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Cited by 374Attention Deficit Hyperactivity DisorderSubstance Abuse Treatment and OutcomesBehavioral and Psychological Studies

Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms

Open access
Safren, Steven A., Sprich, Susan, Mimiaga, Matthew J., Surman, Craig, Knouse, Laura, Groves, Meghan, Otto, Michael W.·2010·JAMA
DOI 10.1001/jama.2010.1192PMC PMC3641654
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Abstract

CONTEXT: Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. OBJECTIVE: To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. DESIGN, SETTING, AND PATIENTS: Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. INTERVENTIONS: Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). MAIN OUTCOME MEASURES: The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. RESULTS: Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. CONCLUSION: Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00118911.

AI snapshot

Written from the paper’s full text.

TL;DR

Among medication-treated adults with persistent ADHD symptoms, 12 individual sessions of cognitive behavioral therapy improved blinded ADHD and Clinical Global Impression outcomes compared with relaxation with educational support. Gains were maintained up to 12 months among CBT responders or partial responders.

Key findings

  • At posttreatment, CBT produced lower Clinical Global Impression scale scores (parameter −0.53; 95% CI, −1.01 to −0.05; P=.03; d=0.53) and lower ADHD rating scale scores (parameter −4.63; 95% CI, −8.30 to −0.96; P=.02; d=0.60) than relaxation with educational support.
  • More CBT patients were treatment responders on the Clinical Global Impression scale (53% vs 23%; OR, 3.80; 95% CI, 1.50 to 9.59; P=.01) and ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P=.002).
  • Weekly self-reported ADHD symptoms improved more in CBT during treatment (β=−0.41; 95% CI, −0.64 to −0.17; P<.001).
  • Among CBT responders or partial responders, follow-up slopes for ADHD rating scale (β=−0.12; 95% CI, −0.41 to 0.18; P=.41), Clinical Global Impression scale (β=0.01; 95% CI, −0.03 to 0.05; P=.59), and self-report (β=0.05; 95% CI, −0.04 to 0.15; P=.26) did not differ from zero, indicating maintenance of gains.

Methods

  • Randomized controlled trial at a US hospital from November 2004 to June 2008, with follow-up through July 2009; 86 adults meeting DSM-IV ADHD criteria, taking medication but still reporting clinically significant symptoms, were randomized to 12 individual sessions of CBT or relaxation with educational support; 79 completed treatment and 70 completed follow-up.
  • Primary outcomes were blinded assessor-rated ADHD rating scale and Clinical Global Impression severity at baseline, posttreatment, and 6- and 12-month follow-up; secondary outcome was self-report ADHD symptoms on the Current Symptoms Scale.
  • Analysis used ANCOVA adjusting for baseline values with multiple imputation, mixed-effects models for weekly self-report and follow-up, and Fisher exact tests/odds ratios for categorical responder analyses; responders were defined as a 2-point CGI reduction or CGI score of 1 or 2, and at least 30% reduction on the ADHD rating scale.

Limitations

  • The paper states that the open follow-up period and nonrandom next-step treatment among nonresponders confound between-group follow-up comparisons; missing data were limited, but multiple imputation cannot account for the possibility that non-completers were not benefiting from treatment.
  • The paper states that motivational effects of entering a clinical trial versus clinical treatment cannot be judged, and later samples may differ in motivation, education, or other factors affecting generalizability; the self-report follow-up also showed a statistically significant condition × time interaction, though of small magnitude and limited clinical significance.
  • Evident from the text: the same therapists delivered both conditions, so contamination/adherence was monitored by rating 14% of sessions; primary follow-up analyses were restricted to CBT responders or partial responders, which limits conclusions about maintenance in nonresponders.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jama.2010.1192

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

3 of 11 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    One subsequent randomized controlled trial found better outcomes for a group-based cognitive behavioral treatment compared with a time-matched control group treatment.

    “Subsequent to our review, one randomized controlled trial found better outcomes for a group-based cognitive behavioral treatment compared with a time-matched control group treatment.6”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Solanto MV Marks DJ Wasserstein J Efficacy of metacognitive therapy for adult ADHD Am J Psychiatry published ahead of print March 15, 2010 doi:10.1176/appi.ajp.2009.09081123 PMC3633586 20231319 source
  • Premisecitation

    A recent review found only 3 randomized controlled trials of psychosocial interventions for adult ADHD.

    “Despite this need, our recent review5 found only 3 randomized controlled trials of psychosocial interventions for adult ADHD.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Knouse LE Cooper-Vince C Sprich S Safren SA Recent developments in the psychosocial treatment of adult ADHD Expert Rev Neurother 2008 8 10 1537 1548 18928346 PMC2628311 source

      The review describes a randomized controlled trial of CBT for adults with ADHD (Individual treatments: CBT for medication-treated adults with ADHD & residual symptoms) and says existing studies are generally uncontrolled or small randomized trials (Expert commentary & five-year view). The passages found do not establish the claimed total of only three randomized controlled trials. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Findingown data

    For the self-report Current Symptoms Scale, there was a significant main effect for treatment condition, with the cognitive behavioral therapy condition having lower (better) scores.

    “For the self-report Current Symptoms Scale, there was a significant main effect for treatment condition, with the cognitive behavioral therapy condition having lower (better) scores (β=−8.18 [95% CI, −12.41 to −3.96]; P<.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    For the self-report Current Symptoms Scale, analysis of slopes indicated an increasing slope for the cognitive behavioral therapy condition.

    “Analysis of slopes for each treatment condition separately indicated an increasing slope for the cognitive behavioral therapy condition (β=0.08 [95% CI, 0 to 0.15]; P=.04).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There were more treatment responders in cognitive behavioral therapy for the Clinical Global Impression scale (53% vs 23%; OR, 3.80; 95% CI, 1.50 to 9.59; P=.01).

    “there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P=.01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P=.002).”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 12
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Those 3 randomized controlled trials showed beneficial acute effects for cognitive behavioral approaches, but had small sample sizes, used wait-list controls, and did not examine whether gains were maintained.

    “These studies showed beneficial acute effects for cognitive behavioral approaches, but they had small sample sizes, used wait-list controls, and did not examine whether gains were maintained.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Knouse LE Cooper-Vince C Sprich S Safren SA Recent developments in the psychosocial treatment of adult ADHD Expert Rev Neurother 2008 8 10 1537 1548 18928346 PMC2628311 source

      The section on CBT for medication-treated adults reports a small randomized trial (n = 31) with beneficial post-treatment effects, and the group-treatment section describes a small waitlist-controlled trial. But the CBT trial compared treatment with continued medication, not a waitlist. The coaching-interventions section also reports some maintenance of gains in two waitlist-controlled studies, so the review does not support applying those limitations to all three trials. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    For both blinded assessor-rated scales, posttreatment scores were stable over time; the slopes did not change statistically over the posttreatment, 6-month, and 12-month time points and did not differ by condition.

    “For both blinded assessor-rated scales, there was evidence of overall stability for posttreatment scores over time as evaluated by the slopes of scores across the posttreatment, 6-month, and 12-month assessment time points. The slopes did not change statistically over these time points (ADHD rating scale, β=−0.17 [95% CI, −0.47 to 0.13], P=.27; Clinical Global Impression scale, β=0.01 [95% CI, −0.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data were analyzed following intent-to-treat principles for all participants regardless of whether they changed their medications postrandomization.

    “Following intent-to-treat principles, data were analyzed for all participants regardless of whether they changed their medications postrandomization”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The type of cognitive behavioral therapy studied has effects over and above time and attention with a therapist, and gains were sustained over follow-up.

    “These results demonstrate that the type of cognitive behavioral therapy studied has effects over and above time and attention with a therapist, and that gains were sustained over follow-up.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Relaxation with educational support is an attention-matched control that does not have specific active effects on ADHD, so between-group differences can be attributed to cognitive behavioral therapy-specific effects.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Six participants (4 in cognitive behavioral therapy and 2 in relaxation with educational support) changed their medications during the acute treatment period; 2 of these (both in cognitive behavioral therapy) stopped taking their medications completely.

    “A total of 6 participants (4 in the cognitive behavioral therapy condition and 2 in the relaxation with educational support condition) reported that they changed their medications during the acute treatment period.”
    • Also stated in: § METHODS · plain
      “Two of these participants (both in the cognitive behavioral therapy condition) reported they had stopped taking their medications completely.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The protocol was approved by the Massachusetts General Hospital institutional review board, and signed informed consent was obtained from all participants by study therapists.

    “The protocol was ap proved by the Massachusetts General Hospital institutional review board. Signed informed consent was obtained from all participants by study therapists.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    The treatment was well tolerated, with very low drop-out rates.

    “Generally, the treatment was well tolerated, with very low drop-out rates, and had positive and sustained effects on ADHD symptoms.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The assessor was blinded to treatment condition assignment.

    “The assessor was blinded to treatment condition assignment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Sessions were audio recorded and an outside consultant rated at least 10% for contamination and adherence (14% of sessions rated).

    “Because the same therapists were used for both study conditions, sessions were audio recorded and an outside consultant rated at least 10% for contamination and adherence (14% of sessions rated).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ADHD rating scale has been shown to be sensitive to medication treatment effects in pediatric and adult samples.

    “This scale has been shown to be sensitive to medication treatment effects in pediatric13 and adult samples.14,15”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [13] Faries DE Yalcin I Harder D Heiligenstein JH Validation of the ADHD rating scale as a clinician administered and scored instrument J Atten Disord 2001 5 2 107 115

      Not checked in the free run.

    • cites [14] Spencer T Wilens T Biederman J Faraone SV Ablon JS Lapey K A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder Arch Gen Psychiatry 1995 52 6 434 443 7771913 source
    • cites [15] Wilens TE Biederman J Prince J Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder Am J Psychiatry 1996 153 9 1147 1153 8780417 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Therapists were clinical psychologists and postdoctoral-level clinical psychology fellows, had prior experience with cognitive behavioral therapy, and were supervised weekly in group meetings.

    “Therapists were clinical psychologists and postdoctoral-level clinical psychology fellows. Therapists had prior experience with cognitive behavioral therapy, and were supervised weekly in group meetings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months.

    “Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months.”
    • Also stated in: § COMMENT · plain
      “Across ADHD outcomes, those who were randomized to cognitive behavioral therapy showed significantly better outcomes than those randomized to relaxation with educational support. Additionally, among those who showed at least a partial response to cognitive behavioral therapy, improvements were maintained at the follow-up assessments, up to 9 months posttreatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Consideration was given to dropping or covarying out data from those who received additional treatment outside the study, but this was not appropriate because these data are not missing at random and it would not follow intent-to-treat principles.

    “Consideration was given to dropping or covarying out data from those who received additional treatment outside of the study; however, this was not appropriate because these data are not missing at random, and it would not be following the principles of an intent-to-treat study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    We are unable to judge motivational effects for patients entering a clinical trial vs clinical treatment, and subsequent samples may differ in motivation, education, or other factors that may influence the generalizability of treatment effects.

    “Also, we are unable to judge motivational effects for patients entering a clinical trial vs clinical treatment, and subsequent samples may differ in motivation, education, or other factors that may influence the generalizability of treatment effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Power was based on a prior study; the study estimated an adjustment for a less than large effect (d of approximately 0.8), yielding a total patient requirement of 60 and 80% power at a .05 level of significance, targeting a randomized sample of 80 participants.

    “we estimated an adjustment for a less than large effect (d of approximately 0.8), which would yield a total patient requirement of 60 and an 80% power at a .05 level of significance, targeting a randomized sample of 80 participants, allowing for attrition over follow-up.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] 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 15896281 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Randomization was stratified by sex and Clinical Global Impression scale score for severity (score ≥5), in blocks of 2, and randomly assigned.

    “Groups were stratified by sex and Clinical Global Impression scale score for severity (score ≥5), in blocks of 2 (determined from a table, constructed by coin flip), and were randomly assigned by the research assistant to either cognitive behavioral therapy or a time-matched comparison treatment of relaxation with educational support.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The rater and another blinded assessor listened to, rated, and discussed 28% of audio recordings of the ADHD ratings to ensure continued reliability.

    “The rater and another blinded assessor listened to, rated, and discussed 28% of audio recordings of the ADHD ratings to ensure continued reliability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Therefore, the cognitive behavioral therapy condition maintained gains and the relaxation with educational support condition did not improve during the follow-up.

    “Therefore, the cognitive behavioral therapy condition maintained gains and the relaxation with educational support condition did not improve during the follow-up.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Blinding was maintained by having a single independent assessor who would not participate in meetings when cases were discussed, all participants regardless of assignment having the same number of visits, and reminding participants not to discuss their treatment condition with the assessor.

    “Blinding was maintained by (1) having a single independent assessor who would not participate in meetings when cases were discussed, (2) all participants regardless of assignment have the same number of visits, and by (3) reminding the participants not to discuss which treatment condition they were in with the assessor.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Between-group differences over the follow-up periods are confounded by potential subsequent treatment among nonresponders, and conclusions regarding these analyses are limited.

    “Hence, between-group differences over the follow-up periods are confounded by potential subsequent treatment among nonresponders and conclusions regarding these analyses are limited and subject to multiple interpretations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Many adults with ADHD cannot or will not take medications, while others show a poor medication response.

    “Medications have been the primary treatment; however, many adults with ADHD cannot or will not take medications while others show a poor medication response.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Prince J Wilens T Spencer T Biederman J Barkley RA Pharmacotherapy of ADHD in adults Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment 2006 704 736 Guilford New York, NY 3rd ed

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments.

    “Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments.”
    Quote in the paperNot a substantial claim
22 of 22

  • The paper relies on this without support.

    Relaxation with educational support is an attention-matched control that does not have specific active effects on ADHD, so between-group differences can be attributed to cognitive behavioral therapy-specific effects.

    “relaxation with educational support (which is an attention-matched comparison)”
    “These results demonstrate that the type of cognitive behavioral therapy studied has effects over and above time and attention with a therapist”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • RCTs of individualised CBT have found effect sizes on independently and self-rated ADHD symptom severity in the range of 1.2-1.7 when comparing individualised CBT with TAU and in the range 0.5-0.6 when comparing individualised CBT with relaxation and educational support.

    “RCTs of individualised CBT have found effect sizes on independently and self-rated ADHD symptom severity to be in the range of 1.2-1.7 when comparing individualised CBT with TAU and in the range 0.5-0.6 when comparing individualised CBT with relaxation and educational support (4, 5).”

    From Cognitive–behavioural therapy for adult attention-deficit hyperactivity disorder: a proof of concept randomised controlled trial (2018) · cites this paper as [4]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Addition of psychotherapeutic approaches to pharmacotherapy in adults with ADHD whose symptoms persist despite medication improves symptoms and functioning.

    “Similarly, the addition of psychotherapeutic approaches to pharmacotherapy in adults with ADHD whose symptoms persist despite medication has been shown to improve symptoms and functioning [118].”

    From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [118]

    The Results (page not provided) show that adding cognitive behavioral therapy to ongoing medication improved ADHD symptom ratings and clinical severity compared with relaxation with educational support. The paper does not report a separate measure of functioning, and its findings concern this specific therapy rather than psychotherapeutic approaches generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • There have been four randomized controlled trials of individualised CBT that are structured and manualised.

    “There have been four randomized controlled trials of individualised CBT that are structured and manualised (3-6).”

    From Cognitive–behavioural therapy for adult attention-deficit hyperactivity disorder: a proof of concept randomised controlled trial (2018) · cites this paper as [4]

  • All four randomized controlled trials found that CBT reduced ADHD symptoms (self and independently rated) compared with the control treatment(s).

    “All found that CBT reduced ADHD symptoms (self and independently rated) compared with the control treatment(s).”

    From Cognitive–behavioural therapy for adult attention-deficit hyperactivity disorder: a proof of concept randomised controlled trial (2018) · cites this paper as [4]

  • There were more treatment responders in the CBT group (53%) relative to the relaxation training and educational support group (23%), and gains were maintained over periods of 6 and 12 months.

    “There were more treatment responders in the CBT group (53%) relative to the relaxation training and educational support group (23%), and gains were maintained over periods of 6 and 12 months [119].”

    From Advances in understanding and treating ADHD (2011) · cites this paper as [119]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Self-report interaction estimate falls outside its confidence interval

    Minor

    The reported interaction estimate is negative, but both bounds of its reported 95% confidence interval are positive.

  • Abstract and results give different Clinical Global Impression treatment effects

    Minor

    The abstract reports a treatment-effect magnitude of −0.0531, while the results report −0.53 for the same posttreatment outcome.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. [8]Safren SA Perlman CA Sprich S Otto MW Mastering Your Adult ADHD: A Cognitive-Behavioral Therapy Approach 2005 Oxford Univeristy Press New York, NY
  2. [9]Safren SA Sprich S Perlman CA Otto MW Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Client Workbook 2005 Oxford Univeristy Press New York, NY
  3. [10]First M Spitzer RL Gibbon M Williams J Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition 1995 Biometrics Research Department, New York State Psychiatric Institute New York, NY

Cited by

Sorted by citations

Related

Authors
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W.
Affiliations
  • Massachusetts General Hospital (US)
  • Harvard University (US)
  • Boston University (US)
Corresponding author
Safren, Steven A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2010-08-25
Volume
304
Issue
8
Pages
875
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2010.1192
PMC
PMC3641654
OpenAlex
W2024818417
Semantic Scholar
89519b74428bde08c6b96b48dca9253f69259541
Cited by
374
References
14
Citations by year
2026: 13 · 2025: 15 · 2024: 17 · 2023: 10 · 2022: 10 · 2021: 9 · 2020: 14 · 2019: 13 · 2018: 16 · 2017: 39 · 2016: 36 · 2015: 39 · 2014: 38 · 2013: 35 · 2012: 39
FWCI
21.00
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Mental Health (R01 MH069812, 5R01MH69812)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
treatment, adult ADHD, psychosocial interventions, ADHD Rating Scale, Clinical Global Impression Scale, treatment response, self-reported symptoms, medication adherence, relapse, relapse prevention, psychoeducation, hospital-based treatment, cost-effectiveness, quality of life, social functioning
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Drug Resistance, Female, Humans, Male, Middle Aged, Patient Education as Topic, Relaxation Therapy, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome

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