Complete Treatment of Adult ADD

Complete Treatment of Adult ADD

Look around at the people with whom you work, hang out with, or join on the freeway. About 1 in 20 of those people suffer from attention-deficit disorder. Making careless mistakes, having difficulty sustaining attention, and being easily distracted are three symptoms that can be dangerous on the freeway. As long ago as 1949, Tillman and Hobbes(1) coined the phrase “a man drives as he lives.” Inattention and distractibility, which are directly related to risky driving behavior, are cognitive factors that have been found to account for one fourth of motor vehicle collisions (MVC).(2) Evidence suggests that people with ADD are more likely to have MVC’s than other drivers. Stimulant medication has proved to be effective at improving driving performance in individuals with ADD. Stop reading and move on. You know all you need to know. Boloney! My experience has taught me that once we give this ADD/ADHD diagnosis and talk about the options for treatment, people tune out the behavioral side of treatment. The fact is that medication doesn’t teach us a darn thing about how to drive, organize our work, or manage distractibility.


Research has provided compelling evidence that we have failed to carry out effective cognitive behavioral treatment for ADD because we’ve done such a good job of selling the use of medication. Erroneous conclusions from early studies comparing medication with cognitive behavioral treatment caused treatment providers to focus on medication. There is no question that medication can help relieve symptoms, however even in adults who respond to medication only 50 percent or fewer of the core symptoms of ADD are reduced. This rate is worse than the rates found in children.

Medication does not provide sufferers with strategies and skills that address functional impairment. Therefore, unemployment, underemployment, underachievement, relationship development and maintenance associated with ADD continue into adult life. Cognitive behavior therapy for adult (and child) ADD can provide long-term improvement in residual symptoms in individuals receiving medication.

I tell newly diagnosed ADD/ADHD clients there are four parts to the strategy of dealing with this diagnosis: 1. Talk with your physician or one of our psychiatric providers about medication; 2. Receive cognitive behavior therapy for symptom management and control; 3. Make changes in the environment (accommodations) of work, school, and home that improve performance and enhance relationships; and, 4. Do training with Cogmed to improve working memory capacity.

Obviously, if we focus on medication, the client will likely improve, but remember medication has never taught anybody anything. It can float the boat, but you have to do the rowing to go anywhere. There are three additional pieces to the treatment puzzle. These parts have demonstrated efficacy and lead to long-term improvements in the quality of life of the ADD/ADHD person and their families.

David L. Barnhart, Ed.D.

Licensed Counselor

Certified Clinical Mental Health Counselor



(1) Tillman WA, Hobbs GE. The accident-prone automobile driver. The American Journal of  Psychiatry.1949;106:321–331. [PubMed]
(2) Treat JR, McDonald NS, Shinar D, Hume RD, Mayer RE, Stansifer RL, et al. Tri-Level Study of the Causes of Traffic Accidents, Vol. I: Causal Factor Tabulations and Assessment. Washington D.C.: U.S. Department of Transportation; 1977. (Publication Number DOT-HS-805-085)