Enhancing Self-Esteem and Social Skills in Children with ADHD

by Bruce Sabian, M.A.

This article originally appeared in The ADHD Report, a newsletter dedicated to education and research on ADHD produced by Dr. Russell A. Barkley.

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.