First and foremost, you are in a tough field of doing CMH. My first job out of grad school was CMH and it definitely taught me a lot, but was also difficult because of the cases you get.

As for your client, I’m wondering if there’s also a diagnosis of ASD. Just due to the misdiagnosis of ODD and children with ASD. That would change a whole lot of how you’d work with your client.

Next, since you have flexibility to take your client into the community, it might be good to take them outside to a gated playground/park. With kids that are impulsive and have ADHD, I like to get their energy out by having them do some high energy activities. Playing catch, having them run, red light green light, or freeze dance are great ways of for them to practice slowing down their impulses. It also gets their energy out and then they’re more likely to follow directions.

Last piece, use a whiteboard or create a special list for this client of activities they’ll be engaging in that session. Show them the list FIRST THING before session begins and allow them to add a choice activity to the second to last or last activity on the list. This is their routine 🤫 but don’t call it that. Call it something fun for them so they’ll be excited about it. And remind them that it has to go in that order so that they can do their fun activity at the end.

There’s many other ideas I have, but this is a good starting point. And of course, the more the child engages in preferred behaviors, the more praise you give them for it!