Cognitive Behavioral Therapy (CBT) Worksheet for AMD

Patient Name: AMD
Age: Child
Date: __

Session Overview

This worksheet is designed to help address AMD's behavioral challenges, particularly focusing on emotional regulation, establishing routines, and improving relationships at home and school. The goal of this session is to identify specific behaviors, thoughts, and feelings associated with her challenges, and outline a strategy to promote positive changes.

Understanding Thoughts, Feelings, and Behaviors

Identifying Triggers

1. List situations that cause difficult behavior:

Trigger / Situation	Emotion	Behavior
Being asked to stop a preferred activity	Frustration	Tantrums or arguments
Change in routine (like bedtime or mealtime)	Anxiety / Anger	Resistance or non-compliance
Sensory overload (loud noises, bright lights)	Overwhelmed	Meltdown or withdrawal
Confusion in understanding directions/instructions	Insecurity	Forgetfulness

Exploring Thoughts and Feelings

2. Write down the thoughts or beliefs that come up during these situations:

"Why can't they just let me do what I want?"
"I can’t handle this, it’s too much!"
"No one understands how I feel."

3. How do these thoughts make you feel? (Consider anxiety, anger, sadness, frustration):

Leads to feeling more frustrated
Increases anxiety during transitions
Creates a sense of loneliness or being misunderstood

Developing New Skills

Emotional Regulation Strategies

4. Identify three emotional regulation techniques to try when you feel overwhelmed:

Deep Breathing: Take 3 deep breaths in through the nose, hold for a moment, then exhale slowly.
Counting: Count to 10 slowly when you feel angry or upset.
Quiet Spot: Find a quiet space to cool down when it feels too busy or loud.

Routine Development

5. Create a daily routine
(Consider a chart or a visual schedule that represents different times of the day)

Time	Activity	Notes
7:00 AM	Wake Up	Use an alarm, bright light can help.
7:30 AM	Breakfast	Same food each day for comfort.
8:00 AM	Getting ready for school	Set a timer for each activity.
9:00 AM	School Time	Use a checklist for school tasks.
3:30 PM	Home/Snack Time	Same snack to avoid sensory issues.
4:00 PM	Homework/Quiet Time	Break tasks into smaller parts.
5:30 PM	Dinner	Try familiar foods and textures.
7:00 PM	Relaxation/Playtime	Allow time for favorite movies or games.
8:00 PM	Bedtime Routine	Reading a story or listening to calming music.
9:00 PM	Sleep	Ensure a comfortable sleep environment.

Relationship Building

6. Positive Reinforcement Techniques

Acknowledge good behavior when AMD follows the routine or manages emotions well.
Use a sticker chart to reward consistent routines or good choices in social situations with peers and family.

7. Making Connections

Discuss with a trusted adult about feelings and frustrations regularly.
Participate in a group activity to promote social skills and relationships.

Reflection and Goals

8. Review the Targets:

What skills will you practice this week, and how will you feel when you succeed?
Write down one short-term goal for this week related to emotional regulation or routine consistency.

Goal for This Week:

Success Indicators:

Feeling calmer during transitions.
Follow daily routine at least 3 times consistently.

Closing Note

Remember that change takes time. Celebrate small victories and don't hesitate to return to this worksheet to adjust your goals as needed. Sharing your thoughts and feelings with a trusted adult can further enhance your emotional support system.

Therapist Signature:
Next Session:

Note: Always consult with a therapist or healthcare professional for tailored advice and support based on your unique situation.