Behavioral therapy may aid adult ADHD

NEW YORK (Reuters Health) - A form of behavioral therapy that focuses on practical skills such as time management and planning may help adults with attention-deficit hyperactivity disorder (ADHD), a new study suggests.

ADHD is often thought of as a problem of childhood, but it's estimated that about 4 percent of U.S. adults have the disorder. A number of studies have found that ADHD medications are effective for adults, but there has been little research into whether behavioral therapy is helpful.

The new study, published in the American Journal of Psychiatry, looked at the effectiveness of a newer type of behavioral therapy called meta-cognitive therapy -- which aims to give people new ways of thinking about and tackling their daily tasks and longer-term goals.

In this case, the therapy focused on helping adults with ADHD hone their time management, planning and organizational skills, according to lead researcher Dr. Mary V. Solanto of the Mount Sinai School of Medicine in New York City.

For the study, Solanto and her colleagues randomly assigned 88 adults diagnosed with ADHD to attend small-group sessions of either meta-cognitive therapy or "supportive" therapy -- where patients met with a therapist for education and advice on dealing with their symptoms.

Patients in both groups had two-hour therapy sessions once a week for 12 weeks. Those in the meta-cognitive group also performed "home exercises" so they could put into practice whatever strategies they had learned during therapy.

At the end of the study, patients in the meta-cognitive therapy group showed greater improvements in inattention symptoms, which were assessed by an independent psychologist or psychiatrist who did not know which patients were in which group.

Overall, 53 percent of the meta-cognitive group responded to therapy -- which meant that they had at least a 30-percent reduction in inattention symptoms on a standard measure. That compared with 28 percent of patients who received supportive therapy.

The supportive-therapy group, Solanto explained in an interview, was used as a "control" to try to isolate the specific effects of meta-cognitive therapy -- over and above the more general benefits of simply receiving a therapist's attention or support from other people with ADHD.

The fact that patients in the meta-cognitive therapy group improved to a greater degree suggests the therapy has specific benefits for adults with ADHD.

Solanto and her colleagues also found that in general, patients' inattention symptoms tended to improve along with the number of home exercises they completed.

That, Solanto said, suggests that the at-home portion of the therapy is "very important," and helps patients start to implement what they learn in their daily lives.

Right now, however, adults with ADHD who are interested in meta-cognitive therapy are unlikely to find it in their communities. The approach is not yet widely available, according to Solanto, and researchers are still studying how effective it is for ADHD -- and how it may best fit in with overall therapy for the disorder.

Some remaining questions include how effective meta-cognitive therapy is in comparison to ADHD medications, and whether the benefits may be greater for some patients if they receive a combination of therapy and medication.

SOURCE: American Journal of Psychiatry, online March 15, 2010.