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Psychotherapy for ADHD

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

Medication can be a very helpful tool in managing ADHD, but it isn't a 'magic bullet.' Research has demonstrated the most effective treatment for ADHD is a combination that includes medication, education, and skills training. Drug therapy may continue throughout someone's life, but it's only one part of treatment. Education helps people to understand the disorder. Education can provide valuable information, insight, and motivation for change. Moreover, education can teach people helpful strategies to improve organization, time management, and other skills such as social skills or workplace adaptations. Overtime, these strategies become second nature; a new habit. These new coping skills improve confidence, competence, and satisfaction. So, it is easier to successfully manage problematic ADHD symptoms.

therapy sessionOne of the first therapeutic tasks of a clinician is to help newly diagnosed individuals understand and accept their disorder. Adults with ADHD have lived for many years with their symptoms. They have likely developed a combination of helpful (positive), and not-so-helpful (negative), coping patterns to deal with their disorder. Overtime, negative coping patterns can become deeply ingrained. This causes people to respond, almost as though they are on 'autopilot,' even when they are trying to respond differently. It takes practice, repetition, and determination to develop a new 'autopilot' but it is well worth the effort.

Unhelpful response patterns can be modified once they are identified and accepted without judgment. Let's illustrate these concepts with an example: Keisha is a highly intelligent, and well-educated woman with ADHD. She realized might have ADHD long before she received a formal diagnosis. It was only due to her fierce determination that she completed her advanced education. Due to her high degree of competence, she accurately and thoroughly researched the topic extensively on the Internet. Ordinarily self-education is very helpful. However, instead of being a positive coping pattern, Keisha's unique skill set turned it into a negative coping pattern that needed to be modified. She became so knowledgeable and opinionated about what was learned from her own research that wheneh for assessment and treatment, she rejected their information if it didn't match up with what she had read on the Internet. This often left Keisha feeling that no doctor was skillful enough to work with her.

Fortunately, Keisha learned to modify her approach. She developed a more positive technique. Rather than using her Internet research for self-diagnosis, she instead used what she learned on the Internet to provide her doctor an accurate and complete list of concerning symptoms. She also learned to be more open to input because that is what she hired these professionals to do; i.e., provide her with the benefit of their knowledge and experience.

While Keisha was successful in modifying her approach, these entrenched types of negative coping patterns can be extremely difficult to change. Unlike children, adults have had many years to practice these patterns. Adults with ADHD have also had years to develop additional problems such as depression, or anxiety. Adults with ADHD usually benefit from an examination of behavioral coping tendencies. This will help to determine which behaviors are effective coping skills, and which could be modified and improved.

For ADHD adults, psychotherapeutic skills are taught and practiced using different techniques. Some examples are:

  • Coaching
  • Social Skills training
  • Psychoeducation
  • Cognitive-behavioral therapy

These techniques are often overlapping and may be used at different points in time throughout an individual's life.