Attention-Deficit / Hyperactivity Disorder (ADHD)

Treatment of ADHD

Thankfully, therapy can be a tremendous help in addressing the issues of ADHD. Through collaborative processes between client and therapist, ADHD symptoms are identified and normalized as a treatment plan and goals are set. It is our understanding that knowledge is power. Therefore, through the therapeutic process, we seek to help clients better understand their brain and brain functions specific to them. Once we establish a foundation of knowledge and awareness, we seek to implement thought strategies, problem solving, skills development, and behavior changes to improve the areas the client has decided to address. With the help of a comprehensive treatment team (which may include referrals to psychiatrists or executive coaches), and the help of parents, partners, teachers, and/or coworkers, we work to make lasting and meaningful change that improves the life of the client.

Behavioral Therapy

More specifically, our process of working with individuals with ADHD is evidence-based and tailored to each individual. According to the CDC, one of the most recommended and researched treatments for ADHD is behavioral therapy – an approach we take in working with adults, adolescents, and parents in support of their child(ren). Not only do we spend time to uncover the lived experience and nuances of each persons’ relationship to ADHD, we help bring light to unseen areas of impact, strengths, and “superpowers”.

We utilize the power of knowledge to reassess and re-experience ADHD symptoms in new ways – ways that help the individual to build in more grace, understanding, and skill in managing symptoms in their day-to-day lives. We explore the brain and specific brain functions to optimize every opportunity to adjust behaviors that do not align with the client’s hopes and goals. We utilize problem solving skills and implement behavioral and cognitive strategies to shift behaviors and thoughts that impair the life of the client. We work through commonly co-occurring symptoms of shame, self-criticism, and anxiety that creep in as a result of years of struggling to “perform” per the standards that school or work may have set (often standards that don’t work for people with ADHD).

Here is an example of how we incorporate science into treatment: Research confirms that important aspects of the dopamine reward center of the brain are under-activated in ADHD brains. As a result, a battle for optimal levels of stimulation ensues – will internal desire or external demand prevail? Again, we look to the literature to help us understand this process in more detail as we create customized treatment plans to meet each client’s needs. Internal desires are found to be more motivating and accompanied by more dopamine, thus time and consequences (external demands) are overshadowed by pleasurable reinforcement. For the client, navigating a controllable source of dopamine like social media may become more important than getting ready to meet with a coworker (i.e., the internal desire for optimal levels of stimulation outweigh the external demands of work). With the awareness of this process, we can normalize and adjust expectations accordingly as well as implement strategies to increase personal significance (therefore creating more dopamine) for the external demands.

Emotional Therapy

ADHD treatment does not solely focus on behavior. In fact, a large part of understanding and working toward symptom management is emotional. Commonly, the hyper-arousal of internal systems in individuals with ADHD leaves room for hyper-arousal of self-criticism, shame, and the “it’s my fault” processes that plague otherwise happy individuals.

Emotion Regulation is a major component of the work we do with clients, particularly for those who experience heightened sensitivity toward rejection (Rejection Sensitive Dysphoria). We utilize cognitive and person-centered approaches to hold space for deep emotions while also working to redirect shame cycles into more effective thought patterns that reduce emotional pain.

For example, clients are often quick to mislabel their common ADHD behaviors as “lazy” or “annoying” which may have been a message corroborated by people in their life that didn’t understand ADHD – an experience that undoubtably results in feelings of shame. Through the therapeutic process, we uncover old messages and interpersonal dynamics that contribute to current feelings of shame, hopelessness, and disappointment. Specifically, we work to identify shame-based narratives and old messages about the self that no longer apply along with an increase in symptom awareness (i.e., “what looks like lazy behavior may actually be me adaptively meeting my brains need for stimuli”). Additionally, individuals struggling with impulsivity may find they have large and sometimes explosive emotions which can lead to relational strain and feelings of sadness or remorse. In session, we spend time unpacking the hard emotions surrounding these behaviors to make space for more self-accepting and compassionate understanding which results in the opportunity to change.

Medication

Medication can be incredibly effective for regulating the processes in the brain impacted by ADHD. Specifically, medication can regulate the neurotransmitter norepinephrine (made up of dopamine) to reduce distractibility and hyperactivity/impulsivity and improve focus. Concurrent medication and therapeutic treatment is the gold-standard for addressing symptoms of ADHD.

However, many individuals, especially those newly diagnosed with ADHD, are hesitant to start medication or are unsure of which medication to try. Additionally, individuals already taking medication may sometimes struggle with adequate dosage and managing the unfortunate side effects (decreased appetite, sleep problems, social withdrawal). As a collaborative team, we help our clients get paired up with trusted psychiatrists who can determine if medication is needed and if so, which dose and kind (stimulant or non-stimulant). Our part of the medication journey is to help individuals process their experience and changes in symptoms, explore the decision to take a break from medication (if desired), develop plans for effectively taking medication, manage side effects, and collaborate with psychiatrists to share important information.

Finally, to honor the complex nature of ADHD, the work we do at Restorative Counseling Services is collaborative. We invite family members and support people into sessions to learn alongside the client and offer one-on-one support sessions for family members. We also collaborate professionally with psychiatrists, executive functioning coaches, and primary therapists to create a unified team of professionals that truly understands the client and their needs.