On February 3, a research group including Assistant Professor Sayo Hamatani and Associate Professor Yoshifumi Mizuno of the Division of Affective and Cognitive Development of Research Center for Child Mental Development at the University of Fukui, Research Associate Professor Kazuki Matsumoto of Kagoshima University Hospital, Professor Yoshihiko Kunisato of the School of Human Sciences at Senshu University and their collaborators announced that they identified cognitive behavioral therapy techniques effective for mitigating core symptoms of attention-deficit hyperactivity disorder (ADHD). They also identified the effective cognitive-behavioral therapy components. The research group has already developed an Internet-based treatment program incorporating these components, and the program will be tested in clinical trials. The results were published in the international journal BMJ Mental Health on December 27.
ADHD is a developmental disorder marked by inattention, hyperactivity and impulsivity. Although its exact cause is unknown, it is believed to stem from functional abnormalities in the brain. Secondary disorders, such as learning disorders and depression, result from the core symptoms, leading to a reduced quality of life. Early detection and initiation of treatment are considered important to prevent secondary disorders. It is estimated that 5%-6% of children and 3%-4% of adults have ADHD. Treatment guidelines recommend environmental adjustments as the first approach, followed by pharmacotherapy if the initial approach is ineffective. If pharmacotherapy is not feasible, cognitive-behavioral therapy is considered as an alternative. Cognitive-behavioral therapy is a form of psychotherapy that focuses on identifying cognitive phenomena and behavioral patterns that sustain mental and behavioral issues and transforming them into more adaptive ones. The cognitive-behavioral therapy for ADHD treatment incorporates psychoeducation, organizational strategies, relaxation techniques, third-wave therapies and problem-solving techniques.
Meanwhile, the cognitive-behavioral therapy components are complex, and it was not clear which components were effective even when the therapeutic effectiveness was demonstrated in clinical studies. In this study, the research group sought to identify cognitive-behavioral therapy components effective for mitigating the core symptoms of ADHD. The researchers compiled and analyzed all the evidence from previous reports examining the effectiveness of cognitive-behavioral therapy for the core symptoms of ADHD using network meta-analysis, a statistical method for comparing and analyzing multiple medical techniques in terms of effectiveness. Specifically, they searched five academic databases for relevant terms, looked for associations in abstracts of 18,658 articles, read 139 relevant articles and analyzed 43 randomized controlled trials of cognitive-behavioral therapy interventions in patients with ADHD (aged between 10 and 60 years).
A total of 3,817 people participated in the 43 trials, with a gender ratio of 51.3% men to 48.7% women. Of the participants, 60.3% underwent pharmacotherapy. The treatment response comparison with placebo, for which the odds ratio was set at 1.0, indicated that third-wave therapy (odds ratio 4.8), behavioral therapy (odds ratio 3.5) and cognitive-behavioral therapy (odds ratio 3.1) showed treatment response rates better than placebo. Cognitive-behavioral therapy was proven to be a significant contributor to the alleviation of core symptoms.
Next, they analyzed the component units that were highly associated with the therapeutic effectiveness of cognitive-behavioral therapy. They found that organizational strategies and third-wave therapy were the cognitive-behavioral therapy components that enhanced treatment responsiveness. Meanwhile, placebo was associated with reduced treatment response. Moreover, third-wave therapy was found to be effective for the overall core symptoms of ADHD, whereas problem-solving techniques were effective for inattention symptoms.
Third-wave therapy accesses metacognition to promote attention and emotion regulation and trains the patient to choose adaptive behaviors. Typical examples include mindfulness-based cognitive therapy and dialectical behavior therapy.
Hamatani said, "We have already developed an online cognitive-behavioral therapy program incorporating the three components and are conducting interviews with cooperating families. We plan to conduct a randomized controlled trial after receiving feedback. We believe that cognitive-behavioral therapy via the Internet is suitable for immediately providing effective treatment for children with ADHD and their parents. We hope that this intervention approach can deliver the best treatment to all persons with support needs and help prevent secondary disorders. Moving forward, we will continue to focus our efforts on research to provide the best possible treatment."
Journal Information
Publication: BMJ Mental Health
Title: Components of cognitive-behavioural therapy for mitigating core symptoms in attention-deficit hyperactivity disorder: a systematic review and network meta-analysis
DOI: 10.1136/bmjment-2024-301303
This article has been translated by JST with permission from The Science News Ltd. (https://sci-news.co.jp/). Unauthorized reproduction of the article and photographs is prohibited.