Psychotherapy for adult ADHD
- Mary V Solanto, PhD
Mary V Solanto, PhD
- Associate Professor of Psychiatry
- NYU School of Medicine
Once thought to be exclusively a disorder of childhood, longitudinal follow-up studies have shown that attention deficit hyperactivity disorder (ADHD) persists into adulthood in about 50 percent of cases [1-6]. ADHD is associated with significant impairment in adult functioning in occupational, academic, and social spheres.
While stimulant medication (methylphenidate and amphetamine) and nonstimulant medication (atomoxetine) can reduce the core symptoms of ADHD, they often insufficiently address difficulties in executive self-management with respect to time and organization , as well as problems in social and emotional self-regulation, leading to continued distress and impairment for adults with ADHD [8,9]. Cognitively based psychotherapies therapies have been developed to address these problems.
This topic discusses psychotherapy for ADHD in adults. The epidemiology, pathogenesis, clinical manifestations, assessment, diagnosis, and pharmacotherapy of adult ADHD are described separately. ADHD in children and adolescents is described separately. (See "Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis" and "Pharmacotherapy for adult attention deficit hyperactivity disorder" and "Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis" and "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis" and "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis" and "Attention deficit hyperactivity disorder in children and adolescents: Treatment with medications".)
Psychotherapy can play an important role in the treatment of adult attention deficit hyperactivity disorder (ADHD) as monotherapy or as an adjunct to pharmacotherapy. Research evidence most strongly supports the use of cognitive-behavioral therapy (CBT) targeting deficits in executive function. (See 'CBT targeting executive function' below.)
The great majority of adults with ADHD have difficulty in some aspect of everyday executive function, particularly with respect to time-management and efficiency. Research has shown that executive dysfunction is highly correlated with overall functional impairment in adults . (See "Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis", section on 'Executive dysfunction'.)
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- Rating scales
- Cognitive behavioral therapy
- - Efficacy
- CBT targeting executive function
- - Efficacy
- Predictors of response
- - Administration
- Group versus individual therapy
- Adapted dialectical behavior therapy
- - Efficacy
- Mindfulness-based cognitive behavioral therapy
- Other interventions
- COMPARING MEDICATION AND PSYCHOTHERAPY
- COMBINING MEDICATION AND PSYCHOTHERAPY
- TREATMENT SELECTION
- SUMMARY AND RECOMMENDATIONS