Cognitive behaviour therapy in medication-treated adults with ADHD and persistent Symptoms: A randomized controlled trial
Open accessAbstract
Background: Attention deficit hyperactivity disorder (ADHD) in adulthood is not fully treated by psychopharmacological treatment alone. The main aim of the current study was to evaluate a newly developed cognitive behaviour therapy (CBT) based group programme, the Reasoning and Rehabilitation for ADHD Youths and Adults (R&R2ADHD), using a randomized controlled trial. Methods: 54 adults with ADHD already receiving psychopharmacological treatment were randomly allocated to an experimental (CBT/MED) treatment condition (n = 27) and a 'treatment as usual' (TAU/MED) control condition (n = 27) that did not receive the CBT intervention. The outcome measures were obtained before treatment (baseline), after treatment and at three month follow-up and included ADHD symptoms and impairments rated by independent assessors, self-reported current ADHD symptoms, and comorbid problems. Results: The findings suggested medium to large treatment effects for ADHD symptoms, which increased further at three month follow-up. Additionally, comorbid problems also improved at follow-up with large effect sizes. Conclusions: The findings give support for the effectiveness of R&R2ADHD in reducing ADHD symptoms and comorbid problems, an improving functions associated with impairment. The implications are that the benefits of R&R2ADHD are multifaceted and that combined psychopharmacological and CBT based treatments may add to and improve pharmacological interventions. Trial registration: ACTRN12611000533998 (http://www.ANZCTR.org.au/ACTRN12611000533998.aspx)
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
In a small study of 54 adults with ADHD, of whom 85% had a comorbid axis I or II disorder, addition of psychotherapy to ADHD medication improved ADHD symptoms and antisocial behaviour at the end of the treatment period.
“A small study of 54 adults with ADHD reported that the addition of psychotherapy to ADHD medication in adults with ADHD, of whom 85% had a comorbid axis I or II disorder, improved ADHD symptoms and antisocial behaviour at the end of the treatment period whereas symptoms of depression, anxiety, and social functioning improved after 3 months of continued follow-up [120].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [120]
Methods > Participants reports 54 adults, of whom 46 (85.2%) reported comorbid mental or emotional problems, but it does not establish that 85% had diagnosed Axis I or II disorders. Results > Effectiveness reports significantly better ADHD symptoms on the independent evaluator’s measure and less antisocial behaviour in the CBT-plus-medication group at the end of treatment. The treatment findings are supported; the diagnostic specificity of the comorbidity claim is not. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn that small study of 54 adults with ADHD, symptoms of depression, anxiety, and social functioning improved after 3 months of continued follow-up.
“A small study of 54 adults with ADHD reported that the addition of psychotherapy to ADHD medication in adults with ADHD, of whom 85% had a comorbid axis I or II disorder, improved ADHD symptoms and antisocial behaviour at the end of the treatment period whereas symptoms of depression, anxiety, and social functioning improved after 3 months of continued follow-up [120].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [120]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis
Simon, V., Czobor, P., Bálint, S., Mészáros, Á., & Bitter, I. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.048827 · Cited by 1,601 · see citing works
Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder
Fayyad, J., De Graaf, R., Kessler, R., Alonso, J., Angermeyer, M., Demyttenaere, K., De Girolamo, G., Haro, J. M., Karam, E. G., Lara, C., et al. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.034389 · Cited by 1,321 · see citing works
Kooij, S. J., Bejerot, S., Blackwell, A., Caci, H., Casas-Brugué, M., Carpentier, P. J., Edvinsson, D., Fayyad, J., Foeken, K., Fitzgerald, M., et al. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-67 · Cited by 928 · cited 1× · see citing works
“International guidelines [8,12] recommend multimodal treatment for adults with ADHD comprising of psychoeducation, pharmacotherapy and cognitive behaviour therapy (CBT).”
BackgroundCognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms
Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.07.001 · Cited by 519 · cited 2× · see citing works
“CBT provided on an individual basis has been evaluated by Safren and colleagues [ 16 ] who randomly assigned 31 patients receiving medication to receive 15 sessions of CBT or treatment as usual.”
BackgroundMethodSafren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010) · JAMA · doi:10.1001/jama.2010.1192 · Cited by 374 · see citing works
Efficacy of meta-cognitive therapy for adult ADHD
Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09081123 · Cited by 370 · see citing works
A cognitive remediation programme for adults with Attention Deficit Hyperactivity Disorder
Stevenson, C. S., Whitmont, S., Bornholt, L., Livesey, D., & Stevenson, R. J. (2002) · Australian & New Zealand Journal of Psychiatry · doi:10.1046/j.1440-1614.2002.01052.x · Cited by 261 · cited 1× · see citing works
“, [21] randomized 43 medicated patients to an eight week cognitive remediation therapy (CRT) group programme or treatment as usual and found a significant effect for ADHD symptoms, organizational skills and reduction in feelings of anger for those who completed the programme.”
BackgroundHirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., Rück, J., Wiwe, C., Bothén, P., & Nordström, A.-L. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.01.001 · Cited by 182 · cited 1× · see citing works
“A similar pattern of outcome was reported by Hirvikoski and colleagues [20] who randomly assigned 51 medicated adults to 14 sessions of dialectical behaviour therapy (DBT) or a loosely structured discussion group.”
ResultEvaluation of group cognitive behavioral therapy for adults with ADHD
Bramham, J., Young, S., Bickerdike, A., Spain, D., McCartan, D., & Xenitidis, K. (2009) · Journal of Attention Disorders · doi:10.1177/1087054708314596 · Cited by 179 · cited 1× · see citing works
“Bramham and colleagues [ 22 ] provided an intensive 3-day intervention (one day per month for 3 months) to medicated patients and compared outcome with waiting list controls.”
ResultSelf-citationDalsgaard, S., Mortensen, P. B., Frydenberg, M., & Thomsen, P. H. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.181.5.416 · Cited by 172 · see citing works
Gudjonsson, G. H., Sigurdsson, J. F., Smari, J., & Young, S. (2009) · Journal of Attention Disorders · doi:10.1177/1087054708323018 · Cited by 149 · see citing works
Self-citationVirta (2010) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s11743 · Cited by 71 · see citing works
Flagged first, then by citations
Research works printed but not linked: 20
- Barkley RA Murphy KR Fischer M ADHD in adults: What the science says 2008 New York: The Guilford Press
- Kessler RC Adler L Barkley R Biederman J Conners CK Demler O Faraone SV Greenhill LL Howes MJ Secnik K Spencer T Ustun TB Walters EE Zaslavsky AM The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication American Journal of Psychiatry 2006 163 Suppl 4 716 23 16585449 PMC2859678
- Young S Gudjonsson GH Wells J Asherson P Theobald D Oliver B Scott C Mooney A Attention Deficit Hyperactivity Disorder and critical incidents in a Scottish prison population Personality and Individual Difference 2009 46 265 269 10.1016/j.paid.2008.10.003 · DOI
- Young S Wells J Gudjonsson GH Predictors of offending among prisoners. The role of Attention Deficit Hyperactivity Disorder (ADHD) and substance use Journal of Psychopharmacology in press Published Online First: 17 June 2010 20558498
- Langley K Fowler T Ford T Thapar AK van den Bree M Harold G Owen MJ O'Donovan MC Thapar A Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder The British Journal of Psychiatry 2010 196 235 240 10.1192/bjp.bp.109.066274 20194547 · DOI
- National Institute for Health and Clinical Excellence Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults 2009 London: The British Psychological Society and the Royal College of Psychiatrists 22420012
- Gudjonsson GH Wells J Young S Personality disorders and clinical syndromes in ADHD prisoners Journal of Attention Disorders in press 20978272
- Wilens TE Spencer TJ Biederman J A review of the pharmacotherapy of adults with attention-deficit/hyperactivity disorder Journal of Attention Problems 2002 5 Suppl 4 189 202 11967475
- McCarthy S Asherson P Coghill D Hollis C Murray M Potts L Sayal K de Soysa R Taylor E Williams T Wong IC Attention-deficit hyperactivity disorder. Treatment discontinuation in adolescents and young adults British Journal of Psychiatry 2009 194 Suppl 3 273 277 19252159
- Young S Bramham J ADHD in Adults: A Psychological Guide to Practice 2007 Chichester: John Wiley & Sons
- Young S Toone B Tyson C Comorbidity and psychosocial profile of adults with Attention Deficit Hyperactivity Disorder Personality and Individual Differences 2003 35 743 755 10.1016/S0191-8869(02)00267-2 · DOI
- Magnusson P Smari J Sigurdardottir D Baldursson G Sigmundsson J Kristjansson K Sigurdardottir S Hreidarsson S Sigurbjornsdottir S Gudmundsson OO Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semistructured diagnostic interview Journal of Attention disorders 2006 9 Suppl 3 494 503 16481666
- National Institute of Mental Health CGI Clinical Global Impression Scale-NIMH Psychopharmacology Bulletin 1985 21 839 844
- Spencer TJ Adler LA Meihua Qiao Saylor KE Brown TE Holdnack JA Schuh KJ Trzepacz PT Kelsey DK Validation of the Adult ADHD Investigator Symptom Rating Scale (AISRS) Journal of Attention Disorders 2010 14 Suppl 1 57 68 19794135
- Zhang S Faries DE Vowles M Michelson D ADHD rating scale IV: psychometric properties from a multinational study as clinician-administered instrument International Journal of Methods in Psychiatric Research 2005 14 Suppl 4 186 201 16395872 PMC6878282
- Barkley RA Attention deficit/hyperactivity disorder: A handbook for diagnosis and treatment 1998 2 New York; Guilford Press
- Beck AT Ward C Mendelson M Beck Depression Inventory (BDI) Archives of General Psychiatry 1961 4 561 571 13688369
- Gudjonsson GH Sigurdsson JF Gudmundsdottir HB Sigurjonsdottir S The relationship between ADHD symptoms in college students and core components of maladaptive personality Personality and Individual Differences 2010 48 601 606 10.1016/j.paid.2009.12.015 · DOI
- Clarke AY Cullen AE Walwyn R Fahy T A quasi-experimental pilot study of the Reasoning and Rehabilitation programme with mentally disordered offenders The Journal of Forensic Psychiatry and Psychology 2010 21 490 500 10.1080/14789940903236391 · DOI
- Young S Gudjonsson G Chick K A preliminary Evaluation of Reasoning and Rehabilitation 2 in Mentally Disordered Offenders (R&R2M) Across Two Secure Forensic Settings in the United Kingdom Journal of Forensic Psychiatry and Psychology 2010 21 Suppl 3 336 349
Cited by
Sorted by citations
Emotion Dysregulation in Attention Deficit Hyperactivity Disorder
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13070966 · Cited by 1,232 · see citing works
Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012) · BMC Medicine · doi:10.1186/1741-7015-10-99 · Cited by 759 · see citing works
Self-citationAdult ADHD and comorbid disorders: clinical implications of a dimensional approach
Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1463-3 · Cited by 732 · see citing works
Updated European Consensus Statement on diagnosis and treatment of adult ADHD
Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., Nunes Filipe, C., et al. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2018.11.001 · Cited by 686 · see citing works
Self-citationZulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-013-0436-6 · Cited by 214 · see citing works
Philipsen, A., Jans, T., Graf, E., Matthies, S., Borel, P., Colla, M., Gentschow, L., Langner, D., Jacob, C., Groß-Lesch, S., et al. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.2146 · Cited by 175 · see citing works
Young, S., Hollingdale, J., Absoud, M., Bolton, P., Branney, P., Colley, W., Craze, E., Dave, M., Deeley, Q., Farrag, E., et al. (2020) · BMC Medicine · doi:10.1186/s12916-020-01585-y · Cited by 162 · see citing works
Self-citationPharmacological and non-pharmacological treatment of adults with ADHD: A meta-review
De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017) · Evidence Based Mental Health · doi:10.1136/eb-2016-102415 · Cited by 150 · see citing works
Young, Z., Moghaddam, N., & Tickle, A. (2020) · Journal of Attention Disorders · doi:10.1177/1087054716664413 · Cited by 138 · see citing works
Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults
Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010840.pub2 · Cited by 140 · see citing works
Matheson, L., Asherson, P., Wong, I. C. K., Hodgkins, P., Setyawan, J., Sasane, R., & Clifford, S. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-184 · Cited by 126 · see citing works
A randomized controlled trial of CBT therapy for adults with ADHD with and without medication
Weiss, M., Murray, C., Wasdell, M., Greenfield, B., Giles, L., & Hechtman, L. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-30 · Cited by 119 · see citing works
“There are now four manuals for psychological treatment of adults with ADHD, which enable replication and use of these interventions by clinicians [16-19].”
BackgroundSprich, S. E., Safren, S. A., Finkelstein, D., Remmert, J. E., & Hammerness, P. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12549 · Cited by 114 · see citing works
Arnold, L. E., Hodgkins, P., Caci, H., Kahle, J., & Young, S. (2015) · PLOS ONE · doi:10.1371/journal.pone.0116407 · Cited by 111 · see citing works
Self-citationMeta-analysis of cognitive-behavioral treatments for adult ADHD
Knouse, L. E., Teller, J., & Brooks, M. A. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000216 · Cited by 101 · see citing works
Mongia, M., & Hechtman, L. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0303-x · Cited by 102 · see citing works
Hepark, S., Janssen, L., de Vries, A., Schoenberg, P. L. A., Donders, R., Kan, C. C., & Speckens, A. E. M. (2019) · Journal of Attention Disorders · doi:10.1177/1087054715613587 · Cited by 84 · see citing works
Schrantee, A., Tamminga, H. G. H., Bouziane, C., Bottelier, M. A., Bron, E. E., Mutsaerts, H.-J. M. M., Zwinderman, A. H., Groote, I. R., Rombouts, S. A. R. B., Lindauer, R. J. L., et al. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.1572 · Cited by 77 · see citing works
Psychological treatments in adult ADHD: a systematic review
Fullen, T., Jones, S. L., Emerson, L. M., & Adamou, M. (2020) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-020-09794-8 · Cited by 73 · see citing works
Cognitive behavioural therapy for ADHD in adults: systematic review and meta-analyses
Jensen, C. M., Amdisen, B. L., Jørgensen, K. J., & Arnfred, S. M. H. (2016) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-016-0188-3 · Cited by 81 · see citing works
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
Moëll, B., Kollberg, L., Nasri, B., Lindefors, N., & Kaldo, V. (2015) · Internet Interventions · doi:10.1016/j.invent.2014.11.004 · Cited by 61 · 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
López-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
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
Are Motivation Deficits Underestimated in Patients With ADHD? A Review of the Literature
Modesto-Lowe, V., Chaplin, M., Soovajian, V., & Meyer, A. (2013) · Postgraduate Medicine · doi:10.3810/pgm.2013.07.2677 · Cited by 41 · see citing works
Wang, X., Cao, Q., Wang, J., Wu, Z., Wang, P., Sun, L., Cai, T., & Wang, Y. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.11.003 · Cited by 21 · see citing works
Schein, J., Cloutier, M., Gauthier-Loiselle, M., Bungay, R., Chen, K., Chan, D., & Childress, A. (2024) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2024.30.6.588 · Cited by 6 · see citing works
- Authors
- Emilsson, B., Gudjonsson, G., Sigurdsson, J. F., Baldursson, G., Einarsson, E., Olafsdottir, H., & Young, S.
- Affiliations
- King's College London (GB)
- National University Hospital of Iceland (IS)
- Corresponding author
- Young, Susan
- Venue
- BMC Psychiatry
- Published
- 2011-07-25
- Volume
- 11
- Issue
- 1
- Pages
- 116-116
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC3155481
- OpenAlex
- W2029896062
- Cited by
- 208
- References
- 12
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 4 · 2023: 10 · 2022: 9 · 2021: 8 · 2020: 12 · 2019: 15 · 2018: 9 · 2017: 11 · 2016: 27 · 2015: 17 · 2014: 25 · 2013: 24 · 2012: 18
- FWCI
- 15.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Portal (King's College London) (submittedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- Funders
- Eli Lilly and Company
- Icelandic Centre for Research (080443022)
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, cognitive behavioral therapy, group therapy, psychopharmacological treatment, combined psychotherapy and pharmacotherapy, comorbidities, functional disability, treatment effects
- MeSH terms
- Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Combined Modality Therapy, Female, Humans, Male, Psychiatric Status Rating Scales, Psychotherapy, Group, Cognitive Behavioral Therapy, Self Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
