2.2.2 Cognitive behavioural therapy

For children and adolescents with ADHD, NICE guidelines state that support should be provided to parents and teachers in the first instance. However, if ADHD symptoms persist, it is recommended that medication is provided. For those who benefit from medication but whose symptoms are still causing significant problems in one area, for example, in school or at home, or for those who refuse medication, it is suggested that the medication is combined with cognitive behavioural therapy (CBT), a form of psychological therapy aiming to alter thought processes and behaviours.

CBT is considered the ‘gold standard’ of psychological therapy in the UK and the USA and it dominates in healthcare settings. For example, the National Health Service (NHS) initiative Improving Access to Psychological Therapies (IAPT) principally involves counselling with basic CBT-trained practitioners. However, accessing this therapy via the NHS may be difficult due to limited resource so some individuals seek private sessions. For example, details of private practitioners within the UK can be accessed via the British Association for Behavioural and Cognitive Psychotherapies.

In ADHD management, CBT focuses on establishing structures and routines, and clear rules and expectations for key settings, for example at home and in school or work. It can also be used to help with social skills with peers, problem-solving, active listening skills, and dealing with and expressing feelings.

A key aspect of CBT is cognitive restructuring. This involves identifying, and then changing, negative thoughts. Negative thoughts lead to negative emotions and negative relationships with others. Some examples of negative thought patterns include comparative thinking (making unsuitable comparisons between yourself and others) and thinking in terms of ‘should’ statements (how things should be in an ideal world). Often for a person with ADHD these negative thoughts will focus on their abilities. CBT restructures these thoughts, helping to manage negative emotions, which can improve engagement with the other strategies aimed at establishing structure and routines (mentioned above).

It is possible for CBT to be delivered online rather than in a face-to-face setting. In one study of an internet based six-month modular CBT programme in adults with ADHD, the therapy was found to be significantly more effective than the wait-list control group. The ‘wait-list control group’ refers to participants who remained on a waiting list for treatment that would be received after the study, but who did not receive the CBT during the study (Pettersson et al., 2017).