Core intervention: Skill training

What is Skills Training?

In skill training, you will work with your client to create a concrete step-by-step plan to develop or expand skills that can be used instead of unhelpful behaviours. This can include household chores or planning and organizational skills.

When do you provide skills training?

When someone with ADHD encounters certain problems, it's advisable to look at behaviours or skills that may be causing or perpetuating these issues. This can apply in various settings, such as at home, in school, or at work.

The following topics can be relevant for skill training in ADHD:

1. Self-estimation in memory, accuracy, control, task execution, and planning. For instance, if someone frequently forgets things, is careless, or has difficulty maintaining a schedule.
2. Time estimation. For example, if someone is consistently late because they need more time to complete tasks.
3. Task estimation. For instance, if someone struggles to initiate studying or frequently procrastinates.
4. Cleaning, organizing, and structuring. For example, if someone has difficulty maintaining their household.
5. Impulsivity. For instance, if someone frequently gets into trouble due to impulsive decisions.
6. Frustration tolerance. For example, if someone frequently experiences anger outbursts at work.

How do you do skills training?

Before you begin skill training, it's important to first investigate the problems that someone with ADHD experiences in their daily life. You can inquire about recurring issues or non-helpful behaviours, or share information about common estimation problems in ADHD, impulsivity, or frustration tolerance. This initial assessment helps tailor the training to address specific challenges and needs.

Absolutely, it's valuable to investigate why the current behaviour exists or persists. Often, individuals engage in certain behaviours because they serve a purpose or provide some benefit. For instance, procrastination might offer short-term relief from stress, or change may be difficult to adapt to. Therefore, it's important to explore whether you can reintroduce certain benefits while developing skills. For instance, you can emphasize that completing tasks that take only 5 minutes immediately can also create a sense of calm, as opposed to procrastination. Subsequently, you can highlight the negative consequences and explore the potential positive outcomes of skill training.

In this form of skill training, non-helpful thoughts also play a crucial role. It's essential to explain to your client in advance the relationship between thoughts and behaviour and why this is a part of the intervention. You can use the Thought record as a tool, both for identifying non-helpful thoughts and for challenging and generating alternatives.
 

Finally, make as concrete as possible what will be practiced or changed. Make clear agreements and try to be as specific as possible. For example, schedule it, make it a new routine, monitor its success, and adjust it where necessary. Don't forget to encourage your client to stick to the changes!

For successful skill training, you can use the following step-by-step plan:

• Step 1: Describe the reason for starting skill training. What is your client currently doing or not doing, and what problems is this causing?
• Step 2: Identify the benefits of the old behaviour. What does your client gain from continuing this behaviour in the same way?
• Step 3: Identify non-helpful thoughts that sustain the old behaviour. For example, thoughts like "I can't do this" or "I don't have time for this.
• Step 4: Describe what you want to practice or change. What needs to happen to solve a problem or bring about a positive change?
• Step 5: Determine the motivation for this new behaviour. Why is it important to make this change?
• Step 6: Brainstorm alternatives to the benefits identified in Step 2. Is it possible to achieve the same benefits in a different way?
• Step 7: Identify the necessary steps to perform the new behaviour. What does your client need? What skills need to be employed? Is assistance required? When will it be considered successful?
• Step 8: Create a concrete and practical plan for implementing the new behaviour. Don't forget to evaluate it at the end. Use SMART goals to ensure that the plan is Specific, Measurable, Achievable, Relevant, and Time-bound.
• Step 9: Generate realistic thoughts for difficult moments. For example, "It gets easier once you start!" or "After this, you can do something enjoyable with a clearer mind!"

Example of a completed step-by-step plan:

• Step 1: Almost every evening, I order food to be delivered to my home. This is detrimental to my physical and mental health, and it's also costing me a lot of money.
• Step 2: I do this because I'm often stressed by the end of the day, and it's usually quicker and easier to order food than to cook a meal myself. I often forget to buy groceries as well.
• Step 3: I frequently think, "I don't have time for this" or "Cooking will only bring me more stress."
• Step 4: I want to start cooking healthy meals for myself to eat after work. To do this, I need to decide what I want to cook, purchase the necessary ingredients, and allocate time in the evening to cook.
• Step 5: Cooking for myself will save me a lot of money in the long run. This will alleviate some financial stress. Additionally, cooking for myself will help me eat healthier, improving my physical and mental well-being.
• Step 6: I can set aside time on Sunday evening to plan and prepare meals, as well as buy any required ingredients. This will save me time after work. I can also consider making larger portions to eat for multiple days instead of cooking every day.
• Step 7: I need to allocate time for planning and meal preparation. I must decide what I want to eat, what I need, and when I'll prepare it. I should avoid doing this during busy moments. If needed, I can seek assistance from friends.
• Step 8. Starting from 5:00 PM every Sunday evening, I'll allocate two hours to create a meal plan for the week. I'll then head to the local supermarket around the corner to buy the necessary ingredients and make any required preparations. First, I'll search online for what I want to cook and create a shopping list to ensure I don't forget anything. After work on Monday and Wednesday, I'll set aside enough time to cook a meal that will last for at least two evenings. While cooking, I'll play my favorite music.
• Step 9. Some helpful thoughts for me could be: "Once you start cooking, the stress will naturally fade away" or "After I finish cooking and enjoy something delicious and healthy, I can take pride in that and find peace in it too."

💡 How do you do skills training in NiceDay?

• Ask your client to record common problems or non-helping behaviours in the diary. Additionally, request them to write down the benefits of this behaviour.
• Assign your client to practice filling out Thought records throughout the week. (Tip: set up a daily notification!)
• Give homework to brainstorm motivation for developing or expanding skills and write it down in the diary.
• Assign homework to think of alternative benefits of old behaviour and write them down in the diary.
• Schedule skill practice as a (repeating) activity in NiceDay for your client. They can provide feedback on how it went.
• Create a list of helpful thoughts in NiceDay so your client can access them whenever needed.
• Use reminders in the form of notifications to have inspirational or motivating thoughts come up regularly.

Sources

• Vink, S. (2021). Cognitieve gedragstherapie bij volwassenen met ADHD. Handleiding voor therapeuten. BSL.
• Vink, S (2021). Los van de chaos. Werkboek voor cliënten. BSL.