Cognitive–behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis

Abstract

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.MethodA total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive–behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.ResultsCBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.ConclusionsThe study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.

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

“…We have previously reported clinical outcomes [15], and in this study we report functional outcomes using the RATE-S scales [19] which were developed to assess attention, social functioning, emotional control and antisocial behaviour. Outcomes were assessed post-group and at three-month follow-up.…”

Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome

“…This possibility merits further research. Secondly, LoC may take longer than the other measures to show treatment effects; this has been found for other outcome measures[25]. …”

“…The two main violent attitudes measured by the MVQ, which have implications for treatment targets, are the use of violence to defend or enhance vulnerable self-esteem and the general acceptance that violence is justified as a way of life. Typically, controlled treatment trials compare the treatment group with a control group with the former including outcome measures of those who did not complete the programme (“Intention to Treat”; “ITT”), which in fact reduces the effect size where there is a poor completion rate[25]. This may bias the apparent effectiveness of specific outcome measures.…”

“…Future research should investigate the effects of these six factors. Reducing the sessions of the original R&R has clearly improved treatment completion; completion in institutional settings may be better than programmes delivered in the community[32,25]. …”

“…For treatment effectiveness we relied on differences in the outcome measures between baseline and end of treatment for those participants who completed the programme. In controlled trials the failure to complete the programme reduces the real differences between the treatment and control groups[25]. …”