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1ADHD GROUP INTERVENTION

Academic, Social, and Organizational Skills Group for Early Adolescents with

Attention Deficit/Hyperactivity DisorderLauren Rockwell

University of Cincinnati

CNSL 787 Dr. Mei TangJuly 19, 2011


Introduction

The National Institute of Mental Health lists Attention Deficit/Hyperactivity Disorder as

one of the most common childhood disorders that can continue through adolescence and

adulthood. The American Psychiatric Association states that between three and seven percent of

school-aged children in the United States have ADHD (Centers for Disease Control and

Prevention, 2010). Symptoms include difficulty staying focused and paying attention, difficulty

controlling behavior, and hyperactivity. ADHD has three subtypes – combined inattentive and

hyperactive type, predominately inattentive type, and predominately hyperactive type.

("Attention deficit hyperactivity," 2008). The Diagnostic and Statistical Manual – Fourth Edition

lists ADHD’s symptoms as:

Inattentive Symptoms:

1. Often does not give close attention to details or makes careless mistakes in

schoolwork, work, or other activities.

2. Often has trouble keeping attention on tasks or play activities.

3. Often does not seem to listen when spoken to directly.

4. Often does not follow through on instructions and fails to finish schoolwork,

chores, or duties in the workplace (not due to oppositional behavior or failure to

understand instructions).

5. Often has trouble organizing activities.

6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort

for a long period of time (such as schoolwork or homework).

7. Often loses things needed for tasks and activities (e.g. toys, school assignments,

pencils, books, or tools).


8. Is often easily distracted.

9. Is often forgetful in daily activities.

Hyperactive/Impulsive Symptoms:

1. Often fidgets with hands or feet or squirms in seat when sitting still is expected.

2. Often gets up from seat when remaining in seat is expected.

3. Often excessively runs about or climbs when and where it is not appropriate

(adolescents or adults may feel very restless).

4. Often has trouble playing or doing leisure activities quietly.

5. Is often "on the go" or often acts as if "driven by a motor".

6. Often talks excessively.

7. Often blurts out answers before questions have been finished.

8. Often has trouble waiting one's turn.

9. Often interrupts or intrudes on others (e.g., butts into conversations or games).

Research indicates that the middle school years can be a particularly difficult time for

adolescents who struggle with planning and organizing, symptoms which are characteristic of

Attention Deficit/ Hyperactivity Disorder (Langberg, 2011). Students move from an elementary

school single-classroom environment to a complex schedule where they must transition between

classes and teachers daily. Management of materials during this transition can be especially

difficult for students with ADHD, which can cause them to struggle in an increasingly difficult

academic environment. In addition to these changes in school structure and workload, social

relationships also begin to shift during the middle school years. Peer relationships become

increasingly important, however, these relationships can be difficult for students with ADHD

who are often less mature than their non-ADHD peers (Langberg, 2011). According to the


Centers for Disease Control, parents of children with a history of an ADHD diagnosis report

three times as many peer problems as those without a history of ADHD. In addition, parents also

report that children with ADHD are almost 10 times as likely to have difficulties that specifically

interfere with friendships and peer relationships (Centers for Disease Control and Prevention,

2010).

Intervention for adolescents with ADHD is especially important due to the comorbid

behavioral issues. Young and Gudjonsson found that adolescents with ADHD were more

impaired on comorbid measures of socialization, anxiety, and antisocial behavior when

compared to the non-ADHD control group. It is important for school counselors to provide

appropriate services to students with ADHD in order to prevent the development or progression

of these associated problems (Young & Gudjonsson, 2006). Students with ADHD may require

additional help in areas of behavioral modification, organization, and social skills.

Rationale

Research indicates that group-based interventions are highly effective for children and

adolescents (Hoag & Burlingame, 1997). Group work has been shown to significantly alleviate

problems and negative symptoms associated with disruptive behavior, academic performance,

social skills, and self-esteem (Hoag & Burlingame, 1997). A group intervention for middle

school students with ADHD is appropriate because it will target the social, behavioral, and

academic problems that are characteristic of the disorder. Evans, Axelrod, and Langberg found

that middle school students in group-based interventions made large improvements in areas of

inattention and school functioning, as well as moderate improvements in grades and peer

relations (Evans et al., 2004). Clearly, these results indicate that school-based group

interventions for adolescents are useful, practical, and evidence-based.

http://www.tandfonline.com/action/doSearch?action=runSearch&type=advanced&result=true&prevSearch=%2Bauthorsfield%3A(Gudjonsson%2C+Gisli+H.)


In addition to the topics discussed above, group work provides characteristic therapeutic

factors, which will greatly benefit middle school students with ADHD (Yalom, 2005). The

therapeutic factors which are most relevant to a group intervention for adolescents with ADHD

are universality, guidance, and development of social skills. Through participation in the school-

based group, students will learn that they are not the only ones dealing with ADHD and its

comorbidities. Middle school can be a time where individuals feel isolated and alone, and

participation in this group will help them realize that they are not alone in dealing with their

problems. In addition to the therapeutic factor of universality, students will also receive guidance

and learn effective coping strategies and study skills. Students will receive guidance not only

from the group leader, but from other group members as well. The group will be a safe place to

bounce ideas and learn techniques that work. Lastly, the group will serve as a place to learn new

and helpful social skills. Students with ADHD often have problems with appropriate social

behavior and interaction with peers. Groups provide an opportunity for adolescents to not only

learn new social skills, but to practice them in a real-life scenario with fellow members.

The group intervention proposed here is primarily a psychoeducational group, with

certain aspects of a counseling group. James Trotzer describes psychoeducational groups as

being made up of members who are “at risk” of developing a problem, or seeking personal

enhancement (Trotzer, 2006). Counseling groups, however, are comprised of members who have

a diagnosis or are currently experiencing a particular problem (Trotzer, 2006).

Psychoeducational groups focus on developing resilience, knowledge and skills; where as

counseling groups tend to focus on problem-solving, growth and development (Trotzer, 2006).

The group process outlined below include aspects of both counseling and psychoeducational


groups because while the members are currently experiencing a problem with ADHD, the focus

of the group is more on prevention of problems and skill building.

Group Plan

Context & Inputs

This group intervention for middle school students with ADHD will be lead by the

building school counselor. Group membership will be comprised of approximately 10 members,

both male and female across the six, seventh and eighth grades. Trotzer states that groups with

adolescent members should be kept to approximately 6-10 members in order to the leader to be

able to manage behavior effectively (Trotzer, 2006). This group size will allow for enough time

for individual sharing and participation by each member. The rationale for mixed gender and

grade-level group is to mimic the realistic school environment for students. This will provide

them with a safe place to practice social skills that are relevant to their school and social lives.

Members who are appropriate for this group include middle school students with an

ADHD diagnosis, or students who meet criteria for either four symptoms of inattention, four

symptoms of hyperactivity, or a combination of 6 inattentive and hyperactive symptoms as

endorsed by parents and one or more teachers. While an official diagnosis of ADHD is not

necessary for group membership, the interventions are tailored to help middle schoolers with

ADHD, so some symptoms must be present in order to participate in the group. Students who are

not appropriate for group membership are those who are not struggling with organization, social

skills, or academics. Also, students who have other, more pressing problems to deal with such as

learning disabilities, substance abuse or dependence, or suicidal ideation are not appropriate for

the group until their other problems have been addressed and alleviated.


Recruitment efforts will primarily be lead by teachers in the school. The school counselor

will announce the formation of an organizational, academic, and social skills group for students

with ADHD during a staff meeting in the first quarter of the school year. He or she will ask

teachers to refer students who they think would be appropriate for the group. The counselor will

then send a letter home to the parents of referred students to see if they are interested in having

their child participate in the group. Students with an existing ADHD diagnosis will not need to

meet any other criteria in order to be considered for the group, however, students without an

official ADHD diagnosis will have parents and one or more teachers complete a Vanderbilt

rating scale which lists the symptoms of ADHD and has the parent or teacher rate the child’s

behavior on a scale of zero to three (with zero meaning “never”, one meaning “occasionally”,

two meaning “often”, and 3 meaning “very often”) (Vanderbilt Rating Scale). Items with a score

of two or three are counted towards a total number of symptoms met. As discussed above,

students must meet criteria for either four symptoms of inattention, four symptoms of

hyperactivity, or a combination of 6 inattentive and hyperactive symptoms in order to be eligible

for group participation. Once eligibility has been established, parents and students must sign a

consent form agreeing to participate in the group intervention. Parents will get a copy of the

consent form which will include an outline of the group plan and dates, as well as the school

counselor’s contact information.

The group will be run as an after-school program once per week over an eight-week time

period in the second quarter of the academic year. Student’s academic, organizational, and

behavioral problems often get worse as the school year goes on, so implementing this

intervention during the second quarter of school will help prevent problems from developing

later on in the school year. The first quarter will be used to establish baseline data on student’s


grades, discipline records, and classroom behavior. The group will be held in a regular classroom

after school hours so that group members will have ample space for various activities. The

rationale for holding the program in an after-school setting is due to students’ need to not miss-

out on classroom activities or lunch. Students with ADHD are often struggling academically due

to problems with paying attention and organizing. Thus, it would be inappropriate and

detrimental to their academic performance to pull them from the regular classroom. Students

with ADHD also often have problems socially with age inappropriate behavior. Pulling these

students from lunch would limit the time they have for social interaction and hurt their social

skills development. The intervention will be run after-school for one hour and school guidance

program funds will be used to provide a bus that will take students home after group so they will

not be reliant on their parents picking them up.

Group and Individual Goals

The group goals for this group intervention will be the acquisition of organizational,

social, and academic skills to alleviate some of the problematic behaviors associated with

ADHD. Individual goals may vary, but can include objective measures such as improvement in

grades and a decrease in the number of behavior-related discipline referrals. In addition to these,

individual goals may also include subjective measures such as improvement in social skills and

peer relationships and a reduction in the struggle to complete homework in the evenings.

One overall goal for this group intervention is that skills should be generalizable and

maintained after the group ends. It is unrealistic to provide students with individual guidance on

these skills in the long-term, so this intervention aims to teach students organizational,

interpersonal and study skills that they will be able to maintain long after the group is completed.


The goal is for students to be able to carry the skills they learn in this group through middle

school and on to high school and beyond in order to prevent problems from developing later on.

Group Process

Session One. The session will begin with introduction and rapport building. The

counselor will facilitate an ice-breaker activity in order to allow students to get to know each

other and foster a sense of security among members. The counselor will ask each student to share

their name, grade level, and favorite activity or hobby outside of school.

The counselor will then give students their new binder and supplies. These supplies will

be used throughout the course of the intervention to build organizational skills. Specifically,

students will receive:

- One two-inch binder

- A folder for each of the student’s classes, plus one additional folder to be used as

homework folder

- Loose leaf paper for the binder

- Assignment tracking sheet (optional, students can use the school agenda book if one is

provided by the school)

The counselor will spend the rest of the session helping students organize their new

binder systems. This will include labeling each folder for its associated class and putting each

class’s papers in the corresponding folder. The counselor will explain to students how to use

their new organizational system by putting papers in the appropriate folder and homework in the

homework folder each night.

Session Two. This session will begin with a brief check-in to see how members are doing

and get everyone in the mindset to begin group. After the check-in, the counselor will re-


establish the binder system and refresh students’ memories regarding how the system works. The

counselor will then facilitate a discussion about how the first week of using the binder system

went and any related challenges or successes.

Session Three. Session three will being with a check-in and the first true “binder check”,

where the counselor goes through with the group and makes sure each student has

- Brought their binder to group

- Binder contains folders for each class

- Binder contains homework folder

- Papers are in appropriate folders, no loose papers in binder

- Student brought homework assignment tracking sheet (or school provided agenda book)

After the counselor has completed the binder check, he or she will conduct the first social

skills intervention of the group. This social skills intervention is adapted from the Challenging

Horizons Program by Drs. Steve Evans and Joshua Langberg (Evans & Langberg, 2010). The

focus of the intervention is on interpersonal problem solving and is known by the acronym

WILBUR. The counselor will have the students come up with a real or hypothetical problem

they may be having with their peers. They will then work together as a group to complete the

following steps:

- What is my problem?

- What would I like to happen?

- List possible courses of action.

- Which is the best option?

- Utilize the solution.

- Rate the effectiveness of the solution.


The purpose of the WILBUR social skills intervention is to teach students to stop and

think before acting in interpersonal interactions. Students with ADHD can often be impulsive in

peer relationships, and the WILBUR intervention is targeted at helping them generate multiple

courses of action and then choosing the “best” option for resolving their conflicts.

Session Four. This session will begin with the same format as the previous session with a

brief check-in, followed by the counselor checking each student’s binder according to the binder

checklist. After check-in and binder check, the counselor will introduce the first study-sills

session of the intervention, which will be a lesson on note taking. This note-taking method has

been adapted from the Challenging Horizons Program (Evans & Langberg, 2010) and will focus

on using the format of:

I. Main Idea

A. Supporting Idea

1. Sub-ideas

2. Sub-ideas

3. Sub-ideas

B. Supporting Idea

1. Sub-ideas

2. Sub-ideas

3. Sub-idea

Students will be taught to use this format when taking notes during class lecture or

summarizing text. They will practice this technique in their classes during the following week

and bring a copy of their completed notes to next week’s session.


Session Five. This session will begin with the same format as the previous session with a


checklist. After check-in and binder check, the counselor will introduce the evening schedule.

The evening schedule is a planning tool that can be used to schedule time for activities after

school such as homework, snack, practice, etc. The evening schedule should follow this format:

Time Activity

3:00 – 4:00

4:00 – 5:00

5:00 – 6:00

6:00 – 7:00

7:00 – 8:00

8:00 – 9:00

9:00 – 10:00

The counselor should then have each student write down an evening schedule for one

school night that week. They will bring their completed evening schedule to next week’s session.

Session Six. This session will begin with the same format as the previous session with a


checklist. After check-in and binder check, the counselor will have students discuss how the

evening schedule of activities worked for them. They can discuss whether or not it was helpful in

teaching them to organize and manage their time effectively. The rest of the session will be spent

doing another social skills problem solving WILBUR activity. If the students are unable to


generate a hypothetical problem, the counselor should be prepared to present one for them such

as, “my friends are talking about me behind my back and spreading false rumors”.

Session Seven. This session will begin with the same format as the previous session with

a brief check-in, followed by the counselor checking each student’s binder according to the

binder checklist. After check-in and binder check, the counselor will introduce the second set of

study skills, which are test taking strategies. The counselor will discuss various strategies for

taking multiple choice, short answer, and essay questions. The counselor should spend a few

minutes at the end of group discussing the fact that next week is the last week of group and

preparing students for the termination of group.

Session Eight. This session will begin with the same format as the previous session with

a brief check-in, followed by the counselor checking each student’s binder according to the

binder checklist. The remainder of the group should be spent discussing translation of skills for

when group ends. The counselor should encourage members to use the skills learned over the

course of the group in subsequent quarters and years of their academic career. The final section

of the group session should be spent allowing members to discuss their reflections on group and

say goodbyes.

Accountability

Accountability and program success will be measured in many different ways for this

intervention. First of all, students, parents, and teachers will complete end-of intervention

satisfaction questionnaires to assess their overall satisfaction with the program, program leader,

and outcomes. Participant satisfaction is an important measurement of program success because

if students, parents, and teachers do not have buy-in regarding the program, the program will not

be able to continue.


In addition to assessing satisfaction, several objective measures of program success will

also be collected. Student grades will be collected at the end of each quarter to track academic

progress and improvement. Additionally, school discipline records will be analyzed to look for a

reduction in disruptive classroom behaviors. Lastly, the individual student’s binder checklists

will be saved from each group session and analyzed to look for trends in organizational

improvement over the course of the intervention. These permanent products will serve and an

objective measure of the organizational skills learned in group.


References

Centers for Disease Control and Prevention. (2010, November 10). Attention deficit/hyperactivity

disorder (ADHD). Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html

DSM-IV-TR. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text

Revision. Washington, DC: American Psychiatric Association.

Evans, S.W., & Langberg, J.M. (2010). Challenging horizons program treatment manual.

Athens, OH: Ohio University Department of Psychology.

Evans, S.W., Axelrod, J., & Langberg, J.M. (2004). Efficacy of a school-based treatment

program for middle school youth with adhd. Journal of Behavior Modification, 28(4),

528-547.

Hoag, M.J., & Burlingame, G.M. (1997). Evaluating the effectiveness of child and adolescent

group treatment: A meta-analytic review. Journal of Clinical Child Psychology, 26, 234-

246.

Langberg, J.M. (2011). Homework, organization, and planning skills (HOPS) interventions.

Bethesda, MD: NASP Publications.

Trotzer, J.A. (2006). The counselor and the group: integrating theory, training, and practice.

New York, NY: Routledge Taylor & Francis Group.

http://www.cdc.gov/ncbddd/adhd/data.html


U.S. Department of Health and Human Services, National Institute of Mental Health. (2008).

Attention deficit hyperactivity disorder (ADHD). (NIH Publication No. 08-3572).

Yalom & Leszcz. (2005). The Theory and Practice of Group Psychotherapy, 5th edition, Basic

Books, Preface p. xii

Vanderbilt ADHD Diagnostic Parent Rating Scale & Vanderbilt ADHD Diagnostic Teacher

Rating Scale

Young, S., & Gudjonsson, G.H. (2006). ADHD symptomatology and its relationship with

emotional, social and delinquency problems. Psychology, Crime & Law, 12(5), 463-471.

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