Treating Adult ADHD
What you need to know about treatment if you're an adult with ADHD.
When It's Not Just ADHD
Most adults with ADHD don't just have ADHD; 75% to 80% also have disorders such as mood swings, anxiety, and substance abuse, according to a study published in BMC Medicine.
Depression and anxiety are often what brings an adult with ADHD into a therapist's office, Tzelepis says.
"Honestly, most adults who are going to seek treatment aren't going to seek treatment for just ADHD," Tzelepis says. "My approach, and this is supported in the literature, is this is a neurobiological problem. The best treatment is going to involve a combination of medication and the therapy, or other nonpharmacologic interventions.''
For some people, the baggage that comes with ADHD is part of the problem.
"Some of the emotional issues you see have to do with not feeling good about themselves, feeling that they aren't capable and competent, because things they do take more effort and they internalize that," Tzelepis says. "The kind of feedback they get from others -- that they're lazy or if they worked harder they'd do better -- they constantly get the message they aren't good enough.''
Should I Try Psychotherapy?
Yes. Cognitive-behavioral therapy seems especially beneficial for adults with ADHD, mainly to help develop organizational skills. And if you have other mental health issues, you definitely need to start talk therapy.
If ADHD seems to be the patient's primary disorder, Tzelepis says she'll help a patient focus on "executive functions" including time management and planning.
In one case, a young woman who had flunked out of her first year of university after a stellar high school run came to Tzelepis to get on track. She had never had a bedtime or much structure to her days, and that was her downfall as a college student.
"It became clear she did have ADHD and hadn't been diagnosed because she was bright and was able to do well academically," Tzelepis says. Aside from getting her a calendar, Tzelepis helped the patient gain more mastery over her reactions and emotions.
The young woman spent a year at community college and is heading back to the university.
"What you need is therapy with goals that are specific to the behaviors and symptoms that are problematic. If you have difficulty keeping a calendar, how are you going to keep a calendar, what are the barriers?'' Tzelepis says. "It's not, 'how do you feel about keeping this calendar?'"
However, Adler says some patients may get better with ADHD medicine alone.
"They can make a change in their life, unlearn bad habits, use their organizers well, plan better, listen better. They don't need a psychosocial intervention," he says. "You can make a meaningful difference with these medicines.''
What About Coaching?
Coaching, a new industry that offers very specific problem-solving, can also work for some people, Tzelepis says.
"It's akin to what you have with a kid and a tutor," Tzelepis says. "I've referred people to coaches because I need to work on other pieces -- the emotional-psychological component of what is going on."
An Australian study that paired ADHD adults with coaches for eight weekly sessions found that most participants improved their organizational abilities and had reduced levels of anger that they maintained for a year after the therapy. Participants also had to complete homework exercises. The study was designed to target attention problems, low motivation levels, poor organizational skills, poor anger control, and impulsivity.
For the relatively few adults who only have ADHD symptoms, coaching or talk therapy may be the only thing necessary to put them back on track, Tzelepis says.