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. 2018 Mar 23;2018(3):CD010840. doi: 10.1002/14651858.CD010840.pub2

Pettersson 2017.

Methods Randomised controlled trial
Participants Country: Sweden
Setting: hospital (outpatients)
Age: adults (specific ages not given)
 Sample size: 45
Sex: 29 women, 16 men
 Inclusion criteria: having ADHD as the primary diagnosis; having access to a computer and the Internet; and being able to set aside one afternoon a week for group meetings
Exclusion criteria: diagnosis of borderline or antisocial personality disorder and bipolar disorder; ongoing substance abuse; suicidal ideation; dyslexia; mental retardation; ongoing psychotherapy
Interventions Intervention:
  1. Internet‐based cognitive behavioral therapy (iCBT) in a self‐help format (unspecified session frequency) (n = 13; 7 participants with specific pharmacotherapy for ADHD and 6 without specific pharmacotherapy)

  2. iCBT with weekly group‐therapy sessions (3 h once a week for 10 weeks) (n = 14; 6 participants with specific pharmacotherapy for ADHD and 8 without specific pharmacotherapy)


Both the iCBT‐G and iCBT‐S groups followed the iCBT programme In Focus, developed by the Swedish company Livanda – Internet Clinic, Ltd., in collaboration with the NPC.
Control: waiting list group (n = 18; 9 participants with specific pharmacotherapy for ADHD and 9 without specific pharmacotherapy)
Dosage, timing of dosage and administration of pharmacotherapy were not specified.
Outcomes Primary outcome
  1. ADHD symptoms ‐ Current ADHD Symptoms Scale (self‐report)


Secondary outcomes
  1. Depression ‐ Beck Depression Inventory, second edition (BDI‐II)

  2. Anxiety ‐ Beck Anxiety Inventory (BAI)

  3. Quality of life ‐ ADHD Impact Module‐Adult (AIM‐A)

Notes We could not contact the authors due to incorrect email address.
Study start date: not specified
Study end date: not specified
Funding source: the author(s) disclosed receipt of financial support for the research, authorship, and/or publication of this article: this study was financed by the 'Sjukskrivningsmiljarden', an economic fund established by the Swedish government to encourage Swedish county councils to give higher healthcare priority to sick leave and to develop processes and methods to reduce its frequency. In addition, Kent W Nilsson, as the principal investigator, received research grants from Forskningsrådet för samhällsvetenskap och arbetsliv (FAS), Systembolagets råd för alkoholforskning (SRA), the Swedish Brain Foundation, the Uppsala and Örebro Regional Research Council, Fredrik and Ingrid Thurings Foundation, the County Council of Västmanland, the König‐Söderströmska Foundation, the Swedish Psychiatric Foundation, and Svenska Spel Research Foundation. None of these organisations had a role in the study design, data collection, data analysis, data interpretation, or writing of the report.
Declarations of interest: the author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Richard Pettersson is a partner and shareholder in the company Livanda – Internet Clinic, Ltd, that constructed and owns the rights to the Internet‐based treatment programme In Focus. Richard Pettersson was also involved in the design and construction of the programme.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "A series of 54 patients were randomised in blocks to one of the study conditions over a period of four semesters (spring 2009 to autumn 2010). The results were kept in sealed envelopes, each coupled to the number in the consecutive series of patients referred to the study and who met the inclusion criteria. Unfortunately, the study had to be adjusted before the planned sample of 54 patients had been recruited because of the referral of fewer patients than expected, as well as limited financial resources and access to personnel. A total of 45 patients had been randomised to the study at the time of adjustment."
Allocation concealment (selection bias) Low risk Comment: the randomisation protocol was created by an independent statistician.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Comment: it is not possible to blind personnel in a psychosocial intervention.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "Independent evaluators, blinded to group assignment, administered the self‐report measures and conducted the semi‐structured interview."
Incomplete outcome data (attrition bias) 
 All outcomes High risk Quote: "The treatment dropout rate, defined as patients who did not complete all nine treatment modules, was 50% (seven patients) in the iCBT‐G group and 46% (six patients) in the iCBT‐S group. This gave a total dropout rate of 50% in the iCBT‐G group and 77% in the iCBT‐S group."
Selective reporting (reporting bias) Low risk Comment: the study protocol is not available, but it is clear that the published reports include all expected outcomes, including those that were prespecified.
Other bias Low risk Comment: there was no evidence of other bias.
Conflict of interest High risk Comment: the principal author was a partner and shareholder in the company Livanda – Internet Clinic, Ltd, that constructed and owns the rights to the Internet‐based treatment programme, In Focus. The principal author was also involved in the design and construction of the programme.