A cognitive remediation programme for adults with Attention Deficit Hyperactivity Disorder
Abstract
OBJECTIVE: This is the first systematic examination of the efficacy of a cognitive remediation programme (CRP) for management of adult Attention Deficit Hyperactivity Disorder (ADHD). The CRP was designed to target problems commonly associated with adult ADHD, namely, attention problems, poor motivation, poor organizational skills, impulsivity, reduced anger control and low self-esteem. METHOD: In a randomized, controlled trial, a representative sample of adults with ADHD (some medicated, some not) were assigned to either a CRP (n = 22) or a waiting list control (n = 21). The CRP was delivered in an intensive format with eight two-hour, weekly sessions with support people who acted as coaches, and participant workbooks with homework exercises. RESULTS: Participants who completed the CRP reported reduced ADHD symptomatology (effect size (d) = 1.4), improved organizational skills (d = 1.2) and reduced levels of anger (d = 0.5). Clinically significant improvements in ADHD symptomatology (d = 1.4) and organizational skills (d = 1.3) were maintained one year after the intervention. CONCLUSIONS: These findings suggest that the CRP provides a practical way of enhancing daily functioning for adults with ADHD.
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CBT enhances self-management, goal-setting, and time organization by targeting maladaptive cognitions and behaviors.
“By targeting maladaptive cognitions and behaviors, CBT enhances self-management, goal-setting, and time organization [160].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [160]
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“Abbreviations ADHD: Attention deficit hyperactivity disorder; AN: Anorexia nervosa; AN-EXRP: Exposure and response prevention for AN; BMI: Body mass index; BRIEF: Behavior rating inventory of executive function; CAT: Cognitive analytic therapy; CBT: Cognitive behavioral therapy; CREST: Cognitive remediation therapy an…”
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“Randomized controlled trials (RCTs) that evaluate the combination of these treatments ( versus medication alone) have reported medium to large treatment effects for both self-rated and clinician-rated improvements in ADHD symptoms (Stevenson et al. 2002; Safren et al. 2005, 2010; Safren, 2006).”
Stevenson, C. S., Stevenson, R. J., & Whitmont, S. (2003) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.356 · Cited by 75 · see citing works
Self-citationVirta (2010) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s11743 · Cited by 71 · see citing works
“The tasks involved domains of attention as follows: focus-executive (tasks 2 and 7), sustain (1A-D, 4A), encode (5), and shift (6),(25) and focused (all tasks), sustained (1A-D, 2, 3, 4A-B, 5, 9), selective (1E), alternating (6), and divided (4C, 7, 8) attention.”
Hirvikoski, T., Lindström, T., Carlsson, J., Waaler, E., Jokinen, J., & Bölte, S. (2017) · European Psychiatry · doi:10.1016/j.eurpsy.2017.04.005 · Cited by 71 · see citing works
Group cognitive remediation therapy for adolescents with anorexia nervosa
Wood, L., Al‐Khairulla, H., & Lask, B. D. (2011) · Clinical Child Psychology and Psychiatry · doi:10.1177/1359104511404750 · Cited by 70 · see citing works
Cook, J., Knight, E., Hume, I., & Qureshi, A. (2014) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-014-0133-2 · Cited by 69 · see citing works
“Some of these difficulties were remedied in RCTs evaluating the efficacy of cognitive remediation, which aimed to reduce the impact of psychosocial factors including self-esteem on ADHD (Stevenson et al. 2002, 2003).”
BackgroundMethodCBT for adult ADHD: adaptations and hypothesized mechanisms of change
Ramsay, J. R. (2010) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.24.1.37 · Cited by 67 · see citing works
LaCount, P. A., Hartung, C. M., Shelton, C. R., & Stevens, A. E. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715594423 · Cited by 67 · see citing works
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Philipsen, A., Graf, E., van Elst, L. T., Jans, T., Warnke, A., Heßlinger, B., Ebert, D., Gerlach, M., Matthies, S., Colla, M., et al. (2010) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-010-0046-7 · Cited by 61 · see citing works
“…to psychopharmacological trials there are still fewer studies addressing the effects of nonmedical treatment in adult ADHD (Hesslinger et al. 2002; Stevenson et al. 2002; Safren et al. 2005; Bramham et al. 2009; Zylowska et al. 2008; Solanto et al. 2010; Virta et al. 2008; Salakari et al. 2010).”
BackgroundResultCherkasova, M. V., French, L. R., Syer, C. A., Cousins, L. S., Galina, H., Ahmadi-Kashani, Y., & Hechtman, L. T. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716671197 · Cited by 63 · see citing works
“In studies that included both medicated and unmedicated patients (Hesslinger et al., 2002; Solanto et al., 2008; Solanto et al., 2010; Stevenson et al., 2002; Virta et al., 2008), medication status was not randomly assigned, and the effects of medication could not be examined rigorously.”
BackgroundHirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2014) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-014-0141-2 · Cited by 60 · see citing works
“…therapies (CBTs, such as cognitive therapy, dialectical behavioral therapy, and meta-cognitive therapy) to be a promising treatment strategy for adults with ADHD (Emilsson et al. 2011; Hirvikoski et al. 2011; Philipsen et al. 2013; Safren et al. 2010; Solanto et al. 2010; Stevenson et al. 2002).”
BackgroundPhilipsen, A. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.91 · Cited by 57 · see citing works
ADHD Symptomology and Social Functioning in College Students
Sacchetti, G. M., & Lefler, E. K. (2014) · Journal of Attention Disorders · doi:10.1177/1087054714557355 · Cited by 62 · see citing works
Young, S., Emilsson, B., Sigurðsson, J. F., Khondoker, M. R., Philipp-Wiegmann, F., Baldursson, G., Ólafsdóttir, H., & Gudjonsson, G. H. (2016) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-016-0735-0 · Cited by 59 · see citing works
“Group interventions are attractive for clinical delivery as they are cost effective as well as demonstrating medium to large treatment effects for the reduction of ADHD symptoms in randomised control trials of medicated ADHD patients [9-15].”
BackgroundDahlgren, C. L., Lask, B. D., Landrø, N. I., & Rø, Ø. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22155 · Cited by 58 · see citing works
Torrente, F. M., López, P. L., Prado, D. A., Kichic, R., Cetkovich, M., Lischinsky, A. G., & Manes, F. F. (2012) · Journal of Attention Disorders · doi:10.1177/1087054712443153 · Cited by 57 · see citing works
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Comorbid Psychiatric and Substance Abuse Disorders: Recent Treatment Research
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“Although the emphasis has been on the use of medications to treat ADHD, there is a growing literature on the potential utility of nonpharmacologic interventions such as cognitive remediation (49) and other cognitive behavioral approaches (50) to treat ADHD.”
BackgroundTreatment of adult ADHD: Is current knowledge useful to clinicians?
Torgersen, T. (2008) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s1223 · Cited by 49 · see citing works
“The treatment period ranged from 8 to 15 weeks, and two studies had follow-up periods of 2 and 12 months, respectively (Stevenson et al 2002, 2003).”
InfluentialEarly maladaptive schemas in adult patients with attention deficit hyperactivity disorder
Philipsen, A., Lam, A. P., Breit, S., Lücke, C., Müller, H., & Matthies, S. (2016) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-016-0211-8 · Cited by 49 · see citing works
Morgensterns, E., Alfredsson, J., & Hirvikoski, T. (2016) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-015-0182-1 · Cited by 48 · see citing works
“Thus, the obtained results were in general stable 3 months after finished skills training program, which is in line with previous follow-ups on psychological interventions (Stevenson et al. 2002, 2003).”
BackgroundResultLópez-Pinar, C., Martínez-Sanchís, S., Carbonell-Vayá, E., Sánchez-Meca, J., & Fenollar-Cortés, J. (2020) · Journal of Attention Disorders · doi:10.1177/1087054719855685 · Cited by 47 · see citing works
Moukhtarian, T. R., Mintah, R. S., Moran, P., & Asherson, P. J. (2018) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-018-0086-8 · Cited by 49 · see citing works
Psychosocial Interventions in Attention-Deficit/Hyperactivity Disorder
Antshel, K. M. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.08.002 · Cited by 46 · see citing works
LaCount, P. A., Hartung, C. M., Shelton, C. R., Clapp, J. D., & Clapp, T. K. W. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.07.004 · Cited by 45 · see citing works
Cognitive Behavioral Therapy for Adolescents with ADHD
Antshel, K. M., & Olszewski, A. K. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.001 · Cited by 44 · see citing works
Philipsen, A., Graf, E., Jans, T., Matthies, S., Borel, P., Colla, M., Gentschow, L., Langner, D., Jacob, C., Groß-Lesch, S., et al. (2014) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-013-0120-z · Cited by 44 · see citing works
“…of behavioral individual and group psychotherapy approaches for both medicated and non-medicated adult ADHD patients (Hesslinger et al. 2002; Stevenson et al. 2002; Safren et al. 2005, 2010; Rostain and Ramsay 2006; Philipsen et al. 2007; Bramham et al. 2008; Zylowska et al. 2008; Solanto…”
BackgroundAnger Self-Management Training for People With Traumatic Brain Injury
Hart, T., Vaccaro, M. J., Hays, C., & Maiuro, R. D. (2011) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0b013e31820e686c · Cited by 44 · see citing works
Neural markers of the development of executive function: relevance for education
Shanmugan, S., & Satterthwaite, T. D. (2016) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2016.04.007 · Cited by 45 · see citing works
Attention Deficit/Hyperactivity Disorder in Adults
Moss, S. B., Nair, R. J., Vallarino, A., & Wang, S. (2007) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2007.05.005 · Cited by 43 · see citing works
Optimal management of ADHD in older adults
Torgersen, T., Gjervan, B., Lensing, M. B., & Rasmussen, K. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s59271 · Cited by 42 · see citing works
Ramsay, J. R. (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0056-0 · Cited by 41 · see citing works
Addressing the lack of studies in attention-deficit/hyperactivity disorder in adults
Ramos-Quiroga, J., Nasillo, V., Fernández-Aranda, F., & Casas, M. (2014) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2014.908708 · Cited by 30 · see citing works
“Similarly, cognitive rehabilitation has not been shown to improve symptoms of comorbid anxiety and depression [106,112].”
BackgroundDo we over‐diagnose ADHD in North America? A critical review and clinical recommendations
Gascon, A., Gamache, D., St‐Laurent, D., & Stipanicic, A. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23348 · Cited by 41 · see citing works
Adapting Psychotherapy to Meet the Needs of Adults With Attention-Deficit/Hyperactivity Disorder.
Ramsay, J. R., & Rostain, A. L. (2005) · Psychotherapy · doi:10.1037/0033-3204.42.1.72 · Cited by 38 · see citing works
“…studies of psychosocial treatments for adult ADHD each used either a group format actively structured by the therapists (Hesslinger et al., 2002; Stevenson et al., 2002; Wiggins et al., 1999) or a cognitive therapy approach, in which therapists are generally more active and directive with…”
BackgroundInfluentialAssessing Treatment Outcomes in Attention-Deficit/Hyperactivity Disorder
Epstein, J. N., & Weiss, M. D. (2012) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.11r01336 · Cited by 37 · see citing works
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Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period
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Corbisiero, S., Bitto, H., Newark, P. E., Mörstedt, B., Elsässer, M., Buchli-Kammermann, J., Künne, S., Nyberg, E., Fallahpour, M. H., & Stieglitz, R. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00571 · Cited by 33 · see citing works
“(38) reported a reduction of ADHD symptoms of 37% (baseline to pre-treatment) and at posttreatment the statistically significant reduction was 55%.”
BackgroundNonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being.
Ramsay, J. R. (2010) · American Psychological Association eBooks · doi:10.1037/12056-000 · Cited by 33 · see citing works
Cognitive-Behaviorally-Oriented Group Rehabilitation of Adults With ADHD
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“Thus far, only Stevenson et al. (2002) have reported a systematic posttreatment follow-up of their participants.”
BackgroundResultBrief Cognitive Behavioral Therapy for College Students With ADHD: A Case Series Report
Eddy, L. D., Canu, W. H., Broman‐Fulks, J. J., & Michael, K. D. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.05.005 · Cited by 33 · see citing works
Coaching for College Students with ADHD
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Psychotherapie der ADHS im Erwachsenenalter
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New Developments in the Treatment of ADHD
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Treatment of adults with attention-deficit/hyperactivity disorder
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- Authors
- Stevenson, C. S., Whitmont, S., Bornholt, L., Livesey, D., & Stevenson, R. J.
- Affiliations
- New South Wales Institute of Psychiatry (AU)
- The University of Sydney (AU)
- Macquarie University (AU)
- ORCID
- Stevenson, Richard J
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2002-10
- Volume
- 36
- Issue
- 5
- Pages
- 610-616
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2171546569
- Cited by
- 261
- References
- 45
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 3 · 2021: 11 · 2020: 5 · 2019: 8 · 2018: 9 · 2017: 12 · 2016: 13 · 2015: 12 · 2014: 21 · 2013: 16 · 2012: 22
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Sydney
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, attention deficits, organizational skills, anger management, impulsivity, motivation, self-esteem, coaching, homework exercises, treatment efficacy, symptom maintenance
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Motivation, Self Concept, Socialization, Program Evaluation, Cognitive Behavioral Therapy
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