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Cognitive–behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis

  • S. Young (a1) (a2) (a3), M. Khondoker (a4) (a5), B. Emilsson (a4) (a6), J. F. Sigurdsson (a3) (a6) (a7), F. Philipp-Wiegmann (a2) (a4), G. Baldursson (a6), H. Olafsdottir (a6) and G. Gudjonsson (a2) (a3) (a4)...

Abstract

Background

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.

Method

A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive–behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.

Results

CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.

Conclusions

The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

* Address for correspondence: S. Young, Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, 37 Claybrook Road, London W6 8LN, UK. (Email: susan.young1@imperial.ac.uk)

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Keywords

Cognitive–behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis

  • S. Young (a1) (a2) (a3), M. Khondoker (a4) (a5), B. Emilsson (a4) (a6), J. F. Sigurdsson (a3) (a6) (a7), F. Philipp-Wiegmann (a2) (a4), G. Baldursson (a6), H. Olafsdottir (a6) and G. Gudjonsson (a2) (a3) (a4)...

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