Evidence-based treatment manuals for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) are few and far between. Mary Solanto's Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction is an oasis in an evidence-based treatment manual desert. Over the past 10 years or so, treatment guidelines for therapists working with adults diagnosed with ADHD are beginning to emerge. What makes this book and the treatment manual that it contains so unique is that it is based on the treatment administered in past clinical research by Dr. Solanto's group (Solanto, Marks, Mitchell, Wasserstein, & Kofman, 2008; Solanto et al., 2010). Further, this is the first manualized group treatment for ADHD in adulthood. Dr. Solanto's treatment is a cognitive-behavioral therapy that targets the executive functioning deficits regularly compromised in ADHD, particularly time management, planning, and organization. The audience for this book includes clinicians, scientists, and graduate students. As outlined below, this book not just provides a user-friendly treatment manual, but also a section that helps orient readers to the treatment (e.g., rationale of the treatment, empirically-based assessment, and a review of the treatment outcome research), which makes this book an indispensable resource for anyone working with adults diagnosed with ADHD. Given the focus of this book on assessment and treatment, graduate students in particular may find this to be an invaluable addition to their personal library.
The book is divided into two sections: (1) Therapist Guide and (2) Treatment Manual. The first section of this book, the therapist guide, contains six chapters that provide a thorough background and rationale for this treatment. Chapter 1 provides a summary of ADHD diagnostic criteria, typical presentations and ADHD characteristics, medication as a treatment for ADHD, theoretical conceptualizations of deficits in ADHD, and overall principles and components of the treatment program. Diagnostic guidelines for assessing ADHD in adulthood are covered in Chapter 2. This chapter provides a comprehensive yet succinct guide to empirically-based assessment that is informative for anyone new to field. In particular, this chapter provides examples of measures typically administered (including neuropsychological tests) and case examples, including samples of actual assessment reports. A thorough diagnostic conceptualization is important for any patient before starting treatment for ADHD, which makes this chapter particularly stand out as a unique contribution. In Chapter 3, guidelines to successful therapist substance and style are provided. Therapist enthusiasm and structure in particular are important for treating this population that struggles with self-defeating cognitions and regularly feeling in disarray. Other unique components of this treatment are covered in this chapter as well, including the use of mantras (e.g., “getting started is the hardest part”), which serve to encourage patients, cue the use of skills, and aid in establishing cognitive-behavioral techniques as habits. Chapter 4 provides examples of typical patient profiles, which assists therapists in conceptualizing obstacles to treatment quickly and accurately. Case study examples of a variety of presentations are provided, including the “ADHD skeptic” who is in denial of his or her ADHD diagnosis, the oppositional patient, the demoralized patient, and the intellectualizing obsessional patient. ADHD presentations are commonly varied, including but not limited to ADHD subtype, psychiatric comorbidity, and personality styles. This approach to profiling that Solanto and her colleagues address is an important aspect of treatment not commonly acknowledged in the adult ADHD treatment literature. This type of approach allows therapists to tailor treatment to the individual needs of each patient from an organized framework. Practical guidelines for modifying treatment for an individual therapy setting are provided in Chapter 5. Finally, Chapter 6 is a review of the evidence base for cognitive-behavioral therapy for ADHD in adulthood, including a thorough review of research on the treatment outlined in this book.
The second section of this book is the manual for the 12-session treatment program. This session-by-session guide targets three major domains in which adults diagnosed with ADHD commonly struggle: time management, organizing, and planning. In addition, an optional session on getting to bed, getting up, and getting to work on time is provided. Each session includes user-friendly therapist notes, take-home notes for patients, and take-home exercises for patients. To assist therapists with emphasizing the main points of each session, material that is particularly important to convey to patients is presented in bold and italics. The general structure of each session is outlined as well (i.e., review of take-home exercises [60 min], presentation of new material and in-session exercises [45 min], and presentation and discussion of the next take-home exercise [15 min]). Forms that can be photocopied and provided to patients are also included in this section of the book. This treatment is quite comprehensive and, in comparison to adult ADHD treatment manuals used in other treatment outcome research (Safren, Perlman, Sprich, & Otto, 2005), this treatment offers a unique focus on the use of self-reinforcement, explicit exercises to assess and improve time management difficulties, and flexible guidelines to apply this treatment in a group or individual therapy setting. The use of mantras to reify main points of the treatment is also unique. Given that treatment for adults diagnosed with ADHD is so cumulative and requires persistence—an area this population commonly struggles with—the encouragement provided by these mantras and the economy of speech they provide is key.
I found this book and its evidence-based treatment manual to be a user-friendly, yet detailed “how to” resource that also incorporates theory on executive functioning. This book should belong to anybody interested in working with adults diagnosed with ADHD. Adults diagnosed with ADHD often struggle is various aspects of their lives and need to find ways to cope with their presenting concerns. This book provides clear, practical, and accessible guidelines to assist such patients. In a field that is in its early stages of development, this book sets a benchmark for manualized adult ADHD treatments and will serve to ensure the continued growth of evidence-based approaches to treating ADHD in adulthood.