Medication Plus Therapy Still the Most Effective ADHD Treatment, Study Finds — But Therapy May Be Catching Up
While medication combined with cognitive behavioral therapy shows the quickest and most dramatic improvement on ADHD symptoms, CBT by itself becomes more and more effective as time goes on.
Reviewed on March 2, 2018
January 24, 2017
Medication is the most empirically validated treatment for ADHD, especially when used in conjunction with cognitive behavioral therapy (CBT). But for adults who cannot or prefer not to take medication, CBT is showing more merit as a standalone treatment. A new study confirms that medication paired with CBT is still the best treatment for ADHD; however, CBT alone works almost as well and becomes more and more effective over time — whereas medication therapy tends to plateau.
The study, published in The Journal of Attention Disorders on October 6, 2016, followed 88 adults with ADHD who were randomly chosen to receive either CBT on its own, or CBT combined with stimulant medication. All of the participants participated in 12 weekly group CBT sessions, as well as 12 brief individual sessions and weekly phone calls with their therapists. The medication group had its dose optimized over the course of several weeks before beginning therapy, and then maintained that dose during and after the therapy period.
Results taken immediately after the conclusion of the 12-week CBT program showed that the CBT-plus-medication group showed significantly more improvement in ADHD symptoms, organizational skills, and self-esteem than did the CBT-only group. At a follow-up six months later, however, researchers reported that both groups performed equally well on all of the above measures; the CBT-plus-medication group appeared to have maintained its post-treatment levels, while the CBT-only group had continued to improve even after formal therapy stopped.
The study’s results challenge some of the conventional wisdom surrounding medication and CBT, says David Rabiner, Ph.D., a research professor at Duke University who was not involved in the study. In an email, he said that there was no longer “a clear answer” to the question of whether medication “provides significant additional benefits” over CBT.
For adults with ADHD who are weighing treatment options, he said, “It would be helpful to know whether medication is likely to provide significant benefits above and beyond those they would gain from well-conducted therapy.” The answer, he continued, “Depends on what outcomes are being considered and the time frame in which they are being looked at.”
Since medication starts working faster than CBT, Rabiner suggests that adults with severe ADHD focus on the two-pronged treatment plan — they may find that their symptoms normalize faster, mitigating any potential negative impact from poorly treated ADHD. Adults with milder symptoms, on the other hand, may be more inclined to focus on CBT alone; the effects won’t be as great immediately, but, if this study is a good indication, they may soon catch up to their medicated peers.