BONUS RESOURCE: Evidence-Informed Psychotherapy Strategies for ADHD, Autism, and AuDHD

Practical interventions to discuss with your therapist

ADHD and autism can affect attention, organization, emotional regulation, sensory processing, communication, and the energy required to manage everyday responsibilities. When both conditions occur together (AuDHD), individuals may experience competing needs, such as wanting novelty while also needing predictability.

Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Solution-Focused Brief Therapy (SFBT) offer practical strategies that can be adapted to these differences.

The following are common therapeutic interventions that clinicians may use or adapt within these approaches. Some have direct research support for ADHD or autism, while others are clinically informed applications of established psychotherapy skills. Discuss the strategies that interest you with your treating therapist or healthcare provider to determine which best fit your needs and goals.

1. Cognitive Behavioral Therapy (CBT)

Focus: Executive functioning, task initiation, anxiety, and unhelpful thinking patterns.

Behavioral Activation and Reward-Based Task Initiation

Plain Talk: Make difficult tasks easier to start by breaking them into small actions and adding immediate rewards, novelty, or enjoyable activities. For example, pair household chores with a favorite podcast or commit to working for just five minutes.

Metacognitive Therapy and Executive Function Scaffolding

Plain Talk: Build systems that do some of the remembering and organizing for you. Use visual reminders, calendars, checklists, timers, written instructions, or structured work routines instead of relying entirely on memory and willpower.

Cognitive Restructuring for Internalized Self-Criticism

Plain Talk: Challenge thoughts such as “I'm lazy” or “I should be able to do this.” Learn to recognize how executive functioning differences affect performance and replace self-blame with accurate, constructive thinking.

Adapted CBT Thought Records

Plain Talk: Use written notes, diagrams, or visual maps to identify how thoughts, emotions, physical sensations, sensory overload, and behaviors interact. This can make stressful situations easier to understand and manage.

Structured Problem-Solving and Cognitive Flexibility

Plain Talk: Practice identifying a problem, creating two or three possible solutions, and choosing a manageable next step. Develop backup plans for unexpected changes without expecting yourself to abandon routines that genuinely help.

Gradual Exposure for Anxiety

Plain Talk: Work with your therapist to approach situations avoided because of fear, one manageable step at a time. Sensory accommodations should remain available; the goal is to reduce anxiety-driven avoidance, not force exposure to harmful or intolerable sensory conditions.

2. Dialectical Behavior Therapy (DBT)

Focus: Emotional regulation, distress tolerance, impulsivity, and relationships.

STOP Skill

Plain Talk: When emotions rise or you feel an urge to interrupt, react, or withdraw, practice: Stop, Take a step back, Observe, and Proceed mindfully. This creates a brief opportunity to choose your response.

Sensory-Adapted TIPP Skills

Plain Talk: Use brief physical regulation strategies, such as paced breathing, appropriate movement, or muscle relaxation, to reduce intense emotional arousal. Your therapist can adapt or omit temperature-based and other techniques based on sensory preferences and medical needs.

DEAR MAN: Interpersonal Effectiveness

Plain Talk: Learn a structured way to ask for what you need, communicate boundaries, request accommodations, or address misunderstandings without excessive explaining or avoiding the conversation.

Check the Facts

Plain Talk: Separate what actually happened from what you fear it means. For example, a supervisor's short email does not necessarily mean you are in trouble.

Radical Acceptance

Plain Talk: Acknowledge your real needs, limits, and circumstances without shame. Accepting that you need extra recovery time or a quieter environment allows you to make practical adjustments rather than fighting your own capacity.

Emotion Regulation and Vulnerability Reduction

Plain Talk: Identify factors that make emotions harder to manage, such as sleep disruption, hunger, prolonged concentration, sensory overload, or repeated social demands. Address these needs before stress becomes overwhelming.

3. Acceptance and Commitment Therapy (ACT)

Focus: Psychological flexibility, values, self-acceptance, and sustainable functioning.

Cognitive Defusion

Plain Talk: Learn to step back from repetitive or self-critical thoughts rather than becoming caught in them. Instead of “I'm going to fail,” practice “I'm noticing the thought that I'm going to fail.”

Values Clarification

Plain Talk: Identify what truly matters to you, such as creativity, independence, relationships, meaningful work, or learning. Use these values to guide decisions rather than measuring yourself against other people's expectations.

Values-Based Energy Management

Plain Talk: Consider which responsibilities are necessary, which activities are meaningful, and which demands consume substantial energy. Plan your time so important activities remain possible without repeatedly exhausting yourself.

Committed Action with Small Steps

Plain Talk: Choose realistic actions that move you toward your goals, even when motivation varies. Progress might mean sending one email, completing the first step of a project, or establishing one helpful routine.

Self-as-Context and Neurodivergent Identity

Plain Talk: Recognize that ADHD, autism, anxiety, and past difficulties are parts of your experience, but they do not define your entire identity or personal worth.

4. Solution-Focused Brief Therapy (SFBT)

Focus: Existing strengths, practical solutions, and achievable progress.

Exception Finding

Plain Talk: Explore times when something was easier. If you were productive yesterday, what helped? Was the room quieter, the task more interesting, or the instructions clearer? Identify conditions you can recreate.

Scaling Questions

Plain Talk: Rate your stress, energy, confidence, or ability to manage a task from 0 to 10. Discuss what would help improve that number by just one point.

Preferred Future / Miracle Question

Plain Talk: Imagine what daily life would look like if your difficulties became more manageable. Identify concrete changes, such as easier mornings, fewer misunderstandings, or more consistent task completion.

Strengths and Resource Identification

Plain Talk: Identify what already works: your interests, problem-solving abilities, supportive people, helpful technology, and environments where you function well. Build practical strategies around those strengths.

5. Additional Strategies for AuDHD

Focus: Competing needs, sensory regulation, masking, and recovery.

These strategies integrate established psychotherapy principles with individualized neurodevelopmental accommodations. They are not all independently validated AuDHD-specific treatment protocols.

Novelty–Predictability Balancing (CBT/ACT-Informed)

Plain Talk: Create enough structure to feel organized while allowing enough novelty to remain engaged. For example, maintain a predictable daily schedule but rotate interesting activities or approaches within it.

Interoceptive Awareness Training

Plain Talk: Practice noticing signals of hunger, thirst, fatigue, tension, or emotional overload before they become overwhelming. Build reminders or regular check-ins when body signals are difficult to recognize.

Pacing and Energy Accounting

Plain Talk: Treat mental, emotional, and sensory energy as limited resources. Alternate demanding activities with recovery periods, anticipate high-effort days, and avoid repeatedly exceeding your available capacity.

Social Masking Awareness and Recovery Planning (ACT/CBT-Informed)

Plain Talk: Explore when deliberately adjusting your social behavior is useful and when it becomes exhausting. Practice communicating needs more openly, reducing unnecessary self-monitoring, and planning recovery after demanding interactions.

Sensory Regulation and Environmental Modification

Plain Talk: Adjust lighting, noise, seating, clothing, workspace organization, or communication methods to make everyday tasks easier. Sometimes changing the environment is more effective than trying harder to tolerate it.

Transition Planning and Externalized Executive Supports

Plain Talk: Use advance reminders, visual schedules, written stopping points, and short transition periods to make switching activities less disruptive. External tools can reduce the burden on working memory.

A Final Thought

The goal of therapy is not to make a neurodivergent person appear neurotypical. It is to improve quality of life, reduce unnecessary distress, strengthen practical skills, and develop environments and routines that support sustainable functioning.

You do not need to use every strategy. Select a few that address your greatest difficulties and work collaboratively with your therapist to evaluate what genuinely helps.

Selected Research References

• Safren, S. A., et al. (2010). Cognitive behavioral therapy for medication-treated adults with ADHD: A randomized controlled trial. JAMA, 304(8), 875–880.

• Solanto, M. V., et al. (2010). Efficacy of meta-cognitive therapy for adult ADHD. American Journal of Psychiatry, 167(8), 958–968.

• Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical Psychology Review, 49, 41–54.

• Pahnke, J., et al. (2023). Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study. Autism.

• Huntjens, A., et al. (2024). The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: A pragmatic randomized controlled trial. Psychological Medicine.

• Mantzalas, J., et al. (2022). What is autistic burnout? A thematic analysis of posts on two online platforms. Autism in Adulthood, 4(1).