Effectiveness of Usual-Care Multimodal Cognitive Behavioral Therapy for Adolescents With Attention-Deficit/Hyperactivity Disorder Rated by Parents and Patients

Abstract

Objective:

Highly controlled, randomized controlled trials (RCTs) have provided evidence of the efficacy of multimodal cognitive behavioral therapy (CBT) including pharmacotherapy in adolescents with attention-deficit/hyperactivity disorder (ADHD). However, the effectiveness under routine care conditions has not been sufficiently evaluated. The present study investigates this transfer of evidence from randomized controlled trials to routine clinical practice investigating a large clinically referred sample of adolescents with ADHD receiving a CBT treatment under routine care conditions.

Methods:

In a sample of N = 420 adolescents with ADHD, we analyzed changes in parent- and self-rated emotional and behavioral symptoms during routine treatment at a university outpatient clinic using paired t-tests, effect sizes, and comparisons to a historical waitlist control group. The treatment included multimodal CBT for all patients and pharmacotherapy for about a quarter of patients. Results were compared to a historical waitlist control group.

Results:

In the total sample, small to medium pre-post effect sizes emerged for parent-rated (d = 0.47–0.68) and self-rated (d = 0.37–0.47) emotional and behavioral symptoms. For adolescents who rated in the clinical range at the start of treatment, large effect sizes were found for ADHD symptoms (d = 0.80–1.28), and the comparison with the control group revealed moderate to large effect sizes in favor of the treated sample (d = 0.52–0.93). On the whole, symptom change did not differ between patients with versus without additional pharmacotherapy.

Conclusions:

The findings suggest that routine outpatient treatment based on CBT principles may be effective for adolescents with ADHD, thus supporting the results of previous RCTs.