Cognitive Behavior Therapy for ADHD or ADD

Written by Dr. Campos, Ph.D.

photo by oussama zaidi on unsplash

What is CBT?

Cognitive Behavior Therapy, or CBT, is a time-limited, goal-oriented, and evidence-based therapy that proposes that maladaptive (or unhelpful) thinking styles can lead to unhelpful, recurrent emotional states, actions, and mental disorders. CBT also theoretically incorporates behavior therapy or behaviorism principles. These principles include identifying the antecedents and consequences (reinforcers or punishers) of behavior. In doing so, an individual’s environment can be modified to facilitate desirable behaviors and motivational states. In randomized clinical trials, CBT has been found to be effective with children, teens, and adults experiencing ADHD, Anxiety Disorders, Depressive Disorders and other mental health conditions (Chiu et al., 2013; Oud et al., 2019). Nonetheless, CBT must be appropriately modified for children and teens in order to be effective. For example, such modifications may include incorporating Play Therapy and Parent/Caretaker Training (Out et al, 2019).

Why CBT for ADHD?

In clinical trials, CBT has been found to be effective in treating specific ADHD symptoms among children, teens, and adults. CBT can often target executive dysfunction through skill development, behavior modification, and cognitive restructuring. Executive functioning includes the following domains: working memory, inhibition, and set-shifting (Kofler et al., 2019). Not only does executive functioning skill development benefit mental health, but it can also translate to academic and career-related achievements. Executive functioning skills are increasingly required to navigate complex, ever-changing academic and workplace contexts, as increased executive functioning facilitates agility and cognitive flexibility.

For individuals experiencing any of the three ADHD presentations (i.e., ADHD Predominantly Inattentive Presentation; Predominantly Hyperactive-Impulsive Presentation; and Combined Presentation), it is hypothesized that executive functioning deficits may, in some cases, underlie these presentations (Kofler et al., 2019). CBT is a goal-oriented approach that targets S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and Time-sensitive) goals. Executive functioning domains can be targeted with S.M.A.R.T goals, such as increasing self-awareness and self-management.

Behavior modification is an additional benefit of CBT, particularly for children and adolescents. Notably, one meta-analysis (a study of multiple others studies) found that behavior modification treatment was significantly related to treatment gains (Fabiano et al., 2008). Behavior modification methods include creating a functional behavior assessment and developing and implementing a behavior support plan (note: this plan often includes a specific schedule of reinforcement for a target behavior that should be consistently implemented by caretakers). Behavior modification methods often require active parental and even teacher involvement in order to be effective.

Cognitive restructuring, or changing unhelpful thought patterns, can also address ADHD and comorbid (e.g., Generalized Anxiety, Social Anxiety Disorder) symptoms. ADHD often presents with unhelpful thought patterns, such as absolutist or black-and-white thinking. An example of this type of thought pattern would include the following thought: “I either work on all of my homework early or finish it entirely right before the deadline.” Through cognitive restructuring, a CBT psychologist or therapist would help a client challenge this thought pattern to find a more balanced thought and perspective. An array of techniques can be used to facilitate cognitive restructuring, such as socratic questioning, evidence-seeking, and behavioral experimentation.

How to Find a Provider

Finding an appropriate provider can be difficult, as discussed here here. When searching for a CBT provider for ADHD, it is helpful to start with identifying providers who specialize in both areas (i.e., CBT and ADHD). If you are looking for a provider for a child or adolescent, you will also want to find a mental health provider with specialized training in this area. As noted, CBT and other behavioral therapies must be adapted to suit a child or adolescent’s developmental level and expressive/receptive speech level.

If you are looking for therapy/counseling, you could search for a provider who is a Licensed Psychologist (doctoral level provider), Licensed Mental Health Counselor (master’s level provider), or Board-Certified Behavior Analyst (master’s or doctoral level provider specializing in ABA therapy), for example. A Board-Certified Behavior Analyst is specifically trained in providing ABA therapy, which focuses on behavior modification noted above and is often used to treat young children or individuals with limited expressive or receptive communication abilities, such as in the case of Autism Spectrum Disorder.

If you are looking for a provider to prescribe medications, we recommend searching for a Board-Certified Child or Adolescent Psychiatrist (if searching for a child or teen) or a Board-Certified Psychiatrist (if searching for an adult). In addition, you will want to find a provider with experience in treating ADHD specifically, as ADHD is a complex Neurodevelopmental Disorder with high rates of comorbidity with other mental disorders.

If you or a loved one are struggling with ADHD, know that treatment options are available. The sooner you seek treatment, the more likely greater treatment gains will occur. For more information on this topic, we recommend the following articles:

https://www.healthline.com/health/adhd/treatment-overview#therapy-and-training

https://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895

https://icpstampa.com/what-to-do-if-your-child-or-teen-has-adhd-tampa/

References

Chiu, A. W., Langer, D. A., McLeod, B. D., Har, K., Drahota, A., Galla, B. M., Jacobs, J., Ifekwunigwe, M., & Wood, J. J. (2013). Effectiveness of modular CBT for child anxiety in elementary schools. School Psychology Quarterly, 28(2), 141–153. https://doi.org/10.1037/spq0000017

Fabiano, G. A.; Pelham Jr., W. E.; Coles, E. K.; Gnagy, E. M.; Chronis-Tuscano, A.; O’Connor, B. C. (2008). “A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder”. Clinical Psychology Review. 29(2): 129–40. doi:10.1016/j.cpr.2008.11.001. PMID 19131150.

Kofler, M.J., Irwin, L.N., Soto, E.F. et al. Executive Functioning Heterogeneity in Pediatric ADHD. J Abnorm Child Psychol 47, 273–286 (2019). https://doi.org/10.1007/s10802-018-0438-2

Oud, M., de Winter, L., Vermeulen-Smit, E., Bodden, D., Nauta, M., Stone, L., … Stikkelbroek, Y. (2019). Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. European Psychiatry, 57, 33–45. http://doi.org/10.1016/j.eurpsy.2018.12.008

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