Adult ADHD: How a Clinical Psychologist Can Help

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) effects 1 in 20 Australians¹, and with the accessibility of information increasing and the stigma of neurodivergence decreasing, we are seeing more individuals seeking assessment, support, and acknowledgement of their differences.

“Disorder” is unfortunate terminology when it comes to describing ADHD. Simplistically, ADHD is a neurological difference involving many structural and neurochemical variations within the brain which are present from birth. These differences mainly impact one’s executive functioning, or what is referred to as our “control centre”. This is the doing part of the brain.

Individuals with ADHD struggle with performance, not knowledge or skill. Common difficulties are seen in:

• Working memory (holding information in one’s mind long enough to act on it)
• Initiation and completion of tasks
  Sustained effort
• Emotional control (regulating one’s emotions, low frustration tolerance)
• Organisation and time management
• Attentional difficulties (concentration, distractibility)

Difficulties paying attention is, of course, a major hallmark of ADHD. However, this aspect is often misunderstood as not being able to pay attention, when in actuality difficulties arise because the ADHD brain pays attention to everything. This is because it is highly geared toward seeking reward and activation, hence why it may feel impossible to engage in a mundane task, yet time is easily lost when playing a video game or scrolling social media – we are receiving continuous activation, immediate feedback, and a sense of reward.

For more information about the signs and symptoms of ADHD click here

What are the current Evidence-Based Interventions for adult ADHD?

• Medications: some stimulant medications have found to be effective for the management of ADHD. These can be explored with a psychiatrist and show most effectiveness when used in conjunction with psychological support.
• Cognitive Behavioural Therapy (CBT): CBT holds most evidence in supporting ADHD as it encapsulates many therapeutic strategies and practical tools.
• Clinical Neuropsychologists often incorporate neurorehabilitation techniques to specifically target executive dysfunction symptoms.
• Other adjunctive interventions such as exercise, yoga, and mindfulness (see below).

How does CBT help adult ADHD?

Clinical Psychologists are trained in CBT which targets the two major elements of ADHD – the cognitive symptoms and the behavioural consequences. The overarching aim is to use the ADHD brain to our advantage.

Psychoeducation is an important element of therapy as it builds self-awareness and understanding. Individuals with ADHD are supported in understanding the neurobiological processes of the ADHD mind and how this impacts them specifically. When we understand our difficulties we often feel more empowered to tackle them.

Cognitive elements focus on thoughts and beliefs and how these impact what we feel, and ultimately, how we behave.

The effects of ADHD can be impactful throughout formative years and may lead to low self-esteem or self-worth. The common difficulties experienced in schooling, relationships, and/or employment may lead to unhelpful beliefs about the self or one’s abilities. Identifying, understanding, and reshaping these beliefs through cognitive therapy can improve the relationship with ourselves and overall functioning.

Some other examples include:

• Supporting the adjustment and acknowledgement of an ADHD diagnosis.
• Dealing with the emotional experiences that arise with ADHD.
• Identifying and challenging unhelpful self-statements through cognitive restructuring.
• Building self-esteem, self-worth, and self-efficacy.

Behavioural elements focus on the “point of performance” to assist the doing aspects. This includes environmental modifications, compensatory aids, and reinforcement strategies to compensate for executive function difficulties. Some examples include:

• Creating and utilising reward systems to increase activation and motivation systems.
• Implementing techniques to support memory and problem-solving.
• Time management strategies – making time physical and real through the use of clocks, timers, and techniques to develop time awareness skill.
• Learning to self-manage competing demands through organisational strategies.
• Behavioural techniques to aid emotion regulation including reward structures, building a routine, breath work, relaxation training etc.

Other Adjunctive Strategies
There are many other tools and strategies that have demonstrated effectiveness in managing ADHD. Additional strategies that Clinical Psychologists incorporate or recommend throughout therapy include:

• Exercise: we know the profound effects of exercise in reducing stress, boosting mood, and calming the mind. However, a recent systematic review has shown regular, short-bouts of intense exercise may be especially beneficial for improving executive functions.²
  Yoga: lower-intensity exercise like yoga is also beneficial, particularly due to the incorporation of breath work, meditation, and relaxation training. Recent studies have shown yoga has a beneficial impact on ADHD symptoms through increasing effective regulation of the sympathetic nervous system (the stress system).³
• Mindfulness: this can sound daunting to the ADHD mind, most likely because mindfulness is commonly misunderstood. Mindfulness is not not thinking, but rather, being attuned to attentional drifts and bringing your attention back to the here-and-now. With practice, it can improve your ability to focus, intentionally disengage from distractions and better manage big emotions as it builds emotion regulation skills.
• Healthy food choices: a poor diet can exacerbate ADHD symptoms; avoid processed foods and refined sugar; incorporate lots of fruits, veggies, wholegrains, and fibre.
  Prioritise sleep: aim for a minimum of 8 hours; create a wind-down routine; ensure a consistent sleep-wake cycle (even on weekends).

¹https://www.adhdaustralia.org.au/about-adhd/what-is-attention-deficit-hyperactivity-disorder-adhd/

²Lambez, B., Harwood-Gross, A., Golumbic, E. Z., & Rassovsky, Y. (2020). Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis. Journal of psychiatric research, 120, 40-55.

³Chimiklis, A. L., Dahl, V., Spears, A. P., Goss, K., Fogarty, K., & Chacko, A. (2018). Yoga, mindfulness, and meditation interventions for youth with ADHD: Systematic review and meta-analysis. Journal of Child and Family Studies, 27(10), 3155-3168.