This is an amended (third) submission for a NIMH small grant (RO3) to estimate the efficacy of cognitive behavioral therapy for coping with medication-resistant symptoms of Attention Deficit Hyperactivity Disorder (ADHD). The first submission was reviewed quite positively, and, as noted by the set of second reviews, all reviewers' comments were addressed, improving the study design. However, a few new concerns emerged, and despite the improvements, the score was slightly raised. These concerns are fully addressed in this final submission. ADHD in adulthood is a valid, clinically significant, debilitating and prevalent disorder for which there are currently no empirically-validated psychosocial treatments. Although previously thought to be a disorder of childhood, prospective longitudinal data has revealed that ADHD persists in as many as 50% of young adults who were diagnosed in childhood, and that as many as 5% of adults may suffer from this disorder. The combination of core and associated symptoms places persons with this disorder at severe risk for academic and occupational underachievement, relationship difficulties, and significantly-impaired quality of life. Ten years of study by our research team and others -- including controlled studies of stimulant medications and open studies of tricyclic, monoamine oxidase inhibitor, and atypical antidepressants -- reveal that 20-50% of adults are considered nonresponders due to insufficient symptom reduction or their inability to tolerate these medications (Wender, 1998; Wilens et al., 1998a). Moreover, adults who are considered responders typically show a reduction in only 50% or less of the core symptoms of ADHD (Wilens et al., 1998a). This leaves pharmacologically-treated patients with significant residual symptoms which cause functional impairment and may also increase risk for relapse. The current application is to develop and test a skills-building, cognitive-behavioral intervention for adults with ADHD. Interventions will be administered in modules that are matched to domains of impairment characterizing individual patient presentations. The proposed project will lay a foundation for a large scale randomized controlled trial of CBT for residual symptoms of ADHD. The project is to be conducted at Massachusetts General Hospital's Adult ADHD program which provides access to large numbers of patients with ADHD, a strong history of research success, and nationally recognized experts who will serve as mentors for the new investigator PI utilizing the R03 mechanism.
| Knouse, Laura E; Traeger, Lara; O'Cleirigh, Conall et al. (2013) Adult attention deficit hyperactivity disorder symptoms and five-factor model traits in a clinical sample: a structural equation modeling approach. J Nerv Ment Dis 201:848-54 |
| Safren, Steven A; Sprich, Susan E; Cooper-Vince, Christine et al. (2010) Life impairments in adults with medication-treated ADHD. J Atten Disord 13:524-31 |
| Knouse, Laura E; Sprich, Susan; Cooper-Vince, Christine et al. (2009) Attention-Deficit/Hyperactivity Disorder Symptom Profiles in Medication-Treated Adults Entering a Psychosocial Treatment Program. J ADHD Relat Disord 1:34-48 |
| Safren, Steven A; Sprich, Susan; Chulvick, Sophie et al. (2004) Psychosocial treatments for adults with attention-deficit/hyperactivity disorder. Psychiatr Clin North Am 27:349-60 |
