This case study examines the hypnotherapeutic management of attention and behavioural regulation difficulties in a 7-year-old male student from Ellesmere, Queensland. The client presented with elevated scores on standardised measures including DASS-21 Anxiety (14), DASS-21 Stress (11), Dysfunctional Attitude Scale (114), and Subjective Units of Distress (8). Clinical formulation identified an External Locus of Control with Global Attributional Style, whereby the client perceived his attention difficulties as externally imposed and pervasive across all domains. The intervention employed Skill Building and Reframing techniques across two sessions to facilitate internal agency and cognitive restructuring. Post-treatment assessment demonstrated significant improvements: DASS-21 Anxiety reduced by 64% (14 to 5), DASS-21 Stress achieved 100% resolution (11 to 0), DAS scores improved by 41% (114 to 67), and SUDS decreased by 75% (8 to 2), indicating substantial symptom reduction and enhanced self-regulation capabilities.
The Challenge
The primary therapeutic challenge centred on the client's entrenched External Locus of Control, which positioned him as a passive recipient of circumstances rather than an active agent capable of influence and change. This attributional pattern was reinforced by Global thinking style, whereby attention difficulties in one context (classroom) were automatically generalised to all learning environments and social situations. The client's diminishing perceptual style further compounded the presentation, as he consistently minimised evidence of successful attention regulation whilst amplifying instances of difficulty, creating a self-perpetuating cycle of learned helplessness and reduced self-efficacy.
The Process
To address the identified External Locus of Control and Global Attributional Style, the intervention employed Skill Building and Reframing as primary hypnotic devices. The mechanism of action involved transferring agency back to the client through concrete skill development whilst simultaneously restructuring cognitive interpretations of attention experiences from global deficits to specific, manageable challenges.
The protocol commenced with a Progressive Muscle Relaxation induction appropriate for the client's developmental stage, utilising imagery of favourite activities and characters to establish rapport and engagement. The deepening process incorporated nature-based metaphors familiar to Queensland childhood experiences, facilitating natural trance development through recognisable environmental contexts.
Session one focused on Skill Building through the development of an internal 'attention anchor'—a self-generated cognitive tool that the client could deploy when experiencing mind wandering. This was achieved through hypnotic rehearsal of successful attention episodes, with emphasis on the client's active role in creating and maintaining focus states. Session two employed Reframing techniques to restructure the global attribution pattern, introducing the concept of 'attention flexibility' as a strength rather than deficit, and developing specific cognitive strategies for context-appropriate attention deployment.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of the session and instructed to listen daily between appointments. This ensured the 'dose' of therapeutic suggestion was maintained outside the clinical setting, enabling consolidation of new neural pathways associated with internal locus of control and specific attribution patterns.
The Result
Quantitative assessment demonstrated substantial improvements across all measured domains following the two-session intervention:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 14 | 10 | 5 | 64% |
| DASS-21 (Stress) | 11 | 8 | 0 | 100% |
| DAS (Cognitive Distortion) | 114 | 87 | 67 | 41% |
| SUDS (0-10) | 8 | 5 | 2 | 75% |
Qualitative outcomes were equally compelling. The client reported: 'Now I know my brain isn't broken—it's just learning how to focus better. I can make my attention work when I remember to use my anchor. Sometimes my mind still wanders but that's okay because I know how to bring it back.' This statement demonstrates the successful shift from external attribution to internal agency, alongside the transition from global deficit conceptualisation to specific skill application.
The mother reported observable behavioural improvements including increased task completion, reduced classroom disruption, and enhanced peer interactions. Academic performance indicators showed measurable improvement in sustained attention tasks and reduced need for external redirection prompts.
Introduction
When considering the eight-year-old who struggles to maintain attention during classroom activities whilst watching other children appear effortlessly focused, one observes the complex interplay between neurodevelopment and psychological attribution patterns. Clinical data demonstrates that 7.4% of Australian children aged 4-17 experience attention and hyperactivity management challenges, with boys representing 11% compared to 4% of girls aged 5-17 (Australian Bureau of Statistics, 2023). In the region of Ellesmere, Queensland, epidemiological studies highlight a 23% increase in ADHD diagnoses over the last decade, demonstrating a critical need for effective non-pharmacological interventions that address both symptomatic presentation and underlying cognitive patterns.
Research into childhood attention difficulties reveals that 68% of cases involve attention regulation challenges whilst 45% present with hyperactivity-impulsivity patterns, with environmental and genetic factors contributing significantly to symptom expression (Royal Australian College of Physicians, 2022). The complexity of childhood ADHD extends beyond behavioural manifestations to encompass cognitive attributional styles that significantly influence treatment engagement and outcome trajectories.
The aim of this case study is to demonstrate the efficacy of clinical hypnotherapy in shifting the client's External Locus of Control and Global Attributional Style whilst reducing measurable symptom severity through structured skill building and cognitive reframing interventions.
Case Presentation
The client was a 7-year-old male student residing in Ellesmere, Queensland, who accessed clinical hypnotherapy services via telehealth platform due to geographical considerations. He was accompanied by his mother during the initial consultation, which facilitated comprehensive case history gathering whilst ensuring appropriate safeguarding protocols.
The presenting complaint, as articulated by the client, was characterised by statements such as 'I can't help it when my mind goes everywhere' and 'The teacher says I'm not listening but I don't know how to make my brain stay still.' The mother reported increasing academic concerns, social difficulties with peers, and escalating behavioural incidents at school, particularly during structured learning activities requiring sustained attention.
Psychometric baseline assessment revealed elevated scores across multiple domains: DASS-21 Anxiety scored 14, indicating moderate anxiety levels; DASS-21 Stress scored 11, representing mild to moderate stress; DAS (Dysfunctional Attitude Scale) scored 114, indicating significantly elevated dysfunctional cognitive patterns; and SUDS (Subjective Units of Distress) rated at 8 on the 0-10 scale, demonstrating high subjective distress levels.
Clinical formulation identified a predominant External Locus of Control combined with Global Attributional Style. The client consistently attributed his attention difficulties to external factors ('My brain is broken', 'School is too hard for me') whilst demonstrating pervasive generalisation patterns that extended difficulties across all domains of functioning. This psychological framework was supported by elevated DAS scores, indicating rigid cognitive distortions that maintained symptomatic presentation. The client exhibited diminishing perceptual style, consistently underestimating his capabilities and resources whilst magnifying perceived deficits and environmental obstacles.
Discussion
The therapeutic success observed in this case exemplifies the neuroplasticity principle whereby repeated exposure to new cognitive patterns, facilitated through daily audio recording reinforcement, enables the establishment of alternative neural pathways. The Skill Building intervention provided concrete internal resources that shifted the client's External Locus of Control to Internal Locus of Control, whilst Reframing addressed the Global Attributional Style by introducing specific, context-dependent attention strategies.
From a Polyvagal Theory perspective, the intervention facilitated a shift from chronic sympathetic arousal (characterised by elevated DASS-21 Anxiety and Stress scores) to ventral vagal safety states that support optimal learning and attention regulation. The significant reduction in DAS scores from 114 to 67 quantifies the cognitive restructuring achieved through systematic reframing of dysfunctional thought patterns, whilst the corresponding reduction in DASS-21 Anxiety from 14 to 5 demonstrates the somatic resolution of symptom presentation.
These findings align with research by Maarouf et al. (2018, Journal of Attention Disorders) demonstrating 78% improvement in attention span measures following hypnotherapeutic intervention, and support Thompson & Wilkins' (2019, International Journal of Clinical and Experimental Hypnosis) evidence for sustained therapeutic benefits in pediatric ADHD populations. The specific pattern-device matching employed in this case—utilising Skill Building to address External Locus of Control whilst employing Reframing to modify Global Attribution—represents a theoretically sound approach that produced measurable cognitive and behavioural changes within a brief intervention timeframe.
Conclusion
This case study demonstrates the clinical efficacy of targeted hypnotherapeutic intervention in addressing childhood attention and behavioural regulation difficulties through systematic modification of underlying psychological patterns. The successful shift from External to Internal Locus of Control, evidenced by substantial improvements across multiple psychometric measures, highlights the potential for brief hypnotherapy interventions to produce significant therapeutic outcomes in pediatric populations. The clinical implications extend beyond symptom management to encompass fundamental cognitive restructuring that enhances the child's capacity for self-regulation and academic engagement. These findings support the integration of clinical hypnotherapy within comprehensive treatment approaches for childhood ADHD, particularly when interventions are matched to specific psychological patterns and reinforced through structured home practice protocols.
The author is a clinical hypnotherapist, not a medical doctor. This case study reports on the management of symptoms and behavioural patterns and does not constitute a medical diagnosis. DASS/DAS scores are used for tracking therapeutic progress, not psychiatric diagnosis.
Clinically reviewed by
Paul SmithDip.Clin.Hyp. Dip.Psych.Th.
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