To review the efficacy of cognitive behavioral therapy for adults with attention deficit hyperactivity disorder. Recent, controlled studies of the efficacy of Cognitive Behavior Therapy (CBT) treatment in adults with ADHD are reviewed. CBT is a feasible and acceptable treatment strategy in medicated adults with ADHD that leads to improvement in ADHD symptoms and co-morbid problems. CBT includes delivery of cognitive and/or emotional strategies to individuals or groups of 4 to 10 participants. The number of CBT sessions may vary from 6 to 14. Blinding may help reduce response bias. Coaching and homework may enhance motivation as well as help in generalizing strategies to patient’s daily lives. Outcomes studied include participants’ self-reports of symptoms and evaluator reports based on standardized measures of ADHD and its comorbidities. CBT is an effective treatment for adults with ADHD particularly when combined with medication.
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Kessler R, Lane M, Stang P, et al. The prevalence and workplace costs of adult attention deficit hyperactivity in a large manufacturing firm. Psychol Med. 2009;39:137–47.
Kessler R, Adler L, Ames M, et al. The prevalence and the effects of adult attention deficit hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med. 2005;47:565–72.
Safren SA. Cognitive behavioral approaches to ADHD treatment in adulthood. J Clin Psychol. 2006;67:46–50.
•• Safren SA, Sprich S, Mimiaga MJ, et al. Cognitive behavioral therapy vs relaxation with educational support for medication treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304:875–80. The study detailed in this paper demonstrated that CBT, in contrast with relaxation exercises, led to significantly greater improvements in ADHD Rating Scale scores, and Clinical Global Impression Scale scores. These positive effects of CBT treatment were maintained at longer term (12 months)..
Knouse LE, Safren SA. Current status of cognitive behavioral therapy for adult attention deficit hyperactivity disorder. Psychiatr Clin North Am. 2010;33:497–509.
Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–23.
Hirvikoski T, Waaler E, Alfredsson J, et al. Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial. Behav Res Ther. 2011;49:175–85.
•• Weiss M, Murray C, Wasdell M, et al. A randomized controlled trial of CBT for adults with and without medication. BMC Psychiatry. 2012;12:30. This is the most recent article on the subject that attempts to demonstrate the pertinent issue of how medication augments the outcome of CBT. This study proposes that CBT may be effective in individuals not on medication and that medication is not essential for increasing subject’s receptivity to CBT..
Newark PE, Stieglitz RD. Therapy relevant factors in adult ADHD from a cognitive behavioral perspective. Atten Defic Hyperact Disord. 2010;2:59–72.
Safren S, Otto M, Sprich S, et al. Cognitive behavior therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther. 2005;43:831–42.
•• Emilsson B, Gudjonsson G, Sigurdsson JF, et al. Cognitive behavior therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatry. 2011;11:116. This recent study evaluated a newly developed CBT program and demonstrated that CBT is effective in improving ADHD symptoms in adults. Further, it showed that these gains from treatment could be maintained at follow-up at 3 months..
Bramham J, Young S, Bickerdike A, et al. Evaluation of group cognitive behavioral therapy for adults with ADHD. J Attention Disord. 2009;12:434–41.
Virta M, Salakari A, Antila M, et al. Short cognitive behavioral therapy and cognitive training for adults with ADHD—a randomized controlled pilot study. Neuropsychiatr Dis Treat. 2010;6:443–53.
• Solanto MV, Marks DJ, Wasserstein J, et al. Efficacy of metacognitive therapy for adult ADHD. Am J Psychiatry. 2010;167:958–68. This paper demonstrates the efficacy of manualized CBT vs supportive therapy on 86 adults with ADHD. Improvements in the severity of ADHD were seen for meta-cognitive over supportive psychotherapy group..
Knouse LE, Cooper-Vince C, Sprich S, et al. Recent developments in the psychosocial treatment of adult ADHD. Expert Rev Neurother. 2009;8:1537–48.
Hesslinger B, Philipsen A, Richter H. Psychotherapie der ADHS im Erwachsenenalter: Ein Arbeitsbuch Hogrefe Verlag. Göttingen, Germany: GmbH & Co. KG; 2004.
M. Mongia: none; L. Hechtman: board member and consultant for Shire, Purdue Pharma, Janssen-Ortho, and Eli Lilly and Company, and payment for lectures including service on speakers’ bureaus, payment for development of educational presentations, and travel/accommodations/meeting expenses reimbursed from Shire, Purdue Pharma, Janssen-Ortho, and Eli Lilly and Company.
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Mongia, M., Hechtman, L. Cognitive Behavior Therapy for Adults with Attention-Deficit/Hyperactivity Disorder: A Review of Recent Randomized Controlled Trials. Curr Psychiatry Rep 14, 561–567 (2012). https://doi.org/10.1007/s11920-012-0303-x
- Attention-deficit/hyperactivity disorder
- Cognitive behavior therapy