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Psychotherapy, Atomoxetine or Both? Preliminary Evidence from a Comparative Study of Three Types of Treatment for Attention-Deficit/Hyperactivity Disorder in Children



The current study aimed to investigate using a superiority framework the efficacy of a combined treatment (cognitive-behavioral therapy based on behavioral components derived from classical behavioral therapy modifications and cognitive components mainly derived from rational emotive behavior therapy, plus an attention training component in a virtual environment (CBT/REBT + ATX, N = 20) as compared to psychotherapy alone (CBT/REBT, delivered over 16 weeks, N = 18—reference treatment) and non-stimulant medication alone (atomoxetine; ATX, N = 21—reference treatment) for children with Attention-Deficit/Hyperactivity Disorder (ADHD).


A three-arm pilot randomized controlled trial was conducted. Fifty-nine children (Mage = 8.46, SD = 1.57) were randomly allocated to one of the 3 conditions.


Our preliminary findings indicated a significant difference between the CBT/REBT + ATX and ATX group at post-treatment for the total ADHD symptoms rated by parent, d = 1.30, 95% CI [0.63, 1.98], p = 0.010.


The combined treatment seems to be superior to the medication alone on parent ratings on ADHD symptoms, however, on clinical ratings on ADHD diagnosis and functioning there are no significant group differences between treatments. Future larger trials with follow-up assessments are needed to test the stability of the effects over time.

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  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental Disorders (4th ed., Revise ed.). Washington, DC: American Psychiatric Association.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Anastopoulos, A. D., O'Rourke, S. R., & Bray, A. C. (2018). Facilitating understanding and management of attention-deficit/hyperactivity disorder. In P. C. Kendall (Ed.), Cognitive therapy with children and adolescents: A casebook for clinical practice (pp. 195–220). New York: Guilford Press.

  • Anton, R., Opris, D., Dobrean, A., & David, D. (2009). Virtual reality in the rehabilitation of Attention Deficit/Hyperactivity Disorder. Instrument construction principles. Journal of Evidence-Based Psychotherapies, 9(2), 235.

    Google Scholar 

  • Beau-Lejdstrom, R., Douglas, I., Evans, S. J. W., & Smeeth, L. (2016). Latest trends in ADHD drug prescribing patterns in children in the UK: Prevalence, incidence and persistence. British Medical Journal Open, 6(6), e010508.

    Article  Google Scholar 

  • Bioulac, S., Micoulaud-Franchi, J.-A., Maire, J., Bouvard, M. P., Rizzo, A. A., Sagaspe, P., et al. (2020). Virtual remediation versus methylphenidate to improve distractibility in children with ADHD: A Controlled Randomized Clinical Trial Study. Journal of Attention Disorders, 24(2), 326–335.

    Article  PubMed  Google Scholar 

  • Boyer, B. E., Doove, L. L., Geurts, H. M., Prins, P. J. M., Van Mechelen, I., & Van der Oord, S. (2016). Qualitative treatment-subgroup interactions in a randomized clinical trial of treatments for adolescents with ADHD: Exploring what cognitive-behavioral treatment works for whom. PLoS ONE, 11(3), e0150698.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., … Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 61, 27–36.

  • Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., … Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS ONE, 12(7), e0180355.

  • Chacko, A., Wymbs, B. T., Rajwan, E., Wymbs, F., & Feirsen, N. (2017). Characteristics of parents of children with ADHD who never attend, drop out, and complete behavioral parent training. Journal of Child and Family Studies, 26(3), 950–960.

    Article  Google Scholar 

  • Cheung, K., Verhamme, K. M. C., Herings, R., Visser, L. E., & Stricker, B. H. (2019). Methylphenidate treatment initiated during childhood is continued in adulthood in half of the study population. Journal of Child and Adolescent Psychopharmacology, 29(6), 426–432.

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum Associates.

    Google Scholar 

  • Comeau, J., Georgiades, K., Duncan, L., Wang, L., Boyle, M. H., & 2014 Ontario Child Health Study Team. (2019). Changes in the prevalence of child and youth mental disorders and perceived need for professional help between 1983 and 2014: Evidence from the Ontario Child Health Study. The Canadian Journal of Psychiatry.

  • Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., … Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5, 727–738.

  • David, D., Lynn, S. J., & Ellis, A. (2010). Rational and irrational beliefs: Research, theory, and clinical practice. Oxford: Oxford University Press.

    Google Scholar 

  • David, O. A., & DiGiuseppe, R. (2016). The rational positive parenting program. In O. A. David & R. DiGiuseppe (Eds.), The rational positive parenting program (pp. 15–48). Cham: Springer.

  • Dobrean, A., Păsărelu, C.-R., Balazsi, R., & Predescu, E. (2019). Measurement invariance of the ADHD Rating Scale–IV home and school versions across age, gender, clinical status, and informant. Assessment.

    Article  PubMed  Google Scholar 

  • Dobrean, A., Rusu, C., Comsa, M., & Balazsi, R. (2005). Standardizarea pe populatia Romaniei a testului Matrici Progresive Raven Color Forma Paralel. In J. Raven, J. C. Raven, & J. H. Court (Eds.), Manual Raven: Sectiunea 2, Matrici Progresive Color. Cluj-Napoca: Editura ASCR.

  • Döpfner, M., Breuer, D., Schürmann, S., Metternich, T. W., Rademacher, C., & Lehmkuhl, G. (2004a). Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder – global outcome. European Child & Adolescent Psychiatry, 13(Suppl 1), I117–129.

    Article  Google Scholar 

  • Döpfner, M., Ise, E., Breuer, D., Rademacher, C., Metternich-Kaizman, T. W., & Schürmann, S. (2016). Long-term course after adaptive multimodal treatment for children with ADHD: An 8-year follow-up. Journal of Attention Disorders, 24(1), 145–162.

    Article  PubMed  Google Scholar 

  • Döpfner, M., Ise, E., Metternich-Kaizman, T. W., Schürmann, S., Rademacher, C., & Breuer, D. (2015). Adaptive multimodal treatment for children with attention-deficit-/hyperactivity disorder: An 18 month follow-up. Child Psychiatry & Human Development, 46(1), 44–56.

  • Döpfner, M., Schürmann, S., & Lehmkuhl, G. (2004b). Copilul hiperactiv si incapatanat. Cluj-Napoca: Romanian Psychological Testing Services.

  • Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., … Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.e2.

  • Doyle, K. A., & Terjesen, M. D. (2006). Rational-emotive behavior therapy and attention deficit hyperactivity disorder. In A. Ellis & M. E. Bernard (Eds.), Rational emotive behavioral approaches to childhood disorders (pp. 281–309). Cham: Springer.

  • DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD rating scale-IV: Checklists, norms and clinical interpretation. New York: Guilford Publications.

    Google Scholar 

  • Ellis, A. (1994). Reason and emotion in psychotherapy (revised and updated ed.). New York: Birch Lane Press.

  • Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 157–198.

    Article  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

    Article  Google Scholar 

  • Ferguson, C. J. (2009). An effect size primer: A guide for clinicians and researchers. Professional Psychology: Research and Practice, 40(5), 532.

    Article  Google Scholar 

  • Gellatly, R., & Beck, A. T. (2016). Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cognitive Therapy and Research, 40(4), 441–452.

  • Gonzalez, J. E., Nelson, J. R., Gutkin, T. B., Saunders, A., Galloway, A., & Shwery, C. S. (2004). Rational emotive therapy with children and adolescents: A meta-analysis. Journal of Emotional and Behavioral Disorders, 12(4), 222–235.

    Article  Google Scholar 

  • Handen, B. L., Aman, M. G., Arnold, L. E., Hyman, S. L., Tumuluru, R. V., Lecavalier, L., … Smith, T. (2015). Atomoxetine, parent training, and their combination in children with autism spectrum disorder and attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(11), 905–915.

  • Hanwella, R., Senanayake, M., & de Silva, V. (2011). Comparative efficacy and acceptability of methylphenidate and atomoxetine in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis. BMC Psychiatry, 11, 176.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hien, D., Matzner, F. J., First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1994). Structured clinical interview for DSM-IV-child edition (version 1.0). New York: Columbia University.

  • Holmberg, K., & Bölte, S. (2014). Do symptoms of ADHD at ages 7 and 10 predict academic outcome at age 16 in the general population? Journal of Attention Disorders, 18(8), 635–645.

    Article  PubMed  Google Scholar 

  • Hutchison, S. L., Ghuman, J. K., Ghuman, H. S., Karpov, I., & Schuster, J. M. (2016). Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: A review. Therapeutic Advances in Psychopharmacology.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff, H. B., Greenhill, L. L., … Hur, K. (2007). 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 989–1002.

  • Kashdan, T. B., Jacob, R. G., Pelham, W. E., Lang, A. R., Hoza, B., Blumenthal, J. D., et al. (2004). Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: Modeling relationships with family functioning. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 33(1), 169–181.

    Article  Google Scholar 

  • Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2011). Working memory deficits and social problems in children with ADHD. Journal of Abnormal Child Psychology, 39(6), 805–817.

    Article  PubMed  Google Scholar 

  • Majewicz-Hefley, A., & Carlson, J. S. (2007). A meta-analysis of combined treatments for children diagnosed with ADHD. Journal of Attention Disorders, 10(3), 239–250.

    Article  PubMed  Google Scholar 

  • MacDonald, B., Pennington, B. F., Willcutt, E. G., Dmitrieva, J., Samuelsson, S., Byrne, B., et al. (2019). Cross-country differences in parental reporting of symptoms of ADHD. Journal of Cross-Cultural Psychology, 50(6), 806–824.

    Article  PubMed  PubMed Central  Google Scholar 

  • Margari, F., Craig, F., Petruzzelli, M. G., Lamanna, A., Matera, E., & Margari, L. (2013). Parents psychopathology of children with Attention Deficit Hyperactivity Disorder. Research in Developmental Disabilities, 34(3), 1036–1043.

    Article  PubMed  Google Scholar 

  • Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., … Houck, P. R. (2009). The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484–500.

  • Myrén, K.-J., Thernlund, G., Nylén, Å., Schacht, A., & Svanborg, P. (2010). Atomoxetine’s effect on societal costs in Sweden. Journal of Attention Disorders, 13(6), 618–628.

    Article  PubMed  Google Scholar 

  • National Institute for Health and Clinical Excellence. (2018). Attention deficit hyperactivity disorder: diagnosis and management. NICE clinical guideline 87.

  • Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., … Atomoxetine/Methylphenidate Comparative Study Group. (2008). Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: Acute comparison and differential response. The American Journal of Psychiatry, 165(6), 721–730.

  • Ottosen, C., Petersen, L., Larsen, J. T., & Dalsgaard, S. (2016). Gender differences in associations between attention-deficit/hyperactivity disorder and substance use disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 55(3), 227–234.e4.

    Article  PubMed  Google Scholar 

  • Parsons, T. D., Duffield, T., & Asbee, J. (2019). A comparison of virtual reality classroom continuous performance tests to traditional continuous performance tests in delineating ADHD: A meta-analysis. Neuropsychology Review, 29, 338–356.

  • Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. The American Journal of Psychiatry, 164(6), 942–948.

    Article  PubMed  Google Scholar 

  • Raven, J. C., Court, J. H., & Raven, J. C. (1990). Manual for Raven’s progressive matrices and vocabulary scales—section 2: Coloured progressive matrices. Oxford: Oxford Psychologists Press.

  • Renoux, C., Shin, J.-Y., Dell’Aniello, S., Fergusson, E., & Suissa, S. (2016). Prescribing trends of attention-deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995–2015. British Journal of Clinical Pharmacology, 82(3), 858–868.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rescorla, L., Achenbach, T. M., Ivanova, M. Y., Dumenci, L., Almqvist, F., Bilenberg, N., … Verhulst, F. (2007). Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries. Journal of Consulting and Clinical Psychology, 75(2), 351–358.

  • Rescorla, L. A., Ginzburg, S., Achenbach, T. M., Ivanova, M. Y., Almqvist, F., Begovac, I., … Verhulst, F. C. (2013). Cross-Informant Agreement Between Parent-Reported and Adolescent Self-Reported Problems in 25 Societies. Journal of Clinical Child & Adolescent Psychology, 42(2), 262–273.

  • Sacchetti, G. M., & Lefler, E. K. (2014). ADHD symptomology and social functioning in college students. Journal of Attention Disorders.

    Article  PubMed  Google Scholar 

  • Savill, N. C., Buitelaar, J. K., Anand, E., Day, K. A., Treuer, T., Upadhyaya, H. P., et al. (2015). The efficacy of atomoxetine for the treatment of children and adolescents with attention-deficit/hyperactivity disorder: A comprehensive review of over a decade of clinical research. CNS Drugs, 29(2), 131–151.

    Article  CAS  PubMed  Google Scholar 

  • Schweren, L., Hoekstra, P., van Lieshout, M., Oosterlaan, J., Lambregts-Rommelse, N., Buitelaar, J., … Hartman, C. (2019). Long-term effects of stimulant treatment on ADHD symptoms, social-emotional functioning, and cognition. Psychological Medicine, 49(2), 217–223.

  • Smith, T., Aman, M. G., Arnold, L. E., Silverman, L. B., Lecavalier, L., Hollway, J., … Handen, B. L. (2016). Atomoxetine and parent training for children with autism and attention-deficit/hyperactivity disorder: A 24-week extension study. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), 868–876.e2.

  • Su, Y. (Esther), Wang, H., Geng, Y.-G., Sun, L., Du, Y.-S., Fan, F., & Su, L.-Y. (2015). Parent ratings of ADHD symptoms in Chinese urban schoolchildren: Assessment with the Chinese ADHD rating Scale–IV: Home version. Journal of Attention Disorders, 19(12), 1022–1033.

  • Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., … Visser, S. (2011). ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022.

  • Svanborg, P., Thernlund, G., Gustafsson, P. A., Hägglöf, B., Schacht, A., & Kadesjö, B. (2009). Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: A randomized, double-blind, placebo-controlled study in Swedish children and adolescents. European Child & Adolescent Psychiatry, 18(12), 725.

    Article  Google Scholar 

  • Szentagotai, A., Opriş, D., & David, D. (2011). Virtual reality in evidence-based psychotherapy. In J.-J. Kim (Ed.), Virtual reality (pp. 445–468). InTech. Retrieved from

  • Taylor, E., Döpfner, M., Sergeant, J., Asherson, P., Banaschewski, T., Buitelaar, J., … Zuddas, A. (2004). European clinical guidelines for hyperkinetic disorder—first upgrade. European Child & Adolescent Psychiatry, 13(1), i7–i30.

  • The MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086.

    Article  Google Scholar 

  • Theule, J., Wiener, J., Tannock, R., & Jenkins, J. M. (2013). Parenting stress in families of children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders, 21(1), 3–17.

    Article  Google Scholar 

  • Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135(4), e994–e1001.

    Article  PubMed  Google Scholar 

  • Vernon, A. (2019). REBT with children and adolescents. In W. Dryden & M. E. Bernard (Eds.), REBT with diverse client problems and populations (pp. 243–263). Cham: Springer.

    Chapter  Google Scholar 

  • Vîslă, A., Flückiger, C., grosse Holtforth, M., & David, D. (2016). Irrational beliefs and psychological distress: A meta-analysis. Psychotherapy and Psychosomatics, 85(1), 8–15.

  • Waxmonsky, J. G., Waschbusch, D. A., Pelham, W. E., Draganac-Cardona, L., Rotella, B., & Ryan, L. (2010). Effects of atomoxetine with and without behavior therapy on the school and home functioning of children with attention-deficit/hyperactivity disorder. The Journal of Clinical Psychiatry, 71(11), 1535–1551.

    Article  CAS  PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., et al. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79–117.

    Article  Google Scholar 

  • Wilens, T. E., & Biederman, J. (1992). The stimulants. Psychiatric Clinics, 15(1), 191–222.

  • Young, S., Moss, D., Sedgwick, O., Fridman, M., & Hodgkins, P. (2015). A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychological Medicine, 45(2), 247–258.

    Article  CAS  PubMed  Google Scholar 

  • Zwi, M., Jones, H., Thorgaard, C., York, A., & Dennis, J. A. (2011). Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. The Cochrane Database of Systematic Reviews, 2011(12).

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We want to thank Dr. Silviu Matu and Dr. Ioana Cristea for their constructive comments on the manuscript.


This study was supported by National Council for Research (Romania) (Grant No. CEEX Contract no 78 / 2006).

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Daniel David is Director of Research and a Diplomate/Supervisor at the Albert Ellis Institute, SUA. Anca Dobrean received speaker fee from Eli Lilly. Viorel Lupu received speaker fees from Eli Lilly and Janssen Cilag. Elena Predescu received consulting and speaker fees from Eli Lilly, Janssen Cilag and research support from the Romanian Ministry of Education and Research. Manfred Döpfner received consulting income and research support from Lilly, Medice, Shire, Takeda, and Vifor and research support from the German Research Foundation, German Ministry of Education and Research, German Ministry of Health, and Innovation Fund. He received income as head, supervisor, and lecturer of the School of Child and Adolescent Cognitive Behaviour Therapy at the University Hospital Cologne and as consultant for Child Behaviour Therapy at the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung). He also received royalties from treatment manuals, books and psychological tests published by Beltz, Elsevier, Enke, Guilford, Hogrefe, Huber, Kohlhammer, Schattauer, Springer, Wiley. Costina Ruxandra Păsărelu and Felicia Iftene declared no potential conflict of interests.

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David, D., Dobrean, A., Păsărelu, C.R. et al. Psychotherapy, Atomoxetine or Both? Preliminary Evidence from a Comparative Study of Three Types of Treatment for Attention-Deficit/Hyperactivity Disorder in Children. Cogn Ther Res 45, 149–165 (2021).

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