A randomized controlled trial reporting functional outcomes of cognitive–behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology

Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive–behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.Susan Young has received consultancy fees, speaker’s fees and/or travel honoraria from Janssen, Eli Lilly, Shire, Novartis and Flynn Pharma, and received research grants from Janssen, Eli Lilly and Shire. She is a consultant for the Cognitive Centre of Canada and co-author of R&R2ADHD. Gisli Gudjonsson has received consultancy fees, speaker fees and/or travel honoraria from Eli Lilly, Janssen and Shire. Brynjar Emilsson and Gisli Baldursson have received travel honoraria from Janssen. The other authors have no competing interests. Support for the study was received from research grants awarded by RANNIS the Icelandic Centre for Research (Nr. 080443022), the Landspitali Science Fund and Janssen-Cilag, Iceland. No writing assistance was utilized in the writing of the manuscript. MK receives salary support from the National Institute for Health Research (NIHR) [Mental Health Biomedical Research Centre] at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.Peer Reviewe