nonjudgmental support and a level of trust was developed.The client was urged to feel safe in expressing ADHD symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about the expression of painful feelings; the client was encouraged to use the safe haven of therapy to express these difficult issues.2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.
3 Identify Targets (3)The various stimuli that have triggered the client's ADHD behavior were assessed, including situations, people, and thoughts.The thoughts, feelings, and actions that have characterized the client's ADHD behavior and their consequences were reviewed.The client was assisted in identifying target behaviors, antecedents, consequences, and the appropriate placement of interventions.Placement of interventions was prioritized in school-based situations and, to a lesser extent, home-based and peer-based situations.Placement of interventions was prioritized in home-based situations and, to a lesser extent, school-based and peer-based situations.Placement of interventions was prioritized in peer-based situations and, to a lesser extent, home-based and school-based situations.
4 Rule Out Alternative Conditions (4)Alternative conditions that could cause inattention, hyperactivity, and impulsivity were reviewed.Behavioral, physical, and emotional problems were reviewed in regard to the effect on the client's inattention, hyperactivity, and impulsivity.The client's level of normal developmental behavior was reviewed.
5 Coordinate Psychological Testing (5)The client was administered psychological testing in order to establish or rule out the presence of ADHD problems.The Connors ADHD Rating Scale (CARS) was administered to the client.The Substance Abuse Subtle Screening Inventory–3 (SASSI-3) was administered to the client.Psychological testing has established the presence of an ADHD problem.The psychological testing failed to confirm the presence of ADHD.
6 Monitor and Rate ADHD Symptoms (6)The client was taught techniques to monitor their ADHD symptoms.The client was asked to rate the severity of their ADHD symptoms on a daily basis, on a scale from 1 to 100.The client was assisted in rating their ADHD symptoms.The client has not monitored their ADHD symptoms and was redirected to do so.
7 Assess Level of Insight (7)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.The client was noted to be in agreement with others' concerns and is motivated to work on change.The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
8 Assess for Correlated Disorders (8)The client was assessed for evidence of research-based correlated disorders.The client was assessed in regard to the level of vulnerability to suicide.The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.The client has been assessed for any correlated disorders, but none were found.
9 Assess for Culturally Based Confounding Issues (9)The client was assessed for age-related issues that could help to better understand their clinical presentation.The client was assessed for gender-related issues that could help to better understand their clinical presentation.The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand their clinical presentation.Alternative factors have been identified as contributing to the client's currently defined “problem behavior” and these were taken into account in regard to treatment.Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
10 Assess Severity of Impairment (10)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to their impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
11 Accept Powerlessness and Unmanageability Over ADHD Symptoms (11)The client was taught about the use of a 12-step recovery program's Step 1 exercise to acknowledge unmanageability of ADHD symptoms and addiction.The client was assigned the Step 1 exercise from The Alcoholism and Drug Abuse Client Workbook (Perkinson).The client was noted to accept the concept of being powerless and unable to manage ADHD symptoms and addiction problems.It was noted that the client has had increased serenity after accepting powerlessness and inability to manage ADHD symptoms and addiction.The client rejected the concept of powerlessness and unmanageability over ADHD and addiction symptoms and was urged to monitor this dynamic.
12 Teach About the Relationship Between ADHD and Addiction (12)The client was taught, through the use of a biopsychosocial approach, about the relationship between ADHD symptoms and addictive behavior.The client was assisted in acknowledging several instances in which ADHD symptoms have prompted addictive behavior.As ADHD symptoms have decreased, the client has identified a corresponding decrease in addictive behavior; this progress was highlighted.
13 Develop an ADHD and Addiction Recovery Program (13)The client was assisted in developing a program of recovery that includes the elements necessary to bring ADHD and addictive behavior under control.The client was assigned “Developing a Recovery Program” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client was reinforced as they identified specific portions of their ADHD/addiction recovery program, including the use of medication, behavior modification, environmental controls, aftercare meetings, and further therapy.It was noted that the client has begun to use the recovery program.The client has not used their specific recovery program and was redirected to pursue these elements.
14 Teach About a Higher Power (14)The client was presented with information about how faith in a higher power can aid in recovery from ADHD traits and addiction.The client was assisted in processing and clarifying ideas and feelings regarding the existence of a higher power.The client was encouraged to describe beliefs about the concept of a higher power.The client rejected the idea of a higher power and was urged to remain open to this concept.
15 Refer to a Specialist to Remediate Learning Disabilities (15)The client was referred to an education specialist to design remedial procedures for learning disabilities present in addition to ADHD.The client reported meeting with the educational specialist, who has been able to design remedial procedures for learning disabilities.The client described benefits from the remedial procedures used to counter the effects of learning disabilities.The client has not yet met with an education specialist to design remedial procedures for learning disabilities and was redirected to do so.
16 Refer for Medication Evaluation (16)A referral to a prescribing clinician was made for the purpose of evaluating the client for a prescription of psychotropic medications.The client has followed through on a referral to a prescribing clinician and has been assessed for a prescription of psychotropic medication, but none were prescribed.Psychotropic medications have been prescribed for the client.The client has been monitored for side effects
