The psycho-educational element of giving information by discussion supplemented with fact sheets is crucial to CBT. This may help in improving compliance to treatment and is genuinely appreciated by the child, family, school, and often the referring general physician.

Educating adolescents and parents about ADHD as a disorder, its symptoms, course, types, comorbidity, causes, impact, role of parental disciplining, and resources available to deal with it may help them understand from a scientific point of view.

In addition, clarifying misconceptions associated with this disorder such as ADHD is an intentional behavior on the part of the child that these children are absolutely normal or on the other hand are absolutely abnormal and can never function normally and that they are absolutely handicapped, among several others may be essential to initiating effective management. Parents who feel that their child is malingering symptoms may attribute resultant problems to adolescent’s behavior, whereas those who understand it as being caused by uncontrollable biological factors and maintained by environmental factors may work in collaboration with the adolescent sufferer and may support him/her in dealing with their symptoms. Misconceptions are thus addressed, and a balanced view of ADHD is presented to the parents.

In this session, after assessing the adolescent and parents’ subjective stress levels on a visual analog scale, they are educated about stress: what is stress, how stress build up, what factors may maintain it, what happens when it continues beyond a point, and how ADHD and associated problems may cause and maintain stress in them. Further, adolescents and their parents are asked about ways in which they cope with problems. They are then educated about the different types of coping such as positive coping (adaptive and constructive coping) viz. anticipation or proactive coping (anticipating what the problem situation will be like and preparing the steps to cope with it), social coping (seeking social support), and meaning focussed coping (understanding the meaning of stress causing situation), temporary avoidance of thoughts or circumstances that cause stress and getting back to them when calm, relaxation exercises, physical exercises, healthy nutrition and adequate sleep, and humor. The adolescent and their parents also receive an understanding of how these positive ways of coping help in improving overall functioning (Table 15.3).

They are further taught about the negative or maladaptive coping strategies that may provide temporary relief from symptoms or problem but may maintain it in the long term. Ways of coping negatively include dissociation (the ability of the mind to separate and compartmentalize thoughts, memories, and emotions), sensitization (seeking to learn about, rehearse, and/or anticipate fearful events in a protective effort to prevent these events from occurring in the first place), safety behaviors (relying on something, or someone, as a means of coping with excessive anxiety), anxious avoidance (avoiding anxiety-provoking situations by all means), and escape (fleeing the situation at the first sign of anxiety).

Thus by the end of this session, the adolescents and parents are able to identify the various ways in which they cope with different situations and whether their ways of coping help them in overcoming or maintaining their distress.

This session is a continuation of the last session in that it teaches some coping strategies to deal with specific symptoms of ADHD. Relaxation techniques such as deep breathing and imagery are taught to adolescents with ADHD. In addition, distraction techniques such as writing a diary, talking out to a friend, engaging in a hobby, reading books for pleasure, going out for a walk, praying, yoga, an elastic band around the wrist, holding an ice cube in the hand, or stroking a pet while distracting may actually help the adolescent in bring back his trail of thoughts to the point where he got distracted. Some mental strategies such as learning a rhyme, memorizing motivational quotes, or tongue twisters such as ‘she sells seashells on the sea shore’ may also challenge the distracting stimuli and remind the adolescents to divert back their focus to the task at hand. Similarly, self-use of memo or flash cards can also help in distracting adolescents with positive messages or memories of happy experiences such as holidays or personal achievements, reminding you that things will improve again (Table 15.4).

Further, adolescents are taught an important technique in cognitive behavior therapy, i.e., cognitive restructuring which is a set of techniques for becoming more conscious of one’s thoughts and for modifying them whenever they are distorted or unrealistic. Adolescents are taught to use cognitive restructuring technique to use reason and evidence to replace the distorted thought patterns with more accurate, believable, and functional ones.

For helping the adolescents identify their thought distortions as well as restructure them after brief evaluation, the adolescents are introduced to the following worksheet (Tables 15.5 and 15.6):

Next, the adolescents are taught the technique called problem solving which involves the following steps:

All these techniques are also taught to the parents to help adolescents (who are comfortable involving their parents in the therapy process) understand and implement these strategies. For those parents whose adolescent children are not comfortable in involving them in the therapy process as well as for others, it is advisable to implement these strategies to deal with their own day-to-day problems.

The last technique that is taught in this session is planning and management. The adolescent is taught to maintain a daily routine such that adequate time is allotted to each activity. Each activity must be followed by a small break. The important thing is to get to the next task after the break time is over. Planning for unexpected events is important to avoid frustration later on.

This session begins with teaching adolescents the technique called ABC charting. This involves educating them about (Table 15.7):