COUNSELING AND INTERVENTION STRATEGIES: EXTERNALIZING DISORDERS

Constance J. Fournier

OVERVIEW Attention Deficit Hyperactivity Disorder

(ADHD) and types of ADHD Basic interventions with ADHD ADHD and the typical comorbidity

ADHDInattentive symptoms

Often fails to give close attention to details, or makes careless mistakes

Difficulty sustaining attention in tasks or play (rule governed behavior)

Does not seem to listen when spoken to directly

ADHD Inattentive symptoms continued

Does not follow through on instructions, fails to finish tasks (not due to oppositional behavior or inability to understand)

Difficulty organizing tasks or activities Avoid, dislikes, reluctant to engage in

mental effort tasks Often loses necessary things

ADHD Inattention symptoms continued

Often distracted by extraneous stimuli Often forgetful in daily activities

ADHD Hyperactivity symptoms

Fidgets with hands, feet, squirms in seat Leaves seat when remaining seated is

expected Runs or climbs excessively; adolescents

report restlessness On the go, driven by a motor Talks excessively

ADHD Impulsivity symptoms

Blurts out answers before the question is completed

Difficult awaiting turn Interrupts or intrudes on others (butting

into conversations or games)

ADHD Inattentive type Hyperactive-Impulsive type Combined type

Helps to put on the tri Venn diagram Diagnosed before age 7

ADHD Inattentive/impulsive Hyperactive Combined Not otherwise specified

ADHD CLASSROOM STRATEGIES Precorrections Two desks Supply paper and pencils Direct questions specifically to the

child(say two questions) Allow to give hints

SPECIAL TIME Developing rapport with students Announce that this is special time Only rules—do something together, no

hurting self, others, or objects Let student pick activity Do a running commentary on the

actions Do not correct behavior unless it is

hurting self, others, or object

CONNECT DOT GAME Three people in a group, one is the

counselor, one is the observer, and one is the child.

Observer: give feedback of what the counselor did well, and what they might do better

Game 1: Marcus Game 2: Courtney

SPECIAL TIME Needs to be safe Needs to be predictable Helpful to most children because across

the table eye to eye is very uncomfortable

Sit beside or at angle, not directly across if at all possible

OPPOSITIONAL DEFIANT DISORDER pattern of negative, hostile, defiant

behavior often loses temper argues with adults refuses or defies adults’ requests deliberately annoys others blames others for own mistakes touchy and easily annoyed by others angry and resentful spiteful, vindictive

CONDUCT DISORDER aggression toward people and animals

bullies, threatens, intimidates initiates fights used a weapon that can cause serious

harm cruel to people cruel to animals stolen while confronting victim forced sexual activity

CONDUCT DISORDER destruction of property, e.g. fire setting

deceitfulness or theft, e.g., breaking into a house

serious rule violation, e.g. truancy other considerations

Impairs social, academic, occupational functioning

not other disorders

ANTISOCIAL PERSONALITY DISORDER Only after age 18 Pattern of disregard for and violation of

rights failure to conform to society norms deceitfulness impulsivity, failure to plan ahead irribility, aggressiveness disregard for safety of self or others consistent irresponsibility lack of remorse

DSM POSSI BLE CHANGES Emotional callousness is being

considered for ODD and ASP Inability to take others’ perspective Disregard for feelings or pain caused to

others Actions for self

INTERVENTIONS Parent training (Barkeley Program for

Parents) Supportive environment Structure Predictability Contracting

INTERVENTIONS Precorrections Giving choices Giving hints Using self monitoring

VEGGIE BURGER OF FEED BACK 3. Top: positive

2. Middle: feedback with “I” messages

1. Bottom: positive

CASES Case 1: Your colleague starts talking

about students when you are out for coffee. You like him/her, but know this is a small world.

Case 2: You are at an IEP meeting, and a teacher who needs to participate is distracting him/her self and you by constantly texting under the table. He/she is a very good teacher.

RESOURCES www.chadd.org

Children and adults with Attention Deficit Disorders

www.help4adhd.org Combined resources

www.nasponline.org National Association of School Psychologists

www.ed.gov Department of Education

RESOURCES www.nichcy.org

National information center for children and youth with disabilities

www.aap.org American Academy of Pediatrics

www.apa.org American Psychological Association

www.aacap.org American Academy of Child and Adolescent

Psychiatry