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.

As growth mindset interventions increase in scope and popularity, scientists and policymakers are asking: Are these interventions effective? To answer this question properly, the field needs to understand the meaningful heterogeneity in effects. In the present systematic review and meta-analysis, we focused on two key moderators with adequate data to test: Subsamples expected to benefit most and implementation fidelity. We also specified a process model that can be generative for theory. We included articles published between 2002 (first mindset intervention) through the end of 2020 that reported an effect for a growth mindset intervention, used a randomized design, and featured at least one of the qualifying outcomes. Our search yielded 53 independent samples testing distinct interventions. We reported cumulative effect sizes for multiple outcomes (i.e., mindsets, motivation, behavior, end results), with a focus on three primary end results (i.e., improved academic achievement, mental health, or social functioning). Multilevel metaregression analyses with targeted subsamples and high fidelity for academic achievement yielded, d = 0.14, 95% CI [.06, .22]; for mental health, d = 0.32, 95% CI [.10, .54]. Results highlighted the extensive variation in effects to be expected from future interventions. Namely, 95% prediction intervals for focal effects ranged from −0.08 to 0.35 for academic achievement and from 0.07 to 0.57 for mental health. The literature is too nascent for moderators for social functioning, but average effects are d = 0.36, 95% CI [.03, .68], 95% PI [−.50, 1.22]. We conclude with a discussion of heterogeneity and the limitations of meta-analyses.

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD.

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Synopsis Attention-deficit / hyperactivity disorder (ADHD) is a valid and impairing psychological disorder that persists into adulthood in a majority of cases and is associated with chronic functional impairment and increased rates of comorbidity. Cognitive-behavioral therapy (CBT) approaches for this disorder have emerged relatively recently, and available evidence from open and randomized controlled trials suggests that these approaches are promising in producing significant symptom reduction. A conceptual model of how CBT may work for ADHD is reviewed along with existing efficacy studies. A preliminary comparison of effect sizes across intervention packages suggests that targeted learning and practice of specific behavioral compensatory strategies may be a critical “active ingredient” in CBT for adult ADHD. The article concludes with a discussion of future directions and critical questions that must be addressed in this area of clinical research.