1 - (SYM 34) Cognitive-behavioral Therapy for Adult ADHD: Meta-analysis of the Efficacy on Symptoms, Comorbidity, and Functional Outcomes

Objective: Cognitive-behavioral therapy has emerged as a promising psychosocial intervention for adults with ADHD. This systematic review and meta-analysis aimed to summarize the latest findings on CBT efficacy for ADHD symptoms, comorbid conditions, and functional outcomes, while exploring the role of intervention and sample characteristics.

Methods: Two comprehensive meta-analyses included 82 studies examining symptom outcomes (48 RCTs, 7 non-randomized trials, 27 uncontrolled trials; ~5,152 participants) and 70 studies examining functional outcomes (38 RCTs, 4 non-randomized trials, 25 single-arm trials, 4 single-case designs; 2,900 participants). Studies evaluated CBT and related interventions (DBT, mindfulness, psychoeducation) compared to control conditions. Outcomes included ADHD symptoms (self, clinician, informant-reported), comorbid anxiety and depression, global functioning, quality of life, and domain-specific functioning (social, occupational, educational). Random-effects meta-analyses examined effects at post-treatment and follow-up.

Results: CBT demonstrated moderate-to-large effects on ADHD symptoms across informants (SMD = 0.44-0.76), sustained at follow-up. Small-to-moderate effects on anxiety and depression remained stable over time. For functional outcomes, CBT produced moderate effects on global functioning post-treatment (SMD = 0.47) that increased at follow-up (SMD = 0.67). Occupational functioning showed strongest improvements, social functioning showed moderate effects, and academic benefits were limited. Quality of life effects were smaller and non-significant at follow-up. CBT remained effective regardless of medication status, comorbidities, age, or sex. Therapist-delivered, combined-format, and individual interventions with longer duration showed advantages. ADHD symptom improvement predicted quality of life but not functioning, suggesting skill acquisition drives functional gains beyond symptom reduction.

Conclusions: CBT is highly effective as first-line psychosocial treatment for adults with ADHD, demonstrating robust efficacy for both symptom reduction and functional improvement across diverse contexts. Effects on functioning strengthen over time and are strongest for directly targeted domains, supporting process-oriented intervention approaches.