Individual Treatment

Individual Treatment

Individual Treatment

Individual Therapy

Individual therapy - also known as psychotherapy, talk therapy, or counseling - is a one on one collaborative process between a therapist and client that aims to set goals to facilitate change and improve quality of life. Therapy can help people confront barriers that interfere with emotional and mental well-being, and it can also increase positive feelings such as compassion, self-esteem, love, courage, and peace. The overall duration of therapy depends both upon how the client is functioning and progressing. We provide both short term therapy for acute concerns and ongoing supportive therapy for clients with ongoing needs. Many people find they enjoy the therapeutic journey of becoming more self-aware, and they may pursue ongoing psychotherapy as a means of self-growth and self-actualization.

Alternatives to Medication

Alternatives to Medication
Stimulant medication can be effective in treating the symptoms of ADHD but some children are unable to use them because of side-effects, because they are too young or because they have a medical condition that puts them at risk. Many parents prefer to use alternatives as the first line of treatment for their child and medication only as a last resort. We know that ADHD is the result of neurotransmitter and neuroendocrine imbalances. The four main imbalances include high norepineprine and cortisol, dopamine dysfunction, serotonin deficiency, and insulin irregularity. These imbalances are rooted in nutritional deficiencies that with treatment, improve symptoms of hyperactivity and inattention. Food allergies and sensitivities also contribute to malabsorption of these nutrients. Alternative treatment to medication is available and includes nutritional counseling to change dietary habits and correct deficiencies and sensitivities, supplementation, reducing electronic stimulation, increase exercise habits, improvement of sleep patterns, behavior therapy and parents counseling, neurofeedback and Cogmed Working Memory Training.

Our assessments always screen the quality of the client's nutrition and sleep, exercise habits and stress management skills. The client's individualized treatment plan includes treatment to improve any of these areas identified as problematic.

Correct Irregular Sleep Cycles
Children and adolescents with inattention need from 8 to 10 hours of uninterrupted sleep. Behavior therapy and parent counseling is effective in treating children who fight sleep and bedtime. Other children wake during the night and instead of going back to sleep go and find their parents. Others cannot fall asleep because of intrusive obsessive thoughts about things that worry them. Children with ADHD often complain that their brain will not switch off and when they finally fall asleep from exhaustion their sleep is restless and superficial. Reducing electronics several hours before bedtime prevents the negative effect of the blue screen light on the hormone melatonin in the brain which starts the sleep cycle. 

Sleep protocols develop good sleep hygiene which helps children and adults create a calming sleep routine that is consistent to help them relax. A warm bath, relaxation exercises and yoga, reading, journaling, and using guided imagery tapes to block out intrusive thoughts are helpful pre-bed and bedtime activities. Students using computers up until they go to bed can learn how to use the application on electronic equipment to change the light from blue to yellow or orange which reduces the negative affect of electronics on the sleep cycle.

Stabilize Blood Sugar and Insulin Levels 
Nutritional counseling that teaches children and parents how to keep blood sugar and insulin levels stable will improve inattention and hyperactivity symptoms. Nutritional education about limiting processed sugars and starches in the diet, emphasizing the importance of protein and avoiding certain food colorings and preservatives in their diet is critical for children with ADD/ADHD. Small servings of protein should be eaten at regular intervals. Convenient protein sources include nuts, yogurt, hummus, protein bars and protein smoothies.

Correct Nutritional Deficiencies
Research-based nutritional counseling is important for the management of ADHD; however, identifying and correcting nutritional deficiencies is also important as deficiencies play an important role in neurotransmitter balance. The most common nutritional deficiencies include low B vitamin levels, low magnesium, and low levels of amino acids. Our nutritionist can arrange for Micronutrient and Food Sensitivity testing to evaluate your potential for nutritional deficiencies and food sensitivities and then provide supplementation and dietary counseling to correct them.

For many children, serotonin imbalance is the cause of ADHD Inattentive Type. A quick morning workout before heading to class gives the brain a serotonin boost. Try running up and down the stairs five times or 10 jumping jacks. A brisk morning walk may also help “wake up” your serotonin. Children diagnosed with ADHD should never be kept in during recess or physical education because their activity during these periods will improve their attention skills when they return to class.

Create an Electronic Budget
Children and adults diagnosed with ADHD can become obsessed with iPhones, iPads and other electronics because the electronic screen stimulates their brains to release more Dopamine which allows them to hyper-focus. If allowed they will spend hours focused on these activities separated from family and friends. Attention skills also deteriorate of extensive electronic stimulation. Most children should have an “electronic budget” that limits use of TV, video games, phones and other gadgets to one hour per day. Adults need an electronic budget as well. While jobs may force us all on the computer for long periods of time, having “electronic-free” hours can help build focus and attention. Turn off your electronics by 10 p.m. and keep four hours at least one day per week gadget/electronic-free.

Behavior Therapy, Parent Behavior Modification therapy, Parent Child Interaction Therapy
Behavior Therapy and Parent Behavior Modification Therapy are recommended as the first line of therapy for preschoolers diagnosed with ADHD by the Pediatric Medical Board and not medication. This recommendation emerged from the findings of the Preschool ADHD Treatment Study (PATS)conducted by the National Institute of Mental Health which found that one third of the of the 303 preschoolers in the study and their parents only needed a 10-week behavior therapy program to significantly reduce their ADHD symptoms. Parent Child Interaction Therapy based on behavior modification is also very effective in reducing oppositional defiant behavior.

Cogmed Working Memory Training Program
Working memory is the "metal workspace" in our memory which we use to hold data and manipulate it for reasoning, problem solving and comprehension. ADHD often limits the storage capacity of this “workspace” and when it becomes overwhelmed the data is lost causing a break in the person's attention. Cogmed is a research-based, home computer based program that improves working memory and attention in children and adults with working memory deficits and poor attention.

Neurofeedback is a type of biofeedback that measures brain waves to produce a signal that can be used as feedback to teach self-regulation of brain function. Neurofeedback is commonly provided using video or sound, with positive feedback for desired brain activity and negative feedback for brain activity that is undesirable.

QEEG has been used to develop EEG models of ADHD. According to this model, persons with ADHD often have too many slow theta brain waves (associated with relaxation) and not enough fast beta wave activity (associated with mental focus). Neurofeedback therapies for ADHD generally attempt to increase the production of betawaves and decrease the number of slower brain waves. This can be accomplished by allowing the patient to view their levels of brain waves on a screen and attempt to alter them, or by integrating brain waves into a video game.

Although many patients will still need ADD/ADHD medications, trying natural alternatives can keep us all less medication dependent and living healthier. Focus on alternatives in beating your ADD/ADHD, naturally.

Behavior Modification / Therapy

Behavioral issues such as oppositional, impulsive and disruptive behavior can make independence skills, educational achievement, social relationships, and family interactions more challenging. Behavior modification has proven to be an effective treatment approach to change unwanted behaviors or to develop desirable new behaviors such as helping an autistic child learn to make eye contact. It is particularly valuable for treating children but is also effective in the treatment of adolescents and adults. Behavior treatment combines research-based methods with an individualized approach to reduce difficult behaviors, develop new desirable behaviors, improve pro-social choices, and enhance overall quality of life in multiple settings. Treatment can target any difficult situation from toilet training to compliance issues, aggression and destruction, and even inability to participate in tasks in the community, such as grocery shopping or eating out. Interventions can be done in home, day care, school, day habilitation, work, or other community-based settings.

The Behavioral Treatment Plan process will begin with a one hour interview with family, which usually takes place in the home. The clinician will then complete a one hour observation of the child in two separate settings (for example, home and school). Target behaviors that need to be changed or new behaviors that need to be developed are identified by the clinician. The clinician then develops an in-depth behavioral treatment plan which is designed to change the target "problem" behaviors to more pro-social goal behaviors using incremental “baby steps” and positive reinforcers to motivate the client's participation. Parents and or teachers will receive a 1.5-hour training session (in the home or in the classroom) to learn how to implement the interventions the plan requires. The clinician will then schedule follow-ups to monitor family progress or the child's progress in the classroom as well as be available to answer any questions.

Executive Skills Coaching

What are Executive Skills?
Executive skills help us to regulate our behavior. These high-level cognitive functions help us to plan and organize activities, to sustain attention, and to persist in completing a task. They help us organize our behavior over time and override immediate demands in favor of longer term goals and they help us to decide what activities or tasks we will pay attention to and which ones we will choose to do.

Certain executive skills allow us to select and to achieve goals or to develop problem solutions.
  • Planning – the ability to create a roadmap to reach a goal or to complete a task
  • Organization – the ability to arrange or place things according to a system
  • Time management – the ability to estimate how much time one has, how to allocate it, and how to stay within time limits and deadlines.
  • Working memory – the ability to hold information in mind while performing complex tasks
  • Metacognition – the ability to stand back and take an objective view of oneself. It is an ability to observe how you problem solve. 
Other executive skills guide or modify our behavior as we move along toward our goals.
  • Response inhibition – the capacity to think before you act
  • Self-regulation of affect – the ability to manage emotions in order to achieve goals, complete tasks, or control and direct behavior
  • Task initiation – the ability to begin a task without undue procrastination, in a timely fashion
  • Flexibility – the ability to revise plans in the face of obstacles, setbacks, new information, or mistakes
  • Goal-directed persistence – the ability to follow through to the completion of a goal and not be put off by the demands of our competing interests
  • Sustained attention – the capacity to be paying attention to a situation on task in spite of distractibility, fatigue or boredom
Response inhibition, working memory, emotional control and attention all develop early within the first 6 to 12 months of life. Children show planning skills when they find a way to get a desired object. Planning is more evident when a child walks. Between 12 and 24 months, flexibility is developed because children can react to change. All the other executive skills, such as task initiation, organization, time management and goal-directed persistence develop later, around preschool and early elementary school years.

Neurological Base for Executive Skills
The neurological base for executive skills is the frontal brain systems, which includes the frontal and prefrontal cortex along with connections to adjacent areas. The prefrontal brain systems are among the last two fully develop, usually in late adolescence, and they are the final common pathway for managing information and behavior from other brain regions. 

Hart and Jacobs (1993) summarized the critical functions of the frontal lobes and the management of information and behavior:
  1. The frontal lobes decide what is worth attending to and what is worth doing.
  2. The follow-ups provide continuity and coherence to behavior cross time.
  3. The follow-ups modulate affect us and interpersonal behaviors so that drives are satisfied within the constraints of the internal and next to environments.
  4. The frontal lobes monitor, evaluate and adjust.
ADHD and Executive Skills
Most ADHD researchers believe that ADHD is fundamentally a disorder of executive skills. One prominent theory (Barkley) of ADHD sees this disorder as one of reduced ability to self-regulate. A common cluster of executive skills impairment appears with those who have ADHD. These executive skills are responsive addition, sustained attention, working memory, time management, task initiation and goal directed persistence.
Persons with ADHD need to know their strengths and weaknesses relative to executive skills to function optimally. Assessment of executive skills is important to the overall treatment of ADHD. Behavioral interventions based on executive skill assessment can help people with ADHD perform better at school and at work. 

Underachievement and Executive Skills
It should be noted that people who do not have a diagnosis of ADHD can and do have executive skill impairments. There are patterns of strengths and weaknesses in executive skill development in all of us. However, if executive skill weaknesses are adversely impacting our performance at school or at work it is be important to address these issues so that we can succeed in an ever-increasing complex world. Academic underachievers who are not ADHD generally have executive skill weaknesses.

Cognitive-Behavioral Therapy (CBT)

What is CBT?
Cognitive Behavioral Therapy (CBT) is a psychotherapeutic approach that focuses on examining the relationships between dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic process. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people can modify their patterns of thinking to improve coping. CBT is different from traditional psychodynamic psychotherapy in that the therapist is problem-focused, and goal-directed in addressing the patient’s symptoms and in that the patient and therapist actively works together to help the patient develop more effective coping skills. 

Components of CBT
People often experience thoughts or feelings that reinforce or compound faulty beliefs. Such beliefs can result in problematic behaviors that can affect numerous life areas, including family, romantic relationships, work and academics. For example, a person suffering from low self-esteem might experience negative thoughts about his or her own abilities or appearance. As a result of these negative thinking patterns, the individual might start avoiding social situations or pass up opportunities for advancement at work or at school.   

The premise of cognitive behavioral therapy is that changing maladaptive thinking or in changing one’s relationship to maladaptive thinking leads to change in affect and in behavior. The individual’s therapist challenges the patient’s patterns and beliefs and replaces errors in thinking such as over-generalizing, magnifying negatives, minimizing positives and catastrophizing, with more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior, or to take a more open, mindful, and aware posture toward them so as to diminish their impact.

What is the CBT Process?
In order to combat destructive thoughts and behaviors, a cognitive behavior therapist begins by helping the client to identify the problematic beliefs. This stage is important for learning how thoughts, feelings and situations can contribute to maladaptive behaviors. The process can be difficult, but it can ultimately lead to self-discovery and insight that are an essential part of the treatment process. 

The second part of cognitive behavior therapy focuses on the actual behaviors that are contributing to the problem. The client begins to learn and practice new skills that can then be put into use in real-world situations. For example, a person suffering from drug addiction might start practicing new coping skills and rehearsing ways to avoid or deal with social situations that might trigger a relapse. 

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