Group Therapy for Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Abstract

To determine the efficacy of group cognitive-behavioral therapy (CBT) on adolescents with attention-deficit/hyperactivity disorder (ADHD) who were in pharmacological treatment but still had persistent symptoms. We conducted a multicenter, randomized, rater-blinded, controlled trial between April 2012 and May 2014 in a cohort of 119 adolescents (15-21 years of age). Participants were randomly assigned to 12 manualized group CBT sessions (n= 45) or a waiting list control group (n= 44). Primary outcomes were assessed by a blinded evaluator (ADHD Rating Scale [ADHD-RS], Clinical Global Impression Scale for Severity [CGI-S], Global Assessment of Functioning [GAF]) before and after treatment, as well as by self-report and parent informant ratings. Of the initial 119 participants enrolled, 89 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the group CBT sessions experienced significantly reduced ADHD symptoms compared to the control group (ADHD-RS Adolescent:-7.46, 95% CI=-9.56 to-5.36, p< .001, d=7.5; ADHD-RS Parents:-9.11, 95% CI=-11.48 to-6.75, p< .001, d= 8.38; CGI-S Self-Report:-0.68, 95% CI=-0.98 to-0.39, p< .001, d= 3.75; CGI-S Clinician:-0.79, 95% CI=-0.95 to-0.62, p< .001; d=7.71). Functional impairment decreased significantly inthe CBT group according to parents (Weiss Functional Impairment Scale-4.02, 95% CI=-7.76 to-0.29, p< .05, d= 2.29) and according to the blinded evaluator (GAF:-7.58, 95% CI=-9.1 to-6.05, p< .001, d= 7.51). Group CBT associated with pharmacological treatment is an efficacious intervention for reducing ADHD symptoms and functional impairment in adolescents. Clinical trial registration information-CBT Group for Adolescents With ADHD: a Randomized Controlled Trial; http://clinicaltrials.gov/; NCT02172183.