title: A randomized controlled trial reporting functional outcomes of cognitive-behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology.
abstract: Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive-behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.
authors.affiliation: Centre for Psychiatry, Imperial College London, Du Cane Road, London, W12 0NN, UK. susan.young1@imperial.ac.uk.|Broadmoor Hospital, WLMHT, Crowthorne, UK. susan.young1@imperial.ac.uk.|Reykjavik University, Reykjavik, Iceland. susan.young1@imperial.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Young
authors.affiliation: Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.|Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Brynjar
authors.initials: B
authors.lastname: Emilsson
authors.affiliation: Reykjavik University, Reykjavik, Iceland.|Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: Jon Fridrik
authors.initials: JF
authors.lastname: Sigurdsson
authors.affiliation: Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.|Department of Applied Health Research, University College London, London, UK.
authors.forename: Mizanur
authors.initials: M
authors.lastname: Khondoker
authors.affiliation: Broadmoor Hospital, WLMHT, Crowthorne, UK.|Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Florence
authors.initials: F
authors.lastname: Philipp-Wiegmann
authors.affiliation: Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Gisli
authors.initials: G
authors.lastname: Baldursson
authors.affiliation: Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Halldora
authors.initials: H
authors.lastname: Olafsdottir
authors.affiliation: Broadmoor Hospital, WLMHT, Crowthorne, UK.|Reykjavik University, Reykjavik, Iceland.|Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Gisli
authors.initials: G
authors.lastname: Gudjonsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000987:Antisocial Personality Disorder / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
keywords: ADHD; Cognitive behaviour therapy; R&R2; RCT; Reasoning and rehabilitation; Treatment