What Are the Benefits of Therapy for Adolescents with ADHD?
An article recently published in the Journal of Consulting and Clinical Psychology (Sibley, Coxe, Zulauf-McCurdy, & Zhao, 2022) examined the specific components of psychosocial treatment that are the most significant and impactful for reducing ADHD symptoms among adolescents. Researchers found that the most meaningful reductions in ADHD symptoms were related to two main interventions: the development of organization, time management, and planning skills (OTP) and improved parent-teen communication skills. These findings suggest that comprehensive care for adolescents with ADHD should include OTP skills as an essential element, and that a hybrid model of including both parents and teens in treatment may be most effective.
For adolescents with ADHD, the two evidence-based treatment approaches are medication management and psychosocial intervention, or therapy. The research support for therapeutic interventions emerged relatively more recently (Evans et al., 2018, Sibley, Kuriyan, et al., 2014) than the support for medication, and in practice, the use of medication alone remains more common for the treatment of ADHD than behavioral interventions or combination of medication and behavioral interventions (Visser et al., 2016). Per parent report, two-thirds of those diagnosed with ADHD take medication to treat symptoms and less than half receive behavioral intervention (Danielson et al., 2018). There are several reasons that it would be beneficial for families to consider seeking therapeutic support for their teens as a complement to medication management.
Medications for ADHD, especially stimulants, reduce ADHD symptoms at a neurological level as they improve attention abilities and cognitive control (Heal et al., 2009). However, medications do not inherently improve the skills that are typically impaired by ADHD symptoms, including organization, planning/prioritization, task initiation, and time management. Therapy can target the development of these skills through instruction, direct practice, and positive reinforcement. Even if/when medication is discontinued, the benefits of skills training are likely to persist if these habits are consistently practiced and reinforced.
The finding that improved parent-teen communication skills were a mediator of ADHD symptom reduction in a recent study further supports the argument for therapeutic involvement. Many of the challenging symptoms and behaviors associated with ADHD can create strain on family systems and relationships. The development of strategies to improve interpersonal communication and effectiveness can therefore target these areas for improvement. Understandably, it may seem counterintuitive to have parents involved in their teenagers’ therapy, particularly at a time when establishing independence and personal responsibility is an appropriate developmental goal. Treatment sessions would likely only involve parents on an occasional or as-needed basis to support their teens’ efforts and to target family relationships. I frequently tell parents that while their child’s symptoms are not their fault, it is incredibly helpful for them to take an active role in supporting their growth and symptom management.
Finally, there is a high degree of comorbidity between ADHD and other psychiatric symptoms that would likely benefit from therapeutic involvement. More than 40% of individuals with a diagnosis of ADHD also meet criteria for another diagnosis, most commonly oppositional defiant disorder (ODD), a mood disorder, and/or an anxiety disorder (Pliszka, 2015). For adolescents, cognitive behavioral therapy (CBT) is an evidence-based treatment approach for mood and anxiety disorders; this intervention has also shown promise for the treatment of ADHD itself. There is often an interaction between ADHD symptoms and other psychiatric symptoms (e.g., anxiety associated with difficulty focusing and completing tasks, and vice versa), so targeting the emotional component of an individual’s experience is likely to provide more comprehensive and long-term relief.
When I evaluate for and diagnose ADHD, I always recommend therapy as a component of ongoing treatment. As we continue to learn more about effective treatments for ADHD and how they work, it is my hope that more families and medical providers will consider psychosocial intervention as an essential component of managing ADHD in children and adolescents. If you’re interested in learning more about how therapy for ADHD could benefit your family, connect with a member of our team below.
Looking for further consultation regarding your child or teen with ADHD? Get started with Dr. Raines.
References
Danielson, M.L., Bitsko, R.H., Ghandour, R.M., Holbrook, J.R., Kogan, M.D., & Blumberg, S.J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2): 199-212. doi:10.1080/15374416.2017.1417860.
Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 47(2),157–198. https://doi.org/10.1080/15374416.2017.1390757
Heal, D. J., Cheetham, S. C., & Smith, S. L. (2009). The neuropharmacology of ADHD drugs in vivo: Insights on efficacy and safety. Neuropharmacology, 57(7–8), 608–618. https://doi.org/10.1016/j.neuropharm.2009.08.020
Pliszka, Steven R. (2015). Comorbid psychiatric disorders in children with ADHD. In Russell A. Barkley (Ed). Attention-deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.), (pp. 140–168). New York, NY, US: Guilford Press.
Sibley, M. H., Coxe, S. J., Zulauf-McCurdy, C., & Zhao, X. (2022). Mediators of psychosocial treatment for adolescent ADHD. Journal of Consulting and Clinical Psychology, 90(7), 545–558. https://doi.org/10.1037/ccp0000743
Sibley, M. H., Kuriyan, A. B., Evans, S. W., Waxmonsky, J. G., & Smith, B. H. (2014). Pharmacological and psychosocial treatments for adolescents with ADHD: An updated systematic review of the literature. Clinical Psychology Review, 34(3), 218–232. https://doi.org/10.1016/j.cpr.2014.02.001
Visser, S.N., Danielson, M.L., Wolraich, M.L., Fox, M.H., Grosse, S.D., Valle, L.A., … Peacock, G. (2016). Vital signs: National and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2-5 years - United States, 2008-2014. Morbidity and Mortality Weekly Report, 65(17), 443-450.