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:
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Neurocognitive Module teaches techniques to improve attentional control, memory,
impulse control and develop skills in constructive planning;
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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;
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Emotional Control Module teaches managing thoughts and feelings of anger and
anxiety;
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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.
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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
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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:
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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:
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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
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