CBT Spawning New Treatments for Adult Attention Deficit Disorder

Identifying and treating ADD and ADHD has long been harder in adults than children, in part because adults develop coping mechanisms which can mask their underlying symptoms. But while clinicians have been improving diagnosis of attention deficits in adults, they have also been expanding the range of effective treatments, with many studies appearing over just the last three years showing how cognitive-behavioral principles can help.

There was a time, not too long ago, that many believed Attention Deficit Disorder (ADD) was a condition that only affected children. And some even thought that even afflicted children simply “grew out of” their difficulties as they got older. But in recent years we’ve come to appreciate the true nature of attention deficiencies and how the various conditions arising out of them affect individuals both young and old.

People having problems fixing and sustaining their attention can also have problems with impulsiveness and heightened motor activity (as in the case of Attention Deficit Hyperactivity Disorder, or ADHD). Further, when a person has trouble focusing, it negatively impacts a variety of other abilities, including a the ability to learn — which is why ADD plays such a key role in various learning disabilities — as well as the ability to carry out activities professionals call “executive functions,” such as planning, organizing, seeing tasks through to completion, and the ability to exercise good judgment and control over behavior. While the symptoms of ADD and ADHD in children are fairly well known, largely due to the fact that they often surface quite glaringly in the classroom setting, they are often more difficult to recognize in adults.

The prevalence of Adult Attention Deficit Disorder (AADD) and Adult Attention Deficit Hyperactivity Disorder (AADHD) is estimated to be between 2 and 4 percent of the general population. And the most common symptoms are related to executive functioning that lags behind what is considered typical for a mature adult, especially with regard to planning, organizing, task completion, and behavioral self-monitoring. But, as is also often the case for children, problems in these areas are sometimes erroneously attributed to laziness, stubbornness, carelessness, and thoughtlessness. Adults with the hyperactive version of the disorder are often seen as restless, fidgety, and constantly “on the go.”

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One reason it took a while to recognize ADD as a legitimate condition affecting adults is that many sufferers were able to develop various coping mechanisms over time, thus masking the more glaring indications of their impairment. Another reason is that some adults suspected of having the condition didn’t appear to respond as well to the typical medical treatments used for children, so it was surmised that they couldn’t possibly be suffering from the same condition. But in the past several years there has been considerable improvement in diagnosing adult attention problems. That’s largely because clinicians have come to appreciate that problems with executive functioning provide a much bigger red flag for adults suffering from attention deficits. And not only has there been significant improvement in diagnosing conditions like AADD and AADHD, but there have also been significant gains made in the various types of therapies available to assist adults afflicted with these conditions.

Since 2009, more than a dozen studies published in well-respected journals such as the American Journal of Psychiatry and the Journal of the American Medical Association have shown that various therapies based on cognitive-behavioral principles (e.g., Cognitive Behavioral Therapy, or CBT, and Meta-Cognitive Therapy, or MCT), can enhance the benefits derived from treatment of AADD and AADHD with medication alone or even treatment with medication plus supportive therapy. These cognitive-behavioral therapies target thinking patterns that foster anxiety and depression, and impair time management, organization, and planning. They also incorporate reinforcement strategies for re-directing thoughts and implementing coping skills (MCT particularly emphasizes skill acquisition and implementation). The therapies are often time-limited and specifically focused, giving the AADD or AADHD sufferer the tools they need not only to sustain better focus but also to bring their level of executive functioning up to a point where they are better able to plan and organize their work, persist on tasks until successful completion, exercise better judgment about solving problems, and make optimal use of their time. The therapies not only help ameliorate the symptoms of AADD and AADHD but also help reduce the anxiety and depression that often accompany these conditions and which, in many cases, exacerbate symptoms.

It seems like every time you turn around, there’s some new benefit being discovered from therapies derived from cognitive-behavioral theory. The relationship between thinking patterns and behavior is well established. And even conditions well-known to have a substantial biological component — including anxiety, depression, ADD, PTSD, and others — appear to improve when therapies using cognitive-behavioral strategies are employed. Now, the same principles and strategies that have helped so many overcome anxiety and depression are showing great promise in helping adults whose abilities have for too long been compromised by their attention deficits.

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