Maybe you recently started seeing a new therapist for your ADHD. Or maybe you’re attending therapy for the first time. Maybe you’re taking a different medication. Or you began working with an ADHD coach.
How do you know if you’re actually getting better? How do you know if the treatment is working?
Many of psychotherapist Terry Matlen’s clients don’t know. This isn’t uncommon. “Adults with ADHD often are poor self-observers,” she said.
According to clinical psychologist Roberto Olivardia, Ph.D, before treatment, clients with ADHD are often incredibly overwhelmed and depressed. They may be struggling with substance abuse. Their self-esteem is sinking. They’re frustrated that they have a hard time accomplishing tasks that are effortless for others, he said.
Some people are so overwhelmed that they just shut down, said Matlen, MSW, ACSW, also an ADHD coach and author of The Queen of Distraction: How Women with ADHD Can Conquer Chaos, Find Focus, and Get More Done.
For instance, a mom with ADHD throws meals together at the last minute, and her house is a complete mess. Even more importantly, internally, she feels like a complete failure, she said.
“During therapy, clients learn to accept themselves [and] understand that their problems are real and have neurological and genetic underpinnings,” Olivardia said.
They learn how to work with their ADHD and adopt new systems to achieve goals and get things done.
“After therapy, clients feel empowered that they can succeed ‘at life,'” said Olivardia, a clinical instructor in the department of psychiatry at Harvard Medical School. “They’re also no longer pummeling themselves with insults. They start to see their ADHD through “a strength-based lens.”
This “includes focusing on what your ADHD brain can do and the ways that ADHD can be assets in your life (assuming the pitfalls are avoided or treated).” These assets might be thinking outside the box and determination to execute your passions, he said.
“After appropriate treatment is initiated, it’s shocking how much change can occur,” Matlen said. There are both internal and external improvements, she said: The mom with ADHD feels a lot less overwhelmed. Her self-esteem increases. She’s able to keep up with household chores. And she enjoys her children more.
Below, Matlen and Olivardia shared other ways you can tell your treatment is working.
The first thing Olivardia looks at is whether his client accepts that they have ADHD and is open to engaging in strategies to work with it. It’s also helpful to ask yourself if you still feel shame or embarrassment about having ADHD, he said.
Your Internal Experience
Matlen is interested in her clients’ internal experiences. Instead of focusing on whether their home or workspace is tidy, she focuses on how they see themselves and how they feel.
“Successful treatment means the individual is comfortable in his skin, is happy in general and is productive, leading a more meaningful life,” she said. It means they’re a lot less anxious and angry, she said.
“The ADHD no longer defines [the person]; it’s simply a part of them that at times, can cause difficulties but it no longer makes life miserable.”
Olivardia also gauges a client’s improvement by whether they’re less distressed or depressed, and whether they feel an increased sense of hope and empowerment.
To explore your internal experience, Matlen suggested asking yourself: “How do I feel now? Am I overwhelmed? Or do I have a handle on things?”
Because of the nature of ADHD, impulsivity can be a serious issue. It can lead to overspending, abusing drugs or alcohol, becoming addicted to pornography or engaging in other self-destructive behaviors, Olivardia said.
Another important question to explore, he said, is whether you’ve eliminated these habits from your life or you’re actively treating them.
Matlen suggested asking someone close to you if they notice any improvements. Do you seem less stressed? Are you less impulsive or distractible? Do you seem more satisfied and less anxious? Are you more present during conversations? Are you speaking compassionately about yourself?
“[L]ook at areas that have been challenging before and see how things have changed,” Matlen said. For instance, are you paying bills on time? Are you leaving the house and getting to work on time? Are your employee reports improving? Can you plan a get-together without feeling super stressed? Are tasks taking less effort? Are you performing them more efficiently?
Olivardia shared this example: A college student with ADHD needs to write a term paper. They’re able to perform the necessary tasks without getting distracted. They select their topic, collect references, write an outline, type up the paper and take breaks. After their breaks, they’re able to easily return to their paper. And they’re able to submit the term paper on time.
Olivardia also suggested asking yourself these questions to gauge improvement: “Do I understand how my ADHD brain works? Do I have tools or strategies that can help me deal with the ADHD symptoms that get in my way?”
In general, according to Matlen, improvement means that ADHD symptoms, such as impulsivity and inattention, slowly start to lift and become easier to manage.
If you’re in the beginning phases of treatment, it’s important to understand that things don’t change overnight, Matlen added. “Problems with managing laundry, bills, work assignments, and the like don’t automatically disappear once treatment is initiated.”
It takes time, hard work and support from others to make meaningful changes, she said. This might mean everything from learning how to use a planner to finding ways to hold yourself accountable for completing tasks, she said.
It’s also important to take care of your physical, emotional, mental and relational health. According to Olivardia, this includes exercising, eating well, getting restful sleep, processing your emotions, nurturing your relationships and connecting to what you love.
Slip-ups will still happen. This is normal. When new stressors arise, your symptoms may worsen, Matlen said. This is especially common for women experiencing hormonal changes, she said.
The key is to talk to your treatment provider or team, because these are issues you can work through, learn from and get back on track.