Treatment of adult ADHD: Effectivness of single and combined treatment with cognitive behavioural group training and atomoxetine

Abstract

The aim of this study was to determine if treatment is beneficial in adult attention-deficit / hyperactivity disorder (ADHD). Therefore Atomoxetine (ATX) and a specifically designed group training based on behavioral therapy (“Training bei Aufmerksamkeitsdefizitstörung im Erwachsenenalter” (TADSE) by Baer & Kirsch, 2012) was administered. This training aims to strengthen planned behavior by practicing response delay as a behavioral inhibition skill. The deficit in behavioral inhi¬bition is thought to be the core problem in ADHD. To control treatment effects a pla¬cebo and support group (SG) approach was used. Direct and indirect changes in symptomatology rated by the patients themselves and by the examiner as well as neuropsychological parameters (errors and reaction time) were used as outcome measures.

After 8 weeks of intervention 55 randomized data sets were available. Pre and post measures were used for indirect changes in neuropsychological parameters and symptom questionnaires. In a 2x2x2 factorial design (Time [pre/post] x Substance [ATX/Placebo] x Group [TADSE/SG]) main effects and interaction effects of single or combined treatment were examined.

In the symptom ratings, persisting improvements could be shown over all participants independently of the intervention. Also in some neuropsychological parameters improvements over time showed up. 38,9% of all participants felt significant better regardless of treatment received. The ATX only lead to slightly lesser omission errors on one parameter, which is attributed to better attention. Trends to an interaction effect came up with the external symptom rating in favor of the TADSE intervention. Most effects could be shown in the reaction times. The TADSE intervention slowed down reaction time in several neuropsychological tests, which is attributed to better behavioral inhibition skills. Furthermore a connection was found, which showed that the better the person could slow down its pace of work, the greater the self rated symptom reduction was.

This study shows that a structured group setting is effective in the treatment of adult ADHD. Furthermore the behavioral therapy based TADSE training leads to better behavioral inhibition skills and therefore to a more purposeful manner of acting. Even more, the better one person could manage response delay the more symptom reduction appeared. This leads to the conclusion that the TADSE training is a tool to strengthen inhibition skills in adult ADHD.