R&R2 FOR ADHD YOUTHS AND ADULTS A PROSOCIAL COMPETENCE TRAINING PROGRAM The "R&R2 for ADHD Youths and Adults" is a cognitive behavioural training program that provides specific techniques to target the cognitive, attitudinal, emotional and behavioral difficulties that are associated with ADHD symptoms – problems that often limit individuals’ academic performance and lead to their engaging in various disruptive or anti-social behavior at home, in school or in the community. Program Targets: The highly structured, manualized, small group program is designed for youths and adults (age 13+) who evidence inattention, impulsivity, poor concentration, and/or hyperactivity - not only individuals who have been diagnosed with ADHD, but the much larger population of individuals who may not have been diagnosed but are exhibiting behavior problems and evidence some or all of the ADHD characteristics. The program has been specifically designed for those adolescents and adults with attentional problems and impulse control problems and lack essential prosocial skills and values – individuals who may evidence not only antisocial behaviour but poor interpersonal relationships, educational underachievement, employment problems and/or other social, financial or legal difficulties that reflect a lack of prosocial competence. The program also targets those youths and adults whose antisocial behavior involves delinquency or crime. However, it is designed not only for those under the supervision of community criminal justice agencies or those in institutions, but also for the very large population of youth who have not (or not yet) been adjudicated in juvenile or adult court. The vast majority of such ‘at risk’ and antisocial youths are not found in the criminal justice system or in the juvenile justice system but are ‘under the care’ of social agencies in community or residential ‘treatment’ placements. Many are to be found in community schools where their problems create academic and behavioural difficulties for themselves, for their teachers and for other pupils. Youths and Adults: Most people with ADHD will gradually experience an improvement of symptoms with maturation. Nevertheless, although their ability to attend to information and remain on task may have improved, “graduates" of childhood ADHD are likely to retain a learned sense of helplessness reinforced by years of failure. Although their symptoms may improve, the improvements may come too late to prevent their acquisition of patterns of dysfunctional and/or antisocial behavior that have been called the “hangover” of ADHD (Young, 2003). Many will follow an increasingly antisocial trajectory. Accordingly, the R&R2 ADHD program was designed in such a way that it will be helpful for individuals who no longer have residual symptoms of childhood ADHD but can benefit from acquiring the academic skills, the cognitive/emotional skills and the behavioral coping skills that are taught in the program in order to accelerate their development of prosocial competence. The program spans a broad age range but is designed to be taught in age-appropriate groups, e.g. 13-15, 15-18, 18-25 etc. Thus the program enables maximum flexibility for Trainers so that they may be applied at the most appropriate developmental level of the participants. Younger children (age 8-12) can be trained using the children’s version (in development). Program Development: The program is based on the "Reasoning and Rehabilitation" (R&R) program (Ross & Ross, 1986), that has been delivered over the past 21 years to more than seventy thousand at risk and antisocial individuals in seventeen countries. The efficacy of R&R has been demonstrated in numerous independent, international evaluations and through comprehensive reviews, cost-benefit analyses and metaanalyses. The R&R2 ADHD program is a specialized version of R&R that includes much greater emphasis than R&R provides on the core dimensions of ADHD - particularly concentration, attention, memory and impulse control. The program has been developed through the collaboration of Dr Susan Young, Clinical Psychologist and Clinical Neuropsychologist, at the Institute of Psychiatry in London and Professor Robert Ross, University of Ottawa, the author of the original R&R program. The R&R2 ADHD program has been successfully field-tested at the Maudsley Hospital in the London between 2005 and 2007. Program Design: The program has 15 sessions. Each session requires 90 minutes of training (with breaks) and includes homework tasks. Sessions may be delivered once a week or more. The programs provide specifically designed neurocognitive skills training techniques to improve attentional control, memory, and impulse control and to develop achievement strategies by learning constructive planning and coping techniques. It also provides training in the social cognitive/emotional/behavioural skills and values that are taught in the R&R program. There are five modules presented over the 15 sessions: - Neurocognitive Module teaches techniques to improve attentional control, memory, impulse control and develop skills in constructive planning; - Problem Solving Module teaches a process of skilled thinking as opposed to automatic thinking - scanning for information, problem identification, generating alternative solutions, consequential thinking, managing conflict and making choices; - Emotional Control Module teaches managing thoughts and feelings of anger and anxiety; - Social Skills Module teaches recognition of the thoughts and feeling of others, both verbal and nonverbal, social perspective taking and the development of empathy, negotiation skills and conflict resolution. - Critical Reasoning Module teaches participants that they have choices to make in life, that there are alternative possibilities, and trains them in effective skills in thinking and behaving, in evaluating options, and in making good choices. PAL: The program also introduces a unique coaching system, whereby patients identify a Participant Aid for Learning [PAL] with whom they meet between sessions. The PAL may be a friend, family member, social worker or keyworker. Their function is to 2 reinforce what the patient has learned in the session and encourage the person to apply the new skills outside the session. Booster Program: Booster sessions have also been developed for the program which enable review and unlimited extended training in keeping with the importance of 'throughcare" for antisocial individuals. Assessment: The program kit also includes a well validated screening measure to determine the suitability of individuals for the program: the “RATE”. It is specifically designed to identify individuals whose antisocial behavior is associated with symptoms of ADHD. The "RATE" can also serve as a pre-post program measure of program efficacy. The RATE scales assess the behaviors, attitudes and feelings of the individual and the items are classified according to four scales: ADHD symptom scale Emotional problem scale Antisocial behaviour scale Social functioning scale Program Kit: The materials for conducting the program are presented in a program kit that includes the following: A Program Handbook that articulates the program principles and procedures for delivering the program. RATE assessment forms and scoring keys. A Program Manual that provides complete and detailed step-by-step instructions for delivering the program. A CD that presents PowerPoint slides for each session, a number of mystery games for practicing acquired thinking and problem-solving skills. The CD includes two MPEG movies that form the basis for in-class exercises in applying various social cognitive emotional skills and values that are taught in the program. A Training Video of Dr. Young teaching the program in a setting for mentally disordered offenders. Participants Workbooks – each participant recives a workbook that summarizes what is taught in each session and provides materials for in-session exercises and instructions for homework. PALs Guides – each PAL receives a manual of instructions for each session and a guideline for his/her role in the program Booster Program Manual – complete instructions for delivering the Booster program Booster Program Participants Workbooks Certificates of Achievement A variety of cards including wallet-sized cards for participants that list the steps that they are trained to follow in solving problems. A Session Record Form Program Report Form Inquiries: Information on training requirements, accreditation and training opportunities can be obtained through the Cognitive Centre of Canada: cogcen@canada.com 3