Effectiveness of cognitive behavioural-based interventions for adults with attention-deficit/hyperactivity disorder extends beyond core symptoms: A meta-analysis of randomized controlled trials

Psychol Psychother. 2023 Sep;96(3):543-559. doi: 10.1111/papt.12455. Epub 2023 Feb 16.


Objectives: To provide an updated systematic review of randomized controlled studies for the efficacy of cognitive behavioural therapy (CBT) in treating adults with attention-deficit/hyperactivity disorder (ADHD).

Design: Meta-analysis.

Methods: PROSPERO registration: CRD42021273633. The methods used aligned with the PRISMA guidelines. Database searches identified CBT treatment outcome studies eligible for conducted meta-analysis. Treatment response was summarized by calculating the standardized mean differences for changes in outcome measures for adults with ADHD. Measures included core and internalizing symptoms and were assessed on the basis of self-reporting and investigator evaluation.

Results: Twenty-eight studies met the inclusion criteria. This meta-analysis indicates that CBT for adults with ADHD was effective in reducing both core and emotional symptoms. Decreases in depression and anxiety were predicted by the reduction of core ADHD symptoms. An increase in self-esteem and quality of life were also observed for adults with ADHD who were received CBT. Adults who received either individual or group therapy significantly exhibited a greater reduction of symptoms than those who received active control intervention, received treatment as usual, or were on the treatment waitlist. Traditional CBT was equally effective in reducing core ADHD symptoms but outperformed other CBT approaches in reducing emotional symptoms among adults with ADHD.

Conclusions: This meta-analysis offers cautiously optimistic support for the efficacy of CBT in treating adults with ADHD. The additional reduction of emotional symptoms demonstrates the potential of CBT in adults with ADHD who are at higher risk for depression and anxiety comorbidities.

Keywords: anxiety; attention-deficit/hyperactivity disorder; cognitive behavioural therapy; depression; quality of life; self-esteem.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity* / psychology
  • Attention Deficit Disorder with Hyperactivity* / therapy
  • Cognition
  • Cognitive Behavioral Therapy* / methods
  • Humans
  • Quality of Life
  • Randomized Controlled Trials as Topic