For ADHD Adult Patients, Cognitive Behavioral Therapy Plus Medication Better Than Medication Alone
An adult with attention-deficit/hyperactivity disorder (ADHD) who takes targeted medication combined with 1-on-1 sessions of CBT (cognitive behavioral therapy) is likely to experience significantly greater improvement of symptoms compared to an ADHD adult patient who only has the medication, according to research published in JAMA (Journal of the American Medical Association), August 25th issue,2010
The authors wrote:
Approximately 4.4% of adults in the United States have ADHD, which is a disorder characterized by impairing levels of inattention, hyperactivity, and impulsivity. Medications have been the primary treatment; however, many adults with ADHD cannot or will not take medications while others show a poor medication response. Furthermore, those considered responders to medications (i.e., 30% symptom reduction) may continue to experience significant and impairing symptoms. Thus, there is a need for alternative and next-step strategies.[1.]
An assessor rated ADHD symptoms using an ADHD rating scale and Clinical Global Impression scale when the trial started, then at the end of treatment. There were further 6- and 12-month follow-ups.
The study revealed significantly better ADHD rating scale scores and Clinical Global Impression scale scores among the patients who received CBT, compared to those who were assigned to relaxation with educational support.
There was also a greater percentage of responders in the cognitive behavioral therapy condition compared with the relaxation condition, using criteria from both the Clinical Global Impression scale (53% vs. 23%) and the ADHD rating scale (67%vs. 33%).
Self-reported symptoms were also considerable more improved for CBT therapy throughout treatment. Responders and partial responders in the cognitive behavioral therapy condition held on to their gains during the 6 and 12 month periods.
Further researcher is needed to determine whether this CBT intervention might help patients who cannot or will not take ADHD medications, the researchers added
The authors wrote:
Additionally, because the only other tested treatment is a group intervention, further investigation is needed to examine whether different patients or settings may be more receptive or conducive to an individual vs. a group approach.
“This study suggests that cognitive behavioral therapy for ADHD in adults appears to be a useful and efficacious next step strategy for adults who show continued symptoms despite treatment with medication. Generally, the treatment was well tolerated, with very low drop-out rates, and had positive and sustained effects on ADHD symptoms. Clinical application of these strategies to patients in need is encouraged..
What is ADHD (Attention Deficit Hyperactivity Disorder)?
Health experts say that ADHD (attention deficit hyperactivity disorder) is the most common behavioral disorder that starts during childhood. However, it does not only affect children – people of all ages can suffer from ADHD. Psychiatrists say ADHD is a neurobehavioral developmental disorder.
An individual with ADHD finds it much more difficult to focus on something without being distracted. He has greater difficulty in controlling what he is doing or saying and is less able to control how much physical activity is appropriate for a particular situation compared to somebody without ADHD. In other words, a person with ADHD is much more impulsive and restless.
Health care professionals may use any of the following terms when describing a child (or an older person) who is overactive and has difficulty concentrating – attention deficit(AD), attention deficit hyperactivity disorder(ADHD), hyperkinetic disorder(HD), hyperactivity.
North Americans commonly use the terms ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder). In the UK hyperkinetic disorder is the official term – however, ADD and ADHD have become widely used.
ADHD in children is completely different from normal childhood excited and boisterous behavior. Many children, especially very young ones, are inattentive and restless without necessarily being affected by ADHD.
The Centers for Disease Control and Prevention (CDC) estimates that approximately 4.4 million children aged 4 to 17 have been diagnosed with ADHD in the USA by a healthcare professional. As of 2003 two-and-a-half million American children aged 4 to 17 are being treated for ADHD with medicines. The CDC adds that in 2003 7.8% of all school-aged American children were reported to have an ADHD diagnosis by their parent.
Three Types of ADHD
According to the CDC, there are three types of ADHD. They are defined according to which symptoms stand out the most.
Predominantly Inattentive Type
The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations.
Predominantly Hyperactive-Impulsive Type
The person finds it hard to keep still – they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive – interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.
A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.
What are the general signs of ADHD in children?
the child is restless, overactive, fidgety
the child is constantly chattering
the child is continuously interrupting people
the child cannot concentrate for long on specific tasks
the child is inattentive
the child finds it hard to wait his/her turn in play, conversations or standing in line (queue)
The above signs may be observed in children frequently and usually do not mean the child has ADHD. It is when these signs become significantly more pronounced in one child, compared to other children of the same age, and when his/her behavior undermines his/her school and social life, that the child may have ADHD.
What causes ADHD?
The main cause of ADHD is not yet known. Studies reveal that a person’s risk of developing ADHD is higher if a close relative also has/had it. Twin studies have indicated that ADHD is highly heritable. We also know that ADHD is much more common in boys than girls. The scientific community generally agrees that ADHD is biological in nature. Many reputable scientists believe ADHD is the result of chemical imbalances in the brain.
Some studies have indicated that food additives, specifically some colorings, may have an impact on ADHD behaviors. In July 2008, the European Union ruled that synthetic food colorings (called azo dyes) must be labeled not only with the relevant E number, but also with the words “may have an adverse effect on activity and attention in children”.
How do I know- Is my child, spouse or relative has ADHD?
ADHD cannot be diagnosed physically, i.e. with a blood test, urine test, brain scan or a physical check up. As most children have problems with self-control anyway, a proper diagnosis can be quite challenging.
An ADHD diagnosis has to be carried out by a specialist – usually a psychiatrist, psychologist or pediatrician. The specialist will observe the child and recognize behavior patterns. Data regarding the child’s behavior at home and at school will also be studied. Only a specialist will be able to accurately detect whether other problems and/or conditions are resulting in ADHD-like behavioral characteristics.
When ADHD does starts? How long does ADHD last ?
According to New Zealand’s ADHD online Support Group, the onset of ADHD usually occurs before the person is 7 years old. For about 75% of ADHD sufferers, symptoms continue into adulthood. However, levels of hyperactivity tend to decrease as the person gets older.
It was not until the 1970s that researchers began to realize that what we today know as ADHD did not always go away during a person’s teen years. It was during that decade that it was also noticed that some ADHD symptoms were identified in the parents of children undergoing ADHD treatment. In 1978 ADHD was formally recognized as a condition that also afflicts adults, and the term Adult ADD began – the ‘H’ of ADHD was dropped because it seemed the adults were not as hyperactive as children.
According to uspharmacist.com, approximately 8 million adults in the USA have ADHD. An adult with ADHD who is untreated will tend to have a chaotic lifestyle – they may seem more disorganized compared to people who are not afflicted with ADHD. Healthcare professionals believe there are millions of adults who have ADHD but do not know and remain untreated. Studies indicate that adults with ADHD benefit enormously from a combination of medication and behavior therapy.
1.“Cognitive Behavioral Therapy vs Relaxation With Educational Support for Medication-Treated Adults With ADHD and Persistent Symptoms”
Steven A. Safren, PhD, ABPP; Susan Sprich, PhD; Matthew J. Mimiaga, ScD, MPH; Craig Surman, MD; Laura Knouse, PhD; Meghan Groves; Michael W. Otto, PhD
JAMA. 2010;304(8):875-880. doi:10.1001/jama.2010.1192.
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