What You Should Know About Counseling for Attention Deficit Disorder

At the ADHD Information Library we are big believers that you should not just be giving a child with Attention Deficit Hyperactivity Disorder medication without also providing some sort of counseling or therapy. There are good, long-term studies that show that medication by itself over the long term is not a whole lot better than no treatment at all (Satterfield, Medication for Attention Deficit Disorder is far more effective when it is combined with counseling of one type or another. But not all forms of counseling are worth the investment of time or money. Read on to learn what works and what does not.

Family therapy is helpful.

The family needs to adjust to the ADHD child, and needs to know how to do that. Parents need to know what to expect from the ADHD child, and the siblings need to be filled in on what is going on as well.

In fact, often the focus of family therapy ought to be the siblings. There is often a lot of jealousy with the siblings focused at the ADHD patient. Why? Because the patient has been getting all kinds of attention from the parents, both good attention and bad, over the past several years. Also because the ADHD child probably gets away with a lot more than his non-ADHD siblings do. So the jealousy needs to be addressed at some point in the family context. 

Parent training classes are great.

Most classes focus on getting kids with Attention Deficit Disorder to be more compliant. It doesn't matter if the ADHD child is noncompliance because he's a space cadet and can't remember what he's supposed to do, or if he's non-compliant because he's being defiant and refuses to do what he's supposed to do. Either way there's a problem that needs to be fixed. A good parent training class will give parents the skills needed to teach their ADHD kids to be successful at being obedient. 

There's another program that is nationwide, so it would be available to most any of you reading this. However, it has become a very controversial parenting class. It is by Gary and Ann Marie Ezzo, and is called "Growing Kids God's Way." When it comes to basic parenting principles I think the class is very good. When it comes specifically to dealing with kids with neurological problems, such as ADHD kids, then the class leaves something to be desired.

I have several friends who know the Ezzos personally, and think they are great people. However, sometimes the people hosting the video lessons of the classes are so inflexible that they misrepresent what the Ezzos are trying to teach. It is a Bible-based program, basically focusing on the moral principles which underlie our rules of conduct. It stresses respect for other people as one of the main reasons why we expect certain kinds of behavior.

Please don't write me and try to tell me that this is a cult, or something like that. It's not. Please don't waste my time criticizing the class unless you have actually taken the program and there was something that you didn't like. I've seen about half of the tapes, and liked what I saw, and I've seen several families go through the program with good success. My family has gone through their class for teenagers and parents, and I thought it was very good. I used to be critical of the class myself, but only based on hearsay. It's not perfect (neither am I, and neither are you), but it may be very useful to your family.

What about individual counseling or therapy for Attention Deficit Disorder?

Individual therapy using cognitive-behavioral approaches can be very helpful in the treatment of ADHD. Stop and think therapy, teaching the ADHD child how to solve problems, and teaching him how to decrease his impulsivity is great. Teaching the ADHD child how to monitor his own behaviors is important as well.

But some forms of individual therapy may be a waste of time and money. I really have a tough time with people doing regular psychotherapy with these kids. "Well, how does that make you feel? Here, come play with this doll." Sorry, I have a tough time with that. The problem isthe child's Attention Deficit Disorder, which is a neurological problem.

Attention Deficit Disorder is an impulse-control disorder, or dis-inhibition disorder, and ADHD children need to be taught how to control themselves, how to decrease their impulsivity, how to solve problems, and how to stop and think before they act. They need to be taught the necessary skills to help them be more successful. 

I rarely ask ADD kids, "How do you feel?" simply because I rarely care how they feel. Now, that may sound cold to you, but it's really not. I don't try to help ADHD kids to "feel good" about themselves, or have "good self-esteem." There are too many people who feel good about themselves, but do wrong things, things that keep them from being successful, or things that get them into trouble, or things that hurt other people. This may shock you, but Self-Esteem is highly overrated. 

Some of you may find this opinion offensive. I'm sorry, but I know in my heart that I'm right. Self-Esteem, without Self-Control and Respect for others, leads to selfish behaviors at best, and to criminal behaviors at worst. Every criminal behind bars has good Self-Esteem, so much so that they believed that the laws of our society did not apply to them.

For those of you who want to argue, first consider this: one study published in 1997 reported that the "average" criminal locked up in prison had committed 116 crimes for which he was not arrested, or convicted, for each crime for which he was arrested and convicted! That's 116 to 1!

Every sociopath in the world has self-esteem. We have to stop pushing self-esteem and start pushing self-control and respect for others. Self-esteem should come naturally as the result of hard work which leads to success, not from "Self-Esteem Classes" or "Workbooks." We've become a society that praises mediocre work so that we don't offend anyone, and as a result our national work ethic has eroded away. Kids need less self-esteem, and more self-control.

The Keys to making this work: Teach SELF-CONTROL and RESPECT FOR OTHERS.

In order to be successful in life, which should be the goal of therapy, Attention Deficit Disorder kids need to learn what to DO to be successful. The good "feelings" will come as a result of the successful "doing."  ADHD individuals need to be taught how to be under control, how to wait their turn, how to be polite, how to finish their work, how to work fast and hard until they are finished, how to pay attention to the right thing, how to follow rules, and how to obey their parents and teachers.

If your therapist can do this for you, stick with him. You can learn more about ADHD at the ADHD Information Library.


Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of Incorporated.

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