ATTENTION DEFICIT DISORDER (ADD)—ADULT

BEHAVIORAL DEFINITIONS

1. Childhood history of Attention Deficit Disorder (ADD) that was either diagnosed or later concluded due to the symptoms of behavioral problems at school, impulsivity, temper outbursts, and lack of concentration.

2. Unable to concentrate or pay attention to things of low interest, even when those things are important to his/her life.

3. Easily distracted and drawn from task at hand.

4. Restless and fidgety; unable to be sedentary for more than a short time.

5. Impulsive; has an easily observable pattern of acting first and thinking later.

6. Rapid mood swings and mood lability within short spans of time.

7. Disorganized in most areas of his/her life.

8. Starts many projects but rarely finishes any.

9. Has a “low boiling point and a short fuse.”

10. Exhibits low stress tolerance; is easily frustrated, hassled, or upset.

11. Chronic low self-esteem.

12. Tendency toward addictive behaviors.

LONG-TERM GOALS

1. Reduce impulsive actions while increasing concentration and focus on low-interest activities.

2. Minimize ADD behavioral interference in daily life.

3. Accept ADD as a chronic issue and need for continuing medication treatment.

4. Sustain attention and concentration for consistently longer periods of time.

5. Achieve a satisfactory level of balance, structure, and intimacy in personal life.

SHORT-TERM OBJECTIVES	THERAPEUTIC INTERVENTIONS
1. Cooperate with and complete psychological testing. (1)	1. Arrange for the administration of psychological testing to the client to establish or rule out Attention-Deficit Disorder (ADD); provide feedback as to testing results.
2. Cooperate with and complete a psychiatric evaluation. (2)	2. Arrange for a psychiatric evaluation of the client to assess his/her need for psychotropic medication.
3. Comply with all recommendations based on the psychiatric and/or psychological evaluations. (3, 4)	3. Process the results of the psychiatric evaluation and/or psychological testing with the client and answer any questions that may arise.
	4. Conduct a conjoint session with significant others and the client to present the results of the psychological and psychiatric evaluations. Answer any questions they may have and solicit their support in dealing with the client’s condition.
4. Take medication as prescribed, on a regular, consistent basis. (5, 6)	5. Monitor and evaluate the client’s psychotropic medication prescription compliance and the effectiveness of the medications on his/her level of functioning.
	6. Confer with the client’s psychiatrist on a regular basis regarding the effectiveness of the medication regime.
5. Identify specific benefits of taking prescribed medications on a long-term basis. (7, 8, 9)	7. Ask the client to make a “pros and cons” spreadsheet regarding staying on medications after doing well; process the results.
	8. Encourage and support the client in remaining on medications and warmly but firmly confront thoughts of discontinuing when they surface.
	9. Assign the client to list the positive effects that have occurred for him/her since starting on medication.
6. Read material that is informative regarding ADD to gain knowledge about the condition. (10)	10. Ask the client to read material on ADD (e.g., Driven to Distraction by Hallowell and Ratey; The Hyperactive Child, Adolescent and Adult by Wender; Putting on the Brakes by Quinn and Stern; You Mean I’m Not Lazy, Stupid or Crazy by Kelly and Ramundo); process the material read.
7. Identify the specific ADD behaviors that cause the most difficulty. (11, 12, 13)	11. Assist the client in identifying the specific behaviors that cause him/her the most difficulty.
	12. Review the results of psychological testing and/or psychiatric evaluation again with the client assisting in identifying or in affirming his/her choice of the most problematic behavior(s) to address.
	13. Ask the client to have extended family members and close collaterals complete a ranking of the
	three behaviors they see as interfering the most with his/her daily functioning (e.g., mood swings, temper outbursts, easily stressed, short attention span, never completes projects).
8. List the negative consequences of the ADD problematic behavior. (14)	14. Assign the client to make a list of negative consequences that he/she has experienced or that could result from a continuation of the problematic behavior; process the list.
9. Apply problem-solving skills to specific ADD behaviors that are interfering with daily functioning. (15, 16)	15. Teach the client problem-solving skills (i.e., identify problem, brainstorm all possible options, evaluate each option, select best option, implement course of action, and evaluate results) that can be applied to his/her ADD behaviors.
	16. Assign problem-solving homework to the client specific to the identified behavior (i.e., impulse control, anger outbursts, mood swings, staying on task, attentiveness); process the completed assignment and give appropriate feedback to the client.
10. Utilize cognitive strategies to curb impulsive behavior. (17)	17. Teach the client the self-control strategies of “stop, listen, think, and act” and “problem-solving self-talk.” Role-play these techniques to improve his/her skill level.
11. Implement a specific, time-limited period if indulging impulses that are not self-destructive. (18)	18. Structure a “blowout” time each week when the client can do whatever he/she likes to do that is not self-destructive (e.g., blast themselves with music, gorge on ice cream).
12. Use “time out” to remove self from situations and think about behavioral reaction alternatives and their consequences. (19)	19. Train the client to use a “time out” intervention in which he/she settles down by going away from the situation and calming down to think about behavioral alternatives and their consequences.
13. Implement relaxation procedures to reduce tension and physical restlessness. (20)	20. Instruct the client in various relaxation techniques (e.g., deep breathing, meditation, guided imagery) and encourage him/her to use them daily or when stress increases.
14. Reward self when impulsivity, inattention, or forgetfulness are replaced by positive alternatives. (21, 22)	21. Design and implement a self-administered reward system to reinforce and encourage the client’s decreased impulsiveness, loss of temper, inattentiveness, and so on.
	22. Teach the client to utilize external structure (e.g., lists, reminders, files, daily rituals) to reduce the effects of his/her inattention and forgetfulness; encourage the client to reward himself/herself for successful recall and follow-through.
15. Cooperate with brainwave biofeedback to improve impulse control and reduce distractibility. (23, 24)	23. Refer for or administer brainwave biofeedback to improve attention span, impulse control, and mood regulation.
	24. Encourage the client to transfer the biofeedback training skills of relaxation and cognitive focusing to everyday situations (e.g., home, work, social).
16. Report a decrease in statements and feelings of negativity regarding self and life. (25)	25. Conduct conjoint sessions in which positive aspects of the relationship, the client, and significant other are identified and affirmed.
17. Introduce behaviors into life that improve health and/or serve others. (26, 27)	26. Direct the client toward healthy addictions (e.g., exercise, volunteer work, community service).
	27. After clearance from the client’s personal physician, refer client to a physician fitness trainer who can design an aerobic exercise routine for him/her.
18. Attend an ADD support group. (28)	28. Refer the client to a specific group therapy for adults with ADD to increase the client’s understanding of ADD, to boost his/her self-esteem, and to obtain feedback from others.
19. Use a “coach” who has been trained by therapist to increase organization and task focus. (29, 30)	29. Direct the client to pick a “coach” who is a friend or colleague to assist him/her in getting organized and staying on task and to provide encouragement and support (see Driven to Distraction by Hallowell and Ratey).
	30. Instruct the coach in HOPE technique (i.e., Help, Obligations, Plans, and Encouragement) as described in Driven to Distraction by Hallowell and Ratey.
20. Report improved listening skills without defensiveness. (31)	31. Use role-playing and modeling to teach the client how to listen and accept feedback from others regarding his/her behavior.
21. Have significant other attend an ADD support group to increase his/her understanding of the condition. (32)	32. Educate the client’s significant other on ADD and encourage him/her to attend a support group.
22. Report improved communication, understanding, and feelings of trust between self and significant other. (33, 34, 35, 36)	33. Ask the client and significant other to list the expectations they have for the relationship and each other. Process the list in a conjoint session with a focus on identifying how the expectations can be met and how realistic they are.
	34. Assist the client and his/her significant other in removing blocks in their communication and in developing new communication skills.
	35. Refer the client and significant other to a skill-based marriage/relationship seminar (e.g., PREP, Marriage Encounter, Engaged Encounter) to improve communication and conflict resolution skills.
	36. Assign the client and significant other to schedule a specific time each day to devote to communicating together, expressing affection, having fun, or talking through problems. Move assignment toward becoming a daily ritual.
23. Develop a signal to act as a warning system to indicate when anger levels are escalating with the partner. (37)	37. Assist the client and significant other in developing a signal system as a means of giving feedback when conflict behaviors and anger begin to escalate.

DIAGNOSTIC SUGGESTIONS