Current Status of Cognitive Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder

Abstract

Synopsis Attention-deficit / hyperactivity disorder (ADHD) is a valid and impairing psychological disorder that persists into adulthood in a majority of cases and is associated with chronic functional impairment and increased rates of comorbidity. Cognitive-behavioral therapy (CBT) approaches for this disorder have emerged relatively recently, and available evidence from open and randomized controlled trials suggests that these approaches are promising in producing significant symptom reduction. A conceptual model of how CBT may work for ADHD is reviewed along with existing efficacy studies. A preliminary comparison of effect sizes across intervention packages suggests that targeted learning and practice of specific behavioral compensatory strategies may be a critical “active ingredient” in CBT for adult ADHD. The article concludes with a discussion of future directions and critical questions that must be addressed in this area of clinical research.

Computerized Progressive Attention Training (CPAT) vs. Active Control in Adults with ADHD

“…This possibility raises the question of what should be appropriate subjective outcome measures in studies of cognitive training for adults with ADHD. It has been suggested that instead of report of ADHD symptoms, a better measure would be report of the need for compensatory strategies to cope with symptoms (Knouse and Safren 2010). In addition, other objective measures of daily life functioning such as academic performance are important in order to assess the broad impact of any given treatment.…”

Coaching nursing students with attention deficit hyperactivity disorder in clinical settings: A case study

“…[5,7,11] We concentrated on three areas: preparation, organization and setting priorities, and managing distractions. [8,10] We used retrospective, reflective review of his most recent clinical shifts to prompt WYM's rehearsal and planning for upcoming shifts. WYM was affirmed and commended for implementing actions and strategies which had positive outcomes.…”

“…Weekly coaching sessions, using retrospective reflection and review, provided us with a concrete, practical teaching strategy intervention, and helped our student, WYM, to develop lasting clinical executive skills. [5,8,10] A crucial parallel metacoaching intervention supported and encouraged the clinical NI to reinforce the coaching strategies with the student in the clinical practice setting. Throughout all coaching sessions, with the student and meta-coaching of the NI, the expert nurse-coaches focused on increasing the student's self-esteem, belief in own self-efficacy and decreasing performance anxiety.…”

“…[10] Adaptive learning strategies that the individual with ADHD used successfully prior to entering college to attain and retain knowledge may not apply in the performance arena of nursing clinical practice. Academic accommodations, such as extra time for exams, or writing exams in a separate room have not been designed for performance-based learning situations, and cannot be replicated in nursing practice settings.…”

“…However, without consideration of the underlying issue, nursing students with ADHD are likely to start down a predictable trajectory: they will be given learning development plans in clinical practice courses, have a lower academic performance as indicated by lower grade point average (GPA), be placed on academic probation and risk failing to graduate, with consequent symptoms of anxiety, depression, substance abuse and personality disorders. [5,10,12] To re-direct this trajectory, clinical teaching strategies for nursing students with ADHD are urgently needed.…”