Relationships are significantly impacted by ADHD, particularly if the symptoms are left unchecked or not effectively managed. The science of ADHD suggests that medication remains the best single intervention for adult ADHD. But medication does not address every aspect of the disorder. For example, medication often has less impact on disorganization, time management, and multi-tasking problems. Moreover, not everyone experiences a noticeable level of symptom reduction with ADHD medication. Finally, problematic side effects are common in both adults and children with ADHD medications.
Individual Treatments for Adult ADHD
Medication is not the only intervention for adult ADHD. Still, most professionals that I have talked to suggest that the combination of therapy and medication is more effective than just therapy for ADHD. But this blog is about individual interventions for adult ADHD. So what is available?
Well, in addition to couples’ therapy with a clinician who is well-acquainted with ADHD, several individualized approaches are available. The first of these is cognitive behavioral therapy.
Cognitive Behavioral Therapy (CBT)
A number of systematic psychotherapies have been developed to help adults with ADHD. One well-known model is that of Steven Safren’s adaptation of cognitive-behavioral therapy (CBT) for individuals with adult ADHD. It uses a focused approach to develop skills for frequent problems like distraction and disorganization. It also provides individuals with tools to reduce the effects of procrastination and other frequent challenges in adult ADHD. The model does not directly deal with relationship problems due to ADHD as couples counseling would, but the individual’s partner or another family member is involved in the treatment process. Division 12 of the American Psychological Association lists CBT treatment approaches like that of Safren as having “strong research support” in the treatment of adult ADHD (http://www.psychologicaltreatments.org/).
Peer Support and Learning About ADHD
In addition to specific techniques and skills to address ADHD, it is often helpful for an individual with the disorder and his/her partner or family members to just learn more about what ADHD is and is not. How, for instance, is ADHD different in adults than in children?
This is where participation in organizations like CHADD, adult peer support groups, and educational groups can be so useful. As with so many other things, knowledge is power for ADHD. Some of the regular problems that develop in relationships impacted by adult ADHD result from faulty assumptions, misinformation, and preconceived notions about ADHD. Learning more about the disorder can directly address these issues. Additionally, gaining an informed perspective of adult ADHD (sometimes for the first time) and meeting others with similar struggles related to the disorder are often powerful and affirming experiences.
Another approach that is often used in conjunction with CBT is mindfulness based therapy. Mindfulness has a long history in the treatment of anxiety, depression, and chronic pain. Put simply, mindfulness involves extending one’s focus and developing a nonjudgmental awareness of one’s thoughts. It helps people to strengthen their concentration, calm racing thoughts, and activate relaxation. Obviously these skills are difficult for someone with adult ADHD! However, studies at UCLA by Dr. Lidia Zylowska and others suggest that adults with ADHD can learn and benefit from mindfulness techniques. Using mindfulness provides them with some tools to counter the distractibility and impulsivity of the disorder, and mindfulness may activate the prefrontal cortex, an area implicated as being dysfunctional in ADHD.
Computer Skill Training
Although not really a form of therapy, one last approach I want to mention is computer skill training. It involves computerized training of specific skills with tasks of increasing difficulty. These programs usually target problems in working memory (multi-tasking) or sustained attention. They are similar to familiar products like Lumosity® but are typically administered in a more controlled manner with clinician coordination and oversight. Some examples are Cogmed® Working Memory Training from Pearson and Captain’s Log® by Brain Train. So are they effective?
Well, the opinions are mixed. The Pearson web site provides research support for it product, Cogmed® (http://www.cogmed.com/research), while an April 2013 posting by Gareth Cook of The New Yorker is highly skeptical on the topic (http://www.newyorker.com/online/blogs/elements/2013/04/brain-game...). Some scientific commentary has questioned how well the training generalizes to real-life, non-computerized tasks. Other considerations for the training programs involve their overall expense and the fact that insurance companies do not generally reimburse for such training.
A number of non-pharmaceutical interventions exist for individuals impacted by adult ADHD. Besides informed couples’ therapy, some approaches to manage symptoms and develop skills in adult ADHD include cognitive behavioral therapy (CBT), peer-support and education, and mindfulness. Computerized skills training is also an option but the overall trend on its real-world effectiveness is unclear at this point.
Regardless of what approach is used though, the key is still hard work and persistence. In the words of a colleague of mine, adults with ADHD need to “participate in their own healing” process or meaningful change remains unlikely.