Adult ADHD and Comorbid Disorders
Many adults with ADHD suffer from comorbid disorders, such as major depression (Kessler and co., 2006). Many patients who are depressed aren't able to take medication and could benefit from therapy.
Medications that most effectively improve core symptoms of ADHD are those that boost and balance levels of specific neurotransmitters in the brain. The most frequently prescribed stimulants include amphetamine, methylphenidate, and similar medications.
Medications
Many medications that are used to treat ADHD in children can be used on adults. However the dosages differ and the drugs may cause adverse effects that aren't present in children. The doctor will look at the medical history, the family health history, and other medical health conditions of the patient to determine which medication is the best for them.
The most common ADHD medication is a stimulant. It works by adjusting the levels of norepinephrine, and dopamine in the brain. The stimulants methylphenidate and dextroamphetamine (commonly called Adderall) increase the amount of these neurotransmitters, which can improve focus and decrease aggression and impulsivity. These stimulants are available in different forms, such as skin patches, liquids and chewable tablets. These long-acting stimulants are favored because they improve patient compliance, and an easier, longer-lasting improvement in symptoms.
It is important to keep in mind that co-occurring disorders like anxiety or depression may influence the response to ADHD medication. Therefore, it is recommended that psychiatric disorders be treated first, with medication be used as a second measure. The medications that are used to treat comorbid psychiatric disorders include bupropion, atomoxetine and tricyclic antidepressants (Wilens 2004).).
Some patients may have an "rebound effect" in which their ADHD symptoms get worse after stopping stimulant medication. In these cases a short trial of a low dosage of stimulant medication can be helpful.
Some people are unable to take stimulant medication or take it because of drug misuse or other health conditions such as severe hypertension or heart issues. In these instances, non-stimulant drugs like atomoxetine or viloxazine may be beneficial. These drugs don't have the same adverse effects as stimulants and are less likely to be abused or diverted.
Psychotherapy
People suffering from ADHD are able to benefit from psychotherapy (talk therapy). It can help them learn techniques to improve their lives manage stress and anxiety, resolve conflicts, and manage issues in relationships or at work. It can also assist with co-existing mental disorders like depression and addiction disorders.
Talk therapies include cognitive behavior therapy (CBT), mind-body cognitive therapy, and schema therapy. These therapies are based upon the idea that thoughts and beliefs affect how a person behaves, thinks and feels. CBT assists a person to recognize negative behaviors and thinking patterns, and then formulates and implements positive strategies to change them. Meditation techniques are employed in mindfulness-based cognitive therapy to help someone concentrate on their emotions and thoughts as well as control their impulses and improve executive functioning. Schema therapy, along with other forms psychotherapy that focus on the family history of a person can be beneficial for people suffering from ADHD.
Psychotherapy, as well as medication, can assist with specific ADHD issues, like difficulty keeping up with schoolwork or getting along with other people. treatments for adult adhd can also help in avoiding important dates and responsibilities and making decisions that are impulsive and lead to financial and legal problems. It can also assist people to identify and resolve issues that may be contributing to their ADHD symptoms, like anxiety or depression.
Psychotherapy can help a person develop healthy coping strategies and reduce stress, such as exercising, improving sleep and healthy eating habits. It can also offer support to a family or partner member who may be dealing with the effects of ADHD on their relationship. Marriage and family therapy can help families and couples communicate better and learn how to manage ADHD symptoms together.
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that focuses on changing the negative patterns of thinking that clients have. It uses skill-based dialogue with an experienced mental health professional (a therapist) to address the root causes of their symptoms. The goal of this treatment is to eliminate limitations and implement strategies for coping that fit with the daily routine of the client.
Therapists who specialize in adult ADHD-CBT teach clients to recognize unhelpful thinking patterns and assist them to learn to replace them with more productive thoughts. This process can take time. It is a viable option for adults who do not feel enough relief from their medication.
A recent RCT study found that when paired with medication, CBT is superior to cognitive behavioral therapy alone in improving the emotional symptoms, core symptoms, self-esteem and social functioning of adults suffering from ADHD (Clarke and co. 2017). CBT combined with methylphenidate can be particularly effective for people with more severe underlying problems.
Therapists who provide this kind of treatment work with their clients to develop an action plan to address their specific issues. They typically teach them a series of practical skills that are easy to implement and have a high likelihood of being successful. Charts are often utilized to track progress and to reward positive behavior. For an infant, this could be a daily journal that lists all the school-related tasks or positive behavior they have to perform, as well as a system for recording and earning rewards. The therapists can also discuss the possibility that negative consequences could be introduced when a child does not complete their task. This can be done in a very sensitive and supportive manner.
Metacognitive Therapy
A more recent form of therapy, metacognitive therapy, assists individuals in changing how they think. This kind of therapy can be beneficial for people who suffer from a variety mental health issues like depression. It is a form of cognitive behavioral therapy that assists people in recognizing negative thought patterns and their effects on their emotions. This kind of therapy can help to develop mental tools that are versatile and useful.
This study was designed to investigate the relationship between metacognitive skills and daily functioning among adults suffering from ADHD. In order to do this we compared self and informant-rated impairments in daily functioning with the predictors of metacognition (comprehensive knowledge, regulation of Cognition, Debugging, Information Management, and Evaluation). The results indicated that comprehensive knowledge was associated with daily functioning among adults suffering from ADHD however, it was not associated with regulatory processes. The predictive ability of a model incorporating metacognition predictors was moderate, which suggests that they can account for significant proportions of the variance in daily functioning for adults with ADHD.
Metacognitive Therapy (MCT) is an intervention which focuses on reversing metacognitive beliefs that are dysfunctional and perpetuate states like worry, rumination and attention fixation. MCT was created by Adrian Wells based on an information processing model created by Wells and Gerald Matthews. A case series has proven the effectiveness of MCT in tackling anxiety disorder, but it's still a relatively new concept and more research is required to determine its efficacy for other disorders.
This study was designed to determine the efficacy of MCT in the reduction of symptoms of illness anxiety disorder, however it can be applied to a range of disorders and could be more effective than other treatments. This isn't an effective treatment, but it can be utilized to treat ADHD.
Family Therapy
In family therapy the therapy therapist works with the entire family. Everyone can gain a better understanding of the issues of the client and learn to assist their loved ones. It also helps them find ways to manage their own feelings of frustration and improve their communication skills. Additionally, this type of counseling is useful in dealing with comorbid disorders like depression or alcohol abuse, which are commonly seen alongside ADHD.
The therapist will start with an intake session to gain a better understanding of the family's perspective of the problem and evaluate their suitability for family intervention. It can be done online or in person. The Therapist will explain to each person the nature of treatment and the do's & don'ts for family therapy.
A therapist with had experience working with adults suffering from ADHD asks a lot questions to get a better understanding of their present symptoms as well as their past and the impact they've had on their family, work, and relationships. They will also inquire whether there are any other mental health issues present like anxiety or depression.
Cognitive behavioral therapy is a type of counseling that helps you learn how to manage your behavior and transform negative patterns of thinking into positive ones. It concentrates on improving your self-esteem and self-control by teaching you methods to deal with stress and anger. It is a short-term treatment that can be used in conjunction with other types of psychotherapy.
Individual talk therapy can help people suffering from ADHD deal with emotional burdens resulting from long-standing patterns of underachievement, failure, academic difficulties, frequent job changes and conflict in relationships. It can teach you strategies for coping with stress and stress reduction as well as how to better manage your finances and time. It can also help with comorbid disorders such as depression and anxiety, which are often seen with ADHD.