Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
JAMA. 2010 Aug 25;304(8):875-80. doi: 10.1001/jama.2010.1192.
Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments.
To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms.
DESIGN, SETTING, AND PATIENTS: Randomized controlled trial assessing the efficacy of cognitive behavioral therapy for 86 symptomatic adults with ADHD who were already being treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments.
Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison).
The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms.
Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude -0.0531; 95% confidence interval [CI], -1.01 to -0.05; P = .03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963; P = .02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (beta = -0.41; 95% CI, -0.64 to -0.17; P <001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P = .01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P = .002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months.
Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months.
clinicaltrials.gov Identifier: NCT00118911.
成人注意缺陷多动障碍（ADHD）是一种普遍存在的、令人痛苦的、且会造成损害的疾病，单纯药物治疗无法充分缓解，且缺乏基于循证的心理社会治疗。
评估药物治疗后仍存在明显症状的成人 ADHD 患者接受认知行为疗法的效果。
设计、场所和患者：评估药物治疗的 86 名有症状的成人 ADHD 患者接受认知行为疗法的疗效的随机对照试验，这些患者正在接受药物治疗。该研究于 2004 年 11 月至 2008 年 6 月在美国一家医院进行（随访于 2009 年 7 月结束）。在随机分组的 86 名患者中，79 名完成了治疗，70 名完成了随访评估。
患者被随机分为接受 12 次认知行为疗法或放松训练联合教育支持（这是一种注意力匹配的对照）。
主要结局指标是在基线、治疗后以及 6 个月和 12 个月随访时由评估者评定的 ADHD 症状（ADHD 评定量表和临床总体印象量表）。评估者对治疗分组情况设盲。次要结局指标是自我报告的 ADHD 症状。
认知行为疗法在临床总体印象量表（-0.0531；95%置信区间，-1.01 至-0.05；P =.03）和 ADHD 评定量表（-4.631；95%置信区间，-8.30 至-0.963；P =.02）上的治疗后评分均低于放松训练联合教育支持。在整个治疗过程中，认知行为疗法的自我报告症状也显著改善（β = -0.41；95%置信区间，-0.64 至-0.17；P <001），认知行为疗法的治疗应答者更多，无论是在临床总体印象量表（53%比 23%；优势比[OR]，3.80；95%置信区间，1.50 至 9.59；P =.01）还是 ADHD 评定量表（67%比 33%；OR，4.29；95%置信区间，1.74 至 10.58；P =.002）上。认知行为疗法组的应答者和部分应答者在治疗后 6 个月和 12 个月时保持了他们的改善。
在接受药物治疗且持续存在 ADHD 症状的成年人中，与放松训练联合教育支持相比，使用认知行为疗法可改善 ADHD 症状，并且这种改善可在 12 个月时保持。
clinicaltrials.gov 标识符：NCT00118911。
