ACT and ADHD
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I wonder what is the experience of ACT with (adult) ADHD clients. They experience a notorious difficulty in focusing the attention on anything, including inner 'objects', therefore the mindfullness-based approaches should be quite difficult (not to mention other challenges, such as following a structured program, as requested by homeworks or by self-help books).
Is it any solid evidence that the mindfulness-based exercises would help increasing the concentration capacity of the attention deficient subjects?
In any case, I see here also a great opportunity for the field of ACT/RFT, 'attention' being at the crossroads of behavioral, cognitive and more subjective psychological functions.
Nick
ACT, CBT, and Adult ADHD
Adult ADHD is my area of both research and clinical interest and I have been contemplating how to apply ACT strategies in concert with the concrete, behavioral self-management strategies that are the staple of emerging CBT approaches. Some patients seem to exhibit barriers to skill/strategy use that relate to non-acceptance of the disorder and its consequeces. In addition, experiential aviodance is sometimes VERY severe in these patients, perhaps because of the ease of shifting attention away from negative internal experiences and/or because of a lowered frustration/boredom threshold inherent in the disorder. Experiential avoidace also frequently takes the form of short-term sensation-seeking/distraction.
I wonder whether ACT based on a chronic medical condition (e.g., chronic pain) might be a useful model for use of ACT with ADHD?
ADHD Adults and ACT
I have worked in the treatment of ADHD in adults for approximately 10 years and have been trying to apply some ACT techniques over the past year. First, concerning the evidence for ADHD in adulthood it is both broad and quite compelling. From brain scans studies to studies of genetic transmission (where estimations are upward of a 90% inheritability) to a broad collection of double blind placebo-controlled drug studies, there is a great deal of evidence to justify the existence of diagnostic category. Certainly there are substantial problems including the fact that the DSM diagnostic symptoms are biased toward children rather than adults and toward males more then females.
While I have certainly found mindfulness techniques to be of use with my ADHD clients, like most other aspects of counseling it tends to be substantially more effective following initiation of medication. To my knowledge there are not any published studies providing evidence of the effectiveness of meditation on symptoms of ADHD. My clinical experience does suggest it is of benefit in providing improved perspective on mind chatter that tends to occur with a vengeance in individuals with ADHD. Still, I have had very limited success helping clients achieve a consistent practice when they are unmedicated.
Also very interesting from an ACT perspective is the whole issue of self control as it pertains to ADHD. A very typical early childhood experience is one of receiving a great deal of aversive feedback about being too emotional, too active, too needy, and generally being out of control. While often described as a deficiency in self-regulation, ADHD also seems to intensify the average experience around emotional self-control. I suspect that part of the reason that approximately 75% of ADHD adults have some type of comorbid psychological disorder relates to this early experience.
Adult ADHD?
I wonder what the evidence is for adult ADHD. I know that the diagnosis of ADHD for children and adolescents tells us nothing about what the core difficulty (disorder) is with this very broad group. I imagine that this problem is even more confounded with adults. The very few adults I have seen who told me they had, or thought they had, adult ADHD certainly failed to meet the DSM-IV criteria for the disorder (for what that is worth), and their difficulties could be explained in much more parsimonious terms.
ACT and Adult ADHD
My specialty is adult ADHD, and I have been working on incorporating ACT techniques into the structured, skills-based approach that I normally use. What I am finding is that helping adults with ADHD accept their strengths and weaknesses seems to help them be able to live their lives more in line with their ADHD rather than fighting it. For instance, a few of my clients have decided to make career changes so that they don't have to sit at a desk anymore or spend lots of time managing other people or organizing things. I have found most of my clients with ADHD to be very open to the ACT philosophy and quite liberated by it. I'd love to hear from anyone else who has been using with this population.
Tanya M. Morrel, Ph.D.
Licensed Psychologist
Specializing in Adult ADHD
The Charleswood Building
8422 Bellona Lane, Suite 205
Ruxton, Maryland 21204
(410) 583-0011
drmorrel@acceptandcommit.com
www.acceptandcommit.com
YES! ADULT ADHD.
The ADHD is a very frequent problem, with few researches in the cognitive psychotherapy area though. Generally, when a therapist treats a child, he will have to deal with a disorder with characteristics of Axis I mainly. When the diagnosis is established in adulthood, such characteristics will have already been crystallized, tending to lead the therapist to treat beliefs and behaviors the same way he would treat disorders of Axis II.
As the child moves from adolescence to adulthood, the predominant symptoms of ADHD tend to shift from external, visible ones (such as physical hyperactivity) to internal symptoms. There seems to be a decrease in observable symptoms of ADHD with age. Although a given adult may not meet the full DSM-IV criteria for full ADHD any longer, he or she may still experience significant impairment in certain aspects of life. Depending of professional or domestic situation, the adult may need to deal with more complex, abstract issues. A given individual’s perception of his or her degree of impairment may vary. ADHD affects thirty to fifty percent of adults who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention to early development, and symptoms of inattention, distractibility, impulsivity and emotional lability. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse. Despite the fact approaches should be different in each age range, one of the most important difficulties faced by the therapist is related to the patient’s non-cooperation.