ADHD in Adults

by Richard Wilkinson

Almost five in 100 adults in the US have attention deficit hyperactivity disorder or ADHD.  In the last few years more focus has come to the fact that for females, the disorder may not be apparent until later in life since the hyperactivity component may be missing.  Treatment for both genders usually involves medication, but challenges remain for most with the condition.  What to do?  Add cognitive behavioral therapy to the mix, a study in the Journal of the American Medical Association seems to conclude.

Researchers studied an admittedly small number of adults (86) who were diagnosed with ADHD, were already taking medication for the condition, but had residual symptoms.  They were randomized to either cognitive behavioral therapy (CBT) or relaxation techniques with educational support.  Those who had CBT experienced greater improvement of their symptoms, and this improvement persisted for 12 months.

Rick and I agree in this week's podcast that this is a great result.  It utilizes a low risk, non-pharmacologic technique to help people with a very common condition gain more control of their symptoms.  And I would add, likely has a positive impact on their mood as well, although that wasn't addressed in this study.

CBT has gained ground in the last several years as a very defined, time limited form of therapy that doesn't start folks off with analyzing early childhood trauma or the like.  Rather it seeks to provide specific skills and coping strategies to allow people to move forward in their lives. 

In this study the CBT took place over 12 sessions of 50 minutes each (that psychiatric truncated hour).  The sessions covered education about the condition, then moved through organizing, planning, problem-solving, and learning skills to reduce distractibility and think creatively in distress-producing situations.  Wow!  I think I need to sign up.  People who completed the sessions reported persistent improvement in symptoms out to the 12 month follow up.

No doubt this sounds great for those with ADHD.  Rick recommends finding someone trained in CBT technniques specific to ADHD by consulting a pediatrician or local medical school or teaching hospital.

Other topics in this week's podcast (while Rick is cycling in France) include underinsurance among American children in NEJM, the interaction of vitamin D with the genome in Genome Research and the true cost of prostate cancer treatments in Cancer Online  .  Until next week, y'all live well.

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