Efficacy of internet-based cognitive behavioral therapy for medicated adults with attention-deficit/hyperactivity disorder (ADHD): A randomized controlled trial

Background: Cognitive behavioral therapy (CBT) is an effective treatment for adults with attention-deficit/hyperactivity disorder (ADHD), but its use is limited by poor accessibility and time constraints-barriers that internet-based CBT (iCBT) may help overcome. This trial aimed to explore the short- and long-term efficacy of iCBT in medicated adults with ADHD.

Methods: Eighty-six adults with ADHD were randomized into two groups: the iCBT combined with medication group (iCBT+M, n = 43) and the medication-only group (n = 43). The iCBT+M group received 12 weeks of iCBT with ongoing medication, while the medication-only group continued with medication alone. The primary outcome was the change in ADHD symptoms. Secondary outcomes included emotional symptoms, executive function, quality of life, and global functioning. Outcomes were assessed at baseline, post-treatment (T1), 6-month (T2), and 12-month follow-up (T3). Mixed linear models were used to assess the differences in outcomes between the two groups at each follow-up point.

Results: Compared to the medication-only group, the iCBT+M group showed greater improvements in ADHD symptoms (d = 0.50 at T1/T2, 0.59 at T3), executive function (d = 0.87 at T1, 0.49 at T2, 0.25 at T3), quality of life (d = -0.74 at T1, -0.59 at T2, -0.28 at T3), global functioning (d = 0.66 at T1, 0.85 at T2, 0.42 at T3), and anxiety (d = 0.43 at T1).

Conclusion: iCBT interventions may benefit medicated adults with ADHD by improving core symptoms, executive function, quality of life, and overall functioning, with effects sustained for 12 months.