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The efficacy of cognitive–behavioral therapy for older adults with ADHD: a randomized controlled trial

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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

Older adults with ADHD exhibit significant functional impairment, yet there is little research to guide clinicians in evidence-based care of these adults. This study examined response to treatment in older adults who participated in a previous study of the efficacy of cognitive–behavioral treatment (CBT) in adult ADHD. It was hypothesized that older adults would respond less well to CBT than younger adults, given the cognitive demands of the treatment. As described in the original publication, 88 adults who met DSM-IV criteria for ADHD were randomized to receive either a manualized 12-week CBT group intervention targeting executive dysfunction or a parallel Support group. In the current study, outcomes for 26 adults, aged 50 or older, were compared with those of 55 younger adults with respect to inattentive symptoms assessed on a structured interview by a blind clinician, as well as on ratings by self and/or collateral on measures of attention, executive dysfunction, and comorbidity. Contrary to the hypothesis, older and younger adults were equally responsive to CBT on measures of attention. The older adults also responded as well to Support as to CBT on several outcome measures. The results provide preliminary evidence that CBT is an effective intervention for older adults with ADHD. The unexpected response to support highlights a possible age-specificity of effective therapeutic intervention that requires further investigation.

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Author notes

  1. Mary V. Solanto

    Present address: Division of Developmental and Behavioral Pediatrics, Hofstra-Northwell School of Medicine, 1983 Marcus Avenue, Suite 130, Lake Success, NY, 11042, USA

Authors and Affiliations

  1. Department of Psychiatry, New York University School of Medicine, New York, NY, USA

    Mary V. Solanto

  2. Department of Psychiatry, The Massachusetts General Hospital, Boston, MS, USA

    Craig B. Surman

  3. Pfizer, Inc., New York City, NY, USA

    Jose Ma. J. Alvir

Authors
  1. Mary V. Solanto
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  2. Craig B. Surman
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  3. Jose Ma. J. Alvir
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Correspondence to Mary V. Solanto.

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Conflict of interest

Dr. Solanto receives royalties from Guilford Press for CBT for Adult ADHD: Targeting Executive Dysfunction. Dr. Surman has received, in his lifetime, consulting fees from McNeil, Nutricia, Pfizer, Rhodes, Shire, Somaxon, and Takeda. He has also received payments for lectures for Alcobra, McNeil, Janssen, Janssen-Ortho, Novartis, Shire, and Reed/MGH Academy as well as global medical education (GME) and continuing medical education (CME) (both funded by multiple companies). Royalties have been given to Dr. Surman from Berkeley/Penguin for FASTMINDS: How To Thrive if You Have ADHD (or think you might) and from Humana/Springer for “ADHD in Adults: A Practical Guide to Evaluation and Management.” Additionally, Surman has conducted clinical research at Massachusetts General Hospital supported by Abbot, Cephalon, Hilda and Preston Davis Foundation, Eli Lilly, Magceutics/Neurocentria, Johnson & Johnson/McNeil, Lundbeck, Merck, Nordic Naturals. Dr. Alvir reports no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants gave informed consent to participate. Supported by NIMH Grant R34MH071721 to Dr. Solanto.

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Solanto, M.V., Surman, C.B. & Alvir, J.M.J. The efficacy of cognitive–behavioral therapy for older adults with ADHD: a randomized controlled trial. ADHD Atten Def Hyp Disord 10, 223–235 (2018). https://doi.org/10.1007/s12402-018-0253-1

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