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Mastering Your Adult ADHD A Cognitive Behavioral
Treatment Program Client Workbook Steven A. Safren
Digital Instant Download
Author(s): Steven A. Safren, Susan Sprich, Carol A. Perlman, Michael W. Otto
ISBN(s): 9780195188196, 0195188195
Edition: Workbook
File Details: PDF, 1.10 MB
Year: 2005
Language: english
Page|1
 Mastering Your Adult ADHD

A COGNITIVE-BEHAVIORAL TREATMENT PROGRAM

Client Work book

Steven A. Safren • Susan Sprich

Carol A. Perlman • Michael W. Otto

2005

Page|2
About Treatments That Work™
One of the most difficult problems to confront patients with various disorders and diseases is how to find the best help available. Everyone is aware of
friends or family who have sought treatment from a seemingly reputable practitioner, only to find out later from another doctor that the original diagnosis was
wrong or the treatments recommended were inappropriate or perhaps even harmful. Most patients, or family members, address this problem by reading
everything they can about their symptoms, seeking out information on the Internet, or aggressively “asking around” to tap knowledge from friends and
acquaintances. Governments and health care policymakers are also aware that people in need don’t always get the best treatments—something they refer to as
“variability in health care practices.”
Now health care systems around the world are attempting to correct this variability by introducing “evidence-based practice.” This simply means that
it is in everyone’s interest that patients get the most up-to-date and effective care for a particular problem. Health care policymakers have also recognized that
it is very useful to give consumers of health care as much information as possible so that they can make intelligent decisions in a collaborative effort to
improve health and mental health. This series, “Treatments That Work™,” is designed to accomplish just that. Only the latest and most effective interventions
for particular problems are described in user-friendly language. To be included in this series, each treatment program must pass the highest standards of
evidence available, as determined by a scientific advisory board. Thus, when individuals suffering from these problems or their family members seek out an
expert clinician who is familiar with these interventions and decides that they are appropriate, they will have confidence that they are receiving the best care
available. Of course, only your health care professional can decide on the right mix of treatments for you.
This particular program presents the first evidence-based effective psychological treatment for adult attention-deficit/hyperactivity disorder
(ADHD). At present, it offers the best chance of experiencing some relief from this debilitating condition. In this program, you will learn skills that directly
attack the three clusters of symptoms that make living with adult ADHD so difficult. These symptoms include difficulty focusing attention and being easily
distracted, difficulties with organization and planning, and impulsivity. This program can be effectively combined with medications, or, for those 50 percent
of individuals who derive relatively little benefit from medications, this program may be sufficient. This program is most effectively applied by working in
collaboration with your clinician.

David H. Barlow, Editor-in-Chief,

Treatments That Work™
Boston, MA

Reference
Biederman, J., Wilens, T. E., Spencer, T. J., Farone, S., Mick, E., Ablon, J. S., & Keily, K. (1996). Diagnosis and treatment of adult attention-deficit/hyperactivity disorder. In M.
Pollack & M. Otto & J. Rosenbaum (Eds.), Challenges in clinical practice (pp. 380–407). New York: Guilford Press.

Page|3
Contents

Information About ADHD and This Treatment Program

Chapter 1: Introduction
Chapter 2: Overview of the Program
Chapter 3: Involvement of Your Family Member

Organization and Planning

Chapter 4: The Foundation: Organization and Planning Skills
Chapter 5: Organization of Multiple Tasks
Chapter 6: Problem-Solving and Managing Overwhelming Tasks
Chapter 7: Organizing Papers

Reducing Distractibility
Chapter 8: Gauging Your Attention Span and Distractibility Delay
Chapter 9: Modifying Your Environment

Adaptive Thinking
Chapter 10: Introduction to a Cognitive Model of ADHD
Chapter 11: Adaptive Thinking
Chapter 12: Rehearsal and Review of Adaptive Thinking Skills

Additional Skills
Chapter 13: Application to Procrastination
Chapter 14: Relapse Prevention

References

About the Authors

Page|4
Information About Adult ADHD and This Treatment Program

Page|5
 Chapter 1 Introduction

Goals
■ To understand the characteristics of ADHD in adulthood

■ To learn why ADHD symptoms continue in adults even after treatment with medications

■ To understand that ADHD is a valid diagnosis for adults

What Is ADHD?
Attention-deficit/hyperactivity disorder, or ADHD, is a valid, medical, psychiatric disorder. ADHD begins in childhood. However, many
children with ADHD go on to have significant symptoms as adults.
As shown, people with ADHD have three major types of symptoms, which typically relate to
1. Poor attention
2. High impulsivity (or disinhibition)
3. High activity (hyperactivity)

Page|6
The term “disinhibition” (lack of inhibition) is also sometimes used to describe the impulsivity and hyperactivity symptoms. Many people with
ADHD have at least some symptoms of poor attention, some symptoms of hyperactivity, and some symptoms of impulsivity; many people have
symptoms that are predominately from one category.
The term “Attention Deficit Disorder,” or ADD, is also sometimes used when an individual has the attentional symptoms but not the
hyperactivity symptoms.

ADHD Is Not Related to Intelligence or Laziness

ADHD is a problem in which patients can learn coping skills to manage associated difficulties

Kate Kelly and Peggy Ramundo have written a self-help book for those with adult ADHD called You Mean I’m Not Lazy, Stupid, or
Crazy? This title underscores many of the common misperceptions that people with ADHD have about themselves.

ADHD is a neurobiological disorder, unrelated to intelligence, laziness, aptitude, craziness, or anything similar. This program, which
typically begins after stable medication treatment, can help control the symptoms of ADHD for adults. By actively learning skills and practicing
them regularly, you will see significant improvements.

What Are the Specific Criteria for a Diagnosis of ADHD?

To diagnose a person with ADHD, mental health professionals use criteria set forth in the Diagnostic and Statistical Manual of Mental
Disorders, published by the American Psychiatric Association (DSM-IV; APA 1994). Each of the following five criteria (A-E) must be met in
order to qualify for a diagnosis of ADHD.
A. Either six or more of the following symptoms of inattention or six or more of the following symptoms of
hyperactivity/impulsivity must be present.

Symptoms of Inattention Symptoms of Hyperactivity/Impulsivity

Often fails to give close attention to details or makes careless mistakes Often fidgets with hands or feet or squirms in seat
in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities Often leaves seat in classroom or in other situations in which remaining
seated is expected
Often does not seem to listen when spoken to directly Often runs about or climbs excessively in situations in which it is

Page|7
 inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
Often does not follow through on instructions and fails to finish Often has difficulty playing or engaging in leisure activities quietly
schoolwork, chores, or duties in the workplace (not because of
oppositional behavior or failure to understand instructions)
Often has difficulty organizing tasks and activities Is often “on the go” or often acts as if “driven by a motor”
Often avoids, dislikes, or is reluctant to engage in tasks that require Often talks excessively
sustained mental effort
Often loses things necessary for tasks or activities Often blurts out answers before questions have been completed
Is often easily distracted by extraneous stimuli Often has difficulty awaiting turn
Is often forgetful in daily activities Often interrupts or intrudes on others

B. Some symptoms were present before the age of 7.

C. Some impairment from the symptoms is present in two or more settings (e.g., work and home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other
psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder,
dissociative disorder, or personality disorder).

How Do You Distinguish ADHD as a Diagnosis From Normal Functioning?

Some of the symptoms just listed sound like they might apply to almost anyone at certain times. For example, most people would
probably say that they are sometimes easily distracted or sometimes have problems organizing. This is actually the case with many of the
psychiatric disorders. For example, everyone gets sad sometimes, but not everyone suffers from a clinical diagnosis of depression.
This is why criteria C and D exist. In order to for ADHD to be considered as a medical diagnosis for any individual, he must have
significant difficulties with some aspect of his life, such as work, significant relationship problems, and/or significant problems in school. These
two criteria define the problem as significantly distressing to the person and as significantly interfering with some aspect of the person’s life.
“Significantly distressing” means that the problem causes emotional distress or pain. “Significantly interfering” means that the problem is
somehow disruptive in a person’s life, such as work, school, or relationships.
For ADHD to be the appropriate diagnosis, not only must the distress and impairment be present, but this distress and impairment must
be caused by ADHD and not something else.

Page|8
 How Do Cognitive and Behavioral Variables Exacerbate ADHD for Adults?
■ Cognitive components (thoughts and beliefs) can worsen ADHD symptoms. For example, a person who is facing something that feels
overwhelming might shift her attention elsewhere or think things like “I can’t do this,” “I don’t want to do this,” or “I will do this later.”

■ Behavioral components are the things people do that can exacerbate ADHD symptoms. The actual behaviors can include things like
avoiding doing what you should be doing or not keeping an organizational system.

The model on the following page shows how we believe ADHD affects the lives of adults.
According to this model, the core symptoms of ADHD are biologically based. However, we believe that cognitive and behavioral
variables also affect symptom levels.
Core neuropsychiatric impairments—starting in childhood—prevent effective coping. Adults with ADHD, by definition, have been
suffering from this disorder chronically since childhood. Specific symptoms such as distractibility, disorganization, difficulty following through
on tasks, and impulsivity can prevent people with ADHD from learning or using effective coping skills.
Lack of effective coping can lead to underachievement and failures. Because of this, patients with this disorder typically have
sustained underachievement, or things that they might label “failures.”
Underachievement and failures can lead to negative thoughts and beliefs. This history of failures can result in developing overly
negative beliefs about oneself, as well as a habit of engaging in negative, maladaptive thinking when approaching tasks. The negative thoughts
and beliefs that ensue can therefore add to avoidance or distractibility.
Negative thoughts and beliefs can lead to mood problems and can exacerbate avoidance. Therefore, people shift their attention even
more when confronted with tasks or problems, and related behavioral symptoms can also get worse.
The following model (originally published in Safren et al., 2004) shows how these factors interrelate:

Cognitive-Behavioral Model of Adult ADHD

Page|9
 Don’t Medications Effectively Treat ADHD?
Yes.
Medications are currently the first-line treatment approach for adult ADHD, and they are the most extensively studied. The classes of
these medications are stimulants, tricyclic antidepressants, monoamine oxidase inhibitors (antidepressants), and atypical antidepressants.
However, a good number of individuals (approximately 20 to 50 percent) who take antidepressants are considered nonresponders. A

P a g e | 10
nonresponder is an individual whose symptoms are not sufficiently reduced or who cannot tolerate the medications. Adults who are considered
responders typically show a reduction in only 50 percent or less of the core symptoms of ADHD.
Because of these data, recommendations for the best treatment of adult ADHD include using psychotherapy (cognitive-behavior therapy,
in particular) with medications. Medications can reduce many of the core symptoms of ADHD: attentional problems, high activity, and
impulsivity.

If Medications Work, Why Have This Cognitive-Behavioral Treatment?

Medications do not intrinsically provide patients with concrete strategies and skills for coping.
Furthermore, disruptions in overall quality of life such as underachievement, unemployment or underemployment, economic problems,
and relationship difficulties associated with ADHD in adulthood call for the application of additional ameliorative interventions.

Evidence That ADHD in Adulthood Is a Real and Valid Medical Condition

We include this section here because in the recent past, ADHD was a controversial diagnosis.
However, the past 15 years of study have shown that its validity is strong. We will describe the controversy regarding the diagnosis and
outline the evidence that has led experts to conclude that it is a prevalent, distressing, and impairing, valid medical diagnosis.
Psychiatric and psychological diagnoses are difficult to validate compared to other biomedical diseases. ADHD in adulthood is a
real, reliably diagnosed medical illness that may affect up to 5 percent of the adult population in the United States. ADHD in adulthood has
historically been a controversial diagnosis. One of the reasons for this is that psychiatric diagnoses, in general, are difficult to validate. In many
other medical fields, doctors can perform a blood test, do an x-ray, do a biopsy, or even take a patient’s temperature in order to inform a
diagnosis. In these cases, overt medical evidence complements the report of the patient. However, for psychiatric disorders, this is presently
impossible. Doctors must diagnose psychiatric disorders on the basis of only the report of patient’s symptoms, their own observation of the
patient, or the observations of others. Therefore, psychiatrists and psychologists have developed a way to categorize psychiatric disorders that
involves the presentation of clusters of symptoms that people have.
How do doctors validate psychological or psychiatric diagnoses? In order to validate a psychiatric or psychological diagnosis,
psychologists and psychiatrists therefore examine data such as the degree to which trained individuals agree on diagnosis, the degree to which
the disorder runs in families (including adoption studies to determine the relative impact of biology versus one’s environment), any
neuroimaging and neurochemistry studies, and the degree to which people who have the problem experience distress. This has been done
sufficiently for adult ADHD.
How do we know that ADHD is a real diagnosis? Sufficient scientific evidence has accumulated over the past 15 years converging on

P a g e | 11
the finding that ADHD is a real, significant, distressing, interfering, and legitimate medical problem. This includes evidence that ADHD can be
reliably diagnosed in adults and that the diagnosis meets standards of diagnostic validity similar to those of other psychiatric diagnoses.
Accordingly, core symptoms in adulthood include impairments in attention, inhibition, and self-regulation. These core symptoms yield
associated impairments in adulthood such as poor school and work performance (e.g., poor organizational and planning skills; a tendency to
become bored easily; deficient sustained attention to reading and paperwork; procrastination; poor time management; impulsive decision
making); impaired interpersonal skills (problems with friendships; poor follow-through on commitments; poor listening skills; difficulty with
intimate relationships); and behavior problems (lower level of educational attainment than would be expected for level of ability; poor financial
management; trouble organizing one’s home; chaotic routine). There is further evidence for the validity of ADHD as a diagnosis from
medication treatment studies, genetic studies that include adoption and family studies, and neuroimaging and neurochemistry research.
Children with ADHD do grow up. Estimates of the prevalence of ADHD in adulthood range from 1 to 5 percent. This is consistent with
estimates that ADHD affects 2 to 9 percent of school-age children, and follow-up studies of children diagnosed with ADHD showing that
impairing ADHD symptoms persist into adulthood in 30 to 80 percent of diagnosed children.

P a g e | 12
 Chapter 2 Overview of the Program

Goals
■ To learn how this program was developed

■ To learn about the concerns of medication-treated adults with ADHD

■ To understand the success rate of the program so far

■ To understand what the program will involve

This treatment program is meant to be completed with the assistance of a cognitive-behavioral therapist. The treatment was developed by
the Massachusetts General Hospital’s Cognitive-Behavioral Therapy Program. It was based on the clinical experience of the authors, input from
adults living with ADHD, and published works on treatment for adults with ADHD (e.g., Barkley, 1998; Hallowell, 1995; Mayes 1998;
McDermott, 2000; Nadeau, 1995). It is designed for patients who have been diagnosed with ADHD, have been on medications for ADHD, and
have found a stable medication regimen. The strategies may be useful for adults with ADHD who cannot take medications; however, we have
tested it only for individuals who were already taking medications.

How Was the Program Developed?

Clinical experience of the authors. The program was developed by a group of psychologists at Massachusetts General Hospital and
Harvard Medical School after treating patients with ADHD in our clinic using cognitive-behavioral therapy. From this perspective, it was
originally developed from the clinical experience of the authors, general principles of cognitive-behavioral therapy, and published clinical
guidelines for working with adult patients with ADHD.
Input from adults living with ADHD. Patients with ADHD also gave input to the development of the treatment program. One of the
authors interviewed a group of patients with ADHD who had been taking medications and obtained their views regarding the types of problems
they were experiencing and what they felt would be helpful regarding cognitive-behavioral treatment.
The most frequently discussed problems among adult patients with ADHD who had been taking medicines were (1) organizing and
planning, (2) distractibility, and (3) associated anxiety and depression. Other concerns included problems with procrastination, anger
P a g e | 13
management, and communication issues. Examples are discussed below.
Organizing and Planning
Problems with organizing and planning involve difficulties figuring out the logical, discrete steps to complete tasks that seem
overwhelming. For many patients, this leads to giving up, procrastination, anxiety, and feelings of incompetence and underachievement.
We have had, for example, several patients who were underemployed or unemployed who had never done thorough job searches. This
resulted in their not having a job, working in a much lower-paying position than they could have, or not having a job that would lead to
appropriate employment.
Distractibility
The problems with distractibility involved problems in work or school. Many of our patients have reported that they do not complete
tasks because other, less important things get in the way.
Examples might include sitting down at one’s computer to work on a project but constantly going on the Internet to look up certain Web
sites or browsing items on eBay. We had a student in our program who lived alone; whenever he sat down to do his thesis, he would find another
place in his apartment to clean (even though it was already clean enough).
Mood Problems (Associated Anxiety and Depression)
In association with core ADHD symptoms, many of our patients have mood problems.
These problems involve worry about events in their lives and sadness regarding either real underachievement or perceived
underachievement. Many individuals with ADHD report a strong sense of frustration about tasks that they do not finish or tasks that they
complete less well than they feel they should or could have.

Has This Program Been Successful?

Yes!
In our study of this treatment, we found that people who completed this program in addition to taking their medications did significantly
better than people who stayed on their medications but did not receive this treatment (Safren et al., in press).
We conducted a “randomized controlled trial” to find these results. Randomized controlled trials are a primary way researchers test
whether treatments work. They are randomized in that patients entering the study randomly receive either the treatment or a control condition.
In our study, we took in only patients who had been treated with medications but still had significant problems. These patients were
randomized to either getting the treatment described in this book or no additional treatment (all patients continued on their prescribed
medications).
In this study, the people who got the treatment had significantly lower symptoms of ADHD after the treatment. This was evaluated by an
independent assessor who did not know whether the participants got the treatment or not and by the self-report of participants who completed
written questionnaires about their symptoms. According to these assessments, patients who got the program experienced about a 50 percent

P a g e | 14
decrease in symptoms, and those who did not had negligible changes.

What Will the Program Entail?

The program will entail regular meetings with a therapist and homework. The treatment involves regular meetings with a
cognitive-behavioral therapist and homework assignments. We have found that weekly sessions work best. By having weekly sessions, you have
a chance to practice the skills discussed in the treatment in the time between your meetings with your therapist. Also, there is a relatively short
period of time between sessions, so any problems with follow-through can be solved and any questions about the approach can be answered.
When we have conducted sessions every other week, patients reported that they found it difficult because they would forget what they were
supposed to be doing on their own.
The treatment is different than traditional psychotherapy. In fact, in some ways it is more like taking a course than being in supportive
psychotherapy. Each session will have an agenda, and each session will involve a homework assignment. Practice is essential.
The program involves practicing outside the sessions! There are no two ways about it! We have found that many patients have tried
similar strategies in the past but have had difficulties integrating this practice in their daily life. In other words, the tendency to be distractible
and forgetful can get in the way of treatment. We will work with you to “set in” new habits that you can keep with you over the years
■ You will need to practice these new skills long enough for them to become a habit—for them to be easy to use and remember. ■

You will be tempted to quit, but not at the beginning. At the beginning, things will be novel and new and therefore more interesting.
People typically do not quit at the beginning. The middle period can sometimes be the hardest. This is the time when the novelty wears off but
people have not practiced the skills long enough for them to become habits. Many people show some improvement at the beginning, enough
improvement that they start to think that they do not need to use the skills. In this case, people quit because the work is no longer new and
interesting and is not yet an easy habit; they then relapse back to having problems and then think, “I tried to change, and I could not do it.”
Hence, the cycle of negative emotions and continued ADHD symptoms continues.
■ Do not succumb to this temptation. ■

This may be the hardest part of the treatment program. The key to getting better is to stay on track, keep with the program long enough
for it to be easy, and practice.
The program will entail ups and downs; sometimes it will entail setbacks. When there is a “down,” this is definitely not a time to
quit; this is a time to learn from the things that led up to the setback, and to figure out how to handle them in the future. This is extremely
important.
■ Setbacks are a major part of progress. You need to have setbacks and learn to handle them in order to reduce the likelihood of future
setbacks! ■

P a g e | 15
 The final period is easier; however, it also entails challenges. Once things are going better, you will be faced with the challenge of
continuing to invest some time and energy to maintaining these systems and skills even though things are going better.
We have found that some people, once they are doing better, feel less motivated to keep using the coping skills. If things are bad, then
there is more motivation because people feel that they need to “get out of the hole.”

The Program Will Entail Different Modules

Organization and Planning
The first part of the treatment involves organization and planning skills. This includes skills such as:
■ Learning to effectively and consistently use a calendar book
■ Learning to effectively and consistently use a task list
■ Working on effective problem-solving skills, including (1) breaking down tasks into steps and (2) choosing a best solution for a
problem when no solution is ideal
■ Figuring out a system for organizing and responding to mail and papers

Managing Distractibility
The second part of treatment involves managing distractibility. Skills and strategies include the following:
■ Maximizing and building on one’s attentions span (breaking tasks into steps that correspond to the length of one's attention span, then
working to expand this strategy)
■ Using a timer, cues, and other techniques to help reduce the effects of distractibility

Using Adaptive Thinking

The third part of treatment involves learning to think about problems and stressors in the most adaptive way possible. This includes:
■ Positive “self-coaching”
■ Learning how to identify and dispute negative thoughts
■ Learning how to look at situations rationally, and therefore make rational choices about the best possible solutions for you

Application to Procrastination
An optional additional module exists for procrastination. We include this because most of the previous modules do relate to
procrastination, but some people require extra help in this area. This module therefore specifically points to how to use the skills already learned
to help with procrastination.

P a g e | 16
 The Program Will Entail Monitoring Your Progress
Before starting this program, your doctor will likely have done a diagnostic interview to establish whether or not you have ADHD. Part
of the treatment approach described in this workbook involves regularly monitoring your improvement. Because, unlike many medical illnesses,
we do not have a blood test for symptom severity, we need to use the next best thing, which is the ADHD Symptom Severity Scale, which is
included on page 23. You should complete this around the time of your first session. We recommend completing it each week thereafter so that
you can monitor your progress and so that you can target areas that may not be improving at the rate you would like.
The program will entail setting an agenda for each treatment session. In order to ensure that important material is covered, each
session corresponds to the material presented in this workbook.
One potential pitfall with modular treatment is that not everything can be covered at once. Although the treatment approach is
offered one module at a time, patients may have areas of difficulty that will not be addressed until future sessions.
This is another issue that is sometimes frustrating for people who do this program. The program typically starts with the development of
a calendar and task list system. This module also involves learning organization and planning skills. The next module targets distractibility.
People sometimes have problems with the first module because they get easily distracted, but distractibility is not covered until the next module.
Unfortunately, it is impossible to learn everything all at once, so we ask that you do your best, but realize that you will not have learned all the
necessary skills until the end of the treatment program.

The Program Will Entail Repetition

There are many areas of the treatment where we repeat key information. We do this because repetition is the best way to learn new
information. Each module contains new information but also contains information from previous modules that are important to review.

The Program Will Entail Using Specific Strategies for Remembering to Take Medication
For some people with ADHD, taking medication every day, sometimes more than once a day, can be difficult. Symptoms of ADHD such
as distractibility or poor organization may interfere, causing you to forget to take all of your prescribed doses or to have difficulty developing a
structured routine for taking medication. This treatment will help you prioritize taking medication and will provide you with opportunities to
work with a therapist and problem-solve around difficulties taking medications. Each week you will discuss factors that have led you to miss
doses.

P a g e | 17
 Chapter 3 Involvement of Your Family Member

Overview
This single chapter will assist you in working with a family member to better manage your ADHD symptoms. As has been discussed
earlier, this treatment program is best done with the aid of a therapist who is familiar with cognitive-behavioral therapy. We therefore
recommend that you and your partner meet with the therapist for one session to go over the material presented in the first two chapters and to
deal with any other information that may be pertinent.
Involving a family member in treatment will enable you to:
■ Gain support as you complete treatment
■ Decrease tension in your relationship related to ADHD symptoms

Goals
■ To provide education about ADHD

■ To discuss ways in which ADHD has affected your relationship with a family member

■ To provide an overview of the CBT model of the continuation of ADHD into adulthood

■ To discuss organization and planning techniques

■ To discuss techniques for coping with distractibility

■ To discuss adaptive thinking techniques

Review of Symptom Severity Scale

P a g e | 18
 As you have been doing each week, you should complete the ADHD self-report symptom checklist. Be sure to review your score and
take note of symptoms that have improved and those that are still problematic.
Score: ______________
Date: ______________

Review of Medication Adherence

As you have been doing each week, you should record your prescribed dosage of medication and indicate the number of doses you
missed. Review triggers for missed doses, such as distractibility, running out of medication, or thoughts about not wanting/needing to take
medication.
Prescribed doses per week: ____________________________________
Doses missed this week: ____________________________________
Triggers for missed doses: ____________________________________
_________________________________________________________
_________________________________________________________

Review of Material From Chapters 1 and 2

The information presented in the previous two chapters can be shared with your partner or spouse. This information lays the groundwork
for the remaining sessions. We recommend that this be discussed with your cognitive-behavioral therapist, who can answer questions that your
partner might have.

How Has ADHD Affected Your Relationship?

ADHD can certainly contribute to strained relationships with family members, especially when they are not familiar with the symptoms
of ADHD and associated difficulties. Both you and your partner should answer each of the following questions separately and then compare the
responses.
Client Responses

P a g e | 19
What are the symptoms of ADHD that you think are most significant?

What are the three most important ways that these symptoms have affected the relationship?
1.

2.

3.

Family Member Responses

What are the symptoms of ADHD in your partner that bother you most?

What are the three most important ways that these symptoms have affected the relationship?
1.

2.

3.

P a g e | 20
 Monitoring Progress
Each week we monitor progress by completion of the ADHD symptom rating scale. We find that this is helpful to identify areas that are
most problematic and areas that should be targeted for additional work.
We also sometimes ask the family member to complete a symptom rating scale as a secondary way to report on progress. If you are
willing, we would like to have the family member complete one, and we can compare ratings to see if problematic areas are similar.
This measure is included in this workbook. To obtain a total score, add all of the ratings. Use o for items rated “never or rarely,” 1 for
items rated “sometimes,” 2 for items rated “often,” and 3 for items rated “very often.”

P a g e | 21
Current Symptoms Self-Report Form Week of:

Instructions: Please check the response next to each item that best describes your behavior during the past week.

From R. A. Barkley & K. R. Murphy (1998), Attention-Deficit Hyperactivity Disorder: A clinical workbook (2nd ed.). New York: Guilford Press.

P a g e | 22
Current Symptoms Family Member Report Form
Instructions: Please check the response next to each item that best describes your family members behavior during the past week.

Adapted from R. A. Barkley & K. R. Murphy (1998), Attention-Deficit Hyperactivity Disorder: A clinical workbook (2nd ed.). New York: Guilford Press.

P a g e | 23
Organization and Planning

P a g e | 24
 Chapter 4 The Foundation: Organization and Planning Skills

Goals
■ To understand the severity of your initial symptoms as a basis for tracking treatment progress

■ To discuss realistic goals

■ To learn about the modular approach to treatment, and the importance of practice, motivation, and staying with it

■ To be introduced to using a notebook and calendar system

■ Homework: To get started with a notebook and calendar system

Review of Symptom Severity Scale

The ADHD Symptom Severity Scale, on page 23, lists each of the diagnostic symptoms of ADHD to help you rate yourself. A total score can be
obtained by summing all of the ratings. Use o for all items rated “never or rarely,” 1 for all items rated “sometimes,” 2 for all items rated “often,”
and 3 for all items rated “very often.”
Each week of treatment, we will target specific symptoms from this assessment. As you go through the treatment, you should expect to
see a gradual decline in symptom severity. If there are specific sets of symptoms that do not seem to be changing, these are areas on which you
should focus.
Tracking your symptoms on a weekly basis can also help you become more aware of these difficulties. Being aware that these are
symptoms of ADHD, doing this self assessment on a weekly basis, and tracking the changes can also be helpful on its own. This awareness can
help you remember to use the skills that you will be learning in the sessions that follow.
Complete the ADHD self-report symptom checklist. Pay particular attention to the items that have the highest ratings; these should be
targets for goals of treatment.

Score: ______________
Date: ______________

P a g e | 25
Review of Medication Adherence
As you have been doing each week, you should record your prescribed dosage of medication and indicate the number of doses you
missed. Review triggers for missed doses, such as distractibility, running out of medication, or thoughts about not wanting/needing to take
medication.
Prescribed doses per week: ____________________________________
Doses missed this week: ____________________________________
Triggers for missed doses: ____________________________________
_________________________________________________________
_________________________________________________________

Goals for Cognitive-Behavioral Therapy for ADHD

You have just completed a checklist of the symptoms that are typical of ADHD in adults. We find that reviewing this list can also help
you think about individual goals that you might have regarding which types of problems most affect you. Additionally, it might help you think
about how they actually interfere in your life.
Part of getting started on this course of cognitive-behavioral therapy for ADHD is making sure you have realistic goals for the treatment.
Realistic goals for cognitive-behavioral therapy for ADHD are things that you can control. You might be thinking that a long-term (or
medium-term) goal of yours is to get a better job. This is a great goal, and we believe the skills described in this workbook can help you increase
the chances of getting a better job. However, the outcome of getting a better job is dependent on lots of other factors that you do not directly
control (such as the economy and the availability of the types of jobs you want). A realistic goal would therefore be to figure out what steps are
necessary to improve the chances to get a better job, and to act on these steps.
There are likely areas related to ADHD that are also preventing you from getting a better job. These might include figuring out an
effective job search process, improving your organizational skills at work, and improving your productivity. These are issues that the treatment
can help with because we can directly control them.
Questions to Help Come Up with Goals

The following questions may be helpful with respect to coming up with goals regarding your treatment.
What made you decide to start this treatment now?
What types of things would you like to be different regarding how you approach tasks?
What are some issues that others have noticed about how you approach things?
If you did not have problems with ADHD,what do you think would be different?

P a g e | 26
 In the following table, write down your goals for cognitive-behavioral therapy. There are columns for controllability and whether the
goal is short or long term. For controllability, write down how much control you think you would have over this goal if the ADHD symptoms
were gone (o percent represents no control; 100 percent represents complete control). Also indicate whether this is a short-term or long-term
goal.

Goal List

We ask you to rate controllability (and this should be done with a therapist) so that you can gain a realistic appraisal of your goals for
CBT. For example, a goal might be to get a job. However, as we have noted, there are many factors involved in getting a job. Therefore, we
prefer to have a related goal that is more controllable—for example, to complete the tasks that are necessary to optimize the chances of getting a
job.
P a g e | 27
 Re-review the goals and the controllability ratings. Ask yourself if there are specific areas that you can control about each situation and if
there are specific areas that are beyond your control.

Additional Information About the Modular Approach to Treatment

As we have discussed, this treatment is modular. In other words, it is designed so that each skill builds upon previously learned skills. So
you will learn one technique at a time. As you begin this treatment program, there are several things to keep in mind about how the treatment is
structured.
The therapy is active. First, due to difficulties known to be associated with ADHD, the therapy will be especially active, almost like
taking a course. Each session will have an agenda, which you and your therapist will discuss at the beginning.
The therapy requires homework. Each session will involve a review of the things you have already learned and are working on, as well
as a discussion of new coping strategies. You will also be expected to try them out over the next week. The more you are able to do this, the
better the results you will see.
The therapy works on one skill at a time. This means that you will have areas of difficulty that are not addressed right away. For
example, the first module is on organizing and planning. The second is on distractibility. Of course, organizing and planning things is much
easier if you do not become distracted. Likewise, if we started with distractibility, it would be difficult to figure out what you were getting
distracted from if you are not organized. Therefore, it is important to realize that only one thing at a time can be changed, and the key is to
practice things long enough so that you can really tell if they will be helpful to you.

Practice Makes Perfect

You are about to start a treatment for problems that involve difficulties with follow-through. Some or all of these skills may seem
difficult. This is why you will be practicing them with a therapist and not on your own, and is also why it is critical to know right from the start
how important practicing these new skills is. Remember the model that is in the previous chapter. Many people with ADHD never get a chance
to learn coping skills because they quit before they have practiced them enough for them to become a habit!

Motivation Is Key
Because motivation is so important for this treatment, the following exercise is a way to help you figure out whether this program is for
you and to resolve any ambivalence about completing it.
This exercise is a good one to keep and review again as you continue in treatment. As discussed earlier, going through the program is

P a g e | 28
likely to involve some ups and some downs. You may or may not notice benefits right away, but as you move through the exercises, keep in
mind that you are developing new strategies that are aimed at both current and future patterns of behavior. As you do this exercise, be sure to
keep in mind the important long-term benefits.
Motivational Exercise: Pros and Cons of Changing
Therapy will ask you to try new things and, at times, to try strategies you have tried in the past. Also, homework will be assigned
following each session, and this homework is aimed at having you do things differently from your usual habit. The result of a new therapy like
this is that, at least for a while, you will need to leave your natural “comfort zone” and try things in a new way. As you prepare to try things in a
new way, it will be helpful for you to keep in mind the natural difficulties you will have with change, as well as the potential benefits. For
example, when you think about trying a new organizational system, you may think, “I hate the idea of getting a notebook. I have had one in the
past, and it didn’t work for me; I just ended up with page after page of lists that I did not complete.”
Accordingly, one of the “cons” of trying the notebook system is that you face old thoughts and old memories about how notebooks may
not work. On the other hand, it is quite possible that the way in which the notebook system is applied in this therapy at this time may have
benefit. So a “pro” about trying the notebook system again is that it may have some important features that might lead to success at the present
time.
As you go through the rest of the chapter, notice ways in which you may be reluctant to try the new system. Then come back to the
following page and list some of the pros and cons that trying new behaviors may bring. Space is provided for considering two new strategies.

Motivational Exercise: Pros and Cons of Changing

New Strategy to Be Considered

PRO CON
Short-term consequences

Long-term consequences

New Strategy to Be Considered

PRO CON

P a g e | 29
Short-term consequences

Long-term consequences

Skill: Using a Calendar and Notebook

Having a calendar and notebook system is the foundation of being organized. It is absolutely necessary. Although there are other things
also necessary, this is critical. We consider it akin to eating.
In order to maintain your health, you need to be able to eat. However, there are many other things that you also need to do to maintain
your health, such as go to the doctor, go on medicines if you get an infection, and so on. Eating is a necessary but not sufficient requirement for
health. We believe that maintaining a calendar and notebook system is necessary but not sufficient for being organized.
Using the Calendar and Notebook Together
The calendar system and notebook systems can be personalized, though we give specific recommendations. Many individuals report that
they have tried to use a calendar system in the past but it has not worked, or they did not keep up with it. Remember, the goal of this treatment is
to try things long enough for them to become habits. Every week from here on in involves learning tasks that build on the use of the calendar and
notebook system. These two items can be used together.
The notebook will contain information you need but that is not tied to a specific date, including things like recording phone messages,
directions to places, and to-do list items. The notebook should replace random pieces of paper that can be easily lost.
The calendar is your key to appointments. When using the calendar with the notebook, you may place items from the to-do list onto
specific days or times.
Rules for the Calendar and Notebook
1. The calendar and notebook replaces ALL pieces of paper.
■ Pieces of paper just get lost.
■ Instead of keeping an appointment slip, a business card, or anything of this sort, copy the information into the notebook. When the
notebook is full, you can replace it.

2. Phone messages from voice mail or other places go in the notebook.

■ All phone messages (e.g., from voice mail) get logged into the notebook as a to-do item.
■ If you keep the notebooks after they are full, you can refer back to them if you need someone’s number in the future.

P a g e | 30
 ■ If you enter the date when the tasks are completed, you will have a record of your work, in case anyone asks you about it in the future.

3. All appointments go in the notebook.

■ No appointment slips that can easily get lost!

4. The notebook must contain a to-do list.

■ The to-do list is something that will be further developed in future chapters. This is a key component of the program.
■ To-do list items should be looked at every day and revised as necessary.
■ When it gets messy, recopy the list.

5. Do not obsess trying to get a perfect system.

■ Many individuals want to have the perfect calendar and to-do list system. Do not fall into this trap. This will just result in not having a
system.
■ If you cannot decide on the “best” system, then just use a simple calendar book and, separately, a regular notebook.
■ Remember, it’s important to give your system a fair shot! This means keeping one system for at least three months, long enough to get
used to it.

6. If you have difficulty with computers, do not try to use a computerized system.
■ Many individuals feel that they want to start using a computerized or PDA system. This works wonderfully for individuals who are
already proficient with computers. If this is not you, this is not the time to start.
■ If you are not proficient with computers, you can always try to become proficient at the end of this treatment. We recommend that this
be a separate goal from this program, however. Either learn to use a computer before starting the program or do so afterward.

Potential Pitfalls
It is important to remember that learning any new skill takes practice, and takes time. You may not be used to writing down appointments
or carrying around a calendar or notebook. Be aware of thoughts that may sabotage your success down the road:
“I don’t have room in my bag for a calendar. ”
“It’s a hassle to have to bring a notebook everywhere with me. ”
“I’ve never been an organized person, so why start now?”
“ If I write down my appointments and assignments, I will
then be responsible for them. ”

P a g e | 31
 You will be learning ways to manage these interfering thoughts in later chapters. For now, try to keep focused on your reasons for
beginning this program, the goals you hope to achieve, and the accomplishment you will feel for taking positive steps in your life.

Homework

Begin using a calendar and notebook system following the rules given in this chapter.

Bring in the calendar and task list to the next treatment session.

P a g e | 32
 Chapter 5 Organization of Multiple Tasks
The main focus of this session is to teach you how to manage multiple tasks. It is important for you to remember that practice makes
perfect.
Although these techniques may seem unfamiliar at first, over time they will become more automatic. Even if you feel frustrated, it is
important for you to stick with the techniques until they become habits.

Goals
■ To continue to monitor your progress

■ To review your use of the calendar and task list

■ To learn how to manage multiple tasks

■ To learn how to prioritize tasks

■ To problem-solve regarding any anticipated difficulties using this technique

■ To identify exercises for home practice

Review of Symptom Severity Scale

As you have been doing each week, you should complete the ADHD self-report symptom checklist. Be sure to review your score and
take note of symptoms that have improved and those that are still problematic.
Score: ______________
Date: ______________

Review of Medication Adherence

P a g e | 33
 As you have been doing each week, you should record your prescribed dosage of medication and indicate the number of doses you
missed. Review triggers for missed doses, such as distractibility, running out of medication, or thoughts about not wanting/needing to take
medication.
Prescribed doses per week: ____________________________________
Doses missed this week: ____________________________________
Triggers for missed doses: ____________________________________
_________________________________________________________
_________________________________________________________

Review of Previous Modules

Each week you should examine your progress in implementing skills from each of the previous modules. It is important to acknowledge
the successes you have achieved and to problem-solve around any difficulties.
Review: Tools for Organization and Planning
■ Calendar for managing appointments
■ Notebook for recording a to-do list

Homework Review
Remember, having a good calendar and task list system is necessary (but not sufficient) for getting organized.
If you have not yet purchased a notebook or calendar book, find a way to get one immediately.
Remember, problem-solving skills are covered in future sessions. However, before actually getting to those sessions, try to figure out
how to problem-solve getting a calendar and notebook. If necessary and possible, purchase one right now. In order for this approach to be
successful, it is imperative that you have the proper tools!
If you have obtained a calendar book and notebook system, review specifics:
■ Where you will keep the book?
■ How will you remember to use it every day?
■ How will you remember to look at your task list every day? (We find that picking a time every day is the best—for example, when
you feed your dog, after you brush your teeth, while you are having your morning coffee or breakfast.)
Remember, just because you have a to-do list, it doesn’t mean that you have to complete all of the items on the list immediately! It is
simply a tool that is going to help you become organized and avoid forgetting things that you have not written down.
■ The calendar and task lists are building blocks for the rest of the treatment program. Make sure to plan a strategy to look at them

P a g e | 34
EVERY DAY! ■

In the task list and the calendar, you may have noticed that we often need to manage multiple tasks at one time. When you have ADHD,
it can become difficult to decide which task is most important. Even when you have decided that a particular task is important, it is often difficult
to stick with it until it is completed.
In the following exercise, you will learn a concrete strategy to help you decide which tasks are most important. This technique is one
example of how you can force yourself to organize tasks even though it is difficult for people with ADHD to process this type of information.

Skill: Prioritizing
When you are faced with a number of tasks that you must do, it is important to have a clear strategy for prioritizing which tasks are most
important so that you make sure that you complete the most important tasks.
The best way that we know of to do this is to rate each task.
We find that people like to complete the tasks that are easier but less important first. This can be problematic. When we do this, we get
the feeling that we are getting things accomplished but find that we are never making progress on our important goals.

Skill: The A, B, Cs

Use the “A,” “B,” and “C” ratings. We have found that it works best to list all of the tasks first and then assign the priority ratings.
“A” Tasks: These are the tasks of highest importance. This means that they must be completed in the short term (like today or
tomorrow).
“B” Tasks: These are tasks of less importance, to be done over the long term. Some portions of the task should be completed in the short
term, but the other portions may take longer.
“C” Tasks: These tasks, of the lowest importance, may be more attractive and easier to do but are not as important as tasks with higher
rankings.
In this chapter, you should generate a task list, and discuss ratings for each item. Be very careful not to rate too many items as A!

Skill: Using This Technique

P a g e | 35
 You can now add this technique to your “tool box” of skills that you are developing to combat your ADHD symptoms. In addition to
making a to-do list for each day, you should now assign a rating of “A,” “B,” or “C” to each task. You should do all of the “A” tasks before
doing any of the “B” tasks!! This may be hard for you, but it is very important! It will help you to make sure that you complete the tasks that are
important to you.
■ Use this technique every day. Make a new list when the old one becomes too messy to read easily. ■

Potential Pitfalls

You may be feeling that we are asking you to do a lot.

Don’t get discouraged!
You are trying to learn some new skills, and it will take some time before the skills become habits. As you become more accustomed to
writing down your to-do list, you will learn more about how much is realistic for you to expect to do in one day.
At this point, if you find that you are not finishing all of the items on your list, simply re-rate them the next day. In later chapters, you
may want to problem-solve if you are finding that you are consistently not finishing the most important items on your list.
Remember, at this point, you are just trying to get in the habit of using the to-do list.

Homework

Use your notebook every day to maintain your to-do list.

Use and look at your task list and calendar EVERY DAY!

Rate each task “A,” “B,” or “C.”

Practice doing all of the “A” tasks before the “B” tasks and all of the “B” tasks before the “C” tasks (for this reason, there should be

P a g e | 36
fewer A tasks than B or C tasks).

Carry over tasks that are not completed; cross out the ones that are completed.

Consider any difficulties that you anticipate may interfere with your completing your homework.

An example of a task list is provided on page 43. See if you like this format for your task list.
Task List

P a g e | 37
P a g e | 38
 Chapter 6 Problem-Solving and Managing Overwhelming Tasks
The main skills that you will learn in this session are how to solve problems effectively and how to take a task that, at first, seems
overwhelming and break it down into manageable steps. The problem-solving techniques are adapted from cognitive-behavioral interventions
that focus exclusively on problem-solving (e.g., D’Zurilla, 1986; Nezu, Nezu, Friedman, Faddis, & Houts, 1998).

Goals

■ To continue to monitor your progress

■ To review your use of the calendar and task list, particularly the A, B, and C priority ratings

■ To learn how to use problem-solving to overcome difficulties with task completion or selection of a solution

■ To learn how to break a large task into manageable steps

■ To troubleshoot difficulties using this technique

■ To identify exercises for home practice

Review of Symptom Severity Scale

As you have been doing each week, you should complete the ADHD self-report symptom checklist. Be sure to review your score and
take note of symptoms that have improved and those that are still problematic.
Score: ______________
Date: ______________

Review of Medication Adherence

P a g e | 39
 As you have been doing each week, you should record your prescribed dosage of medication and indicate the number of doses you
missed. Review triggers for missed doses, such as distractibility, running out of medication, or thoughts about not wanting/needing to take
medication.
Prescribed doses per week: ____________________________________
Doses missed this week: ____________________________________
Triggers for missed doses: ____________________________________
_________________________________________________________
_________________________________________________________

Review of Previous Modules

Each week you should review your progress in implementing skills from each of the previous modules. It is important to acknowledge
the successes you have achieved and problem-solve around any difficulties.

Review: Tools for Organization and Planning

■ Calendar for managing appointments

■ Notebook for recording a to-do list
■ Use of the “A,” “B,” and “C” priority ratings

Skill: Problem-Solving Strategies

In this section, we focus on learning to recognize when you are having difficulty completing a task or are becoming overwhelmed and
cannot figure out exactly where to start. The reason we call problems “problems” is that there is no easy solution at hand; usually any solution
has serious pros and cons.
This typically can lead to problems like procrastination.
Once you recognize that there is a problem, you can use these problem-solving strategies to help.
We are going to go over two skills that may seem simple but are actually quite powerful.

P a g e | 40
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Joonas. Heidän tehtäväkseen oli Santeri määrännyt hiihtää
tullimiesten perässä niin kaukana ja varovasti, etteivät Saalkreeni ja
Jönsson saisi heistä vihiä. Mutta Järvirannan taipaleella heidän tuli
hiihtää hyvin likellä, ihan perässä, ollakseen apuna kuormia
ryöstämässä, kun hän, Santeri, miehineen tulisi vastaan.

Santeri selitti miehilleen, kuinka piti menetellä. Tullimiehet

otettaisiin kiinni, ja toiset pidättäisivät heitä kinoksessa sillä aikaa,
kun toiset nostaisivat tavaroita omiin resloihin. Tullimiesten hevoset
ajettaisiin menemään tyhjin rein eteenpäin, ja vasta sitten, kun omat
kuormat olisivat reilassa ja toiset jo menossa, laskettaisiin tullimiehet
irti… ja kaikin sitten he ajaisivat jäälle ja Kalliosaaren luo Suomen
puolelle. Kalliosaaren törmän alle purettaisiin kuormat ja palattaisiin
heinäteitä Käkisaaren kautta.

Santerin suunnitelmaa pitivät kaikki miehet viisaana ja parhaana.

Ja rohkeasti he aikoivat yrittää ja, jos niin tarvittaisiin, vähän
kepittääkin tullimiehiä, sillä kaikilla oli entistä kaunaa heitä kohtaan.

Isolan Antti ja Taavolan Kalle, jotka olivat vankimpia joukossa,

ehdottivat, että he ottaisivat toinen Saalkreenin, toinen Jönssonin
hoitaakseen. Toiset hommatkoot, että kuormat vaihtuvat omiin
resloihin.

Ja niin keskustellen he ajelivat eteenpäin ja ryyppäsivät väliin, sillä

Santeri oli toimittanut runsaasti eväitä mukaan.

Yö oli pimeä ja taivas pilvessä.

Ei ainoatakaan ihmistä näkynyt Kolukankaan kylässä liikkeellä,

kun siitä läpi ajettiin Ruotsin puolelle.
 Pian he saapuivat Järvirannalle, ja kun oli noustu maantielle ja
päästy talottomalle taipaleelle, annettiin hevosten kävellä. Hetkisen
kuljettuaan he pysähdyttivät hevoset, kuuntelivat ja ottivat hyviä
ryyppyjä.

Santeri neuvoi ja rohkaisi miehiään. Kaikkien piti olla hiljaa, ja

ääntä päästämättä piti kaiken tapahtua, sillä tässä oli pääasiana se,
ettei heistä ketään tunnettaisi. Lyödä ei saanut, ellei ihan ollut pakko,
mutta sitä piti välttää, ettei hengenlähtöpaikalle osuisi.

Heillä oli reissään sylen pituisia aisankappaleita, joita he aikoivat

käyttää aseinaan. Kaikki olivat jo ryypänneet sen verran, että olivat
rohkeimmillaan, parhaassa nousuviinassa. Juuri kun taas pullo kulki
miehestä mieheen, alkoi tien mutkan takaa kuulua aisatiu'un ääntä…

He menivät kukin rekeensä, Santeri ja Taavolan Kalle istuen

ensimmäisessä reessä ja ajaen vähän edellä toisista.

Oli pimeä, mutta Santeri tunsi Saalkreenin, joka istui ensiksi

vastaantulevan hevosen reessä kuorman päällä… He ajoivat sen ja
vielä toisenkin hevosen ohitse, jolla ei ollut ajajaa.

Silloin Santeri hyppäsi seisaalle ja kiljaisi. Se oli merkki toisille.

Takaapäin alkoi kuulua kauheaa kiroilemista, seassa

revolverinlaukauskin… ja edestäpäin julman äreä miehen ääni…

Taavolan Kalle riensi sinne, missä Iso-Joonas ja Rämä-Heikki

tappelivat
Jönssonin kanssa… Santeri tuli perässä, mutta kun Iso-Joonas ja
Rämä-Heikki alkoivat nostella jauhosäkkejä reistä toisiin, pääsi
Jönsson irti Taavolan Kallelta ja tarttui Santeriin kiinni avonaisesta
turkinrinnuksesta, nykäisten Santerin kuin kuivan rievun kinokseen.

Sillä aikaa sai Taavolan Kalle reestä aisankappaleen ja iski sillä

Jönssonin päätä kohti, mutta toinen ehti väistää ja isku putosi
raskaasti reenperää vasten. Santeri ehti kinoksesta pystyyn ja
karjaisi:

»Lyökää lujemmin, pojat!»

Mutta silloin oli Taavolan Kalle jo saanut Jönssonin alleen

tiepuoleen, ja Joonas ja Rämä-Heikki nostelivat kuin riivatut säkkejä,
keskenään supattaen.

Takaapäin kuului silloin hätäinen ääni:

»Ajakaa menemään! Ihmisiä tulee!»

Santeri ja Taavolan Kalle hyppäsivät oman hevosensa rekeen,

johon ei ollut ehditty panna kuin yksi tupakkakuli. Kannaksille ehti
vielä Iso-Joonaskin, läähättäen kuin ajettu poro.

Santeri iski hevosta selkään, ja virma juoksija karkasi heti täyteen

laukkaan.

Rämä-Heikki ehti saada kiinni jälkimmäisen reslan perästä, kun

yksi tullimiesten hevosista oli kääntynyt poikkipuolin tielle, niin että
toisten täytyi ajaa tiensyrjää pitkin.

Jönsson oli päässyt jaloilleen ja ehti iskeä kannaksilla seisovaa

Rämä-Heikkiä olkapäähän maasta sieppaamallaan
aisankappaleella.
 Pimeä oli, eikä yksikään uskaltanut huutaa tai kovaa puhua.
Hurjaa menoa kavaltajat ajoivat eteenpäin, eikä kukaan oikeastaan
vielä tiennyt, kuinka oli käynyt. Jälkimmäisillä hevosilla oli täydet
kuormat, mutta tiepuolessa oli ollut monta jauhosäkkiä kinoksessa
sillä kohdalla, jossa tullimiesten hevonen oli esteenä.

Kun Järvirannan taival loppui ja kylä alkoi, oli siinä joella tie, jota
heinämiehet kulkivat. Siitä oli ollut puhe ajaa jäälle.

Perässä tulevat kuulivat jo hevosten laukkaavan myötälettä joelle

päin, ja kaikki kääntyivät samaa jälkeä perässä.

Juuri tienhaarassa tuli heitä vastaan kaksi rahdista palaavaa

miestä, jotka näkivät kaksi jälkimmäistä hevosta laukkaamassa
heinätietä pitkin rantaan. Viimeisen reen kannaksilla seisoi mies
koukussa, molemmin käsin pitäen reslan perästä kiinni.

Vasta kun oli päästy poikki Käkisaaren, pysähdyttivät Santeri ja

Taavalan Kalle hevosensa ja odottivat toisia. Ensiksi tarkastettiin
kuormat, mitä oli saatu ja mitä oli täytynyt jättää.

Ja nyt alkoi kukin kertoa, mitä oli ehtinyt toimittaa. Saalkreenia oli
huitaistu selkään, niin että hän kaatui silmilleen kinokseen; vain
kerran hän oli ehtinyt ampua, luoti oli mennyt metsään. Neljästä
kuormasta oli tavarat saatu, viides oli jäänyt.

Yhteen rykelmään kokoontuneina seisoivat kavaltajat, joita nyt,

kun Rämä-Heikki ja Iso-Joonas olivat lisänä, oli kahdeksan miestä ja
viisi hevosta, ja kahakasta selvitti kukin töitään ja tavaroitaan. Ja
musta, kiiltävä pullo kierteli miehestä mieheen, ja kun se tyhjeni,
kiskoi Santeri uuden auki.
 Kahdet ryypyt otettuaan he istuivat taas resloihin ja ajoivat
Käkisaaren laitaa pitkin korkearantaisen Kalliosaaren luo. Sinne,
korkean törmän alle, jonka yläpuolella kasvoi laajoiksi levinneitä
pajupensaita, kaivettiin kinokseen kuoppia, joihin tavarat aluksi
kätkettiin.

Sillä niin oli Santeri ennakolta päättänyt.

Mutta miehet alkoivat olla humalassa jokainen, ja Rämä-Heikki

kiljaisikin jo pari kertaa ja noitui, että sukset jäivät häneltä
taistelutantereelle. Liian paljon oli Santerikin tällä kertaa maistanut.
Kieli sammalsi, eikä hän kyennyt pitämään miehiä oikein kurissa.
Kun he nostelivat säkkejä, suistuivat he tavantakaa lumeen,
nauroivat ja kirosivat.

Isolta-Joonaalta oli kahakassa hukkunut lakki ja Santerilta

molemmat kintaat.

Vihdoin he pääsivät lähtemään. Ajettiin heinätietä myöten joen

rantaa pitkin ja vasta lähellä Palomäkeä noustiin maantielle, jolloin
toiset hajaantuivat kukin omalle suunnalleen.

Silloin alkoi jo näkyä aamun sarastusta.

Joonas seurasi Santeria Palomäkeen ja hoiperteli siitä vielä poikki

väylän avopäin Lampalle.

Santeri hiipi hiljaa omaan huoneeseensa ja retkahti vaatteet yllään

sänkyynsä, johon heti nukkui.

*****
 Hän heräsi siihen, että pihaan ajettiin parilla hevosella, ja tiu'ut ja
kulkuset soivat niin, että nurkat helisivät.

Hän hyppäsi kuin orava vuoteeltaan ja riensi ikkunaan, joka oli

pihan puolella… Oli jo iso päivä.

Hän säpsähti, mutta tointui merkillisen pian unen ja kohmelon

vallasta. Ensiksi hän näki Saalkreenin ja Jönssonin, jotka virkamerkit
rinnoillaan nousivat jälkimmäisen reestä. Toisessa reessä olivat
olleet vallesmanni ja poliisi, jotka jo seisoivat pihalla.

Santeri pyyhkäisi hiuksiaan, hieraisi silmiään ja meni pirttiin. Hän

arvasi, mitä varten tulijat olivat liikkeellä, ja omituinen säpsähdys,
jonkalaista hän ei ollut ennen tuntenut, kävi hänen hermostonsa läpi.

Hän koetti tyyntyä, eikä hänen kasvoistaan nähnytkään

minkäälaista mielenliikutusta. Se pelko, että hänet tai heidät kaikki oli
tunnettu, ahdisti kuitenkin niin, että hän liikkeissään näytti
hermostuneelta.

Vallesmanni selitti Santerille, mikä heillä oli asiana.

Tullimiehet, vallesmanni ja Santeri olivat menneet talon saliin

isännän pyynnöstä. Vallesmannin puhuessa Santeri seisoi
näennäisesti tyynenä, vaikka Saalkreenin ja Jönssonin vihaiset
katseet tähtäsivät häntä kuin ahmaa puussa.

»En ole kuullut koko asiaa», vastasi Santeri hyvin kuivalla äänellä.

Vallesmanni kivahti:

»Tiedätkö, että tämä on raskas rikos, josta sinua syytetään?»

 »Niin tuntuu olevan, mutta syytön minä olen», vastasi Santeri.
Jonkinlaista hermostumista hänessä sittenkin voitiin huomata.

»Se näytetään toteen, että sinä olet ollut joukossa ryöstöä

tehdessä», sanoi Saalkreeni yhteisesti Santerille ja nimismiehelle.

»Kotonani olen ollut», väitti Santeri.

Tullimiesten pyynnöstä kuulusteltiin todistajina talon palvelijoita,

renki Uptan Kreusia ja piika Josefina Alasenpäätä sekä
mäkitupalaisia Juho Malmia ja Liisa Vuojokea, jotka viimeksimainitut
poliisi oli käynyt heidän kotoaan kutsumassa.

Kaikki tulivat saapuville.

Vallesmanni piti pöytäkirjaa, ja poliisi istui ovensuussa.

Saalkreeni ja Jönsson istuivat nimismiehen kahden puolen, ja

Santeri seisoi poliisin vieressä. Emäntäkin tuli kuuntelemaan.

Ensiksi kuulusteltiin renki Uptan Kreusia, sitten toisia siinä

järjestyksessä kuin tullimiehet olivat todistajia ilmoittaneet. Ja he
kertoivat:

Uptan Kreusi: Pääasiaan ei tiennyt mitään. Illalla isäntä oli ollut

kotona, kun hän pani maata, ja samoin nyt aamulla. Hevoset olivat
olleet koko yön tallissa eikä niitä ollut yön aikana liikuteltu, koska
tallinavain oli ollut hänen huostassaan. Muuta ei tiennyt.

Josejina Alasenpää: Ei tiennyt mitään. Isäntä oli ollut maatapano-

aikana kotona.
 Juho Malmi (Ranta-Jussi): Ei tiennyt mitään. Ei ollut viikkoon
käynyt koko talossa eikä ollut takavarikostakaan kuullut mitään.

Liisa Vuojoki (Iso-Liisa): Ei tiennyt, oliko isäntä ollut kotona vai ei,
sillä hän ei ollut talossa käynyt edellisenä päivänä.

Muita todistajia tullimiehet eivät sanoneet tällä kertaa olevan,

mutta vaativat jo kuitenkin, että Santeri vangittaisiin. Sanoivat
tuovansa todistuksia Ruotsin puolelta.

Saalkreeni tosin vielä muisti Rämä-Heikin, mutta vallesmanni

selitti, ettei Heikki kelvannut todistajaksi, sillä hänellä ei ollut
kansalaisluottamusta ennenkuin vasta kolmen vuoden päästä.

Mutta tullimiesten vaatimukseen ei vallesmanni ainakaan vielä

voinut suostua, sillä eihän ollut mitään todistusta, että Santeri
Palomäki oli ryöstössä osallisena.

»Siihen kyllä saadaan todistuksia», vakuuttivat sekä Saalkreeni

että
Jönsson.

»Se on sitten eri asia», sanoi nimismies ja rupesi kokoomaan

papereitaan.

Ja niin päättyi poliisitutkinto, joka oli ensimmäinen Palomäen

talossa ja josta asia sitten kehittyi.

*****

Santeri sulkeutui koko päiväksi kamariinsa mietiskelemään.

 Vielä ei ollut mitään hätää. Hänen tietääkseen ei heiltä ollut
kukaan tuntenut eikä Kolukankaallakaan kukaan nähnyt, kun he
ajoivat Ruotsin puolelle. Ne miehet, jotka olivat tulleet
keskeyttämään ryöstöä, olivat kaiketi olleet ruotsalaisia, eivätkä
tietenkään heitä tunteneet. Samoin ei ollut heidän tuloaankaan
nähty.

Mistä siis todistukset tulisivat?

Mutta rauhaa hän ei kuitenkaan saanut, ja aina johtui mieleen joku

seikka, josta he voisivat päästä alkuun.

Jönsson oli sanonut varmasti tunteneensa joukossa Santerin,

mutta muita ei ollut tuntenut! Siinä oli paha pykälä. Ja nyt Santeri
lisäksi muisti huutaneensa: lyökää lujemmin, pojat!… Olisiko sitä
sattunut kukaan vieras kuulemaan?

Koko päivän hän mietti ja otti pari hyvää ryyppyä vahvistuakseen.

Kului päiviä.

Santerin oli tehnyt mieli käydä Lampalla, ja monta kertaa oli

Lamppa lähettänyt kutsun, mutta hän päätti vielä olla lähtemättä.
Sillä huhuja alkoi kuulua monenlaisia ja monelta haaralta. Ranta-
Jussi ja Iso-Liisa kuljettivat kaikki kuulemansa Santerille. Ruotsin
puolelta olivat tullimiehet vihdoin saaneet todistuksia, ei kuitenkaan
Santeria, vaan Taavolan Kallea vastaan.

Ja jonkun päivän päästä kerrottiin, että tullimiehet olivat löytäneet

ryöstetyt tavarat Kalliosaaren törmän alta ja vieneet pois. Sitäpaitsi
oli liikkeellä huhu, että Kettu-Heikki oli ollut Kalliosaaressa
heinäladon suojassa samana yönä, jona kavaltajat sinne kätkivät
ryöstämiänsä tavaroita. Hän oli kuullut heidän rähinänsä, mutta
muita ei ollut tuntenut äänestä kuin Taavolan Kallen. Ja huhu tiesi
lisätä, että tullimiehet olivat myöskin Kettu-Heikiltä saaneet tietoja.

Sellaisia sanomia Jussi ja Liisa toivat Santerille. Joka päivä tuli

lisää ja aina pahempia. Ja kummallisinta oli, että ne kohdistuivat
Taavolan Kalleen. Muita ei ollut tunnettu.

— Jos Taavolan Kalle joutuu kiinni, — mietti Santeri, — niin pian

siihen sekaantuvat muutkin. Kalle ei ole mikään luotettava mies ja
saattaa, kun näkee itselleen huonosti käyvän, ilmiantaa toisetkin.
Hänet pitäisi saada pois tieltä….

Ja eräänä päivänä toi Iso-Liisa uutisen, että Taavolan Kalle joutuu

kiinni. Liisa oli puhutellut Kallea, joka oli ollut kovasti huolissaan.

»Vai niin. Kumma, kun ei korjaa luitaan pois!» sanoi Santeri Liisan
puheisiin.

»Kyllä uskon, että korjaisi, jos joku avustaisi matkaan.»

Muutamien päivien perästä etsittiin Taavolan Kallea, mutta häntä

ei näkynyt, ei kuulunut. Mökkinsä, vaimonsa, lapsensa ja elukkansa
hän oli jättänyt, itse kadoten. Vaimo kertoi hänen menneen käymään
kaupungissa, mutta häntä ei kuulunut sieltä takaisin.

Asiaa ei jätetty vieläkään.

Kevätpuolella löytyivät kinoksesta ryöstöpaikalta Santerin kintaat,

joissa oli selvästi musteella kirjoitettu nimi Santeri Palomäki, ja siitä
alkoivat huhut taas viritä. Sitäpaitsi oli toinenkin huhu samaan aikaan
lähtenyt liikkeelle. Kolukankaalla oli Varpulan isäntä nähnyt, että viisi
hevosta samana yönä, jona ryöstö tehtiin, ajoi heidän pihansa läpi
jäälle ja siitä Ruotsin puolelle, Järvirantaa kohden. Ensimmäisessä
reessä olijat oli isäntä tuntenut Palomäen Santeriksi ja Taavolan
Kalleksi.

Nämä tiedot toi Ranta-Jussi Santerille. Jussi oli käynyt Lampalla,

ja Lampan puodissa oli siitä puhuttu. Patruunaa Jussi ei ollut nähnyt,
mutta Joonas oli kertonut hänen itsekseen kiroilevan ja välistä
kävelevän öilläkin. Joonastakin hän oli potkinut ja lyönyt korvalle sinä
päivänä, jona tuli tieto, että tullimiehet olivat löytäneet tavarat
Kalliosaaren törmältä.

Syviin mietteisiin jäi Santeri, kun Jussi oli kertonut kaikki

kuulemansa.

»Mutta niin kuuluivat arvelevan Lampan puodissa, ettei sitä

Palomäen
Santeria saada syylliseksi, vaikka onkin löydetty kintaat», koetti
Jussi lohduttaa nähdessään, että Santeri oli synkissä ajatuksissa.

Mutta siihen Santeri ei vastannut mitään.

Hän koetti puuhailla talossaan niinkuin ennenkin, mutta ei pysynyt

kauan yhdessä työssä, ennenkuin siirtyi toiseen ja siitä meni
kamariinsa mietiskelemään. Emäntänsä kanssa hän vältti jäämästä
kahden kesken ja kulki kylällä useammin kuin hänellä ennen oli
tapana ollut.

Hän oli huomaavinaan kaikkien ihmisten ja varsinkin

kotikyläläisten katseissa ikäänkuin salaista iloa ja toivoa, että hänet
pantaisiin kiinni…
 Sillä sen hän tiesi, että hänellä oli paljon kadehtijoita, jotka olisivat
suoneet hänelle pahinta. Ja se häntä kiukutti… Pääsisivät hänen
vahingostaan iloitsemaan, kun saisivat nähdä hänet, kylän
rikkaimman isännän, raudoissa…

Kerran hän tapasi kylällä poliisin ja alkoi tälle kertoa, että häntä
ahdistettiin viattomasti. Hän voisi näyttää toteen, että hän oli
ryöstöyönä ollut koko ajan kotona…

Poliisi oli vain arvellut, että tämä oli paha asia, jos siitä kiinni
joutuisi.

Mutta sittenkin Santeri vielä uskoi, ettei mitään sellaista todistusta

ollut olemassa, joka näyttäisi hänen syyllisyytensä. Ja viimeisenä
toivona oli, että jos todellakin alkaisi näyttää vaaralliselta ja huhut
yhä varmistuisivat, silloin hänellä olisi tie valmis… hän karkaisi
Amerikkaan. Sillä linnaan hän ei lähtisi…

Ja hän varusteli runsaasti rahaa lompakkoonsa, jota aina piti

pöytänsä laatikossa siltä varalta, että tulisi hyvinkin kiire.

Kerran hän oli kauan aikaa kahden kesken Ranta-Jussin kanssa

kamarissa. Jussi oli juuri palannut kuulustelumatkalta Ruotsin
puolelta ja tiesi kertoa, että siellä oli pidetty poliisitutkinto ja siinä oli
päässyt todistamaan Jönssonkin, joka oli sanonut varmasti
tunteneensa Santerin. Muuan rahtimies lisäksi oli kertonut
tunteneensa Santerin ja Taavolan Kallen Järvirannan taipaleella
vähää ennen ryöstöä.

»Se on pitkä vale!» sanoi siihen Santeri.

 Mutta näiden kuulemiensa johdosta arveli Jussi omana
mielipiteenään, että Santerin pitäisi olla varuillaan… Ja jos hän,
Jussi, nyt olisi Santerin sijassa, niin matkalle lähtisi…

Santeri ei väittänyt tätä vastaan, vaikkei toisaalta myöntänyt

Jussin puhetta oikeaksikaan.

Siitä illasta alkaen hän kuitenkin aina makasi vaatteet yllään ja

valveilla melkein koko yön. Reki oli myös valmiina pihalla ja oriilla
valjaat selässä…

Hän pelkäsi nyt todenteolla, mutta ei saanut päätetyksi, lähteäkö

karkuun vai eikö…

Niin kului joku päivä.

Mutta eräänä yönä, kun Santeri oli nukahtanut vuoteelleen, hän

kuuli kolkutusta ovelta ja ääniä pihalta.

Kun hän sytytti tulen ja aukaisi oven, näki hän vallesmannin ja

poliisin astuvan sisälle. Hän pysyi kuitenkin tyynenä ja kysyi, mitä
olisi asiaa.

Vallesmanni selitti tulleen ilmi niin raskauttavia asianhaaroja, että

hänen nyt oli pakko vangita Santeri, mahdollisen karkaamisen
varalta näin rajamaalla.

»Vai niin», sanoi Santeri kylmällä äänellä, mutta levollisesti.

»Tehkää tehtävänne! Tässä minä olen!»

Eikä hän puhunut sen enempää, kun häntä lähdettiin viemään

vanginkuljettajan luo.
VII

Aavistamatta tuli Lampalle tieto, että Santeri oli pantu kiinni ja

lähetetty linnaan välikäräjiä odottamaan.

Jo samana päivänä oli siitä tuotu sana Lampalle, ja koska se myös

tiedettiin muualla.

Uutisen kuultuaan Lamppa kirosi ja käveli koko päivän eikä

kärsinyt ketään puheillaan; toisena päivänä hän joi ja pauhasi Tiltalle
ja potki Joonasta, mutta kolmantena päivänä hän oli sairas ja synkkä
ja kulki itkien konttorissaan. Sillä kaiken muun lisäksi hän sai
haasteen viinanmyynnistä ja monivuotisesta tullipetoksesta.

Eräänä iltana piti Joonaan lähteä käskemään Ranta-Jussia hänen

puheilleen.

Silloin oli kevät ja hangen aika, tikkatiekin pohotti jo

likaisenmustalta, ja kinosten harjat olivat pudonneet matalammiksi.

Keväthankea pitkin Joonas palasi iltahämyssä Jussin kanssa.

Patruuna puhutteli Jussia ystävällisesti, ikäänkuin olisi saanut

taloonsa sukulaisen. Viimeksi hän oli nähnyt Jussin syysmunakan
aikana.

Mitä nyt -kuului Suomen puolelle?

Jussin piti selittää juurta jaksain kaikki mitä tiesi. Patruuna käveli
edestakaisin poltellen sikaaria ja kysellen. Jussi istui konttorin
pöydän päässä ja teki selvää kaikista tullikavallusasioista ja tästä
viimeisestä ryöstöstä, josta patruunalle koitui niin suuri vahinko ja
Santeri oli pantu kiinni.

»Kumma mies se Santeri, kun ei minua uskonut», puheli Jussi

alakuloisella äänellä. »Minä kehotin lähtemään varalta pois… mutta
hän ei uskonut, että saataisiin todistajia. Mutta kun se Jönssonkin
pääsi todistamaan, vaikka luultiin, ettei pääse, niin kummako sitten
oli…»

»Joo, mutta kun ne tulevat käräjille, niin eivät tiedä puoltakaan. Irti
lasketaan Santeri… Odotappa, jahka välikäräjät tulevat», tuumi
patruuna vielä toivoen.

Jussi näytti epäilevän.

»Ei sitä miestä niinkään tuomita siitä, mitä yksi ja toinen on ollut
näkevinään», vahvisti patruuna omaa uskoaan.

»Kumma mies kuitenkin… Muita osasi toimittaa meren taakse, kun

ymmärsi hädän tulevan, mutta itse ei älynnyt lähteä», sanoi siihen
Jussi, äänessä epäilys.

Patruuna ei ollut kuullutkaan mitä jälestäpäin oli tullut ilmi, ei

tiennyt, mitä Kolukankaan isäntä oli poliisitutkinnossa todistanut, eikä
sitäkään, että Santerin kintaat olivat löytyneet tappelupaikalta. Mutta
nyt sen Jussilta kuultuaan hän oli hyvän aikaa ääneti ja sanoi
viimein:

»Jaa, mutta…»

Mutta siihen hän ei tiennytkään jatkaa. Käveli vain edestakaisin ja

veti sikaarista savuja.

»Olisipa ollut se Rämä-Heikki joutilaampi mies linnaan kuin

Santeri», sanoi hän sitten.

»Olisi kyllä joutanut, eikä papinkirja olisi siitä paljoa huonommaksi

mennyt», myönsi Jussikin.

Patruuna vetäisi kuin vihapäissään sikaaria ja jatkoi:

»Sillä muutoin tästä ei tule mitään. Eiväthän ne enää uskalla tänne

tulla tyhjinäkään Suomen puolelta. Pelkäävät mokomia rakkareita…
Mutta sen minä sanon, että… Jo se oli sentään onneton juttu, että
noin piti käydä…»

»Santerikin oli ollut sinä yönä vähän liiemmältä ryypyissä…

siinäkin
Kalliosaaren luona olivat niin huutaneet ja mellastaneet…»

»Niin, ja nyt tavarat kuitenkin joutuivat tullimiesten käsiin…»

»Niin kävi…»

»Olisi pitänyt toimittaa ne tänne heti seuraavana päivänä!»

»Niinpä tietenkin. Mutta kuka silloin uskalsi lähteä?»

»Sepä se… kuka uskalsi lähteä!»

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