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CBT benefits adults with ADHD who take medication.

Cognitive-behavioral therapy significantly improved symptoms of attention-deficit/hyperactivity disorder in adult patients who were already taking medication, compared with patients who used relaxation with educational support, according to data from a study of 86 adults aged 18-65 years.

More than 4% of adults in the United States meet criteria for ADHD, but even those who take medication often experience significant symptoms, said Steven A. Safren, Ph.D., of Massachusetts General Hospital in Boston, and his colleagues.

To test the effectiveness of cognitive-behavioral therapy (CBT) to improve persistent symptoms, Dr. Safren and his colleagues randomized 43 adults with ADHD to receive 12 individual sessions of CBT or 12 individual sessions of relaxation therapy with educational support.

The average age of the patients was 44 years; 91% were white, and 55% were men (JAMA 2010;304:875-80). All of the patients in the study were taking medication for their ADHD.

The primary outcome measures were ADHD symptoms as evaluated by an assessor who was blinded to the randomization assignments.

Symptoms were assessed based on the ADHD rating scale and the CGI (Clinical Global Impression) scale at baseline, after treatment, and at the 6-and 12-month follow-up visits.

Patients who received cognitive-behavioral therapy had significantly lower posttreatment scores on both scales, compared with those who received relaxation therapy and educational support.

The mean ADHD rating scale scores were 26.4 and 14.5 at baseline and posttreatment, respectively, in the CBT group, compared with 25.3 and 19.1, respectively, in the relaxation/education group.

The mean CGI scores were 4.7 and 3.2 at baseline and posttreatment, respectively, in the CBT group, compared with 4.6 and 3.7, respectively, in the relaxation/education group. The scores did not change significantly from the posttreatment assessment to the assessments at 6 months and 12 months.

"The cognitive-behavioral therapy condition maintained gains and the relaxation with educational support condition did not improve during the follow-up," the researchers noted.

Overall, significantly more patients in the CBT group responded to treatment, compared with the relaxation/education group, on both the ADHD (67% vs. 33%) and CGI scores (53% vs. 23%), according to Dr. Safren and his associates.

In addition, the patients in the CBT group self-reported significant improvements in their symptoms, compared with patients in the relaxation/education group.

Patients with moderate to severe major depression, clinically significant panic disorders, mental disorders, psychotic spectrum disorders, and bipolar disorders, as well as those with active substance abuse or dependence problems, were among those who were excluded from the study.

The study findings were limited by a small amount of missing posttreatment data, the researchers pointed out; however, the treatment was generally well tolerated, and very few patients chose to discontinue thier participation in the study.

"Cognitive-behavioral therapy for ADHD in adults appears to be a useful and efficacious next step strategy for adults who show continued symptoms despite treatment with medication," the researchers said. "Clinical application of these strategies to patients in need is encouraged," they added.

Future study is needed to examine whether CBT might help people who are either unable or unwilling to take medication for ADHD, Dr. Safren and his associates said.

Also, further investigation is needed to determine "whether different patients or settings might be more receptive or conducive to an in individual approach," they pointed out.


Major Finding: CBT significantly improved symptoms in adults who were already taking ADHD medication, compared with relaxation with educational support.

Data Source: A randomized trial of 86 adults aged 18-65 years with ADHD.

Disclosures: The study was funded by a grant from the National Institutes of Health. Dr. Safren reported receiving royalty payments from Oxford University Press.


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Title Annotation:PSYCHIATRY; cognitive-behavioral therapy; attention-deficit/hyperactivity disorder
Author:Splete, Heidi
Publication:Internal Medicine News
Geographic Code:1USA
Date:Sep 15, 2010
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