CBT for ADHD: How It Works, Examples & Effectiveness

How Can CBT Help With ADHD?

When working with someone with attention-deficit/hyperactivity disorder (ADHD), treatment usually involves extensive behavior modification. Behavioral interventions, organizational skills, and social skills are all areas of focus, whether the client is a child or has adult ADHD. CBT treats many of the peripheral symptoms, such as ADHD procrastination and time and task management.

A CBT session focuses on these areas of daily functioning and the therapist creates a plan for treatment of ADHD to address these concerns. Tasks can range from staying on top of financial responsibilities to encouraging endeavors that facilitate personal wellbeing, including sleep, exercise, and hobbies.¹

CBT can help someone with ADHD cope with and overcome negative thinking patterns, like:²

• All-or-nothing thinking: Someone with ADHD often sees things as black and white. So not being able to complete something “perfectly” is felt or thought of as a failure and can cause someone to procrastinate.
• Overgeneralization: People with ADHD can look at things broadly, taking one isolated negative incident and interpreting it as a recurrent pattern of defeat.
• Fortune telling: A person living with ADHD tends to think that things will turn out terribly and therefore predict the worst-case scenario regardless of any contradictory evidence.
• “Should” statements: Someone with ADHD may be inclined to develop this cognitive distortion when they feel they have not lived up to an “ideal” outcome.
• Mental filtering: Someone with ADHD may fixate on a small negative detail and from there will only see the negative aspects of any experience.
• Comparative thinking: Although it is common to use others and societal standards as points of reference, this becomes a distortion when the comparison is unrealistic.
• Disqualifying the positive: A person with ADHD may dismiss a rewarding experience in order to sustain a negative belief that is contradictory to their experience.

How Exactly Does CBT Improve ADHD in Adults?

CBT programs have been created specifically for adults with ADHD targeting relevant impairments they face in their daily lives. CBT treatment plans for ADHD adults aim to dismantle dysfunctional thought and behavioral patterns that perpetuate the negative effects of this condition. Additionally, CBT techniques can be particularly beneficial in treating core ADHD symptoms in adults by enhancing executive functioning, controlling impulsiveness, reducing stress, and more.³

Furthermore, adults with ADHD have a greater likelihood of having or developing a comorbid psychological condition such as depression or anxiety. For this reason, treatment approaches that incorporate CBT may be significantly helpful in overcoming the emotional symptoms and/or managing mood distress in adults with ADHD and depression or ADHD and anxiety.⁴

Cognitive Behavioral Therapy Techniques for ADHD

ADHD treatment requires a great deal of focus on behavior modification, though other aspects of cognitive behavioral therapy (CBT), such as relaxation and cognitive restructuring, can also be beneficial for treating ADHD symptoms.

Here are more common techniques used for working with ADHD:

S.M.A.R.T. Goals

S.M.A.R.T. means the goals are:⁵

• Specific: The client knows exactly what it is they want to accomplish. The goal is clearly defined
• Measurable: The client will know if progress is being made and when they have achieved their goal
• Attainable: The client has the skills and resources necessary to reach the goal.
• Realistic: It is something the client will devote their time and energy into accomplishing.
• Time specific: An appropriate amount of time is set for completing the goal

Example: In the scenario of a teenager who is often delayed while going to school due to forgetting important items, SMART goals can help this teenager stay more focused so they don’t forget important school items and can get to school on time:

• The specific goal in this situation is getting to school on time
• It is measurable by tracking the time when they get to school
• It is attainable because the teenager will have learned ways to organize themselves, such as making a checklist of items or organizing them the night before
• It is realistic assuming the teenager is motivated and committed to this goal
• Time specificity could be 1-2 weeks for this particular example

Cognitive Restructuring

Cognitive restructuring is the process of breaking down negative thinking patterns by identifying irrational thoughts and replacing them with rational ones. Though this may not seem like an integral part of a treatment plan for ADHD, it often is for those with ADHD and comorbid depression, anxiety, or low self-esteem. Cognitive restructuring helps retrain them to see themselves and their environment in a more positive, productive way.

Behavior Modification

Behavior modification works by identifying and eliminating any unwanted behaviors and encouraging and developing new, appropriate behaviors. Behavior modification in children typically requires parental involvement in treatment. The parents and therapist work together to develop an action plan for behavior modification, which the parents then apply at home. Collaboration with teachers is also beneficial as children often have the same behavior issues at school.

Skills Training

Skills training addresses life skills that may be difficult for those with ADHD. These skills include:

• Time management
• Social skills
• Organizational skills
• Healthy lifestyle adjustments

Activity Scheduling

Activity scheduling is a tool that can assist people with ADHD who typically struggle with organizing, initiating, and sustaining actions over time. This technique consists of teaching the client a variety of skills and strategies that enables them to be intentional, realistic, and specific about time-management, organizing responsibilities, planning activities, and so forth. The therapist will generally suggest and encourage the regular use of calendars, planners, checklists, phone reminders, or anything else that is practical and works well for a particular individual.⁶

Positive Self-Talk

People living with ADHD tend to experience more recurrent life setbacks which can negatively impact how they view themselves and everything around them. As part of CBT, a person can counteract this issue by learning to alter any demoralizing self-talk with more realistic, uplifting messages of self-assurance and compassion. Thus, a positive internal dialogue can make it easier for someone with ADHD to feel more optimistic, driven, and confident in fulfilling tasks and endeavors while also diminishing unpleasant feelings when confronted with life challenges.⁶

Distractibility Delay

People with ADHD often have a difficult time staying focused on any given task, shifting their attention toward less important endeavors or becoming easily derailed. Distractibility delay interventions provide helpful tools that individuals can use to stay on task while managing distractions or interruptions in the environment. This may involve creating a distraction-free area, developing a plan for how to handle interruptions, jotting down distracting thoughts to revisit them later, and setting reminders to ensure you’re staying on task.⁶

Successive Approximation

Individuals struggling with ADHD can feel overwhelmed when faced with a big project or complicated task. Successive approximation can teach the person with ADHD to work their way up to completion by breaking a complex task into small pieces and getting started, which is generally the most difficult part. This technique can help someone master simpler steps and build on that as they move through a continuum towards their desired goal.⁶

Is CBT Effective for Treating ADHD?

CBT has long been established as one of the leading therapeutic approaches utilized for treating many mental health conditions. It is also one of the top-researched types of therapy and is therefore a highly evidence-based treatment approach.⁷

Here are examples of the effectiveness of treating ADHD with CBT:

• In a series of studies, there was found to be a significant improvement in those with ADHD who received a combination of CBT and medication as compared with those who only received medication. These findings were found true for children, adolescents, and adults with ADHD.^8,9
• In a randomized control trial examining the efficacy of CBT on college students with ADHD, measured over two semesters, it was found that these college students had overall improved executive functioning and better use of disability accommodations.¹⁰
• In a randomized clinical trial for adults with ADHD and substance abuse disorder, it was found that after 15 sessions of CBT therapy, these adults had reduced symptoms of ADHD and substance utilization.¹¹
• In a review of studies pertaining to ADHD treatment for children aged 6 to 12, followed longitudinally for 24 months, it was found that CBT in addition to medication was found to be the most effective in mitigating ADHD symptoms than medications alone, though medications did have improvements as well.¹¹
• CBT has also been proven effective in treating ADHD along with the often co-occurring conditions, such as anxiety, depression, and conduct disorder.⁷

What Is a Typical CBT for ADHD Session Like?

Generally, the CBT treatment structure for ADHD focuses on addressing common ADHD symptoms or deficits and providing the tools for dealing with organizing and planning, coping with distraction, and modifying dysfunctional thinking and behavioral patterns. The course of treatment may differ from person to person and the CBT techniques are adapted to suit their specific needs.

In the first few sessions, the counselor will typically educate the client about their condition and how treatment can help. From there, a discussion about the areas the person wants to work on will follow which may relate to time-management, prioritizing responsibilities, completing projects, and so on. Then, the therapist and client will collectively devise a treatment plan to meet the desired therapy goals. The person in therapy may be given homework between sessions to help them practice newly acquired skills in their day-to-day life.

Is CBT for Adult ADHD Different Than for Kids?

Cognitive behavioral therapy is usually the first treatment option for children under age six. It allows the parents to develop skills and training to effectively help their child. With children, a great deal of behavior management training with the parents and even with the child’s school is often required, as well as individual behavior training with the child.¹ Under the age of six, behavior management can be just as effective as medication without the worry of side effects associated with ADHD medications.

When Can I Expect to See Results From CBT?

Seeing results from CBT treatment depends on the individual and the variability of their symptoms. The standard treatment model of CBT is 10 to 12 sessions with one session a week, each session lasting one hour. It can take time to see results depending on other mental health issues or past traumas. It’s important to go in with an open mind and do the homework your therapist sets up for you in order to see timely results.¹²

Can CBT Be Combined With Medication for ADHD?

Traditionally, talk therapy combined with ADHD medication is the gold standard for treatment of ADHD. Different modalities of CBT, such as mindfulness-based CBT and motivational CBT, can also have a greater impact than traditional CBT depending on co-occurring mental health disorders such as depression, anxiety, or PTSD. Overall, medications and CBT work well in treating ADHD, however the combination of the two is shown to be most effective.¹¹

Examples of CBT For ADHD

Everyone’s experience with ADHD is unique to them, but CBT can help with a variety of ADHD issues. Whether it’s trouble focusing at work or school, a behavioral issue, or problems getting out the door in the morning, CBT can provide techniques that lead to lasting change.

Trouble With Being Late & Staying Motivated

Melissa is a 45-year-old business professional. She was fired from her previous job after she received multiple reprimands for showing up late and not meeting deadlines for her assignments. She says she has a difficult time motivating herself to do activities that she doesn’t enjoy and often forgets due dates for her assignments.

Melissa is starting a new job and has decided to see a therapist to help her understand why she is struggling with these issues. Her therapist diagnosed her with ADHD and together they developed a treatment plan including daily planning of assignments and appointments, time management strategies, and cognitive restructuring to help her work through her feelings of frustration and a sense of failure.

Trouble With Academic Performance

Todd is 16 and in high school. His mom describes him as lazy and unmotivated. She worries that he will not be able to get into college after he graduates due to his poor academic performance. Though Todd does well on tests, he struggles with homework and lengthy assignments. His teachers say he doesn’t follow along during lectures and interrupts other students while they are talking.

Todd’s mom takes him to see a psychiatrist who diagnoses him with ADHD. The psychiatrist prescribes Todd medication and refers him to a CBT therapist to work on his behavioral issues. In therapy, Todd learns how to set goals for himself and break those goals down into smaller, easy-to-accomplish steps.

He applies this to his homework assignments and begins turning them in on time after he learns how to use a planner to keep track of assignments and due dates. He also learns social skills that help him have more productive interactions with peers and teachers.

Behavioral Problem & Inattention

Jay is 7 years old and starting 2nd grade. He was referred to the school counselor for behavioral issues. His teacher said she couldn’t keep Jay in his seat; he would constantly leave his desk and wander around the room. During a conference with his parents, the school counselor learned that Jay is having trouble at home as well.

His mom says she has to ask him multiple times to do simple tasks like picking up his toys or getting ready for bed. She says he becomes easily frustrated when making decisions and that leads to emotional outbursts. Jay’s school counselor completes testing and determines Jay has ADHD. She refers Jay to a CBT therapist who begins working with Jay and his parents.

Together they develop a detailed routine for Jay that begins from the time he wakes up to the time he goes to bed. They break down more complicated tasks like getting ready for bed into simple steps: Take a bath, put on pajamas, brush his teeth, comb his hair, read a story, then go to sleep. Having a routine helps Jay feel secure and more in control.

The therapist also works with Jay on impulse control and helps his parents implement effective rewards and consequences for his behaviors. The parents and therapist consult with his teacher and pass along the behavior strategies they’ve used with him that she can use with him in class.

How to Find a CBT Therapist Familiar With ADHD

Knowing how to choose a therapist can feel overwhelming. When contacting a provider, you can ask if they are familiar with cognitive behavioral therapy and how much clinical experience they have using CBT specifically for ADHD. An online directory is a great way to filter for CBT specialists that are available for in-person or online CBT sessions. Or, you can ask your primary care provider for a referral.

How Much Does CBT Cost?

The cost of therapy for ADHD can usually be covered by mental health insurance. Many children especially have coverage for ADHD treatment when it has been diagnosed by the child’s pediatric care team. However, there is still usually a copay for mental health services as well as a copay for medications, which can range from $10 and upwards of $100 depending on your insurance coverage.

Looking at “in-network” providers might be able to help with the out-of-pocket costs with copays and keep it as low as possible. Out-of-network providers or those who do not accept insurance may charge anywhere from $80 to $200 a session. Therapists and practices may offer sliding scale prices for sessions to ensure you are able to attend the full course of treatment.

At-Home CBT Exercises For ADHD

There are many everyday changes you can make that help manage the symptoms of ADHD. If you’re concerned about your every-day wellbeing, working with a qualified CBT therapist is always advised, but cognitive behavioral therapy techniques can be used in various settings outside of therapy in order to keep control over symptoms of ADHD.

Here are CBT techniques you can implement as part of your ADHD treatment plan:¹

• Create a routine: Set a schedule each day from morning to night
• Get organized and maintain organization daily: Have designated spots for things like school supplies, shoes, and clothing
• Manage distractions: Learn what background noises impede attention and what may help, such as movement or music
• Take breaks: Try to break down long or complicated tasks into shorter, more manageable ones
• Set goals and reward accordingly: Make sure goals are achievable and rewards are congruent with the goal accomplished
• Search for and create positive opportunities: Those with ADHD may find certain situations stressful. Identifying ways in which you excel, whether work, school, or hobbies, can help create positive experiences
• Maintain a healthy lifestyle: Eating nutritious foods and getting regular physical exercise are an important part of overall health that can have a positive impact on managing ADHD symptoms

Final Thoughts on CBT for ADHD

If your ADHD is holding you back in any way, CBT can provide helpful tools for changing your thought and behavior patterns. You don’t have to suffer alone—therapists with experience in ADHD can help you cope and live your best life with ADHD.