A randomized controlled trial reporting functional outcomes of cognitive–behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology

Abstract

Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive–behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.

Long-term Effects of Multimodal Treatment on Adult Attention-Deficit/Hyperactivity Disorder Symptoms

“…Current evidence on follow-up assessments of cognitive behavioral therapy (CBT) in adults with ADHD is limited in terms of sample size and shorter follow-up periods compared with COMPAS. 6 , 51 , 52 , 53 , 54 , 55 , 56 A 2018 meta-analysis on long-term efficacy of psychosocial treatments for adults with ADHD 57 found evidence of sustained effects of ADHD-specific psychosocial treatment approaches on ADHD symptoms for at least 12 months.…”

Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis

“…Hence, they are individuals with a higher rate of comorbidity. Even if some specific psychological interventions have been developed for youths and adults with ADHD [e.g., ( 31 , 37 , 38 )], there is a dearth of data on both pharmacological and psychological intervention for people with ADHD in the criminal justice system and this should be investigated as a priority, given the high prevalence of ADHD in detainees.…”

A Comparison of Cognitive-Behavioral Therapy and Pharmacotherapy vs. Pharmacotherapy Alone in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD)—A Randomized Controlled Trial

“…According to guidelines, psychopharmacological treatment is currently considered as first-line treatment for adults in ADHD ( 12 , 13 , 19 , 67 ). However, the course of the disorder seems to justify additional psychological interventions for several reasons: Some symptoms seem to be more accessible by psychotherapy (e.g., organizational and social behavior) whereas other symptoms respond more readily to medication (e.g., attention, emotional instability) ( 11 ).…”