Current Status of Cognitive Behavioral Therapy for Adult Attention-Deficit Hyperactivity Disorder

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Cognitive behavioral therapy for adult attention-deficit/hyperactivity disorder: conceptual basis

Given that prior research supports a strong neurobiological basis for ADHD, what is the conceptual basis for applying CBT to the disorder in adults? Consistent with current theories of ADHD, the treatment model proposed by Safren and colleagues13 (Fig. 1) begins with the premise that neuropsychological impairments are at the core of the disorder. Deficits in sustained attention, inhibitory control, working memory, and motivation underlie the cardinal symptoms of ADHD: inattention,

Cognitive behavioral therapy for adult attention-deficit/hyperactivity disorder: empirical basis

As the authors have discussed elsewhere,15 the current evidence for the use of psychosocial approaches in treating adults with ADHD can best be described as emerging and lags behind the evidence base for medication treatment of adult ADHD11 and cognitive behavioral treatment for other adults disorders (eg, mood and anxiety disorders). Bearing these limitations in mind, the preliminary evidence base for cognitive behavioral approaches applied to this population are promising.

Comparison of cognitive behavioral therapy–oriented approaches

The available data on CBT for adult ADHD suggest that these interventions, as a group, show promise as efficacious interventions; however, more studies of the same treatment and more methodologically rigorous trials are needed. Despite the small overall number of trials, a range of distinct but related approaches have emerged. Can any preliminary conclusions be drawn from existing data regarding the most effective approaches at this stage? If so, common features might suggest promising

Summary and future directions

The conceptual and empirical basis for CBT approaches in adult ADHD is growing and suggests that targeted, skills-based interventions have a role in effectively treating this disorder. At this stage of development, however, subsequent studies must progress in methodological rigor. Additional randomized controlled trials with active control groups are needed and intervention packages must be tested across multiple trials by more than 1 research group. Importantly, nearly all published trials to

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    Some of the investigator time for preparation of this paper was supported by NIH Grant 5R01MH69812 to Steven A. Safren and by the Kaplen Fellowship on Depression from Harvard Medical School to Laura E. Knouse.

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