The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index; 3 of the 11 sources its claims cite were checked for support.
Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms: A Randomized Controlled Trial
Open accessAbstract
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.
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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.
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Claims the paper makes
3 of 11 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“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”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Conclusion
What the sources say
- Supportedcites [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
The Method > Design section reports that adults with ADHD were randomly assigned to group MCT or a Support group. Method > Supportive Therapy says the control matched session and treatment duration, and the Discussion reports greater improvement in inattentive symptoms with MCT. (LLM, conf=0.94)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Despite this need, our recent review5 found only 3 randomized controlled trials of psychosocial interventions for adult ADHD.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Conclusion
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > RESULTS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > RESULTS
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (β=−0.41; 95% CI, −0.64 to −0.17; P<001)”
- Also stated in: § RESULTS · plain
“For the weekly ADHD current symptom scores obtained during treatment, the slope of improvement in the cognitive behavioral therapy condition was greater than that for the relaxation condition (β=−0.41 [95% CI, −0.64 to −0.17]; P<.001)”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, this was qualified by an interaction of treatment condition by time (β=−0.15 [95% CI, 0.04 to 0.27]; P=.01).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > RESULTS
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 18
- Probably not a substantial claim. 12
- The quote only partly states this claim. 1
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Conclusion
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Following intent-to-treat principles, data were analyzed for all participants regardless of whether they changed their medications postrandomization”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > COMMENT
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedn = 6Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Also stated in: § METHODS · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The protocol was ap proved by the Massachusetts General Hospital institutional review board. Signed informed consent was obtained from all participants by study therapists.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Generally, the treatment was well tolerated, with very low drop-out rates, and had positive and sustained effects on ADHD symptoms.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > COMMENT
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The assessor was blinded to treatment condition assignment.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Main Outcome Measures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“This scale has been shown to be sensitive to medication treatment effects in pediatric13 and adult samples.14,15”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
What the sources say
- Not checked yetcites [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 — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Conclusion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § COMMENT · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > COMMENT
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > COMMENT
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
What the sources say
- Not checked — no full text of the sourcecites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The rater and another blinded assessor listened to, rated, and discussed 28% of audio recordings of the ADHD ratings to ensure continued reliability.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Therefore, the cognitive behavioral therapy condition maintained gains and the relaxation with educational support condition did not improve during the follow-up.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > RESULTS
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > METHODS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > COMMENT
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Conclusion
What the sources say
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments.”
§ Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms > Abstract > Design, Setting, and Patients
Strength:plain· not yet calibratedn = 86Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“A recently published study suggests that, when compared with adults with ADHD who received relaxation training and educational support, adults with ADHD who received 12 sessions of CBT had lower self-reported ADHD symptoms and greater functional improvements as rated by a blinded assessor [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
MinorThe reported interaction estimate is negative, but both bounds of its reported 95% confidence interval are positive.
“β=−0.15”
“[95% CI, 0.04 to 0.27]”
Abstract and results give different Clinical Global Impression treatment effects
MinorThe abstract reports a treatment-effect magnitude of −0.0531, while the results report −0.53 for the same posttreatment outcome.
“Clinical Global Impression scale (magnitude −0.0531; 95% confidence interval [CI], −1.01 to −0.05; P=.03)”
“Clinical Global Impression scale scores (estimated parameter for treatment effect, −0.53 [95% CI, −1.01 to −0.05]; t24.31=−2.29, P=.03; d=0.53)”
Citations
Cites
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Recent developments in the psychosocial treatment of adult ADHD
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Flagged first, then by citations
Research works printed but not linked: 3
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- [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
- [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
McHugh, R. K., Whitton, S. W., Peckham, A. D., Welge, J. A., & Otto, M. W. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12r07757 · Cited by 800
Self-citationAdult ADHD and comorbid disorders: clinical implications of a dimensional approach
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Metadata
- Authors
- Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W.
- Affiliations
- Massachusetts General Hospital (US)
- Boston University (US)
- Corresponding author
- Safren, Steven A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2010-08-25
- Volume
- 304
- Issue
- 8
- Pages
- 875
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3641654
- OpenAlex
- W2024818417
- Semantic Scholar
- 89519b74428bde08c6b96b48dca9253f69259541
- Cited by
- 394
- References
- 14
- Citations by year
- 2026: 20 · 2025: 17 · 2024: 19 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 18 · 2019: 13 · 2018: 18 · 2017: 41 · 2016: 38 · 2015: 39 · 2014: 38 · 2013: 35 · 2012: 39
- FWCI
- 20.14
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH069812)
- 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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