Question: In adults with ADHD, what is the evidence that psychotherapy (including individual and group CBT, psychoeducation, psychosocial interventions) when compared to any other intervention (including medication, medication plus psychotherapy, no treatment) improves patient outcomes, including reduction in inattentive, hyperactive and impulsive symptoms, improvement in co-morbid symptoms such as anxiety, depression or anger, reduction or withdrawal from medication, and improving well-being or quality of life

Answer:

Plain language summary

Limited research suggests that combining CBT with pharmacological interventions is effective in reducing symptoms of ADHD. However, more high quality evidence is needed into the effectiveness of psychotherapy, particularly looking into other interventions than CBT, for improving outcomes in adults with ADHD.

Clinical and research implications

Most of the available evidence about psychological interventions for ADHD relates to cognitive behavioural therapy (CBT) and there is insufficient evidence to support the effectiveness of any other psychological intervention. The evidence about CBT is inconsistent; some small, poorly reported randomised controlled trials (RCTs) have found that adding group or individual CBT interventions to medication can improve ADHD symptoms and general functioning. However, a large four arm RCT, with 2.5 year follow-up, which compared group CBT to individual management and methylphenidate to placebo found that, whilst methylphenidate was superior to placebo, group CBT offered no significant advantage over individual clinical management. The evidence in this summary is consistent with current guidance that drug therapy should be the first-line treatment for ADHD. Research is needed to adequately assess the effectiveness of psychological interventions other than CBT. Further large RCTs assessing the possible adjunctive value of CBT combined with pharmacotherapies other than methylphenidate may be of value.

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