This case study examines the application of clinical hypnotherapy in managing childhood ADHD through cognitive restructuring interventions. A 13-year-old male student presenting with attention regulation difficulties, elevated stress responses, and external locus of control patterns received four sessions of targeted hypnotherapy utilising skill building and reframing devices. Pre-treatment psychometric assessment revealed DASS-21 Anxiety score of 10, Stress score of 18, DAS score of 118, and SUDS rating of 6. The intervention focused on shifting from external attribution patterns to internal locus of control through structured cognitive reframing and self-regulation skill development. Post-treatment outcomes demonstrated significant improvements: 70% reduction in anxiety (DASS-21: 10→3), 94% reduction in stress (DASS-21: 18→1), 34% improvement in dysfunctional attitudes (DAS: 118→78), and complete resolution of subjective distress (SUDS: 6→0). The findings support the efficacy of hypnotherapeutic interventions in addressing the underlying cognitive patterns that maintain ADHD symptomatology in children.
The Challenge
The primary therapeutic challenge centred on the client's deeply entrenched External Locus of Control, which manifested as a fundamental belief that his attention and behaviour were entirely beyond his conscious influence. This attribution pattern had been reinforced through years of struggling with ADHD symptoms, creating a learned helplessness response that significantly impacted his motivation to engage with therapeutic interventions.
The Process
To counteract the External Locus of Control and shift the client towards internal attribution patterns, the hypnotic devices of Skill Building and Reframing were strategically implemented across four sessions. The mechanism of action focused on transferring agency back to the client by developing concrete self-regulation skills whilst simultaneously restructuring his cognitive framework about his capabilities and potential for change.
The therapeutic protocol commenced with a Progressive Muscle Relaxation induction to establish neurological calm and enhance receptivity to suggestion. This was followed by a counting deepener that incorporated embedded suggestions about the client's natural ability to focus and direct his attention purposefully. The primary intervention utilised Skill Building techniques to develop specific attention regulation strategies, including breath awareness, cognitive anchoring, and internal dialogue modification.
The Reframing device was employed to restructure the client's interpretations of his ADHD-related experiences, shifting from deficit-based language ('I can't focus') to strength-based perspectives ('I'm learning to direct my attention more effectively'). Each session incorporated post-hypnotic suggestions that linked these new skills to specific academic and social contexts, enabling generalisation beyond the therapeutic setting.
To facilitate neuroplasticity through repetition and reinforcement, the client was provided with a digital audio recording of each session and instructed to listen daily between appointments. This ensured the 'dose' of the therapeutic suggestion was maintained outside the clinical setting, with research demonstrating that daily exposure to hypnotic suggestions significantly enhances neurological integration and behavioural change in children with ADHD.
Session content progressively built upon previous interventions, with each appointment introducing increasingly sophisticated self-regulation strategies whilst reinforcing the fundamental cognitive shift from external to internal locus of control. The final session incorporated future pacing techniques to anchor the new attention regulation skills across various academic and social scenarios.
The Result
Quantitative assessment revealed significant improvements across all measured domains following the four-session intervention:
| Measure | Baseline | Mid-Treatment | Post-Treatment | % Change |
|---|---|---|---|---|
| DASS-21 (Anxiety) | 10 | 7 | 3 | 70% |
| DASS-21 (Stress) | 18 | 12 | 1 | 94% |
| DAS (Cognitive Distortion) | 118 | 91 | 78 | 34% |
| SUDS (0-10) | 6 | 3 | 0 | 100% |
The most notable improvement occurred in stress management, with the DASS-21 Stress subscale demonstrating a 94% reduction from 18 to 1, indicating movement from severe stress levels to well within the normal range. Anxiety levels showed substantial improvement with a 70% reduction, whilst the DAS score improvement of 34% reflected significant cognitive restructuring away from dysfunctional thinking patterns.
Qualitative feedback from the client demonstrated the cognitive shift achieved through the intervention. At post-treatment assessment, he stated: 'I used to think my brain was just broken and there was nothing I could do about it. Now I know I have these tools that actually work, and I can choose to use them when I need to focus. It's like I finally have some control over my own mind.' This statement reflects the successful transition from external to internal locus of control that was the primary therapeutic target.
Introduction
Attention Deficit Hyperactivity Disorder represents one of the most prevalent neurodevelopmental conditions affecting Australian children, with clinical data revealing that 7.4% of Australian children aged 4-17 experience ADHD-related challenges. In the Northern Beaches region of Narraweena, New South Wales, this translates to significant demands on educational and therapeutic resources, with boys being disproportionately affected at rates of 11% compared to 4% in girls aged 5-17. Statistical analysis reveals a 23% increase in ADHD diagnoses over the past decade, highlighting the urgent need for effective non-pharmacological interventions that can address the underlying cognitive and emotional regulation patterns.
Traditional approaches to childhood ADHD management often focus on symptom suppression rather than addressing the foundational cognitive distortions and attributional styles that maintain the condition. Research demonstrates that children with ADHD frequently develop external locus of control patterns, where they attribute their attention difficulties to unchangeable factors beyond their influence, leading to learned helplessness and reduced self-efficacy. This psychological pattern, when combined with negative expectancy about their ability to focus and regulate behaviour, creates a self-perpetuating cycle of academic and social difficulties.
Clinical hypnotherapy offers a unique approach to ADHD management by accessing the neuroplasticity of the developing brain to restructure these underlying cognitive patterns. The aim of this case study is to demonstrate the efficacy of clinical hypnotherapy in shifting a client's external locus of control and negative expectancy patterns whilst reducing ADHD-related symptom severity through measurable psychometric outcomes.
Case Presentation
The client was a 13-year-old male student from Narraweena, New South Wales, who presented for clinical hypnotherapy following ongoing challenges with attention regulation, emotional reactivity, and academic performance. The client described feeling 'completely out of control' of his focus and behaviour, stating that his brain 'just doesn't work properly like other kids.' He reported significant frustration with his inability to complete homework tasks, frequent conflicts with teachers about missing assignments, and social difficulties stemming from impulsive behaviour patterns.
Psychometric assessment at intake revealed elevated scores across multiple domains. The DASS-21 Anxiety subscale indicated a score of 10, representing moderate anxiety levels significantly above the normal range for his age group. The DASS-21 Stress subscale showed a score of 18, indicating severe stress levels that were impacting his daily functioning. The Dysfunctional Attitude Scale (DAS) revealed a score of 118, demonstrating elevated cognitive distortions and rigid thinking patterns about his capabilities and future prospects. The Subjective Units of Distress Scale (SUDS) indicated a baseline rating of 6 out of 10, reflecting substantial emotional distress related to his ADHD symptoms.
Clinical formulation revealed a predominant External Locus of Control combined with Stable/Global Attributional Style and Negative Expectancy patterns. The client consistently attributed his attention difficulties to immutable factors such as 'having a broken brain' or 'being stupid,' demonstrating minimal awareness of his own agency in managing attention and behaviour. His responses on the DAS particularly highlighted beliefs that his worth was dependent on academic performance and that making mistakes was catastrophic. This external attribution pattern was reinforced by his tendency to magnify perceived failures whilst diminishing his successes, creating a cognitive framework that maintained his ADHD symptomatology.
The client exhibited characteristics consistent with Low Tolerance to Ambiguity, becoming highly distressed when faced with uncertain outcomes or open-ended tasks. His Future Orientation was predominantly negative, frequently catastrophising about upcoming academic challenges and social situations. These cognitive patterns, as evidenced by his elevated DAS score, created a psychological environment where attention regulation became increasingly difficult due to the emotional arousal generated by his dysfunctional beliefs about his capabilities.
Discussion
The significant improvements observed in this case study can be understood through the lens of neuroplasticity and the brain's capacity for adaptive change during adolescence. The daily audio reinforcement provided between sessions facilitated the consolidation of new neural pathways associated with self-regulation and attention control. Research indicates that repetitive hypnotic suggestions delivered consistently over time create measurable changes in brain structure and function, particularly in regions associated with executive attention and emotional regulation.
From a Polyvagal Theory perspective, the client's initial presentation suggested chronic activation of the sympathetic nervous system, evidenced by his elevated stress and anxiety scores. The hypnotherapeutic intervention facilitated a shift towards ventral vagal activation, creating the neurophysiological foundation necessary for improved attention regulation and emotional stability. This is reflected in the dramatic 94% reduction in stress levels, indicating successful nervous system regulation.
The substantial improvement in the client's DAS score from 118 to 78 represents successful cognitive restructuring away from the rigid, self-defeating thought patterns that maintained his external locus of control. This cognitive shift was directly linked to the resolution of ADHD symptoms, as evidenced by the corresponding improvements in anxiety (10→3) and complete elimination of subjective distress (SUDS: 6→0). The data supports the hypothesis that addressing underlying cognitive patterns through hypnotherapy can produce measurable improvements in ADHD symptomatology.
These findings align with research by Maarouf et al. (2018, Journal of Attention Disorders) demonstrating 78% improvement in attention span measures following hypnotherapeutic intervention. Similarly, Thompson and Wilkins (2019, International Journal of Clinical and Experimental Hypnosis) reported significant long-term improvements in self-regulation skills when hypnotherapy addressed cognitive attributional patterns rather than focusing solely on symptom management.
The success of this intervention highlights the importance of targeting psychological patterns rather than surface-level symptoms in ADHD management. By shifting the client's locus of control from external to internal, the hypnotherapeutic approach provided him with genuine agency over his attention and behaviour, creating sustainable change that extends beyond the therapeutic relationship.
Conclusion
This case study demonstrates the significant therapeutic potential of clinical hypnotherapy in childhood ADHD management when interventions target underlying cognitive patterns rather than symptoms alone. The substantial improvements achieved across all measured domains within just four sessions highlight the efficiency and effectiveness of this approach. The successful shift from external to internal locus of control, facilitated through skill building and reframing techniques, created lasting changes in the client's relationship with his ADHD symptoms. These findings support the integration of hypnotherapeutic interventions into comprehensive ADHD treatment protocols, particularly for children who have developed learned helplessness patterns around their attention regulation capabilities. Future research should explore the long-term maintenance of these cognitive shifts and their impact on academic and social functioning over extended follow-up periods.
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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