title: Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.
  
  
  METHODS
  A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.
  
  
  RESULTS
  CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.
  
  
  CONCLUSIONS
  The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.
authors.affiliation: Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College London,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Young
authors.affiliation: King's College London,Institute of Psychiatry,Psychology and Neuroscience,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Khondoker
authors.affiliation: King's College London,Institute of Psychiatry,Psychology and Neuroscience,London,UK.
authors.forename: B
authors.initials: B
authors.lastname: Emilsson
authors.affiliation: Reykjavik University,Reykjavik,Iceland.
authors.forename: J F
authors.initials: JF
authors.lastname: Sigurdsson
authors.affiliation: Broadmoor Hospital,West London Mental Health NHS Trust,Crowthorne,UK.
authors.forename: F
authors.initials: F
authors.lastname: Philipp-Wiegmann
authors.affiliation: Landspitali - The National University Hospital of Iceland,Reykjavik,Iceland.
authors.forename: G
authors.initials: G
authors.lastname: Baldursson
authors.affiliation: Landspitali - The National University Hospital of Iceland,Reykjavik,Iceland.
authors.forename: H
authors.initials: H
authors.lastname: Olafsdottir
authors.affiliation: Broadmoor Hospital,West London Mental Health NHS Trust,Crowthorne,UK.
authors.forename: G
authors.initials: G
authors.lastname: Gudjonsson
mesh_terms: D000328:Adult; D001007:Anxiety; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression; D003913:Dextroamphetamine / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018765:Dopamine Uptake Inhibitors; D003913:Dextroamphetamine
keywords: Attention-deficit/hyperactivity disorder; R & R2; cognitive–behavioural therapy; randomized controlled trials; reasoning and rehabilitation; treatment