5 Ways to Optimize CBT for ADHD
Cognitive behavioral therapy, enhanced with a neurodiversity-affirming approach, emphasizes goal achievement over symptom reduction.
ADHD is not a pathology to be cured. It is a difference to be explored and respected. This truth is self-evident but begs the question: How do we help people manage their ADHD without erasing the traits that shape who they are?
Increasingly, cognitive behavioral therapy (CBT) is being used to support executive functions and reshape environments to encourage behavioral change. At the same time, it works to reduce the shame, avoidance, and perfectionism that so often accompany ADHD.
Unlike other therapies, CBT measures patients’ outcomes in relation to their goals rather than ADHD symptom reduction. It supports patients’ time management, organization, emotional regulation, and other skills – not by encouraging them to change who they are, but by providing tools to improve functioning in ways that are meaningful to them.
CBT is most effective when it is designed collaboratively and personalized to meet a patient’s needs. For therapists, these guidelines for delivering neurodiversity-affirming care are a good place to start:
CBT Techniques for ADHD: Guidance for Therapists
💡Free Guide! 10 Things I Wish Someone Had Told Me About ADHD
1. Normalize ADHD
To aid patients in breaking unhelpful patterns, you must first understand and explain how ADHD impacts thoughts, behaviors, and emotions, Make the connection clear from a framework of difference, not deficits. Here’s an example:
PATIENT: I should be starting my report, but I keep thinking, I can’t do this. I’m a failure. I get anxious, scroll through my phone, and feel worse.
PRACTITIONER: That loop makes sense. With ADHD, large tasks demand a lot of executive functioning. When the first step isn’t clear, the brain sends an “avoid” signal. With that said, what’s a more balanced thought that still feels honest?
PATIENT: Starting is hard when the task is vague, but I’ve handed in reports before. I can begin if I make the first step tiny.
2. Follow the Patient’s Lead
When a patient tries to broadly suppress their ADHD symptoms, they end up consciously or unconsciously masking their identity. While most people mask to some degree, constant camouflaging leads to lower life satisfaction.
Abandon preconceived notions about impairing symptoms or challenges. Instead, ask your patient about their goals and the behaviors they want to change. Say:
- What would you prefer to focus on – career, health, relationships, or something else?
- What are your goals in this area?
- What tasks put you in line with your goals?
💡Read: What Makes a Life Fulfilling? Pursuing Goals Important to You, Not Others.
3. Watch Your Language
Does your patient prefer identity-first language (“ADHD person”) or person-first language (“person with ADHD”)? Do they have a preferred term for their neurotype? For example, Variable Attention Stimulus Trait (VAST), coined by Edward Hallowell, M.D., and John Ratey, M.D., is an alternative term for ADHD that has grown in popularity. Use non-pathologizing terms (also based on patient preference):
4. Look Beyond the Individual
Is your approach centered on making individuals meet neurotypical standards? Are you exploring opportunities to reshape their environment to help them thrive? For instance, you might suggest that a patient relocate to a quieter corner of their office and schedule brief, daily check-ins with their supervisor.
5. Provide Supports
The skill-building and between-session tasks associated with CBT can be difficult for people with ADHD, possibly triggering rejection sensitivity. To address this barrier to care:
- Supply tools. Provide a timer, for example, rather than asking your patient to buy one.
- Gauge what can be done. Ask, “On a 10-point scale, with 10 being a done deal, how likely are you write in your thought journal every day?” If their answer is less than eight, adjust the task.
- Plan frequent check-ins for accountability and opportunities to troubleshoot.
- Suggest options. A paper checklist may help one patient stay organized, while a to-do list app may work better for another. Always give choices and allow patients to experiment autonomously.
CBT Techniques for ADHD: Next Steps from ADDitude
Saskia Van Der Oord, Ph.D., is a professor of clinical psychology at KU Leuven in Belgium.
Michael Meinzer, Ph.D., is an associate professor of psychology at the University of Illinois, Chicago.
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