Cognitive, Interpersonal and Other Individual Therapies 339Attention deficit hyperactivity disorder
ADHD children and adolescents have short attention spans and difficulty
in repressing immediate, often inappropriate, responses to stimuli rather
than stopping and evaluating the best course of action. Cognitive therapy
should, in theory, be well suited to address this kind of difficulty. Self-
instructional programmes that attempt to slow down cognitive processing
to permit examination of alternative courses of action have, however, not
been especially effective. It is as if the very nature of the problem means
the capacity to activate a different approach to information processing is
absent. Behavioural programmes controlling immediate contingencies are
more effective, but less so than medication, and with smaller effect sizes
than in conduct disordered children and adolescents.
Social problem-solving skills programmes
Myrna Shure and George Spivack, in the USA, have developed perhaps
the most comprehensive intervention programme, called Interpersonal
Cognitive Problem Solving (ICPS). Many studies have shown that several
groups of children and adolescents lack interpersonal skills, especially
aggressive children and adolescents, rejected children and adolescents,
isolated children and adolescents with few friends and some depressed
children and adolescents. The ICPS programme concentrates on three core
cognitive processes that have been shown to be impaired:
1 Generation of alternatives: the ability to come up with several different
solutions to a problem situation.
2 Consequential thinking: the ability to see the immediate and longer-term
consequences of each line of action proposed, and incorporate this in
coming to a decision about the best response.
3 Means–ends thinking: the ability to distinguish the purpose of a plan of
action from its content, so ways round an obstacle can be devised if the
initial plan fails.
A variety of methods are used to foster these skills, including both indi-
vidual and group processes with games, discussion and group interaction
techniques. They can be applied even at preschool level, for example,
the words ‘or’ and ‘different’ are taught to help children and adolescents
think about alternative ways to tackle situations, for example, ‘I can
hit him or tell him I’m cross. Hitting is different from telling.’ As these
programmes have evolved, it has become evident that a number of core
skills in perceiving the mental states of others need to be developed in
many children and adolescents:
1 Emotional awareness. Becoming sensitive to the feelings and wishes of
others. Some children and adolescents may even be unaware of their
own basic feelings. As these are developed, they can be taught that
not everyone feels the same way about things, and that children and