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rucklidge j 2010 adapting cbt for adhd journal of the new zealand college of clinical psychologists 20 3 21 24 adapting cbt for adhd julia j rucklidge this article is ...

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                  Rucklidge, J. (2010). Adapting CBT for ADHD.  
                  Journal of the New Zealand College of Clinical Psychologists, 20(3), 21-24. 
                   
                  Adapting CBT for ADHD 
                                                                                                      Julia J Rucklidge 
                   
                      This article is adapted from: Rucklidge, J. J. (2008). Gender differences in ADHD: implications for psychosocial treatments. 
                      Expert Review of Neurotherapeutics, 8, 643-655. 
                   
                  ADHD is  a  complex  neurodevelopmental                   nonpharmaceutical treatments have evolved 
                  syndrome of impaired executive functioning                over the years for the treatment of ADHD 
                  that  significantly  affects,  particularly  over         with  varying  degrees  of  effectiveness  and 
                  time,  an  individual’s  ability  to  successfully        varying     degrees     of    empirically-based 
                  negotiate  the  world.  As  such,  treatments             research  supporting  their  effectiveness. 
                  need to be integrative and multimodal, and                Treatments also vary depending on the age 
                  the  case  conceptualized  with  consideration            of the individual affected by ADHD.  
                  of  all  the  individual  variables  present.              
                  Although  not  all  cases  of  ADHD  need                 Over  100  studies  have  found  that  parent 
                  treatment beyond medication, many do and                  and  teacher  programs  improve  child 
                  it is up to us to identify the more complex               compliance,  reduce  disruptive  behaviours 
                  presentations  and  offer  these  clients  a              and  improve  interactions.  The  programs 
                  combination  of  treatments  with  a  good                that   specifically   offer   good  outcomes 
                  empirical base such that they can make an                 involve operant conditioning, whereas those 
                  informed decision on treatment choices.                   using     a    more      cognitive-behavioural 
                                                                            approach have fared less well, at least in the 
                  With  queries  related  to  the  long-term                child  literature.  The  rationale  for  using 
                  effectiveness  of  front-line  medications  for           behavioural  approaches  lies  in  both  the 
                  the  treatment  of  ADHD  (Jensen  et  al.,               neurological     research     suggesting     that 
                  2007),  we  are  challenged  to  investigate              neurotransmitter pathways can be modified 
                  alternative  treatment  options.  Psychosocial            by behavioural management (e.g. Sagvolden, 
                  treatments  have  a  solid  grounding  in                 Aase,  Johansen  &  Russell,  2005)  and  the 
                  empirically  based  research.  Part  of  a                evidence that social factors can contribute to 
                  clinician’s  role  is  to  assist  individuals  with      the    severity    and     comorbid      profiles 
                  ADHD to find a “good fit” between their                   associated  with  the  disorder.  Although  the 
                  symptoms  and  their  environment.  Adults                initial results emerging from the MTA study 
                  with ADHD are particularly likely to hold                 indicated that behaviour management added 
                  core  beliefs  of  inadequacy  and  display               nothing  to  the  effect  of  medications, 
                  concomitant behaviours, such as avoidance,                subsequent  publications  have  shown  that 
                  that  exacerbate  the  core  symptoms  of                 this   was  only  true  for  those  with 
                  inattention,  hyperactivity  and  impulsivity             uncomplicated  ADHD but for  those  with 
                  (Ramsay  &  Rostain,  2005b).  Psychosocial               additional  comorbidities  (e.g.,  anxiety  and 
                  treatments, target these secondary problems.              disruptive    behavioural      disorders),    the 
                  Particularly for those identified in adulthood            psychosocial       component         statistically 
                  with ADHD, instilling hope and reframing                  improved outcomes (Conners et al., 2001). 
                  the past may be some of the more important                Moreover, data collected 2 years post MTA 
                  foci of the early stages of therapy.                      further  diminished  the  superiority  of  the 
                                                                            medicated       groups       (Group,       2004). 
                  It  is  clear  that  individuals  with  ADHD,             Behavioural  treatments  are  also  known  to 
                  regardless of gender, struggle far beyond the             allow  for  a  decrease  in  the  dose  of 
                  symptoms of ADHD and that these other                     medications  used  and  parents  of  children 
                  problems  need  due  consideration  when                  receiving  both  medication  and  behavioural 
                  developing treatment plans. As such, many                 treatments report more “normalized”  
                   Julia Rucklidge, a Clinical Psychologist, is an Associate Professor at the University of Canterbury, Department of Psychology, and 
                   Director of the ADHD Diagnostic Assessment and Research Unit.  
                    
                      Rucklidge, J. (2010). Adapting CBT for ADHD.  
                      Journal of the New Zealand College of Clinical Psychologists, 20(3), 21-24. 
                      children compared with parents of children                               sense  the  treatment  effects  would  largely 
                      who only received medications (Greene &                                  disappear. This externalising of rewards and 
                      Ablon, 2001).                                                            punishers is also consistent with behavioural 
                                                                                               management  practices,  like  token  systems. 
                      There  has  been  increasing  interest  in  the                          The  key  is  to  externalise  what  should 
                      neural mechanisms underlying ADHD and a                                  otherwise          be       internally         represented 
                      number of fascinating animal models have                                 information,  be  that  in  the  form  of  cues, 
                      been proposed to assist us in understanding                              lists,      reminders,          bells,       or      timers.  
                      the changes that occur at the neuronal level                             Maintenance of routines and schedules are 
                      when  rewards  and  punishment  reinforcers                              also      an  integral         part     of     behavioural 
                      are in place (see Sagvolden et al, 2005, for a                           management  practices.  Of  course  other 
                      comprehensive review of this theory). The                                issues  are  also  important  to  manage  and 
                      implications of this model are that rewards                              modify  such  as  sleep  hygiene,  diet  and 
                      for  individuals  with  ADHD  must  be                                   exercise (Staller & Faraone, 2006). 
                      immediate,  punishers  are  less  likely  to                              
                      influence behaviours in the long-term with                               Although  cognitive-behavioural  treatments 
                      individuals  affected  by  ADHD,  and  any                               have  lost  favour  amongst  those  treating 
                      behavioural         programme  needs  to  be                             children with ADHD, it has recently been 
                      maintained over time in order to have any                                considered as a viable treatment for adults 
                      lasting  influence  on  behaviours.  In  other                           with  ADHD.  More  and  more  adults  are 
                      words,  psychosocial  treatments  serve  to                              seeking        psychotherapy  to  complement 
                      provide ADHD individuals with an external                                medications,  the  assumption  being  that 
                      scaffold that needs to be permanently targeted                           neuropsychological  difficulties  that  stem 
                      at the core ADHD symptoms to assist with                                 from        the      disorder         often       lead      to 
                      behaviour management over time.                                          dysfunctional  patterns  of  thinking,  feeling 
                                                                                               and  behaving.  Over  the  last  few  years,  a 
                      These ideas are in line with those of Barkley                            number  of  studies  have  been  published 
                      (2006)  who  described  the  importance  of                              investigating the efficacy of using traditional 
                      targeting  interventions  at  the  point  of                             CBT approaches with ADHD adults (e.g., 
                      performance,  that  is  where  the  desired                              (Rostain  &  Ramsay,  2006;  Safren  et  al., 
                      behaviour  is  to  occur,  rather  than  in  the                         2005).  CBT  focuses  on  challenging  deeply 
                      office  where  undesirable  behaviours  are                              held beliefs and developing coping strategies 
                      unlikely to be activated. In other words, the                            for managing ADHD-related difficulties.  
                      further  in  time  a  suggested  intervention  is                         
                      located, the less effective it is likely to be.                          Safren  et  al.  (2005)  found  that  there  were 
                      This  would  be  true  of  both  behavioural                             significantly  more  treatment  responders 
                      management strategies offered to children as                             among  patients  who  received  CBT  and 
                      well  as  CBT  interventions  distributed  to                            medications (56%) compared to those who 
                      adults      with       ADHD.  Based  on  the                             received  only  medications  (13%).  Rostain 
                      neurocognitive deficits present in individuals                           and  Ramsay  (2006)  used  a  combined 
                      with  ADHD,  it  follows  that  therapies                                treatment approach for adults with ADHD 
                      delivered in the clinic are going to be less                             using  a  6  month  course  of  concurrent 
                      effective         than        those        directed         at           pharmacotherapy (ADDerall) and CBT (16 
                      environmental  reconfigurations,  curriculum                             sessions).        Forty-one          percent        showed 
                      adjustments,  and  other  options  that  target                          significant  improvement  based  on  Brown 
                      the structure of the natural setting (Barkley,                           ADD  Scale  (BADDS)  scores,  and  there 
                      2006). The cognitive deficits also imply that                            were  significant  changes  on  all  self-report 
                      treatments must be sustained over time; if                               scales and Clinical Global Impression (CGI) 
                      the         behavioural             treatments            and            scores, 81% of participants reported at least 
                      environmental structure created to sustain a                             mild  improvement,  and  70%  reported 
                      behaviour  are  eliminated,  then  it  makes                             moderate  to  significant  improvement  (see 
                      Rucklidge, J. (2010). Adapting CBT for ADHD.  
                      Journal of the New Zealand College of Clinical Psychologists, 20(3), 21-24. 
                      Ramsey  &  Rostain,  2005a,  for  details  on                            employment  difficulties  (Murphy,  2005). 
                      modules  and  modifications  of  CBT  for                                Tardiness,         disorganisation,          poor       time 
                      ADHD).  Further,  mindfulness  approaches                                management  and  missing  deadlines  are  all 
                      based on Marsha Linehan’s work with adults                               some of the things that will interfere with 
                      with  Borderline  Personality  Disorder,  have                           job  performance,  suggesting  that  the  job 
                      been  piloted  and  appear  promising  in  the                           may be ill fitted to suit the strengths of the 
                      treatment  of  emotional  dysregulation  in                              adult  with  ADHD.  Therefore,  part  of  the 
                      adults with ADHD (Hesslinger et al., 2002;                               challenge  of  working  therapeutically  with 
                      Solanto,  Marks,  Mitchell,  Wasserstein  &                              ADHD  adults                is     about        vocational 
                      Kofman, 2008).                                                           counselling  and  matching  patients  to  jobs. 
                      Psychoeducation         is    also      an      important                Coaching is another area that has developed 
                      component of psychosocial interventions. It                              over  the  last  decade  as  an  adjunctive 
                      is   important  to  discuss  ADHD  as  a                                 treatment for adults with ADHD. However, 
                      handicapping  condition;  one  that  can  be                             there  is  no  empirical  data  to  support  the 
                      managed  but  not  cured.  Other  areas  to                              efficacy of coaching (Murphy, 2005).  
                      cover  include  what  medications  can  and                               
                      cannot aid, and the fact that medications can                            References  
                      equally       alleviate      inattentive        symptoms                 Barkley, R. A. (2006). A theory of ADHD. In R. A. 
                      (Weiss, Worling & Wasdell, 2003). Further,                                          Barkley (Ed.), Attention-Deficit Hyperactivity 
                      knowing neurocognitive deficits are chronic                                         Disorder: A handbook for diagnosis and treatment 
                      and  difficult  to  modify  permanently  over                                       (3rd ed.). (pp. 297-394). New York, NY: The 
                                                                                                          Guilford Press. 
                      time,  it  is  helpful  to  discuss  these  deficits                     Barkley, R. A., & Cox, D. (2007). A review of driving 
                      within  the  context  of  medications,  as                                          risks  and  impairments  associated  with 
                      medications  have  been  documented  to                                             attention-deficit/hyperactivity  disorder  and 
                      improve some neurocognitive deficits (e.g.,                                         the  effects  of  stimulant  medication  on 
                      Bedard, Martinussen, Ickowicz & Tannock,                                            driving    performance.  Journal        of   Safety 
                                                                                                          Research, 38, 113-128. 
                      2004;  McInnes,  Bedard,  Hogg-Johnson  &                                Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, 
                      Tannock,  2007).  Risks  associated  with                                           K.  (2006).  Young  adult  outcome  of 
                      ADHD  may  need  to  be  discussed  to                                              hyperactive  children:  Adaptive  functioning 
                      highlight        areas      that      need       additional                         in major life activities. Journal of the American 
                      intervention. For example, we know people                                           Academy  of  Child  and  Adolescent  Psychiatry, 
                                                                                                          45(2), 192-202. 
                      with ADHD are at increased risk for driving                              Bedard,  A.-C.,  Martinussen,  R.,  Ickowicz,  A.,  & 
                      related  accidents  (Barkley  &  Cox,  2007;                                        Tannock,      R.    (2004).     Methylphenidate 
                      Fischer, Barkley, Smallish & Fletcher, 2007),                                       improves visual-spatial memory in children 
                      with  females  potentially  showing  higher                                         with            attention-deficit/hyperactivity 
                      risks  associated  with  driving  offences,  at                                     disorder.  Journal  of  the  American  Academy  of 
                                                                                                          Child and Adolescent Psychiatry, 43(3), 260-268. 
                      least in adolescence (Nada-Raja et al., 1997).                           Conners, C. K., Epstein, J. N., March, J. S., Angold, 
                      Adolescent girls with ADHD have a higher                                            A.,  Wells,  K.  C.,  Klaric,  J.,  et  al.  (2001). 
                      risk  for  teen  pregnancy  (30-40%;  Barkley,                                      Multimodal  treatment  of  ADHD  in  the 
                      Fischer,  Smallish,  &  Fletcher,  2006)  and  a                                    MTA:  An  alternative  outcome  analysis. 
                      fourfold  increase  in  risk  for  sexually                                         Journal  of  the  American  Academy  of  Child  and 
                                                                                                          Adolescent Psychiatry, 40(2), 159-167. 
                      transmitted  disease  (Barkley  et  al.,  2006)                          Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, 
                      compared with non ADHD girls. Because                                               K.  (2007).  Hyperactive  children  as  young 
                      of  these  risks,  they  need  to  be  discussed                                    adults:   Driving      abilities,  safe    driving 
                      with      individual        patients       as     part     of                       behavior,  and  adverse  driving  outcomes. 
                      psychoeducation, such that decisions about                                          Accident Analysis and Prevention, 39(1), 94-105. 
                                                                                               Greene, R. W., & Ablon, J. S. (2001). What does the 
                      treatment take these risks into consideration.                                      MTA  study  tell  us  about  effective 
                      Vocational  rehabilitation  is  likely  an  area  of                                psychosocial treatment for ADHD? Journal 
                      ongoing  concern  for  adults  with  ADHD.                                          of Clinical Child Psychology, 30(1), 114-121. 
                      Individuals with ADHD are more likely to                                 Group,  M.  T.  A.  C.  (2004).  National  Institute  of 
                      quit,      terminate         and       have        ongoing                          Mental Health Multimodal Treatment Study 
                                                                                                          of    ADHD  follow-up:             Changes       in 
                    Rucklidge, J. (2010). Adapting CBT for ADHD.  
                    Journal of the New Zealand College of Clinical Psychologists, 20(3), 21-24. 
                              effectiveness  and  growth  after  the  end  of          Ramsay,  J.  R.,  &  Rostain,  A.  L.  (2005b).  Girl, 
                              treatment. Pediatrics, 113(4), 762-769.                            Repeatedly  Interrupted:  The  Case  of  a 
                    Hesslinger, B., van Elst, L. T., Nyberg, E., Dykierek,                       young  adult  woman  with  ADHD.  Clinical 
                              P.,  Richter,  H.,  Berner,  M.,  et  al.  (2002).                 Case Studies, 4(4), 329-346. 
                              Psychotherapy       of     attention     deficit         Rostain, A. L., & Ramsay, J. R. (2006). A combined 
                              hyperactivity  disorder  in  adults:  A  pilot                     treatment approach for adults with ADHD: 
                              study  using  a  structured  skills  training                      Results  of  an  open  study  of  43  patients. 
                              program.  European  Archives  of  Psychiatry  and                  Journal of Attention Disorders, 10(2), 150-159. 
                              Clinical Neuroscience, 252, 177-184.                     Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., 
                    Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello,                      Wilens,  T.  E.,  &  Biederman,  J.  (2005). 
                              B.,  Abikoff,  H.  B.,  Greenhill,  L.  L.,  et  al.               Cognitive-behavioral therapy for ADHD in 
                              (2007).  3-year  follow-up  of  the  NIMH                          medication-treated  adults  with  continued 
                              MTA study. Journal of the American Academy of                      symptoms.  Behaviour  Research  and  Therapy, 
                              Child and Adolescent Psychiatry, 46, 989-1002.                     43(7), 831-842. 
                    McInnes,  A.,  Bedard,  A.  C.,  Hogg-Johnson,  S.,  &             Sagvolden, T., Aase, H., Johansen, E. B., & Russell, 
                              Tannock, R. (2007). Preliminary evidence of                        V.  A.  (2005).  A  dynamic  developmental 
                              beneficial  effects  of  methylphenidate  on                       theory    of    attention-deficit/hyperactivity 
                              listening   comparison  in  children  with                         disorder        (ADHD)          predominantly 
                              attention-deficit/hyperactivity       disorder.                    hyperactive/impulsive        and     combined 
                              Journal     of     Child     and      Adolescent                   subtypes. Behavioral and Brain Sciences, 28(3), 
                              Psychopharmacology, 17, 35-49.                                     397-468. 
                    Murphy,  K.  (2005).  Psychosocial  treatments  for                Solanto,  M.  V.,  Marks,  D.  J.,  Mitchell,  K.  J., 
                              ADHD  in  teens  and  adults:  A  practice-                        Wasserstein,  J.,  &  Kofman,  M.  D.  (2008). 
                              friendly  review.  Journal  of  Clinical  Psychology,              Development  of  a  new  psychosocial 
                              61(5), 607-619.                                                    treatment  for  adult  ADHD.  Journal  of 
                    Nada-Raja, S., Lagley, J. D., McGee, R., Williams, S.                        Attention Disorders, 11(6), 728-736. 
                              M.,  Begg,  D.  J.,  &  Reeder,  A.  I.  (1997).         Staller, J., & Faraone, S. V. (2006). Attention-Deficit 
                              Inattentive and hyperactivity behaviors and                        Hyperactivity       Disorder       in      girls: 
                              driving offences in adolescence. Journal of the                    Epidemiology  and  management.  CNS 
                              American  Academy  of  Child  and  Adolescent                      Drugs, 20(2), 107-123. 
                              Psychiatry, 36, 515-522.                                 Weiss,  M.  D.,  Worling,  D.  E.,  &  Wasdell,  M.  B. 
                    Ramsay, J. R., & Rostain, A. L. (2005a). Cognitive                           (2003).  A  chart  review  study  of  the 
                              Therapy     for    Adult    ADHD.  In  L.                          Inattentive    and    Combined  Types  of 
                              VandeCreek  (Ed.),  Innovations  in  clinical                      ADHD. Journal of Attention Disorders, 7(1), 1-
                              practice:  Focus  on  adults.  A  volume  in  the                  9. 
                              innovations in clinical practice series (pp. 53-63).      
                              Sarasota,  FL,  US:  Professional  Resource 
                              Press/Professional Resource Exchange. 
                     
                     
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...Rucklidge j adapting cbt for adhd journal of the new zealand college clinical psychologists julia this article is adapted from gender differences in implications psychosocial treatments expert review neurotherapeutics a complex neurodevelopmental nonpharmaceutical have evolved syndrome impaired executive functioning over years treatment that significantly affects particularly with varying degrees effectiveness and time an individual s ability to successfully empirically based negotiate world as such research supporting their need be integrative multimodal also vary depending on age case conceptualized consideration affected by all variables present although not cases studies found parent beyond medication many do teacher programs improve child it up us identify more compliance reduce disruptive behaviours presentations offer these clients interactions combination good specifically outcomes empirical base they can make involve operant conditioning whereas those informed decision choices...

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