What is ADHD CBT?
CBT stands for ‘Cognitive Behavioural Therapy’ and it is a type of talking therapy. Adult ADHD CBT is very different to the typical Anxiety CBT – a common treatment offered by the NHS which normally focuses on mild anxiety or depression.
ADHD CBT is a behavioural course of counselling that specifically deals with symptoms and executive function difficulties which people with ADHD struggle with. For example, inattention and its impact on daily tasks. Ideally, the therapist has experience and is aware of adult ADHD. From our experience of meeting people at our ADHD support groups, many people have found ADHD CBT to be very helpful and much more effective than just medication on its own (but may have previously been discouraged by CBT that was not designed for someone with neurodiversity, so it is important to stress that you receive appropriate care with your health practitioners). ADHD CBT is available through the NHS and is typically 10 – 14 sessions rather than the 6 that are provided for standard Anxiety CBT.
How to access ADHD CBT on the NHS
It is helpful that the NICE Guideline for NHS England recommends for ADHD alternative treatments to medication, such as ADHD CBT, to be available. However, the reality of the situation is that very few areas provide any service. Some areas may not provide CBT, but may have an ADHD nurse or ADHD coach that provides a similar service. A good place to find out about services in your area is to go to a local peer support group.
If you think you would benefit from ADHD CBT, we encourage you to request it. If the service is not available in your area, you can request an ‘out of area referral' to the National ADHD Clinic at the Maudsley Hospital, London. An ‘out of area’ referral is a special referral that causes your local NHS to have a funding meeting that determines, on a case-by-case basis, whether a service for that patient will be funded. From our experience with peer support groups, most ‘out of area’ referrals are successful, or the local NHS makes special arrangements locally to provide that service to that patient.
If you are also taking medication, and your request is challenged on these grounds, it can be helpful to demonstrate that you are still impaired in an aspect of functioning and state that ADHD CBT will address this; the NICE Guidelines state that for ADHD alternative treatments to medication must be provided.
Requesting ADHD CBT is not only very effective in terms of improving symptoms, but requesting the service also sends a message to the NHS that there is a demand for this service. For many people, when they have ADHD CBT, it is the first time they have spoken to any therapist who understands and acknowledges ADHD; for many people, this can be life-changing.
How to request an ‘out of area’ referral
If you are already diagnosed with ADHD, the place to start is to request ADHD CBT with your GP or psychiatrist. It might be that you are referred to the community mental health team and they may offer you a course of standard Anxiety / Depression CBT. Although anxiety and depression can co-occur with ADHD, often it is unmanaged ADHD symptoms that are the cause for the anxiety and/or depression symptoms. Therefore, the most effective treatment would be to actually treat the cause – the ADHD symptoms. Many people have reported feeling worse after having CBT that did not focus on ADHD, or a therapist who did not have any understanding of ADHD. Therefore we would recommend that you refuse any inappropriate and non-tailored treatment and make it clear that you would like ADHD-specific CBT.
After making this request, you may be refused treatment because a service for ADHD CBT is not available in your area. At this stage, once you have been refused treatment, go back to your GP or psychiatrist and request an ‘out of area’ referral to the Maudsley Clinic. If your request is not taken seriously, you can ask to see a different GP, or you can request the reasons for your rejection in writing with your GP and work to contradict these reasons. See below for the Maudsley Clinic details and quotes from the NICE guidelines that you can copy and print out.
ADHD and ASD Psychology Service
Monks Orchard House
Bethlem Royal Hospital
Monks Orchard Road
Beckenham BR3 3BX
Tel: 020 3228 6171
Fax: 020 3228 3434
Consider non-pharmacological treatment in combination with medication for adults with ADHD who have benefited from medication but whose symptoms are still causing a significant impairment in at least one domain.
When non-pharmacological treatment is indicated for adults with ADHD, offer the following as a minimum:
- a structured supportive psychological intervention focused on ADHD
- regular follow‑up either in person or by phone.
- Treatment may involve elements of or a full course of CBT. 
Consider non-pharmacological treatment for adults with ADHD who have:
- made an informed choice not to have medication
- difficulty adhering to medication
- found medication to be ineffective or cannot tolerate it. 
Finding a private ADHD CBT therapist or psychologist
As therapist and psychologist service provision is not widely available on the NHS, another option is to pay for this privately. The cost of this typically ranges from £40 – £60 per an hour (although you can pay significantly more up front for an ADHD assessment, which may be a pre-requisite for some psychiatrists to treat you). If you are currently working and ADHD is affecting your employment, you may be able to apply for funding through the ‘coping strategy training’ with the governments’ Access to Work scheme.
Some good places for looking for private a private practitioner are to use practitioners accredited by recognised professional bodies, such as the British Association for Behavioural & Cognitive Psychotherapies. Another good resource is the website AADDUK that has a page for psychologists.
As described, it can be difficult to find a therapist who has experience of adults with ADHD, so if you are seeing a therapist with little or no previous knowledge of ADHD, an excellent resource to refer them to is Susan Young and Jessica Bramham’s book ‘ADHD in Adults: A Psychological Guide to Practice’. Here, they can learn more about CBT programs that are most effective for their adult clients with ADHD.
ADHD CBT in the Brighton & Hove Area
As part of the local autism strategy, the Brighton and Hove NHS Clinical Commissioning Group (CCG) increased their funding to provide group-based ADHD CBT. This service is provided at the Neurodevelopmental Service, and has to be requested when you see psychiatrists at the clinic. Unfortunately, this service is only available for the Brighton and Hove CCG area (Portslade to Peacehaven) and there is a long waiting list (their website indicated two years as of November 2021 when we last updated this information). However, members from the Support Group have said it is well worth the wait. In special cases, when group therapy has not been helpful or appropriate, they have also provided one-to-one CBT.
References & further reading
NICE guideline quotes sourced from:
Attention Deficit Hyperactivity Disorder: Diagnosis and Management. NICE Guidelines 87. March 2018. https://www.nice.org.uk/guidance/ng87/
Cognitive-Behavioural Therapy for ADHD in Adolescents and Adults: A Psychological Guide to Practice, 2nd Edition. Susan Young Jessica Bramham