Background

People with ADHD have difficulty paying attention, concentrating, dealing with hyperactivity (e.g. waiting in queues) and acting without thinking (i.e. impulsivity). In adults, ADHD significantly affects social interactions, study and employment performance.

Previous studies suggest that cognitive-behavioural therapy (CBT) could be effective for treating adults with ADHD, especially when combined with pharmacological (i.e. drug) treatment. CBT aims to change the thoughts and behaviours that reinforce the harmful effects of the disorder by teaching people techniques to control the core symptoms. CBT also aims to help people cope with emotions, such as anxiety and depression, and to improve self-esteem.

Review question

Does CBT, alone or in combination with pharmacological treatment, reduce the core symptoms of ADHD in adults more than other treatments or no specific treatment?

Search dates

The evidence is current to June 2017.

Study characteristics

We found 14 randomised controlled trials (studies in which participants are randomly assigned to different treatment groups) that described the effects of CBT in 700 adults with ADHD, aged between 18 and 65 years. Thirteen trials took place in the northern hemisphere and one in Australia.

Of the included studies, three compared CBT versus other specific interventions and seven versus unspecific control conditions (unspecific supportive therapy, waiting list or no treatment). Additionally, two compared CBT plus pharmacotherapy versus pharmacotherapy alone. One trial compared CBT to two control groups, one of which was given other specific non-pharmacological treatment and one of which was a no-treatment control.

Quality of the evidence

Because of imprecision (i.e. inaccurate results), inconsistency (i.e. results differ across trials) and methodological limitations, we considered the quality of the evidence of the included studies to range from very low to moderate.

Key results

The findings suggest that CBT might improve the core symptoms of ADHD, reducing inattention, hyperactivity and impulsivity.

When combined with pharmacotherapy, there was evidence of an improvement in global functioning (i.e. a person’s overall level of functioning in life) and a reduction in depression and anxiety compared to that seen with pharmacotherapy alone.

None of the included studies reported severe adverse events. However, five participants described some type of adverse event, such as distress and anxiety.