Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. For most, ADHD is diagnosed in childhood and lasts through adulthood. Those with ADHD may have trouble paying attention, be fidgety or unable to sit still, or be unable to control impulsive behaviors. Cognitive Behavioral Therapy can be an effective treatment to help control these behaviors.
How Can CBT Help With ADHD?
Cognitive Behavioral Therapy is a practical type of therapy that looks at the way our thoughts, emotions, and behaviors are shaped by both our own preconceived notions and our environment. The goal of CBT is to help the individual learn to recognize irrational thought patterns that lead to negative behavioral outcomes, and construct new, rational thought patterns in their place.
When working with someone with Attention-Deficit/Hyperactivity Disorder, 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 an adult with ADHD. CBT treats many of the peripheral symptoms of ADHD, such as procrastination and time and task management.
A CBT session focuses on these areas of daily functioning and the therapist creates a treatment plan for an adult with 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.3
CBT for Children With ADHD
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.3 Under the age of six, behavior management can be just as effective as medication without the worry of side effects associated with ADHD medications.
Common CBT Techniques for ADHD
Working with someone with ADHD requires a great deal of focus on behavior modification, though other aspects of Cognitive Behavioral Therapy, such as relaxation and cognitive restructuring, can also be beneficial for treating ADHD symptoms.
Here are some of the more common techniques used for working with ADHD:
S.M.A.R.T. Goals
S.M.A.R.T. means the goals are:4
- 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, often those with ADHD have co-occurring diagnoses of 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 include things like:
- Time management
- Social skills
- Organizational skills
- Healthy lifestyle adjustments
Is CBT Effective for Treating ADHD?
Cognitive Behavioral Therapy (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.5
- 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 diagnosed with ADHD.6,7
- 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.9
- 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.5
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.8
CBT & Medication for ADHD
Traditionally, talk therapy combined with 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. 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 that includes daily planning of her work assignments and appointments, time management strategies to help her get to work on time and complete assignments by their due dates, and cognitive restructuring to help her work through her feelings of frustration and sense of failure that has plagued her because of her ADHD symptoms.
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. Todd’s mom has also received multiple calls from his teachers about his behavior in class. 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 diagnosis 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 also consult with his teacher and pass along the behavior strategies they’ve used with him that she can use with him in class.
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 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 several CBT techniques you can try implementing for yourself as part of your ADHD treatment plan:3
- Create a routine that follows a set 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 by learning what background noises impede attention and what may help, such as movement or music.
- Take breaks when completing long tasks and 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.
How to Find a CBT Therapist
Finding the right therapist can feel overwhelming, but fortunately, the effectiveness of the cognitive-behavioral approach has led to many mental health professionals who specialize in CBT. 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.
How Much Does CBT Cost?
CBT 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. Some therapists and practices may offer sliding scale prices for sessions to ensure you are able to attend the full course of treatment.
