Cognitive Behaviour Therapy (CBT) for ADHD
CBT for ADHD
Attention deficit hyperactivity disorder is a complex neurological condition which affects concentration, memory (especially short term working memory) and mood or affect regulation. It is genetic in origin but is believed to come about through a combination of other factors such as developmental instability during pregnancy and birth trauma.
You cannot catch ADHD or develop it in later life– you are either born with it or you don’t have it. That said, the effects often don’t manifest until the child is in school and generally we don’t make a diagnosis until the child is at least seven years of age.
It can be thought of as similar to Dyslexia in many ways, it is a life-long condition and although there is no cure, with the right help (and for some appropriate medication) the disability can be managed successfully.
Attention Deficit Hyperactivity Disorder
Although ADHD seems like a relatively new phenomenon it has been known about for a long time. Indeed back in 1845 a German psychiatrist Heinrich Hoffman, wrote a book about Fidgety Phillip and we can see that this is a clear description of the symptoms we know today as Attention Deficit Hyperactivity Disorder – hyperactive type. Scientists continued to explore the phenomenon but the modern diagnosis really only came to the fore in the 1980′s. It is important to note that not all ADHD sufferers are hyperactive – some have attention deficit inattentive type ADHD-I and some have a combination ADHD-C.
Obviously, in schools, pupils who are unruly and disruptive draw attention to themselves and are more likely to get referred to a child psychiatrist. Whilst some of these may have ADHD their symptoms can often also be put down to other factors such as disrupted home life and it is important to rule out other diagnosis first rather than to assume that all hyperactive children have ADHD.
Another aspect that complicates the picture for genuine sufferers of ADHD is that the benefits system will pay enhanced rates to a parent who can present a child as ADHD; it is believed that this can lead to misdiagnosis in some cases.
Tragically, many people who do genuinely have ADHD go undiagnoised. For the children who are intelligent is the likelihood that their symptoms will not seem bad enough to warrant a trip to the psychiatrist: they know not to throw chairs and act too defiantly.
Even though they may be chronically disorganised, over-talkative or excitable, and prone to ‘forgetting’ homework they typicaly are not enough of a problem to the school to get a diagnosis. However, their chronic lack of organisation and tendency to make careless mistakes will hold them back and they are unlikely to achieve their full potential without support. For the child with ADHD inattentive type is the endless label of space cadet; dream boat; and again, since they don’t cause overt trouble they are unlikely to get a diagnosis.
Just as with dyslexia, many children who have ADHD will get through the school system unnoticed despite their difficulties and may find their adult lives similarly held back and never know why.
Can adults have ADHD?
ADHD is a lifelong condition and although for some the symptoms reduce over time, it is clear that a significant number of people continue to have residual difficulties as adults. Although people may self select careers that avoid the core difficulties there may still be situations where the difficulties re-surface.
I recall a client who worked successfully for many years within retail as a store assistant when her work involved attending to the displays, managing stock, and helping customers. When her manager moved her to a till based job she started to suffer work related stress symptoms: this role left her feeling caged in, and increasingly frustrated at the low level of activity and stimulation required. She found herself increasingly unable to tolerate the discomfort and this led to her being signed off work by her GP.
Recognising the symptoms and getting a referral through the occupational health specialist led to her negotiating a change back to her previous role where she returned to working successfully. Another client worked in a highly pressured work environment where he thrived on the constant challenges his job as a fraud investigator posed.
When he moved to another company though, he found there was less work to do and the endless paperwork required by this new organisation to document everything drove him to distraction and it wasn’t long before he found himself surfing the internet during working hours to break the tedium of what had become a boring job. This led to conflict with his manager and it wasn’t long before he found himself signed off work with stress and dreading his return.
An inability to tolerate repetitive or mundane tasks is a key problem for sufferers of ADHD – nobody likes boring jobs but for the ADHD individual this is not just uncomfortable, its painful. ADHD sufferers will previously have been told it is laziness on their part but the research shows that the part of the brain that regulates mood is the part that is different.
Adult ADHD symptoms
Just as with dyslexia the symptoms will vary from person to person, however, common symptoms in adult ADHD are:
- Poor organisation – particularly prone to forgetting to remember things such as paying bills on time.
- Tendency to procrastinate or put off uninteresting tasks and or need constant reminders.
- Tendency to have many projects started but few finished
- Tendency to be late for appointments (or obsessive about timekeeping as a compensation strategy)
- Tendency to constantly be misplacing items such as keys, mobile phone, etc. (or obsessively organised to compensate: note that even this strategy still fails some times)
- Tendency to hyper-focus on certain things (seen as more stimulating or rewarding) and have difficulty de-prioritising/ending it and returning to other tasks.
- Tendency towards impatience – getting easily frustrated when things don’t work properly.
- Tendency towards acting impulsively – may say inappropriate things in social settings, be prone to impluse purchases in shops; at the destructive end vulnerability to gambling and domestic violence.
- Tendency towards interrupting or talking over others, or finishing other people’s sentences.
- Tendency towards monologuing when in conversation, forgetting to take turns.
- May have difficulty concentrating during lovemaking leading to sexual dysfunction or disappointment or may engage in unsafe or risky sexual acts.
- Endlessly on the go, finding it hard to relax or unwind with a tendency to work flat out and then crash out.
- Tendency in some cases towards undue risk taking while driving.
CBT for ADHD
Cognitive Behavioural Therapy (CBT) can offer useful strategies for managing the difficulties people with ADHD suffer. Time management strategies can help the ADHD individual learn how to find ways to prioritise important tasks and develop systems to create organisation from the chaos.
The therapy space can also help to identify ways to cope with tasks that cannot be avoided by learning how to approach them: Learning at what time of day to do certain tasks, whether to break particular tasks down into manageable chunks, or whether to block out sufficient time to tackle the task in one hit. An important part of this process is working beyond negative self messages (I’m just lazy that’s why I put it off) and replacing these with more accurate messages (this is a more difficult task for me than others so I need to be patient with myself).
CBT for ADHD can also help you come to terms with the emotional aspects of accepting both the idea of a diagnosis and the realities of accepting that some things will continue to be difficult – particularly intimate relationships. Living with ADHD is not easy for partners and it takes effort and understanding on both parts to work the relationship successfully.
Be aware too that the genetic heritability of this condition makes it more likely that any children you have may be prone to having the same vulnerability and will need to be monitored in school so that any difficulties can be addressed early before they become a problem. Raising a child with ADHD can make parenting more challenging too.
Do I have ADHD?
Getting a diagnosis can be a drawn out and expensive process and is only worth contemplating if you need medication or for your employer to offer you dispensation under the Disability Discrimination Act (DDA). A full diagnosis would be conducted by a clinical psychologist under controlled conditions and will take a few hours and involve a battery of carefully designed tests to assess your cognitive functioning in a range of domains and involve the exploration of how these symptoms have acted throughout your life – in school, at work, at home.
And it is important to remember that diagnosis will not solve the problem, merely give you a name or label for it. From here the challenge begins since it is about your ability to find strategies to manage the worst excesses of your condition that will determine how disabled you are by it. There are various self diagnostic screening tests on the internet. It is important to recognise that these don’t give you a diagnosis – merely indicate the possibility that further investigation may be called for.
Hope for adults with ADHD
ADHD can be managed and some very successful people have turned it to their advantage by learning how to learning to optimise the strengths and minimise the negative aspects. For everyone though who has ADHD, the potential that with the right coaching and support (and for some appropriate medication) a successful and enjoyable life can be achieved.
|About The Author
Alex Drummond is a fully qualified Cognitive Behavioural Psychotherapist and Counsellor located near Caerphilly Glamorgan. His clients come from Cardiff, Newport, Ebbw Vale, Pontypool, Cwmbran and the surrounding valleys.
For more information about Alex’s work visit his GoToSee profile page here
Visit his website www.talkmebetter.com