Consciously Counseling Adults with ADHD A. Maren Tolley, MS Ed, LCPC
Best Hopes I sure hope we talk about
What is Adult ADHD? 3 core characteristics: Inattentive (trouble focusing) Hyperactive (restless) Impulsive (in spending, sex, driving, conversation, social media) Symptoms must be present before age 12
Problems in Adulthood Difficulty with organization and planning (executive functioning) Scheduling and prioritizing tasks Keeping track of time Problems with self care (Bilkey, Surman, & Weintraub, 2014) Inattention Lack of interest Difficulty putting effort into unrewarding tasks or tasks that require effort. (Lasky, et al. 2016) Hyperactivity Restlessness, fidgeting.
Screening and Assessment Adult ADHD Self-Report Scale-V1.1 (ASRS) Symptom Checklist http://webdoc.nyumc.org/nyumc_d6/files/psych_ adhd_checklist.pdf Adult ADHD Assessment Tool Kit http://naceonline.com/adultadhdtoolkit/assessm enttools/assessmenttoolssection-1.pdf
Adult ADHD Self-Report Scale Symptom Checklist Adult ADHD Self-Report Scale (ASRS-v1.1) Screener 1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? 2. How often do you have difficulty getting things in order when you have to do a task that requires organization? 3. How often do you have problems remembering appointments or obligations? 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started? 5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? 6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Additional Cues to Symptoms 7. How often do you make careless mistakes when you have to work on a boring or difficult project? 8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work? 9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly? 10. How often do you misplace or have difficulty finding things at home or at work? 11. How often are you distracted by activity or noise around you? 12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated? 13. How often do you feel restless or fidgety? 14. How often do you have difficulty unwinding and relaxing when you have time to yourself? 15. How often do you find yourself talking too much when you are in social situations? 16. When you re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves? 17. How often do you have difficulty waiting your turn in situations when turn taking is required? 18. How often do you interrupt others when they are busy?
How Can ADHD Impact the Counseling Process? Late or missed appointments Financial mismanagement Difficulty focusing during session ( birdwalks ) Fidgeting/walking around room Not completing homework
Treatment Drugs Sustained-release stimulants (Vyvanse, Adderall XR, Focalin XR, Concerta, Ritalin LA) Non-stimulant (Strattera) (Williamson & Johnston, 2015) Behavioral Therapy Drugs are effective, but clients often still lack organization and planning skills
Characteristics of successful adults with ADHD Internal resilience factors Control Desire Goal orientation Reframing Persistence Learned creativity (Nadeau, 2005)
Characteristics of successful adults with ADHD, cont d External Resilience factors Goodness of fit Supportive social environment Mentors Support services (Nadeau, 2005)
Element of Psychotherapy Treatment Calendars Task lists and prioritizing Problem-solving Organizing space Coping skills for distractibility Recognizing critical moments
Self-regulating Strategies Organization Hyper-focus Follow-through Remembering Relaxation (Royal, Wade, &Nickel, 2015)
Aids Technology Computer/smart phone reminders Distraction blockers Planning/calendaring tools People Personal assistants Accountants Computer specialists Professional organizers
Career Choice Choosing appropriate context can help Some helpful contexts: Stress and challenge Novelty and multi-tasking Busy and fast-paced Physical labor Hands on work or active learning Intrinsically interesting
Person-Environment Fit (Trait and Factor Theory) Also consider characteristics of ADHD Environmental characteristics suitable for ADHD: Freedom of movement Series of short tasks/projects Minimal distractions Environment with control over noise/stimuli (separate setting) Independent work (may be distracted by group) (Royal, Wade, &Nickel, 2015)
Empirically Validated Treatments Two empirically validated treatments: Individual: Mastering your Adult ADHD: A Cognitive- Behavioral Treatment Program (Safren, et al., 2010) Group Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction (Solanto, et al., 2008)
Individual Treatment 1. Involving family member 2. Organization and planning skills 3. Organization of multiple tasks 4. Problem-solving and managing overwhelming tasks 5. Organizing papers
Individual Treatment, cont d 6. Gauging your attention span and distractibility delay 7. Modifying your environment 8. Introduction to a cognitive model of ADHD 9. Adaptive thinking 10.Rehearsal and review of adaptive thinking skills. 11.Application to procrastination 12.Relapse prevention
Group Treatment 1. Making Peace with the diagnosis and committing to growth 2. Time awareness and scheduling 3. Making tasks manageable and rewarding yourself 4. Prioritizing and To Do lists 5. Overcoming emotional obstacles 6. Activation and Motivation
Group Treatment, cont d 7. Setting up an organizational system 8. Implementing an organizational system 9. Maintaining an organizational system 10.Plan a project and get it done! 11.Project planning: implementation 12.Looking to the future 13.Getting to bed, getting up, and getting to work on time
References Bilkey, T., Surman, C., & Weintraub, K. (2014). ADHD GROWS UP. Scientific American Mind, 25(1), 64. Fedele, D. A., Hartung, C. M., Canu, W. H., & Wilkowski, B. M. (2010). Potential symptoms of ADHD for emerging adults. Journal Of Psychopathology And Behavioral Assessment, 32(3), 385-396. doi:10.1007/s10862-009-9173-x Hartung, C. M., Canu, W. H., Cleveland, C. S., Lefler, E. K., Mignogna, M. J., Fedele, D. A., &... Clapp, J. D. (2013). Stimulant medication use in college students: Comparison of appropriate users, misusers, and nonusers. Psychology Of Addictive Behaviors, 27(3), 832-840. doi:10.1037/a0033822 Lasky, A. K., Weisner, T. S., Jensen, P. S., Hinshaw, S. P., Hechtman, L., Arnold, L. E., &... Swanson, J. M. (2016). ADHD in context: Young adults reports of the impact of occupational environment on the manifestation of ADHD. Social Science & Medicine, 161160-168. doi:10.1016/j.socscimed.2016.06.003 Nadeau, K. G. (2005). Career choices and workplace challenges for individuals with ADHD. Journal Of Clinical Psychology, 61(5), 549-563. doi:10.1002/jclp.20119
References, cont d Royal, C., Wade, W., & Nickel, H. (2015). Career Development of Adults with Attention-Deficit/Hyperactivity Disorder [ADHD]. Career Planning & Adult Development Journal, 31(4), 54. Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms. JAMA: Journal Of The American Medical Association, 304(8), 875. Solanto, M. V., Marks, D. J., Mitchell, K., Wasserstein, J., & Kofman, M. D. (2008). Development of a new psychosocial treatment for adults with ADHD. Journal of Attention Disorders, 11(6), 728-736 Williamson, D., & Johnston, C. (2015). Gender differences in adults with attention-deficit/hyperactivity disorder: A narrative review. Clinical Psychology Review, 4015-27. doi:10.1016/j.cpr.2015.05.005