Table 7 Practice recommendations for adults with comorbid ADHD and ASD: non-pharmacological clinical interventions

1. The general clinical approach for working with adults is similar to that applied to working with children and adolescents, especially for those with intellectual limitations (refer to Table 4).

2. For those individuals with intellectual disability, the issues of consent and capacity may need to be carefully considered as this impacts on the individual’s decision-making and legal rights. Any information shared with parents/carers must be done with the individual’s knowledge and consent.

3. It may be necessary to support parents/carers to gain advice from reputable services about guardianship (particularly when intellectual disability has been diagnosed) and the need for long-term financial planning arrangements to be put in place.

4. Additional support and guidance may be required for individuals with ADHD and ASD who become parents.

5. Psychoeducational interventions should be provided to both the individual and carers.

6. Individuals may benefit from attending peer group support interventions (i.e. a peer version of the parent/carer support interventions described in the child section).

7. Cognitive approaches (including cognitive remediation therapy [CRT] and cognitive behavioural therapy [CBT]) are likely to be effective interventions for adults with ADHD and ASD (see text for topics). Specific adaptions may be needed for individuals with social communication and intellectual limitations, including greater support and supervision by the therapist.

8. Adults may be better able to cope with group delivered treatments than children and adolescents, especially when specific adaptations are arranged, for example by increasing the number of group facilitators to ensure individual support can be provided.

9. Support strategies and planning are needed for transition between child and adult services. In addition, salient life-path transitions (e.g. parental bereavement) should trigger enhanced planning, as should geographical re-location or major relationship changes.

10. As for children, interventions should be integrated into a bespoke collaborative care plan for the individual, including a Positive Behavioural Support plan to ensure consistency of interventions (including educational) between different caregivers, staff and service-user(s). The care plan should be shared with all relevant parties, with appropriate consent.