ADHD can lead to significant problems with self-esteem, self-confidence and interpersonal relationships. When ADHD is diagnosed, it can cause relief— but also despair, as patients reflect on opportunities they lost because they did not get treated when they were younger (particularly common in age 40 and older). In any case, psychotherapy is critical. There are different types of psychotherapy, and different formats.
If possible, establish a group of patients because they can learn from one another and groups are a cost-effective way to see many patients with similar problems at the same time. You might not have the space to hold group sessions, so it may be necessary to run the group at a local school, for example. A group format is a very efficient way to pass on information and reduce redundancy, and it can free up space in your practice by meeting with many people all at once on an established date.
Bad habits have to be changed, so lifestyle management is critical. The role of the primary care practitioner is to help patients find resources to facilitate lifestyle changes. Considerable evidence points to exercise as a protective factor, so emphasize it. Furthermore, more than 30 percent of patients have sleep disorders that must be managed. Another important change is for patients to simplify their lives by eliminating clutter—the mantra “Let it go” has both psychological and practical significance.
Occupational therapy: Occupational therapists can help patients review basic life skills and create plans for organizing their lives.
ADHD coaching: While there are few trained coaches, they can help patients reach their goals by creating accountability.
Electronic strategies: Reducing clutter and reorganizing information using digital technologies can help patients deal with “paper problems.”
Vocational assessment: This type of intervention can support patients at work and help them obtain workplace accommodations. Some people do not want to disclose to their employer, but it can ensure workplace accommodation.
Community support networks: ADHD support groups can meet the psychological needs of patients and identify strategies that others have found useful. Often, spouses get the most benefit as they develop a better understanding of their partners.
Because ADHD is often accompanied by mood disorders, one-on-one cognitive-behavioural therapy can help patients to reframe negative situations as positive ones. For example, constantly being made to believe that they are bad due to their impulsive behaviour is reframed so that this impulsivity becomes the potential for entrepreneurship and initiative.
People with ADHD have belief systems that are based on a lack of accomplishment and, at times, a cynical worldview, where everyone else is doing well and they are not, despite their potential. By providing encouragement, you help them to develop greater self-control. It is here that primary care practitioners have the greatest influence because the long-term therapeutic alliance is the anchor of stability that the patient seeks.