Family Therapy For Kids With ADHD

-Mean to siblings/disrespectful to parents

-argumentative/won’ take responsibility for behaviors

-irritability/lack of emotional regulation

-resistant to completing homework and chores/won’t get off electronics

-hard time socializing with others/understanding social cues

These are some of the most common concerns parents bring to the first session. After gathering the background information I need about the kid and the family, I introduce parents to the model of therapy I use to provide family therapy to address these ADHD symptoms. The reason why I emphasize the importance of family therapy and parent participation in therapy sessions is that individual therapy for kids with ADHD is ineffective. While meeting with the kids individually, they are really good at participating in a therapy session and articulating the skills they have learned and when they plan to use them. However, after leaving the therapy session, these same kids really struggle to execute the skills when needed and therefore nothing changes. Parent involvement provides the additional insights and the ability to create structure kids with ADHD need in order to grow and develop their executive functioning skills.

Collaborative and Proactive Solutions (CPS) formed by Dr. Ross Greene (https://livesinthebalance.org) is the model of therapy I use to provide families with the tools to address ADHD symptoms in their kid. The first point I always emphasize is with this model of therapy is starting with the assumption kids do well when they can, not when they want to. This assumption that the kid you’re trying to help, is already trying their best, allows the parents to see the kid in a new light. They get to see the kid as someone struggling with executive functioning skills (i.e. emotional regulation, frustration tolerance, rigid thinking) rather than viewing them as manipulative/coercive/lazy etc. Of course, this new lens of the kid struggling rather than intentionally defiant does not excuse them from parents’ expectations. However, it does change the role of the parents from being more punitive to more of a support role. This mindset encourages parents to be curious about their kid’s struggles and view the kid as their partner to help solve the problems in the home rather than an opponent that has to be strong armed or out witted.

The second concept I emphasize from this therapy model is that it is proactive. Both parents are encouraged to form an agreed upon set of expectations (i.e. bed times, chores, eating dinner together) for the kid and an agreed upon way they plan to respond when the kid struggles to meet the expectations. This allows parents to feel prepared and focuses on preventing angry outbursts rather than setting the family up for an explosion from the kid and then trying to deescalate it.

When working with both the parents and the kid in the family therapy session, I start by having parents select a specific expectation they’d like to address (i.e. homework is completed before bedtime). Then I model for the parents how to empathize with kid’s struggles. Parents should be able to articulate, with a lot of help from the kid in the session, what the kid sees as their biggest struggle to meeting the expectation (i.e. kid wants to take a mental break after school). After this, I guide parents to share with the kid why their expectation is important to them (i.e. kid gets really anxious when they turn in homework late). Lastly, I guide parents and kid to problem solve together; encouraging them to find a solution that meets both of their concerns (a solution that allows kid to take a break after school and has them finish the work before bedtime).

For the sake of brevity, I have to skip a lot of the details of this model of therapy but at its core it is a solution focused therapy model. The beauty of this model is that it works simultaneously on different levels. To use the example from the paragraph above, when parents use this model of therapy, they are solving the immediate problem in the home of the kid completing their homework before bed time. As a result, the kid gets a break, parents don’t have to watch their kid get anxious because their homework is late and a meltdown is avoided. However, while practicing this problem solving method; the kid with ADHD, who naturally struggles with executive functioning skills, is getting lots practice growing in these areas. The kid practices frustration tolerance and introspection while sharing their perspective with the parents. The kid then practices perspective taking while listening to the parents’ concerns behind their expectations. Lastly, the kid practices problem solving and anticipation of future events while forming a solution with the parents. With this model of therapy, not only to do we help the family avoid conflict in the moment but it also sets the kid up for success in the future.