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(p. 283) Therapist Outlines 

(p. 283) Therapist Outlines
Author(s):

Andrea Chronis-Tuscano

, Kelly O’Brien

, and Christina M. Danko

Page of

PRINTED FROM OXFORD CLINICAL PSYCHOLOGY ONLINE (www.oxfordclinicalpsych.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Clinical Psychology Online for personal use (for details see Privacy Policy and Legal Notice).

date: 27 October 2020

To facilitate covering the material from this therapist guide in session, we have included a brief therapist outline for each module here in Appendix B. You can refer to these outlines in session as a kind of “cheat sheet” or “Cliffs Notes” until you become more familiarized with the program. In addition, you might find it helpful to return to the introduction for reference as needed throughout treatment.

If you would like to download these Therapist Outlines so that you can have a single page for each module in front of you, go to the Treatments ThatWork web site at www.oxfordclinicalpsych.com/ADHDparenting

(p. 284) Module 1: Psychoeducation and Theoretical Foundations

Therapist Outline

  • Welcome parents and orient to the program

  • Using Form A: Top Problems, ask parents about their top problems and severity ratings

  • Provide an overview of the transactional model of ADHD and families

    • Give parents Worksheet 1.1: ADHD in Families

  • Describe the first factor, Child Characteristics

    • Ask about child’s temperament/personality and how it relates to child’s behavior

  • Describe the second factor, Parent Characteristics

    • Ask parents to share their characteristics that influence parent–child interactions

  • Describe the third factor, Marital or Co-Parenting Relationship

    • Ask parents about the martial/co-parenting relationship, if applicable

  • Describe the fourth factor, Sibling Relationship

    • Ask parents about their child’s sibling relationship(s), if applicable

  • Describe the fifth factor, School or Community factors

    • Ask parents about their child’s school

  • Describe the sixth factor, Culture

    • Discuss cultural context of parenting, child behavior, and mental health views

  • Check in with parents about stressors affecting their family or parenting

  • Introduce and draw the ABC model

  • Discuss antecedents including examples of situations where child does best

  • Discuss child behavior with a focus on specific, observable behaviors

  • Discuss consequences

    • Ask parents for examples of positive/negative consequences they currently use

  • Show parents Module 1 Parent Summary, and provide copy

  • Explain mood monitoring and provide Worksheet 1.2: Looking at Connections: My Mood/Stress and How I Feel as a Caregiver

  • Assign Home Practice:

    • Give Worksheet 1.2: Looking at Connections: My Mood/Stress and How I Feel as a Caregiver

    • Ask parents when and how they will do their mood monitoring

(p. 285) Module 2: Special Time and Pleasant Activities Scheduling

Therapist Outline

  • Review home practice and Top Problems

  • Explain the importance of daily Special Time and the short- and long-term benefits

  • Give best/worst supervisor analogy

  • Describe the main goal of Special Time, to follow the child’s lead during an activity and distribute Handout 2.1: Special Time Guidelines

  • Introduce the structure of Special Time, length (10 mins), and amount of talking

  • Instruct parents to use descriptions during Special Time

  • Explain avoiding questions during Special Time

  • Instruct parents to avoid giving directions during Special Time

  • Explain avoiding criticism during Special Time

  • Discuss the importance of praise during Special Time

  • Ask parents to recall what they will do and avoid during Special Time

  • Discuss how Special Time can be added to the daily schedule

  • Discuss appropriate activities for Special Time given child’s age and interests

  • Explain how to handle inappropriate behaviors during Special Time

  • Role-play Special Time and emphasize parents being fully present and following child

  • Introduce Worksheet 2.1: Special Time Record Form

  • Introduce and draw the CBT (thoughts-feelings-behaviors) model

    • Define thoughts, feelings, and behavior in the CBT model

  • Demonstrate how each part of CBT model is influenced by other parts

  • Discuss the importance of parental self-care

  • Give parents Worksheet 2.2: Pleasant Activities, and explain the mood-activity relationship

  • Help parents choose 3–5 activities that are feasible, important, and enjoyable

    • Discuss how parents will plan to do the activities

  • Give parents Worksheet 2.3: Looking at Connections: My Mood/Stress, Caregiving, and Activities, and ask them to track mood-influencing activities

  • Distribute Module 2 Parent Summary, and assign home practice:

    • Give Worksheet 2.1: Special Time Record Form and Worksheet 2.3: Looking at Connections: My Mood/Stress, Caregiving, and Activities

(p. 286) Module 3: Maintaining a Consistent Schedule and Time Management

Therapist Outline

  • Review home practice and Top Problems

  • Discuss the importance of a consistent and predictable daily schedule to support children with ADHD

  • Ask parents about how they currently manage routines and completing tasks

  • List day-to-day tasks and activities with parents

  • Work with parents to thoughtfully schedule daily activities

    • Discuss sleep, morning routines, meals, homework, bedtime, Special Time, and pleasant activities

  • Discuss the steps of parent and child morning routines

  • Give parents Handout 3.1: Sample Routines and review it with them

    • Help parents select one routine and break it down into the component parts

    • Discuss using prompts and praise for completing steps of the routine and a reward/reinforcer for completing the routine

  • Introduce using a calendar system or review the parents current calendar system

  • Give parents Worksheet 3.1: Categorizing Tasks, and discuss prioritizing tasks

    • Describe Eisenhower matrix and ask about current task/priority conflicts

  • Discuss assertiveness and saying “no” when needed

    • Normalize the need to set boundaries with others to help manage time

  • Discuss the need for flexibility and problem-solving within daily routines and schedules when there are disruptions like illness, travel, extra activities, or projects

  • Distribute Module 3 Parent Summary, and assign home practice:

    • Implement changes to the daily schedule or routine

    • Practice using at least one of the time management techniques discussed such as use of a calendar system, a prioritized to-do list, delegating or not doing a task that is not a priority, or using assertiveness to say no to a request that is not a priority

    • Give Worksheet 3.2: Looking at Connections: My Mood/Stress, Caregiving, and Activities and Worksheet 3.3: Special Time Record Form

(p. 287) Module 4: Praise and Changing Your Thinking to Feel Better

Therapist Outline

  • Review home practice and Top Problems

  • Draw ABC model and explain how attention influences (reinforces) child behavior

    • Child appropriate behavior and caregiver positive attention should be paired

  • Discuss “catching their child being good” to prevent misbehavior and specific praise

  • Explain praising children for effort (as well as success) and progress along the way

    • Discuss praising “positive opposites”

  • Give Worksheet 4.1: Catch Your Child Being Good

    • Have parents write specific behaviors to praise this week

  • Draw the CBT model and discuss the connection between thoughts and feelings

  • Introduce Ellis’s ABCD model and go through an example using ABCD method

  • Explain “hot thoughts” and go through challenging parenting situation example

  • Give Handout 4.1: Thinking Errors and Strategies for Increasing Helpful and Decreasing Unhelpful Thoughts

    • Describe thinking errors with examples, focusing on most relevant errors

  • Explain disputing the thinking error and generating a more balanced thought

  • Distribute Worksheet 4.2: Practice Hot Thoughts and Thinking Errors to complete in session

  • Discuss how parents can help children with thinking errors by modeling helpful self-talk and coaching flexible thinking when child is calm

  • Discuss strategies to decrease unhelpful thoughts: thought interruption, rubber band technique, worry time, and blow-up technique

  • Discuss strategies to increase helpful thoughts: writing down positive self-talk statements (priming), using cues, writing down successes daily, and time projection.

  • Introduce mindfulness (presence without judgment) to respond rather than react

  • Distribute Module 4 Parent Summary, and assign home practice:

    • Give Worksheet 4.3: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 4.4: Special Time and Child Behavior Record Form

(p. 288) Module 5: Planned Ignoring and Relaxation Skills

Therapist Outline

  • Review home practice and Top Problems

  • Review the ABC model and the rewarding nature of parent attention

  • Introduce active (planned) ignoring and the benefits of using attention strategically

    • Discuss situations where child engages in mild inappropriate behaviors

  • Explain differential attention as an effective way to influence child behavior, and encourage parents to praise “positive opposites” of behaviors that will be ignored

  • Explain how to do active ignoring

    • Discuss expected reactions of child and normalize “extinction burst”

    • Emphasize the importance of consistency when ignoring

    • Help parents select two behaviors to ignore over the next week

    • Help parents problem-solve how they will handle the reactions of others when using active ignoring with their child

  • Introduce how relaxation techniques benefit parents and that their ability to relax in more challenging situations will increase with regular practice

  • Ask parents about past and/or current use of relaxation strategies

  • Explain the Benson Procedure (focus on breath while repeating meditative word; see link in the module)

    • Practice the Benson Procedure in session for at least 5 minutes

  • Distribute Handout 5.1: Progressive Muscle Relaxation (PMR), and instruct parents on using the technique at home

  • Distribute Handout 5.2: Mindfulness, and explain how to practice mindfulness meditation (being present without judgment) in daily activities at home

  • Distribute Module 5 Parent Summary, and assign home practice:

    • Give Worksheet 5.1: Special Time and Child Behavior Record Form and Worksheet 5.2: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts

    • Remind parents of two specific minor child behaviors on which they plan to use active ignoring for this week (and praise positive opposites!)

    • Practice relaxation skills daily for 10–15 minutes

(p. 289) Module 6: Assertiveness, Effective Commands, and House Rules

Therapist Outline

  • Review home practice and Top Problems

  • Explain what assertiveness is (letting others know what you feel, need, or want) and why it is beneficial

  • Draw and explain the communication continuum (passive-assertive-aggressive)

  • Explain the goal of starting and staying assertive in challenging situations

  • Provide examples of passive, aggressive, and assertive communication using a few different situations

    • Ask parents to describe their communication style

  • Distribute Worksheet 6.1: Communication Styles

    • Ask parents to identify thoughts that make it harder to be assertive and help identify replacement thoughts

    • Describe and practice how to use assertive imagery to improve assertiveness

    • Help parents complete Handout 6.1: Assertiveness, and select a situation to practice assertiveness in their lives

  • Explain how effective commands use assertive communication and make child compliance more likely (and show as antecedent in ABC model)

  • Discuss guidelines for effective commands: necessary, stated directly, simple and one-step, have the child’s attention, and consider the timing of the direction

  • Distribute Worksheet 6.2: Effective Commands to complete in session

  • Describe how to choose house rules (never-allowed behaviors, impulsive behaviors, behaviors a child needs to “stop”)

  • Discuss how to start house rules at home including discussing them at a calm time

  • Distribute the Module 6 Parent Summary, and assign home practice:

    • Give Worksheet 6.3: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 6.4: Special Time and Child Behavior Record Form

    • Practice assertiveness imagery and using assertive thoughts and behavior

    • Identify several house rules, discuss them with the child, and post them

(p. 290) Module 7: Time Out and Privilege Removal

Therapist Outline

  • Review home practice and Top Problems

  • Draw the ABC model and review how changing antecedents (Special Time, routines, effective commands, house rules) and consequences (praise, active ignoring) have led to improvements for the family and child behavior

  • Ask parents about current strategies for addressing misbehavior and rule breaking

  • Introduce time out from positive reinforcement (TOR) as effective consequence

    • TOR is a predictable, consistent, and meaningful consequence so that misbehavior is not accidentally reinforced; helps with self-control

  • Explain and model the TOR steps using the stoplight analogy with role-play

    • Explain how to take the child to the time out chair

    • Discuss the time out chair and placement

    • Discuss the procedures for when the child refuses to sit in time out

    • Discuss how to start using time out at home

  • Explain how to use antecedents and TOR strategies in public settings

  • Use the CBT model to identify thoughts, feelings, and actions that occur when parents are in challenging situations with child noncompliance or rule breaking

  • Use Handout 7.1: Using my CBT Skills to Help Me with Time Out to develop a coping plan to help support parents’ use of TOR

    • Incorporate assertiveness, relaxation, mindfulness, helpful thinking, and pleasant activities for parents as they establish TOR consequence at home

  • Ask about and address concerns that remain around the use of TOR

  • Distribute Module 7 Parent Summary, and assign home practice:

    • Give Worksheet 7.1: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 7.2: Special Time and Child Behavior Record Form

    • Show parents there is a new column to track if child goes to time out

    • Emphasize the importance of continuing daily Special Time when TOR begins

(p. 291) Module 8: Working Effectively with the Schools

Therapist Outline

  • Review home practice and Top Problems

  • Discuss the importance of establishing and maintaining a collaborative working relationship with the school

  • Discuss accommodations the child may be eligible for and help parents to understand the child’s educational rights

    • Give template (see link in the module) to ask for child’s need for a 504 Plan or Individual Education Plan (IEP) to be evaluated

  • Provide an overview of evidence-based approaches to managing classroom behavior

    • Describe use of behavioral strategies by teachers (influencing antecedents and consequences) and explain the range of possible accommodations

  • Give Handout 8.1: Sample Daily Report Card, as well as Worksheet 8.1: Daily Report Card, to parents and help parents set up a daily report card (DRC)

  • Describe how parents’ ability to be skillful in social situations may be impacted when parents are upset and how they can use social skills when interacting with school

  • Discuss how assertive communication can be used in school communication

    • Draw passive-assertive-aggressive communication continuum and give examples of school–parent communications for each style

  • Hand out Worksheet 8.2: Social Skills and Assertiveness, and complete the assertiveness section as in-session activity

  • Discuss strategies to prepare for and actively participate in all meetings related to their child’s academic plan

    • These strategies can include organizing materials, identifying others who can advocate in meetings, knowing their rights, and plans for coping and self-care

  • Distribute Module 8 Parent Summary, and assign home practice:

    • Take action steps toward identified school-related goals

    • Give Worksheet 8.3: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 8.4: Special Time and Child Behavior Record Form

(p. 292) Module 9: Emotion Coaching

Therapist Outline

  • Review home practice and Top Problems

  • Discuss the important role parents play as teachers in emotion regulation

  • Discuss the challenges for parent emotion regulation in difficult parenting situations

    • Draw CBT (thoughts-feelings-behavior) model to show parents’ experience when their child is having strong emotions

    • Add a second CBT triangle to show child’s thoughts, feelings, and behaviors when very upset

  • Share the important idea that emotions are a time to connect and support the child

  • Give parents Handout 9.1: Child Emotion List and Handout 9.2: Emotion Coaching, and explain how to validate their children’s emotions (accepting child’s emotions without judgment)

  • Explain the importance of emotion labeling and help parents identify recent situation where they used (or could have used) emotion labeling (see Handout 9.1)

  • Discuss the importance of children being able to tolerate a range of emotions and that parents use of emotion coaching skills will help their child to do this

  • Explain what tolerating does not look like (on Handout 9.2: Emotion Coaching)

    • Don’t distract, minimize, deny, judge, expect child to be logical, or have child be responsible for parents’ emotions

  • Discuss the importance of parents’ own self-regulation (CBT skills learned can help!)

  • Give parents Handout 9.3: Emotion Coaching and Misbehavior, and discuss how to decide when to use emotion coaching and when limit setting is needed

  • Encourage parents to praise efforts to cope with strong emotions and give examples

  • Explain the importance of timing when teaching coping skills or helping child to problem-solve (prior to or after intense emotions, “strike while the iron is cold”)

  • Role-play emotion coaching skills with parents

  • Distribute Module 9 Parent Summary, any Module 9 handouts that have not been distributed yet, and assign home practice:

    • Give Worksheet 9.1: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 9.2: Special Time and Child Behavior Form

    • Find opportunities for emotion coaching

(p. 293) Module 10: Home Point Systems

Therapist Outline

  • Review home practice and Top Problems

  • Provide rationale for the use of a more frequent, intensive, and structured reward system for some behavioral goals

  • Discuss the benefits of a reward system in which behaviors are more clearly tied to privileges

    • Share Handout 10.1: Sample Weekly Home Point System to show example

  • Help parents identify two specific, observable behaviors to target increasing with the home point system

    • Give parents Worksheet 10.1: Weekly Home Point System

  • Help parents identify a currency for their home points system

  • Help parents identify a reward menu with short-term and long-term rewards

  • Address any barriers to the home point system

  • Discuss the importance of not providing a reward unless it is earned

  • Ask parents to identify a specific target goal and reward for themselves

  • Distribute Module 10 Parent Summary, and assign home practice:

    • Give Worksheet 10.2: Looking at Connections: My Mood/Stress, Caregiving, Activities, and Thoughts and Worksheet 10.3: Special Time and Child Behavior Record Form

    • Set up a home point system

(p. 294) Module 11: Review, Wrap Up, and Planning for the Future

Therapist Outline

  • Review home practice and Top Problems

  • Convey confidence that the parents have learned skills that will help them throughout their child’s developmental stages when used consistently and proactively (when possible)

  • Review the ABC model and give examples of how this can be used for future transitions and problem behaviors

  • Review the thoughts-feelings-behavior triangle (CBT model) and how it can be used on an ongoing basis to improve mood, decrease stress, and prevent a negative spiral

  • Provide Worksheet 11.1: Effective Parenting Strategies, and have parents reflect on which skills are the most helpful for their child and family

  • Give Worksheet 11.2: Effective Self-Care Strategies, and ask parents to think about the self-care strategies that are most effective for them

    • Discuss skills that were effective but difficult to implement or maintain to help parents problem-solve and encourage ongoing use of skills

  • Discuss the importance of continued monitoring of child behavior and their mood/stress level to catch things early and to determine if more support is needed

  • Discuss sources of support for parents and family as the program comes to an end

  • Hand out Module 11 Parent Summary