CBT versus TAU for ADHD Review information

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1 CBT versus TAU for ADHD Review information Authors [Empty name] 1, Brynjar Emilsson 1 1 [Empty affiliation] Citation example: [Empty name], Emilsson B. CBT versus TAU for ADHD. Cochrane Database of Systematic Reviews [Year], Issue [Issue]. Contact person [Empty name] Dates Assessed as Up-to-date: Date of Search: Next Stage Expected: Protocol First Published: Not specified Review First Published: Not specified Last Citation Issue: Not specified What's new Date / Event Description History Date / Event Description Characteristics of studies Characteristics of included studies Emilsson 2011 Methods Participants Randomized controlled trial. Independent psychiatrist randomly allocated the participants. Participant were reffered to an outpatient rehabilitaiton clinic or self-reffered from advertisement to members of the Icelandic ADHD association 92 refferrals initially. All patients were medicated and stable on prescibed medication for at least a month. Thirty-eight were excluded on the following grounds: 13 were off medication, 9 with a questionable diagnosis, 4 misusing drugs/alcohol, 7 declined to participate, 5 did not show up or could not be reached by the phone or .). 54 participants randomised (27 to each group); 34 women og 20 men with ADHD (not specified DSM-IV or ICD-10) Review Manager 5.3 1

2 Interventions Outcomes Notes Cognitive behavioural therapy plus medication vs. treatment as usual (only medication). Intervention group:15 sessions manualised CBT programme Reasoning & Rehabiitation programme. Controls: Medication treatment only Primary outcomes: ADHD symptoms. Secondaray outcome: anxiety, depression, emotional control, social functioning and antisocial behaviour High drop-out rate at 3 month FU. Poor description of randomisation Risk of bias table Bias Random sequence generation (selection bias) Allocation concealment (selection bias) Blinding of participants and personnel (performance bias) Blinding of outcome assessment (detection bias) Incomplete outcome data (attrition bias) Selective reporting (reporting bias) Authors' judgement Support for judgement Unclear risk An independent pschiatrist randomly allocated the particcpants to either the CBT/MED or TAU/MED. Not futher specified. Unclear risk Not descibed High risk Low risk High risk Low risk Other bias Low risk Not detected Safren 2005 Professionals and participants could not be blinded. Outcome assessor blinded for some outcomes, som were self-assessment. 27 randomised to each group, some outcomes only assessed for 8 of these. 20/27 completed the intervention, 21/27 controls complted the randomised period. The publised report included all expected outcomes Methods Participants Interventions Outcomes Notes Randomized Controlled trial. Participant were randomly assigned to CBT or TAU. Not futher descibed. 40 were sceened for the study. 9 were not enrolled because they did not meet criteria for ADHD, 4 had not stabilized their medication or were not on medication, 1 had active cannabis use, 1 had severe learning disability and probaly IQ less than 90, 1 moved away after evaluation, 1 did not complete the evaluation. 31 persons, 17 women and 14 men who met DSM-IV criteria for ADHD, were randomised. Cognitive behavioural therapy vs. treatment as usual (only medication). All patients were medicated. Stabel in medication for 2 mdr. and no more than 10 % change in dosage for a month. Unclear number of sessions and duration of sessions. 1. ADHD symptoms, 2. CGI, 3. depression, 4. anxiety outcome rated by independent evaluater and self-rated Review Manager 5.3 2

3 Risk of bias table Bias Random sequence generation (selection bias) Authors' judgement Unclear risk Support for judgement Not descibed Allocation concealment (selection bias) Unclear risk Not descibed Blinding of participants and personnel (performance bias) Blinding of outcome assessment (detection bias) High risk Low risk Blinding not possible Incomplete outcome data (attrition bias) Low risk No dropouts Professionel rater were blinded. Participants could not be blinded Selective reporting (reporting bias) Low risk Not detected, all expected results were reported Other bias Low risk Not detected Footnotes Characteristics of excluded studies Footnotes Characteristics of studies awaiting classification Footnotes Characteristics of ongoing studies Footnotes Summary of findings tables Additional tables References to studies Included studies Emilsson 2011 [Other: ] [Empty] Review Manager 5.3 3

4 Safren 2005 [Other: ] [Empty] Excluded studies Studies awaiting classification Ongoing studies Other references Additional references Other published versions of this review Data and analyses 1 CBT+medication versus medication alone Outcome or Subgroup Studies Participa nts Statistical Method Effect Estimate 1.1 Funktionsniveau/GAF (CGI-skala), 3 måneder FU, independent evaluator 1.2 Beck Depression Scale, self-assessment 1.3 Beck Anxiety Scale, self-assessment 1.4 ADHD symptomer (DuPaul) Independent evaluator 1.5 ADHD symptomer (BCS/CBS), self-assessment 1.6 Depression (Hamilton), independent assessor 1.7 Anxiety, Hamilton Scale, independent observer Figures 2 52 Mean Difference (IV, Random, 2 63 Mean Difference (IV, Random, 2 63 Mean Difference (IV, Random, 1 31 Std. Mean Difference (IV, Random, 2 63 Std. Mean Difference (IV, Random, 1 31 Mean Difference (IV, Random, 1 31 Mean Difference (IV, Random, [-1.44, -0.46] [-12.94, -1.87] [-6.68, -1.61] [-1.32, 0.12] [-1.53, -0.47] [-9.71, -1.41] [-10.32, -1.04] Review Manager 5.3 4

5 Figure 1 (Analysis 1.1) Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.1 Funktionsniveau/GAF (CGI-skala), 3 måneder FU, independent evaluator. Figure 2 (Analysis 1.2) Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.2 Beck Depression Scale, self-assessment. Figure 3 (Analysis 1.3) Review Manager 5.3 5

6 Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.3 Beck Anxiety Scale, self-assessment. Figure 4 (Analysis 1.4) Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.4 ADHD symptomer (DuPaul) Independent evaluator. Figure 5 (Analysis 1.5) Review Manager 5.3 6

7 Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.5 ADHD symptomer (BCS/CBS), self-assessment. Figure 6 (Analysis 1.6) Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.6 Depression (Hamilton), independent assessor. Figure 7 (Analysis 1.7) Review Manager 5.3 7

8 Forest plot of comparison: 1 CBT+medication versus medication alone, outcome: 1.7 Anxiety, Hamilton Scale, independent observer. Figure 8 Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Sources of support Internal sources No sources of support provided External sources No sources of support provided Review Manager 5.3 8

9 Feedback Appendices Review Manager 5.3 9

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