Cognitive Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach (Practical Clinical Guidebooks)

252 Pages·2007·2.53 MB·English

by  J. Russell Ramsay

Cognitive-Behavioral
Therapy for
Adult ADHD
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Ramsay and Rostain Cognitive Behavioral Therapy
for Adult ADHD: An Integrative
Psychosocial and Medical
Approach
ii
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Cognitive-Behavioral
Therapy for
Adult ADHD
An Integrative Psychosocial and
Medical Approach
J. Russell Ramsay
Anthony L. Rostain
New York London
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Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 2 Park Square
New York, NY 10016 Milton Park, Abingdon
Oxon OX14 4RN
© 2008 by Taylor & Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business
Printed in the United States of America on acid‑free paper
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International Standard Book Number‑13: 978‑0‑415‑95501‑0 (Softcover) 978‑0‑415‑95500‑3 (Hardcover)
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic,
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Library of Congress Cataloging‑in‑Publication Data
Ramsay, J. Russell.
Cognitive behavioral therapy for adult ADHD : an integrative psychosocial and
medical approach / J. Russell Ramsay, Anthony L. Rostain.
p. ; cm. ‑‑ (Practical clinical guidebooks series)
Includes bibliographical references and index.
ISBN‑13: 978‑0‑415‑95500‑3 (hb)
ISBN‑10: 0‑415‑95500‑9 (hb)
ISBN‑13: 978‑0‑415‑95501‑0 (pb)
ISBN‑10: 0‑415‑95501‑7 (pb)
1. Attention‑deficit disorder in adults‑‑Treatment. 2. Cognitive‑behavioral therapy.
I. Rostain, Anthony L. II. Title. III. Series.
[DNLM: 1. Attention Deficit Disorder with Hyperactivity‑‑therapy‑‑Case Reports. 2.
Cognitive Therapy‑‑Case Reports. WM 190 R179c 2007]
RC394.A85R36 2007 616.85’89‑‑dc22 2007001557
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the Routledge Web site at
http://www.routledge.com
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This book is dedicated to the loving memory of my father, J.
Roger Ramsay (1939–1998), and to my beloved daughters,
Abigail and Brynn Ramsay, who collectively inspire me to
strive to do my best in my most valued job: “Dad.”
J.R.R.
I dedicate this book to the loving memory of my mother, Gita
Alfandary (1926–2004), and my stepfather, Sol Lefkowitz
(1927–1991), and to my wonderful kids, Isabelle, Julian, Sam,
and Gen, who have taught me what it really means to be a dad.
A.L.R.
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Contents
Preface xi
Acknowledgments xix
Chapter 1 Adult ADHD: Diagnosis, Symptoms, Etiology,
and Assessment 1
Diagnostic Criteria and Symptoms Across The Life Span 3
Persistence and Prevalence of Adult ADHD 10
Comorbidity and Life Outcomes of Adults with ADHD 12
Etiology 15
Neurobiology 15
Executive Functions 18
Genetics 20
Assessment of Adult ADHD 22
Assessing Symptoms of ADHD 26
Adult ADHD and Comorbidity 32
Summary 37
Chapter 2 Models of Treatment: Cognitive Behavioral
Therapy and Pharmacotherapy for Adult
ADHD 39
Cognitive Behavioral Therapy for Adult ADHD 41
Case Conceptualization 42
CBT for Adult ADHD in Clinical Practice 52
Pharmacotherapy for Adult ADHD 78
Summary 83
vii
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viii Contents
Chapter 3 Research Evidence for Cognitive Behavioral
Therapy (CBT) and Medications for Adult
Attention-Deficit Hyperactivity Disorder
(ADHD) 85
Review of Research Evidence for Psychosocial
Treatments for Adults with ADHD 87
Review of Research Evidence for Pharmacotherapy
for Adults with ADHD 99
Summary 103
Chapter 4 Clinical Case Examples 105
Case Example 1: William 105
Case Example 2: Jack 117
Case Example 3: Lauren 130
Chapter 5 Complicating Factors 145
Readiness for Change 146
Comorbidity 148
Medication‑Related Complications 160
Professionals’ Reactions to ADHD Patients 163
Significant Impairment 165
Social Skills and Relationship Problems 166
Systemic Complications 168
Summary 170
Chapter 6 Maintenance and Follow-Up 173
Maintenance and Follow‑Up: CBT 174
Maintenance and Follow‑Up: Pharmacotherapy 181
Summary 182
Appendix A Informational Resources about Adult
ADHD Online Resources and Organizations
Regarding Adult ADHD 185
Recommended Readings about Adult ADHD: For
Consumers 185
Recommended Readings about Adult ADHD: For
Clinicians 186
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Contents ix
Appendix B Outline of a Typical CBT Session for Adult
ADHD 189
Appendix C Outline of a 20-Session Course of CBT for
Adult ADHD 191
Session 1: Getting Started 191
Session 2: Getting Started (Continued) 191
Sessions 3 through 6: Early Phase 191
Sessions 7 through 15: Middle Phase 192
Sessions 16 through 20: Final Phase 192
Appendix D Typical Medications Prescribed to Treat Adult
ADHD 193
References 197
Index 219
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