She said that the approach that they use, described by Safren and colleagues,4 was developed based on the idea that most patients would be taking medication, and many studies thus report effectiveness of CBT in patients receiving pharmacological treatment. That said, Sprich noted that her group has piloted a CBT approach for patients who are not taking medications, describing their preliminary results as “promising.”

Laura Knouse, PhD, a psychologist at the University of Richmond, wrote in a recently published chapter on CBT for adults with ADHD5 that clinicians should have as their ultimate goal to teach clients to “be their own therapist.” She described individual and group approaches, including the individual approach developed by Safren and associates4 that focuses on three core modules: organization and planning, distractability reduction, and dysfunctional thought patterns.

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As noted, although negative patterns are a recognized problem in adults with ADHD, positive thought patterns can also be dysfunctional. Mitchell said that with CBT, the behavioral aspect of treatment will “mostly focus on negative thinking and the depressive and anxious flavors of cognition.” However, he and Knouse also have found6 that what look like positive cognitions can be “really maladaptive.”

One example cited by Mitchell is when a patient mentions a belief that “I can do these things at the last minute, I’m a really good multitasker,” but the evidence suggests instead that this attitude is “really causing a lot of problems.” Sprich concurred. “I absolutely agree with this observation,” she said. “It is something that we see very often when working with individuals with ADHD.”

In addition to the standbys of CBT and pharmacotherapies, a potential new intervention rests on the adult ADHD treatment horizon: mindfulness. A few studies have suggested success with this technique in patients being managed with pharmacological treatment,7-9 and Mitchell said there is potential in the approach.

Sprich agreed that mindfulness therapy holds promise. “I do think that these interventions are somewhat useful in ADHD,” she said. “Relaxation and mindfulness skills can help patients slow down, observe when the skills are needed, and take the time to implement CBT strategies.”

Emily Willingham, PhD, is a freelance science writer with a background in developmental biology and physiology. She holds a PhD in biological sciences from the University of Texas at Austin and completed a postdoctoral fellowship in urology at the University of California-San Francisco.


  1. Zulauf CA, Sprich SE, Safren SA, Wilens TE. The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Curr Psychiatry Rep. 2014;16(3):436. doi: 10.1007/s11920-013-0436-6.
  2. Kessler RC, Green JG, Adler LA, et al. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Arch Gen Psychiatry. 2010;67(11):1168-1178.
  3. Grane VA, Endestad T, Pinto AF, Solbakk AK. Attentional control and subjective executive function in treatment-naive adults with attention deficit hyperactivity disorder. PLoS One. 2014;9(12):e115227.
  4. Safren SA, Otto MW, Sprich S, et al. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms.Behav Res Ther. 2005;43(7):831-842.
  5. Knouse KE. Cognitive-behavioral therapies for ADHD. In: Barkley RA, ed. Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment. New York, NY: Guilford Press; 2014:757-773.
  6. Knouse KE, Mitchell JT. Incautiously optimistic: positively-valenced cognitive avoidance in adult ADHD. Cogn Behav Pract. 2015;22(2):192-202.
  7. Emilsson B, Gudjonsson G, Sigurdsson JF, et al. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatry. 2011;11:116.
  8. Young S, Khondoker M, Emilsson B, et al. Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis. Psychol Med. Published May 29, 2015.
  9. Safren SA, Sprich S, Mimiaga MJ, et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875-880.