Short cognitive behavioral therapy and cognitive training for adults with ADHD - a randomized controlled pilot study

The Effect of 6 weeks Physical Activity on Cognitive Control and Trait Impulsivity in Multi-problem Young Adults: First Findings of an RCT-study

This study aimed to report the effect of a 6-week light-active versus moderate-active physical activity intervention embedded in a multimodal day treatment program on selected measures of cognitive control (i.e., response inhibition, error processing, and cognitive interference) and trait impulsivity. A randomized controlled design was implemented, including male multi-problem young adults (aged 18-27) assigned to either light-active (N = 12) or moderate-active physical activity lessons (N = 11). A repeated measures design was used to examine treatment effects between the two groups over time on response inhibition, error processing, and cognitive interference (measured respectively with a Go/NoGo task, a Flanker task, and the Stroop) and trait impulsivity (measured with the Dutch Baratt Impulsiveness Scale). Cognitive control, but not trait impulsivity, improved over time. Specifically, enhancements in inhibition and reduced cognitive interference were observed after 6 weeks. Error processing did not improve, but we did observe improved performance on an error-processing task. No interaction with physical activity intensity was found, suggesting similar treatment effects regardless of intensity. Results should be interpreted with caution due to several limitations, including the small sample size. Overall, due to current limitations (i.e., physical activity embedded in a larger treatment program, small sample size at follow-up, and low intervention adherence), it is not possible to draw any definite conclusions. However, the current findings contribute to a growing body of evidence suggesting potential benefits of physical activity (embedded in a multi-modal day treatment program) in the enhancement of cognitive control deficits in at-risk populations, independent of exercise intensity.

Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period

Attention-deficit/hyperactivity disorder is a childhood-onset neurodevelopmental disorder that frequently persists into adulthood with 3% of adult women having a diagnosis of attention-deficit/hyperactivity disorder. Many women are diagnosed and treated during their reproductive years, which leads to management implications during pregnancy and the postpartum period. We know from clinical practice that attention-deficit/hyperactivity disorder symptoms frequently become challenging to manage during the perinatal period and require additional support and attention. There is often uncertainty among healthcare providers about the management of attention-deficit/hyperactivity disorder in the perinatal period, particularly the safety of pharmacotherapy for the developing fetus. This guideline is focused on best practices in managing attention-deficit/hyperactivity disorder in the perinatal period. We recommend (1) mitigating the risks associated with attention-deficit/hyperactivity disorder that worsen during the perinatal period via individualized treatment planning; (2) providing psychoeducation, self-management strategies or coaching, and psychotherapies; and, for those with moderate or severe attention-deficit/hyperactivity disorder, (3) considering pharmacotherapy for attention-deficit/hyperactivity disorder, which largely has reassuring safety data. Specifically, providers should work collaboratively with patients and their support networks to balance the risks of perinatal attention-deficit/hyperactivity disorder medication with the risks of inadequately treated attention-deficit/hyperactivity disorder during pregnancy. The risks and impacts of attention-deficit/hyperactivity disorder in pregnancy can be successfully managed through preconception counselling and appropriate perinatal planning, management, and support.

Long-term efficacy of a new 6-session cognitive behavioral therapy for adults with attention-deficit/hyperactivity disorder: A randomized, controlled clinical trial

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects about 2.8 % of the adult population. Cognitive behavioral therapy (CBT) has been demonstrated to be the most effective psychological intervention for ADHD. The aim of this study was to explore the efficacy of a new 6-session CBT program in comparison with a 12-session CBT program for adults with ADHD at short- and long-term.

METHODS

81 adults with ADHD (58 % males; mean age = 41.27±9.26 years old) were randomly assigned to each treatment condition (6- or 12-session CBT). Validated instruments were used to assess ADHD symptoms, comorbidities (anxiety and depression), and functional impairments at post treatment, and at 3- and 6-month follow-up.

RESULTS

A significant improvement in ADHD severity, comorbidities (anxiety and depression) and functional impairments were found in both CBT programs after treatment. Furthermore, this improvement was also reported at 3- and 6-month follow-up.

CONCLUSION

The current study highlights that a 6-session CBT program is as effective as a 12-session CBT program for ADHD improvement at post treatment and follow-up. The newly developed 6-session CBT program can be used to treat a larger number of patients, reducing the financial cost.

Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial

This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).

Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): a meta-analysis of randomized controlled trials with blinded and objective outcomes

This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be "probably blinded" (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[-0.01 to -0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[-0.03 to-0.28]). These findings remained when analyses were restricted to trials (n: 5-13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02-0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04-0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09-0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24-0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31-0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5-15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5-7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.

Effects and feasibility of psychological interventions to reduce inattention symptoms in adults with ADHD: a systematic review

BACKGROUND

Adult ADHD is common, highly comorbid, and restricts daily functioning. However, only a minority of patients receive appropriate treatment.

AIMS

Primary objective: To identify psychological interventions that diminish inattention symptoms in adults with ADHD. Secondary objective: To evaluate feasibility aspects.

METHODS

A search in PubMed, Cochrane Library, PsycInfo, PSYNDEX, and Eric was conducted. Interventions were grouped in: ADHD coaching, neuro feedback, cognitive training, psychoeducation, and behavioral therapy. Inattention symptoms were evaluated using standardized mean differences. Study quality was rated with the Cochrane Risk of Bias tool. Feasibility was assessed by number and time of sessions, setting, and qualification of the provider.

RESULTS

A total of N = 2229 results were identified, 19 randomized controlled studies were included in the analysis. Behavioral therapy showed effects on inattention symptoms [SMD: 0.44-1.71] when compared to inactive controls. In terms of feasibility, longer interventions did not outperform shorter ones and individual sessions were not superior to group sessions. No effects were given for neuro feedback, cognitive training, and psychoeducation in comparison to controls.

CONCLUSION

For adults with ADHD behavioral therapy seems an effective intervention to reduce inattention symptoms. In terms of feasibility, brief interventions may be valuable for a primary care setting.

Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial interindividual heterogeneity that challenges the systematic assessment and treatment. Considering mixed evidence from previous neurofeedback research, we present a novel feedback system that relies on gaze behavior to detect signs of inattention while performing a neuropsychological attention task in a virtual seminar room. More specifically, an audiovisual feedback was given whenever participants averted their gaze from the given task.

METHODS

Eighteen adults with ADHD and 18 healthy controls performed a continuous performance task (CPT) in virtual reality under three counterbalanced conditions in which either gaze-based feedback, sham feedback, or no feedback was provided. In all conditions, phases of high and low virtual distraction alternated. CPT errors and reaction times, proportions of gaze dwell times (e.g., task focus or distraction focus), saccade characteristics, EEG theta/beta ratios, head movements, and an experience sampling of ADHD symptoms were analyzed.

RESULTS

While patients can be discriminated well from healthy controls in that they showed more omission errors, higher reaction times, higher distraction-related dwell times, and more head movements, the feedback did not immediately improve task performance. It was also indicated that sham feedback was rather associated with an aggravation of symptoms in patients.

CONCLUSIONS

Our findings demonstrate sufficient suitability and specificity for this holistic ADHD symptom assessment. Regarding the feedback, a single-session training was insufficient to achieve learning effects based on the proposed metacognitive strategies. Future longitudinal, multi-session trials should conclusively examine the therapeutic efficacy of gaze-based virtual reality attention training in ADHD.

TRIAL REGISTRATION

drks.de (identifier: DRKS00022370).

Efficacy of cognitive behavioural therapy in medicated adults with attention-deficit/hyperactivity disorder in multiple dimensions: a randomised controlled trial

The study aimed to evaluate the efficacy of group cognitive behavioural therapy (CBT) in medicated adults with attention-deficit/hyperactivity disorder (ADHD) with a multidimensional evaluation and follow-up to week 36. Ninety-eight adult ADHD were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M) only group. The primary endpoint was the ADHD-Rating Scale (ADHD-RS). Secondary endpoints included emotional symptoms, self-esteem, automatic thoughts, quality of life (QoL), and executive function (EF). The outcome measures were obtained at baseline (T1), after the 12-week CBT treatment (T2), and at two follow-up time points (week 24, T3, and week 36, T4). Compared to the M-only group, the patients in the CBT + M group showed an overall significantly greater reduction from baseline in ADHD core symptoms (ADHD-RS total score at T3, and inattention subscale at T2 and T3), depression and anxiety symptoms (T2-T4), state anxiety (T2 and T3) and trait anxiety (T2), automatic thoughts questionnaire at T3, and QoL (physical domain, psychological domain, and social domain, most significant at T3 and weakened at T4). These findings further confirmed the efficacy of CBT on multiple dimensions and verified improvements in automatic thinking in adult ADHD. The superiority of the combination treatment mainly manifested in reduced inattention, emotional symptoms, and maladaptive thoughts and improved QoL. Trial registration number ChiCTR1900021705 (March-05-2019).

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

BACKGROUND

The present meta-analysis aimed to evaluate the efficacy of various non-pharmacological interventions on comorbid emotional symptoms such as depression, anxiety, and emotional dysregulation (ED) in children and adults with ADHD.

METHOD

Forty-four randomized controlled trials (23 studies with ADHD children and 21 studies with ADHD adults) were included. Risk of bias, heterogeneity assessment, and subgroup analyses were conducted.

RESULTS

We found that therapies targeting the relationship between children and others (i.e., parent-training [on ED and depression] and social skills training [on ED]) were efficacious in the treatment of emotional symptoms in children with ADHD at post-intervention. As for adults with ADHD, cognitive behavioral therapy was found to be effective for the improvement of emotional symptoms at both post-intervention and follow-up.

CONCLUSION

Our findings demonstrate that the efficacy of non-pharmacological interventions varies substantially across children and adults with ADHD. These results provide important implications for the selection of non-pharmacological interventions for children with ADHD.

The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To systematically review the literature on published randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) for adult ADHD and to establish the effectiveness of CBT in reducing ADHD symptoms. Method: A systematic review of nine RCTs and two subsequent meta-analyses of eight of the studies were conducted. Results: Just nine studies were identified, of generally good quality but with some limitations. Four trials (total N = 160) compared CBT with waiting list controls, and three trials (total N = 191) compared CBT with appropriate active control groups. Meta-analyses showed that CBT was superior to waiting list with a moderate to large effect size (standardized mean difference [SMD] = 0.76, 95% confidence interval [CI] [0.21, 1.31], p = .006) and superior to active control groups with a small to moderate effect size (SMD = 0.43, 95% CI [0.14, 0.71], p = .004). Conclusion: These results give support to the efficacy of CBT in reducing symptoms of ADHD post-intervention.

Non-pharmacological interventions for adult ADHD: a systematic review

BACKGROUND

Attention-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.

METHODS

We 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.

RESULTS

There were 32 eligible studies with the largest number of studies assessing cognitive behavioural therapy (CBT). CBT consisted of either group, internet or individual therapy.

CONCLUSIONS

The 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.

Non-pharmacological interventions for cognitive difficulties in ADHD: A systematic review and meta-analysis

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and is associated with significant risk of educational failure, interpersonal problems, mental illness, and delinquency. Despite a number of comparative and comprehensive reviews on the effects of ADHD treatments on ADHD core symptoms, evidence synthesizing the effects of ADHD interventions on cognitive difficulties is limited. In this meta-analysis, the neuropsychological effects of non-pharmacological interventions for ADHD were examined across studies published between 1980 and 2017. Data were extracted from studies that used objective cognitive measures (either computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare the effectiveness across these interventions. Publication bias was assessed, as well as quality of the evidence, using Cochrane risk of bias tool for randomized control trials studies. Our final meta-analysis included 18 studies with interventions that were categorized into four categories: neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises. Physical exercises demonstrated the highest average effect size (Morris d = 0.93). A further evaluation of cognitive functions yielded 49 effect sizes for the five categories, including attention, inhibition, flexibility, and working memory. Analyses demonstrated a homogenous, medium to large, effect size of improvement across interventions, with inhibition demonstrating the largest average effect size (Morris d = 0.685). This study highlights the positive effect of psychological interventions on ADHD cognitive symptomology and supports the inclusion of non-pharmacological interventions in conjunction with the commonly used pharmacological treatments.

A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with attention-deficit/hyperactivity disorder (ADHD)

The study aimed to explore whether cognitive behavioral therapy (CBT) combined with medication is superior to CBT alone in core symptoms, emotional symptoms, self-esteem as well as social and cognitive functions of adult attention-deficit/hyperactivity disorder (ADHD) patients. Samples from a previous RCT study and outpatient participants were all included. A total of 124 patients received 12 weeks of manualized CBT sessions, either with (n = 57) or without (n = 67) medication. Efficacy variables were evaluated at baseline and each week. Mixed linear models (MLM) were used to compare differences between the two groups in all of the above domains. Within-group comparisons showed that both groups had robust improvements in core ADHD symptoms, emotional symptoms and social functional outcomes. The CBT + M group presented more domains of improvement in executive functions than the CBT group. However, comparisons between groups didn't indicate the superiority of CBT + M in core symptoms, emotional symptoms and self-esteem. Instead, the CBT group showed a greater improvement in the physical domain of the WHOQOL-BREF than the CBT + M group. This study further indicated that CBT is an effective treatment for adults with ADHD. A combination of CBT and medication presented broader improvements in executive functions, but not in clinical symptoms, than CBT alone.

Cognitive-Behavioral Therapy for Adult ADHD: A Randomized Clinical Trial in China

OBJECTIVE

Cognitive-behavioral therapy (CBT) is effective for adult ADHD, and booster sessions may improve long-term outcome. This study was designed to investigate the effects of group CBT and its booster sessions for Chinese adult patients with ADHD.

METHOD

There were CBT only group ( n = 43), CBT +booster group ( n = 43), and control group with patients on the waiting list ( n = 22). The primary outcome was the score of the ADHD-Rating Scale (ADHD-RS). Secondary outcomes included emotion, executive function (EF), impulsivity, self-esteem, and life quality at 12th and 24th week.

RESULTS

At 12th week, the score of ADHD-RS, EF, and impulsivity showed significant improvement in CBT +booster group comparing with control group. At 24th week, differences between CBT only group and CBT +booster group were not significant.

CONCLUSION

CBT was effective for Chinese adult patients with ADHD. Booster sessions do not appear to provide additional benefits.

Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a developmental condition characterised by symptoms of inattention, hyperactivity and impulsivity, along with deficits in executive function, emotional regulation and motivation. The persistence of ADHD in adulthood is a serious clinical problem.ADHD significantly affects social interactions, study and employment performance.Previous studies suggest that cognitive-behavioural therapy (CBT) could be effective in treating adults with ADHD, especially when combined with pharmacological treatment. CBT aims to change the thoughts and behaviours that reinforce harmful effects of the disorder by teaching people techniques to control the core symptoms. CBT also aims to help people cope with emotions, such as anxiety and depression, and to improve self-esteem.

OBJECTIVES

To assess the effects of cognitive-behavioural-based therapy for ADHD in adults.

SEARCH METHODS

In June 2017, we searched CENTRAL, MEDLINE, Embase, seven other databases and three trials registries. We also checked reference lists, handsearched congress abstracts, and contacted experts and researchers in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating any form of CBT for adults with ADHD, either as a monotherapy or in conjunction with another treatment, versus one of the following: unspecific control conditions (comprising supportive psychotherapies, no treatment or waiting list) or other specific interventions.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures suggested by Cochrane.

MAIN RESULTS

We included 14 RCTs (700 participants), 13 of which were conducted in the northern hemisphere and 1 in Australia.Primary outcomes: ADHD symptomsCBT versus unspecific control conditions (supportive psychotherapies, waiting list or no treatment)- CBT versus supportive psychotherapies: CBT was more effective than supportive therapy for improving clinician-reported ADHD symptoms (1 study, 81 participants; low-quality evidence) but not for self-reported ADHD symptoms (SMD -0.16, 95% CI -0.52 to 0.19; 2 studies, 122 participants; low-quality evidence; small effect size).- CBT versus waiting list: CBT led to a larger benefit in clinician-reported ADHD symptoms (SMD -1.22, 95% CI -2.03 to -0.41; 2 studies, 126 participants; very low-quality evidence; large effect size). We also found significant differences in favour of CBT for self-reported ADHD symptoms (SMD -0.84, 95% CI -1.18 to -0.50; 5 studies, 251 participants; moderate-quality evidence; large effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: CBT with pharmacotherapy was more effective than pharmacotherapy alone for clinician-reported core symptoms (SMD -0.80, 95% CI -1.31 to -0.30; 2 studies, 65 participants; very low-quality evidence; large effect size), self-reported core symptoms (MD -7.42 points, 95% CI -11.63 points to -3.22 points; 2 studies, 66 participants low-quality evidence) and self-reported inattention (1 study, 35 participants).CBT versus other interventions that included therapeutic ingredients specifically targeted to ADHD: we found a significant difference in favour of CBT for clinician-reported ADHD symptoms (SMD -0.58, 95% CI -0.98 to -0.17; 2 studies, 97 participants; low-quality evidence; moderate effect size) and for self-reported ADHD symptom severity (SMD -0.44, 95% CI -0.88 to -0.01; 4 studies, 156 participants; low-quality evidence; small effect size).Secondary outcomesCBT versus unspecific control conditions: we found differences in favour of CBT compared with waiting-list control for self-reported depression (SMD -0.36, 95% CI -0.60 to -0.11; 5 studies, 258 participants; small effect size) and for self-reported anxiety (SMD -0.45, 95% CI -0.71 to -0.19; 4 studies, 239 participants; small effect size). We also observed differences in favour of CBT for self-reported state anger (1 study, 43 participants) and self-reported self-esteem (1 study 43 participants) compared to waiting list. We found no differences between CBT and supportive therapy (1 study, 81 participants) for self-rated depression, clinician-rated anxiety or self-rated self-esteem. Additionally, there were no differences between CBT and the waiting list for self-reported trait anger (1 study, 43 participants) or self-reported quality of life (SMD 0.21, 95% CI -0.29 to 0.71; 2 studies, 64 participants; small effect size).CBT plus pharmacotherapy versus pharmacotherapy alone: we found differences in favour of CBT plus pharmacotherapy for the Clinical Global Impression score (MD -0.75 points, 95% CI -1.21 points to -0.30 points; 2 studies, 65 participants), self-reported depression (MD -6.09 points, 95% CI -9.55 points to -2.63 points; 2 studies, 66 participants) and self-reported anxiety (SMD -0.58, 95% CI -1.08 to -0.08; 2 studies, 66 participants; moderate effect size). We also observed differences favouring CBT plus pharmacotherapy (1 study, 31 participants) for clinician-reported depression and clinician-reported anxiety.CBT versus other specific interventions: we found no differences for any of the secondary outcomes, such as self-reported depression and anxiety, and findings on self-reported quality of life varied across different studies.

AUTHORS' CONCLUSIONS

There is low-quality evidence that cognitive-behavioural-based treatments may be beneficial for treating adults with ADHD in the short term. Reductions in core symptoms of ADHD were fairly consistent across the different comparisons: in CBT plus pharmacotherapy versus pharmacotherapy alone and in CBT versus waiting list. There is low-quality evidence that CBT may also improve common secondary disturbances in adults with ADHD, such as depression and anxiety. However, the paucity of long-term follow-up data, the heterogeneous nature of the measured outcomes, and the limited geographical location (northern hemisphere and Australia) limit the generalisability of the results. None of the included studies reported severe adverse events, but five participants receiving different modalities of CBT described some type of adverse event, such as distress and anxiety.

Cognitive-behavioural therapy for adult attention-deficit hyperactivity disorder: a proof of concept randomised controlled trial

OBJECTIVE

To investigate efficacy, patient acceptability and feasibility of formulation-based cognitive-behavioural therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD). NICE guidelines for adult ADHD recommend further research into psychological treatments.

METHOD

Sixty participants with adult ADHD were randomly allocated to treatment as usual (TAU) vs. TAU plus up to 16 sessions of individual formulation-based CBT for ADHD.

RESULTS

Adding formulation-based CBT to TAU for ADHD significantly improved ADHD symptoms on the Barkley Current Symptoms Scale and scores on the Work and Social Adjustment Scale. Adjusted effect sizes (ES) were 1.31 and 0.82 respectively. There were also significant improvements on secondary outcomes including independently evaluated clinical global improvement, self-rated anxiety, depression, global distress and patient satisfaction (adjusted effect sizes 0.52-1.01).

CONCLUSIONS

This is the first randomised controlled trial to provide preliminary evidence of efficacy and acceptability of individual formulation-based CBT for ADHD when added to TAU over TAU alone. This approach now needs to be tested in a larger multicentred randomised controlled trial.

The Efficacy of Computerized Cognitive Training in Adults With ADHD: A Randomized Controlled Trial

OBJECTIVE

This is a randomized control trial examining the efficiency of computerized cognitive training (CCT) for adults with ADHD, comparing two training conditions with graded levels of executive cognitive demands.

METHOD

Adults with ADHD (n = 60) were randomized into study (n = 34) and control (n = 26) groups. Training was conducted with the computerized AttenFocus program. Control group received a simple, non-hierarchical version with less executive demands.

RESULTS

Significant positive changes in symptoms ratings, ecological measures of executive functions, and occupational performance were found in both groups. No significant changes were found in variables of neurocognitive performance battery and quality of life. No significant time by group interaction effects were found.

CONCLUSION

No benefits of the intervention were found relative to the control. Lack of interaction effects may be due to insufficient power, non-specific cognitive training or placebo effects. Results demonstrate some positive findings for general CCT, yet do not support the inclusion of specific higher level executive training.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l’adulte

Introduction Le trouble déficitaire de l’attention avec ou sans hyperactivité (TDA/H) affecte environ 2,5 % de la population adulte mondiale. L’impact sur la vie des individus atteints est important, engendrant fréquemment des difficultés académiques, professionnelles, sociales et émotionnelles. Malgré le caractère invalidant de ce trouble, peu d’individus souffrant de ce déficit reçoivent une aide appropriée. De plus, bien que longtemps considérée comme la seule option envisageable, il est aujourd’hui reconnu que la psychopharmacologie est rarement suffisante à elle seule. Dans cette optique, la thérapie cognitive-comportementale (TCC) s’avère une approche prometteuse.

Objectif L’objectif de cette étude est d’effectuer une revue de la documentation scientifique et d’évaluer quantitativement l’efficacité de la TCC, dans la réduction des symptômes associés au TDA/H et des manifestations anxieuses et dépressives comorbides chez l’adulte, à travers plusieurs études, par l’entremise d’une méta-analyse.

Méthode Les études incluses dans cette méta-analyse ont été publiées entre 1946 et 2015, et recensées dans des bases de données électroniques, notamment MEDLINE, EMBASE et PsycINFO. Un modèle à effets aléatoires, les rapports des cotes et les g de Hedges ont été utilisés.

Résultats Les données de 12 études contrôlées randomisées ont été incluses dans cette recherche, totalisant 575 participants. Les résultats démontrent que la TCC est significativement plus efficace que les groupes de comparaison quant à l’amélioration des symptômes du TDA/H (g de Hedges = 0,95), de la symptomatologie anxieuse (g de Hedges = 0,39) et dépressive (g de Hedges = 0,30). Suite à la cessation du traitement, seuls les symptômes du TDA/H continuent de s’améliorer.

Conclusion En somme, cette étude met en lumière les résultats encourageants de la TCC dans le traitement du TDA/H chez l’adulte.

Optimal management of ADHD in older adults

BACKGROUND

The manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed.

METHOD

A systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years.

RESULTS

ADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered.

CONCLUSION

It is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk-benefit ratio when pharmacotherapy is considered to be a possible treatment.

Cognitive-Behavioral Therapy for Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that regularly persists into adulthood and is associated with a number of maladaptive functional outcomes. Cognitive-behavioral therapy (CBT) is an empirically based treatment that has demonstrated effects on core ADHD symptoms and related impairments in adult samples. One manualized CBT in particular is proposed to target both core symptoms of ADHD and underlying executive functioning (EF) deficits. Targeting underlying dysfunction is important to ongoing treatment development efforts and may enhance efficacy. This manualized CBT was developed for groups. The aims of this case study were twofold. First, we adapted a manualized group-based CBT for adult ADHD for an individual format. Second, we discuss a case study to exemplify how clinicians can measure and track EF symptoms in a clinic setting using a multi-method approach. Self-report and collateral-report questionnaire data provided initial support for adaptation of Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction to an individual format. Outcome data were more limited with cognitive test scores. The discrepancy between questionnaire and cognitive test data along with the complications observed at 2-month follow up are discussed.

“Turning Intentions Into Actions”

Contemporary models of attention-deficit/hyperactivity disorder (ADHD) provide frameworks for understanding this condition that move beyond the diagnostic symptom criteria. ADHD is currently viewed as a developmental syndrome of impaired self-regulatory processes that underlie the common symptoms and functional problems. Most clinic-referred adults with ADHD report chronic difficulties executing their intended plans despite recognizing the negative consequences for not doing so. Seeing as the psychosocial treatments for adult ADHD intervene at the level of life impairments and functioning, it is important that interventions directly target these implementation problems. The goal of this article is to discuss the case of a young woman with ADHD who has difficulties engaging in the various tasks she needs to perform to pursue her post-college goals. In particular, a cognitive-behavioral therapy approach that emphasizes implementation strategies designed to help adults with ADHD follow through on their plans is illustrated.

The impact of hypnotic suggestions on reaction times in continuous performance test in adults with ADHD and healthy controls

Attention is one of the key factors in both hypnotic processes and patients with ADHD. In addition, the brain areas associated with hypnosis and ADHD overlap in many respects. However, the use of hypnosis in ADHD patients has still received only minor attention in research. The main purpose of the present work was to investigate whether hypnosis and hypnotic suggestions influence the performance of adult ADHD (n = 27) and control participants (n = 31) in the continuous performance test (CPT). The hypnotic susceptibility of the participants was measured by the Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A) and the attentional task was a three minute long auditory version of the CPT. The CPT task was administered four times: before hypnosis (CPT1), after a hypnotic induction (CPT2), after suggestions about speed and accuracy (CPT3), and after the termination of hypnosis (CPT4). The susceptibility of the groups measured by HGSHS:A did not differ. There was a statistically significant decrease in reaction times in both ADHD and control groups between CPT2 and CPT3. The differences between CPT1 and CPT2, even though non-significant, were different in the two groups: in the ADHD group reaction times decreased whereas in the control group they increased. Both groups made very few errors in the short CPT. This study indicates that hypnotic suggestions have an effect on reaction times in the sustained attention task both in adult ADHD patients and control subjects. The theoretical and clinical implications are discussed.

Cognitive behavioral therapy for adults with attention-deficit hyperactivity disorder: study protocol for a randomized controlled trial

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is a mental disorder beginning in childhood, and about half of patients have symptoms lasting into adulthood. Adult ADHD causes various impairments of emotional, self-esteem, and executive function and life quality aspects. Furthermore, adverse outcomes include academic and occupational failures, traffic accidents and substance abuse, which would be a family and social burden. A combination of medication and psychotherapy is recommended as the treatment for adult ADHD, and cognitive behavioral therapy (CBT) has been validated mostly with evidence-based researches. However, there has been a lack of randomized controlled trials of CBT for patients in China. Moreover, booster sessions of CBT for other disorders have proven effective in reducing recurrence and improving long-term outcomes, which has not been investigated for adult ADHD. This study will testify to the effect of CBT and explore the efficacy of subsequent booster sessions on adult ADHD.

METHODS/DESIGN

It is a three-armed randomized controlled trial to evaluate the efficacy of 12 weeks of CBT based on the published and validated manual and its booster sessions. The 12 weeks of CBT will be conducted weekly and will end at the 12th week, and then the booster sessions will be conducted monthly and end at the 24th week. There are three randomized groups, including a CBT with booster sessions group, a CBT group and a waiting group. Participants are outpatients of the Peking University Sixth Hospital who are diagnosed as having adult ADHD. The Primary efficacy endpoints are the scores of ADHD core symptoms at 12 and 24 weeks. Secondary endpoints include emotion, executive function, self-esteem, life quality and functional magnetic resonance imaging (fMRI) data at different time points, and the change within every group will also be analyzed.

DISCUSSION

This is the first study to explore the efficacy of booster sessions of CBT in adult ADHD as far as we know. The results might increase proof of efficacy of CBT for adult ADHD in China, and the results showing efficacy of the booster sessions would also benefit our clinical practice.

TRIAL REGISTRATION

Current Controlled Trials: NCT02062411, date of registration: 12 February 2014.

Psychosocial interventions in attention-deficit/hyperactivity disorder: update

Attention-deficit/hyperactivity disorder (ADHD) is the most common reason for referral to child and adolescent psychiatry clinics. Although stimulant medications represent an evidence-based approach to managing ADHD, psychosocial interventions for child/adolescent ADHD target functional impairments as the intervention goal, and rely heavily on behavioral therapy techniques and operant conditioning principles. Evidence-based psychosocial interventions for managing pediatric ADHD include behavioral parent training, school-based interventions relying on behavioral modification, teaching skills, and operant conditioning principles, and intensive summer treatment programs. The use of conjoint psychosocial treatments with ADHD medications may enable lower doses of each form of treatment.

Cognitive behavioral therapy for adolescents with ADHD

Attention deficit/hyperactivity disorder (ADHD) often persists into adolescence and has the same functional impairments as were present during childhood. Medications lessen ADHD symptoms yet do not reliably affect functioning. Thus, there exists a great need for psychosocial treatments in adolescents with ADHD. Nonetheless, relative to the vast literature that has been reported on children with ADHD, much less data have been reported about psychosocial interventions for adolescents with ADHD. Cognitive behavioral therapy interventions that are being used with adolescents rely more on traditional behavioral principles than cognitive therapy tenets.

Protocol for a proof of concept randomized controlled trial of cognitive-behavioural therapy for adult ADHD as a supplement to treatment as usual, compared with treatment as usual alone

BACKGROUND

ADHD is prevalent in adults and frequently associated with impairment and distress. While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone, cannot tolerate medication or do not wish to take it. Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option. To date, individual cognitive-behaviour therapy (CBT) has been found to be efficacious in three randomized controlled trials (RCTs). There is a need for more RCTs to be carried out in order to replicate these results in different sites, to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model. This randomized controlled trial investigates the efficacy of individual, formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone.

METHODS/DESIGN

Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to 1 of 2 treatments, 'Treatment as Usual' (TAU) or TAU plus 16 sessions individual CBT (TAU + CBT). In the TAU + CBT, the first 15 sessions take place over 30 weeks with a 16th 'follow-up' session at 42 weeks. Outcomes are assessed at 30 weeks and 42 weeks following randomization. The two primary outcomes are self-rated ADHD symptoms and functioning (occupational and social). Secondary outcomes include distress, mood, ADHD-related cognitions, ADHD-related behaviours and informant-rated ADHD symptoms. The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments. Secondary outcomes will be analysed similarly.

DISCUSSION

The results of the study will provide information about a) whether CBT adds benefit over and above TAU for ADHD and, b) if CBT is found to be efficacious, potential mechanisms of change and predictors of efficacy.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN03732556, assigned 04/11/2010.

Psychotherapy for adult attention deficit/hyperactivity disorder: a comparison with cognitive behaviour therapy

Attention deficit/hyperactivity disorder (ADHD), a disorder generally associated with children, has become a valid disorder for adults in the last decade. The first line treatment of adult ADHD is medications, but historically there have been limitations to medication as the only treatment. Psychotherapy has become a feasible modality in the treatment of ADHD for those who have residual symptoms. The aim of this review of literature is to compare cognitive behaviour therapy with other psychotherapeutic treatment for effectiveness in improving symptoms of ADHD in adults and adolescences. The evidence-based practice approach by Stillwell et al. is adopted to guide the systematic review. The use of this small evidence utilization project that led to a synthesis of available research will provide direction for future research and expand knowledge in treatment for adult ADHD.

Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: a randomized controlled pilot study

The aim of the present study was to assess the efficacy of psychoeducation as compared with cognitive behavioral group therapy in adults with attention deficit hyperactivity disorder (ADHD) who still had significant symptoms and were in pharmacological treatment. This is the first study on psychoeducation in adults with ADHD. Thirty-two individuals were randomized to two treatment conditions: 15 were in the psychoeducation group and 11 were in the cognitive behavioral group therapy. A total of 30 completed treatment, and 26 completed the follow-up assessments. The results indicated that both treatments were associated with statistically significant improvements on inattention, hyperactivity, impulsivity, and self-esteem. The patients in both groups showed a decrease in anxiety symptoms and obtained significantly lower scores in depression. Measures on functional impairment showed statistically significant differences on improved quality of life and on lower global severity as perceived in self-report and assessed by clinician report. Psychoeducation demonstrated to be an effective treatment in reducing ADHD core symptoms.

Psychosocial therapy in the treatment of adults with attention-deficit/hyperactivity disorder

Optimal management of attention-deficit/hyperactivity disorder (ADHD) requires a comprehensive treatment approach that reduces symptoms and improves quality of life. Psychosocial therapy, an important adjunct to pharmacotherapy for patients with ADHD, enables patients to improve functional performance across domains of life and maximizes the benefits of symptom reduction achieved via medication. This article evaluates the main types of psychosocial therapies used in the treatment of adult ADHD and discusses treatment goals within the context of skill acquisition and strength optimization. Factors influencing the success of psychosocial therapy and the role of a comprehensive treatment approach are also examined. The sequenced presentation of symptom reduction and skill acquisition plays a key role in coordinating psychosocial therapy and pharmacotherapy in a multimodal strategy for the effective treatment of adult ADHD.

Psychotherapy in adult attention deficit hyperactivity disorder: implications for treatment and research

Attention deficit hyperactivity disorder (ADHD) is a risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Previous trials of psychotherapeutic programs for adult ADHD were based on cognitive behavioral psychotherapeutic approaches and showed significant effects. Targets of psychotherapeutic interventions include not only coping with the core symptoms and associated problems such as depression and anxiety, but also probable consequences such as low self-esteem. Improvements in ADHD symptomatology and associated symptoms have been reported after psychotherapeutic treatment. The support of other participants is strongly regarded as helpful by patients in group therapy. This manuscript provides an overview of psychotherapy approaches and results of studies evaluating programs developed to treat adults with ADHD. Finally, the specific requirements of psychotherapy for adult ADHD as well as further research questions will be discussed.

Assessing treatment outcomes in attention-deficit/hyperactivity disorder: a narrative review

OBJECTIVE

To review measures used to assess treatment response in patients with attention-deficit/hyperactivity disorder (ADHD) across the life span.

DATA SOURCES

Keyword searches of English-language articles in the PubMed database up to and including the May 4, 2011, index date were performed with the search strings (1) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (outcome assessment [MeSH] OR adaptation of life skills OR executive function [MeSH]) and (2) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (function OR functioning OR quality of life [MeSH]).

STUDY SELECTION

Articles found through this search were then selected based on relevance to the topic area; no specific quality criteria were applied.

DATA EXTRACTION

Narrative review.

RESULTS

The vast majority of studies assessing ADHD treatments have measured treatment response using ADHD symptom measures. Additional domains relevant for assessing treatment response among children and adults with ADHD include functional impairment, quality of life, adaptive life skills, and executive function. Validated rating scales exist for assessing these additional domains, but there has been minimal research evaluating the sensitivity of these instruments for detecting treatment response in pediatric and adult samples.

CONCLUSIONS

Assessment of treatment outcomes in ADHD should move beyond symptom assessment to incorporate measures of functioning, quality of life, adaptive skills, and executive function, especially when assessing long-term treatment response. The authors recommend a potential battery and schedule of measures that could be used to more comprehensively assess treatment response in patients with ADHD.

Cognitive behavior therapy for adults with attention-deficit/hyperactivity disorder: a review of recent randomized controlled trials

To review the efficacy of cognitive behavioral therapy for adults with attention deficit hyperactivity disorder. Recent, controlled studies of the efficacy of Cognitive Behavior Therapy (CBT) treatment in adults with ADHD are reviewed. CBT is a feasible and acceptable treatment strategy in medicated adults with ADHD that leads to improvement in ADHD symptoms and co-morbid problems. CBT includes delivery of cognitive and/or emotional strategies to individuals or groups of 4 to 10 participants. The number of CBT sessions may vary from 6 to 14. Blinding may help reduce response bias. Coaching and homework may enhance motivation as well as help in generalizing strategies to patient's daily lives. Outcomes studied include participants' self-reports of symptoms and evaluator reports based on standardized measures of ADHD and its comorbidities. CBT is an effective treatment for adults with ADHD particularly when combined with medication.

Cognitive control in adults with attention-deficit/hyperactivity disorder

The objective of the present study was to investigate the ability of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) to direct their attention and exert cognitive control in a forced instruction dichotic listening (DL) task. The performance of 29 adults with ADHD was compared with 58 matched controls from the Bergen Dichotic Listening Database (N>1500). Participants in the Bergen DL task listen to and report from conflicting consonant-vowel combinations (two different syllables presented simultaneously, one to each ear). They are asked to report the syllable they hear (non-forced condition), or to focus and report either the right- or left-ear syllable (forced-right and forced-left condition). This procedure is presumed to tap distinct cognitive processes: perception (non-forced condition), orienting of attention (forced-right condition), and cognitive control (forced-left condition). Adults with ADHD did not show significant impairment in the conditions tapping perception and attention orientation, but were significantly impaired in their ability to report the left-ear syllable during the forced-left instruction condition, whereas the control group showed the expected left-ear advantage in this condition. This supports the hypothesis of a deficit in cognitive control in the ADHD group, presumably mediated by a deficit in a prefrontal neuronal circuitry. Our results may have implications for psychosocial adjustment for persons with ADHD in educational and work environments.

Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) in adulthood is not fully treated by psychopharmacological treatment alone. The main aim of the current study was to evaluate a newly developed cognitive behaviour therapy (CBT) based group programme, the Reasoning and Rehabilitation for ADHD Youths and Adults (R&R2ADHD), using a randomized controlled trial.

METHODS

54 adults with ADHD already receiving psychopharmacological treatment were randomly allocated to an experimental (CBT/MED) treatment condition (n = 27) and a 'treatment as usual' (TAU/MED) control condition (n = 27) that did not receive the CBT intervention. The outcome measures were obtained before treatment (baseline), after treatment and at three month follow-up and included ADHD symptoms and impairments rated by independent assessors, self-reported current ADHD symptoms, and comorbid problems.

RESULTS

The findings suggested medium to large treatment effects for ADHD symptoms, which increased further at three month follow-up. Additionally, comorbid problems also improved at follow-up with large effect sizes.

CONCLUSIONS

The findings give support for the effectiveness of R&R2ADHD in reducing ADHD symptoms and comorbid problems, an improving functions associated with impairment. The implications are that the benefits of R&R2ADHD are multifaceted and that combined psychopharmacological and CBT based treatments may add to and improve pharmacological interventions.

TRIAL REGISTRATION

ACTRN12611000533998 (http://www.ANZCTR.org.au/ACTRN12611000533998.aspx).