Adults with ADHD often deal with more than ADHD alone. They may also have another mental health diagnosis, a learning difference or a health problem, or simply a stressful stretch of life. In a Psychology Today blog post, psychologist Russell Ramsay argues that therapy for adult ADHD has to make room for all of this. This is his professional opinion, not a new study.
The approach he discusses
Ramsay focuses on cognitive behavioral therapy, or CBT. CBT is a talking therapy that works on practical skills and on unhelpful thinking patterns. He calls it a non-drug treatment with research support for adult ADHD. The best-known CBT programs for adults follow a written manual. These manuals usually run about 12 to 14 sessions, each with set goals and skills to practise between sessions.
Why he argues for flexibility
Those manuals were tested in randomized controlled trials, in which participants are assigned by chance to one treatment or another. Ramsay explains that such trials often enrolled people with ADHD alone, without other diagnoses. That choice shows the therapy targets ADHD itself. Real clients, though, often bring other conditions and life events, from caring for an ageing parent to a divorce or a new job. Ramsay says even happy changes, such as marriage or a promotion, can be stressful. He suggests therapists keep the core skills of the manual but adapt how and when they teach them. He calls this "flexible rigor".
The research he points to
Ramsay cites a 2026 meta-analysis by López-Pinar and colleagues in the journal Behaviour Research and Therapy. A meta-analysis pools the results of many earlier studies. As Ramsay describes it, CBT improved overall daily functioning in adults with ADHD, not only symptoms. The clearest gains were at work. Effects on social life, studies and overall quality of life were smaller and less consistent. Ramsay also notes that few clinicians receive formal training in adult ADHD. He points to a 2024 study in which some adults reported poor experiences of CBT, and he links this to therapy delivered too rigidly.
Trade-offs and limits
Tailoring therapy depends on a clinician who understands ADHD, and such clinicians can be hard to find. A personalized approach is also harder to compare across studies than a fixed manual. Ramsay himself says future research could test CBT designed for specific areas of life. The meta-analysis results he cites are group averages, so they do not predict how any one person will respond. This post summarizes one expert's view and a few selected studies. It may not reflect every clinician's practice, and it does not replace advice from a person's own care team.
