Neurobehavioral Management of ADHD: what to look for in therapists and e-Health apps

What should neurodivergent individuals and their families keep in mind when looking for a therapist or using any kind of productivity or e-health app?

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Everything has to have been reviewed and adapted by a neuropsychologist or neuroscientist who has been trained to understand neurodivergence.

Cognitive-behavioral therapy –or CBT– applied in its regular form may exacerbate some of the problems neurodivergents often experience. A one sized fits all approach doesn’t work different brains require different therapeutic approaches.

Neurodiversity informed professionals and e-Health apps also make sure their objectives and those of the people they try to help are matching so that they both can progress in the same direction.

This is a fact as widely recognized as the feedback that neurodivergents themselves have long provided about therapists: general procedures and protocols sometimes become a nightmare rather than a source of healthcare especially when they chase a goal that has nothing to do with what the person wishes at that time. 

Take CBT, one of the most successful therapies in terms of proven efficacy: certain neurodiverse individuals are extremely rigid and obsessive, features that make them especially vulnerable to developing secondary effects derived from certain CBT techniques that may be hermetic or exhaustive. This is a common trigger example well known by neuropsychologists (e.g. increases the chances of burnout in individuals with ADHD, makes individuals with Autism Spectrum Disorders develop rigid non-functional rituals, etc…).

In summary, the management of Attention Deficit Hyperactivity Disorder should always be neurobehavioral and should be carried out by neuroprofessionals.

What are the benefits of neurobehavioral management?

Not every difficulty that requires a psychologist has to do with behavior or thoughts, sometimes the person needs help on the cognitive processing side.

Cognition is what psychologists call the result of information processing. Cognition is looking at the sky and knowing that it will rain soon. But knowing that it will rain soon is the result of various cognitive processes. For instance, the person has to use their perceptive skills along with their previous experience to identify what the color of the sky means.

This is where neuropsychologists and e-health apps can come in: whenever a person has a problem with certain cognitive processes, they can adapt therapeutic approaches to the brain and even fuse them with certain cognitive stimulation techniques. From boosting hot executive functions to promoting self-regulation to tracking habits to generate insight about constancy, stimulating self-care novel strategy ideation, learning how to care for the attentional state and preserve it, compensating executive function difficulties, and... improving self-autonomy.

This last point is especially important for people who use e-Health apps and are not seeing a therapist or have never seen one at all: although they are getting by without a professional by their side, at least they have the support of clinicians in the form of an e-Health app.

Side note: these apps are also useful to therapists as patients can use them to track progress and report back to them.

Sometimes we are able to completely overcome our difficulties once we implement strategies, but not always. However, almost everyone can find strategies that help them make it through the day even despite their persisting difficulties: this is called compensation.

This is why e-Health apps can be beneficial for many: daily compensation tactics are paired with a good dose of training self-autonomy –which, in turn, improves the subjective notion of self-efficacy we might have about ourselves. The result is that we will do more of the right things more often and be better at assessing when we are capable of achieving our goals.

But there is one key component of the neurobehavioral management of ADHD: metacognitive training. Conditioning cognition or training it behaviorally only gets you too far...

Metacognition is the ability humans have to think they are thinking. In fact, the way we think about how we think or are able to think is key to regulating our cognitive processing.

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Yes, the beliefs about our own cognitive style dramatically impact our cognitive performance. If someone thinks "I will not remember because my memory is awful", chances are they won't remember.

Metacognition impacts every domain: memory, attention, processing speed, perception, visuospatial skills, and language... If we want to change the way our brain works, we also need to think about it with the support of someone who knows how it works, not only with exercises and therapy techniques –and yes, e-Health apps can help with this too–.

Final note: if you experience any kind of difficulty, it is always important enough to seek help from a professional and not just rely solely on e-health apps. Even if you don’t get a formal diagnosis, if you’re experiencing problems that affect the quality of your life, talking to a professional almost always helps.