https://www.msu.

edu/course/cep/888/ADHD%20files/S
top%20&%20Think.htm
STOP and THINK
Cognitive-Behavioral Therapy for Impulsive Children
Phillip C. Kendall (1992)
Description of Treatment:

 Each individual session involves the therapist teaching the child to use
the problem-solving process.
 20-sessions; 50 minutes each session. Program may be extended by
increasing the number of role-play sessions near the end of the
treatment program.
 The therapist uses self-instructional procedures via coping and
modeling while working on a variety of impersonal and interpersonal
tasks.

Initial tasks are psychoeducational and similar to tasks used in school

 Purpose: Foster the acquisition of the problem-solving steps and rules

for earning STOP and THINK dollars.

Middle sessions shift emphasis to interpersonal play situations and

appropriate use of problem-solving steps.

 Purpose: Gradual build-up to assure that the child has first learned and
understands the use of the problem-solving steps.

Final series of sessions deal with the child’s particular behavior problems
and involve role playing of alternative solutions to specific problematic
situations.

 Purpose: Apply problem-solving steps to emotionally arousing

situations.

Components of Program:

 Response-cost contingencies for violations of the agreed upon “therapy

rules” operate throughout each session.
  STOP and THINK dollars—called points. Begin each session with 20
points. The child can lose points by:
o Going too fast in workbook.
o Forgetting to say a step to solve each task.
o Saying the wrong answer to a task or problem.
 My Reward Shop—allows child and therapist to create an agreed-upon
set of rewards that can be earned.

Session 1: Getting Started

Purpose: Give the child an initial exposure to the problem solving process
that will enable the child to:

1. See how the steps can be sued to “STOP and THINK” before attempting to
solve problems
2. Cope with those inevitable mistakes that everyone makes
3. Provide self-reinforcement for thinking and reflecting as an active problem-
solver.
4. Acquaint child with the STOP and THINK dollars (points), reward menu
and the contingencies.

Session 2: Following Directions

Purpose: Give child skills that can be effectively used in problem-solving

during future sessions. The purpose is twofold:

1. To provide practice materials that directly attack the target area of carefully
following direction
2. To serve as a foundation for later sessions as the child learns to self-instruct
or self-direct himself/herself to “STOP and THINK”.

Session 3: Multiple Tasks

Purpose: Continued opportunities to rehearse and use the problem-solving

steps.
Tasks are more verbal, and may require more advanced thinking for some
children.

Session 4: Arithmetic

Purpose: For the child to learn to apply the self-directed steps to grade-
appropriate
mathematical questions to solve them in a logical and reflective manner.

Session 5: Which is less? Which is more?

Purpose: Use similar tasks as presented in the first four sessions with a greater
emphasis on the relationship between SAYING the steps and DONG the
steps.

Session 6: Word Search

Purpose: Self instructions are implemented to facilitate and improve the

focusing and
use of a strategy by reducing the haphazard, fast, trial-and-error approach
and
practicing the well-thought-out, systematic approach. This session provides
experience
in using the cognitive-behavioral strategy as:
1. A tool for approaching problems
2. A tool for solving more abstract puzzles.

Session 7: Bring Your Own

Purpose: The purpose is three-fold:

1. To provide the opportunity for the application of the verbal self-
instructional problem-solving to each child’s specific weakness.
2. To provide the opportunity to make a direct link between the problem-
solving skills and their use in schoolwork
3. To help children see the application of the STOP and THINK procedure on
materials form outside the therapy/workbook focus.

Session 8: Checkers

Purpose: Apply the self-instructions to a situation bridging the workbook-type

task and
the social situation. In addition, as the therapist-child relationship develops,
the
therapists has the opportunity to further inquire about the personal dilemmas
of the
child.

Session 9: Cat and Mouse

Purpose: Further facilitate the transition of the training to interpersonal

situations.

Sessions 10 to 12: Dealing with Emotions

Purpose: These sessions deal with the recognition of “feelings” in the area of
interpersonal behaviors.
Sessions 13 and 14: The Consequences of Behavior

Purpose: The child learns to generate not only the alternate ways to handle
hypothetical social situations, but also to think about the consequences of the
various
alternatives. The purpose of these sessions is to:
1. Encourage the child to cope with problems or situations which involve the
inhibition of impulses
2. Help the child examine ways he/she could modify his/her behavior in social
situations
3. Help the child to consider the consequences of his/her actions
4. Help the child to approach interpersonal situations in a self-controlled
manner

Sessions 15 and 16: Role Plays

Purpose: The child works to find the best solution to a role-played social
problem.

Session 17: You’re the Expert

Purpose: Allows the child to own the ideas, put them into his/her own frame of
reference, and make a commercial to tell other kids about STOP and THINK.

Session 18: Let’s Review

Purpose: To provide an opportunity for the individual child to review the

areas in need of special practice.

Sessions 19 and 20: Making the Commercial

Purpose: To allow the child to be the expert and demonstrate for others the
new skills
he/she has learned.

Does Stop & Think address the core features of ADHD?

Some of the core features of ADHD include:
• Attention Deficits
• Hyperactivity
• Impulsivity
• Distractibility
• Poor Self-Regulation
• Negative Interactions with Adults and Peers
Stop & Think explicitly targets:

 Impulsivity is addressed in a number of ways. The primary treatment

goal is to help children develop a series of problem solving steps
through explicit teaching and modeling. The four steps are as follows:
1. “What am I supposed to do?”
2. “Look at all the possibilities.”
3. “Pick out an answer.”
4. “Check out an answer.”
 Children are also taught skills to combat impulsivity including:
o Following directions
o Slowing down and focusing in
o Using strategies to solve problems
 General Self-Regulation
o Poor self-regulation is targeted by introducing a response-cost system
(Stop & Think Dollars).
o Students earn dollars for completing tasks, doing homework and for
accurately rating their behavior
o The response cost system shifts from behavior management to
reinforcing thoughtful and systematic problem solving
 Emotional Regulation
o Emotional regulation is taught through helping students to:
o Recognize feelings
o Identify feelings
o Understanding where feelings come from
o Understand how to respond appropriately to feelings

 Negative interactions
o The program affords children the opportunity to have a successful
and reinforcing relationship with an adult in their school setting
o The program helps children allows children to develop the skills to
develop and maintain relationships with their peers
 Using Language to Mediate Behavior
o The program teaches children to use language to work though
general, academic, and social issues

Features of ADHD Not Addressed by the Program:

Stop and Think does not address:
• Inattention: the program doesn’t include strategies for maintaining attention.
In fact, the program is designed to take place over 50 minute sessions, which
might be too long for a child with ADHD.
• Hyperactivity: the program doesn’t address the physical symptoms like
motor agitation, excessive movement, leaving one’s seat, and wandering
around the room that impact classroom performance
• Academic Difficulties: the program doesn’t work with the academic skill
deficits that often accompany ADHD.
• Social Skills Deficits: the program doesn’t address the social skills deficits
that go along with ADHD like, irritability in young children, poor
understanding of social norms, poor listening skills, and impaired ability to
read nonverbal cues

Is Stop & Think developmental in nature?

Stop and Think is clearly designed for children in middle to late
elementary school.
The program requires:
• Abstract Reasoning
• Reading long passages
• Written responses
• Multiple digit addition and subtraction
• Awareness of patterns in math

Developmental Strengths of the Program:

• Teaching Strategies: Stop &Think includes: concrete instruction with
examples, physical reminders of notecards and fingers, reteaching and
repetition, modeling, and role play activities.
• Teaching about Feelings: Stop & Think takes into account that children may
need explicit teaching about feelings (ex: the program includes creating a
Feelings Dictionary)
• Interest in Social Activities: Stop & Think capitalizes on children’s
awareness of and interest in social activities.
• One on One: Stop & Think is designed to be completed with the therapist
and one child, which makes behavior management with active children much
easier.

Developmental Weaknesses of the Program:

Abstract Reasoning: Stop & Think requires abstract reasoning and perspective
taking, which may be difficult for younger children, particularly those
children with ADHD who may have problems with juggling multiple
perspectives.

 Children are asked to remember four steps and repeat them as

necessary.
o Some of the activities require abstract reasoning to complete (e.g.,
Checkers, the game of Cat and Mouse)
o Children are expected to engage in role plays, which require
perspective taking and awareness of others’ feelings.
Prerequisite Academic Skills: As a treatment for ADHD, Stop &
Think doesn’t take into account the difficulty children may have with
academic skills.

 Children are required to read long passages, write responses, solve

academic tasks, and use addition and subtraction to keep track of their
dollars.

Language Orientation: Stop & Think is based on using language and thoughts
to control behavior. For younger children with ADHD, this may be too
sophisticated and abstract.

Time Requirements: Stop & Think was designed to be completed in 50 minute

sessions, which may be far too long for children with ADHD.

Sustained Attention: Stop & Think doesn’t address difficulty of maintaining

attention, particularly for younger children.

Homework: The STIC (Show That I Can) tasks might be challenging for
children with ADHD to complete and return.

Noncompliance: Beyond the response cost system, Stop & Think doesn’t
provide support with noncompliant children.

Interest Level: As children mature, the Detective Dan character might be too
immature for students to take seriously.