ADHD and Child Psychotherapy 1/2: Therapeutic Activities

Social and learning problems for a young person diagnosed with ADHD frequently include peer rejection, conflictual family relationships, physical restlessness, inattention, impulsivity, aggression and emotional regulation difficulties. These can have a severe and negative impact on a child’s emotional state and their relationships. 

Integrative play-based therapy can provide opportunities to express and explore feelings. Therapy is also an opportunity for the young person with ADHD to be in a positive relationship, free for a short time from the structured learning which can make the school classroom such a fraught place. In the Integrative Therapy model, sessions are largely self-directed. A child will not have to work unassisted, or persist with work which they do not find interesting, or experience levels of frustration, persistence or concentration beyond their window of tolerance. The therapist is alongside the child, able to give frequent feedback, encouragement and relational contact.

The activities may be creative – such as painting or making things from playdough or clay. They can be physical, such as ball games, which allow for movement and the discharge of physical energy. These, along with some card and board games have a steadying, turn-taking rhythm to them, which helps a child to stay regulated. In the sessions, as therapist, I am focused on ‘imagining in’ to the child’s world, deploying empathy and asking myself, How does it feel to be you? 

In my work with 10-year-old Hakan, described in my book, I write about hitting an inflatable globe between us. This ball was light enough that no damage could be done to people or things. Sometimes, Hakan would talk about times he’d felt angry or frustrated. For example, when he had been given detention after being very rude to a cover teacher, protesting to me, “That man didn’t know that I have to sit in my special place when it’s maths!” Hakan thwacked the ball and it allowed for a sensory expression of his feeling. I could then reflect back how difficult this may have been, bearing witness to his frustration. 

The game was lively, and it was flexible. We could play ball competitively – a kind of tennis/volleyball – with mutually agreed boundary lines in the room. Or we could play co-operatively – aiming to keep the ball off the floor for as long as possible, passing it back and forth. We had a special chart on which to record our ‘top scores’. This chart was shared and accessible evidence of our mutually enjoyable activity.

Hakan also enjoyed blowing bubbles. We placed a bowl of soapy water on the floor, on a plastic sheet. We used straws to create a giant foam mountain together. We blew large bubbles, which required steady breath and concentration to make. Crucially, this game was fun: all children need to feel that they are accepted and valued for who they are, and that they can be enjoyable company. Hakan sometimes added various toys and objects to the water, creating an imaginary world from which stories could emerge through our shared ideas, some of which carried themes about his experiences. For example, a plastic puppy that he called Jumpy kept trying to swim across the bowl but needed regular rescuing from a lifeboat.

Creative activities, such as making stories, help to build a stronger sense of self. The child puts something uniquely theirs into the world that was not there before. They can feel the satisfaction of knowing I did that! Good self-esteem is crucial to building mutually enjoyable relationships, which in turn foster resilience.   

In my next blog, I will explore in more depth how therapy of this kind can have a positive impact on the child’s relationships with peers and teachers.

Tamsin Cottis’ recent book, How it Feels to be You: Objects, Play and Child Psychotherapy, is published by Karnac.