The Role of Medication in Psychotherapy for ADHD

“I want to learn how to cope without relying on medication.” It’s a common sentiment shared with me by many of my clients with ADHD. Parents of the children and teens with ADHD who I work with share similar thoughts as well: “Can’t you just teach them some skills and strategies?” Indeed, as a psychotherapist, my work with clients with ADHD is all about skills, strategies, and behavioural coping approaches to managing the disorder. In fact, as a Registered Psychotherapist in Ontario I am not even able to prescribe medication. So why do I usually encourage my clients to look into medication options for ADHD? Is medication necessary for people with ADHD? And what are the alternatives to medication for ADHD? Read on to find out more.   

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Medication Fears

For many people, medication is viewed in a bad light and seen as something to avoid. People may consider medication to be risky and full of potential negative side effects. For others, medication is viewed as a crutch - an artificial tool that helps people ‘cheat the system’ or at the very least, something that prevents them from learning how to cope on their own. When it comes to ADHD, these concerns are amplified by a general perception that ADHD medications are overprescribed (Moreira-Maia et al., 2018). Many clients tell me that they don’t want to just take a pill to solve their problems. While the specific reasoning for hesitation may vary, reluctance toward pharmacological treatment for ADHD is common. 

Natural Methods for Coping with ADHD 

Given the concerns around medication clients frequently tell me that they would prefer to try natural approaches to treating ADHD, such as lifestyle changes or learning specific skills. For example, clients want to try eating better, getting more sleep, meditating, exercising more frequently, and engaging in other positive, well-established health habits. Or clients may hope that they or their children can learn new skills and strategies to help them focus, organize themselves, manage time better, and navigate other ADHD-related challenges. These are excellent goals. Indeed, there is good research documenting the effectiveness of such activities in ADHD management (Björk et al., 2020). There is just one problem: ADHD. 

How ADHD Interferes with ADHD Management

While lifestyle changes and behavioral strategies have great potential, the very characteristics of ADHD make it exceptionally difficult to implement them. ADHD is characterized by executive-function deficits (Panah et al., 2022), affecting essential capacities like planning, working memory, problem-solving, attention control, motivation, and time management (Cristofori et al., 2019; Panah et al., 2022). In other words, the very skills required for behavioral change are often impaired in people with ADHD. As Ramsay (2020) puts it, individuals with ADHD struggle not with knowing what to do but with turning their intentions into actions. Exercise, for instance, can be highly beneficial for ADHD (Hoza et al., 2016) – but only if individuals can reliably engage in it. The same goes for almost any other lifestyle change, helpful skill, or new behavioural routine to improve ADHD symptoms. It’s a great idea, but people with ADHD don’t struggle with ideas - they struggle with implementation. 

People with ADHD don’t struggle with ideas - they struggle with implementation. 

Making Great Ideas Work

Given these challenges, medication can play a crucial role in ADHD treatment. Research shows that ADHD medication can improve executive functioning, including attention, working memory, and impulse control (Froehlich et al., 2018). By enhancing these capacities, medication can help individuals engage more effectively in behavioural treatment and skill development. Studies have demonstrated that combining medication with skills-focused psychotherapy yields better outcomes than psychotherapy alone (Cherkasova et al., 2020). Medication may be a primer for effective behavioural treatment for ADHD.

The Limits of Medication 

Medication can be tremendously helpful for people with ADHD and for many people, it has an essential role to play in ADHD management. However, it remains important to understand the limits of medication. While medication may help improve capacities such as focus and motivation, medication tends to work best in tandem with specific skills and strategies (Ramsay, 2020). Medication without skills development is a bit like getting a car without learning how to drive it; you have the potential to go so much further than before but only if you can figure out how to navigate the thing. I’ve had clients with ADHD tell me that they tried medication and found that they could indeed focus more, but that they felt they were now just focusing more on things that weren’t really that important to them. Increased capacities do not automatically translate into improved outcomes, and as a common ADHD refrain goes: pills don’t teach skills. Even with effective medication, it remains essential to learn specific skills and strategies for managing ADHD (Ramsay, 2020).

Increased capacities do not automatically translate into improved outcomes - it remains essential to learn specific skills and strategies for managing ADHD.

ADHD Care Beyond Medication 

Comprehensive ADHD care often requires combined medication and behavioural work to help individuals with ADHD see maximal improvement in their lives (Ramsay, 2020). With medication in place, people with ADHD may be in a much better position to be able to benefit from the many excellent non-pharmacological treatment options for ADHD. These options include health habits such as improving sleep, eating, and exercise habits, the development of new routines and rituals, and specific skills to address core facets of the disorder. Time management, attention training, prioritization, emotion regulation, organization, and self-regulation are all essential areas of skills training that people with ADHD can significantly benefit from. Medication may be the key that enables people with ADHD to benefit from these treatment options - but effective ADHD care needs to go beyond medication and help people engage in new, more adaptive behavioural patterns to produce long-lasting and wide-ranging benefits.

When Medication is Not an Option

Despite its benefits, medication is not always viable. Some individuals experience side effects that make it intolerable (Schien et al., 2023), while others have medical conditions that contraindicate certain ADHD medications (Zhang et al., 2024). Additionally, some individuals are uncomfortable with the idea of taking medication or prefer to explore other options first. In these cases, is ADHD treatment doomed? Absolutely not. Not all of my clients take medication and it is indeed possible to survive and thrive with ADHD without ADHD medication. There are many effective evidence-based treatments for ADHD, from CBT for ADHD to mindfulness for adult ADHD, and beyond (Fullen et al., 2020). There are absolutely treatment options for ADHD beyond medication. Given that ADHD medication can be very helpful for many people, when it is a potential option, medically recommended, and clients are willing to try it, I do encourage my clients to speak to their doctors regarding this potential option that may make their lives easier, and improve their ability to readily develop behavioural strategies for managing ADHD.

Psychotherapy outcomes may be improved for those simultaneously taking ADHD medication (Cherkasova et al., 2020). Yet, it doesn’t mean that psychotherapy or skills training alone is not helpful. In a study evaluating a cognitive-behavioral therapy intervention for ADHD, Cherkasova et al., (2020) assessed the outcomes for two groups of people: one group receiving psychotherapy combined with medication, and the other group receiving psychotherapy only. The group receiving the combined intervention experienced better outcomes on assessments of the immediate and short-term effects of the intervention. However, the group receiving psychotherapy alone did also eventually see significant improvement in symptoms over the long-term. This study highlights how medication can play a beneficial role - perhaps by facilitating improved outcomes more quickly - but how even without medication, individuals with ADHD can benefit from behavioural interventions (Cherkasova et al., 2020). If medication is an option recommended by your physician, it is worth considering taking advantage of it. If it’s not an option, take advantage of the many other evidence-based non-pharmacological treatment options for ADHD. Even when medication is helpful, it is not the be-all and end-all in ADHD treatment and skills training, therapy, and lifestyle changes can and should be an essential aspect of any ADHD treatment plan. 

Skills training, therapy, and lifestyle changes can and should be an essential aspect of any ADHD treatment plan. 

Alternative Treatments for ADHD

This article focuses primarily on medication and behavioural interventions for ADHD. However, I do sometimes get asked about alternative treatments for ADHD, such as supplementation with fish oil or specific dietary changes or other approaches to ADHD treatment. As in the case of medication, dietary or supplement recommendations are outside the scope of my practice as a psychotherapist. Individuals interested in dietary or alternative approaches in ADHD treatment are encouraged to speak to their physicians for specific guidance. For recent literature reviews on the subject discussing the current state of the evidence base on this subject readers may wish to review Granero et al., (2021), Pinto et al., (2022), and Lange et al., (2023). Consultation with your physician should guide your utilization of specific ADHD treatments including supplements or dietary changes. 

Benefiting from a Combined Approach to ADHD Treatment

As a Registered Psychotherapist, I am unable to prescribe medication for my clients. So why did I write this article? My role is to provide psychotherapy and behavioral interventions for ADHD, helping clients develop skills and strategies to improve their daily functioning. Approaches such as cognitive-behavioral therapy (CBT) and mindfulness have been highly beneficial for many of my clients, regardless of whether they take medication. That said, when medication is a viable option, it can significantly enhance a person’s ability to implement these skills and strategies. Research shows that ADHD medication can reduce symptom severity (Ramsay, 2020), allowing individuals to engage more effectively in therapy. Since ADHD symptoms can interfere with the therapy process itself (Janssen et al., 2020), any physician-recommended intervention that reduces these symptoms can be valuable.

There can definitely be valid reasons for not trying ADHD medication and not everyone will have positive experiences with medication. Sometimes people tell me that they or their children feel different and not like themselves with ADHD medication. Side effects may at times not seem worth the potential benefits of medication. This article is not meant to convey the idea that ADHD medication is an absolute requirement for everyone with ADHD. Instead, the goal of this article is to highlight that - in discussion with your physician regarding your personal circumstances - given the potential benefits of medication, it can be valuable to consider its role in your ADHD management before preemptively dismissing this avenue of treatment as many do.

If you or a loved one has ADHD, exploring the risks and benefits of medication with a qualified physician is essential. While medication can make life easier and improve responsiveness to therapy, it is not a substitute for skill-building. Pills don’t teach skills. Medication may improve focus and attention, but lasting functional improvements often come from behavioural changes, strategies, and new coping mechanisms (Ramsay, 2020).

If you are interested in the potential benefits of ADHD medication, consult your physician or your child’s pediatrician to determine if it is the right treatment option. For those seeking non-pharmacological ADHD treatment—whether as a standalone approach or alongside medication—our team at Radcliffe Psychotherapy Clinic can help. We offer therapy for ADHD, including skills training, CBT, mindfulness, and support for ADHD-related challenges in adults, teens, and children.

Contact Radcliffe Psychotherapy Clinic at (289) 801-4133, admin@angerandanxiety.com, or book a consultation at https://sra.janeapp.com/. To see a full list of our Toronto and Ontario based-therapists who specialize in ADHD therapy, visit our Toronto ADHD therapy page.

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Medical Disclaimer

This article is written by a Registered Psychotherapist with experience in ADHD treatment for children, teens, and adults. Registered Psychotherapists in Ontario provide psychotherapy and skills training but do not prescribe medication or possess qualifications to provide psychopharmacological recommendations. The information provided is based on current research and clinical experience but is for informational purposes only. Readers should consult a qualified medical professional, such as a physician or psychiatrist, for specific guidance regarding medication and ADHD treatment. The information in this article should not be interpreted as medical advice, diagnosis, or treatment. Decisions regarding ADHD treatment, including medication, should always be made in consultation with a qualified healthcare provider. For individualized mental health support, consult a registered mental health professional.

References

Björk, A., Rönngren, Y., Wall, E., Vinberg, S., Hellzen, O., & Olofsson, N. (2020). A nurse-led lifestyle intervention for adult persons with attention-deficit/hyperactivity disorder (ADHD) in Sweden. Nordic Journal of Psychiatry, 74(8), 602-612.

Cristofori, I., Cohen-Zimerman, S., & Grafman, J. (2019). Executive functions. Handbook of clinical neurology, 163, 197-219.

Froehlich, T. E., Fogler, J., Barbaresi, W. J., Elsayed, N. A., Evans, S. W., & Chan, E. (2018). Using ADHD medications to treat coexisting ADHD and reading disorders: a systematic review. Clinical Pharmacology & Therapeutics, 104(4), 619-637.

Fullen, T., Jones, S. L., Emerson, L. M., & Adamou, M. (2020). Psychological treatments in adult ADHD: a systematic review. Journal of Psychopathology and Behavioral Assessment, 42(3), 500-518.

Granero, R., Pardo-Garrido, A., Carpio-Toro, I. L., Ramírez-Coronel, A. A., Martínez-Suárez, P. C., & Reivan-Ortiz, G. G. (2021). The role of iron and zinc in the treatment of adhd among children and adolescents: A systematic review of randomized clinical trials. Nutrients, 13(11), 4059.

Hoza, B., Martin, C. P., Pirog, A., & Shoulberg, E. K. (2016). Using physical activity to manage ADHD symptoms: the state of the evidence. Current psychiatry reports, 18, 1-7.

Janssen, L., de Vries, A. M., Hepark, S., & Speckens, A. E. (2020). The feasibility, effectiveness, and process of change of mindfulness-based cognitive therapy for adults with ADHD: A mixed-method pilot study. Journal of Attention Disorders, 24(6), 928-942.

Lange, K. W., Lange, K. M., Nakamura, Y., & Reissmann, A. (2023). Nutrition in the management of ADHD: A review of recent research. Current Nutrition Reports, 12(3), 383-394.

Moreira-Maia, C. R., Massuti, R., Tessari, L., Campani, F., Akutagava-Martins, G. C., Cortese, S., & Rohde, L. A. (2018). Are ADHD medications under or over prescribed worldwide?: protocol for a systematic review and meta-analysis. Medicine, 97(24), e10923.

Panah, M. T., Taremian, F., Dolatshahi, B., Seddigh, S. H., Raeisian, F. S., & Panah, E. (2022). A comparison of Barkley’s behavioral inhibition model (1997) with Barkley’s updated executive functioning model in predicting adult ADHD symptoms: A preliminary report using structural equation modeling. Applied Neuropsychology: Adult, 1-13.

Pinto, S., Correia-de-Sá, T., Sampaio-Maia, B., Vasconcelos, C., Moreira, P., & Ferreira-Gomes, J. (2022). Eating patterns and dietary interventions in ADHD: a narrative review. Nutrients, 14(20), 4332.

Ramsay, J. R. (2020). Rethinking adult ADHD: Helping clients turn intentions into actions. American Psychological Association.

Schein, J., Cloutier, M., Gauthier-Loiselle, M., Bungay, R., Guerin, A., & Childress, A. (2023). Symptoms associated with ADHD/treatment-related adverse side effects and their impact on quality of life and work productivity in adults with ADHD. Current Medical Research and Opinion, 39(1), 149-159.

Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., & Chang, Z. (2024). Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA psychiatry, 81(2), 178-187.