Cognitive Behaviour Therapy in Medication-treated Adults With ADHD and Persistent Symptoms

A Randomized Controlled Trial

Brynjar Emilsson; Gisli Gudjonsson; Jon F Sigurdsson; Gisli Baldursson; Emil Einarsson; Halldora Olafsdottir; Susan Young

Disclosures

BMC Psychiatry. 2011;11(116)

Conclusions

The results give further support for the growing evidence that CBT increases the effect of psychopharmacological treatment in reducing ADHD symptoms and comorbid problems, and demonstrating improvements in functions associated with impairment. These findings support the recommendations of international guidelines for a comprehensive treatment package that includes psychological and psychopharmacological treatments for adults with ADHD.

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Abbreviations
ADHD: Attention Deficit Hyperactivity Disorder, R&R2ADHD: Reasoning and Rehabilitation for ADHD Youths and Adults, CBT: Cognitive Behavioural Treatment, RCT: Randomized Controlled Trial, CBT/MED: group condition receiving CBT and medication, TAU/MED: control condition receiving 'treatment as usual' and medication, KSADS ADHD: Kiddie-Schedule for Affective Disorders and Schizophrenia, ADHD Scale, CGI: Clinical Global Impression, BCS: Barkley ADHD Current Symptoms Scale, BAI: Beck Anxiety Inventory, BDI: Beck Depression Inventory, IE: Independent Evaluator.

Competing interests
BE, JFS, GB, EE & HO declare that they have no competing interests. SY has been a consultant for Janssen-Cilag, Eli-Lilly and Shire. She has given educational talks at meetings sponsored by Janssen-Cilag, Shire, Novatis, Eli-Lilly and Flynn-Pharma and has received research grants from Janssen-Cilag, Eli-Lilly and Shire. SY is a consultant for the Cognitive Centre of Canada and is co-author of 'R&R2 for ADHD Youths and Adults'. GG has been a consultant for Eli-Lilly and given educational talks at meetings sponsored by Janssen-Cilag and Shire.

Authors' contributions
BE, JFS and GB secured financial support for the study. SY provided training in R&R2ADHD. BE and EE carried out the R&RADHD treatment and BE, JFS & GG handled the statistical procedures. GB and HO served as the independent evaluators. JFS, GG and SY supervised BE and EE. All authors contributed to the study design and writing the manuscript. All authors have read and approved the manuscript.

Acknowledgements
Support for the study was received from research grants awarded by RANNIS the Icelandic Centre for Research (Nr. 080443022), the Landspitali Science Fund, and Janssen-Cilag, Iceland. No writing assistance was utilized in the writing of the manuscript.
The authors wish to thank the patients for participating in the study and acknowledge the contributions of Dr. Sigurdur Pall Palsson for the randomization process and Emily Goodwin for help with drafting and proofing the manuscript (neither has any other association with this study or conflicting interests to report).

Cite this: Cognitive Behaviour Therapy in Medication-treated Adults With ADHD and Persistent Symptoms - Medscape - Jul 25, 2011.

Table 1. Means and standard deviations and between group effect sizes (Cohen's d) at outcome
	CBT/MED			TAU/MED
Outcome measures	Baseline Mean(SD)	End of treatment Mean(SD)	Three month follow-up Mean(SD)	Baseline Mean(SD)	End of treatment Mean(SD)	Three month follow-up Mean(SD)	End of treatment Cohen's d	Follow-up Cohen's d
CGI	4.00(.85) n = 26	3.18(1.07) n = 17	3.00(.76) n = 8	4.24(1.05) n = 25	3.88(.70) n = 17	4.08(.86) n = 13	n.s.	1.31*
K-SADS ADHD	40.02(5.35) n = 26	29.88(7.23) n = 17	31.70(4.33) n = 8	38.16(8.14) n = 25	35.94(4.08) n = 17	37.08(4.72) n = 13	1.03**	1.17*
BCS inattention	15.84(6.28) n = 25	10.17(4.44) n = 18	9.76(5.62) n = 15	16.54(6.84) n = 26	14.71(5.19) n = 17	16.24(5.66) n = 17	0.94*	1.15**
BCS hyperactivity/ impulsivity	12.88(5.00) n = 25	7.06(4.41) n = 18	5.94(4.12) n = 15	9.75(6.17) n = 26	8.76(6.22) n = 17	8.76(5.43) n = 17	0.32*	0.58**
BCS Total score	28.72(10.21) n = 25	17.22(7.62) n = 18	15.70(8.74) n = 15	26.29(11.07) n = 26	23.47(8.80) n = 17	25.00(8.54) n = 17	0.76**	1.08***
BAI Anxiety	13.43(8.67) n = 25	11.00(10.61) n = 18	7.25(5.91) n = 15	14.06(7.73) n = 26	15.29(10.72) n = 17	12.89(7.50) n = 17	n.s.	0.83*
BDI Depression	11.60(8.71) n = 25	7.22(6.84) n = 18	5.00(5.77) n = 15	16.09(10.61) n = 26	15.41(9.64) n = 17	15.43(9.25) n = 17	n.s.	1.32*
RATE ADHD symptoms	41.76(11.73) n = 25	34.88(9.42) n = 17	29.12(10.94) n = 14	40.31(13.95) n = 26	41.12(10.86) n = 17	42.00(12.67) n = 17	n.s.	1.08**
RATE Emotional Control	33.24(14.63) n = 25	27.47(11.01) n = 17	21.50(9.59) n = 14	35.73(13.17) n = 26	33.16(12.84) n = 17	36.29(15.58) n = 17	n.s.	1.12*
RATE Antisocial Scale	11.70(4.36) n = 25	9.12(1.41) n = 17	9.00(1.75) n = 14	13.27(7.24) n = 26	10.76(2.39) n = 17	12.06(4.37) n = 17	0.84*	0.89*
RATE Social Functioning	28.52(7.53) n = 25	26.76(9.25) n = 17	24.29(8.07) n = 14	32.46(10.31) n = 26	36.47(10.76) n = 17	36.41(10.93) n = 17	n.s.	1.24**
RATE total score	115.22(29.17) n = 25	98.24(23.14) n = 17	82.20(25.10) n = 14	121.77(30.69) n = 26	121.35(24.08) n = 17	126.76(31.96) n = 17	n.s.	1.46***

Significant results *(p < .05) ** (p < .01) *** (p < .001); n.s. = no between group significance.

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