Though I didn’t set out to become an expert in ADHD, by default, I have ended up working with ADHD fairly often in my practice. This is because ADHD causes relationship challenges when it is unmanaged or when the partner of someone with ADHD doesn’t understand it. In the end, it is fairly simple, and as you probably know, very difficult nevertheless. I’m a licensed psychologist in California, with a Ph.D. in clinical psychology, and these are the six practical elements I use to help my clients manage their ADHD: Sleep, Diet, Exercise, Medications, Therapy, and Mindfulness.

I usually say most people need a minimum of three of these well-dialed in to manage their ADHD, but honestly, my experience says that it is just an upward benefit slope. The more of these you use, the better managed your ADHD will be. Let’s review each one.

How Does Diet Help Manage ADHD Symptoms?

Section TL/DR: Your brain needs the right food to ADHD less, but only the right amounts. I can help you manage this.

Eating well can maximize your cognitive capacity. What does that have to do specifically with ADHD? Well, for one thing, being low on blood sugar can be bad for your ADHD symptoms (even though I know you can kind of thrive in a hyper-focus black hole without eating for many hours). This is because your dorsolateral prefrontal cortex (the brain area that directs attention) thrives on glucose, so if your blood sugar is low, you’ll have difficulty directing your attention where it needs to go or keeping it where it needs to be.

That may not be a problem as long as you’re hyper-focused on the right thing, but heaven help you once you realize how hungry you are and then realize the snack you bought two weeks ago is in the back of the cupboard, and aren’t those the beans you were going to use to make chili . . . oooh, chili! . . .

But the other challenge of ADHD and diet is that if you are too high on sugars, or too many simple carbohydrates, it’ll be hard to focus too. The sugar may make you feel restless, making it hard to keep still. The carbohydrates may be dulling, making it harder to motivate. So, what to do?

Core recommendations to manage eating for ADHD:

• Hide the goodies: Put snacks and sweets hidden away, or better yet, don’t have them in the house in the first place.
• Make fruits and veggies easily accessible, already washed or prepared. This means apples in a bowl right out on the counter, and washed and cut veggies in the eye-level shelf in the fridge. Nuts at hand on the desk for ongoing snacks
• Pre-prepared meals, and for some clients, smaller meals, eaten more often, are better.

How Does Therapy Help Manage ADHD Sleep Issues?

Section TL/DR: You probably need more sleep, but have trouble getting it. I can help with tailored interventions.

Sleep is a cornerstone for mental health of all kinds. Anyone who wants to maximize their wellness and minimize the impact of their mental health should be paying attention to quality sleep as a cornerstone, but when it comes to managing sleep for ADHD specifically, there are some key elements to consider.

Sleep Onset Problems

Subsection TL/DR: ADHD Sleep Onset Problems are usually structure problems or impulse control problems. I can help with both.

Stayed awake till 2a again because you were completing that project before the 8a deadline? Or were you telling yourself you should go to bed, but just couldn’t make yourself stop what you were doing long enough to do so? ADHD related sleep onset problems are usually either structure problems like staying up to finish a deadline or, impulse and attention regulation problems like getting stuck on your phone.

Therapy helps manage ADHD sleep-onset problems by assessing the type of problem and gives you concrete and ongoing support for addressing your specific sleep-onset challenges. For example:

• Using time in the session for you to create small accountability deadlines. For example, getting you to email your colleague, “Can I show you how the big project is coming along and get your input tomorrow?” or to email your boss, “Hey, can we schedule a meeting 3 days before the big deadline so I can show you my draft?” This helps you use therapy to create real-world accountability, so you make incremental progress before the real deadline.
• Sucked in by an app? We’ll identify in session ways to limit the app from deleting it, to limiting it in your phone’s settings, to creating alarms that will interrupt you (yes, more than one). Up late playing video games? We won’t just talk about how you need to stop; we’ll find ways to time box your fun time, set timers when you begin, or put the power cord on a vacation timer.

Notice how I emphasize action in session as much as possible? We have to catch this moment of attention and make sure it is making a difference for you when you aren’t thinking about the session. More about that in a minute.

Early Waking Problems

Subsection TL/DR: Early waking is the most common ADHD related sleep problem I see in my practice. By hearing what you experience when you wake, we’ll strategize tailored solutions for you.

The ADHD challenge with sleep is usually early waking. Most of us have a sleep cycle of around 90 minutes. Between those cycles, we are in the lightest sleep, and we change positions. When a person has ADHD, after about 6 hours of sleep (4 sleep cycles), people with ADHD often wake up too much. Their minds start to hear birds chirping, or they start thinking about what they need to do during the day. Then they can’t shut their mind off, they wake up early. And usually feel fine, but . . .

Most people need 8 hours of sleep (a 5^th sleep cycle +/- a little time between cycles) in order to be fully balanced. The person with ADHD may not even feel the effect of only getting 6 hours of sleep, but if they ever got another sleep cycle, they would likely feel the benefits.

So, therapy for managing ADHD helps the client stay asleep by:

• Checking in regularly with you about your sleep cycles so you don’t forget how important it is.
• Reviewing sleep disruptions like early waking and troubleshooting actionable solutions. For example, being a little warmer can often help people stay in deeper sleep. Or guiding you to keep the room darker so the light doesn’t wake you up as much.

Once we have some things for you to try, I’ll ask you to set an alarm for after the session to help you remember to implement the suggestion. That’s because I’m not going to just come up with ideas; I’m going to help you implement them, recognizing that your ADHD is a barrier.

Good job reading that whole thing. That was a long one, but the next one is shorter, so you can do it!

How Does Therapy Help Manage ADHD Exercise Challenges?

Section TL/DR: Brain does better when you get out your zoomies. I help you exercise without getting rigid about how.

There’s a strong connection between cardiovascular health and cognitive functioning. For people with ADHD, you can also get physical restlessness, zoomies, out by exercising. Here are my top recommendations:

• Minimum of 30 minutes of exercise, any time, any type. <=That’s good and much better than nothing.
• Mid-range: Complete exercise 3 or more hours before bed so the exercise isn’t keeping you awake, and emphasize getting your heart rate up.
• Ideal: As much exercise as you can reasonably fit in, with a combination of strength-based exercise and cardio in the morning before you do anything else.

Notice how I emphasize a range of possibilities without getting rigid about what it has to look like to count?

How Does Therapy Help Manage ADHD Attention Problems?

Section TL/DR: Some people with ADHD swear by meditation. If that’s you, I’ll keep you on it. Otherwise, I don’t torture people with forced meditation.

Some research evidence suggests that mindfulness training is good for people with ADHD[1]. Other research meta-analyses are less conclusive[2], but still suggest some reductions in ADHD symptoms from mindfulness-based intervention. What’s clear to me is that most of my clients with ADHD find mindfulness excruciating. If it is already working for you, or you want to try it, we can incorporate it into your treatment plan. Otherwise, I don’t usually force it.

When I do include mindfulness-based interventions for ADHD, I usually teach a little bit in session and then outsource daily mindfulness practice to an app.

Good job, getting through that section!

How Does Therapy Support Medication to Manage ADHD?

Section TL/DR: Medication can help a lot of people and can be one important support, but I don’t push.

Whether you’re taking a stimulant, Strattera, or a psychiatric medication for another diagnosis, medication management of symptoms is an important aspect of ADHD management. I liken this to weight lifting. Sure, it is great if you can lift a heavy weight a few days a week. But since you have to lift this weight every day for the rest of your life, wouldn’t you like something to lighten the load?

There’s often a little grieving that goes into accepting medication support. A lot of people with ADHD grew up being told they should be able to do this. Especially highly-intelligent and high-performing people, as I see in Silicon Valley, often feel like, “I can do X, Y, and Z, I should be able to manage my ADHD without medications.”

But the thing is, ADHD is an invisible disability. I know you anticipate this big experience of relief and reward once you finally do “it” right. The irony is that for some of my most medication-resistant clients, medication is the support that finally lets them achieve their goals.

How Does Therapy Help Manage ADHD Structure Challenges?

Section TL/DR: You need help to manage the big stuff and the small stuff, and I have a lot of tools for that. I know this feels impossible. Read the section. You’ll see that I’ve got you.

Macro Structure

A core element of ADHD treatment is called externalizing the function. It means you take the part you have a hard time managing by just remembering, and you let something else in your life handle it for you. That’s structure. There are 3 main macro structures that I use with my clients, and I’m supportive of whichever one(s) work for you:

• To-do lists
• Calendars
• Routines

The thing is, we don’t expect them to work forever. There’s a trick to making this work. We let them fall apart, and then I use the last tool mentioned below in the How Does Talk Therapy Help Manage ADHD for Me? section. Aren’t you just dying to see what that is? Go ahead and scroll down to Constant Construction and Destruction. I’ll make sure you don’t miss anything.

Micro Structure

Those help take care of the macro parts of your life. Then there are smaller structures that can help you manage smaller moments like:

• Alarms – Yes, like setting alarms on your phone. But we’ll often do something I’ve never heard someone else suggest. I’ll help you regularly review the alarms in your phone and change the alarm ring tone (“Oh, what’s that noise! That’s something new” <= That makes it harder to just ignore), and we change the time by just a few minutes. This also helps break your attentional blindness so you notice and act on what the alarm was supposed to help you do.
• Tethers – Like literally seatbelting yourself to your chair at work. This can help you stay on task until completion. You say, “But sometimes I need to go to the bathroom? What do I do then?” Keep reading.
• Reminders – So you have to get up from your desk, but you really need to come back. How will I remember to come back? Maybe you tie a piece of string from the desk to a belt loop, or leave your glasses at the desk (But Eric, “I’m almost blind without my glasses.” Exactly)
• Behavioral Interrupts – This is like putting the shoes you’re going to wear immediately in front of the door and putting your keys in the shoes, and putting a post-it on the mirror saying your keys are in your shoes, and your shoes are in front of the door. These are ways of making sure that you can’t get to point B (out the door with your shoes on) without going through point A (getting your keys)
• Rewards – When you complete hard work doing things you don’t want to do, giving your brain a little reward helps a lot. I commonly recommend the following:
  • Sugar: Like one spoonful of ice cream.
  • Salt: Like a small bag of chips
  • Fat: Like ice cream or chips
  • Sex: Not literally in most cases. I mean a positive sensual experience, like a warm bath, rubbing your head, or listening to your favorite song.
  • Cash: Literally moving some cash from a “bank” to a “[Specific Anticipated] Reward” jar.
  • Video Games: Hey, it is fun to experience competence at discrete and achievable goals, and life gives us too damn few of those. Sometimes, we need to live it up.

The key to making rewards work is that they have to be experienced only when you get them as a reward. I know what you’re thinking, “So I only get to have ice cream as a reward?” No, but maybe only your favorite ice cream. It’s a negotiation; we’d talk and make it work for you.

How Does Talk Therapy Help Manage ADHD?

Section TL/DR: Only someone who understands how to treat ADHD knows how to write this much about it and then knows you are going to read the TL/DRs anyway. I’m cool about that and non-shaming.

If you scan back to the writing above, you’ll see many of the core elements of talk therapy for managing ADHD. The key elements are:

• Celebrate successes. ADHD loves a good cheerleader.
• Identifying the way ADHD causes problems for you.
• Trying to set management goals that could work for you.
• Then, because I understand how ADHD interferes with your ability to put that into action, we use time in the session to create the scaffolding so that your intention to make a change in the office goes with you out into the real world.
• Expect you to have ADHD, but don’t have it myself. One of the things that I love about working with people with ADHD is watching threads drop off their attention and me picking their attention up (without shame) and bringing them back.

Eventually, we get to a routine in the sessions. We’ve identified which of these management strategies you’re going to use, and we know how.

We review your core ADHD management strategies every session

For example, I might check in with a client every week on the same 5 things: Sleep, exercise, meds, structure, and that project at work. This means we don’t let ADHD distract you from constantly trying to manage these elements of your life.

Accepting Constant Construction and Destruction

Every other system for managing your ADHD, like Pomodoro, that ADHD workbook, the organizer, or that coach, has only told you a half-truth. The half-truth part is that they are great for managing ADHD. The false part is that they imply their system will work forever. The truth is that their system will only work for a little while.

Managing ADHD successfully in the long-term isn’t about finding the one right way to manage your ADHD.

Managing ADHD is about riding the ongoing waves of constructing management tools, watching them fall apart without shame, and then constructing new management tools with excitement.

Together, we surf the long-term waves of constructing your management strategies, watching them disintegrate, and then we create new ones. So, for a little while, you go to the new gym near your house, but then you stop going. No shame. That’s part of ADHD. First, let’s cancel your membership right now, before you forget. Then we focus on what is exciting you and what will help you exercise now. You want to try hot yoga? Awesome, until it isn’t. We focus on the core and let the contents change. [If you jumped down to read this section because you were in the structure section, go back up now and resume at the Micro Structures subsection]

Can Therapy Help Manage ADHD for Me?

Section TL/DR: Yes. Click here to work with me.

If you’re thinking you’d like to work with me for treatment of ADHD, click here and fill out my contact form before you forget.

You can read the rest of the resources here after you fill out the contact form.

What Are Some Resources for Managing ADHD?

Best books on ADHD:

• “ADHD 2.0: New Science and Essential Strategies for Thriving With Distraction—From Childhood Through Adulthood” by Hallowell and Ratey
• “The ADHD Field Guide for Adults” by Osborn and Gude.
• “The Couple’s Guide to Thriving with ADHD” by Melissa Orlov and Nancy Kohlenberger
• “The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps” by Melissa Orlov.

Best social media focused on helping ADHD:

• YouTube: @HowtoADHD.
• Instagram:
  • @drbotyler.
  • @neurodivergent_insights.
  • @catieosaurus.

FAQ

Q: Does therapy work for ADHD in adults?

A: Yes. When I do therapy like this, my clients’ lives, work performance, and relationships improve significantly. And, sometimes, we have to keep doing therapy because you still have ADHD and can use an external check. In those cases, I often decrease the frequency of sessions and sometimes even reduce the length to 25 minutes (down from 50 minutes). This helps me help you engage in the recreation of your management methods when they fall apart.

Q: What type of therapy works for ADHD?

A: This type of therapy is Cognitive Behavioral Therapy, with a heavy emphasis on the behavioral part of CBT. CBT is an effective therapy for a wide range of clinical issues, including ADHD, and research suggests that it increases the benefits of medication alone.

Q: Is therapy or medication better for ADHD?

A: To quote one article[3], “CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.” The lay translation is that therapy (specifically CBT, as I provide) is more effective with medication. In this study, after therapy ended, the benefits of therapy faded. Which is exactly why I sometimes do ongoing therapy for clients with ADHD, as I described in the answer to my first question.

YOU DID IT! YOU READ THE WHOLE THING! YAY!!!!

[1] Modesto-Lowe, V., Farahmand, P., Chaplin, M., & Sarro, L. (2015). Does mindfulness meditation improve attention in attention deficit hyperactivity disorder? World Journal of Psychiatry, 22, 5(4), 397-403. doi: 10.5498/wjp.v5.i4.397

[2] Kim, H.-H., Jung, N.-H. (2025). Mindfulness-based interventions for adults with ADHD: A systematic review and meta-analysis. Medicine, 104(37), e 44308. doi: 10.1097/MD.000000000004430

[3] Cherkasova MV, French LR, Syer CA, Cousins L, Galina H, Ahmadi-Kashani Y, Hechtman L. Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial. J Atten Disord. 2020 Apr;24(6):889-903. doi: 10.1177/1087054716671197.