Non-pharmacological interventions for adult ADHD: a systematic review

Abstract

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a common developmental disorder, often persisting into adulthood. Whilst medication is first-line treatment for ADHD, there is a need for evidence-based non-pharmacological treatment options for adults with ADHD who are either still experiencing significant symptoms or for those who have made the informed choice not to start medication.MethodsWe systematically searched PsycINFO, MEDLINE (Ovid), EMBASE, CINAHL and CENTRAL for randomised controlled trials of non-pharmacological treatments for ADHD in adults. After screening of titles and abstracts, full text articles were reviewed, data extracted and bias assessed using a study proforma.ResultsThere were 32 eligible studies with the largest number of studies assessing cognitive behavioural therapy (CBT). CBT consisted of either group, internet or individual therapy.ConclusionsThe majority found an improvement in ADHD symptoms with CBT treatment. Additionally, mindfulness and cognitive remediation have evidence as effective interventions for the core symptoms of ADHD and there is evidence for the use of group dialectical behavioural therapy and hypnotherapy. However, evidence for these is weaker due to small numbers of participants and limitations due to the lack of suitable control conditions, and a high risk of bias.

Group-based emotion regulation skills training for adults with ADHD: A feasibility study in an outpatient psychiatric setting

“…Previous research examining the efficacy of available psychological treatments for adults with ADHD has not only shown reduction in ADHD symptoms, but also effects on other outcomes such as depression, anxiety, self-esteem and quality of life (reviews by Fullen et al, 2020;Nimmo-Smith et al, 2020). Although emotion regulation has not been the main focus of any of these treatments, some of them have shown improvements with regard to this construct as well (Morgensterns et al, 2016;Mitchell et al, 2017;Nasri et al, 2020).…”

An Exploratory Investigation of Goal Management Training in Adults With ADHD: Improvements in Inhibition and Everyday Functioning

“…This is also in line with the stated wishes of adults with ADHD, and with findings showing that patients who are offered treatment options in addition to pharmacotherapy are more satisfied with the health services they receive compared to adults without such options ( Solberg et al, 2015 ). Thus, there has been an increasing effort to develop psychologically based treatment alternatives for adults with ADHD ( Kooij et al, 2010 ; Franke et al, 2018 ; Lopez et al, 2018 ; López-Pinar et al, 2018 ; Lam et al, 2019 ; Nimmo-Smith et al, 2020 ), most of which are based on cognitive-behavioral approaches. Findings indicate that such interventions may lead to reductions in core symptoms, and further, that cognitive remediation interventions may specifically improve the ability to organize everyday activities (e.g., Stevenson et al, 2002 ; De Crescenzo et al, 2017 ; Nimmo-Smith et al, 2020 ).…”

“…Thus, there has been an increasing effort to develop psychologically based treatment alternatives for adults with ADHD ( Kooij et al, 2010 ; Franke et al, 2018 ; Lopez et al, 2018 ; López-Pinar et al, 2018 ; Lam et al, 2019 ; Nimmo-Smith et al, 2020 ), most of which are based on cognitive-behavioral approaches. Findings indicate that such interventions may lead to reductions in core symptoms, and further, that cognitive remediation interventions may specifically improve the ability to organize everyday activities (e.g., Stevenson et al, 2002 ; De Crescenzo et al, 2017 ; Nimmo-Smith et al, 2020 ). The evidence in favor of these interventions is, however, still scarce.…”

Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates?

“…Ravi and Khan (2020) hypothesize the association between ADHD and obesity may be caused by disordered eating, especially binge eating (BE). The link between obesity and ADHD is relevant as the management of ADHD, both pharmacological (Cortese, 2020) and non-pharmacological (Nimmo-Smith et al, 2020) may improve the outcome of obesity (Cortese and Castellanos, 2014).…”