Adult ADHD: Psychosocial treatment
Psychoeducation is an important first step in ADHD treatment. It should be provided for various reasons:
- Evidence shows that even successfully treated people with ADHD will deteriorate without changes to their lifestyle.
- ADHD is highly impairing in many domains and the patient may want to rush the agenda by starting medications immediately. Resist the urge to initiate medications without adequately educating the patient.
- A patient who follows through on the agenda is showing commitment to the process.
- There is much to know and knowledge is power. This reduces the patient's dependence on the clinician.
- Behavioural interventions: Lifestyle management is critical with ADHD. Bad habits have to be changed. The role of the primary care clinician is to help patients find resources to facilitate lifestyle changes.
- Occupational therapists: Occupational therapists can be very useful in helping to create organizational plans and reviewing basic life skills.
- ADHD coach: Although there are few trained coaches, they can help patients reach their goals.
- Electronic strategies: Reducing clutter and reorganizing information using computer-based technologies, PDAs and software can help patients deal with the "paper problems."
- Vocational assessment: This can assist the patient in workplace situations and help them advocate the required accommodations.
- Community support networks: ADHD support groups can support the psychological needs of the patient and identify strategies that others have found useful. Often, spouses get the most benefit because they develop a better understanding of their partners.
ADHD can lead to significant problems of low self-esteem, decreased self-confidence and strife in interpersonal relationships. The diagnosis can also cause relief, as well as despair, as the person may reflect on opportunities they have lost because they did not get treatment when they were younger. In any case, a psychological agenda is critical.
- Group interventions: If possible, establish a group of adult patients because they can learn from one another and seeing many patients with similiar problems at the same time is cost-effective. If space is an issue, it may be necessary to outsource this activity.
- Individual therapy: Cognitive-behavioural therapy can help to reframe what the patient considers negative situations into positive ones. Patients often have belief systems based on a lack of accomplishment and a cynical worldview, where everyone else is doing well and they are not, given their potential. The clinician can help them to develop greater self-control. It is here that primary care clinicians have their greatest influence, as the therapeutic long-term alliance is the anchor of stability that the patient seeks.
People with ADHD can function well if they find appropriate interventions for managing their disorder. Ideally, they will find ways to channel the attributes of their disorder in a productive way. Impulsivity becomes entrepreneurship and opportunism, inattention becomes inventiveness and broad thinking, and motor hyperactivity becomes physical stamina and drive. Many people with ADHD patients have highly successful careers as a result. This potential should motivate the clinician to identify the disorder and seek effective treatment.