Abstract
I would like to commend Dr. Cherkasova and colleagues on their recently published study comparing the efficacy of group cognitive behavioral therapy (CBT) with and without stimulant medication in the treatment of adults with attention-deficit/hyperactivity disorder (ADHD; Cherkasova et al., 2016). Such a study has long been needed—since 2010, in fact, when CBT was found to be effective in the treatment of adults with ADHD in the first randomized controlled trials with active control groups. Safren et al. (2010) reported that individual CBT was more effective than a control relaxation treatment in treating residual ADHD symptoms in patients who were suboptimal responders to medication. The other study, by Solanto et al. (2010), (miscited in the Cherkasova paper as having enrolled only medicated adults), enrolled a sample of 88 adults, only half of whom were receiving medication. Post hoc analyses showed that group CBT was more effective than a support group, and was equally effective in medicated and nonmedicated participants. Some caveats regarding this finding, however, were noted in the discussion of that study—in particular, that participants receiving medication were being treated by community providers and may not have been optimally titrated and, second, that patients who were inadequate responders to medication may have self-selected to participate in this study of a nonmedication psychosocial treatment.
The current study by Cherkasova et al. avoided both of these confounds by randomizing patients to receive CBT alone or in combination with a stimulant, as well as by titrating the medication treatment to an optimal dose within the context of the study. The results, which indicated greater improvement in ADHD symptoms, organization, and self-esteem in the combined treatment, are importantly clinically, providing evidence for additive benefits of CBT and medication. Future research might helpfully explore whether adding group CBT to patients stabilized on medication would similarly yield additive benefits.