Reviews

Introduction

Attention-deficit Hyperactivity Disorder (ADHD) is a developmental disorder often first observed in childhood which persists into adulthood. Symptoms of ADHD can have a pervasive and negative effect on the lives of those diagnosed with the disorder, particularly in areas pertaining to academics, career and finances. As of this writing, pharmacotherapy is seen as the most common and effective form of ADHD treatment, however there is a growing body of evidence to suggest psychosocial treatments, particularly Cognitive Behavioral Therapy (CBT), may be an effective alternative/addition to medication when treating symptoms of ADHD. This paper will discuss ADHD and CBT and how CBT may be used as a form of treatment to manage ADHD in adults.

Presenting Problem

Characteristics of ADHD include a pervasive inability to focus on tasks or activities, forgetfulness, a lack of attention to detail, excessive talking, and impatience. A diagnosis of ADHD can only occur if these characteristics cause difficulty in academic, job, social and familial settings. ADHD is most commonly seen in males, though there is anecdotal discourse among social media personalities and influencers suggesting the prevalence in males versus females has more to do with gender bias than anything scientific. ADHD diagnoses have higher rates in children than adults. As of the most recent publishing of the DSM-V-TR, there are no specific biological markers to indicate the presence of ADHD. Though there have been a few neuroimaging studies to indicate differences in brain wave functions in children with ADHD, the data is inconsistent, and more studies must be conducted in order to establish neuroimaging as a form of diagnostic measure to determine the presence of ADHD.

Individuals with ADHD may have co-occurring diagnoses of anxiety, major depression, oppositional defiance, learning disorders, autism spectrum disorder, substance abuse, obsessive-compulsive disorder and sleep difficulties. These comorbidities are not always present; however rates of oppositional defiance disorder and specific learning disorder are higher in individuals diagnosed with ADHD. Thoughts of suicide, suicidal ideation, and attempted suicide are higher in individuals diagnosed with ADHD.

As of this writing, there is a robust online community of individuals diagnosed with ADHD colloquially known as ADHDers, with a sub-community of late diagnosed individuals, predominantly those who identify as female. A late diagnosis can be relieving and frustrating and because of this, community resources and support are shared which give those with the diagnosis (early or late) a sense of connection they may not have enjoyed in childhood as those with ADHD are more likely to experience social impairment and rejection. Anecdotally speaking, ADHD provides affected individuals with a unique set of skills and interests due to their desire and need for novel experiences making ADHDers jacks of all trades, and masters of some. For ADHDers with hyperactivity, they are able to work in fast paced environments that require individuals to wear many hats. An individual with experience in multiple industries and the ability to be many things in one setting is a valuable asset in the commerce industry and retail sector. There are no citations to support these assertions as they are anecdotal, and the information has been acquired over the course of many hours consuming ADHD specific social media and message boards, as well as first-hand experience with a late diagnosis.

Modality

Cognitive Behavioral Therapy (CBT) is rooted in the belief that our thoughts (cognitions) and behaviors affect our emotions/feelings. CBT is a term that encompasses a multitude of techniques that are focused on identifying maladaptive thought processes and finding ways to alter or restructure those thoughts to produce healthy thought patterns and behaviors. Some techniques used in CBT are identification and modification of core beliefs, cognitive restructuring, mindfulness practices, self-monitoring and psychoeducation, to name a few.

Evidence Base

There is evidence to support the effectiveness of Cognitive Behavioral Therapy (CBT) on the treatment of ADHD symptoms. A literature review found CBT was the more effective nonpharmacological mode of therapy versus Dialectical Behavioral Therapy, Mindfulness Based Cognitive Therapy, and Neurofeedback. Additionally, the research suggests that individual therapy is more effective than group therapy. Though meta-analytic reviews found CBT to be the most effective therapy to manage ADHD symptoms, the researchers are careful to point out the limitations of their findings due to the number of studies done on the efficacy of CBT and other psychosocial treatments for ADHD. Reviewers suggest more studies must be conducted to provide a larger body of evidence to draw from in order to fully support CBT as an effective treatment for ADHD.