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ADHD Therapy Outcomes: A Review Based on Recent Research

Written by Andrew Le, MD

UpdatedNovember 13, 2024

Living with ADHD can be overwhelming—not just for those diagnosed but also for their families. The constant struggle to focus, organize, and manage daily tasks can lead to frustration, anxiety, and failure.

Traditional treatments like medication offer some relief, but they often fall short in addressing the full spectrum of challenges ADHD presents. The impact of untreated or inadequately managed ADHD can ripple through every aspect of life, from academic and professional performance to relationships and self-esteem.

In this article, we’ll explore a comprehensive approach to ADHD treatment, including Cognitive Behavioral Therapy (CBT), medication, therapies like probiotics, and personalized medicine based on genetic biomarkers. By targeting not only the symptoms but also the underlying causes and comorbid conditions, these treatments provide a holistic way to manage ADHD.

Cognitive Behavioral Therapy (CBT) in ADHD Treatment

Cognitive Behavioral Therapy (CBT) has long been recognized as an effective treatment for various psychological disorders, including ADHD. It is beneficial in addressing comorbid conditions and enhancing executive functions, which are often impaired in individuals with ADHD.

Efficacy of CBT in Adults With ADHD

CBT has been extensively studied in adult populations, especially in combination with medication. According to a previous study, the combination of CBT with medication showed greater improvements in ADHD symptoms, organizational skills, and self-esteem compared to CBT alone. The study involved 88 adults with ADHD, who were randomly assigned to either a CBT-only group or a CBT-plus medication group.

The results indicated that while both groups showed significant improvements, the group receiving CBT and medication exhibited more pronounced initial benefits. These included reduced core ADHD symptoms, better organizational abilities, and higher self-esteem scores.

However, it was also noted that over time, the CBT-only group continued to improve, suggesting that CBT has a lasting impact even without the addition of medication. This finding is significant as it highlights the potential of CBT to provide sustainable improvements in ADHD symptoms, which may reduce the need for long-term medication in some individuals.

CBT for Comorbid Anxiety in Children With ADHD

Children with ADHD often suffer from comorbid anxiety disorders, which can exacerbate their ADHD symptoms and complicate treatment. One study explored the effectiveness of CBT in treating anxiety in children with ADHD. The study involved 228 children aged 8 to 12 years, randomly assigned to either a CBT intervention or a usual care group.

The CBT program, known as “Cool Kids,” was adapted to address both ADHD and anxiety symptoms. Results showed that children who received CBT had a significant reduction in anxiety symptoms compared to those who received usual care. Additionally, the CBT group demonstrated improvements in ADHD severity, behavior, and quality of life. These findings suggest that CBT is not only effective in treating anxiety in children with ADHD but also contributes to broader improvements in their overall functioning, including better academic performance and social interactions.

Probiotics as a Complementary ADHD Therapy

The exploration of gut-brain interactions has opened new avenues for treating neurodevelopmental disorders, including ADHD. Recent studies suggest that probiotics, which influence gut microbiota, might serve as a complementary treatment for ADHD.

One systematic review evaluated the potential of probiotics in alleviating ADHD symptoms. The review included five randomized controlled trials (RCTs) investigating various probiotic strains and their effects on children with ADHD. The duration of these studies ranged from two to three months.

Among the studies that used the Conners’ Parent Rating Scale, a significant decrease in total ADHD scores was observed in the probiotic groups compared to placebo groups.

One study in the review also noted improvements in the probiotic and control groups when using the ADHD-Rating Scale. Despite these promising results, the authors caution that the small number of studies, diverse probiotic strains, and varying outcome measures make it difficult to draw definitive conclusions. They suggest that while probiotics may offer a modest benefit, further research is necessary to understand their role in ADHD treatment fully.

Community-Based Behavioral Therapy for Adolescents

One study explored the effectiveness of behavioral therapy (BT) in a community setting through a randomized trial known as the Supporting Teens’ Autonomy Daily (STAND) program. The study involved 278 adolescents with ADHD who were treated either with STAND or usual care.

The findings revealed that STAND was particularly effective in reducing conduct problems when delivered by licensed clinicians. However, the study noted that there were no significant differences between the STAND and usual care groups in other comorbid outcomes, such as anxiety and depression.

This suggests that while behavioral therapy can be highly effective in addressing specific ADHD-related behaviors, its success may be contingent on the expertise of the therapist delivering the treatment. The study also highlights the importance of making licensed professionals more accessible in community settings to maximize the effectiveness of behavioral therapy.

Acceptance and Commitment Therapy (ACT) for ADHD and Comorbid Conditions

Acceptance and Commitment Therapy (ACT) is a newer therapeutic approach that has shown promise in treating a variety of psychological disorders, including ADHD, particularly when comorbid with other conditions such as Internet Gaming Disorder (IGD).

One study assessed the effectiveness of ACT in adolescents with ADHD and comorbid IGD. The study involved 20 adolescents aged 12 to 18, all of whom had medically controlled ADHD. The participants underwent an eight-week ACT program, with their symptoms assessed before and after the intervention.

The results showed a significant reduction in IGD severity, with mean scores decreasing from 37.25 to 30.30. Additionally, there were improvements in ADHD-related symptoms, including hyperactivity, inattention, and oppositional behavior.

These findings suggest that ACT can be an effective therapy for managing ADHD symptoms, particularly when complicated by other behavioral disorders such as IGD. The study underscores the importance of considering comorbid conditions in ADHD treatment plans, as addressing these can improve overall functioning (Reference 8, p. 10).

Biomarkers in Predicting ADHD Therapy Outcomes

Recent advances in genetic and epigenetic research have led to the identification of biomarkers that may predict how individuals with ADHD will respond to certain therapies. This personalized approach could revolutionize ADHD treatment by allowing clinicians to tailor therapies to each patient's genetic makeup.

One study explored the role of methylation patterns in the DAT1 gene as potential biomarkers for predicting the severity of ADHD and the likelihood of improvement following therapy. The study found that specific methylation patterns at CpG sites within the DAT1 gene were associated with the initial severity of ADHD symptoms and the response to treatment.

For example, children with a particular methylation pattern at CpG 1 and CpG 6 were more likely to show significant improvement following therapy. The study also highlighted environmental factors, such as parental behavior, that affect these methylation patterns.

This suggests that both genetic and environmental factors should be considered when developing a treatment plan for ADHD. Such biomarkers could enable a more personalized approach to ADHD treatment, potentially improving outcomes by aligning therapies with the patient’s genetic profile.

Wrap Up

Managing ADHD requires a comprehensive and individualized approach that takes into account the diverse range of symptoms and comorbidities associated with the disorder. Cognitive Behavioral Therapy, both alone and in combination with medication, has proven effective in treating core ADHD symptoms and associated conditions like anxiety.

Probiotics offer a promising complementary treatment, though further research is necessary. Behavioral therapy, mainly when delivered by licensed professionals, can significantly reduce adolescent conduct problems.

Acceptance and Commitment Therapy is emerging as a valuable tool for addressing ADHD in the context of comorbid disorders such as Internet Gaming Disorder. Lastly, advances in genetic research, such as the identification of DAT1 methylation patterns, hold the potential to revolutionize ADHD treatment through personalized medicine.

FAQs on ADHD Therapy Outcomes

How does behavior therapy for adolescent ADHD compare to usual care?

Behavior therapy delivered by licensed clinicians in community settings outperformed usual care in reducing conduct problems in adolescents with ADHD.

What is the efficacy of CBT combined with medication for adult ADHD?

CBT combined with medication was more effective than CBT alone in improving ADHD symptoms, organizational skills, and self-esteem in adults with ADHD.

Are there any promising interventions for ADHD that target anxiety?

Cognitive-behavioral therapy (CBT) for treating anxiety in children with ADHD shows promising benefits, with ongoing trials further investigating its efficacy.

References

  • Cherkasova, M. V., French, L. R., [...], & Hechtman, L. (2016). Efficacy of cognitive behavioral therapy with and without medication for adults with ADHD: A randomized clinical trial. Journal of Attention Disorders, 24(6). https://doi.org/10.1177/1087054716671197
  • Sciberras, E., Efron, D., Patel, P., Mulraney, M., Lee, K. J., Mihalopoulos, C., Engel, L., Rapee, R. M., Anderson, V., Nicholson, J. M., Schembri, R., & Hiscock, H. (2019). Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes? Protocol for a randomized controlled trial. BMC Psychiatry, 19(1), Article 359. https://doi.org/10.1186/s12888-019-2359-z
  • Nahidi, M., Soleimanpour, S., & Emadzadeh, M. (2024). Probiotics as a promising therapy in improvement of symptoms in children with ADHD: A systematic review. Journal of Attention Disorders, 28(8). https://doi.org/10.1177/10870547241228828
  • Sibley, M. H., Graziano, P. A., Coxe, S. J., Bickman, L., Martin, P., & Flores, S. (2023). A randomized community-based trial of behavior therapy vs. usual care for adolescent ADHD: Secondary outcomes and effects on comorbidity. Behavior Therapy, 54(5), 839-851. https://doi.org/10.1016/j.beth.2023.03.001
  • Moghaddas, F., Assarian, F., Ahmadvand, A., Rahimi, H., & Ramezani, S. (2023). Treatment outcomes of acceptance and commitment therapy on severity of internet gaming disorder comorbid with ADHD in adolescents. International Archives of Health Sciences, 10(1), 20-24. https://doi.org/10.4103/iahs.iahs_118_22
  • Carpentieri, V., Cugno, S., Lockic, K., Pascale, E., & Adriani, W. (2023). DAT1 5′-un-translated-region methylation patterns as bio-markers of ADHD psycho-pathology: Contribution to disease prognosis and to monitoring of a successful therapy. Biomedicines, 11(9), Article 2546. https://doi.org/10.3390/biomedicines11092546