AT THE ECNP CONGRESS
VIENNA (FRONTLINE MEDICAL NEWS) – One-on-one counseling and manualized cognitive-behavioral therapy are equally effective as adjuncts to methylphenidate in the treatment of adult ADHD, Jan K. Buitelaar, MD, PhD, said at the annual congress of the European College of Neuropsychopharmacology.
He highlighted this finding from what he considers a well-conducted German randomized, double-blind, multicenter clinical trial in his discussion of recent major developments in the field of adult attention-deficit/hyperactivity disorder. He singled out the study because it provides clinicians with an evidence-based approach to treatment of this common disorder: namely, psychotherapy plus medication is better than either alone, and it doesn’t matter whether the psychotherapy takes the form of individual clinical behavioral counseling or a structured group cognitive-behavioral therapy (CBT) program tailored specifically for adult ADHD.
“I think this a great paper from a large German consortium,” declared Dr. Buitelaar , professor of psychiatry and head of the child and adolescent psychiatry center at Radboud University in Nijmegen, the Netherlands.
Investigators in the German COMPAS (Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study) Consortium randomized 419 18- to 58-year-old outpatients with ADHD to one of four treatment arms: group CBT plus methylphenidate or placebo, or nonspecific individual counseling plus methylphenidate or placebo. Psychotherapy sessions were conducted once weekly for the first 3 months and monthly for the next 9 months. The group CBT emphasized building self-esteem, coping skills, and acceptance. Methylphenidate was started at 10 mg per day and titrated over 6 weeks to 60 mg per day or a maximum of 1.2 mg/kg. The medication portion of the trial was conducted double-blind.
The primary outcome was the change in the ADHD Index of the Conners’ Adult ADHD Rating Scale as assessed by blinded observers from baseline to the end of the initial 3-month intensive treatment. The ADHD Index improved significantly from a mean baseline score of 20.6 to 17.6 in the group therapy arms and 16.5 with individual counseling, with no significant difference between the groups. Methylphenidate proved superior to placebo: those in the groups that received the medication in addition to their psychological intervention had a mean 3-month ADHD Index score that was 1.7 points lower than those on placebo ( JAMA Psychiatry. 2015 Dec;72[12]:1199-210 ).
Regarding secondary outcomes, the ADHD Index results remained stable at the study’s conclusion at 12 months. However, there were no significant changes in self-rated depression scores over time. Blinded observers rated the group CBT patients as showing significantly greater improvement on the Clinical Global Impression Scale of Effectiveness.
The COMPAS trial was funded by the German Federal Ministry of Research and Education.
“This study provides real guidance for those of us who treat adult ADHD. The critical question here, of course, is what is the longer-term effect,” Dr. Buitelaar said.
He reported having no financial conflicts of interest regarding his presentation.
