Treatment can involve a number of different components and the exact approach is tailored to your presenting promblems. However, in general ADHD treatment focuses on three interrelated areas.
- Identifying your strengths and areas of interest.
- Addressing the skills deficits often found in people with ADHD.
- Treating any emotional difficulties that may co-occur with your ADHD symptoms.
The strengths and areas of interest help us define the goals and direction for treatment. This includes looking at how ADHD has hindered reaching those goals in the past.
The ADHD-related skills we cover include organization, planning, time management, and reducing distractibility.
- learning how to effectively use a planner and todo list
- becoming a better estimator of time
- breaking down large tasks into smaller steps
- developing an organizational system for important papers
- identifying and eliminating distractions in the environment
- learning to work within (and expand) your attention span, etc
For any emotional problems we would use cognitive behavioral techniques to help you identify thought patterns and behaviors that maintain symptoms and then substitute more adaptive ones.
How Thinking Affects ADHD
While there is a biological basis to ADHD, the way you think plays a role in maintaining or exacerbating the symptoms. For example, when feeling distracted or unfocused at work, thoughts like “What’s the point-I’m too ADD to do this sort of thing” or “I’m so overwhelmed-I’ll surely screw this up again” are likely to lead to increased anxiety and hopelessness. Anxiety can worsen your attention, making matters worse. Hopelessness usually leads you to stop trying.
Cognitive therapy helps you identify the thoughts that get in the way of your productivity. Some examples of cognitive distortions common in ADHD are listed below:
- “I’m not going to do it right, so I might as well not do it at all.”
- “I’m either a success or a failure, either I did a great job or I failed.”
- Going between thinking “I’m great and talented” and “I’m lazy and worthless.”
- Overgeneralization. “I missed the deadline, I’m a total screw-up.”
- Emotional reasoning. “I feel distracted and overwhelmed so I must be incapable of doing this”
- Should statements. “I should be able to stick to a plan without getting distracted, everyone else does.”
- Labeling. “I guess I’m just lazy”
Maladaptive thoughts aren’t always negative though. Just as problematic are permissive thoughts such as “if I didn’t study/clean/work on my project this morning, I might as well write of the whole day” or “I’ll feel more like doing this tomorrow.”
Cognitive therapy can help you identify these thoughts, help you understand how they interact with your ADHD symptoms, and develop new, more adaptive ways of thinking. In CBT, we work together to help you identify biased thinking or problematic behaviors and substitute healthier repsonses. You can turn your thoughts from those that interfere with a task to ones that reorient you to it.
How Behavior Affects ADHD
Dysfunctional behaviors often involve some element of avoidance. Avoiding class or people at work once you’ve fallen behind. Avoiding working on a project until the last minute. Avoiding difficult tasks or painful emotions by surfing the internet, drinking alcohol, etc. Avoiding the fear of failure by choosing tasks that are very easy and avoiding more challenging tasks.
In CBT, we work together to help you identify biased thinking or problematic behaviors and substitute healthier responses. For example, you can learn how to problem-solve a complex situation or break a task down into small steps. Or you can learn assertiveness and communication skills to build confidence. In addition, you learn relaxation and meditation techniques to help decrease stress and improve concentration.
A final note about medication. Patients often ask me, “I would like to manage my ADHD without medication or drugs. Can CBT be an alternative to medication?”
A person’s ability to manage their symptoms without medication depends on a number of variables. The factors that increase the likelihood of symptom management without medication include lower symptom severity, a lack of co-existing conditions such as anxiety or depression, having a job that matches your strength, and frequently using the skills from therapy between sessions. However, many people do best with a multimodal approach that includes both CBT therapy and medication.
I am also frequently told, “I have ADD, not ADHD.” The terminology can be a bit confusing. The condition is no longer known as Attention Deficit Disorder (ADD). The diagnosis ADD was replaced by Attention Deficit Hyperactivity Disorder (ADHD) several years ago. And you can have ADHD without the “H” because the subtypes indicate which symptom groups you experience. There are 3 subtypes: combined presentation, predominantly inattentive presentation, and predominantly hyperactive-impulsive presentation. So if you don’t experience symptoms of impulsivity or hyperactivity, the diagnosis would be ADHD, predominantly inattentive presentation.