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Cited by 114Attention Deficit Hyperactivity DisorderBehavioral and Psychological StudiesChild and Adolescent Psychosocial and Emotional Development

A randomized controlled trial of cognitive behavioral therapy for ADHD in medication‐treated adolescents

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Sprich, Susan E., Safren, Steven A., Finkelstein, Daniel, Remmert, Jocelyn E., Hammerness, Paul·2016·Journal of Child Psychology and Psychiatry
DOI 10.1111/jcpp.12549PMC PMC5026858
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Abstract

Objective: To test cognitive behavioral therapy ( CBT ) for persistent attention‐deficit hyperactivity disorder ( ADHD ) symptoms in a sample of medication‐treated adolescents. Methods: Forty‐six adolescents (ages 14–18), with clinically significant ADHD symptoms despite stable medication treatment were randomly assigned to receive CBT for ADHD or wait list control in a cross‐over design. Twenty‐four were randomized to CBT , 22 to wait list, and 15 crossed‐over from wait list to CBT . A blind independent evaluator ( IE ) rated symptom severity on the ADHD Current Symptom Scale, by adolescent and parent report, and rated each subject using the Clinical Global Impression Severity Scale ( CGI ), a global measure of distress and impairment. These assessments were performed at baseline, 4‐months (post‐ CBT or post wait list), and 8‐months (post‐treatment for those originally assigned to the wait list condition and 4‐month follow‐up for those originally assigned to CBT ). Trial Registration: http://clinicaltrials.gov/show/NCT01019252 . Results: Using all available data, mixed effects modeling, and pooling for the wait list cross‐over, participants who received CBT received a mean score 10.93 lower on the IE ‐rated parent assessment of symptom severity (95% CI : −12.93, −8.93; p < .0001), 5.24 lower on the IE ‐rated adolescent assessment of symptom severity (95% CI : −7.21, −3.28; p < .0001), and 1.17 lower IE ‐rated CGI (95% CI : −1.39, −.94; p < .0001). Results were consistent across 100 multiple imputations (all p < .0001). There was a greater proportion of responders after CBT by parent (50% vs. 18%, p = .00) and adolescent (58% vs. 18% p = .02) report. Conclusions: This study demonstrates initial efficacy of CBT for adolescents with ADHD who continued to exhibit persistent symptoms despite medications.

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  • Given that CBT and MET are effective treatments for SUD and have shown promise in the treatment of ADHD in both adolescents and adults with SUD, CBT/MET, placebo, or both may have caused a ceiling effect, which in turn may have contributed to the failure of pharmacotherapies to separate from the control treatment in the trials on comorbid ADHD and SUD.

    “Hence, given that CBT and MET are effective treatments for SUD and have shown promise in the treatment of ADHD in both adolescents [73] and adults [89] with SUD, CBT/MET, placebo, or both may have caused a ceiling effect, which in turn may have contributed to the failure of pharmacotherapies to separate from the control treatment in the trials on comorbid ADHD and SUD.”

    From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [73]

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  • In five of the six trials with a non-active control condition (waiting-list control group), participants in the intervention group showed stronger post-treatment improvements in ADHD symptoms compared with participants in the control group.

    “In five of the six trials with a non-active control condition (waiting-list control group), participants in the intervention group showed stronger post-treatment improvements in ADHD-symptoms compared with participants in the control group [62,63,64,65,73,74].”

    From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [73]

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Research works printed but not linked: 2

  1. DuPaul GJ Power TJ Anastopoulos AD Reid R 1998 ADHD rating scale-IV: Checklists, norms, and clinical interpretations New York, NY Guilford Press
  2. N.I.M.H 1985 CGI: Clinical Global Impression Scale - NIMH Psychopharmacology Bulletin 21 839 844

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Authors
Sprich, S. E., Safren, S. A., Finkelstein, D., Remmert, J. E., & Hammerness, P.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
  • Boston Children's Hospital (US)
Corresponding author
Safren, Steven A.
ORCID
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2016-03-17
Volume
57
Issue
11
Pages
1218-1226
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
DOI
10.1111/jcpp.12549
PMC
PMC5026858
OpenAlex
W2298127037
Cited by
114
References
41
Citations by year
2026: 8 · 2025: 11 · 2024: 10 · 2023: 14 · 2022: 18 · 2021: 14 · 2020: 13 · 2019: 9 · 2018: 9 · 2017: 7 · 2016: 1
FWCI
7.70
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R34MH083063)
  • National Institutes of Health (1 UL1 RR025758‐03)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
cognitive behavioral therapy, attention deficit hyperactivity disorder, adolescents, stimulant medication, treatment-resistant ADHD, psychotherapy efficacy, symptom severity
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Severity of Illness Index, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Cross-Over Studies

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