Abstract
BackgroundPrevious studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy.MethodThis was a secondary analysis comparing 23 participants randomized to CBT and Dextroamphetamine vs. 25 participants randomized to CBT and placebo. Both patients and investigators were blind to treatment assignment. Two co-primary outcomes were used: ADHD symptoms on the ADHD-RS-Inv completed by the investigator and improvement in functioning as reported by the patient on the Sheehan Disability Scale.ResultsBoth groups showed robust improvement in both symptoms and functioning, but the use of medication did not significantly improve outcome over and above use of CBT and placebo.ConclusionThis study replicates previous work demonstrating that CBT is an effective treatment for ADHD in adults. Within the limits of this pilot, secondary analysis we were not able to demonstrate that medication significantly augments the outcome of CBT therapy for adults with ADHD. The study was funded by GlaxoSmithKline, Clinical Trials Registry #GSK707.
Highlights
Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants
Tests of within-participants effects showed a significant effect of Time, F(1, 46) = 12.70, p < .001, but no significant interaction between Time and Treatment, F(1, 45) = 0.45, Discussion This is the first report of a double blind, randomized controlled study comparing the efficacy of Cognitive Behavior Therapy (CBT) therapy with either stimulant or placebo for adults with ADHD followed over five months
All patients showed significant improvement, going into remission and maintaining those gains over the 20 weeks. This supports the work of Solanto and Safren [17,21] which showed that adults may benefit from short term, structured CBT therapy
Summary
Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy. Even though medications are very useful in treating symptoms of ADHD, there are a number of reasons why psychological treatment may be required. Even when medication is effective, training in the acquisition of adaptive life skills may offer additional benefit, especially when looking at functioning in addition to symptom outcomes. Psychological treatments of ADHD in childhood in combination with medication shows a small margin of additional benefit over medication alone, especially in children with anxiety or other comorbid disorders [5]. Children on medication are in school where they are exposed to demands and training in attention, where an adult on medication is unlikely to receive instruction in executive function or other skills
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