Behavior Modification/Therapy and ADHD

Last updated on: January 28, 2013 at 10:40 am by Kate Cousino

Behavior Modification/Therapy and ADHD 2013-01-28T10:40:00-04:00 Kate Cousino

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I was asked to write a bit about Behavior Modification and ADHD.

I can’t say I know a ton about behavioral modification in children, and I only had a few sessions with a therapist myself. As an adult, I have the advantage of some perspective and years of reflection on what my weaknesses are. On the other hand, as an adult I also have three decades of compensating behaviors some of which are helpful and many of which cause their own problems!

So, for me, once the diagnoses was made, therapy looked a lot like specialized ‘coaching’. This is more or less how it went:

1. Identified the primary ways that ADHD has impaired my life (in order to have a diagnoses, the symptoms must be causing significant problems in at least two areas).
2. Identified goals in those areas.
3. Identified tools to compensate for my weaknesses.
4. Decided on one or two specific strategies to work on or tools to use to meet my goals.

Numbers 3 and 4 were actually the hardest part. I’m intelligent, well-read, and self-aware enough to know that I need help staying on track, so I’ve collected and tried a lot of different organizational and time management tools over the years. But ADHD messes up executive function, which involves the ability to prioritize and make decisions, as well as working memory (the kind of short term memory that lets you recall what you were just doing, or meant to do next). Making a plan, remembering what plan was made, putting it in action, and sticking to it, are all more difficult for someone with a disorder affecting executive function. So I had all these tools, but not the ability to use them effectively.

My psychologist asked me if I was a ‘list-maker’, and I admitted that I actually had several different lists on the go, and they were getting pretty confused. I had a dayplanner, a google calender, a small notebook (because the dayplanner didn’t fit in my bag terribly well), a large notebook (for more involved note-taking) and usually I wound up with a list on random bits of paper so I could have something to carry in my pocket. On top of that, I made lists on the ‘sticky note’ program on my laptop as well. I didn’t set out to have several different tools on the go, but when one tool wasn’t working for some reason I tended to try to compensate by trying something different. Occasionally, I simply forgot I had already started a list for one or another arena of my life. And some tools were perennials that I would give up on when I became overwhelmed, and then pick up again in a burst of optimism.

You can probably see the problem with this – I rarely had the list I needed with me, and any extra steps I needed to take to reach productivity increased the chance of becoming distracted or just feeling overwhelmed and falling into an avoidance behavior. What I needed was to prune down my tools and build in routines that would keep me on track. Simpler said than done, but my therapist helped me, and gave me accountability and feedback as I put our plans into practice.

Children who need behavioral modification would need a lot more outside structure to make it successful – people to help them set goals (one at a time), identify a strategy to accomplish their goal, remain mindful of the goal and the strategy, measure progress, and reinforce progress through measurement and rewards. I can’t emphasize how important the measurement and positive reinforcement are! It’s hard to assess progress for yourself when you can’t accurately hold your initial position, goals, and current position in working memory. Without that ability to track progress, self-assessment tends to consist of feelings, usually the feelings left by the most recent interaction or the most common interaction.

I can’t say I saw immediate improvement from behavior therapy. A lot of what I learned in those sessions and through my reading didn’t translate into progress until I finally found the right medication for me – which was also (coincidentally) around the time I bought my first smart phone, which made consolidating my tools and remembering to use them even easier to do. But something certainly improved the moment I had my diagnoses, and I think I will write more about that in a post I might call, “Why Short People Don’t Play Basketball.”

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