On Sunday, December 11, 74 NJ-ACT members attended psychologist Mary Solanto’s presentation of her CBT program for adult ADHD.  

            Dr. Solanto reported that one quarter to one half of ADHD adults do not obtain an “adequate” clinical response to medication (25% symptom reduction). Even when medication helps patients focus their attention, they often lack the skills to function effectively at work, school or home. Solanto designed her CBT program to address these problems. Empirical evidence indicates that the program is twice as effective as supportive therapy for patients already receiving medication. 

 

Assessment

            Solanto recommended the Conners Adult ADHD Rating Scale because it has norms for men and women of every age. She also emphasized the importance of a detailed and precise history. If anxiety and depression precede patients’ concentration difficulties, ADHD is probably not the correct diagnosis. 50% of adult ADHD patients experience depression, and 25% suffer from an anxiety disorder.

 

Components of Solanto’s CBT for Adult ADHD

            CBT for ADHD focuses on time management, organization and planning. Patients learn to:

            1. Use external aids such as planners, to-do lists, and filing systems;

            2. Self-instruct when organizing, prioritizing, scheduling, and activating. Self-instruction includes repeating axioms and “mantras” until they become automatic. Examples include: 

                        “If I’m having trouble getting started, the first step is too big.”

                        “If it’s not in the planner it doesn’t exist.”

                        “Anything I want to remember should be in sight.” (distraction control)

                        “A place for everything and everything in its place.” (organization)

                        “All things must be done in order of priority.”

            3. Self-reinforce when they complete difficult or avoided tasks. 

            4. Visualize long-term rewards of adaptive behavior to counteract the short-term rewards of behavioral avoidance.

            5. Address perfectionism, self-doubt, depression and low self-esteem with traditional CBT.

            Patients choose a personal Home Exercise at the end of every session. They use a flow chart to plan its completion.

 

Session format

            1. Discuss the Home Exercise, reviewing the relevant skills when patients do not complete the exercise. About half of each session is devoted to discussing the Home Exercise, since completion of the Home Exercise predicts positive outcome; 

            2. Psychoeducation about the week’s topic skill.

            3. An in-session exercise, such as breaking a task into steps, setting priorities, creating a schedule from a to-do list, developing a filing system, sorting papers that might be found on a desk, or organizing a physical space to prevent distraction.

            4, Positive reinforcement from the therapist who functions as cheerleader, teacher, and psychotherapist throughout. 

 

            Directions for therapists, patient hand-outs, and homework forms appear in Solanto’s 2011 book Cognitive Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction (Guilford). When treatment ends, Dr. Solanto believes that ADHD patients require ongoing community support.