Case Study on Cognitive Behavioral Therapy (CBT) of a Patient with ADHD

Supervisor: Ruth Paige

Authors: Erica Barnes

Abstract:

Cognitive Behavioral Therapy (CBT) is an effective treatment option for adults with attention deficit hyperactivity disorder (ADHD). ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity symptoms, which can significantly impair an individual’s functioning in different areas of life. Here is a case of a 29-year-old patient with ADHD who was successfully treated with CBT. The CBT intervention focused on developing self-monitoring, self-regulation, and problem-solving skills to help the patient manage her ADHD symptoms. After completing the CBT intervention, the patient showed significant improvements in her ADHD symptoms, including a reduction in hyperactivity and impulsivity, an improvement in her ability to focus on tasks, and an increase in confidence, as proved in the past literature.

Introduction:

Cognitive Behavioral Therapy (CBT) is an effective treatment option for adults with attention deficit hyperactivity disorder (ADHD). ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity symptoms, which can significantly impair an individual’s functioning in different areas of life (Rostain & Ramsay, 2006). CBT is a psychotherapeutic approach that focuses on helping individuals identify and modify negative thought patterns and behaviors that contribute to their symptoms.

The goal of CBT for adults with ADHD is to provide them with the tools to manage their symptoms effectively and improve their overall quality of life. This therapy approach typically involves teaching patients specific skills, such as time management, organization, and problem-solving, as well as cognitive restructuring to help them develop more adaptive ways of thinking about themselves and their experiences (Bramham et al., 2009).

CBT for ADHD may also include behavioral strategies, such as rewards and positive reinforcement, to help patients develop and maintain healthier habits and routines. Research has shown that CBT can lead to significant improvements in ADHD symptoms, as well as in other areas of functioning, such as social skills and academic or occupational performance (Cherkasova et al., 2020). Here is a case discussed in which a patient with ADHD is treated with CBT successfully.

Case presentation:

A 29-year-old patient voluntarily goes to a clinic. She fidgets and struggles to remain seated during the interview, where she discloses that she is at risk of losing her job and has a disagreement with her husband about starting a family. In addition, she is concerned that her disorganization will hinder her ability to be a good mother.

She needs help with time management, often misplacing everyday items and running late to appointments. In addition, her desire for perfectionism creates additional stress and leads to procrastination. Her work performance has suffered as a result, and she has received warnings from her employer about missed deadlines and errors. This has left her anxious, doubtful, and pessimistic about starting a family.

Additional assessments, including feedback from her partner, indicate that she may have adult ADHD.

Management:

The patient was confirmed with a diagnosis of ADHD. In addition, she reported symptoms of inattention, hyperactivity, and impulsivity, which interfered with the child’s academic and social functioning. She was receiving medication for ADHD but showed interest in exploring non-pharmacological interventions to complement medication.

A cognitive behavioral therapy (CBT) intervention focused on developing self-monitoring, self-regulation, and problem-solving skills to help the client manage her ADHD symptoms. The intervention was delivered by a licensed clinical psychologist with expertise in treating ADHD.

The CBT intervention was structured into ten weekly 60-minute sessions. The sessions focused on teaching the client coping skills to manage his ADHD symptoms, including developing strategies to manage distractions, improve time management, and reduce impulsive behaviors. In addition, the intervention included cognitive restructuring, behavior modification, and social skills training.

Outcome:

After completing the CBT intervention, the patient showed significant improvements in her ADHD symptoms, as reported by her friends, parents, co-workers, and college instructor. Specifically, her parents reported a reduction in her hyperactivity and impulsivity and an improvement in her ability to focus on tasks for extended periods. In addition, the instructor reported an improvement in her classroom behavior, including a reduction in disruptive behaviors and an increase in on-task behavior.

In addition to the behavioral improvements, the patient reported feeling more confident managing her ADHD symptoms. She reported using the coping skills learned in the CBT intervention to manage distractions and stay on task during classwork and homework assignments.

Discussion:

The presented case highlights the potential benefits of Cognitive Behavioral Therapy (CBT) as a treatment option for adults with attention deficit hyperactivity disorder (ADHD). The patient, in this case, struggled with various symptoms of ADHD, including disorganization, time management difficulties, and impulsivity. These symptoms significantly negatively impacted her personal and professional life, leading to distress and impairment.

Many people with ADHD are unable or unwilling to take medication, and of those who do, many still suffer severe residual symptoms (Gomez, 2009). Therefore, stimulant medicines are considered first-line therapy for ADHD. However, even individuals deemed responders by the criteria of most drug studies (i.e., 30% or more significant decrease in symptoms may nevertheless endure many incapacitating symptoms depending on the severity of their baseline symptoms. As a result, there is a rising need for psychosocial interventions that address behavioral abnormalities associated with ADHD; however, the supply of these interventions seems to be growing more slowly than the supply of suggestions based only on clinical experience (Solanto & Scheres, 2021).

The Safren and colleagues’ treatment strategy, which is consistent with current theories of ADHD, starts with the assumption that neuropsychological deficits are the root of the condition. For example, inattention, hyperactivity, and impulsivity—three of ADHD’s hallmark symptoms—are caused by deficits in sustained attention, inhibitory control, working memory, and motivation (Safren et al., 2004). These deficiencies result in functional impairment and hinder adaptive behavior, such as adopting more sophisticated organizing and planning techniques that might ease symptom-related challenges.

The CBT intervention provided to the patient focused on teaching her self-monitoring, self-regulation, and problem-solving skills to help manage her ADHD symptoms. The intervention included a combination of cognitive restructuring, behavior modification, and social skills training and was delivered over ten weekly sessions. The intervention aimed to equip the patient with coping skills to manage her symptoms effectively, improve her academic and social functioning, and enhance her self-efficacy.

In a multisite open trial research (N = 72), 66 individuals finished the study. They demonstrated statistically significant decreases in self-reported ADHD symptoms on two measures with medium and modest effect sizes from baseline to treatment. A medium effect size showed a considerable reduction in self-reported depressive symptoms. In addition, the participants said they felt more capable of managing their ADHD symptoms and more informed. The authors state that a large, multisite, randomized controlled study comparing medicine to group skills training with the combination of these therapy modalities is now being conducted (Philipsen et al., 2007).

The cognitive behavioral therapy mentioned above was more effective than continuing to take medicines alone in a randomized controlled experiment (N=31). Participants completed a battery of self-report questionnaires and an impartial assessment with a judge who was unaware of the participants’ treatment status. At the time of the outcome assessment, those randomly assigned to CBT (n=16) showed lower levels of self-reported ADHD symptoms and independent assessor-rated ADHD symptoms and global severity (CGI-S) than those randomly assigned to continuing psychopharmacology alone (n=15). Also, those in the CBT group exhibited reduced levels of self-reported and independent assessor-rated anxiety and independent assessor-rated depression, with a tendency towards lower self-reported sadness. Using a conservative outcome of a CGI score drop of 2 points or more significant, it also looked at the proportion of treatment responders in each condition. According to this approach, patients who got CBT (56%) had a much higher rate of treatment responders than those who did not (13%) (Safren et al., 2005).

The intervention results were positive, with the patient showing significant improvements in her ADHD symptoms, as reported by her family, friends, co-workers, and college instructor. The patient’s parents reported a reduction in her hyperactivity and impulsivity and an improvement in her ability to focus on tasks for extended periods. The college instructor reported an improvement in her classroom behavior, including a reduction in disruptive behaviors and an increase in on-task behavior. Additionally, the patient reported feeling more confident in managing her ADHD symptoms and using the coping skills learned in the CBT intervention to manage distractions and stay on task.

The case demonstrates that CBT can be a promising and effective treatment option for adults with ADHD. The intervention was successful in helping the patient develop coping skills to manage her symptoms effectively, improve her academic and social functioning, and enhance her self-efficacy. In addition, the positive results of the intervention were reported by multiple sources, indicating that the changes were sustained over time and impacted different areas of the patient’s life.

Conclusion:

This case study adds to the growing body of literature that supports using CBT as an adjunctive treatment for adults with ADHD. CBT provides a non-pharmacological option for individuals seeking to manage their symptoms, complementing medication use. In addition, CBT interventions can be tailored to meet each patient’s specific needs and can be an effective way to improve ADHD symptoms, reduce distress, and enhance functioning.

References:

1. Bramham, J., Susan Young, Bickerdike, A., Spain, D., McCartan, D., & Xenitidis, K. (2009). Evaluation of Group Cognitive Behavioral Therapy for Adults With ADHD. Https://Dx.Doi.Org/10.1177/1087054708314596, 12(5), 434–441. https://doi.org/10.1177/1087054708314596
2. Cherkasova, M. V., French, L. R., Syer, C. A., Cousins, L., Galina, H., Ahmadi-Kashani, Y., & Hechtman, L. (2020). Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial. Journal of Attention Disorders, 24(6), 889–903. https://doi.org/10.1177/1087054716671197
3. Gomez, R. (2009). Invariance of parent ratings of the ADHD symptoms in Australian and Malaysian, and North European Australian and Malay Malaysia children: A mean and covariance structures analysis approach. Journal of Attention Disorders, 12(5), 422–433. https://doi.org/10.1177/1087054708315171
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6. Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 43(7), 831–842. https://doi.org/10.1016/J.BRAT.2004.07.001
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