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teach the significant other throughout therapy how to help support change and overcome obstacles to therapeutic improvement.
Learn and implement organization, planning, and time management skills. (30, 31, 32, 33)
Teach the client organization and planning skills, including the routine use of a calendar and daily task list.
Develop with the client a procedure for classifying and managing mail, other relevant paperwork and files, as well as scheduled appointments.
Teach the client problem-solving skills (i.e. identify problem, brainstorm all possible options, evaluate the pros and cons of each option, select best option, implement a course of action, and evaluate results) as an approach to planning; for each plan, break it down into manageable time-limited steps to reduce the influence of distractibility (or supplement with “Getting Organized” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
Assign homework asking the client to apply problem-solving skills to an everyday problem (i.e. impulse control, anger outbursts, mood swings, staying on task, attentiveness); review and provide corrective feedback toward improving the skill (or supplement with “Problem Solving: An Alternative to Impulsive Action” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Learn and implement skills to reduce the disruptive influence of distractibility. (34, 35, 36, 37)
Assess the client's typical attention span by having him/her/them do a few boring tasks (e.g. sorting bills, reading something uninteresting) to the point that he/she/they report distraction; use this as an approximate measure of his/her/their typical attention span.
Teach the client stimulus control techniques that use external structure (e.g. lists, reminders, files, daily rituals) to improve on-task behavior; remove distracting stimuli in the environment; encourage the client to self-reward for successful focus and follow-through.
Teach the client to break down tasks into meaningful smaller units that are likely to be completed without interruption by distraction based on his/her/their demonstrated attention span.
Teach the client to use timers or other cues to remind him/her/them to cease a task before he/she/they become distracted, in an effort to reduce the frequency of distraction and off-task actions (see Mastery of Your Adult ADHD – Therapist Guide by Safren et al.).
Identify, challenge, and change self-talk that contributes to maladaptive feelings and actions. (38, 39, 40)
Use cognitive therapy techniques to help client identify maladaptive self-talk and/or underlying assumptions (e.g. “I must do this perfectly,” “I can do this later,” “I can't organize all these things”); challenge biases, generate alternatives, and do behavioral experiments to reinforce the validity of the alternatives (see Cognitive Behavior Therapy by Beck; or supplement with “Negative Thoughts Trigger Negative Feelings” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Use Metacognitive Therapy to examine the client's “thinking about his/her/their thinking” (i.e. the meaning he/she/they place on his/her/their vulnerabilities associated with ADHD and his/her/their thoughts about how to respond to them accordingly) toward developing a more adaptive plan based on new, less maladaptive metacognitive appraisals (see Metacognitive Therapy for Anxiety and Depression by Wells).
Assign homework asking the client to implement cognitive knowledge and skills in relevant tasks; review, reinforcing strengths and problem-solve obstacles toward sustained, effective use.
Acknowledge procrastination and the need to reduce it. (41)
Assist the client in identifying positives and negatives of procrastinating toward the goal of motivating him/her/them to work on staying goal-oriented and task-focused.
Learn and implement skills to reduce procrastination. (42, 43, 44, 45)
Teach the client to apply problem-solving skills to planning as a first step in overcoming procrastination; for each plan, break it down into manageable time-limited steps to reduce the influence of distractibility and increase the likelihood of successful completion.
Teach the client to apply new cognitive restructuring skills to challenge thoughts that encourage the use of procrastination (e.g. “I can do this later” or “I'll finish this after I watch my TV show”)
