Question
Cognitive–behavioural therapy (CBT) is frequently implemented for individuals with attention-deficit hyperactivity disorder (ADHD). It is still unknown which specific components are effective, because CBT is a complex intervention with several components. The objective of this review was to assess the efficacy of CBT components for ADHD.
Study selection and analysis
Building on definitions of the components used in CBT strategies, we conducted network meta-analyses to evaluate the efficacy at both the treatment level (ie, combinations of these components) and the component level (ie, individual component). Primary outcome was treatment response of ADHD core symptoms. Secondary outcomes were total ADHD symptoms, inattention symptoms, hyperactivity-impulsivity symptoms and dropout from the treatment. We searched MEDLINE (via PubMed), Embase, PsycINFO, ClinicalTrials.gov and Cochrane Library for literature published up to 31 March 2022. This review included only randomised controlled trials.
Findings
43 trials with 3817 participants were included in the network meta-analyses. Third-wave therapy (OR=4.80, 95% credible interval (CrI) 2.50 to 9.10), behaviour therapy (OR=3.50, 95% CrI 1.70 to 7.30) and CBT (OR=3.10, 95% CrI 1.70 to 5.70) were treatments that demonstrated superior efficacy compared with placebo. The component-level analyses showed organisational strategies (incremental OR (iOR)=2.03, 95% CI 1.27 to 3.24) and third-wave components (iOR=1.95, 95% CI 1.30 to 2.93) were associated with increase in treatment response. Problem-solving techniques (incremental standardised mean difference=0.42, 95% CI 0.01 to 0.83) were associated with a reduction in inattention symptoms.
Conclusions
Our findings suggest that the optimal treatment package for ADHD may include organisational strategies, third-wave components and problem-solving techniques.
PROSPERO registration number
CRD42022323898.
I’ve been toying with the idea of getting an air purifier for my home for…
Background Evidence-based mental health requires patient-relevant outcome data, but many indicators lack clinical meaning and…
Background Obsessive-compulsive disorder (OCD) is associated with an increased risk of morbidity and mortality due…
Background Depression alongside multiple long-term conditions (MLTCs) in older adults poses a critical public health…
Objectives Should a young person receive psychotherapy or medication for their depression and on what…
Background People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD),…