The primary goal of an ADHD management plan is to control the core symptoms of inattention and hyperactivity/impulsivity. A multimodal management plan that incorporates a variety of strategies may work best for many patients with ADHD.1
Not all interventions are appropriate for all patients.
Medication may be an important part of the management plan for patients with ADHD. There are FDA-approved treatment options that may help improve ADHD symptoms.2
*Pharmacologic treatment may not be appropriate for all patients. Reassess pharmacotherapy periodically.
There are no official US guidelines for the treatment of ADHD in adults.
Individuals may respond differently to different medications. It is important to closely monitor symptom improvement and medication side effects for each patient to tailor the individual management plan to the current needs.
Reassess pharmacotherapy periodically
†Only qualified health care professionals can prescribe medications to treat ADHD.
Several nonpharmacologic interventions may help with ADHD symptoms. These interventions can be used as part of a management plan that may or may not include medication as a part of therapy.‡2,7,9
Education about ADHD is an important starting point in management. The more patients and their families know about the disorder and how it affects them, the better equipped they will be to devise and implement management strategies that target their desired goals.4
COGNITIVE BEHAVIORAL THERAPY
This skills-based approach can help patients change maladaptive behaviors and thought patterns that interfere with daily functioning. Preliminary data support the efficacy of cognitive behavioral therapy as an adjunct to medication in adults with ADHD.4,6,7
Cognitive behavioral therapy for adults with ADHD4
As the name implies, cognitive behavioral therapy joins together cognitive and behavioral therapies as a management approach.
Centers on the premise that how a person interprets an event is more important than the actual event. Treatment focuses on thoughts rather than overt behaviors, with the goal of reducing dysfunctional thoughts as a means to improve adjustment.
Emphasizes the role of basic learning principles (eg, observational learning) in developing and maintaining behavior, both adaptive and maladaptive. Focuses on the stimuli and conditions that maintain maladaptive behaviors, rather than the thoughts driving these behaviors.
Cognitive Behavioral Therapy
Blends these 2 therapeutic approaches based on 3 core beliefs:
Evidence for effectiveness of cognitive behavioral therapy in adults with ADHD2,4
The literature on cognitive behavioral therapy in ADHD suggests that patients with ADHD who receive this form of psychological treatment may attain symptom improvement when added to pharmacotherapy.
In a study involving patients with ADHD already receiving ADHD medication treatment, those individuals randomly assigned to also receive cognitive behavioral therapy reported significant reductions in the core symptoms of ADHD (ie, inattention, hyperactivity, impulsivity) both at the end of treatment and at the end of follow-up 3 months later.
The cognitive behavioral therapy program applied in this study included the following 5 components:
learning strategies to improve attentional control, memory, impulse control, and planning
developing skilled thinking, problem identification, consequential thinking, managing conflict, and making choices
managing feelings of anger and anxiety
recognizing the thoughts and feelings of others, empathy, negotiation skills, and conflict resolution
evaluating options and developing effective behavioral skills
ADHD coaches can help adults learn practical life skills to manage the daily challenges of the disorder (eg, being disorganized, forgetful, tardy).3-5
ADHD coaching is an emerging field that seeks to address the daily challenges of living with the disorder. An ADHD coach helps patients learn how to manage the basics of daily life (eg, keeping appointments) in an organized, goal-oriented, and timely fashion. A coach accomplishes this by teaching patients practical life skills and ways to initiate change in their daily lives.
Coaches provide encouragement, recommendations, and feedback and teach practical techniques, such as reminders, questions, and calendar monitoring. Through individualized support, coaches help patients focus on where they are now, where they want to be, and how they can get there.
Skills a patient may acquire through coaching6
Some of the life skills a patient may acquire through ADHD coaching include:
Regular meetings—either in person, by phone, or by e-mail—are an essential part of the ADHD coaching process. Interaction enables the coach to learn how ADHD symptoms influence the daily life of the patient, enabling the coach to tailor his or her encouragement, recommendations, feedback, and practical techniques to address specific challenges faced by the patient.
Patients most likely to benefit from coaching5,6
Research suggests that ADHD coaching may be beneficial for adults and possibly some teens with the disorder.5 Patients may benefit from coaching when they are able to commit to the process and are able to admit they have a problem. Patients also benefit when they spend the time necessary to create strategies for improving their behavior and can adhere to those strategies to the best of their ability.
A caveat about ADHD coaching6
Patients who are considering coaching should be informed of the following caveat: Coaching is not therapy. Coaches address the challenges of daily life—they focus on what, when, and how, not why. They are not trained to address psychiatric, emotional, or interpersonal challenges; these issues fall under the purview of mental health professionals.
MANAGING ADHD AT WORK
The symptoms of ADHD can present many challenges for an adult in the workplace, just as they may for a child in school. Although each adult patient’s challenges are unique, some general strategies may be helpful to adults with ADHD when applied at work.9
A very helpful, but sometimes overlooked, intervention involves reasonable accommodations in the workplace setting.
Take steps to decrease distractibility
The patient may consider requesting a private office or quiet cubicle, or he or she may find it helpful to take work home or work when others are not in the office. Another key strategy is to perform only one task at a time; another task should not be started until the current one is done.
Learn how to limit impulsivity
Adults with ADHD who struggle with impulsivity in the workplace may benefit from learning how to anticipate problems that regularly trigger impulsive reactions and develop routines for coping with these situations. Practicing relaxation and meditation techniques may also help.
A patient with ADHD may find it helpful to take intermittent breaks to move around, exercise, or take a walk. During meetings, taking notes may help to prevent restlessness.
Outsmart a poor memory
To counteract forgetfulness, adults with ADHD can try writing checklists for complicated tasks; using a day planner, smart phone, or other PDA device to keep track of tasks and events; setting up reminder announcements on the computer; and writing notes on sticky pads and putting them in highly visible places.
Avoid the opportunity for procrastination
Having a firm deadline in place can help prevent a patient from continuously delaying completion of a project. Tasks can be broken into smaller pieces, with small rewards along the way (eg, a walk to the coffee shop). The patient may also want to consider working on a team with a coworker who manages time well.
‡Not all interventions are appropriate for all patients.