Treatments for ADHD

Please note that I do not currently offer ADHD treatment as my practice is entirely focused on assessment. However based on my experience as a therapist and ADHD sufferer I can offer the following suggestions. I will focus on the two most evidence-based treatments for ADHD which are: 1) Medications (pharmacotherapy) and 2) Talk-based treatments (counselling, coaching or the various cognitive-behavioural therapies). Both are usually very valuable.

ADHD Medication

Questions about medication generally should be discussed with a physician (for instance a family doctor, a psychiatrist, or in some cases a nurse practitioner). However, it is useful to know that ADHD medications are generally safe and effective. They work by directly regulating the arousal system, which is, in theory, the root cause of many ADHD symptoms such as inattentiveness and impulsivity. This graphic describes most of the ADHD medications that are used in Canada at the moment.

Cognitive Behavioural Therapies (CBT)

Cognitive Behavioural Therapies (usually called CBT) are really a group of different evidence-based interventions for ADHD.  But CBT can mean a lot of different things, and some implementations of CBT may be quite unsuitable for some ADHD people. 

It might help to get some sense of what we are trying to achieve. The main targets in therapy for ADHD are as follows: 

Executive dysfunction problems

These can be loosely defined as not acting effectively, or not acting in a timely way, or not acting at all.  Specifically, this includes problems with  procrastination, avoidance, neglect of personal care, neglect of relationships, etc. 

Impulsivity problems

These can be loosely defined as not acting in accordance with our values due to poor self-regulation. Examples include substance problems and addictive behaviour in general as well as some kinds of emotionally disregulated behaviour such as angry outbursts. 

Problems related to inattentiveness and mind-wandering

These include some items from the categories above, but the more specific issue is usually negative, problem-focused thinking (i.e. rumination) that interferes with mood. Examples include excessive self-judgment, excessive fantasizing, excessive identification with victim status, etc. 

Strategies

Here are some suggested strategies. These can be discussed with your therapist or used to guide your own reading and self-reflection: 

• Values Clarification. Who and what are important to me right now?  Am I important to myself? What happens to my behaviour when I pay attention to my values? 
• Behavioural Focus.  What am I doing right now? Is this action moving me towards what I value (I call this a “towards move”) or away from what I value (an “away move”)?
• Non-judgmental Observation.  What happens if I notice my thoughts, feelings or behaviours without drama or judgment? What if I apply the same approach to my relationships or to the world in general? 
• Cognitive Skills (e.g. thought logs, parts work, defusion exercises, etc).  Am I taking my thoughts too literally or seriously? Are my thoughts really the boss of me? Are these thoughts useful? Are these thoughts even mine? What if I had a more thoughtful relationship with this voice in my head? 
• Self Compassion Work. Because people with ADHD can be very hard on themselves.
• Commitment Work. Because on the other hand people with ADHD can also be a bit foggy about their own accountability, agency and responsiblities.
• Mindfulness Work. This is a tricky one because ADHD people often find mindfulness difficult. Nevertheless these practices can be extremely valuable so I recommend taking them seriously. Remember that ADHD usually involves problems with arousal regulation so the more relaxing and sleepy-making forms of mindfulness may not work. We probably need something more activating, in the way that a video game is activating. Neurofeedback is one way to gamify the experience of mindfulness practice. You might want to explore neurofeedback devices or gadgets such as Muse, Heartmath, Mendi. Some of these are evidence-based. But everybody is different so keep the receipt. Movement-based mindfulness (e.g. yoga, martial arts) can also be useful.

Which Therapist?

Therapy is usually a closed-door, confidential activity. It’s also a matter of interpersonal chemistry. Therefore it’s very tricky to recommend a good therapist! Using a search engine like Psychology Today you can generate a short list of therapists in your location and budget and then start contacting them to see if there is a good fit. Additionally I would look for someone with solid experience in treating ADHD and an interest in one of the following approaches, which should cover off most of the strategies I mentioned: Cognitive-Behavioural Therapy, Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, Mindfulness Based Cognitive Therapy. Even if funds are tight, you can still probably find some low-cost or no-cost CBT therapy. Most counsellors are trained in CBT and counselling may be available through employee assistance, churches, drop-in centres, etc.

Other Ideas

I’ve focused on the main evidence-based treatments, but everybody is different and in theory almost anything might help a bit with ADHD. Diet, supplements, apps, etc. are all worth a shot. However if you are looking for substantial change over a shorter and longer timeframe, medication in conjunction with CBT therapy is currently the best bet.