Cognitive Behavioral Therapy Can Help With ADHD

Both adults and kids can benefit. Here's how to find a good therapist.

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Adults who struggle with being disorganized, late, and distracted as a result of having attention deficit hyperactivity disorder can benefit from cognitive behavioral therapy that teaches them how to solve problems, use calendars and lists effectively, and write down distractions instead of being distracted by them, according to new research in the Journal of the American Medical Association. But CBT not only helps the 4 percent of adults with ADHD; it also helps children who struggle with schoolwork and friendships because of the disorder.

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Cognitive behavioral therapy is a technique that teaches skills for handling life challenges or overcoming negative thoughts. CBT for children with ADHD is aimed largely at improving their behavior through praise and rewards that motivate them to calm down enough to cope with school or other challenges. Parents or teachers would be trained to reward a child with praise or small treats for paying attention and responding to requests, for example. That's different than CBT for adults, which teaches thinking and self-management skills. Although CBT doesn't cure ADHD, it does make it easier for children to get along in a world that's often intolerant of typical ADHD behavior, explains Richard Gallagher, an associate professor of child and adolescent psychiatry at the New York University School of Medicine. Gallagher is working on a randomized, controlled study that is trying to see if CBT can help children with thinking skills like managing time, keeping track of homework assignments, and planning ahead.

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The beauty of CBT is that it's very practical, designed so that a person can learn and practice new skills, and then apply them to make life better. Good CBT typically takes 12 weeks of sessions, though some families continue for nine months. Behavioral therapy for ADHD is offered by a number of organizations, including the Institute for Attention Deficit Hyperactivity and Behavior Disorders at New York University's Child Study Center and the Duke Child and Family Study Center in North Carolina. But most families don't live near an academic medical center with a research program on behavioral therapy for ADHD.

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Parents can find an individual therapist who does cognitive behavioral therapy, but it's tricky shopping; many counselors say they do CBT, but really don't follow its simple yet rigorous requirements. A good place to start is the Association for Behavioral and Cognitive Therapies, which certifies CBT therapists and has a therapist finder on its website. (Here's a blog post I wrote recently on finding good CBT therapy for children, with a nuts-and-bolts explanation of CBT.) Even if a therapist isn't listed with the ABCT, you can use the organization's description of good cognitive behavioral therapy to figure out if a therapist you're considering knows how to deliver it.

The new study on CBT and ADHD, conducted by researchers at Massachusetts General Hospital, gave adults who were already being treated with medications such as Ritalin for ADHD 12 weekly one-on-one counseling sessions. The sessions focused on skills training in organization and planning, setting priorities, problem solving, and learning how to persevere in stressful situations. After the training, two-thirds of the participants saw a 30 percent improvement in ADHD symptoms, while just one-third of the control group, which learned relaxation techniques, had improved. The study was led by Steven Safren, director of behavioral medicine at the Massachusetts General Hospital's department of psychiatry, and author of the book Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Therapist Guide (Treatments That Work) (Oxford University Press, 2005). The book is written for therapists, alas, but there's also a guide for adults with ADHD; the guide's website includes a six-question quiz: Do You Think You Have Adult ADHD?

For a positive look at the benefits of ADHD, check out my interview with psychiatrist Ned Hallowell on how to make the most of your child's ADHD. He has ADHD, and his kids do, too. He's convinced that ADHD can help kids master a fast-paced world, if they learn to manage the condition effectively.