Attention Deficit/Hyperactivity: ADHD Therapy

ADHD Therapy: Starting with the terms

Let us start with the technical part, including a few things you may not know about Attention Deficit/Hyperactivity Disorder (henceforth ADHD) that are critical in understanding what's involved in ADHD therapy. For starters, the more familiar ADD, which stood for Attention Deficit Disorder, was replaced in recent editions of the DSM-IV by Attention Deficit/Hyperactivity Disorder (ADHD). The change reflects a shift in thinking about the disorder, and about ADHD therapy, namely that hyperactivity and inattention are two separate issues that don't necessarily have to present together. With the change, the DSM-IV divided the disorder into 3 subtypes: primarily inattentive type, primarily hyperactive type, and a combined type. Understanding these types is critical in articulating what happens in ADHD therapy.

ADHD Therapy: More than hyperactivity

One significant issue highlighted by the shift is that ADHD can be diagnosed in people who don't seem to be "ADD" in the sense we commonly think of that label meaning. In other words, just because someone is not hyperactive does not mean the disorder cannot be applied--there may be issues related to inattention that go unnoticed because they are not accompanied by hyperactivity. In children, this also often means that the inattention goes unnoticed; unlike hyperactivity, which is highly disruptive in most homes and classrooms, inattention is easier to overlook.

ADHD Therapy from non-diagnostic therapists

The challenge for non-diagnostic therapists like ourselves in providing ADHD therapy is to both recognize the serious challenges that can come with hyperactivity, inattention or both, while not relating to these in an overly narrow way. To put it differently, it is important to note that, as you probably expect, ADHD (of any of the three varieties) is most commonly treated with medication. These medications (counter-intuitively stimulants--most of the ADHD medications are similar to speed and stimulate the parts of the brain that regulate attention, focus and impulse control) are highly effective and also wrought with side effects. And, in my experience, are often exactly what's needed for both children and adults who struggle with serious attention and impulse control difficulties.

However, because the treatment is almost always constituted by medication alone, many other serious issues may be left unaddressed. Whether medication is prescribed or not (and we do not universally oppose or condone its use), there is a great need for attention to be given to broader developmental issues. Here are some of those issues:

Intimacy and closeness

In our experience, both children and adults who have difficulty with focus and attention commonly have a challenging time being close to others. Perhaps there is a cycle of cause and effect here: difficulty with attention makes it harder to develop intimacy which perpetuates difficulty with attention. After all, it's hard to be close to someone who's running in circles around the room or can't sit through a conversation. Psychotherapy focused on relationship building is a critical tool for developing one's ability to handle closeness and intimacy.

Intimacy and closeness

As with intimacy and closeness, challenges with attention and focus interfere in fairly obvious ways with many of the tasks associated with building a life. Things like planning, budgeting, building relationships, and following through with responsibilities are all made more challenging by these difficulties. And also similar to sustaining close relationships, this cycle can compound itself (life skills go unlearned, opportunities are missed).

Psychotherapy for Attention Deficit/Hyperactivity Disorder (AD/HD Therapy)

Yes, there is a great role for psychotherapy to play in supporting children and adults with AD/HD. If you're interested in an alternative to stimulant medications, or looking to reduce the amount or stop taking medications altogether, this is a particularly important choice.