secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g. increased suicide risk when comorbid depression is evident).
Assess for any issues of age, gender, or culture that could help explain the client's currently defined problem behavior and factors that could offer a better understanding of the client's behavior.
Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g. the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g. the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment).
Verbalize the powerlessness and unmanageability that resulted from treating ADHD symptoms with addiction. (11)
Using a 12-step recovery program's Step One exercise, help the client to accept his/her/their powerlessness and unmanageability over ADHD symptoms and addiction (or assign the client to complete the Step 1 exercise from The Alcoholism and Drug Abuse Client Workbook by Perkinson).
Verbalize the relationship between ADHD and addiction. (12)
Using a biopsychosocial approach, teach the client about the relationship between ADHD symptoms and the vulnerability to substance use (see Substance Use in Adolescents with ADHD by Kennedy et al.).
Implement a program of recovery structured to bring ADHD and addiction under control. (13)
Help the client to develop a program of recovery that includes the elements necessary to bring ADHD and addiction under control (e.g. medication, behavior modification, environmental controls, aftercare meetings, further therapy); (or supplement with “Developing a Recovery Program” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma).
List five ways a higher power can be used to assist in recovery from ADHD and addiction. (14)
Teach the client about the Alcoholics Anonymous concept of a higher power and how this power can assist him/her/them in recovery.
Implement remedial procedures for any learning disabilities that add to the client's frustration. (15)
Refer the client to an educational specialist to design remedial procedures for any learning disabilities that may be present in addition to ADHD.
Take medication as prescribed. (16, 17)
Arrange for a medication evaluation by a prescriber.
Monitor the client for psychotropic medication prescription compliance, side effects, and effectiveness; consult with the prescriber at regular intervals (or supplement with “Evaluating Medication Effects” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce).
Parents and the client verbalize increased knowledge about ADHD symptoms. (18, 19, 20, 21)
Educate the client and/or client's parents about the signs and symptoms of ADHD.
Discuss with the client and/or parents the various treatment options for ADHD (e.g. behavioral parent training, classroom-based behavioral management programs, peer-based programs, medication, cognitive behavioral therapy [CBT]), discussing risks, benefits, and matching treatment to developmental age to fully inform the client's and parents' decision making (see ADHD in Adolescents by Becker).
Assign the parents readings to increase their knowledge of ADHD (e.g. Taking Charge of ADHD by Barkley; Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach by Monastra; The Family ADHD Solution: A Scientific Approach to Maximizing Your Child's Attention and Minimizing Parental Stress by Bertin).
Assign the client readings to increase his/her/their knowledge about ADHD and ways to manage related behavior (e.g. The ADHD Workbook for Teens: Activities to Help You Gain Motivation and Confidence by Honos-Webb; Take Control of ADHD: The Ultimate Guide for Teens With ADHD by Spodak & Stephano; ADHD – A Teenager's Guide by Crist).
Parents learn and implement Parent Management Training to increase prosocial behavior and decrease disruptive behavior of their adolescent child/children. (22, 23, 24, 25, 26)
Explain how parent and child behavioral interactions can reduce the frequency of impulsive, disruptive, and negative attention-seeking behaviors and increase desired prosocial behavior through prompting and reinforcing positive behaviors as well as use of clear instruction, time-out, and other loss-of-privilege practices for problem behavior (recommend The Kazdin Method for Parenting the Defiant Child by Kazdin; Parents and Adolescents Living Together: The Basics by Patterson & Forgatch).
Teach the parents how to specifically define and identify problem behaviors, identify their reactions to the behavior, determine whether the reaction encourages or discourages the behavior, and generate alternatives to the problem behavior (or supplement with “Switching from Defense to Offense” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce).
Teach parents about the possible functions of the ADHD behavior (e.g. avoidance, attention, to gain a desired object/activity, regulate sensory stimulation); how to test which function(s) is being served by the behavior; and how to use parent-training methods to manage the behavior.
