Tratamiento psicológico cognitivo-conductual en adolescentes y adultos con TDAH

Abstract

Introduction: CBT is the most evidence based psychological treatment for adults with ADHD. However, no previous studies on psychoeducation compared to CBT treatment have been published. Also, the majority of psychological interventions in adolescents with ADHD have focused on parent treatment programs and school interventions. Little is known on psychological interventions which consist of a direct focus on the adolescent. Method: two studies have been carried out in order to assess CBT efficacy in adults and adolescents with ADHD. In the first study, 32 adults with ADHD were randomized to two treatment conditions: psychoeducation group (N=17) and CBT group (N=15). The second study is a randomized controlled trial carried out in a sample of 119 adolescents (15-21 years). Patients were randomly assigned to 12 group manualized CBT sessions (n=59) or a waiting list control group (N=60). Results: In the adult trial, results indicated that both treatments (psychoeducation and CBT) were associated with statistically significant improvements on ADHD core symptoms (ADHD-RS p<0.001 d=0.12; CAARS-inattention p<0.001 d=0.15; CAARS hyperactivity p<0.001 d=0.19, CAARS impulsivity p<0.05 d=0.32), improvements on self-steem (CAARS: p<0.05 d=0.12), decreases in anxiety (STAI: p<0.001 d=0.35), depressive symptomatology (BDI: p<0.001 d=0.1) and improvements on quality of life (QLESQ: p=0.05 d=0.33). Nevertheless, no statistically differences between groups were observed in these measures. In the adolescent trial, patients who were in the CBT group condition reduced significantly ADHD symptoms compared to the control group [ADHD-RS Adolescent: magnitude−7.46; (95% confidence interval, −9.56 to −5.36); p<0.001; d=7.5 and ADHD-RS Parents: −9.11 (95% CI, −11.48 to −6.75); p<0.001; d=8.38], and also less symptoms severity according to CGI-S [CGI-Self-Report: −0.68; (95% CI, −0.98 to −0.39); p<0.001; d=3.75] and CGI-S Clinician [−0.79 (95% CI, −0.95 to −0.62); p<0.001; d=7.71]. Functional impairment decreased significantly more in the CBT group according to parents [Weiss Functional Impairment Scale −4.02 (95% CI, −7.76 to −0.29); p < 0.05; d=2.29] and the blinded evaluator [GAF: −7.58 (95% CI, −9.1 to −6.05); p<0.001; d=7.51]. However, no differences were observed on associated symptoms (anxiety, depressive symptoms or difficulties in anger management). Conclusion: Psychoeducation demonstrated to be an efficacious treatment in reducing ADHD core symptoms for adults with ADHD and CBT group associated with pharmacological treatment proved to be an efficacious intervention for adolescents with ADHD in reducing ADHD symptoms.

Date of Award	9 Jul 2015
Original language	Spanish
Supervisor	Jose Antonio Ramos Quiroga (Director)