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ACTIVITIES OF DAILY LIVING (ADL)

BEHAVIORAL DEFINITIONS

1. Lack of independence with self-feeding, as evidenced by not open-ing the mouth in response to stimulation or not eating indepen-dently with proper utensils.

2. Assistance needed with dressing, as evidenced by not selecting ap-propriate attire, failure to physically put clothes on, or inability tomanipulate fasteners.

3. Impaired identification of hygienic needs and/or initiation of re-sponse to hygienic needs, as evidenced by deficiencies in caring fora runny nose, toileting needs, bathing, washing hands, and brush-ing teeth, resulting in poor hygiene.

4. Lower than expected eating, dressing, toileting, and/or hygieneskills resulting from overprotection of client by caregiver.

5. Absence of initiating activities of personal interest.6. Failure to complete required tasks.7. Failure to seek assistance when needed.8. Lack of initiative to resolve problems.9. Absence of self-assertion and self-advocacy.

10. Difficulties in comprehending requests, emotions, greetings, com-ments, protests, or rejection due to limitations in receptive com-munication.

11. Difficulties in expressing requests, emotions, greetings, comments,protests, or rejection due to limitations in expressive communica-tion.

12. Poor interaction skills characterized by limited eye contact, insuf-ficient attending, and awkward social responses.

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SHORT-TERM OBJECTIVES

1. Participate in a psychologi-cal assessment of adaptiveand/or intellectual abilities.(1, 2, 3, 4)

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THERAPEUTICINTERVENTIONS

1. Arrange for or conduct acomprehensive intellectualand adaptive assessment toestablish a baseline of the

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LONG-TERM GOALS

1. Strengthen existing ADL skills and develop independence withnew ADL skills.

2. Develop and maintain appropriate eating habits that promote in-dependence.

3. Develop and maintain skills for maintaining proper hygiene andpersonal cleanliness to promote good health.

4. Develop and maintain skills of dressing self to create greater au-tonomy from caregivers.

5. Maximize independence in all ADL areas.6. Use adaptive equipment and training modalities that support in-

dependent functioning.7. Reduce the frequency and severity of maladaptive behaviors that

interfere with ADLs.8. Caregivers and client reach a consensus on client’s identified goals.9. Caregivers provide adequate supervision and assistance to ensure

client’s safe treatment within a supportive learning environment.10. Maximize the client’s choices and preferences whenever possible.11. Caregivers reinforce all steps toward independence with ADL skill

acquisition.

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2. Complete neuropsychologi-cal testing to assess contri-bution of organic factorscontributing to behavioraldeficits. (4, 5)

3. Accept and adhere to rec-ommendations made by theinterdisciplinary team re-garding appropriate inter-ventions. (5)

4. Cooperate with a physicaland occupational therapyassessment to facilitateADL skill acquisition. (6, 7)

5. Cooperate with a speech/language evaluation. (8)

6. Cooperate with nurse’smonitoring of physical andmedical conditions. (9)

7. Cooperate with a physi-cian’s examination for an-nual check up and/ortreatment of acute medicalproblems. (10)

8. Take medications as pre-scribed by physician tomaintain physical health.(11)

9. Cooperate with dental ex-amination to promotehealthy teeth and gums. (12)

10. Cooperate with visual exam-ination to ensure adequatevision for ADL tasks. (13)

11. Cooperate with psychiatricexamination to assess theneed for psychotropic medi-cations. (14)

12. Parents communicate withcaregivers regarding psychi-atric symptoms. (15)

14 MENTAL RETARDATION AND DEVELOPMENTAL DISABILITY PLANNER

client’s ability and gain in-sight into his/her strengthsand weaknesses.

2. Attend person-centeredplanning (PCP) meetingwith client, family, clientadvocate, school officials,and caregivers to determineeducational, vocational,recreational, communica-tive, ADL, and health goalsalong with eligibility forspecial services.

3. Consult with client, family,school officials, and care-givers to obtain an overviewof all multidisciplinarytreatments wanted by theclient.

4. Arrange for or conduct aneurological exam and/orneuropsychological testingto identify sensory modali-ties best suited for theclient’s learning style.

5. Provide feedback to client,family, and staff on the results of intellectual, adaptive, psychological, be-havioral, and neuropsycho-logical testing.

6. Refer the client to a physi-cal therapist to determinehis/her level of motor func-tioning and whether ongo-ing physical therapyservices are needed.

7. Refer the client to an occu-pational therapist for evalu-ation to determine whatADL skills training wouldbe most appropriate.

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13. Accept and follow dietician’srecommendations. (16)

14. Accept placement in appro-priate residential setting.(17)

15. Accept placement in an ap-propriate day program orschool setting for rehabilita-tion and/or vocational train-ing. (18)

16. Attend physical therapysessions designed to main-tain and/or enhance rangeof motion. (19, 20, 21, 22)

17. Use relevant adaptiveequipment to promote inde-pendence in ADLs. (22)

18. Participate in occupationaltherapy sessions designedto maximize independencevia ADL skills acquisition.(23, 24, 25)

19. Take bath or shower, combhair, brush teeth, andapply deodorant daily. (23, 24, 38)

20. Eat and drink to fullest ca-pability of independence.(23, 24, 25, 28)

21. Attend speech therapy ses-sions to improve functionalcommunication. (26)

22. Utilize augmentative speechmaterials to improve func-tional communication. (27)

23. Increase the frequency ofunprompted expressivestatements. (28, 38)

24. Use expressive/receptivelanguage skills when inter-


8. Refer the client to a speechtherapist to determine theclient’s communicativestrengths and weaknessesalong with mode of commu-nication best suited forhim/her.

9. Refer the client to a nursefor ongoing monitoring ofbasic health, medical con-cerns, and medication man-agement.

10. Arrange an appointment foran annual physical examalong with any follow-up orspecialist care that is indi-cated.

11. Monitor the procedures forthe administration of medi-cations that have been pre-scribed for the client.

12. Arrange for biannual dentalexaminations and cleanings.

13. Arrange for yearly visionexaminations.

14. Arrange for psychiatricevaluation to determine if aconcomitant Axis I disordermay be contributing to poorADLs and whether psy-chotropic medication maybe helpful.

15. Enlist the help of familymembers and caregivers tomonitor signs and symp-toms of the client’s psychi-atric condition to provideaccurate information to thepsychiatrist.

16. Facilitate the client’s ob-taining dietician-approved

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acting with others. (28, 29, 30, 38)

25. Initiate and respond to so-cial greetings and smilesand make eye contact wheninvolved in social situa-tions. (30)

26. Begin to demonstrate andinitiate independence bymaking all possible choicesin daily events as evidencedby choosing clothing, food,leisure interests, and peergroup. (30, 31)

27. Comply with prescriptivebehavioral plan. (32, 33, 34)

28. Increase frequency of in-compatible adaptive behav-iors that compete withmaladaptive behaviors. (35, 36, 37, 38)

29. Identify various emotionsand their triggering events.(39)

30. Verbalize positive self-talkthat reduces the level offrustration and anger. (40)

31. Parent increases positivefeedback to the client. (41, 42)

32. Parents and caregivers de-velop realistic expectationsof the client’s ADL abilities.(43, 44)

33. Parents increase and/ormaintain involvement withtheir son/daughter andhis/her treatment. (45, 46, 47)

34. Caretakers reduce the fre-quency of speaking for theclient and/or performing ac-


foods and meals that he/sheenjoys.

17. Consult with client, family,school officials, and assignedclinicians on different resi-dential options (e.g., adultfoster care home, grouphome, supported living envi-ronments, apartments, orcommunity treatmenthomes) before making anappropriate referral.

18. Refer the client to a suitableprogram site, a day programwith habilitative training,community based instruc-tion, a sheltered workshop,enclave work, or vocationaltraining that has vocationalopportunities that are of in-terest to the client.

19. Coordinate follow-throughon physical therapy to pro-vide range of motion exer-cises to preventcontractures.

20. Assign the client suitablegross motor activities thatwill increase independencewith ADL skills.

21. Seek advice and recommen-dations from a physicaltherapist regarding suitablepositioning for the client.

22. Arrange for the client to ob-tain necessary adaptiveand/or physical therapyequipment.

23. Develop a skills acquisitionprogram designed to teachfeeding, bathing, grooming,and/or dressing skills.

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tivities that the client is ca-pable of doing indepen-dently. (48, 49, 50)

35. Client indicates comfort andenjoyment in his/her activi-ties through verbal andnonverbal behaviors, as evi-denced by verbalizing posi-tive statements, smilingoften, relaxes posture, ap-proaching caregivers freelyand decrease in amount oftime withdrawing. (51, 52, 60)

36. Caretakers verbalize thedegree of the emotionalstrain related to providingservice to the client. (53)

37. Caretakers utilize relax-ation skills and respite careto relieve stress. (54, 55, 56)

38. Participate in stress-relieving activities. (57, 58)

39. Increase participation in ex-tracurricular activities andoutings. (58, 59, 60, 61, 62)

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24. Specify suitable promptinglevels for ADL skills acqui-sition programs (e.g., verbalprompts, physical prompts,or hand-over-hand guid-ance).

25. Assign the client suitablefine motor activities thatwill increase independencewith ADL skills.

26. Provide or arrange fortraining in the client’s recommended form of com-munication (e.g., sign lan-guage, picture symbols,computerized device, or pic-ture board).

27. Arrange for the client to ob-tain recommended augmen-tative speech materials, andprovide for ongoing trainingusing augmentative speedmaterials.

28. Expand the client’s recep-tive language by modelingpointing to body parts, ob-jects, foods, clothing, ani-mals, and responding todirections.

29. Expand the client’s expres-sive language by demon-strating naming objects,body parts, food, clothing,animals, and verbs; per-sonal identification; andlinking nouns and verbs to-gether.

30. Teach the client effectivebasic communication skills(i.e., noninterruptive listen-ing, good eye contact, as-serting self with “I”

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statements, and respondingto greetings) to improvehis/her ability to expressthoughts, feelings, andneeds more clearly.

31. Present situations suchthat the client is required tomake a choice between twoto three options, and rein-force independent choices.

32. Using behavioral analysis,determine motivating vari-ables for the client’s mal-adaptive behaviors.

33. Identify several reinforcersthat can be used to rewardadaptive behaviors that areincompatible with maladap-tive behaviors.

34. Assess ecological factorscontributing to the mainte-nance of maladaptive be-havior.

35. Design and implement a be-havioral plan that rein-forces desired behaviorscoupled with behavioraltechniques to decrease oreliminate maladaptive behaviors (e.g., shaping,fading, extinction, or differ-ential reinforcement ofother [DRO] behavior).

36. Conduct an in-service ses-sion with all caregivers onthe client’s behavioral treat-ment program to ensure ef-fective implementation oftreatment to strengthen de-sirable, prosocial behavior.

37. Obtain approval from theclient’s guardian and the

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agency oversight committeefor any restrictive or aver-sive programming.

38. Design a reward system tomotivate the client to im-prove ADL, communication,and social skills.

39. Teach the client about thedifferent emotions and howto identify the triggeringevent of an emotion (e.g., “Iam angry because I wasviewed as different”).

40. Teach the client positiveself-talk that will helphim/her accept and posi-tively cope with his/herADL difficulties.

41. Monitor the client’s progressat specified intervals and re-port information to client,family, and caregivers.

42. Encourage family membersand caregivers to providefrequent and immediatepositive feedback to theclient for progress in ADLskills training.

43. Educate family membersand caregivers on expectedtime frames of ADL skillstraining along with poten-tial obstacles the client mayface.

44. Assist family members andcaregivers in developing re-alistic expectations of theclient’s adaptive functioning.

45. Arrange for family mem-bers to read The SpecialNeed Reading List (Sweeny)to provide information on

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resources on general issuesaffecting lives of the dis-abled along with informa-tion on specific disabilities.

46. Encourage family membersto maintain regular socialcontact with the client.

47. Encourage family membersto maintain regular commu-nication with involved clini-cians regarding status ofthe client’s ADL skills,health, and maladaptive be-haviors.

48. Provide family membersand caregivers with train-ing and/or in-service ses-sions needed to support theclient’s advancement withADL training.

49. Assess the client’s strengthsand weaknesses in self-determination by using TheARC’s Self-DeterminationScale (Wehmeyer) and useresults to promote theclient’s involvement in plan-ning future goals with thesupport of his/her family.

50. Encourage family membersand caregivers to agree topromote lifelong learningopportunities and experi-ences for the client to pro-mote his/her choice making,decision making, problemsolving, goal setting, and at-tainment along with self-awareness and knowledge.

51. Monitor, acknowledge, andreinforce all signs of theclient’s pleasure, self-

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esteem, confidence, and so-cial comfort.

52. Contact a recipient rightsrepresentative if the client’srights have been violated.

53. Observe family membersand caregivers for frustra-tion, which may reducetheir effectiveness to inter-act effectively with theclient, and provide themwith opportunities for vent-ing feelings as necessary.

54. Teach deep muscle relax-ation, abdominal breathing,and safe place imagery tocaregivers to alleviate thestress of the many demandsof caring for a person withADL deficits.

55. Arrange for respite care forfamily members and care-givers.

56. Recommend that familymembers read The Re-sourceful Caregiver: Help-ing Family Caregivers HelpThemselves (National Fam-ily Caregivers Association).

57. Teach the client stress re-duction techniques (e.g.,deep muscle relaxation, ab-dominal breathing and safeplace imagery) to alleviatestressors encountered.

58. Refer the client to a recre-ational therapist to deter-mine possible leisure andcommunity activities avail-able to the client.

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DIAGNOSTIC SUGGESTIONS

Axis I: 299.00 Autistic Disorder299.80 Rett’s Disorder299.80 Asperger’s Disorder299.10 Childhood Disintegrative Disorder299.80 Pervasive Developmental Disorder NOS


59. Encourage the client’s par-ticipation in SpecialOlympics.

60. Assess the client’s and/orfamily members’ interest infaith-based activities andprovide access to churchministry as indicated.

61. Refer family members andcaregivers to Dimensions ofFaith and CongregationalMinistries with Personswith Developmental Dis-abilities and Their Families(Gavanta) to obtain infor-mation on many differentfaith-based books, videos,and programs available forpersons with developmentaldisabilities and their fami-lies.

62. Observe the client for obvi-ous and subtle signs of likesand dislikes and provide allpossible enjoyable situa-tions.

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307.6 Enuresis Not Due to General MedicalCondition

787.6 Encopresis With Constipation and OverflowIncontinence

307.7 Encopresis Without Constipation and OverflowIncontinence

799.9 Diagnosis or Condition Deferred on Axis IV71.09 No Diagnosis or Condition on Axis I

Axis II: 317 Mild Mental Retardation318.0 Moderate Mental Retardation318.1 Severe Mental Retardation318.2 Profound Mental Retardation319 Mental Retardation, Severity UnspecifiedV62.89 Borderline Intellectual Functioning799.9 Diagnosis or Condition Deferred on Axis IIV71.09 No Diagnosis or Condition on Axis II

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ANGER


1. Explosive, aggressive physical or verbal outbursts that are out ofproportion to any precipitating stressors.

2. Swift and harsh judgment statements made to or about others.3. Physical aggression toward self or others.4. Property destruction and/or hostile opposition that occurs in re-

sponse to correction, confrontation, or unwanted directives.5. Body language characterized by tense muscles such as clenched

fist or jaw, glaring looks, or refusal to make eye contact.6. Use of verbally abusive language.7. Hostile, threatening, and/or assaultive behavior in response to ap-

propriate requests from others.8. History of poor anger management resulting in significant impair-

ments in family, social, and vocational relationships or opportunities.

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LONG-TERM GOALS

1. Reduce intensity and frequency of all types of angry behaviors.2. Identify early warning signs of anger or hostility.3. Implement prosocial ways of expressing anger, frustration, embar-

rassment, or impatience.

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1. Participate in a psychologi-cal/neuropsychological as-sessment of anger problems,including developmentalhistory, family history, andprevious psychiatric in-volvement. (1, 2, 3, 4, 5)

2. Cooperate with medical ex-amination to rule out medi-cal etiologies for anger oraggression. (6, 7)

3. Cooperate with psychiatricexamination to assess theneed for psychotropic medi-cations. (7, 8, 9)

4. Attend individual and/orgroup therapy sessions fo-cused on resolving anger is-sues and teaching angermanagement skills. (10, 11)

5. Complete homework exer-cises that promote anger

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1. Arrange for a psychologicalassessment of the client’sanger symptoms, includinga developmental history,family history, and previouspsychiatric involvement.

2. Refer the client for a neuro-logical exam or neuropsy-chological testing.

3. Operationally define andcollect data on behaviors re-lated to anger.

4. Assess the severity of theclient’s anger/aggressionthrough interviews, reportsfrom caregivers, and ratingscales such as the ReissScreen for Maladaptive Be-havior, Second Edition(Reiss) or the State-TraitAnger Expression inventory(Spielberger).

4. Avoid situations that produce feelings of anger, frustration, embar-rassment, or impatience when possible.

5. Complete requested tasks without verbal or physical aggression.6. Enjoy warm and caring relationships with family, friends, and

caregivers.7. Make choices and communicate preferences whenever possible.8. Caregivers reinforce all steps toward managing anger.

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awareness and anger man-agement. (12)

6. Correctly label and recog-nize emotions generated inself and others. (13, 14, 15)

7. Identify and list early signsof feeling and expressingfrustration, annoyance, andanger. (13, 16, 17)

8. Identify personal triggersfor anger. (13, 18)

9. Verbalize problem-solvingtechniques that will be usedin future anger-arousingsituations. (19, 20)

10. Carry written lists of problem-solving techniquesto remind self of actions toimplement in conflict situa-tions. (21, 22)

11. Implement conflict copingstrategies at early stages ofanger arousal. (23, 24, 25)

12. List triggers for anger andalternate healthy responsesto those triggers. (26)

13. Identify the negative im-pact uncontrolled anger ex-pression has on others. (27)

14. Increase the usage of as-sertive responses to meetpersonal needs. (28, 29, 30)

15. Implement proper nutri-tion, increased exercise, andtime management as meansto reduce stress. (31)

16. Identify maladaptive re-sponses to stress that createtheir own set of problems.(32)


5. Train family members andcaregivers to monitor signsand symptoms of the client’spsychiatric condition to pro-vide accurate information tothe psychiatrist and psychol-ogist.

6. Arrange for the client to ob-tain a complete physical torule out any biomedicalcauses for his/her anger/aggression symptoms (e.g.,temporal epilepsy, diabetes,or brain tumor).

7. Follow up on recommenda-tions from the evaluation,including additional labwork, medications, or spe-cial assessments.

8. Arrange for a psychiatricevaluation to determinewhether psychotropic medi-cations may be helpful.

9. Monitor the client for com-pliance, effectiveness, andside effects associated withprescribed medications.

10. Arrange for the client to re-ceive individual therapyusing a therapeutic modelbest suited for him/her (e.g.,cognitive, behavioral, devel-opmental cognitive, or psy-choeducational).

11. Arrange for the client toparticipate in group therapyto learn anger managementskills.

12. Assign homework exercises(e.g., problem-solvingsheets, mood log, utilizingaction plan, and/or asking

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17. Report success at imple-menting relaxation tech-niques. (23, 33)

18. Attend group sessions thatfocus on enhanced socialskills. (34, 35)

19. Identify reinforcers forangry and calm behavior.(1, 36, 37, 38)

20. Increase positive manage-ment of anger through behavior modification pro-cedures. (39, 40, 41)

21. Family members, care-givers, and client modifythe environment to reducestress. (42)

22. Identify irrational beliefsand negative self-talk thatmediates anger. (43)

23. Verbalize positive self-talkthat mediates calm. (44)

24. List positive, adaptive alter-natives for expressinganger. (45, 46)

25. Demonstrate independenceand initiative by making allpossible choices in dailyevents, as evidenced bychoosing clothing, food,leisure interests, and peergroup. (47, 48)

26. Family members and care-takers assist and supportthe client in his/her at-tempts to make positive be-havioral changes to manageanger. (49, 50)

27. Increase participation in ex-tracurricular activities andoutings. (51, 52)

ANGER 27

for assistance) from theAnger Workbook (Bilodeau)to promote anger manage-ment skills. Emphasize theclient’s choice and power tomake good decisions inmanaging his/her anger.

13. Teach the client to be awareof, to be able to label, and tounderstand the universalityof different emotionsthrough the use of model-ing, pictures, and intermit-tent testing.

14. Present verbal or pictorialscenarios of conflict be-tween two people. Requestthat the client verbally de-scribe what is happeningfrom both parties’ perspec-tive and why each perspec-tive is different.

15. Using real conflicts from theclient’s life, discuss the dif-ferences in perspective be-tween self and the other inorder to foster developmentof empathy toward and un-derstanding of others.

16. Request that the clientidentify his/her early signsof feeling and expressinganger and frustration, solic-iting input from others whoknow the client’s anger ex-pression patterns.

17. Request that the client ver-bally identify or demon-strate how our bodieschange during anger (e.g.,clenched fist and teeth,tense posture, narrowed

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eyes, or faster breathing);ask the client to identifyhis/her own body cues.

18. Request that the clientidentify the situations andconditions under whichhe/she typically developsfeelings of anger or frustra-tion (e.g., “I am angry be-cause my friend ignoredme”). Direct the client to so-licit input from others.

19. Teach the client problem-solving techniques (e.g.,identifying the problem,listing possible solutions,selecting a solution, andevaluating the solution’soutcome; see Thinking ItThrough: Teaching a Problem-Solving Strategyfor Community Living[Foxx and Bittle]).

20. Role-play several problemsituations for the client tosolve, and provide feedbackon the client’s progress.

21. Provide the client with anotebook of problem-solvingsheets (e.g., identifying theproblem, listing possible so-lutions, selecting a solution,and evaluating the solu-tion’s outcome) to use as sit-uations occur and use as areference if problems re-peatedly occur.

22. Create small cards with pic-torial or written remindersof conflict resolution tech-niques. Provide these forthe client and caregivers.

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ANGER 29

23. Discuss several activitiesthat the client can do whenbeginning to feel angry inorder to reduce tension(e.g., talk with others, gofor a walk, listen to sooth-ing music, write a letter,keep a mood log, practiceprogressive muscle relax-ation, do deep breathing,and use thought-stoppingtechniques).

24. Reinforce the client’s ef-forts to use healthy alter-nate activities to reducetension and anger whileemphasizing the impor-tance of practice.

25. Read Don’t Pop Your Corkon Mondays! (Moser) to theclient (or request thathe/she read or view it) inorder to promote his/her un-derstanding of the impor-tance of controlling anger.

26. Assist the client in creatinga master list of his/her angertriggers, angry responses,personal signs of anger, andidentified prosocial alternateresponses. Encourage theclient to keep the list closeat hand for easy reference.

27. Use role-playing and role-reversal techniques to teachthe client the impact ofhis/her negative behavioron others.

28. Model assertive, passive,and aggressive responses tosituations, and request thatthe client identify which of

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the three is most effective.Request that the client role-play assertive, passive, andaggressive responses toidentify his/her current re-sponse type.

29. Use an assertiveness ques-tionnaire to query the clientabout situations in whichhe/she would like to bemore assertive (see The Re-laxation and Stress Reduc-tion Workbook [Davis,Eshelman, and McKay]).

30. Using specific examplesfrom the client’s experience,request that he/she role-play assertive responses toa variety of situations. Pro-vide feedback on the client’sprogress with role-playing,and encourage him/her touse assertive responseswhen needed.

31. Review lifestyle changesthat can help in reducingstress (e.g., proper nutri-tion, regular exercise, andtime management skills).Encourage the client toadopt these healthy lifestylechanges.

32. Assist the client in identify-ing nonproductive means ofexpressing anger (e.g., alco-hol, drugs, aggression, andventing) and request thathe/she identify why theseare not effective responses.

33. Review the different typesof relaxation techniques

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ANGER 31

(e.g., deep breathing, pro-gressive muscle relaxation,or imagery) and providetraining in the various re-laxation techniques. En-courage and reinforce useand practice.

34. Arrange for the client to ob-tain the necessary socialskills training to foster goodinterpersonal relationships(see Social Skills in thisPlanner).

35. Refer the client to a supportgroup for individuals withdevelopmental disabilities.

36. Refer the client to a behav-ior specialist in order to de-termine the eliciting stimuliand maintaining reinforcersfor his/her maladaptive ex-pression of anger.

37. Assess the ecological factorscontributing to the mainte-nance of the client’s angeror aggression.

38. Identify several reinforcersthat can be used to rewardprosocial behaviors that areincompatible with angeroutbursts. Request that theclient identify or endorsedesired reinforcers.

39. Refer the client to a behav-ioral specialist to designand implement a behaviorplan that reinforces desiredbehaviors coupled with be-havioral techniques (e.g.,reinforcing low reactivitylevels, reinforcing incom-patible behaviors, extinc-

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tion, response cost, andovercorrection) to decreaseor eliminate angry and ag-gressive behaviors.

40. Train all caregivers on theclient’s behavioral treat-ment program to ensureconsistent, effective imple-mentation and strengthen-ing of desirable prosocialbehaviors (see Skills Train-ing for Children with Behavioral Disorders[Bloomquist] for a guidecovering basic behavioraltechniques).

41. Obtain approval from theclient’s guardian and theagency oversight committeefor any use of restrictive oraversive programming.

42. Modify the client’s environ-ment to remove physicaland psychological conditionsnot conducive to healthy be-haviors (e.g., noisy condi-tions, hunger, crowding, orheat). Replace with condi-tions that encourage calm,relaxed behaviors.

43. Review a list of irrationalbeliefs (e.g., “Everybody al-ways picks on me,” “Nobodyever says anything nice tome,” and “My parents donot love me”) that are con-tributing to the client’sanger. Using client-specificexamples, present alterna-tive self-talk to demonstratethe importance of changingirrational beliefs.

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ANGER 33

44. Facilitate the client’s under-standing that anger is dueto how he/she perceives andinterprets the situationrather than any externalevent, situation, or person.Model and role-play client-specific situations thatdemonstrate his/her controlover the self-talk that gov-erns how a problematic sit-uation is perceived.

45. Request that the client read(or read to the client) Don’tRant and Rave on Wednes-days! (Moser) or Dealingwith Anger (Johnston) to fa-cilitate an understanding ofthe universality of angerand the optional positivebehaviors for dealing withthis powerful emotion.

46. Demonstrate different waysto release anger to theclient, and process the se-lected activity with him/her(e.g., forgiving, letting go,writing or drawing aboutfeelings, and using humoror symbolic activities).

47. Present multiple choices ina variety of situations suchthat the client is able tomake a selection betweenthe options.

48. Encourage the client’s fam-ily to allow the client tomake all possible choicesand to demonstrate maxi-mum independence in dailyevents.

49. Obtain the client’s consentto enlist support for his/her

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Axis I: 312.34 Intermittent Explosive Disorder296.xx Bipolar I Disorder296.89 Bipolar II Disorder310.1 Personality Change Due to Axis III Disorder309.81 Posttraumatic Stress Disorder290.xx Dementia of the Alzheimer’s Type


anger management effortsfrom clinicians, residentialstaff, family members, andvocational and educationalstaff.

50. Encourage family membersand caregivers to increasethe frequency of positive in-teractions with the clientwhile modeling desirableconflict resolution behaviors,positive demeanor, and help-ful attitudes. Model thesebehaviors to family mem-bers and caregivers in for-mal and informal situations.

51. Refer the client to a recre-ational therapist to deter-mine possible leisure, social,and community activitiesavailable to the client.

52. Encourage the client’s par-ticipation in SpecialOlympics or other athleticevents.

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ANGER 35

294.1 Dementia Due to Head Trauma, Parkinson’sDisease, Huntington’s Disease, or Axis IIIDisorder

294.8 Dementia NOS995.2 Adverse Effects of Medication NOS299.00 Autistic Disorder299.80 Rett’s Disorder299.10 Childhood Disintegrative Disorder299.80 Asperger’s Disorder299.80 Pervasive Developmental Disorder NOS799.9 Diagnosis or Condition Deferred on Axis IV71.09 No Diagnosis or Condition on Axis I

Axis II: 317 Mild Mental Retardation318.0 Moderate Mental Retardation318.1 Severe Mental Retardation318.2 Profound Mental Retardation319 Mental Retardation, Severity UnspecifiedV62.89 Borderline Intellectual Functioning799.9 Diagnosis or Condition Deferred on Axis IIV79.09 No Diagnosis or Condition on Axis II

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ANXIETY


1. Feeling restless, keyed up, or on edge, as evidenced by increasedmotor activity, muscle tension, or shakiness.

2. Autonomic hyperactivity including dry mouth, nausea, diarrhea,shortness of breath, or rapid heartbeat.

3. Hypervigilance, as evidenced by difficulty in falling or stayingasleep, difficulty with concentration, exaggerated startle response,or irritability.

4. Disorganization or agitated behaviors following exposure to a trau-matic event.

5. Fears specific to a certain situation that interfere with daily life be-cause of high levels of anxiety or avoidance of certain stimuli.

6. Excessive or unrealistic anxiety, worry, or apprehension.7. Obsessions or compulsions that are time consuming, interfere with

daily activities, and seem uncontrollable.

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LONG-TERM GOALS

1. Reduce or eliminate anxiety symptoms.2. Develop skills and strategies to cope positively with stressors.3. Implement behavioral and cognitive coping techniques to reduce

anxiety.

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1. Participate in a psychologi-cal assessment of anxietysymptoms. (1, 2, 3, 4)

2. Cooperate with medical ex-amination to rule out medi-cal etiologies for anxietysymptoms. (5)

3. Cooperate with a psychi-atric examination to assessthe need for psychotropicmedications. (6, 7)

4. Attend individual psy-chotherapy sessions focusedon anxiety reduction. (8)

5. Attend group therapy ses-sions focused on teachinganxiety reduction tech-niques. (9)

6. Keep records of anxietysymptoms, precipitatingevents, and resolutionmethods. (10)

7. Verbalize realistic beliefsthat challenge anxiety-inducing thoughts. (11, 12)

8. Report a reduction in pho-bic anxiety after participat-

ANXIETY 37


1. Arrange for psychologicalassessment of the client’sanxiety symptoms, includ-ing developmental history,family history, and previouspsychiatric involvement.

2. Operationally define andcollect data on behaviors in-dicative of anxiety.

3. Assess the severity of theclient’s anxiety (e.g., con-sider using a rating scalesuch as the Diagnostic As-sessment for the SeverelyHandicapped, Second Edi-tion [DASH-II; Matson] orthe Reiss Screen for Mal-adaptive Behavior, SecondEdition [Reiss]).

4. Train family members andcaregivers to monitor theclient’s signs and symptomsof anxiety to provide accu-rate information to the psy-chiatrist or psychologist.

5. Arrange for the client to ob-tain a complete physical torule out any biomedical

4. Make choices and communicate preferences whenever possible.5. Caregivers reinforce all steps toward anxiety reduction.

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ing in systematic desensiti-zation treatment. (13)

9. Increase frequency of relax-ing, calm behaviors thatcompete with anxiety be-haviors. (14, 15, 16)

10. Implement alternative ac-tivities that reduce agita-tion and anxiety at earlystages of onset. (12, 17, 18)

11. Meet with a mentor regard-ing how to minimize prob-lems between self and theenvironment. (19)

12. Attend a support group forindividuals with develop-mental disabilities. (20)

13. Participate in social skillstraining to alleviate socialanxiety. (21)

14. Implement environmentalstress management tech-niques. (22)

15. Cooperate with recommen-dations from a speech ther-apist as to ways to improvecommunication. (23)

16. Family members and care-givers report increased un-derstanding of the client’scommunication and prob-lematic behaviors. (24, 25)

17. Utilize an activity board tokeep self informed of theday’s scheduled events inorder to reduce confusionand ambiguity that couldtrigger anxiety. (26)

18. Identify reinforcers fornonanxious behaviors. (27, 28, 29)


causes for his/her anxietysymptomatology (e.g., sub-stance abuse, medications,and hyperthyroidism).

6. Arrange for a psychiatricevaluation to determinewhether psychotropic medi-cations may be helpful.

7. Monitor the client for com-pliance, effectiveness, andside effects associated withprescribed antianxiety med-ications.

8. Arrange for the client to re-ceive individual therapyusing a therapeutic modelbest suited for him/her (e.g.,cognitive-behavioral, behav-ioral, or psychoeducational)to facilitate changes in anx-ious feeling and thinking.

9. Arrange for the client toparticipate in group therapyto learn skills incompatiblewith his/her anxiety symp-tomatology (e.g., relaxation,visualization, and deepbreathing).

10. Request that the client keepa daily mood record to bet-ter understand his/her anxi-ety patterns, precipitatingevents, and coping behav-iors used.

11. Request that the client read(or read to the client) rele-vant portions of SOS: Helpfor Emotions: ManagingAnxiety, Anger, and Depres-sion (Clark) to help elimi-nate irrational beliefs thatcontribute to his/her anxiety.

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19. Increase the frequency ofcalm and relaxed verbal, so-cial, and motor behaviors.(30, 31, 32)

20. Family members and care-givers decrease the client’sstress through the imple-mentation of a quieter,more routine environment.(29, 33, 34, 35)

21. Demonstrate independenceand initiative by making allpossible choices in dailyevents, as evidenced bychoosing clothing, food,leisure interests, and peergroup. (36, 37)

22. Family members and care-givers express greater un-derstanding of the client’semotional and developmen-tal disorder. (38, 39, 40)

23. Family members and care-takers assist and supportthe client in his/her at-tempts to make positive be-havioral changes to manageanxiety symptoms. (41, 42)

24. Increase participation in ex-tracurricular activities andoutings. (43, 44)

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ANXIETY 39

12. Instruct the client in cogni-tive restructuring tech-niques (e.g., replacingirrational, automaticthoughts with realistic self-talk that mediates calmconfidence) to changehis/her thoughts that per-petuate specific fears.Model these for the clientand provide role-playing op-portunities to facilitatemastery of the new skill.

13. Use systematic desensitiza-tion to assist the client incoping with his/her specificphobic responses. Constructa hierarchy of least-anxiety-provoking to greater-anxiety-provokingscenarios, gradually intro-ducing each level until theclient is anxiety free.

14. Request that the client gen-erate a list of activitieshe/she enjoys and finds re-laxing (e.g., listening tosoothing music, takingbaths, or going for walks)and request that the clientspecify times during theday to schedule calming ac-tivities.

15. Teach the client anxiety-reducing skills for manag-ing anxiety symptoms (e.g.,deep breathing, progressivemuscle relaxation, or posi-tive imagery). Model thesefor the client and providehim/her with practice op-portunities to facilitatemastery of the new skill.

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16. Prepare an audiotape ofprogressive muscle relax-ation prompts or calm,soothing music for theclient to use at early stagesof anxiety. Provide a head-set for the client.

17. Teach the client to recognizeearly signs of negative emo-tions and then to initiate al-ternative activities that willreduce expressed agitation(e.g., client’s preferred ac-tivities, deep breathing,progressive muscle relax-ation, or positive imagery).

18. Provide training and in-service sessions to familymembers and caregivers topromote their identificationof early signs of the client’sagitation. Direct familymembers to assist the clientin utilizing distraction orcoping techniques at lowlevels of agitation (e.g.,deep breathing, relaxation,or positive self-talk).

19. Coordinate a mentor rela-tionship with a volunteer ora peer who can assist in re-solving conflicts betweenthe client and his/her envi-ronment to promote moreeffective management ofproblems.

20. Refer the client to a supportgroup for people with devel-opmental disabilities.

21. Arrange for the client toparticipate in social skillstraining to reduce anxiety

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ANXIETY 41

experienced in social situa-tions (see Social Skills inthis Planner).

22. Teach the client relevantenvironmental stress reduc-tion techniques to alleviatestressors (e.g., time man-agement, exercise, or im-proved nutrition).

23. Refer the client to a speechtherapist for suggestions orhardware to increase his/hercommunication ability.

24. Use modeling and role-playing to teach familymembers and caregivers tolisten for the client’s directand indirect communica-tions. Reinforce the clientfor cooperating with reason-able, routine requests.

25. Assist family members andcaregivers in identifyingwhat the client may be com-municating through his/herproblematic behavior (e.g.,fear, helplessness, or frus-tration). Refer family mem-bers and caregivers to theParent Survival Manual(Schopler) for examples ofeffective responses to theclient’s behavior problems.

26. Recommend that familymembers and caregiversuse an activity board to dis-play the client’s schedule(written or pictorially) forthe day, week, or month tominimize his/her anxiety re-lated to uncertainty aboutwhat is upcoming.

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27. Use behavioral analysis toidentify reinforcers for theclient’s anxious behaviors.

28. Identify several reinforcersthat can be used to rewardbehaviors that are incom-patible with the client’sanxiety behaviors. Ask theclient to contribute to thelist.

29. Assess ecological factorscontributing to the mainte-nance of the client’s anxietybehaviors.

30. Refer the client to a behav-ioral specialist to design andimplement a behavioralplan that reinforces desiredbehaviors coupled with be-havioral techniques (e.g., re-inforcing low reactivitylevels, reinforcing incompat-ible behaviors, extinction,response cost, and overcor-rection) to decrease or elimi-nate anxious behaviors.

31. Train all caregivers on theclient’s behavioral treat-ment program to ensure ef-fective implementation andstrengthening of desirablenonanxious behaviors. (Con-sider using Skills Trainingfor Children with Behav-ioral Disorders: A Parentand Therapist Workbook[Bloomquist] as a guide.)

32. Obtain approval from theclient’s guardian and theagency oversight committeefor restrictive or aversiveprogramming.

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ANXIETY 43

33. Modify the client’s environ-ment to remove physicaland psychological conditionsnot conducive to low stress(e.g., noisy conditions,hunger, bright sunlight, andphysical discomfort).

34. Recommend that familymembers and caregiversread Helping People withAutism Manage Their Be-havior (Dalrymple) to learnhow to create a structured,ordered environment thataccommodates the client’sneeds and minimizes anxiety.

35. Recommend that familymembers and caregiversread the Anxiety and StressSelf-Help Book (Lark) or theAnxiety and Phobia Work-book (Bourne) to examineenvironmental changes thatcould reduce the client’sanxiety and stress levels(e.g., dietary changes, phys-ical exercise, and breathingexercises).

36. Present situations on adaily basis such that theclient is required to make achoice between two to threeoptions, and reinforce inde-pendent choices.

37. Encourage family membersto allow the client to makeall possible choices and todemonstrate maximum in-dependence in daily events.

38. Obtain the client’s consentto enlist support from clini-cians, residential staff, fam-

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ily members, and vocationaland educational staff.

39. Provide specific informationto client, family, and care-givers about the client’s spe-cific anxiety disorder (e.g.,from the Anxiety and Pho-bia Workbook (Bourne) orfrom the National Instituteof Mental Health Web site).

40. Recommend that caregiversread The Psychiatric Towerof Babble (Gabriel) to learnabout the mental healthneeds of persons with devel-opmental disabilities.

41. Arrange for family mem-bers and caregivers tospend time with the clientdoing only what the clientexpresses an interest in(e.g., planning a meal, play-ing a game, or watching avideo) to promote uncondi-tional, nondemanding inter-actions while the familymembers and caregiversprovide verbal attention tothe client’s activities.

42. Encourage family membersand caregivers to increasethe frequency of positive in-teractions with the clientwhile modeling desirable be-haviors, positive demeanor,and helpful attitudes. Modelthese behaviors to familymembers and caregivers informal and informal situa-tions.

43. Refer the client to a recre-ational therapist to deter-

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ANXIETY 45

mine possible leisure, so-cial, and community activi-ties available to the client.

44. Encourage the client’s par-ticipation in SpecialOlympics or other athleticevents.

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Axis I: 300.02 Generalized Anxiety Disorder300.00 Anxiety Disorder NOS309.24 Adjustment Disorder With Anxiety309.21 Separation Anxiety Disorder300.01 Panic Disorder Without Agoraphobia300.21 Panic Disorder With Agoraphobia300.22 Agoraphobia Without History of Panic

Disorder300.29 Specific Phobia300.23 Social Phobia309.81 Posttraumatic Stress Disorder308.3 Acute Stress Disorder293.89 Anxiety Disorder Due to General Medical

Condition300.30 Simple Phobia299.80 Pervasive Developmental Disorder NOS299.00 Autistic Disorder299.80 Asperger’s Disorder

Axis II: 317 Mild Mental Retardation318.0 Moderate Mental Retardation318.1 Severe Mental Retardation318.2 Profound Mental Retardation

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319 Mental Retardation, Severity UnspecifiedV62.89 Borderline Intellectual Functioning799.9 Diagnosis or Condition Deferred on Axis IIV71.09 No Diagnosis or Condition on Axis II

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CHEMICAL DEPENDENCE


1. Consistent use of alcohol or other mood-altering drugs until high,intoxicated, or passed out.

2. Inability to stop or cut down use of mood-altering drugs oncestarted, despite the verbalized desire to do so and negative conse-quences associated with continued use.

3. Difficulty understanding the concept of substance abuse and itsproblem despite direct feedback from spouse, relatives, friends, oremployer that the use of the substance is negatively affecting themand others.

4. Marked change in behavior as evidenced by withdrawal from fam-ily or friends, loss of interest in activities, or sleep disturbances.

5. Unpredictable mood swings, irritability, tantrums, aggression,property destruction and self-injury resulting from substance use.

6. Continued drug and/or alcohol use despite experiencing persistentor recurring physical, legal, vocational, social or relationship prob-lems that are directly caused by the drug/alcohol abuse, or the in-ability to foresee legal and personal consequences of behavior.

7. Gradual increase in the consumption of the mood-altering sub-stance in larger amounts and for longer periods than intended, inorder to attain the desired effect.

8. Physical symptoms, including shaking, seizures, nausea, head-aches, sweating, anxiety, or insomnia when withdrawing from thesubstance.

9. Long periods of time spent at home with lack of challenging activ-ities due to health problems or employment difficulties, resultingin increased substance use.

10. Typical daily activities affected by time spent obtaining the sub-stance, using it, or recovering from its effect.

11. Continued use of mood-altering chemicals after being told that itpotentiates the effects of existing medications and chronic medicalconditions such as epilepsy, cerebral palsy, or mental illness.

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1. Describe the amount, fre-quency, and history of sub-stance abuse. (1)



1. Gather a complete drug andalcohol history includingthe type, amount, and pat-tern of use, as well as the

12. Family members and caregivers reluctant to address substanceuse because they do not consider substance use problematic orwish to avoid another stigmatizing label.

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LONG-TERM GOALS

1. Accept chemical dependence and begin to actively participate in anintegrated dual diagnosis recovery program.

2. Withdraw from mood-altering substance, stabilize physically andemotionally, and then establish a supportive recovery plan.

3. Gain an understanding of the negative impact of substance abuseon disability concerns and the effectiveness of prescribed medica-tions.

4. Establish and maintain total abstinence while increasing knowl-edge of the disease and the process of an integrated recovery.

5. Identify and pursue relationships, groups, activities, and locationsthat will promote a healthy and satisfying lifestyle.

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2. Participate in a psychologi-cal assessment of adaptiveand intellectual abilitiesand current stressors. (2, 3)

3. Review extended family’schemical dependence historyand verbalize an acceptanceof a genetic component tosubstance abuse. (4, 5)

4. Cooperate with a psychiatricexamination to evaluate theneed for psychotropic medi-cations. (6, 7, 8, 9)

5. Participate in a medical ex-amination to evaluate theeffects of chemical depen-dence. (10, 11, 12)

6. Improve nutritional statusrelative to the effects oflong-term substance abuse.(13, 14)

7. Begin the 12-step recoveryprocess. (15, 16, 17, 18)

8. Cooperate with a super-vised, medically supporteddetoxification program. (19, 20, 21, 22)

9. Implement the assertive-ness and decision-makingskills that promote a sub-stance free lifestyle. (15, 23, 24, 25)

10. Identify the negative conse-quences of drug and/or alco-hol abuse. (25, 26, 27)

11. Verbalize an understandingof the risks and the effectsof substances on the mindand body. (25, 28, 29)

12. Identify the role substanceabuse has played in meet-ing needs. (25, 30, 31, 32)

CHEMICAL DEPENDENCE 49

negative life consequencesresulting from substanceuse (e.g., social, legal famil-ial, and vocational).

2. Assess the client’s intellec-tual, personality, and cogni-tive functioning as theyrelate to his/her chemicaldependence.

3. Explore situational stress-ors contributing to theclient’s substance misuse.

4. Explore the extended fam-ily’s chemical dependencehistory. Utilize a genogramto pictorially display familyrelationships and substanceabuse concerns.

5. Educate the client abouthis/her genetic predisposi-tion to chemical dependence.

6. Arrange for a psychiatricevaluation to evaluatewhether psychotropic medi-cations may be helpful (seeAnxiety and Depression inthis Planner).

7. Monitor the client for com-pliance, effectiveness, andside effects associated withprescribed psychotropicmedications.

8. Train family members andcaregivers to monitor theclient’s signs and symptomsof mental illness to provideaccurate information to thepsychiatrist, psychologist,or other clinicians.

9. Emphasize to the client thedifference between taking aprescribed medication for a

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13. Verbalize an understandingof the risks associated withthe use of mood-alteringsubstances. (33, 34)

14. Eliminate denial behaviorsand accept personal respon-sibility for substance use.(35, 36, 37, 38)

15. Accept legal consequencesof behavior related to sub-stance abuse. (39, 40, 41)

16. Verbalize increased knowl-edge of substance abuse andthe process of recovery. (28, 42)

17. Verbalize an understandingof personality, social, andfamily factors that contrib-ute to substance use. (3, 4, 25, 43)

18. Identify alternative copingbehaviors to handle stress-ors. (25, 44, 45, 46)

19. Identify how sobriety couldpositively impact life. (47, 48)

20. Identify changes needed insocial system and lifestyleto support recovery. (49, 50)

21. Increase number, duration,and intensity of social con-tacts. (16, 51)

22. Identify and alter living sit-uation contributing to sub-stance use. (52, 53, 54)

23. List recreational, social,and household activitiesthat will replace substanceabuse–related activities.(55, 56)


specific medical conditionand the use of street drugsto achieve a high.

10. Arrange for the client to ob-tain a complete physical todetermine the effects ofhis/her substance abuse.

11. Coordinate any follow-up tothe physical examination,such as prescriptions, labtests, or specialized assess-ments.

12. Coordinate with the physi-cian to determine the safestway to decrease or elimi-nate the client’s dependenceon substances.

13. Review the client’s eatinghabits and encourage theclient to maintain healthynutrition.

14. Refer the client to a dieti-cian or nutritionist for assessment or recommenda-tions regarding his/her di-etary needs.

15. Review support groupsavailable for persons withdevelopmental disabilitiesexperiencing difficultieswith substance abuse (e.g.,Alcoholics Anonymous [AA],Narcotics Anonymous [NA],community mental healthagencies, drug detoxifica-tion centers, or supportgroups for persons with de-velopmental disabilities).Refer the client to the mostsuitable programs.

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24. Agree to make amends tosignificant others who havebeen hurt by the life domi-nated by substance abuse.(25, 57)

25. Write a goodbye letter todrug of choice telling it whyit must go. (58)

26. Identify potential relapsetriggers and develop strate-gies for constructively deal-ing with each trigger. (59, 60, 61, 62)

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16. Arrange for volunteers totake the client to AA or NAmeetings.

17. Arrange for the client to re-ceive training on the jargonand customs of AA meetingsso he/she can avoid feelinglost and inadequate.

18. Teach the client social skillssuch as assertiveness, re-ciprocity, and courtesy toensure that he/she can fitsocially into support groups(see Social Skills in thisPlanner).

19. Advocate with the sub-stance abuse treatment pro-gram for the client to beable to utilize existing pre-scription medications formedical conditions while intreatment.

20. Coordinate with the treat-ment program to extend thelength of treatment, simplifyinformation, provide infor-mation repetitively, and usebehavioral techniques asneeded by the client to en-sure that he/she gets maxi-mal benefits from program.

21. Provide substance abuseprofessionals with informa-tion regarding mental retar-dation (e.g., this TreatmentPlanner) as well as sub-stance abuse training formental retardation profes-sionals (e.g., The ChemicalDependence TreatmentPlanner [Perkinson andJongsma]).

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22. Coordinate the developmentof a multidisciplinary, inter-agency team to provide in-tegrated treatment.

23. Arrange for the client to re-ceive individual, family,and/or group counseling todiscuss substance use.

24. Use a variety of activities topromote self-exploration,handling peer pressure, anddecision-making skills, (e.g.,see 101 Support Group Ac-tivities: For Teenagers Re-covering from ChemicalDependence [Fleming]).

25. Assign appropriate home-work assignments from theChemical Dependence Treat-ment Homework Planner(Finley and Lenz). Modifythe assignments as neededto meet the client’s level ofintellectual functioning.

26. Request that the clientmake a list of the ways sub-stance abuse has negativelyimpacted his/her life andprocess it with the clinician.

27. Assign the client to meetwith two or three peoplewho are close to him/her todiscuss how they see his/herchemical dependence nega-tively impacting their lives.

28. Provide the client with fac-tual information in concreteterms on the effects of sub-stance abuse on physicaland mental health (e.g., seeThe Addictions Workbook[Fanning and O’Neill]).

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29. Arrange for the client toview a video on his/her drugof choice (e.g., the GatewayDrugs series: Binge Drink-ing Blowout, Tobacco X-Files, or Marijuana: TheGateway Drug [DiscoverFilms Video]).

30. Discuss with the clienthis/her needs, real and per-ceived, met through sub-stance use. Assist the clientin identifying alternate,constructive ways to meetthese needs while remain-ing abstinent.

31. Ask the client about thephysical cravings he/shehas experienced for the sub-stance of choice; discusscoping behaviors to replacesubstance abuse.

32. Request feedback from theclient on the ways in whichthe drug or alcohol has beenused as a social icebreaker;discuss alternate social andrelaxation skills that couldbe used.

33. Educate the client on the ef-fects of substance misuse(e.g., increased tolerance,altered judgment, and nega-tive medication interac-tions). Stress this conceptby using specific examplesof how his/her quality of lifecan be improved by elimi-nating substance use.

34. Arrange for the client toview a video on the effectsof substance misuse (e.g.,the Addiction and Recovery

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Series [American Institutefor Learning]).

35. Acknowledge and reinforceall statements made by theclient indicating his/her per-sonal responsibility for thesubstance abuse. Provide re-assurances to limit fear orshame that might causeundue guilt and anxiety.

36. Use specific examples to de-scribe positive and negativechoices about substanceuse, and how each choice re-sults in vastly different con-sequences. Determine theclient’s interest in makingpositive future choices.

37. Model and reinforce state-ments made by the clientindicating his/her under-standing of the destructiveconsequences substancemisuse has created for him-self/herself and others.

38. Confront the client’s use ofdefense mechanisms to jus-tify or rationalize behavior.

39. With proper release, pro-vide information to the po-lice or prosecutor regardingthe impact of the client’s de-velopmental disability onhis/her behavior.

40. Facilitate the client’s in-volvement with legal ap-pointments, court dates,and so on. (See Legal Prob-lems in this Planner.)

41. Obtain documentation fromlaw enforcement personnelregarding the client’s illegal

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behaviors relative to sub-stance abuse. Process withthe client the role his/heruse of addictive substanceshas had in illegal activities.

42. Modify educational materi-als (available from localsubstance abuse treatmentagencies) to accommodatethe client’s individual learn-ing requirements (e.g.,orally review written mate-rials on a one-to-one basis,or use simplified pictures orvideos).

43. Question the client abouthis/her understanding ofhow triggers contribute tosubstance abuse. Reinforceknowledge or understand-ing of these relationships.

44. Assist the client in identify-ing healthy alternatives forcoping with problems (e.g.,physical exercise, increasedsocialization, talking to anidentified support person orpeer). Provide the clientwith a written or pictoriallist of alternative behaviorsfor him/her to refer to asneeded.

45. Help to identify the client’sspecific personal triggers forsubstance use (location,events, moods, thoughts, orpeer group). Request thatthe client identify alterna-tive healthy responses toeach identified trigger.

46. Model and role-play with theclient his/her identified al-

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ternative responses until theclient is able to do so inde-pendently and confidently.

47. Assist the client in identi-fying positive changes re-sulting from eliminatingsubstance abuse (e.g., rela-tionships, work, health,and home environment).Create a written or picto-rial list of the positivechanges.

48. Review the negative influ-ence of continuing existingsubstance-related friend-ships (drinking buddies)and assist the client in mak-ing a plan to develop newsubstance-free friendships.

49. Discuss with the client lifechanges needed in order to maintain long-term substance-free living. Re-quest that the client iden-tify specific changes he/shebelieves are necessary. Con-tract with him/her to makethe identified changes.

50. Practice a variety of socialskills with the client (see So-cial Skills in this Planner).

51. Refer the client to drop-incenters, clubhouse pro-grams, and community-based social programs.

52. Evaluate the role of theclient’s living situation infostering a pattern of sub-stance abuse.

53. Assign the client to make alist of negative influencesfor chemical dependence in-

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herent in his/her currentliving situation.

54. Encourage, support, and re-inforce the client’s desire toseek alternative living ar-rangements that will fosterrecovery.

55. Assist the client in planningsocial and recreational ac-tivities that are free fromsubstance use (see Recre-ation/Leisure Activities inthis Planner).

56. Request that the clientidentify household or work-related projects to fill thetime previously spent usingsubstances.

57. Discuss with the client thenegative effects his/her sub-stance abuse has had onfamily, friends, and work re-lationships, and encouragea plan to make amends forsuch hurt.

58. Request that the clientwrite a goodbye letter to thedrug of choice, read it, andprocess related feelingswith the therapist.

59. Help the client develop anawareness of relapse trig-gers and alternative ways ofeffectively handling them.

60. Develop an abstinence con-tract with the client regard-ing the use of his/her drugof choice. Provide the clientwith a copy in a format thatpromotes frequent indepen-dent review (e.g., written orpictorial chart, audiotape,

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Axis I: 303.90 Alcohol Dependence305.00 Alcohol Abuse304.30 Cannabis Dependence305.20 Cannabis Abuse305.60 Cocaine Abuse304.20 Cocaine Dependence304.80 Polysubstance Dependence291.2 Alcohol-Induced Persisting Dementia291.1 Alcohol-Induced Persisting Amnestic DisorderV71.01 Adult Antisocial Behavior304.10 Sedative, Hypnotic, or Anxiolytic Dependence299.00 Autistic Disorder299.80 Asperger’s Disorder


or videotape). Process theemotional impact of thiscontract with the clinician.

61. Develop with the client acomprehensive aftercareplan to ensure maintenanceof changes, including a sup-port network, treatment al-ternatives, a plan for copingwith triggers, and a safetyplan.

62. Recommend that the clientview H.A.L.T.: A RelapsePrevention Guide (VisionsVideo).

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Axis II: 301.7 Antisocial Personality Disorder317 Mild Mental Retardation318.0 Moderate Mental Retardation318.1 Severe Mental Retardation318.2 Profound Mental Retardation319 Mental Retardation, Severity UnspecifiedV62.89 Borderline Intellectual Functioning799.9 Diagnosis or Condition Deferred on Axis IIV71.09 No Diagnosis or Condition on Axis II

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