Tailoring OCD Treatment for ADHD: Effective Strategies
Introduction
A couple of years ago, I was working with Liam, 22, who lived in Edinburgh and was doing his best to get through uni. But every evening he’d be stuck, compulsively checking door locks, taps, windows. Intrusive thoughts kept pulling his mind toward worst-case scenarios: Did he leave the stove on? Was the door locked properly? He could rationally answer “yes,” but still felt compelled to check five, ten, sometimes twenty times. At the same time, Liam had ADHD. He would start exposure homework tasks in the evenings, and then the phone would ping, or he’d remember something else that felt more urgent, then drift away from the task. Frustration built up. He’d feel like he was failing.
That story stuck with me. It shows how OCD and ADHD aren’t just co-occurring conditions you shoehorn together. They interact. They tangle. And unless treatment is adapted, people like Liam often feel misunderstood, beaten by their own mind, or stuck in therapy that “almost works but never quite.”
In July 2025, at the 30th Annual OCD Conference in Chicago, I heard the presentation “Tailoring OCD Treatment to Neurodivergent Clients Across Modalities.” One of the key messages was that ADHD and OCD must be addressed as a single clinical challenge, not two separate ones. ERP, ACT, internet-delivered CBT, and medication all need tweaks. In the UK, this is especially important due to the structure of NHS services, the waiting times, and the way mental health support is often siloed.
In this article, I’ll walk you through what makes OCD and ADHD unique, what the latest evidence says, and how treatment can be tailored in practice across ERP, ACT, remote delivery, and medication. I’ll also bring in what I learned from the conference: affirming language, creative adaptations, and the difference between being a clinician and a technician. By the end, I hope you feel seen, hopeful, and equipped.
Understanding OCD and ADHD
The overlap in the UK
OCD affects about 1.2 per cent of people in the UK at any given time, roughly three-quarters of a million people. Adult ADHD in the UK is estimated at around 2.5 to 3.4 per cent. Studies suggest up to 30 per cent of people with OCD also show traits of ADHD. That number matters because it shows this overlap is not rare or marginal. Many people are somewhere in that space where both conditions collide.
Why ADHD complicates OCD
ADHD makes ERP harder: distractibility interrupts exposures, impulsivity makes resisting compulsions more difficult, and weak executive functioning gets in the way of planning and sticking to hierarchies. Emotional dysregulation exacerbates the challenge, making setbacks feel more catastrophic.
The conference presentation reminded me that therapy is not just about reducing symptoms but about affirming identity and strengths. ADHD traits like creativity, honesty, resilience, and passion can become assets in treatment if we acknowledge them, rather than seeing ADHD as purely an obstacle.
OCD Treatment for ADHD: Why Tailoring Matters
Misdiagnosis and siloed services
In the UK, ADHD traits often mask OCD and OCD behaviours are mistaken for ADHD. Services are usually split, with OCD handled through talking therapies and ADHD through psychiatry. This leaves clients with piecemeal care. The conference speakers called this “siloing,” and stressed how dangerous it can be: when providers avoid learning to work with both, clients fall between gaps.
The therapeutic alliance
Building trust is essential. Clients with ADHD often carry beliefs like “I’m defective” or “therapy never works.” Tailoring treatment means actively challenging those beliefs, setting realistic goals, and asking: “Of all these things, which do you most want help with?” Therapy works best when the client feels the work is really for them.
ERP for ADHD and OCD
The heart of ERP
ERP is still the gold standard for OCD. However, for ADHD clients, it must shift from being a rigid ladder to a flexible and collaborative process. The conference emphasised that exposures should focus on tolerating discomfort, not eliminating it.
Adaptations that matter
Start low and go slow. Make exposures predictable with visual cues. Repetition, repetition, repetition. Incorporate special interests into exposures. Use ritual delay or ritual shortening rather than expecting full prevention straight away. Reinforce not only after exposures, but during them, to override fear with positive associations. Sometimes you even pair feared stimuli with enjoyable activities — counter-conditioning.
Clients may also need functional communication training: learning how to ask for breaks or signal when overwhelmed. The therapy environment itself matters: seating, lighting, sensory safety. ADHD makes consistency difficult, so sessions should integrate predictability and agency: clear agreements, choices, and co-created goals.
I remember Liam finding exposure less terrifying when we added in music he loved during the practice. The fun didn’t erase the anxiety, but it made it bearable. And because we praised even attempts, not just success, he stopped feeling like failure was inevitable.
ACT for ADHD and OCD
ACT’s focus
ACT builds psychological flexibility: the ability to act in line with values even when intrusive thoughts and discomfort are present. It’s not about controlling obsessions, but about freedom to live fully despite them.
How to adapt ACT
Traditional ACT models assume long attention spans, abstract language, and a neurotypical learning history. With ADHD, that doesn’t hold. The conference highlighted the use of short bursts of mindfulness, immediate motivational rewards, and making values work more concrete. Rather than abstract metaphors, we can link values to specific, energising actions: “Spend time with your child without rituals,” or “Create art without restarting it for perfection.”
ACT for ADHD and OCD is also about vitality. Clients often don’t know how to live with joy because life has been dominated by fear and distraction. ACT helps them practise noticing, naming, and savouring moments of vitality.
And ACT is not just individual work. “Building a village” matters — engaging family, loved ones, and community. Therapy must affirm identity, challenge internalised stigma, and foster a sense of belonging.
I-CBT Insights
I-CBT reframes OCD as obsessional doubt rather than fear. It traces the chain of inferences that lead from doubt to obsession, helping clients learn to stop going “upstream” into stories that pull them into compulsions.
For ADHD clients, I-CBT is attractive because it’s cognitive rather than purely behavioural, and often less defensive. But adaptations are needed: more visuals, clearer summaries, slower pacing, more involvement of support systems, and matching the client’s language style. Homework can’t just be writing long narratives — it may need to be voice notes or interactive tasks.
This approach can also help address self-invalidation, which is common in ADHD, by rebuilding trust in one’s own perceptions and capacities.
Psychopharmacology in ADHD and OCD
Same first line, different journey
The first-line medication for OCD remains SSRIs, sometimes clomipramine. ADHD medication, often stimulants, is still needed if ADHD is present. Stimulants are often well tolerated in OCD, and sometimes actually improve ERP engagement.
The difference is in how medication is managed. For neurodivergent clients, side effects can be idiosyncratic and unpredictable. The principle is to start low, proceed slowly, and titrate high if needed. Multiple trials may be necessary before finding the right fit. Past negative experiences with a drug in childhood don’t always predict adult response.
Most importantly, don’t confuse ADHD traits with OCD compulsions. If a client needs stimulants to manage ADHD, withholding them out of fear of worsening OCD may block therapy altogether.
Being a Clinician, Not a Technician
One of the most powerful takeaways from the Chicago presentation was the difference between being a technician and a clinician. A technician follows the manual rigidly, applying tools as written. A clinician understands the “why,” conceptualises cases individually, and adapts flexibly. ADHD and OCD demand the latter. No protocol fits all. Each adaptation is tailored to the individual’s skills, environment, passions, and goals. Creativity is not a luxury here; it’s essential.
Real-Life Insights
Sarah, 30, told me she felt “pulled in two directions,” ADHD making her mind race and OCD making her freeze. She would begin homework, get distracted, and then berate herself for failing. Her shame was heavy. We broke tasks into small steps, used voice notes instead of written diaries, and celebrated attempts. Over time, she began to feel progress was possible.
Jamie, another client, said therapy felt like a treadmill: effort followed by setbacks. What helped was slowing the pace and building predictability into sessions. By accepting missed homework as part of ADHD, rather than a failure, therapy became sustainable.
These stories remind me that treatment is not about forcing a rigid protocol, but about shaping therapy so people can succeed with the brains they have, not the brains we expect.
UK Context and Future Directions
In the NHS, OCD is usually treated with CBT and medication, while ADHD is handled in separate pathways. Waiting lists and inconsistent access make joined-up care difficult. Private therapy can offer more tailored approaches, but is costly.
Policy is shifting. There are calls to integrate ADHD care into primary care and to train therapists in dual approaches to treatment. However, for now, clients must often initiate coordination themselves.
The future needs more UK research: randomised controlled trials of adapted ERP for ADHD and OCD, long-term outcomes, and training for clinicians to integrate ADHD adaptations into standard OCD care.
Conclusion
Living with OCD and ADHD can feel like being caught between racing waves and frozen fear. It’s exhausting. But treatment can work when it’s made to fit you. When exposures are small, rewards are woven in, ACT focuses on vitality, and medication supports focus. When clinicians see you as a whole person, not just a diagnosis.
If you’re in the UK with OCD and ADHD, don’t settle for therapy that feels rigid or shame-based. Therapy can be compassionate, affirming, and tailored to your life. Do you believe that change is possible?
FAQ
What does tailored treatment for OCD and ADHD mean?
It means adapting therapies so they fit ADHD traits: shorter exposures, reminders, rewards, collaboration with medication, breaking tasks down, and using accessible environments.
Will treating ADHD make my OCD better?
Often yes. Reducing ADHD symptoms can make ERP and CBT more effective because you can engage more fully. But medication alone rarely resolves OCD entirely.
Can ERP be too much if I have ADHD?
It can be overwhelming if not adapted. That’s why pacing, micro steps, external supports, and frequent check-ins are so important.
How long does therapy take for OCD and ADHD?
Usually longer than for OCD alone. Progress can feel slower, but steady gains are possible.
How do I find a therapist in the UK who understands both OCD and ADHD?
Look for therapists who mention ADHD and OCD experience. Ask what adaptations they make. Check registers, such as BABCP or specialist private clinics. Always ask about their approach before starting.
Poli, A., et al. (2014). The Neurobiological Link Between OCD and ADHD. Frontiers in Psychiatry.
NHS England. (2022). Mainstreaming adult ADHD into primary care in the UK. BMC Psychiatry.
OCD-UK. (2022). OCD and Adult ADHD. OCD-UK Virtual Conference.
Priory Group. (2025). OCD Statistics UK 2025.
NHS. (2025). Treatment for Obsessive Compulsive Disorder (OCD).