.

Introducing a Cognitive Model of ADHD

This chapter provides the therapist with information needed to orient clients to the cognitive model of ADHD. The therapist teaches clients with ADHD to recognize and identify their automatic thoughts and to understand the relationship among thoughts, behaviors, and feelings. The therapist educates the client about common thinking errors. Using a thought record, clients are taught to self-monitor their thoughts. A case vignette is provided to illustrate the technique of keeping a thought record.

Organizational Systems

This chapter covers how therapists can help clients with ADHD to develop organizational systems. Information is presented on how to help clients develop a system for sorting mail, reducing the chance that important mail and bills will be misplaced. Worksheet 2: Steps for Sorting Mail and Worksheet 3: Developing an Organizational System are introduced. The chapter discusses how to develop systems for other items that might be problematic for the client with ADHD, including papers, electronic files, emails, and household items. A case vignette is provided to illustrate the techniques.

Informational Session with Spouse, Partner, or Family Member (if applicable)

This chapter describes an optional session that can be conducted with a spouse, partner, or family member of the client with ADHD. In this session the therapist would provide psychoeducation about ADHD to the client’s spouse, partner, or family member. The therapist would also provide an overview of the treatment. The chapter offers suggestions on how to conduct a discussion of the role the family member will play in the client’s treatment. The chapter concludes with a case vignette.

Adaptive Thinking

This chapter continues the discussion of the cognitive component of treatment for ADHD introduced in Chapter 8. It includes instructions for the therapist regarding how to review thought records with clients. Therapists can use a coaching story to contrast positive and negative ways of thinking. Therapists learn information about helping clients learn adaptive thinking, which involves formulating helpful rational responses to use in place of negative automatic thoughts. A case vignette illustrates how clients can begin putting these cognitive restructuring techniques into place.

Psychoeducation and Introduction to Organization and Planning

This chapter provides information about the first session in treatment, which includes psychoeducation about ADHD and setting goals for treatment. The modular format of the treatment is described. There is a discussion of identifying and then helping the client resolve potential pitfalls or challenges that may arise. The idea of using calendar and task list systems for organization and planning is introduced. Methods for improving adherence to ADHD medication usage are also discussed. The chapter concludes with a discussion of the client’s motivation for change and a case vignette.

Modifying the Environment

This chapter focuses on more ways in which the therapist can help clients with ADHD to reduce distractibility. Clients are instructed to identify distractions in their work environment and then to modify the environment accordingly. The therapist stresses the importance of keeping track of important objects such as keys, wallet, and phone, and teaches the client how to set up organizational systems to help with this. Clients should use periodic reminders such as alarms to check in and see if they are on track or if they have gotten distracted. A case vignette illustrates ways to modify the client’s environment to minimize distractions.

Rehearsal and Review of Adaptive Thinking Skills

This chapter completes the discussion of adaptive thinking for clients with ADHD. It includes a description of how to review thought records on which clients have developed rational responses. It describes how to work with clients on identifying additional situations that may require adaptive thinking and cognitive restructuring. Information is given on how to evaluate the need for the optional procrastination session described in Chapter 11. A case vignette illustrates how to put these strategies into place.

Problem-Solving and Managing Overwhelming Tasks

This chapter covers how the therapist can help clients with ADHD manage overwhelming tasks, those that remain on the task list for many days or weeks without getting completed. Worksheet 1: Problem-Solving: Selection of Action Plan is introduced. Information is provided regarding how clients can use structured problem-solving techniques to help them arrive at a solution. Instructions are given for helping clients break down large tasks into smaller, more manageable chunks to increase the likelihood that they will complete tasks. A case vignette illustrates how a client can get to work on a seemingly overwhelming task.

Organization of Multiple Tasks

This chapter focuses on how the therapist can help the client with ADHD organize and prioritize tasks. It describes how to help the client choose and begin using an effective calendar and task list system. It offers advice on how to help clients manage multiple tasks. Information is provided about how to help clients prioritize tasks. A case vignette is provided to illustrate these concepts.