posted on November 05, 2012 14:21
A Cognitive-Behavioral Therapy Model
for Adults with ADHD
Mark Katz, PhD
MANY ADULTS WITH ADHD experience problems in
managing their time and organizing, prioritizing, and planning important
day-to-day activities. These problems can have far-reaching
ramifications, potentially affecting their personal relationships, their
careers, their financial security, and their overall physical and mental
Mary V. Solanto, PhD, is among the experts who have identified specific
behavioral and cognitive interventions that can help. Solanto directs
the ADHD Center at the Mount Sinai School of Medicine, where she and her
colleagues have developed a twelve-week group treatment model. The
sessions are briefly summarized in the sidebar below.
The program incorporates a series of behavioral and cognitive strategies
that directly target common trouble spots impacting the lives of adults
with ADHD. Interventions address the weaknesses associated with
executive functions, such as time management, organization, planning,
and prioritizing. Also addressed are the feelings of demoralization,
anxiety, and depression that can so often co-occur in adults who
struggle with ADHD.
As they progress through the program, group members learn mantras or
maxims that serve as self-instructive cues, reminding them of important
strategies and adaptive responses and helping them to generalize
strategies and adaptive responses during the course of their day.
Examples of these maxims include:
“If it’s not in the planner,
it doesn’t exist.”
“If you’re having trouble
getting started, then the first step is too big.”
“Do all things in the order of
“Getting started is the hardest
“A place for everything –
and everything in its place.”
“Out of sight, out of
“What you don’t do today
won’t go away—it will just be that much harder
This treatment model can be adapted for use in individual therapy. This
allows clinicians to tailor the program to those who may not be good
group candidates, or for those whose unique treatment needs are best
served in one-to-one sessions.
An efficacy study published in the American Journal of
Psychiatry in 2010 found the model to be successful in helping
adults improve in areas associated with executive functions.
Two optional sessions were not part of the study. One focused on
changing automatic thoughts and cognitive distortions, expanding upon
material covered in the fifth session. The other is titled Getting
to Bed, Getting Up, and Getting to Work on Time. “Being late
to work is a common problem for adults with ADHD,” says Solanto.
“However, you can’t get to work on time if you don’t
get up on time, and you can’t get up on time if you don’t
get to bed on time.” The session provides strategies that promote
Solanto will conduct an institute on this treatment model at
CHADD’s conference in Orlando in November 2011. Solanto’s
recently published book, Cognitive-Behavioral Therapy for Adult
ADHD: Targeting Executive Dysfunction (Guilford Press, 2011),
includes the detailed treatment manual she and her colleagues have
written for clinicians who wish to replicate the program.
Here is an overview of the twelve-session cognitive-behavioral treatment
program for adults with ADHD developed by Mary Solanto and her
Making Peace with the Diagnosis and Committing to Growth
Participants identify their personal goals for the group, the
emotions that can impede progress, and inner resources and strengths
they can call upon to help facilitate change.
Time Management: Time Awareness and Scheduling
Group members learn the importance of having constant access to
timepieces (watches, clocks), how to become more accurate in estimating
time, how to select a planner that will work best, and how to
effectively use a planner to create to-do lists and schedules.
Time Management: Making Tasks Manageable and Rewarding
Participants learn how to break large and boring tasks into
smaller more manageable chunks, and how to use personal rewards in ways
that make unpleasant tasks more enjoyable.
Time Management: Prioritizing and To-Do Lists
Group members learn how to separate important tasks from less
important ones, how to create to-do lists that take into account
high-priority responsibilities, and how to insure that enough time is
set aside to complete daily tasks, especially the more important and
Time Management: Overcoming Emotional Obstacles
Participants learn how to identify “automatic
thoughts” that represent “cognitive
distortions”—a negative and devaluing form of self-talk that
can lead to feelings of anxiety and depression—then learn how to
challenge and replace these cognitive distortions with a more realistic
array of positive and adaptive thoughts.
Time Management: Activation and Motivation
Group members learn strategies for getting started on tasks and
ways to stay motivated so that tasks are completed. In the process, they
also learn ways to avoid distractions, both sensory and social.
Getting Organized: Setting Up an Organizational System
Participants learn to use organizational strategies that allow
for important things to be easily identifiable and readily
Getting Organized: Implementing an Organizational System
Group members continue to work on their organizational system,
focusing on organizing physical spaces at home or at the office,
incorporating previously learned self-management strategies into the
Getting Organized: Maintaining an Organizational System
Participants learn systems and strategies for filing things
away, putting things in places where they belong, creating more
organized workspaces, and dealing with the mail.
Plan a Project—And Get It Done!
Using the time management, organizational, planning,
self-motivational and other strategies learned in previous sessions,
participants plan a project and the steps required to get it done.
Project Planning: Implementation
Participants continue to focus on the project they identified
in last week’s session, and review strategies learned in earlier
sessions to make sure they are being successfully applied.
Looking to the Future
Group members self-evaluate their progress, identify needs for
future growth, and discuss options for addressing these needs.
Participants also receive a written summary of key strategies learned
during the course of the program.
A clinical and consulting psychologist, Mark Katz is the director of
Learning Development Services, an educational, psychological, and
neuropsychological center located in San Diego. He is a contributing
editor to Attention magazine and a member of its editorial
advisory board, a former member of CHADD’s professional advisory
board, and a recipient of the CHADD Hall of Fame Award.
This article originally appeared in the October 2011 issue of
Attention magazine. Copyright © 2011 by Children and
Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights
reserved. No portion of this article may be reproduced without written
permission from CHADD.