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Adults with attention deficit hyperactivity disorder (ADHD) who receive medication and individual sessions of cognitive behavioral therapy (CBT) show greater improvement in symptoms through 12 months than patients who do not receive CBT, a new study has found [JAMA, 304 (8): 875-880].
Approximately 4.4 percent of adults in the United States have ADHD. However, many adults with ADHD cannot or will not take medications, while others show a poor medication response. Even people who respond to medications may continue to experience significant and impairing symptoms.
Steven Safren, PhD, and colleagues at Massachusetts General Hospital, in Boston, tested CBT for ADHD in 86 adults who were being treated with medication but still had clinically significant symptoms. The study was conducted between November 2004 and June 2008, with follow-up through July 2009. Seventy-nine patients completed treatment, and 70 completed the follow-up assessments. Patients were randomized to 12 individual sessions of CBT or relaxation with educational support.
CBT included sessions that focused on psycho-education about ADHD and training in organizing and planning, learning skills to reduce distractibility, cognitive restructuring and relapse prevention. ADHD symptoms were rated by an assessor using an ADHD rating scale and Clinical Global Impression scale at the beginning of the trial, at the end of treatment, and at six- and 12-month follow-ups.
After treatment was completed, patients who received CBT had significantly better scores on both scales than those who were assigned to relaxation with educational support. There also was a greater proportion of responders in the CBT condition compared with the relaxation condition, using criteria from both the Clinical Global Impression scale (53 percent vs. 23 percent) and the ADHD rating scale (67 percent vs. 33 percent).
Throughout treatment, self-reported symptoms were significantly more improved for CBT. Responders and partial responders in the CBT condition maintained their gains over six and 12 months.
Further study is required to examine whether CBT intervention may be useful for individuals who are unwilling or unable due to medical reasons to take medication for ADHD, the researchers said. "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."
The study suggests CBT for ADHD in adults "appears to be a useful and efficacious next step strategy for adults who show continued symptoms despite treatment with medication," they concluded. "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."
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