J. Russell Ramsay on Managing Adult ADHD

Read our interview with J. Russell Ramsay, co-author of The Adult ADHD Toolkit and Cognitive-Behavioral Therapy for Adult ADHD.

What is the biggest challenge facing practitioners who are working with clients with ADHD?
The main problems in conducting treatment with adults with ADHD are the same ones that lead them to seek professional help in the first place. That is, as they will often state to us, in some form or another, “I know exactly what I need to do, but I just can’t get myself to do it.” Thus, the very difficulties individuals with ADHD have turning their intentions into actions in their daily lives will also create challenges with following through on treatment recommendations, both psychosocial and medical treatment.

What is the most important thing practitioners addressing ADHD should know?
The first step is to have a useful therapeutic framework for understanding ADHD. The “A” and the “H” in the acronym A-D-H-D reflect symptoms of the disorder but do not provide a helpful way to “see” the source of the functional difficulties faced by adults with ADHD. Rather, it is useful to understand ADHD as a problem of poor self-regulation. More specifically, ADHD can be characterized as problems with organizing and implementing behaviors across time, toward a desired goal or outcome that an individual knows will provide important benefits to him or her, but for which these motivations and effort must be sustained despite a delay in achieving the final goal. Using this description to explain the condition to a man newly diagnosed with ADHD, he exclaimed, “That’s it! My boss always tells me that if he needs something from me in 10 minutes, I deliver it in 5 minutes; but, if I have 2 weeks to do a project, it takes me a month.”

Thus, using this framework, clinicians can help clients “see” their ADHD unfold in daily life. Consequently, psychosocial interventions can be targeted to important pivot points at which adults with ADHD may commonly having difficulties managing tasks over time. Thus, the well-known and effective coping strategies related to time management, organization, planning, and dealing with procrastination can be personalized to an individual’s specific circumstances.

What is the most prevalent misconception about ADHD?
When I think about all of the opinions that are out there regarding ADHD, I am reminded of a quote by Mark Twain regarding “classic” books, which he said are “books that everyone loves, but no one has read.” The are many misconceptions, but one that comes to mind relevant to the potential benefits of treatment is that ADHD is often viewed as a relatively mild, nuisance condition – “That’s the condition that makes you misplace your cell phone and car keys, right?” There is a range of severity of symptoms of impairments, but when reviewing the research on life outcomes of adults with ADHD as a group, ADHD is one of the most impairing conditions seen in outpatient clinical psychology and clinical psychiatry. In addition to interfering with various and important domains of life, such as education, workplace functioning, and relationships, untreated ADHD can insidiously erode one’s sense of self, self-efficacy, and willingness to take on reasonable endeavors due to a pervasive fear of failure.

Do you have any key tips you can pass on about managing ADHD in daily life?
As was mentioned before, ADHD is a performance problem inasmuch as individuals have difficulties turning intentions into actions. Most people are very familiar with the recommended coping strategies and skills. However, the clinical focus is on the implementation of the strategies in day-to-day life. To this end, we encourage adults with ADHD to “start small” and by using some specific implementation tactics designed specifically for adults with ADHD, clients will start to increase their ability to follow through on their plans and intentions.

Is there anything in particular that you’d like to highlight about the topic or your book?
Our two new books on adult ADHD can be considered companion works. The second edition of our professional treatment manual provides practicing clinicians with a science-based review of the current frameworks for understanding ADHD, a model for a comprehensive diagnostic evaluation, and, most importantly, an evidence-supported, cognitive-behavioral therapy (CBT) model for the psychosocial treatment of adult ADHD that highlights implementation tactics for helping clients to increase their use of effective coping strategies. The Adult ADHD Tool Kit is written for adults with ADHD as a guidebook for using CBT in their daily lives to turn intentions into actions. It can used on its own or while working with a therapist. We also discuss how CBT is compatible with concurrent medication treatment for ADHD.

By J. Russell Ramsay

  • The Adult ADHD Tool Kit

    Using CBT to Facilitate Coping Inside and Out

    By J. Russell Ramsay, Anthony L. Rostain

    A central source of frustration for most adults with ADHD is that they know what they need to do but they have difficulties turning their intentions into actions. These difficulties also interfere with their ability to use self-help books and to get the most out of psychosocial treatments that…

    Paperback – 2014-09-24

  • Cognitive Behavioral Therapy for Adult ADHD

    An Integrative Psychosocial and Medical Approach, 2nd Edition

    By J. Russell Ramsay, Anthony L. Rostain

    Cognitive Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach has been revised, updated, and expanded for this second edition and remains the definitive book for clinicians seeking to treat adults with ADHD. Clinicians will continue to benefit from the presentation…

    Paperback – 2014-09-19

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