A randomized controlled trial of cognitive behavioral therapy for ADHD in medication-treated adolescents

Susan E. Sprich, Steven A. Safren, Daniel Finkelstein, Jocelyn E. Remmert, Paul Hammerness

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Objective: To test cognitive behavioral therapy (CBT) for persistent attention-deficit hyperactivity disorder (ADHD) symptoms in a sample of medication-treated adolescents. Methods: Forty-six adolescents (ages 14–18), with clinically significant ADHD symptoms despite stable medication treatment were randomly assigned to receive CBT for ADHD or wait list control in a cross-over design. Twenty-four were randomized to CBT, 22 to wait list, and 15 crossed-over from wait list to CBT. A blind independent evaluator (IE) rated symptom severity on the ADHD Current Symptom Scale, by adolescent and parent report, and rated each subject using the Clinical Global Impression Severity Scale (CGI), a global measure of distress and impairment. These assessments were performed at baseline, 4-months (post-CBT or post wait list), and 8-months (post-treatment for those originally assigned to the wait list condition and 4-month follow-up for those originally assigned to CBT). Trial Registration: http://clinicaltrials.gov/show/NCT01019252. Results: Using all available data, mixed effects modeling, and pooling for the wait list cross-over, participants who received CBT received a mean score 10.93 lower on the IE-rated parent assessment of symptom severity (95% CI: −12.93, −8.93; p <.0001), 5.24 lower on the IE-rated adolescent assessment of symptom severity (95% CI: −7.21, −3.28; p <.0001), and 1.17 lower IE-rated CGI (95% CI: −1.39, −.94; p <.0001). Results were consistent across 100 multiple imputations (all p <.0001). There was a greater proportion of responders after CBT by parent (50% vs. 18%, p =.00) and adolescent (58% vs. 18% p =.02) report. Conclusions: This study demonstrates initial efficacy of CBT for adolescents with ADHD who continued to exhibit persistent symptoms despite medications.

Original languageEnglish (US)
Pages (from-to)1218-1226
Number of pages9
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number11
StatePublished - Nov 1 2016


  • ADHD
  • adolescence
  • behavior therapy
  • cognitive therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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