European Child & Adolescent Psychiatry

, Volume 24, Issue 9, pp 1075–1090 | Cite as

Two novel CBTs for adolescents with ADHD: the value of planning skills

  • Bianca E. Boyer
  • Hilde M. Geurts
  • Pier J. M. Prins
  • Saskia Van der OordEmail author
Original Contribution


Adolescents with ADHD have planning problems, often affecting school- and social functioning. Evidence-based treatments for adolescents with ADHD are scarce and treatment drop-out rates are substantial. The effectiveness of two new, individual, short-term cognitive behavioral therapies (CBT) was investigated: One with an aim on improving planning skills and one solution-focused treatment (SFT) without such an aim. Motivational Interviewing elements were added to both treatments to enhance treatment compliance. In a multi-center randomized clinical trial, 159 adolescents (12–17 years) with ADHD were randomly assigned to one of both treatments. Pre-, post- and 3-month follow-up data were gathered on five domains: Parent-rated ADHD, planning problems and executive functioning (primary outcomes), neuropsychological measures of planning, comorbid symptoms, general functioning, and teacher measures. Attrition was low in both treatments (5 %). Adolescents improved significantly between pre- and post-test with large effect sizes on all domains. Improvements remained stable or continued to improve from post-test to follow-up, also when controlling for medication use. Marginally significant differences were found in favor of the planning-focused treatment: parents and therapists evaluated this treatment more positively than SFT and the planning-focused treatment showed more reduction of parent-rated planning problems. Two new CBTs with integrated motivational components were feasible and attrition was low. ADHD symptoms and co-existing problems of the adolescents improved from pre-test to 3 months after treatment. As the planning-focused treatment was evaluated more positive and had marginal additional beneficial effects to SFT, especially planning-focused CBT seems promising to fill the gap in available treatments for adolescents with ADHD.


ADHD Adolescence CBT Treatment Executive functioning Planning 



We thank ZonMw for a research grant. We are grateful to the participating families, students and mental healthcare institutions Lucertis Kinder-en Jeugdpsychiatrie, Bosman GGZ, Jeugdriagg, GGZ Noord-Holland Noord, UvA-Minds, Symphora-groep RCKJP and Riagg for their collaboration. We thank Rietta Oberink, from the UvA, for advice on Motivational Interviewing, Saskia Nyst for her help coordinating the project, and Lisa Doove, from KU Leuven, for advice on statistical analyses.

Conflict of interest

Bianca E. Boyer is co-developer and author of the manuals ‘Plan My Life’ and ‘Solution Focused Treatment’. She receives royalties for the sales of both interventions. Saskia van der Oord has been a paid consultant for Janssen Pharmaceuticals in the development of a serious game “Healseeker”, aimed at training cognitive functions. Also, she is co-developer and author of the manuals ‘Plan My Life’ and ‘Solution Focused Treatment’. However, she has no financial interest in the sales of the interventions. Other authors declare no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 17 kb)
787_2014_661_MOESM2_ESM.docx (12 kb)
Supplementary material 2 (DOCX 12 kb)
787_2014_661_MOESM3_ESM.docx (16 kb)
Supplementary material 3 (DOCX 16 kb)


  1. 1.
    Sonuga-Barke EJS, Bitsakou P, Thompson M (2010) Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 49(4):345–355PubMedGoogle Scholar
  2. 2.
    Barkley RA (2004) Adolescents with attention deficit/hyperactivity disorder: an overview of empirically based treatments. J Psychiatry Pract 10:39–56CrossRefGoogle Scholar
  3. 3.
    Wolraich ML, Wibbelsman CJ, Brown TE et al (2005) Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics 115:1734–1746CrossRefPubMedGoogle Scholar
  4. 4.
    Luman M, Oosterlaan J, Sergeant JA (2005) The impact of reinforcement contingencies on ADHD: a review and theoretical appraisal. Clin Psychol Rev 25:183–213CrossRefPubMedGoogle Scholar
  5. 5.
    Evans SW, Schultz BK, White LC, Brady C, Sibley MH, Van Eck K (2009) A school-based organization intervention for young adolescents with attention-deficit/hyperactivity disorder. School Ment Health 1:78–88CrossRefGoogle Scholar
  6. 6.
    Spear LP (2011) Rewards, aversions and affect in adolescence: emerging convergences across laboratory animal and human data. Dev Cogn Neurosci 1:390–403PubMedCentralCrossRefGoogle Scholar
  7. 7.
    Weyandt LL, DuPaul GJ (2013) ADHD in adolescents (middle and high school). College students with ADHD. Springer, New York, pp 11–24CrossRefGoogle Scholar
  8. 8.
    Kessler RC, Adler L, Barkley RA et al (2006) The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 163:716–723PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Abikoff H, Nissley-Tsiopinis J, Gallagher R et al (2009) Effects of MPH-OROS on the organizational, time management, and planning behaviors of children with ADHD. J Am Acad Child Adolesc Psychiatry 48:166–175CrossRefPubMedGoogle Scholar
  10. 10.
    Safren SA (2006) Cognitive-behavioral approaches to ADHD treatment in adulthood. J Clin Psychiatry 67:46–50PubMedGoogle Scholar
  11. 11.
    Evans SW, Owens JS, Bunford N (2014) Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 43:527–551CrossRefPubMedGoogle Scholar
  12. 12.
    Antshel KM, Olszewski AK (2014) Cognitive behavioral therapy for adolescents with ADHD. Child Adolesc Psychiatric Clin N Am 23:825–842CrossRefGoogle Scholar
  13. 13.
    Abikoff H, Gallagher R, Wells KC et al (2013) Remediating organizational functioning in children with ADHD: immediate and long-term effects from a randomized controlled trial. J Consult Clin Psychol 81:113–128PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Evans SW, Schultz BK, DeMars CE, Davis H (2011) Effectiveness of the Challenging Horizons after-school program for young adolescents with ADHD. Behav Ther 42:462–474PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Langberg JM, Epstein JN, Becker SP, Girio-Herrera E, Vaughn AJ (2012) Evaluation of the homework, organization, and planning skills (HOPS) intervention for middle school students with attention deficit hyperactivity disorder as implemented by school mental health providers. School Psych Rev 41:342–364PubMedCentralPubMedGoogle Scholar
  16. 16.
    Sibley MH, Pelham WE, Derefinko KJ, Kuriyan AB, Sanchez F, Graziano PA (2013) A pilot trial of supporting teens’ academic needs daily (STAND): a parent-adolescent collaborative intervention for ADHD. J Psychopathol Behav Assess 35:436–449CrossRefGoogle Scholar
  17. 17.
    Chronis AM, Jones HA, Raggi VL (2006) Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clin Psychol Rev 26:486–502CrossRefPubMedGoogle Scholar
  18. 18.
    Houghton S, Alsalmi N, Tan C, Taylor M, Durkin K (2013) Treating comorbid anxiety in adolescents with ADHD using a cognitive behavior therapy program approach. J Atten Disord. doi: 10.1177/1087054712473182 PubMedGoogle Scholar
  19. 19.
    Antshel KM, Faraone SV, Gordon M (2012) Cognitive behavioral treatment outcomes in adolescent ADHD. J Atten Disord. doi: 10.1177/1087054712443155 PubMedGoogle Scholar
  20. 20.
    Safren SA, Sprich S, Mimiaga MJ et al (2010) Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA 304:875–880PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Solanto MV, Marks DJ, Wasserstein J et al (2010) Efficacy of meta-cognitive therapie for adult ADHD. Am J Psychiatry 167:958–968PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Kataoka SH, Rowan B, Hoagwood KE (2009) Bridging the divide: in search of common ground in mental health and education research and policy. Psychiatr Serv 60:1510–1515CrossRefPubMedGoogle Scholar
  23. 23.
    Kuin M, Boyer BE, Van der Oord S (2013) Zelf Plannen [Plan My Life]. Uitgeverij Lannoo-Campus, HoutenGoogle Scholar
  24. 24.
    Johnson E, Mellor D, Brann P (2008) Differences in dropout between diagnoses in child and adolescent mental health services. Clin Child Psychol Psychiatry 13:515–530CrossRefPubMedGoogle Scholar
  25. 25.
    Boyer BE, Kuin M, Van der Oord S (2014) Zelf Oplossingen Bedenken [Solution Focused Treatment]. Uitgeverij Lannoo-Campus, HoutenGoogle Scholar
  26. 26.
    Viner RM, Christie D, Taylor V, Hey S (2003) Motivational/solution-focused intervention improves HbA1c in adolescents with type 1 diabetes: a pilot study. Diabet Med 20:739–742CrossRefPubMedGoogle Scholar
  27. 27.
    Erickson SJ, Gerstle M, Feldstein SW (2005) Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health care settings. Arch Pediatr Adolesc Med 159:1173–1180CrossRefPubMedGoogle Scholar
  28. 28.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. text rev. Washington, DCGoogle Scholar
  29. 29.
    Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39:28–38CrossRefPubMedGoogle Scholar
  30. 30.
    Kort W, Schittekatte M, Bosmans M et al (2005) Wechsler Intelligence Scale for Children-III: Handleiding. Pearson, AmsterdamGoogle Scholar
  31. 31.
    Greenhill LL (1998) Childhood attention deficit hyperactivity disorder: Pharmacological treatments. In: Nathan PE, Gorman J (eds) A guide to treatments that work. Oxford University Press, New YorkGoogle Scholar
  32. 32.
    Taves DR (1974) Minimization: a new method of assigning patients to treatment and control groups. Clin Pharmacol Ther 15:443–453PubMedGoogle Scholar
  33. 33.
    Pelham W, Gnagy EM, Greenslade KE, Milich R (1992) Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 31:210–218CrossRefPubMedGoogle Scholar
  34. 34.
    Oosterlaan J, Scheres A, Antrop I, Roeyers H, Sergeant JA (2000) Handleiding bij de Vragenlijst voor Gedragsproblemen bij Kinderen VvGK. Swets Test Publishers, LisseGoogle Scholar
  35. 35.
    Gioia GA, Isquith PK, Guy SC, Kenworthy L (2000) Behavior rating inventory of executive function. Psychological Assessment Resources, OdessaGoogle Scholar
  36. 36.
    Smidts DP, Huizinga M (2009) Handleiding Executieve Functies Gedragsvragenlijst. Hogrefe, AmsterdamGoogle Scholar
  37. 37.
    Delis D, Kaplan E, Kramer J (2001) Delis-Kaplan executive function scale. The Psychological Corporation, San AntonioGoogle Scholar
  38. 38.
    Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ (1996) Behavioral assessment of dysexecutive syndrome. Thames Valley Test Company, St. EdmundsGoogle Scholar
  39. 39.
    Sitarenios G, Kovacs M (1999) Use of the CDI the use of psychological testing for treatment planning and outcomes assessment. Lawrence Erlbaum Associates, New Jersey, pp 267–298Google Scholar
  40. 40.
    Timbremont B, Braet C (2002) Children’s depression inventory, nederlandstalige versie. Handleiding. Swets and Zeitlinger, LisseGoogle Scholar
  41. 41.
    Birmaher B, Khetarpal S, Brent D et al (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553CrossRefPubMedGoogle Scholar
  42. 42.
    Muris P, Bodden D, Hale W, Birmaher B, Mayer B (2007) SCARED-NL: Handleiding bij de gereviseerde Nederlandse versie van de screen for child anxiety related emotional disorders. Boom Test Uitgevers, AmsterdamGoogle Scholar
  43. 43.
    Achenbach TM, Edelbrock C (1991) Manual for the child behavior checklist. University of Vermont Department of Psychiatry, BurlingtonGoogle Scholar
  44. 44.
    Verhulst FC, Van der Ende J, Koot HM (1996) Handleiding voor de CBCL/4-18. Sophia Kinderziekenhuis/Academisch ziekenhuis Rotterdam/Erasmus Universiteit, RotterdamGoogle Scholar
  45. 45.
    Vorst HCM (2008) Schoolvragenlijst voor basisonderwijs en voortgezet onderwijs: Handleiding en verantwoording. Harcourt Assessment, AmsterdamGoogle Scholar
  46. 46.
    Anesko KM, Schoiock G, Ramirez R, Levine FM (1987) The homework problems checklist: assessing children’s homework problems. Behav Assess 9:179–185Google Scholar
  47. 47.
    Prinz RJ, Foster SL, Kent RN, O’Leary KD (1979) Multivariate assessment of conflict in distressed and nondistressed mother-adolescent dyads. J Appl Behav Anal 12:691–700PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Fabiano GA, Pelham WE (2002) Measuring impairment in children with attention-deficit hyperactivity disorder. The ADHD Report 10:6–10CrossRefGoogle Scholar
  49. 49.
    Fabiano GA, Pelham WE, Waschbusch DA et al (2006) A practical measure of impairment: psychometric properties of the Impairment Rating Scale in samples of children with Attention Deficit Hyperactivity Disorder and two school-based samples. J Clin Child Adolesc 35:369–385CrossRefGoogle Scholar
  50. 50.
    Brady CE, Evans SW, Berlin KS, Bunford N, Kern L (2012) Evaluating school impairment with adolescents using the classroom performance survey. School Psych Rev 41:429–446Google Scholar
  51. 51.
    Naar-King S, Suarez M (2011) Motivational interviewing with adolescents and young adults. The Guilford Press, New YorkGoogle Scholar
  52. 52.
    Anderson T, Ogles BM, Patterson CL, Lambert MJ, Vermeersch DA (2009) Therapist effects: facilitative interpersonal skills as a predictor of therapist success. J Clin Psychol 65:755–768CrossRefPubMedGoogle Scholar
  53. 53.
    Gearing RE, El-Bassel N, Ghesquiere A, Baldwin S, Gillies J, Ngeow E (2011) Major ingredients of fidelity: a review and scientific guide to improving quality of intervention research implementation. Clin Psychol Rev 31:79–88CrossRefPubMedGoogle Scholar
  54. 54.
    Baraldi AN, Enders CK (2010) An introduction to modern missing data analyses. J Sch Psychol 48:5–37CrossRefPubMedGoogle Scholar
  55. 55.
    Little RJA, Rubin DB (2002) Statistical analysis with missing data. Wiley, HobokenCrossRefGoogle Scholar
  56. 56.
    Scheffer J (2002) Dealing with Missing Data. Res Lett Inf Math Sci 3:153–160Google Scholar
  57. 57.
    Safren SA, Otto MW, Sprich S, Winett CL, Wilens TE, Biederman J (2005) Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther 43:831–842CrossRefPubMedGoogle Scholar
  58. 58.
    Cohen J (1992) Statistical power analysis. Curr Dir Psychol Sci 1(3):98–101CrossRefGoogle Scholar
  59. 59.
    Boyer BE, Geurts HM, Van der Oord S (2014) Planning skills of adolescents with ADHD. J Atten Disord. doi: 10.1177/1087054714538658 PubMedGoogle Scholar
  60. 60.
    Van der Oord S, Prins PJM, Oosterlaan J, Emmelkamp P (2008) Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: a meta-analysis. Clin Psychol Rev 28:783–800CrossRefPubMedGoogle Scholar
  61. 61.
    Daley D, Van der Oord S, Ferrin M, Danckaerts M, Doepfner M, Cortese S, Sonuga-Barke EJS (2014) Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry 53(8):835–847CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Bianca E. Boyer
    • 1
    • 2
  • Hilde M. Geurts
    • 2
    • 3
  • Pier J. M. Prins
    • 1
    • 3
  • Saskia Van der Oord
    • 4
    • 1
    • 3
    Email author
  1. 1.Department of Developmental PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Dutch Autism and ADHD Research CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Centre for Cognitive ScienceUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Clinical PsychologyKU LeuvenLeuvenBelgium

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