认知行为团体治疗作为 ADHD 症状和相关障碍青少年的心理教育和药物治疗的补充：一项随机对照试验。
Cognitive behavioural group therapy as addition to psychoeducation and pharmacological treatment for adolescents with ADHD symptoms and related impairments: a randomised controlled trial.
机构信息
Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), NTNU- Norwegian University of Science and Technology, Trondheim, Norway.
Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway.
出版信息
BMC Psychiatry. 2022 Jun 2;22(1):375. doi: 10.1186/s12888-022-04019-6.
BACKGROUND
Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment.
METHODS
The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14-18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program (N = 50) or a non-CBT control condition (N = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment.
RESULTS
Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes.
CONCLUSIONS
Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD.
TRIAL REGISTRATION
NCT02937142 , 18/10/2016.
背景
认知行为疗法（CBT）被推荐用于青少年的注意力缺陷/多动障碍（ADHD）。然而，并非所有的 CBT 都是平等的，并且指南没有具体说明哪种 CBT 干预对该患者群体最有效。本研究考察了一种不包括家长参与的团体 CBT 作为短期心理教育干预和药物治疗后持续存在且有损害的 ADHD 症状的青少年的随访治疗，与不进行额外 CBT 相比的疗效。
方法
作者在挪威的两家儿童和青少年心理健康门诊进行了一项双臂平行随机对照试验。100 名年龄在 14-18 岁的 ADHD（66%）或亚临床 ADHD（34%）患者被随机分配到 12 周的团体 CBT 项目（N=50）或非 CBT 对照组（N=50）。评估在就诊时、治疗前两周和治疗后两周进行。主要结果是家长、教师和自我评定的 ADHD 症状（ADHD 评定量表-IV），次要结果是 ADHD 症状严重程度、执行功能、功能障碍和情绪问题的评定。对 ADHD 症状严重程度进行评估的评估者在基线和治疗后使用临床总体印象严重度量表（CGI-S）进行盲法分组。
结果
使用混合效应模型的分析显示，从基线到治疗后，治疗组在主要和次要结果上没有差异。
结论
与我们的假设相反，我们没有发现团体 CBT 作为心理教育和药物治疗后的 ADHD 症状和伴随的障碍的额外治疗效果。CBT 的局限性在于治疗成分数量多且剂量低，导致实践时间有限。与基于证据、个体化的、有家长参与的靶向 CBT 不同，没有家长参与的仅针对青少年的团体 CBT 似乎对治疗 ADHD 无效。
试验注册
NCT02937142，2016 年 10 月 18 日。
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