Level 2: Mid-level evidence

Medications are often used for treatment of adults with attention-deficit hyperactivity disorder (ADHD), but many patients remain symptomatic despite treatment with stimulants or other drugs. A recent randomized trial evaluated the efficacy of cognitive behavioral therapy (CBT) in 86 adult patients with persistent, clinically significant ADHD symptoms who were already being treated with medication (JAMA. 2010;304:875-880). Patients were randomized to 12 weekly sessions of individual CBT vs. progressive muscle relaxation training with educational support. Medications were continued during the trial. In post-treatment assessment at approximately 15 weeks, the CBT group had a higher rate of treatment response on the Clinical Global Impressions scale (53% vs. 23%, P=0.01, NNT 4) and on the ADHD rating scale (67% vs. 33%, P=0.002, NNT 3). CBT was also associated with significantly greater improvement in self-reported symptoms (P <0.001). Responders in the CBT group showed sustained improvement at six- and 12-month follow-up visits.