Adapting Psychotherapy to Meet the Needs of Adults With Attention-Deficit/Hyperactivity Disorder.

Abstract

Requests for the assessment and treatment of attention-deficit/hyperactivity disorder (ADHD) among adult patients are on the rise. The findings from longitudinal research indicate that clinically significant symptoms persist into adulthood for many children diagnosed with ADHD. Many other patients' symptoms are not identified until they are in active treatment for other complaints in adulthood. Thus, psychotherapists are increasingly likely to encounter adult patients with ADHD-related issues. However, the same core symptoms of inattention, impulsivity, and hyperactivity that create functional problems in patients' lives also interfere with the effectiveness of psychotherapy. The aim of this article is to summarize the accumulated clinical and empirical wisdom about how to effectively adapt psychotherapy to meet the needs of adult patients with ADHD. Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that has wide-ranging effects on behavior, learning and cognition, and emotional functioning (Barkley, 1998; Brown, 2000; Wender, 2000). It is estimated that ADHD affects about 3-5% of school-age children in the United States (American Psychiatric Association [APA], 2000). Barkley (1998) summarized prevalence studies of ADHD that used established diagnostic criteria for children and adolescents. The prevalence rates ranged from 2% to 9.5% (M ϭ 4.9%) of children and adolescents when using DSM-III criteria (APA, 1980) and 1.4% to 13.3% (M ϭ 5.9%) when using adults' ratings of DSM-III-R criteria (APA, 1987). Reviews of international samples show similar prevalence rates of ADHD in children in other countries, indicating that ADHD is not simply an American disorder (Barkley, 1998; Faraone, Sergeant, Gillberg, & Biederman, 2003), though diversity issues remain understudied (Gingerich, Turnock, Litfin, & Rosén, 1998). The prevalence of ADHD in adults falls between 4 and 5%, on the basis of surveys of nonclinical samples of college students and of adults applying for their driver's licenses (Bark

New psychotherapeutic approaches in adult ADHD - acknowledging biographical factors

“…Transferred to Young's theory of schema therapy, ADHD traits could be seen as temperamental factors interplaying with other biographical circumstances in the development of maladaptive schemas. Already more than a decade ago, Ramsay & Rostain discussed the importance of internalized core beliefs, also known as schemas, in relation to adult ADHD and ADHD-specific psychotherapy 15 and suggested the targeting of a patient's "compensatory strategies", linked to his schemas, by CBT. The same authors created the concept of ADHD as an "Axis 1.5 disorder", emphasizing the fundamental influence of ADHD traits on a patient's personal development 16 .…”

Evidence-based psychosocial treatments for adult ADHD: A review

“…The treatments reviewed have generally targeted the functional impairments associated with adult ADHD, including promoting a personalized understanding of the myriad effects of ADHD on adult life (ie, psychoeducation), identifying coping skill defi cits, and pinpointing the infl uence of maladaptive cognitions and beliefs on coping efforts and sense of self [11,29]. Both individual and group treatment formats have been found to be helpful.…”

“…Most early psychosocial treatment approaches were modifi cations of existing psychotherapy approaches to address the symptoms and impairments exhibited by adults with ADHD, including those that might interfere with traditional psychotherapy processes [10,11]. In some treatment models, medications were seen as providing a foundation upon which insight could be improved and personality structure modifi ed.…”

“…As the treatment of adult ADHD became more prominent in clinical practice, a variety of psychotherapy models were adapted to address the unique needs of adults with ADHD. Most of these treatment approaches focused on providing a structured approach to targeting specifi c impairments in daily life, an active therapeutic stance, emphasis on the development and implementation of coping strategies, and psychoeducation about ADHD [10,11]. Although the proposed treatment approaches were consistent with prevailing neurobiologic models of ADHD [12], clinical outcome studies were needed to provide evidence of their effi cacy.…”

Current status of cognitive-behavioral therapy as a psychosocial treatment for adult attention-deficit/hyperactivity disorder

“…Psychosocial approaches were adapted from traditional models of psychotherapy and derived from anecdotal accounts of what could be helpful for patients with ADHD [28]. It was generally accepted that unstructured, free associative therapy approaches and traditional formulations of poor follow-through as "resistance" were not beneficial for most adults with ADHD.…”