Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest–posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.

Efficacy of Non-pharmacological Treatments on Emotional Symptoms of Children and Adults with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis

“…Our results revealed that CBT improved comorbid depression, and/or anxiety, and/or ED in adults with ADHD when testing at post-treatment and follow-up, and when the outcomes were evaluated by the patients themselves or an independent observer. These findings are in line with previous meta-analyses studies of adults with ADHD (Jensen et al, 2016;Lopez et al, 2018;López-Pinar et al, 2020), which consistently supported the efficacy of CBT in improving comorbid emotional symptoms (i.e., depression, anxiety, and ED). However, we did not detect the efficacy of CBT in alleviating the emotional symptoms in children with ADHD.…”

“…Finally, another important finding was that publication bias indicators were found only for ED in post-treatment of adults with ADHD. The rest of the outcomes were free from publication bias in studies including children and adults with ADHD, thus supporting the validity of the results, which is consistent with recent meta-analysis works (Lopez et al, 2018;López-Pinar et al, 2020).…”

“…As in previous meta-analytic reviews (Goode et al, 2018;López-Pinar et al, 2020), we included the most-widely used non-pharmacological treatments in the current review, namely, cognitive behavioral therapy (CBT), parent training (PT), social skills training (SST), mindfulness-based therapies (MBT), behavioral therapy (BT), dialectical behavior therapy (DBT), cognitive therapy (CT), psychoeducation (PsyEd), neurofeedback (NFB), sleep intervention(SI), hypnotherapy (HT), and sports. It is important to note that different non-pharmacological treatments might have different efficacy on emotional symptoms.…”

“…For this reason, an extensive line of non-pharmacological treatments has been adopted in recent years to address ADHD core symptoms (i.e., inattention, hyperactivity, and impulsivity) and emotional symptoms (López-Pinar et al, 2020). For example, a systematic literature review (Den Heijer et al, 2017) showed that physical exercise represented an effective treatment in children and adults with ADHD with regard to several cognitive, behavioral, and socio-emotional functions.…”

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

“…Since ED may significantly influence the development of children and adolescents, effective and available treatment is of utmost importance. Psychotherapy may be divided into four groups: (i) Dialectic Behavioral Therapy [reviewed by Courtney-Seidler et al ( 430 )], (ii) Behavioral and Cognitive Behavioral Therapy (including Schema Therapy) [recently reviewed by López-Pinar et al ( 431 )] in adults, (iii) multimodal treatment (including, e.g., parental interventions, pharmacotherapy, and others), (iv) other therapies, such as analytic group therapy, hypnotherapy, neurofeedback, and others.…”