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Evidence summaries

Cognitivebehavioural Interventions for Attention Deficit Hyperactivity Disorder (ADHD) in Adults

Cognitive-behavioural-based treatments may be beneficial for treating the core symptoms of adults with ADHD in the short term. Level of evidence: "A"

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in treatments, controls and outcomes) and indirectness (short follow-up time)

Summary

A Cochrane review [Abstract] 1 included 14 studies with a total of 700 adults. The studies lasted from 8 to 15 weeks.

Primary outcomes: ADHD symptoms

  • CBT vs. unspecific control conditions (supportive psychotherapies, waiting list or no treatment)
    • CBT vs. supportive psychotherapies: CBT was more effective than supportive therapy for improving clinician-reported ADHD symptoms (1 study, n=81) but not for self-reported ADHD symptoms (SMD −0.16, 95% CI −0.52 to 0.19; 2 studies, n=122).
    • CBT vs. 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, n=126). 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, n=251).
    • CBT plus pharmacotherapy vs. 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, n=65), self-reported core symptoms (MD −7.42 points, 95% CI −11.63 points to −3.22 points; 2 studies, n= 66) and self-reported inattention (1 study, n=35).
    • CBT vs. other interventions that included therapeutic ingredients specifically targeted to ADHD: There was a significant difference in favour of CBT for clinician-reported ADHD symptoms (SMD −0.58, 95% CI −0.98 to −0.17; 2 studies, n=97) and for self-reported ADHD symptom severity (SMD −0.44, 95% CI −0.88 to −0.01; 4 studies, n=156).

Secondary outcomes

  • CBT vs. unspecific control conditions: There were differences in favour of CBT vs. waiting-list control for self-reported depression (SMD −0.36, 95% CI −0.60 to −0.11; 5 studies, n=258) and for self-reported anxiety (SMD −0.45, 95% CI −0.71 to −0.19; 4 studies, n=239). There were also differences in favour of CBT for self-reported state anger (1 study, n=43) and self-reported self-esteem (1 study, n=43) vs. waiting list. There were no differences between CBT and supportive therapy (1 study, n=81) for self-rated depression, clinician-rated anxiety or self-rated self-esteem. Also, there were no differences between CBT and the waiting list for self-reported trait anger (1 study, n=43) or self‐reported quality of life (SMD 0.21, 95% CI −0.29 to 0.71; 2 studies,n=64).
  • CBT plus pharmacotherapy vs. pharmacotherapy alone: There were 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, n=65), self‐reported depression (MD −6.09 points, 95% CI −9.55 points to −2.63 points; 2 studies, n=66) and self-reported anxiety (SMD −0.58, 95% CI −1.08 to −0.08; 2 studies, n=66 participants). We also observed differences favouring CBT plus pharmacotherapy (1 study, n=31) for clinician-reported depression and clinician-reported anxiety.
  • CBT vs. other specific interventions: There were 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.

Clinical comments

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