An adult with attention-deficit/hyperactivity disorder (ADHD) who takes targeted medication combined with 1-on-1 sessions of CBT (cognitive behavioral therapy) is likely to experience significantly greater improvement of symptoms compared to an ADHD adult patient who only has the medication, according to research published in JAMA (Journal of the American Medical Association), August 25th issue.

The authors wrote:

Approximately 4.4% of adults in the United States have ADHD, which is a disorder characterized by impairing levels of inattention, hyperactivity, and impulsivity. Medications have been the primary treatment; however, many adults with ADHD cannot or will not take medications while others show a poor medication response. Furthermore, those considered responders to medications (i.e., 30% symptom reduction) may continue to experience significant and impairing symptoms. Thus, there is a need for alternative and next-step strategies.

Steven A. Safren, Ph.D., A.B.P.P., Massachusetts General Hospital, Boston, USA and team tested CBT for ADHD in 86 adults patients treated with medication, but who continued to have clinically significant symptoms.

Of the 86 randomized patients, 79 completed treatment and 70 completed the follow-up assessments. The participants were selected randomly into 12 individual sessions of either CBT or relaxation with education support. The study lasted from November 2004 to June 2008, with a follow up through July 2009.

CBT (cognitive behavioral therapy) involved sessions focusing on psycho-education about ADHD and training in:
  • organizing and planning
  • learning skills to reduce distractibility
  • cognitive restructuring (learning to think more adaptively in situations that cause distress)
  • relapse prevention
An assessor rated ADHD symptoms using an ADHD rating scale and Clinical Global Impression scale when the trial started, then at the end of treatment. There were further 6- and 12-month follow-ups.

The study revealed significantly better ADHD rating scale scores and Clinical Global Impression scale scores among the patients who received CBT, compared to those who were assigned to relaxation with educational support.

There was also a greater percentage of responders in the cognitive behavioral therapy condition compared with the relaxation condition, using criteria from both the Clinical Global Impression scale (53% vs. 23%) and the ADHD rating scale (67%vs. 33%).

Self-reported symptoms were also considerable more improved for CBT therapy throughout treatment. Responders and partial responders in the cognitive behavioral therapy condition held on to their gains during the 6 and 12 month periods.

Further researcher is needed to determine whether this CBT intervention might help patients who cannot or will not take ADHD medications, the researchers added.

The authors wrote:

Additionally, because the only other tested treatment is a group intervention, further investigation is needed to examine whether different patients or settings may be more receptive or conducive to an individual vs. a group approach.

"This study suggests that cognitive behavioral therapy for ADHD in adults appears to be a useful and efficacious next step strategy for adults who show continued symptoms despite treatment with medication. Generally, the treatment was well tolerated, with very low drop-out rates, and had positive and sustained effects on ADHD symptoms. Clinical application of these strategies to patients in need is encouraged.

"Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms"
Steven A. Safren, PhD, ABPP; Susan Sprich, PhD; Matthew J. Mimiaga, ScD, MPH; Craig Surman, MD; Laura Knouse, PhD; Meghan Groves; Michael W. Otto, PhD
JAMA. 2010;304(8):875-880. doi:10.1001/jama.2010.1192

Written by Christian Nordqvist