A randomized controlled trial of CBT therapy for adults with ADHD with and without medication

Margaret Weiss, Candice Murray, Michael Wasdell, Brian Greenfield, Lauren Giles, Lily Hechtman, Margaret Weiss, Candice Murray, Michael Wasdell, Brian Greenfield, Lauren Giles, Lily Hechtman

Abstract

Background: Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy.

Method: This was a secondary analysis comparing 23 participants randomized to CBT and Dextroamphetamine vs. 25 participants randomized to CBT and placebo. Both patients and investigators were blind to treatment assignment. Two co-primary outcomes were used: ADHD symptoms on the ADHD-RS-Inv completed by the investigator and improvement in functioning as reported by the patient on the Sheehan Disability Scale.

Results: Both groups showed robust improvement in both symptoms and functioning, but the use of medication did not significantly improve outcome over and above use of CBT and placebo.

Conclusion: This study replicates previous work demonstrating that CBT is an effective treatment for ADHD in adults. Within the limits of this pilot, secondary analysis we were not able to demonstrate that medication significantly augments the outcome of CBT therapy for adults with ADHD. The study was funded by GlaxoSmithKline, Clinical Trials Registry #GSK707.

Figures

Figure 1
Figure 1
Patient Flow.
Figure 2
Figure 2
Treatment Schedule.
Figure 3
Figure 3
ADHD RS-Inv by Time and Treatment.
Figure 4
Figure 4
Sheehan Disability Scale by Time and Treatment.

References

    1. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K. et al.The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–723. doi: 10.1176/appi.ajp.163.4.716.
    1. Faraone SV, Spencer T, Aleardi M, Pagano C, Biederman J. Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2004;24(1):24–29. doi: 10.1097/01.jcp.0000108984.11879.95.
    1. Mick E, Faraone SV, Biederman J. Age-dependent expression of attention-deficit/hyperactivity disorder symptoms. Psychiatr Clin North Am. 2004;27(2):215–224. doi: 10.1016/j.psc.2004.01.003.
    1. Newark PE, Stieglitz RD. Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective. Atten Defic Hyperact Disord. 2010;2(2):59–72. doi: 10.1007/s12402-010-0023-1.
    1. MTA. A 14-month randomized clinical trial of treatment strategies for attention- deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD [see comments] Arch Gen Psychiatry. 1999;56(12):1073–1086. doi: 10.1001/archpsyc.56.12.1073.
    1. Ratey JJ, Greenberg MS, Bemporad JR, Lindem KJ. Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy. J Child Adolesc Psychopharmacol. 1992;2:267–275. doi: 10.1089/cap.1992.2.267.
    1. Safren SA, Otto MW, Sprich S, Winett CL, Wilens TE, Biederman J. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther. 2005;43(7):831–842. doi: 10.1016/j.brat.2004.07.001.
    1. Safren SA, Sprich S, Perlman CA, Otto MW. Mastering your adult ADHD: a cognitive-behavioral treatment program, client workbook. New York: Guilford; 2005.
    1. Wilens T, McDermott S, Biederman J, Abrantes A, Hahesey A, Spencer T. Cognitive therapy in the treatment of adults with ADHD: a systematic chart review of 26 cases. J Cogn Psychother: An International Quarterly. 1999;13(3):215–226.
    1. Wiggins D. et al.Effects of brief group interventions for adults with attention deficit/hyperactivity disorder. J Ment Heal Couns. 1999;21(1):82–92.
    1. Stevenson CS, Whitmont S, Bornholt L, Livesey D, Stevenson RJ. A cognitive remediation programme for adults with attention deficit hyperactivity disorder. Aust N Z J Psychiatry. 2002;36(5):610–616. doi: 10.1046/j.1440-1614.2002.01052.x.
    1. Hesslinger B, van Tebartz EL, Nyberg E, Dykierek P, Richter H, Berner M. et al.Psychotherapy of attention deficit hyperactivity disorder in adults-a pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci. 2002;252(4):177–184.
    1. Bramham J, Young S, Bickerdike A, Spain D, McCartan D, Xenitidis K. Evaluation of group cognitive behavioral therapy for adults with ADHD. J Atten Disord. 2009;12(5):434–441. doi: 10.1177/1087054708314596.
    1. Rostain AL, Ramsay JR. A combined treatment approach for adults with ADHD-results of an open study of 43 patients. J Atten Disord. 2006;10(2):150–159. doi: 10.1177/1087054706288110.
    1. Ramsay JR, Rostain AL. C ognitive behavioral therapy for adult ADHD: an integrative psychosocial and medical approach. New York: Routledge; 2007.
    1. Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M. et al.Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–880. doi: 10.1001/jama.2010.1192.
    1. Young S, Bramham J. ADHD in adults, a psychological guide to practice. Sussex: Wiley and Sons; 2007.
    1. Young SJ, Ross RR. R&R2 for ADHD Youths and Adults with ADHD: A Prosocial Competence Training Program. 2007.
    1. Emilsson B, Gudjonsson G, Sigurdsson JF, Baldursson G, Einarsson E, Olafsdottir H. et al.Cognitive behaviour therapy in medication-treated adults with adhd and persistent symptoms: a randomized controlled trial. BMC Psychiatry. 2011;11(1):116. doi: 10.1186/1471-244X-11-116.
    1. Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JM. et al.Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry. 2010;167(8):958–968. doi: 10.1176/appi.ajp.2009.09081123.
    1. Philipsen A, Graf E, van Tebartz EL, Jans T, Warnke A, Hesslinger B. et al.Evaluation of the efficacy and effectiveness of a structured disorder tailored psychotherapy in ADHD in adults: study protocol of a randomized controlled multicentre trial. Atten Defic Hyperact Disord. 2010;2(4):203–212. doi: 10.1007/s12402-010-0046-7.
    1. Weiss M, Hechtman L. A randomized double-blind trial of paroxetine and/or Dextroamphetamine and problem-focused therapy for attention-deficit/hyperactivity disorder in adults. J Clin Psychiatry. 2006;67(4):611–619. doi: 10.4088/JCP.v67n0412.
    1. Conners CK, Epstein J, Johnson DE. Conners Adult ADHD Diagnostic Interview DSM-IV. Toronto Multi Health Systems; 2004.
    1. Zhang S, Faries DE, Vowles M, Michelson D. ADHD Rating Scale IV: psychometric properties from a multinational study as a clinician-administered instrument. Int J Methods Psychiatr Res. 2005;14(4):186–201. doi: 10.1002/mpr.7.
    1. Conners CK, Erhardt D, Sparrow EP. Conners' adult ADHD rating scales, technical manual. New York: Multi-Health Systems; 1999.
    1. Sheehan DV. The anxiety disease. New York: Charles Scribner and Sons; 1983.
    1. Solanto MV. Cognitive behavior therapy for adult ADHD, targeting executive dysfunction. New York: Guilford; 2011.
    1. Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB. et al.Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry. 2001;40(2):168–179. doi: 10.1097/00004583-200102000-00011.
    1. Conners CK, Epstein JN, March JS, Angold A, Wells KC, Klaric J. et al.Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. [Research Support, U.S. Gov't, P.H.S.] J Am Acad Child Adolesc Psychiatry. 2001;40(2):159–167. doi: 10.1097/00004583-200102000-00010.

Source: PubMed

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