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Methylphenidate improved outcomes of group psychotherapy, individual counseling for adult ADHD

Among adults with attention-deficit/hyperactivity disorder, cognitive behavioral group psychotherapy did not outperform individual clinical management, however, the addition of methylphenidate improved outcomes of psychological interventions.

“Combined treatment with medication and individual or group cognitive behavioral therapy has demonstrated significant benefits over medication alone. Previous pilot clinical trials have evaluated a specific cognitive group psychotherapy program for adult ADHD. Moderate effect sizes of these and other psychotherapy concepts have been demonstrated. However, these studies have not systematically controlled for medication and include either medicated or mixed (ie, with and without medication) patient samples,” Alexandra Philipsen, MD, of Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy–University Hospital, Karl-Jaspers-Klinik, Germany, and colleagues wrote.

To compare efficacy of cognitive behavioral group psychotherapy with individual clinical management and methylphenidate hydrochloride with placebo, researchers conducted a prospective, multicenter randomized clinical trial among 419 adults aged 18 to 58 years with ADHD. Group psychotherapy and clinical management occurred weekly for 12 weeks and monthly thereafter over 1 year. Participants received methylphenidate or placebo for 1 year.

After 3 months, the all-group baseline mean on the ADHD Index of the Conners Adult ADHD Rating Scale improved from 20.6 to adjusted means of 17.6 for those receiving group psychotherapy and 16.5 for those receiving clinical management. Researchers noted no significant differences between groups.

Participants taking methylphenidate exhibited superior improvements on the ADHD Index of the Conners Adult ADHD Rating Scale compared with those taking placebo, with an adjusted mean of 16.2 vs. 17.9 (P = .003).

Treatment effects remained stable after 1 year, according to researchers.

Methylphenidate was superior to placebo among participants receiving group psychotherapy (P = .04) or clinical management (P = .04), according to descriptive analyses.

There were no significant differences between treatment groups regarding depression, though group psychotherapy was superior to clinical management in the Clinical Global Impression global assessment of effectiveness.

“To our knowledge, [The Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study] is the first trial to demonstrate long-term maintenance effects of ADHD treatments under controlled conditions,” Philipsen and colleagues wrote. “We demonstrate that psychological interventions result in better outcomes when combined with methylphenidate as compared with placebo. Our data do not suggest that highly structured group intervention outperforms individual [clinical management], which is much easier to implement in practical care than specifically tailored and highly structured [group psychotherapy].”

 – by Amanda Oldt

Disclosure: Philipsen reported serving on advisory boards, giving lectures, performing phase 3 studies, or receiving travel grants within the last 3 years from Eli Lilly and Co., Janssen-Cilag, MEDICE Arzneimittel Pütter GmbH and Co. KG, Novartis, and Shire; and authoring books and articles on psychotherapy published by Elsevier, Hogrefe, Schattauer, Kohlhammer, and Karger. Please see the full study for a list of all authors’ relevant financial disclosures.