Summary of findings 2. Cognitive‐behavioural therapy plus pharmacotherapy versus pharmacotherapy alone for attention deficit hyperactivity disorder (ADHD) in adults.
| Cognitive‐behavioural therapy plus pharmacotherapy versus pharmacotherapy alone for ADHD in adults | ||||||
| Patient or population: adults with ADHD Setting: ambulatory Intervention: CBT plus pharmacotherapy Comparison: pharmacotherapy alone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with control conditions | Risk with CBT plus pharmacotherapy | |||||
| ADHD symptoms: clinician rated Assessed by: various scales Follow‐up: 8 to 15 weeks |
— | The mean ADHD clinician‐rated symptoms score in the intervention groups was 0.80 standardised deviations lower (1.31 lower to 0.30 lower) | — | 65 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b | Large effect sizec |
| ADHD symptoms: self‐reported Assessed by: ADHD Current Symptoms Scale (range 0 (best) to 54 (worst)) Follow‐up: 8 to 15 weeks |
The mean ADHD self‐rated symptoms score in the control groups ranged from 14.75 to 17.22. | The mean ADHD self‐rated symptoms score in the intervention groups was 7.42 lower (11.63 lower to 3.22 lower) | — | 66 (2 RCTs) | ⊕⊕⊝⊝ Lowb | Large effect size |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ADHD: attention deficit hyperactivity disorder; CBT: cognitive‐behavioural therapy; CI: confidence interval. | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded the quality of evidence due to methodological limitations (high risk of bias in blinding of participants and personnel, and the fact that Emilsson 2011 had a high risk of bias in three domains in one of the two included studies). bWe downgraded the quality of evidence due to imprecision (considering the width of the CI). cTo assess the magnitude of effect for continuous outcomes, we used the criteria suggested by Cohen 1988: 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect.