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Approach Selection
The main issues that should be addressed through therapy include the patient’s short attention span, poor self-assessment, and lack of communication skills. Group therapy in the early stages of treatment may negatively affect the child’s self-confidence due to his lack of English proficiency. Therefore, one-on-one play therapy has to be considered. The use of play can improve the patient’s ability to communicate and positively affect his concentration. Moreover, some aspects of play therapy may teach him to perform tasks that require planning and, thus, encourage him to perceive situations in a more positive way. General shyness of the patient may also be an obstacle to using group therapy, while allowing the child to play with a therapist alone may help him to create a strong bond with another person and improve his communicational skills without additional stress. Thus, play therapy should be chosen as the main approach to treatment.
The issues connected to ADHD can be resolved with a number of techniques. Some of them are universal and can help with hyperactivity in general, while others affect one particular problem more. First of all, the issue of low concentration can be addressed through games connected to the use of one’s memory and attentiveness. For example, undirected sandbox therapy and role play may help with working memory training (Sonuga-Barke et al., 2013). Here, concentration on storytelling may improve the child’s ability to use short-term memory during one session and long-term memory in between sessions. According to Barkley (2014), working memory affects one’s process of regulating behavior. The physical nature of role playing allows children to visualize their process of gathering and accessing information and helps with strengthening their control over behavior.
Role play can also improve one’s communicational abilities. Verbal games that include storytelling and interaction with different characters give the child an idea of rules that exist in communication. Overcoming a communicational barrier is especially important in this case because the patient’s lack of language proficiency significantly affects his ability to communicate. Thus, by encouraging Andres to use his vocabulary and incorporate new words in stories, the therapist may see an improvement in the child’s communication skills.
Furthermore, according to Meany‐Walen, Bratton, and Kottman (2014), children with ADHD often show physical curiosity rather than verbal or intellectual one. This behavior means that interaction with peers may prove difficult for such children. Therefore, games that are centered on verbal play and interaction can positively affect the child’s ability to communicate. To appear more visual and attract the child’s attention, the process of role playing should be complemented with several toys. These toys can be of any form as long as they can be operated by a therapist and the child without difficulties. For instance, various plush toys and hand puppets fit this description.
The next developmental issue is connected to the patient’s lack of organizational skills, which can be refined through games that deal with various tasks. For example, a therapist can use the directive play that involves the child making and following a particular schedule. Communication between the child and a therapist is essential for this task, as the therapist takes a role of a person who teaches the child to distribute time and follow created rules. This type of game can be incorporated into role playing because it allows the child to repeat all of his actions out loud. Thus, performing a particular set of actions correctly and on time can teach the patient to follow time constraints and make decisions more independently in the future. Moreover, the practice of making a schedule can be included into the continued treatment. Therefore, the child can reinforce the operations at home. The process of following a schedule may also positively affect the child’s performance at school and influence his ability to do homework without distractions.
The style of a therapist in the play room should remain friendly and open at all times. The child can be suggested to choose from activities in a cooperative manner in order to avoid the feelings of punishment or wrongdoing. Moreover, according to Kottman (2014), children with ADHD may feel uncomfortable in a room with many toys due to their low level of concentration and short attention span. Thus, the therapist should consider bringing a minimal number of toys required for each session into a different room to play with the child. Otherwise, the patient may feel overwhelmed and refuse to participate in the planned activities. The issue of school transition can be addressed through play and discussed with the child through the created narrative.
Bullying can be discussed as well. Furthermore, the problem of interaction between peers should be mitigated through treatment because play therapy heavily relies on communication. However, it is important for the therapist to create a positive atmosphere for the child. The cognitive behavioral approach implies that encouraging the patient to think positively can change his behavior in accordance with his thoughts. Thus, the issue of low self-confidence may be ameliorated as well. Conversations should focus on topics connected to the child’s life, including his cultural and religious background, his school and family, and his daily tasks. However, his hobbies and interests should also be taken into consideration. Finally, the patient’s shyness can be alleviated in the process of therapy.
Family Counseling
The use of the family systems theory can prove useful in a family therapy session. This approach implies that every member of a family can play a significant role in the patient’s well-being due to their intimate relationship. In this theory, a family is seen as a system, where every person has a particular role and a set of responsibilities. If this system is balanced, the family remains stable and healthy. Family sessions can be improved by using this theory because it can be utilized to determine the roles of each family member. Therefore, the therapist can establish whether some individuals in the family have roles that do not correspond with each other. It is also important for the therapist to see whether all of the family members have enough independence and emotional stability. According to Fiks, Mayne, DeBartolo, Power, and Guevara (2013), parental decisions and goals can greatly affect their child’s treatment. Thus, their education is significant to the therapy process.
The client’s family includes a mother, father, and the client himself. The parents are involved in the patient’s life. However, they are rather busy due to their work, which makes planning a meeting difficult. During the meeting, the therapist should inform the family members about the boundaries and rules that they need to follow. Family boundaries deal not only with spatial limitations but also with a more broad understanding of personal space. Thus, parents and the child should learn about family spatial and temporal territories, the assets of the family, both material and personal, family life style and family world view. First of all, spatial territory deals with the notion of privacy. It describes territories with limited access to the family’s property. For example, younger children may not be allowed to visit certain areas or rooms because of various hazards.
The existence of temporal territory describes the inability of certain family members to access some places in the house at certain periods of time. This concept also deals with such situations as bringing guests home, calling or receiving calls, and having particular home rituals. For instance, parents can create a rule for their child to bring friends home only on weekends in order to help him concentrate on school assignments during the week. Moreover, restricting such activities as playing games or watching the TV may encourage him to follow a particular schedule, which can improve his organizational skills.
Outlining the concept of possessions is also important. Material possessions include various items in the individual and communal property. Parents should allow the child to have some material assets such as toys or games in order to encourage him to be more responsible and independent. Personal assets of every person include one’s symbolic or highly significant items. Moreover, these things usually cannot be shared with other people. The existence of such items for an individual may also improve his or her level of independence.
Life style and world view are concepts that exist in the minds of the family members. Family life style can include interactions with family members, internal operations, and their sustainability. The language used by parents and children as well as their general tone and style can be considered parts of the family life style as well. The therapist can consult parents on the language that they can use in order to help the patient to deal with complex situations connected to his behavior or his integration into the new environment. For patients with ADHD, the process of setting and following boundaries is important as it can help the individuals to remain in control of their actions (Barkley, 2013). Moreover, the discussion of topics that are allowed or not allowed to address in front of the child is advised. Finally, the world view of a family includes religion and culture. The patient’s family is very religious. Therefore, they should consider their cultural uniqueness and assess the level of its influence on their daily life.
Both parents of the client seem to be highly involved in their child’s life as they attend to his medical and behavioral issues. However, while they are rather experienced with his medical problems, his psychological situation may be more difficult to monitor. Some obstacles in their level of involvement may include the lack of English proficiency and busy working schedule. However, their commitment to the child’s well-being is quite consistent. In this case, parental training may not be required because the parents do not appear to have any internal conflicts. However, low-income jobs can increase the level of stress for both parents, which may lead to a more tense relationship between the members of the family. If such a situation occurs, the therapist can recommend a parental education course concerned with the main actions of addressing children with behavioral issues. According to Barkley (2014), behavioral intervention is the most common approach used for this situation. Moreover, the parents should receive some general recommendations on maintaining the effects of the patient’s therapy at home.
References
Barkley, R. A. (2013). Taking charge of ADHD: The complete, authoritative guide for parents (3rd ed.). New York, NY: Guilford press.
Barkley, R. A. (Ed.). (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York, NY: Guilford Publications.
Fiks, A. G., Mayne, S., DeBartolo, E., Power, T. J., & Guevara, J. P. (2013). Parental preferences and goals regarding ADHD treatment. Pediatrics, 132(4), 1-11.
Kottman, T. (2014). Play therapy: Basics and beyond (2nd ed.). Hoboken, NJ: John Wiley & Sons.
Meany‐Walen, K. K., Bratton, S. C., & Kottman, T. (2014). Effects of Adlerian play therapy on reducing students’ disruptive behaviors. Journal of Counseling & Development, 92(1), 47-56.
Sonuga-Barke, E. J., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M.,… Dittmann, R. W. (2013). Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170(3), 275-289.
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