Cognitive-Behavioral Therapy as an Adjunct to Pharmacotherapy versus Pharmacotherapy Alone in Adults with ADHD: A Systematic Review
DOI:
https://doi.org/10.36489/saudecoletiva.2026v17i107p20070-20083Keywords:
Attention Deficit Hyperactivity Disorder, Cognitive Behavioral Therapy, Drug Therapy, Young Adults, Systematic reviewAbstract
Objective: To evaluate whether adding cognitive-behavioral therapy (CBT) to pharmacotherapy provides additional benefits compared with pharmacotherapy alone in adults with attention-deficit/hyperactivity disorder (ADHD).
Methods: A systematic review of randomized controlled trials was conducted in accordance with PRISMA guidelines. Searches were performed in PubMed/MEDLINE, SciELO, and Google Scholar. Studies comparing combined psychological intervention and pharmacotherapy with pharmacotherapy alone in adults were included, using validated instruments to assess symptoms and functional outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool.
Results: Six randomized controlled trials met the inclusion criteria. The combined intervention demonstrated additional benefits, particularly in functional and psychosocial outcomes, while effects on core ADHD symptoms were variable across studies.
Conclusion: The combination of cognitive-behavioral therapy and pharmacotherapy may provide additional functional benefits in adults with ADHD, although effects on core symptoms remain inconsistent.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC):
American Psychiatric Association; 2000.
Associação Brasileira do Déficit de Atenção (ABDA). O que
é TDAH? [Internet]. 2026 [cited 2026 Feb 4]. Available from:
https://tdah.org.br/sobre-tdah/o-que-e-tdah/
National Institute for Health and Care Excellence (NICE).
Attention deficit hyperactivity disorder: diagnosis and management. London: NICE; 2018. Available from: https://www.
nice.org.uk/guidance/ng87
Carvalho NP, Silva AR, Caiafa L, Paula JJ. Efficacy of cognitive-behavioral therapy for adults with ADHD: a systematic review. Paidéia (Ribeirão Preto). 2024;34:e3420.
doi:10.1590/1982-4327e3420
Safren SA, Otto MW, Sprich S, Winett CL, Wilens TE, Biederman J. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and
persistent symptoms: a randomized controlled trial. JAMA.
;304(8):875-80.
Emilsson B, Gudjonsson G, Sigurdsson JF, et al. Cognitive
behaviour therapy in medication-treated adults with ADHD
and persistent symptoms: a randomized controlled trial. BMC
Psychiatry. 2011;11:116. doi:10.1186/1471-244X-11-116
Weiss M, Murray C, Wasdell M, Greenfield B, Giles L, Hechtman L. A randomized controlled trial of CBT therapy for adults
with ADHD with and without medication. BMC Psychiatry.
;12:30. doi:10.1186/1471-244X-12-30
Philipsen A, Jans T, Graf E, et al. Effects of group psychotherapy, individual counseling, methylphenidate, and
placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry. 2015;72(12):1199-210. doi:10.1001/jamapsychiatry.2015.2146
Cherkasova MV, Hechtman L, Weiss M, et al. Efficacy of
cognitive behavioral therapy with and without medication for
adults with ADHD: a randomized clinical trial. J Atten Disord.
;20(9):1-15. doi:10.1177/1087054716671197
Eto A, et al. Videoconference-based cognitive behavioral therapy in medication-treated adults with attention-deficit/hyperactivity disorder: a randomized, assessor-blinded, controlled trial. Psychother
Psychosom. 2025;94(5):343-57. doi:10.1159/000546539
