The Intervention is intended for children aged 5-10.
Therapist-parent/intake meeting: Since the parent is a central change agent, therapy begins with in-depth introductory meetings with the child's parents. They are asked about the family, immediate and extended, developmental, medical, and educational background, whether there is an ADHD diagnosis, by whom and whether medication is taken. Clarification is made about the existence of additional diagnoses and whether they are being treated by a qualified medical professional. Subsequent meetings address the family's daily routine, home and extracurricular functioning, parental beliefs about ADHD, exploration of family resources (financial, recreational, time and referrals, social resources, etc.), concerns about their child, the parents' and their child's strengths and preferences, and their expectations from therapy. Questionnaires about the child's executive functioning difficulties and parental self-efficacy are administered. General initial intervention goals are then established.
During the intervention, additional meetings are held with parents without the child.
As the intervention approach requires significant commitment and weekly sessions over about 17 consecutive weeks for the child and parent(s), clarification is made with the parents regarding their readiness, whether the family is currently experiencing a crisis/transition/child's health condition or someone in their family reflecting instability. After obtaining a comprehensive picture of the child and their family and verifying that the family indeed seeks continuous intervention, the intervention begins.
Evaluation and acquaintance meetings with the child: The intervention starts with two introductory meetings with the child, during which the therapy routine is modeled: the structure of the meeting and the accompanying management aids, which serve as environmental supports for self, environmental, and interpersonal management. Explanation and practice are given about planning a meeting on a whiteboard, using a timer, recognizing a pre-agreed sign in the room when something is "uncomfortable" and a sign for "pleasant/fun", familiarization with the meeting structure starting with a conversation and ending with a written summary (in a notebook/phone photo). Additionally, a "resources" box is presented to the child, where the strategies learned in the sessions will be placed. In the second acquaintance meeting, the management aids acquired in the previous meeting are reviewed, and when this meeting explicitly addresses the child's strengths, things they enjoy and are interested in, a structured interview is conducted with the child about their strengths using the PICME interview. The child's parents are encouraged to attend this meeting after preparing a list of their child's strengths and abilities in advance. At the end of the meeting, the child and their parents are encouraged to pay attention to actions and situations in which the child succeeds, write it on a note, and put it in the resources box, which also accommodates successes. Sometimes, modeling of how to give feedback on success is done, and how to write a success note.
Intervention units - Acquisition of management strategies: The therapy focuses on intervention units where management strategies are acquired, and each strategy is accompanied by the guidance of the therapist. The strategies are acquired in the following sequence: a strategy for delaying a response "Mr. Stop"; for checking and monitoring - "Mr. Check"; for asking for help - "Mr. Asking for help"; for recruiting effort for initiative and perseverance - "Mr. Effort"; for emotional regulation - "Mr. Feeling" and "Mr. Calm", and for self-management in a social context - "Mr. Social" Sometimes, with older children, the planning strategy is learned - "Mr. Planning". Each strategy is accompanied by a verbal and visual symbol/representation. The number of strategies acquired and the duration of acquisition of each strategy vary and are flexible and tailored to the severity of the management difficulties, the availability of supports and external resources such as pharmacological treatment, environmental supports required in the physical, human environment and in tasks provided by the child's parents and others, the focused relationship enabling positive occupational development, and adaptive awareness development. The last meeting with the child focuses on summarizing the process, celebrating the child's achievements, an activity consolidating the use of acquired strategies, celebrating achievements/goals reached, and resources acquired for the empowerment of the child and their parents.
Parental guidance: Throughout the intervention, meetings are held with the child's parents separately to strengthen and empower them in the process and support their commitment to the interventions. Clarification is made about their understanding of the diagnosis and the child's difficulties, acquisition of psycho-education about the diagnosis and about expected function at different developmental stages, as well as understanding their role as health managers of their child, supporting the child's function by creating management routines and his constant empowerment. In this meeting, additional thinking is done about the intervention goals. The meetings aim to support the parent, strengthen their abilities, help them implement what was learned in the meetings, and refine expectations. Additionally, in these meetings, clarification is made about the available supports for the parent, when and how they can utilize resources, allocate time for self-care and resource replenishment, necessary for their well-being. The frequency of meetings is adjusted to the family's needs and at the therapist's discretion.
Home visit: In the middle of the intervention process, a meeting is held in the child's natural environment - their home, where the acquired strategies are implemented, accompanied by environmental adjustments that have been made or that we want to promote in the child's home. "Mini-goals" raised in therapy are practiced, some are even simulated in the therapy room and transferred to their home. This meeting is designed to empower the child as the "host" and conduct the meeting with the help of supports that they are familiar with - a board, timer, activity planning, etc. It is also intended to help the parent understand their role in providing assistance and adjustments to their child in their home.
Summary: At the end of the intervention, a summary conversation is held with the child's parents about what has been achieved, and whether and how they see continued engagement or follow-up with the therapist or referral to additional frameworks.
It is important to ensure that the parent maintains contact with a medical health manager (pediatric neurologist/child psychiatrist/developmental pediatrician/pediatrician with expertise in ADHD) regarding accompanying conditions, supports from additional treatments and/or pharmacological intervention, etc.
