 Enhancing Self-Esteem and Social Skills in
Children with ADHD, Bruce Sabian, M.A.
Academy
MetroWest is an after-school activity group therapy program. Using physical
activity, counselors attempt to help children develop improved self-esteem
and social skills. The principles and techniques employed are particularly
relevant for children with ADHD.
Groups
meet weekly for 75 minutes. They are small, with no more than six members
in a group. For children with ADHD, this number is ideal. Six children are
enough to provide plenty of opportunities for learning group interaction
skills while keeping the level of stimulation manageable. Groups are
conducted by human service professionals from a number of different
disciplines, and each group is led by one or two counselors. Prior to
beginning in the program, all children undergo an initial interview to
assess their physical skills, developmental abilities, and needs. Based upon
this information, children are placed in homogeneous groups to assure that
they are participating with children who have similar needs and abilities.
This helps to maximize the success that children derive from their
experience with the group.
Physical
activity revolves around cooperative, collaborative, and non-competitive
games. These games are structured so that in order to maximize success,
children must learn to identify and respond to the needs of their fellow
group members. Generally, the more the children are able to work together
in a cooperative, group-oriented manner, the more success they are likely
to have.
Activities
are structured to "eliminate elimination," that is, minimize the
time that children may be out of a particular activity. In traditional
recreation settings, this "down time" can be very problematic for
children with attentional issues. Lacking a specific task on which to
focus, they can easily become distracted and engage in inappropriate
behavior. While many of the activities feature some aspect of temporary
elimination, there is invariably a way in which a child can be
"saved" or "rescued" by his or her teammates.
For
children with ADHD, the teamwork skills necessary for such an activity are
not always present, so they tend to become focused on their own needs and
agendas. Because almost all of our activities feature some component that
requires children to "save" or "rescue" someone else,
children become practiced in thinking in this manner. This creates an
environment in which children can view each other as allies rather than
rivals. Children learn to view their peers as potentially positive
contributors to their own success and enjoyment, rather than mere adjuncts
to activities, at best, and impediments who actively block them from
getting what they want, at worst.
Counselors
draw on a repertoire of approximately 150 activities featuring a range of
cooperative tag games, challenge courses, games that feature physical
contact, bombardment, adapted traditional sports, and problem-solving
activities. Many activities emphasize an age-appropriate fantasy or story,
most of which have been created in-house. These not only make the
activities considerably more enticing, but also help the children to
address some of their own conflicts and issues through their involvement
and investment in the stories.
DEVELOPMENT
OF POSITIVE RELATIONSHIPS
In
addressing childrens' self-esteem, counselors rely upon the development and
sustenance of close relationships and the creation of a group environment
characterized by high levels of concrete success in both physical and
social arenas. The therapeutic relationship used at Academy MetroWest is
created using the same principles as those found in most types of
psychotherapeutic interactions. While counselors spend a significant amount
of time setting limits with children and offering feedback about behavior,
this information is always offered within a context of unconditional
positive regard. Counselors try to convey a message that suggests "I
want the other kids to see you as the great kid that I know you are. In
order for them to be able to do that, you may want to think about making
the following choice." Offering this type of message gives children
the information they may need to make positive behavior changes, but it
does so in a context of acceptance, safety, and security. Children know
that their behavior will be addressed, but they are also aware that to be
accepted and valued by their counselors, they need only be themselves.
Self-esteem can be improved if children can internalize the acceptance and
regard received from their counselors.
Most
children seen at Academy MetroWest fall between the ages of 6 and 12.
During these latency years, one of the most important tasks is to develop a
sense of competence. To facilitate this process, counselors attempt to
create situations in which the level of concrete success each child can
obtain is maximized. Many children with ADHD confront a steady stream of
frustrations and challenges during the week. The challenges they encounter
in family, educational, social or recreational settings may deeply affect
the manner in which they come to view themselves. In structuring groups to
maximize success, counselors attempt to disrupt the cycle of repeated
failures that many of these children experience. Their success in a group
is based on their level of effort and participation rather than on their
athletic prowess. Children can become "heroes" in their group by
keeping the needs of others in mind. Counselors place a premium on
emphasizing a child's strengths rather than shortcomings.
FACTORS
ADDRESSING ADHD
While
Academy MetroWest is not geared exclusively for children with ADHD, certain
factors make the program a particularly good match for these children. It
has been said that the three factors that contribute most strongly to the
success of a child with ADHD are motivation, novelty, and structure. First,
children are motivated to come to their groups because they enjoy them.
Children tend to focus more on the fantasy and play aspects of the program
rather than on the psychoeducational components. One child reported that he
loved coming to the program because "they don't try to make me learn
anything." Rather than viewing his group as therapy that he has to
attend because of his problems, he looks at it as an enticing place to come
because it's fun.
Second,
with the repertoire of activities, groups often present a new and unique
play situation for children. As a counselor in the program, my imagination
and propensities for telling fanciful stories have led children to describe
me as anything from funny and creative (when they are feeling charitable)
to twisted and weird (when they're not). In forcing ourselves to be
creative and inventive, my colleagues and I not only continue to make the
program enjoyable for ourselves but we offer the children a continually
novel, stress-free environment in which they can take some pressure off
themselves and be successful.
Third, the
level of structure present in a given group can vary tremendously. However,
in groups in which children with ADHD are present, the structure tends to
be very tight. Counselors tend to be quicker and more concrete in they way
in which they set limits. This is crucial in controlling the level of stimulation
for the children in a group. Transitions and instructions are shorter, more
concrete, and more specific than in other groups. Counselors also attempt
to build in a healthy amount of routine and predictability. All these
structural elements make it easier for children to remain focused and on
task. If expectations are always known, it is easier for them to steer
clear of distraction and inappropriate behavior and to maximize their level
of success.
In working
with any child, but particularly those with ADHD, maintaining and
communicating realistic expectations is essential. There is always a
temptation to ask children with ADHD to do things that one would
realistically expect from other children. Within the course of any given
week, I ask myself numerous times "Why can't he just keep himself in
control for two minutes so I can go over this game?" It takes a lot of
self-control to make sure that question remains silent and that I keep the
answer to it at the front of my mind. Instead of measuring children by the
standards applied to others, we prefer to emphasize improvement over one's
past performance and effort.
Perhaps
the most important thing that children can gain through involvement in a
group at Academy MetroWest is the ability to concentrate on what they can
do rather than on what they can't. In conjunction with other professional
services, activity group therapy can be a valuable part of a comprehensive
treatment program for children with ADHD.
9
Tech Circle, Natick, MA | 508-655-9200
email: info@academymetrowest.com
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