Efficacy of Meta-Cognitive Therapy for Adult ADHD

Abstract

Objective To examine the efficacy of a 12-week manualized Meta-Cognitive Therapy (MCT) group designed to enhance time-management, organization, and planning in adults with AD/HD. Method Eighty-eight clinically referred adults who met DSM-IV criteria for ADHD based on clinical and structured diagnostic interviews and standardized questionnaires were stratified vis-à-vis ADHD medication use and otherwise randomly assigned to receive MCT or supportive psychotherapy in a group modality. MCT employs cognitive-behavioral principles and methods to impart skills and strategies in time-management, organization, and planning, and target depressogenic and anxiogenic cognitions that undermine effective self-management. The Support group controlled for non-specific aspects of treatment by providing support while avoiding discussion of cognitive-behavioral strategies. MCT and Support groups were comparable in gender (29% and 39% male, respectively) and age (41±11.59 yr and 42 ± 12.09 years, respectively). Therapeutic response was assessed by an independent (blind) evaluator via structured interview pre- and post-treatment, as well as by self-report and collateral informant behavioral ratings. Results General linear models, comparing change from baseline between treatments, revealed statistically significant effects for independent evaluator, self-report, and collateral ratings of DSM-IV inattentive symptoms. Employing dichotomous indices of therapeutic response, a significantly greater proportion of MCT vs. Support group members demonstrated improvement. Logistic regression examining group differences in operationally defined response (controlling for baseline ADHD severity) revealed a robust effect of Treatment Group (odds ratio=5.41; 95%CI=1.77,16.55). Conclusion MCT (vs. Support) yielded significantly greater improvements in dimensional and categorical estimates of ADHD severity, supporting its efficacy as a viable psychosocial intervention.

Effects of methylphenidate on memory functions of adults with ADHD

“…Further improvement of memory functions of adults with ADHD on MPH might be achieved by combining the pharmacological intervention with psychosocial intervention strategies (i.e., cognitive-behavioral therapy [CBT]). Psychosocial intervention programs (such as CBT) were shown to effectively improve symptoms and executive skills of adults with ADHD (Solanto, Marks, Mitchell, Wasserstein, & Kofman, 2008;Solanto et al, 2010;Vidal-Estrada et al, 2012). A combination of both pharmacological and behavioral treatments is therefore suggested and widely regarded as the gold standard for the treatment of adults with ADHD (Rostain & Ramsay, 2006;Vidal-Estrada et al, 2012;S.…”

What Do We Really Know about ADHD in College Students?

“…Other than a recent study on coaching students with ADHD [58], no controlled studies of psychosocial interventions have been published. Also, as previously discussed, recent trials of CBT for adults with ADHD [53,56] have yielded very promising findings, and specifically evaluating the impact of these programs in college students should be a priority. Studies on the effectiveness of academic accommodations that students with ADHD may receive (e.g., additional time for assignments and tests, and distraction-reduced test settings) are also lacking.…”

“…In related work, Solanto, Marks, Mitchell, Wasserstein, and Kofman [56] reported positive results for a small group cognitive behavioral treatment program for 88 adults with ADHD that they call Meta Cognitive Therapy. The focus of Meta Cognitive Therapy is to impart skills and strategies in time management, organization, and planning, and to target depressogenic and anxiogenic cognitions that undermine effective self-management [56].…”

“…The focus of Meta Cognitive Therapy is to impart skills and strategies in time management, organization, and planning, and to target depressogenic and anxiogenic cognitions that undermine effective self-management [56]. Compared to adults randomized to receive supportive therapy, those receiving Meta Cognitive Therapy had significantly fewer inattentive symptoms after treatment according to self-report, conditionblind clinician ratings, and collateral informants [56].…”

Training Cognition in ADHD: Current Findings, Borrowed Concepts, and Future Directions

“…For example, clinic-delivered cognitivebehavior therapy, with a focus on planning and thinking in regard to how future outcomes would occur depending upon the child's different actions, was tested for children with ADHD and was determined to be ineffective in improving functioning [89]. However, cognitive-behavioral strategies do appear to be effective for adults with ADHD [90,91].…”