Psychologists underserve adults with ADHD

Psychologists are underserving adults with attention-deficit/hyperactivity disorder (ADHD), according to a study recently published in the Journal of Attention Disorders. Cognitive behavioral therapy, often facilitated by psychologists, and medication, are the two most effective treatments for ADHD. Insufficient access to cognitive behavioral therapy may be contributing to the widespread undertreatment of ADHD, which is associated with the development of comorbidities such as anxiety and depression, as well as financial, legal and employment problems. 

Nicole Groves, an acting assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and the paper’s lead author, discusses the study in a Q&A. 

Q: Why did you want to pursue this study? 

A: There was a massive boom in ADHD coaching post-COVID, along with a remarkable increase in adults seeking ADHD diagnoses and treatments. Around the same time, medication shortages started that persist today. We suspected that part of why people were turning to coaching is that it’s hard to find a psychologist or a therapist who can do or is willing to do cognitive behavioral therapy for adult ADHD. We wanted to test that out and to see if our anecdotal evidence held up to the information we have available. 

Q: Why is it important for adults with ADHD to have access to cognitive behavioral therapy? 

A: ADHD has a large disease burden. Folks who have ADHD, especially ADHD that goes untreated or undertreated, are more likely to have trouble at work, at home and with romantic partners, kids, friends and family. They’re more likely to have money trouble and legal trouble. ADHD also increases their risk for things like anxiety, depression and other comorbidities.  

In my work with adults who have ADHD, I’ve met some people who have had life-changing improvements when they’ve found out they had ADHD all along and got medication or got good therapy. If we can bridge the gap and connect people with treatment we know works, we’re a lot more likely to help people improve their lives. 

Q: How does access to treatment differ between adults with ADHD and those with anxiety and depression? 

A: We searched the profiles of over 10,000 relevant healthcare professionals. Only 26.4% of those advertised treating adult ADHD. For anxiety and depression, those percentages were 69% and 74%, respectively. Population-prevalence rates are relatively similar across those three conditions, so we would expect or hope people are able to get treatment at similar rates. Our study shows it appears that’s not the case. 

Q: Is there a reluctance among practitioners to treat adult clients with ADHD? 

A: Psychologists may view adult ADHD as a low-priority diagnosis when they choose which clients to take on. For people with ADHD, the core symptoms also make it hard to engage in traditional therapy. Good cognitive behavioral therapy requires doing activities, readings or practices outside of sessions. If you’re already struggling with attention or time management, it is objectively harder to engage in our traditional therapy structure.  

It’s important to highlight that this disparity has multiple dimensions. People of color are more likely to be undertreated and have been historically excluded from ADHD research. People with less financial means or without private insurance may be unable to access care even if they find a psychologist. 

Q: What factors might contribute to psychologists underserving adults with ADHD? 

A: I think a lot of psychologists probably don’t feel adequately trained to treat adult ADHD. We used to think ADHD was a childhood disorder, and so a lot of us didn’t even learn about adult ADHD in our formal training. I hope that is starting to shift in formal training programs. But that still leaves a lot of practicing psychologists who would have to decide to pursue that training. We’re conducting a follow-up study now that asks psychologists about their experiences and decisions about treating these clients. 

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