August 24th, 2010
05:01 PM ET

Adults with ADHD benefit from cognitive behavioral therapy, study says

Attention-deficit hyperactivity disorder is getting a lot of attention in children, but it's widely recognized in adults too: about 4.4 percent of adults in the United States have ADHD. Many of those adults are on medication, but may continue to have symptoms of inattention and impulsiveness that impair their lives.

A study led by Steven Safren at Massachusetts General Hospital Behavioral Medicine works toward an evidence-based approach to treating adults with the condition. Researchers looked at 86 adults who had already been taking medications for ADHD before entering the study, randomly assigning them to one of two therapies. Scientists verified the diagnosis for each of them using criteria from the Diagnostic and Statistical Manual of Mental Disorders.

The main therapy tested in this study was a form of cognitive behavioral therapy, which helps people form healthy habits and thought patterns. This therapy targeted three skill sets: problem-solving, reducing distractibility, and dealing with negative thinking and stress associated with the disorder.

"Negative thinking is not a core symptom of ADHD, but we have shown
many adults with ADHD have had a series of negative life experiences due to the disorder, or not getting as far as they’d like to in school, in work, in their relationships," Safren said. "Sometimes that can affect how you think about yourself, how you think about the world, how you think about other people."

The comparison therapy researchers looked at focused on relaxation: training in progressive muscle relaxation and other techniques as applied to ADHD symptoms. It also included education about the disorder and supportive psychotherapy.

Participants who went through cognitive behavioral therapy had significantly better outcomes than those who did the relaxation therapy.

Safren and colleagues had already published a therapist manual and client workbook detailing their cognitive behavioral therapy method, both called "Mastering Your Adult ADHD," in 2005. But their technique gains credibility in this randomized controlled trial published in the Journal of the American Medical Association.

soundoff (51 Responses)
  1. Bradley Sebastian

    After skimming this article, I've given it some thought and...Look! String!

    August 24, 2010 at 19:40 | Report abuse | Reply
    • rob


      August 25, 2010 at 00:41 | Report abuse |
    • Wendy

      Everyone who suspects ADHD should get tested for food allergies. I was surprised how certain foods actually triggered these symptoms in me. Docs want to drug everyone up instead of getting to the root cause of the issue. Get food allergy tested.

      August 25, 2010 at 13:21 | Report abuse |
  2. James

    Let the ADHD Jokes begin. But really, even though I applaud this study, unfortunately many will use this to say that there are effective non-drug treatments. But all the applicants had been diagnosed previously and were on meds. I doubt there would be a significant result otherwise.

    August 24, 2010 at 22:30 | Report abuse | Reply
    • Gina Pera

      I agree with you, James. It's already happened.

      This study was reported months ago, and widely misinterpreted.

      As a journalist and author of a book on Adult ADHD, I try to re-cast poorly reported research on my blog (ADHDRollerCoaster.org), but it's very hard to keep up!

      Gina Pera, author
      Is it You, Me, or Adult A.D.D.?

      August 24, 2010 at 23:26 | Report abuse |
    • Kay

      I agree with you. My husband was not diagnosed with ADD until his 30's. His whole life he struggled with ADD. He was never hyper, but no matter what he did, he could not focus his attention on one thing very long. He had to sort of do his own cognitive therapy for years, until he was diagnosed with ADD. Then after the first day of Ritalin, he was amazed. He said it was amazing that he could actually pay complete attention at work and remember the events of the day. People may joke, and there may be cases of misdiagnoses, but for my husband medicine has improved his life dramatically.

      August 25, 2010 at 21:07 | Report abuse |
  3. Gina Pera

    Oops. Actually, I must correct myself!

    This is a different study, but it seems to replicate the other recent study.


    August 24, 2010 at 23:27 | Report abuse | Reply
    • rob

      Classic symptom : )

      August 25, 2010 at 00:44 | Report abuse |
    • Dr. Katherine Nell McNeil

      Gina, here is where those of us in the profession feel like we are hitting our heads against the wall. The uneducated will remain so and continue with their jokes about those of us with ADHD. People will continue to put up posts with all the hot button words that we have heard ad nauseum .... zombies, blood tests, proof, etc. We will continue our fight through education one individual at a time.

      August 25, 2010 at 22:36 | Report abuse |
  4. Susie

    A new adjunct therapy for ADHD is omega-3s. I know people who use give their ADHD kids Gudernoobs made by WooHoo Foods b/c it's a healthy snack plus it has flax for omega-3s.

    August 25, 2010 at 05:30 | Report abuse | Reply
    • Brian

      Though Omega 3's may help but, I was diagnosed at the age of 40 and I tried all of the omega 3's and herbs and it didn't do much if anything at all. The older you get the more you need meds.

      August 25, 2010 at 21:35 | Report abuse |
  5. Dr Bill Toth

    What a fantastic concept...behavioral problems treated behaviorally vs with drugs. The field of NLP has been using this approach for appx 30 years now. I wonder how much would we save if we were to apply the same concept to other behavioral conditions – smoking, drinking, eating disorders.?
    live with Intention,

    August 25, 2010 at 06:52 | Report abuse | Reply
  6. Stephanie

    I've been to one two-hour NLP (Neuro-Linguistic Programming) session and it was helpful. Unfortunately, the session was expensive and not covered by insurance. I've since started and stopped insurance-covered "talk therapy", which may be useful to others, but not for me. I'm considering biting the bullet and going for another NLP session, despite the cost. Glad to hear my positive experience was similar to others. NLP seems a bit "out there", but is worth exploring.

    August 25, 2010 at 08:06 | Report abuse | Reply
  7. Gyro

    Why not post some of the benefits of ADHD? In my case, the benefits outweigh the detractors.

    August 25, 2010 at 09:15 | Report abuse | Reply
    • LkSuperiorGrl

      I'm interested....can you give some examples?

      August 25, 2010 at 12:43 | Report abuse |
    • Bruce

      I was diagnosed over 40 years ago. I have used Ritalin to help me deal with the condition almost as long. As a kid my grades went from D's to A's and B's after I went on medication.

      As an adult, I find that my managed ADHD can really be an asset. I am now a senior manager with over 20 projects valued at $500M. My ADHD has helped me to be a more effective multi-tasker and I am much better at dealing with distractions than my non- ADHD contemporaries.

      As for those who are suggesting that diet or streight behavioral training is a solution, I have 40 years of experience that says that it isn't an effective solution for everyone.

      Compare ADHD to Diabetes, not all diabetics require insulin. Some diabetics are able to keep their conditions in check with diet and exercise while others require daily injections. The same may be true with ADHD (Mild vs. more severe conditions).

      The symptom most recognized in ADHD is identified as a "Behaviorial Problem" but management of ADHD isn't as simple as streight "Behaviorial modification" (Or all the time spent in the corner as a kid surely would have corrected the problem). Those that try to apply a one size fits all "Behaviorial" solution are unrealistic and need to reconsider their position.

      August 25, 2010 at 22:37 | Report abuse |
  8. Frank

    When is the neuropsychological community going to admit they have no physiological test for any of these "disorders"? The day they have a blood test for seratonin or dopamine I will admit I was wrong. Until then I will consider psychology like I do astrology...Subjective.

    August 25, 2010 at 10:23 | Report abuse | Reply
    • Pepper Mill

      Frank: They do have a test for this. They use urine and saliva to test your neurotransmitters. I found out I was low on quite a few transmitters including serotonin.

      August 25, 2010 at 13:11 | Report abuse |
    • Brian

      Well Frank, I use to feel the same way until I finally came across something in my life that I couldn't handle alone and was then diagnosed with ADD at the age of 40. Then I read a lot of books on the disorder and found myself in tears of joy because they were describing me to the tee.

      August 25, 2010 at 21:40 | Report abuse |
  9. Shante's mom

    I think more of us have this condition than not. Some are more than others. Any help on this subject is good for all. Too bad there is a high cost for the help one needs.

    August 25, 2010 at 10:42 | Report abuse | Reply
  10. jcuster06

    This article is a good introduction, but I need resouce information that isn't funded by some Pharmaceutical company trying to sell drugs. My wife has a sever case of ADD/ADHD with Bipolar confirmed by several docters. I love her dearly and I want to help her and learn more.

    August 25, 2010 at 11:38 | Report abuse | Reply
  11. LkSuperiorGrl

    My child's ADHD was completely cured when we removed all food coloring from her diet. It was the most dramatic change in a child that you can imagine, she became calm, happy, and normal. If you were to give her, a red sucker, 15-20 minutes later you can see her ADHD symptoms return and it takes about 1.5 days to go away again. I'm not sure how common this food coloring allergy is, but I can't help but wonder how many other kids or adults suffering with ADHD could be 100% cured by a diet change.

    August 25, 2010 at 12:50 | Report abuse | Reply
    • Pepper Mill

      Thats amazing!!! They will NEVER discuss how powerful food allergies can be. All you will see is how children are affected. Millions of adults have food allergies. It can manifest itself with bowel problems, DEPRESSION, ADHD symptoms, headaches, anxiety, etc. Try getting a tradtiional doctor to explain this to you... they won't. You need someone who truly understands the body not someone who gets kickbacks from pharmaceutical companies to shove pills down your throat.

      I think EVERYONE should get a food allergy test done I had one. It is about 100 bucks and it tests for 95 different common foods. I was amazed at how my stomach problems cleared up, anxiety and other issues I thought were totally not related.
      It is WORTH IT 100%.

      August 25, 2010 at 13:16 | Report abuse |
    • leikela

      Very interesting. So much of our food is processed instead of natural. We got rid of high fructose corn syrup from our diet (not easy) and our children (who never had any problems) started sleeping better, having more energy, and longer attention spans.

      August 25, 2010 at 22:07 | Report abuse |
  12. Jerry A.

    I respectfully disagree with Dr. Toth. I'm a biochemist- I'm not sure what degree he has. Smoking is a drug addiction, not a behavioral condition. One study found that nicotine is just as addictive as heroin. You can not cure a physical addiction only by talking about it on a couch. Yes, you have to change people's behavior but it is unrealistic to think that a medical problem can be talked away without treating the body as well as the mind. You would not treat gangrene with talk therapy, I hope. Don't try to treat completely different types of conditions with your own brand of therapy just because that's the only way you were trained and is the way you make your income.

    Similarly, people cannot treat a biological difference (a slightly alternative wiring of the brain) like ADHD effectively without a _combination_ of medication and behavior therapy. Medication gives ADHD people a chance to focus, but it does not train them in how to function in modern society. Cognitive behavior therapy will train them (like any person without ADHD) to function better, once the meds give them the chance to focus their attention on one task. No, I do not have ADHD but both my wife and child do, so I see this effect every day.

    August 25, 2010 at 17:04 | Report abuse | Reply
  13. warytraveler

    I don't care what anyone says, The Postman was a great movie.

    August 25, 2010 at 21:05 | Report abuse | Reply
    • zeekthegeek

      Now this is someone who truly understands AD/HD.

      The Postman was an excellent film.

      August 25, 2010 at 21:29 | Report abuse |
  14. ADD Prone

    As an adult with ADHD, I've recently added a CPAP to deal with my apnea. It's significantly helped my ADHD symptoms and I'm noticing my meds are lasting for longer periods of time than they were after being fatigued day after day from not sleeping properly.

    August 25, 2010 at 21:10 | Report abuse | Reply
    • ADDtoo

      I have had recurring battles with PTSD, major depression and anxiety since my teens. Significant prolonged lack of sleep causes physical and mental health to crash (the worst of which is halucinations). I changed my psychiatrist (more accurately my wife did this for me) during my last bout. After she got me on my feet she diagnosed me with ADD. At the same time I saw an expert on sleep, who diagnosed sleep apnea and identified that I never reached a deep sleep. I also saw an endocrineologist who identified a hormone inbalance.

      With a hormone supplement, ADD medication and Sodium Oxybate to address sleep issues my life has turned around. It is best to take a holistic approach, excercise helps,diet is an influence. It is a good idea to take Omega3 and B complex vitamins.

      ADD is a gift in some respects. It doesn't fit with Corporate Anerica though. Since diagnosis I decided to work for myself and things have been much easier. The jokes and the lol comments are the tip of the iceburg those of us with mental illness face. Admitting to mental illnesss at work ended two jobs for me, discrimination is a major issue, even health insurance isn't applied equally.

      Don't look for one answer, your mind and body are one extremely complex system. Never give up.

      August 25, 2010 at 23:33 | Report abuse |
  15. SoCalMatt

    Why do we need to label someone because they have issues with paying attention? So we'll buy the drugs. Drugs cure all! Gee, I'm not feeling very energetic or social today.....pass me the cocaine!

    August 25, 2010 at 21:20 | Report abuse | Reply
    • Karen

      We already do label them. We call them 'space cadet', 'failure', 'loser'. We give them all sorts of derogatory labels. But for some of them, some of US, the correct label is actually 'ADHD', without any negative connotations.

      August 25, 2010 at 21:39 | Report abuse |
    • Brian

      You obviously don't know very much about ADD. That is only one of the symptoms as there is a whole lot more. Cocaine does work though. lol

      August 25, 2010 at 21:44 | Report abuse |
  16. jenstate

    There are non drug approaches for children, so why wouldn't we apply that to adults? I like the Brain Balance approach – http://www.brainbalancecenters.com . It combines behavioral and occupational therapy with diet changes and brain exercises for a whole person strategy to correcting the underlying brain connectivity issue in neuro-behavorial disorders.

    August 25, 2010 at 21:39 | Report abuse | Reply
  17. ADD all my life

    I was diagosed with ADHD about 30 years ago. I was on the drugs but i felt like a Zomby. I refuse the meds and learned to foses longer by appying emotion to circumstances. You focus on what you are passionate about. Practice focus in an area where it is easy. Then, over time, that focus will be more easily applied to less "motivating" tasks.

    It is all about emotional content people. Drugs might work but they effect the form and function of your brain. Not worth it in the long haul.

    It I had trusted drugs...I would be a 30 year drug user. Kids now snort what they used to make me take everyday.

    August 25, 2010 at 21:41 | Report abuse | Reply
  18. Bradd

    I was labeled ADHD as an adult. I am now 60. It is a awesome blessing when my hyperfocus is in the right place or a productive place. It is a pain when I am supposed to focus on what someone else wants. I have to force myself to stay on track but it (sometimes) can be done. I also found out in 1991 that wheat causes 2 days of serious depression (glutton is not the problem). Now oatmeal is doing the same. My marriage got a lot better when my wife realized I was wired this way and I then worked to compensate. I think ADHD is a gift when it is appreciated and a pain when it doesn't fit. It can't be used as an excuse but at the same time others need to know the power of it and it's difficulties.

    August 25, 2010 at 21:44 | Report abuse | Reply
  19. Bob

    Will somebody please tell the Medical Establishment..

    August 25, 2010 at 22:00 | Report abuse | Reply
  20. Sighko Sis

    What a fabulous new disease! Be the first on your block to get it!

    August 25, 2010 at 22:03 | Report abuse | Reply
  21. Sandy

    Too bad there isn't a cure for ignorant and mean, because there are a lot of people commenting on this article who could stand a dose.

    August 25, 2010 at 22:30 | Report abuse | Reply
  22. Squirrel!!!!!!!

    Why fight it!?!? I'm a 45 y/o female that was "diagnosed" years ago. There's plenty of jobs/situations where the One-Tasker's of the world just don't cut it. When I was young I worked in a warehouse doing shipping and receiving at a frantic pace and discovered I actually EXCELLED at something. Since then I have worked as an firefighter/EMT, it's amazing how many folks in that community are members of the Short Attention Span Theater Group! I am currently a Dispatcher where the ability to juggle 18 things at once is celebrated, several of my co-workers are also officially diagnosed Adult ADHD. I've tried the drugs...hated them. So I, along with many others have found a place in the world where our alledged disorder is a plus.

    August 25, 2010 at 22:44 | Report abuse | Reply
  23. Anymouse

    Prevention is very helpful. I have struggled with ADD and associated learning disorders, and other icky related symptoms, all my life. The drugs used in treating this disorder are psychologically addictive, because they are either speed, sedatives, or both. After a certain age many drugs used for this disorder are no longer an option, due to health risks, such as seizures, strokes, arrhythmia, and the high risk of heart attacks. One can manage without the speed boost, and many of the other drugs. Cognitive behavioral therapy IS incredibly useful In my own case recognizing the important red flag of "Stinking thinking" can help me avert a full blown episode of ADD. If I ignore it then the "Stinking Thinking" turns to anger, depression, social anxiety, stress , panic attacks and confusion that will lead to full blown case of ADHD. It packs my system with so much Adrenalin and cortisol that it can take me days, even weeks to calm back down. A full blown ADHD attack will render me virtually useless, no matter what medications I take at that point. Prevention is key. If I catch it I can head off a full blown episode by avoiding negative triggers. Simple things like not watching the news, switching activities, turning family pictures face down, watching funny movies, or just going for a walk can calm me down. I have headed off many a bad ADD situation with a single dose of Wellbutrin. It is a smoking cessation drug, and also used for depression, but in my case it seems to work as a sedative, and as impulse control. It calms me down, instantly. It's not ideal, like getting rid of a headache, but it can keep me calm enough to isolate for a few days till my system normalizes, rather than upsetting me, and rendering me completely useless for several weeks. Cognitive behavioral therapy, combined with medication can keep me from losing control. If I let myself get to full blown ADHD mode (rare) nothing works. Not even sedation, and any kind of stimulant will only make it worse. I either have to suffer and ride it out, or be knocked out. FYI – the stimulant action of Adderall and Ritalin, does not make the user feel high or good. It's more akin of getting the irritated jitters, like drinking way too much bad coffee. I hate it! It's not like taking street drug type of speed. More often than not, it makes me sluggish, gives me headaches, or makes me go to sleep. It's more to prevent ADD and ADHD in my case, because once I do need it – its already too late. This is a sliding scale disorder, so I can only speak for myself and my own experience. I have had six years of cognitive behavioral type of therapy, and my treatment team consists of a family physician, a neurologist, a psychologist and a psychiatrist. I see them all on a monthly basis, as I'm in a maintenance phase. It used to be every day, for 18 months. I know people who are diagnosed by their GP family physician, and have always felt this is a psychiatric disorder, that should only be diagnosed, medicated and treated by a qualified psychiatric treatment team. Cognitive behavioral modification therapy, with an emphasis on stress and anxiety reduction, and problem solving is key. As is family support, and also care giver support.

    August 25, 2010 at 23:01 | Report abuse | Reply
  24. Anymouse

    Susie – those of us who suffer from full blown ADD and ADHD are usually pretty well versed in the nutritional aspects of treating this disorder. Thank you for bringing it to the readers attention. It is true that essential fatty acids, flush free Niacin, proper electrolyte and fluid levels, a good multivitamin, as well as extra Vitamin D, can be very helpful. One could benefit from a healthy thyroid and liver, and pancreas. So a trip to the MD, internist and a nutritionist would be well worth the effort. As well (of course) as regular fresh air, aerobic exercise, plenty of sleep, meditation, art therapy, and proper nutrition. Of course its the whole package that works, and even then, no matter what, at times it still 🙁 bleh! Plus, its good to remember that our bodies need about 6 weeks to recharge. So what you do today for or against your good health – will be either benefiting or haunting you 4 – 8 weeks down the road. It's something, that frequently slips my mind.

    August 25, 2010 at 23:21 | Report abuse | Reply
  25. Hollyanne

    Hello everyone,

    I just wanted to let you know about a free Adult ADHD CME activity I just came across called "Today’s Patient in ADHD: A Focus on Transitional Care Across the Lifespan." This activity provides insights and learning geared toward treating the most challenging adult patients with ADHD in an interactive online format. You can earn 1.25 AMA PRA Category 1 Credits™

    Register at: http://mycmesite.com/adhd

    September 8, 2010 at 14:42 | Report abuse | Reply
  26. Kenneth Lanerdd

    Neuro Feedback can cure ADHD.

    September 19, 2010 at 16:44 | Report abuse | Reply
  27. Edward Goss Sr.

    Light stimulation via Dr. Marvin berman can eradicate ADHD.

    September 19, 2010 at 16:45 | Report abuse | Reply
  28. Edward Goss Sr./First City Capital Corporation CEO

    Dr. Marvin Berman should be given funding to perform his good Work.

    September 19, 2010 at 16:46 | Report abuse | Reply
  29. E. J. Cabott

    Dr. Marvin Berman is a Brillant man who can cure ADHD, give him funding.

    September 19, 2010 at 16:48 | Report abuse | Reply
  30. Dr, Debbie Netsky

    Dr. Marvin Berman can cure ADHD via light stimulation and Neuro-Feedback.

    His work should be funded by people such as Gates/Buffett

    September 19, 2010 at 16:50 | Report abuse | Reply
  31. Sandy Lanard

    Dr. Marvin Berman could save lives, we need to fund his work!

    September 19, 2010 at 16:51 | Report abuse | Reply
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    Woah this weblog is magnificent i love studying your posts. Stay up the great paintings! You realize, a lot of persons are searching round for this info, you can aid them greatly.

    April 19, 2012 at 06:31 | Report abuse | Reply
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