CBT for Residual ADHD Symptoms in Adults

Project: Research project

Project Details


DESCRIPTION (provided by applicant): This is an amended (third) submission for
a NIMH small grant (RO3) to estimate the efficacy of cognitive behavioral
therapy for coping with medication-resistant symptoms of Attention Deficit
Hyperactivity Disorder (ADHD). The first submission was reviewed quite
positively, and, as noted by the set of second reviews, all reviewers' comments
were addressed, improving the study design. However, a few new concerns
emerged, and despite the improvements, the score was slightly raised. These
concerns are fully addressed in this final submission.

ADHD in adulthood is a valid, clinically significant, debilitating and
prevalent disorder for which there are currently no empirically-validated
psychosocial treatments. Although previously thought to be a disorder of
childhood, prospective longitudinal data has revealed that ADHD persists in as
many as 50% of young adults who were diagnosed in childhood, and that as many
as 5% of adults may suffer from this disorder. The combination of core and
associated symptoms places persons with this disorder at severe risk for
academic and occupational underachievement, relationship difficulties, and
significantly-impaired quality of life.

Ten years of study by our research team and others -- including controlled
studies of stimulant medications and open studies of tricyclic, monoamine
oxidase inhibitor, and atypical antidepressants -- reveal that 20-50% of adults
are considered nonresponders due to insufficient symptom reduction or their
inability to tolerate these medications (Wender, 1998; Wilens et al., 1998a).
Moreover, adults who are considered responders typically show a reduction in
only 50% or less of the core symptoms of ADHD (Wilens et al., 1998a). This
leaves pharmacologically-treated patients with significant residual symptoms
which cause functional impairment and may also increase risk for relapse.

The current application is to develop and test a skills-building,
cognitive-behavioral intervention for adults with ADHD. Interventions will be
administered in modules that are matched to domains of impairment
characterizing individual patient presentations. The proposed project will lay
a foundation for a large scale randomized controlled trial of CBT for residual
symptoms of ADHD. The project is to be conducted at Massachusetts General
Hospital's Adult ADHD program which provides access to large numbers of
patients with ADHD, a strong history of research success, and nationally
recognized experts who will serve as mentors for the new investigator PI
utilizing the R03 mechanism.
Effective start/end date9/1/018/31/04


  • National Institute of Mental Health: $86,500.00
  • National Institute of Mental Health: $86,500.00


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