Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms

Abstract

Context Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments.Objective To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Design, Setting, and PatientsRandomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments.Interventions Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attentionmatched comparison). Main Outcome MeasuresThe primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6-and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. ResultsCognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude −0.0531; 95% confidence interval [CI], −1.01 to −0.05; P=.03) and the ADHD rating scale (magnitude −4.631; 95% CI, −8.30 to −0.963; P=.02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (␤=−0.41; 95% CI, −0.64 to −0.17; PϽ001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P=.01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P=.002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. Conclusion Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months.

The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…However, these studies are limited by small samples sizes and lack of control groups and in recent years randomised controlled trials (RCTs) have begun to emerge (e.g. Emilsson et al, 2011;Safren et al, 2010;Stevenson, Whitmont, Bornholt, Livesey, & Stevenson, 2002).…”

Comorbidity of attention deficit-hyperactivity disorder and substance use disorder

“…Randomized studies found a significant effect of CBT in adult ADHD patients, and this effect lasted for 12 months (64). There are no studies yet to show if this treatment, which is known to be effective in SUD as well, is also effective in comorbidity of both disorders.…”

Developments and challenges in the diagnosis and treatment of ADHD

“…108 The best evidence comes from a trial conducted by Safren et al 109 The study enrolled 86 adults with ADHD who were already being prescribed medication and randomized them to cognitive behavioral therapy or relaxation with attentional support. Cognitive behavioral therapy was associated with greater improvement in ADHD symptoms -with improved scores in the ADHD-rating scale, Clinical Global Impression severity, and self-report ADHD scale -, and the benefits were maintained after 12 months of follow-up.…”