Introduction

According to recent literature on studies of adults with Attention Deficit Hyperactivity Disorder (ADHD), individuals who underwent a combined treatment of stimulant medication and psychosocial treatments have been shown to experience significant reductions in ADHD symptoms. In particular, the psychosocial treatments that were studied included Cognitive Behavioral Therapy (CBT), individualized coaching, and various forms of group therapy. The goal of these treatments was to target core ADHD symptoms (e.g., distractibility, impulsivity, and dysfunctional thinking), by teaching strategies that promote organization, cognitive restructuring, mindfulness, and self-efficacy.

Individual Cognitive Behavioral Therapy and Personal Coaching

In individualized, psychosocial treatments, researchers recognized the positive affects of both Cognitive Behavioral Therapy and personal coaching. While both individual CBT and coaching use targeted intervention strategies, the approach varies significantly between personal coaches and Cognitive Behavioral Therapists. According to Knouse, Cooper-Vince, Sprich, & Safren (2008), in general Cognitive Behavioral Therapists incorporate a structured approach that teach clients coping skills and self-efficacy through weekly skills practice and homework assignments. Individual coaches primarily focuses on helping clients work through specific issues or reach concrete goals in a brief, and frequent type of intervention. Stevenson et al. (2002 & 2003) argued that CBT and individual coaching may promote better results when implemented together rather than separately. More recently in 2011, Emilsson et al. showed that growing evidence supports the understanding CBT increases the effect of psychopharmacological interventions in reducing ADHD symptoms and co-occurring disorders.

Group Therapy

Emerging literature on group therapy highlights four types of treatments for adults with Adult ADHD: metacognitive, CBT, mindfulness, and dialectical behavioral therapy (DBT). In both CBT and metacognitive-based group therapy, therapists incorporate cognitive-behavioral intervention that focus on the development of compensatory skills (e.g., time management, organization, and memory) to deal with ADHD-related symptoms. In DBT and mindfulness-based group therapy, therapists focused on emotion regulation, attention control, and acceptance-oriented skills to help combat inattentive, hyperactive, and impulsive symptoms related to ADHD. All group treatments included a structured approach with components of psychoeducation, weekly assignments, and group sharing. These studies provide preliminary evidence for a supportive, cost-effective treatment for ADHD and comorbid symptoms. Although studies have shown that group-formatted intervention resulted in significant reductions in ADHD-related symptoms, more research is needed to address issues such as bias in self-reporting, small sample sizes, more objective ratings, and the lack of control groups, to allow for more conclusive evidence.

Skills Training

The various, successful psychosocial treatments used in conjunction with stimulant medication (pharmacotherapy) involved in these studies included psychoeducation, training in concrete skills (e.g., organization, time-management, planning), development of metacognitve skills (e.g., emotion control, regulation of dysfunctional thoughts), and emphasis in the practice and maintenance of these strategies in daily life. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) (2013), current research shows that CBT can benefit an individual with ADHD, regardless of whether or not the person is being treated with stimulant medication. Adults who were treated with specific CBT program demonstrated increased habits and skills needed for executive self-management and positive behavior reinforcement; which in turn—helped individuals maintain helpful, adaptive behaviors. Ramsay & Rostain (2006) make an argument that CBT is highly effective when used to treat dysfunctional thinking and to promote adequate, adaptive coping skills.

Conclusions

Medication often helps to control the core symptoms associated with Adult ADHD. However, combining CBT and skills training together with medication management, is becoming widely recognized as extremely important to increasing the habits and skills needed to reduce Adult ADHD related symptoms over time.

References:

Knouse L. E., Cooper-Vince C., Sprich S., & Safren S. A. (2008). Recent developments in the psychosocial treatment of adult ADHD, Expert Rev Neurother. National Institute of Health, 2008 October; 8(10): 1537 – 1548. doi: 10.1586/14737175.8.10.1537.

Stevenson C. S., Whitmont S., Bornholt L., Livesey D., Stevenson R. J. (2002). A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust. NZ J. Psychiatry 2002;36:610 – 616. Report of skills-based group incorporating an individual support person/coach.

Emilsson B., Gudjonsson G., Sigurdsson J.F., Baldursson G., Einarsson E., Olafsdottir H., Young S. (2011). Cognitive behaviour therapy in medication treated adults with ADHD and persistent symptoms: A randomized controlled trial. BMC Psychiatry11:116 http://www.biomedcentral.com/1471-244X/11/116

Ramsay J. R., Rostain A. L. (2006). A combined treatment approach for adults with ADHD—results of an open study of 43 patients. Journal of Attention Disorders, 2006 10:150. doi: 10.11771/1087054706288110.

Solanto M. V. (2013). Cognitive-behavioral therapy for adults with ADHD. National Resource Center on ADHD, A program of CHADD. The Mount Sinai School of Medicine.