Podcast: Cognitive-behavioural therapy for attention deficit hyperactivity disorder (ADHD) in adults

The Cochrane Developmental, Psychosocial and Learning Problems Group covers a wide range of topics relevant to the mental health of both adults and children in the more than 140 Cochrane Reviews it has produced to date. In March 2018, it added to these with a new review of cognitive-behavioural interventions for attention deficit hyperactivity disorder in adults. We asked one of the authors, Pablo Lopez from INECO Foundation and Favaloro University in Buenos Aires, Argentina, to tell us more in this podcast.

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John: Hello, I'm John Hilton, editor in the Cochrane Editorial and Methods department. The Cochrane Developmental, Psychosocial and Learning Problems Group covers a wide range of topics relevant to the mental health of both adults and children in the more than 140 Cochrane Reviews it has produced to date. In March 2018, it added to these with a new review of cognitive-behavioural interventions for attention deficit hyperactivity disorder in adults. We asked one of the authors, Pablo Lopez from INECO Foundation and Favaloro University in Buenos Aires, Argentina, to tell us more in this podcast.

Pablo: Attention deficit hyperactivity disorder, commonly referred to as ADHD, is a serious developmental condition. Its core symptoms are inattention, hyperactivity and impulsivity. People with ADHD also face difficulties with their executive function, emotional regulation and motivation. In adults, the condition significantly affects social interactions, weakens performance when working or studying and is often associated with anxiety, depression and substance abuse.
One of the treatments that might help is cognitive-behavioural therapy, or CBT, which is organised into relatively brief, focused and structured sessions. Most CBT programmes for adults with ADHD include between 8 and 12 sessions, and can be delivered on an individual or a group basis. Their main aim is to change the behaviours that reinforce the damaging effects of ADHD, by teaching people how to manage their core symptoms, improve emotional adjustment and self-esteem, and deal with the other commonly associated problems.
Therefore, we did this review to see if CBT can reduce the symptoms of ADHD when used alone or with drug-based therapy, and have found evidence that it does have a positive effect. We had three main comparisons. Firstly, CBT versus supportive psychotherapies, deferred CBT or no specific treatment; secondly, CBT plus pharmacotherapy versus pharmacotherapy alone; and, lastly, CBT versus other specific interventions that include therapeutic ingredients specifically targeted to ADHD.
We were able to use the findings from 14 randomised trials, involving 700 adults with ADHD. Thirteen of these trials were conducted in the northern hemisphere and one in Australia. None were done in low- or lower-middle-income countries, and none reported on severe adverse events.
In summary, our results suggest that, compared to specific and unspecific interventions, CBT might improve the core symptoms of ADHD; reducing inattention, hyperactivity and impulsivity. There is also evidence that when CBT was combined with pharmacotherapy, there were improvements in global functioning and reductions in depression and anxiety, compared to what happened with pharmacotherapy alone. However, we need to be cautious. The overall quality of the evidence is low, with important methodological limitations that reduce the certainty of the findings of most of the included trials. For instance, many of the trials were small and gave results for different outcome measures, raising the possibility of selective outcome reporting.

John: Thanks Pablo. If you’d like to look at the current evidence in more depth, the full Cochrane Review can be found online. Just go to Cochrane Library dot com and search 'CBT for ADHD' to find it.

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