A Systematic Review of Cognitive Behavioural Therapy as a Non-Pharmacological Intervention for School Aged Children With ADHD

Abstract

Aims

The aim of this poster is to illustrate a systematic review exploring Cognitive Behavioural Therapy (CBT) as a Non-Pharmacological Intervention for School Aged Children with Attention Deficit Hyperactivity Disorder (ADHD). CBT is a common behavioural intervention in several child and adolescent psychopathologies as reported by Ramsay (2010); Solanto et al. (2010); Ramsay (2012); and Lopez et al. (2018). It is recommended as a non-pharmacological intervention alongside parent training, in school-aged children with a moderate severity of ADHD symptoms (National Institute for Health Care and Excellence [NICE] 2018b). This systematic review aimed to evaluate the effects of CBT as an intervention for ADHD in school-aged children. The research objective was to assess the effects of CBT in reducing the core symptoms of ADHD.

Methods

A search strategy was developed and a search of four databases initially yielded 1100 results. The search was then limited to randomised controlled trials (RCT) which evaluated the efficacy of CBT compared with treatment as usual, no treatment, and waitlist, in school-aged children. Inclusion criteria included participants who were diagnosed by a medical professional, and participants under the age of 18 in full-time, mainstream education. Those with co-morbid autism or tic disorder and those with an intellectual disability were excluded.

Results

Six RCTs met the inclusion criteria. The age range of participants was 8–18 years. The medication status of participants varied across the included studies. A narrative synthesis of the results included assessment of methodological quality and risk of bias. Jadad scores were used alongside the Cochrane Risk of Bias Tool (RoB 2) for RCTs, to assess the quality of evidence. The studies all included different modalities of CBT intervention and a variety of measurement tools.

Conclusion

The findings support the use of CBT as a non-pharmacological intervention to reduce the severity of ADHD symptoms in adolescents. However, as there were no available studies that included children aged under 8 years, the findings cannot support the use of CBT in the reduction of severity of ADHD symptoms in this group. Methodological issues within the study designs mean the findings need to be treated with caution. Future research is warranted that includes larger sample sizes and younger children with longer follow-up periods. Different modalities of CBT should be explored with and without pharmacological interventions. There is also a case for exploring modalities of CBT that are suitable for targeting in the younger age range of children.