In this new edition of our expert interviews, we are welcoming Dr. John Russell Ramsay, PhD, associate professor of clinical psychology at the Perelman School of Medicine at the University of Pennsylvania, Co-director and Co-founder of Penn’s Adult ADHD Treatment and Research Program, and an advisor to Mantra Health.
I am with Dr. Russell Ramsay,. Dr. Ramsay, you wrote a book on non-medication treatments for Adult ADHD. How do you conceptualize ADHD as a disorder?
It is often not thought of this way, but ADHD itself is not a knowledge problem but rather a performance or implementation problem – recurring difficulties organizing and following through on tasks and goals despite knowing what needs to be done.
It’s my understanding that medications are highly effective for treating the symptoms of ADHD, including for adults. Don’t these medications usually treat these problems?
Yes. Medications are very effective with symptom reduction, and for many adults these improvements set the stage for improved functioning. However, symptom reduction alone does not necessarily translate into improved time management, organization, or being less prone to procrastination. ADHD coping skills are not in the pills, as the saying goes.
So then, what are the new developments that may address these coping issues?
The psychosocial treatment of adult ADHD, specifically cognitive-behavior therapy or CBT, is well-established as an evidence-based treatment. CBT adapted to adult ADHD is designed to foster the development of coping strategies for managing ADHD that will most definitely improve functioning. There are no trade secrets about what works, but the central focus is on the implementation of these skills.
A recent study examined a course of group-administered CBT that was provided to two groups of adults with ADHD: one group was on a stable regimen of ADHD medications; the other group was not medicated. At the end of the 12-week group treatment, the CBT plus medication group improved at a significantly higher rate than the unmedicated group - no surprise there. But, during the 6-month follow up phase after treatment ended, the CBT + coaching group continued to improve and caught up to the CBT plus medication group in terms of improvements.
What do these results mean for adults with ADHD in their daily lives?
First, medications + CBT from the outset can provide improvements at a faster rate, but the skill-focused CBT for adult ADHD can also lead to improvements over time, which extend beyond treatment, which is important because ADHD requires ongoing efforts to manage. The take home message is that improving concentration with daily medications is great, but making changes to your time management or organizational system can improve your executive functioning over the long-term.
Second, a unique feature of this particular CBT approach was that weekly group meetings were augmented with twice weekly, between-session phone contacts with a “coach” for about 10-15 minutes each to review any coping difficulties and help participants stay on track with their goals. This coaching feature was rated by participants as very helpful. If adopted elsewhere, this added step may improve outcomes for adults with ADHD. This is also consistent with the Mantra approach for integrating care and fostering follow through on patients’ behavioral health and overall wellness goals in daily life.
Dr. Ramsay, thank you for sharing this useful update.