Cog-Fun intervention framework for ages 12-18
The Cog-Fun intervention consists of 17-20 weekly sessions, about one hour each, that include:
- Parent interview
- Assessment meetings with adolescent
- Individual treatment sessions with adolescent
- Parent guidance (2-4 sessions)
- Summary session with parents and adolescent
"He does not take responsibility for his schoolwork, hardly hands in assignments and shows up for tests unprepared…" "Her mess is all over the house…" "He keeps getting in trouble, like disrespecting the school principal or fighting with a friend…" "She's constantly arguing with us…"
These are all common complaints of parents of teenagers with ADHD. Most children diagnosed with ADHD will continue to demonstrate ADHD symptoms in adolescence. Teenagers are required to cope with numerous and complex tasks in school, insocial interactions with peers and in daily life l (e.g. obtaining a driver's license). Teenagers are expected, and usually aspire to deal with these tasks independently, receiving less assistance from their parents and taking more responsibility for their choices and actions. Typical ADHD characteristic ssuch as impulsivity, inattention and difficulty in self-management, make it hard for teenagers with ADHD to cope independently with these challenges. Research shows that these teenagers have a hard time completing school requirements, and their academic achievements often do not reflect their full abilities. They tend to have more confrontations with their parents and are at risk for being socially rejected. Teenagers with ADHD are more prone to risks and deviant activities such as substance abuse . Teen Cog-Fun was developed for teenagers with ADHD in order to promote successful coping with ADHD related difficulties and enable optimal functioning in daily life. Cog-Fun is based on theoretical and practical treatment models in occupational therapy.
Teen Cog-Fun Intervention: Guiding Principles
Teen Cog-Fun is based on the understanding that successful coping and optimal functioning are enabled by:
- Self-awareness of strengths and weaknesses
- Self efficacy – the belief in one's ability to achieve goals and overcome difficulties
- Executive strategies for coping with daily life challenges
- A supportive environment that clearly defines goals and provides appropriate support to achieve them
Application of guiding principles in Teen Cog-Fun intervention
Developing self-awareness and self-efficacy
In order to develop adaptive awareness that will support the teenager during the course of his life we address three major components:
- Socio-Educational component: Information combined with support from social environment enables the teenager to comprehend the ADHD related difficulties and to accurately attribute them to executive deficits and to one's abilities. In Teen Cog-Fun, information is provided to both adolescent and parents.
- Neurogenic component: Neurocognitive ability to discover the executive problem (e.g. ability to stop, notice and monitor experiences). In Teen Cog-Fun, considerable emphasis is placed on online awareness and self-monitoring during task performance.
- Psychogenic component: The emotional ability to face difficulties. Developing awareness of deficits must be done in a gradual manner, with appropriate time and support, and with a constant reminder of personal strengths and environmental coping resources. This process is individually tailored to the teenager's abilities to contain the knowledge of his/her deficits, with continuous boosts to self-efficacy. Self-efficacy is developed through awareness of personal strengths and abilities, and by guiding realistic goal setting that enables successful experiences.
Self-management strategy acquisition
Self-management strategies are organized actions that enable controlled behaviors required to meet environmental demands or to obtain personal goals. These strategies are used to overcome typical ADHD difficulties, for instance making a schedule in order to compensate for difficulties in time management or using relaxation techniques to cope with difficulties in emotional regulation. Strategies are acquired in the context of functional goals set by the teenager and defined as relevant to daily life. The teenager defines personalized goals (e.g. get up on time, manage time efficiently to fit in both schoolwork and social activities) and acquires relevant strategies during the process of goal attainment. The teenager acquires both general strategies that can be applied to a large variety of functional tasks (e.g. goal setting, planning and monitoring) and specific strategies that address his cognitive-emotional profile (e.g. recruiting effort, list making, time management and emotional regulation). Treatment methods include conversations, simulations and activities in a positive empowering atmosphere.
Adaptation and recruitment of environmental resources through parental guidance
The parents are significant partners in the treatment process. Teen Cog-Fun therefore includes a number of sessions designed to guide parents on promoting self-management of their teenage children. Parents are instructed on communication skills, promoting self-efficacy, realistic goal setting and environmental adaptations.
Publications
Fisher, O., Berger, I., Grossman, E. S., & Maeir, A. (2023). Mediated Online Awareness Among Adolescents With and Without ADHD: Using the Occupational Performance Experience Analysis (OPEA). OTJR: Occupational Therapy Journal of Research, 43(4), 600-607.
Berger, I., Grossman, E., Maeir, A., & Fisher, O. (2022). Weekly Calendar Planning Activity (WCPA): Validating a measure of functional cognition for adolescents with ADHD. The American Journal of Occupational Therapy, 76(6).
Levanon-Erez, N., Kampf-Sherf, O., & Maeir, A. (2019). Occupational therapy metacognitive intervention for adolescents with ADHD: Teen Cognitive-Functional (Cog-Fun) feasibility study. British Journal of Occupational Therapy, 82(10), 618-629.
Levanon-Erez, N., Cohen, M., Traub Bar-Ilan, R., & Maeir, A. (2017). Occupational identity of adolescents with ADHD: A mixed methods study. Scandinavian Journal of Occupational Therapy, 24(1), 32-40.
Levanon-Erez, N., & Maeir, A. (2014). The Teen Cog-Fun model of intervention for adolescents with ADHD. In I. Berger & A. Maeir (Eds.), ADHD- A transparent impairment, clinical, daily-life and research aspects in diverse populations. New York: Nova science publishers
Pollak, Y., Oz, A., Neventsal, O., Rabi, O., Kitrossky, L., & Maeir, A. (2016). Do adolescents with attention-deficit/hyperactivity disorder show risk seeking? Disentangling probabilistic decision making by equalizing the favorability of alternatives. Journal of Abnormal Psychology, 125(3), 387.
