This section summarises the evidence examining cognitive-behavioural interventions directly delivered to children aged 5–17 years with ADHD. The phrase cognitive-behavioural interventions is used to refer to a broad range of approaches that use cognitive and/or behavioural interventions to minimise the day-to-day impacts of ADHD symptoms. Overall, there are few studies evaluating these interventions in children and adolescents with ADHD. Cognitive-behavioural interventions also play an important role in addressing co-occurring conditions, such as anxiety or depressive disorders in children and adolescents with ADHD, refer to section 2.2.
Structured dyadic behaviour therapy versus non-specific supportive therapy
No evidence for this comparison was identified in NICE and one new RCT was identified in the updated search involving children aged 8–12 years with ADHD-Combined type (Curtis, Heath, & Hogan, 2021). This study in children with ADHD had moderate risk of bias and very low-certainty evidence, and compared structured dyadic behaviour therapy focused on improving behavioural self-regulation with child-centred dyadic therapy. There were statistically significant benefits of structured dyadic behaviour therapy, relative to child-centred dyadic therapy, for parent-reported ADHD inattention, hyperactivity and for oppositionality and externalising symptoms index, but no statistically significant differences were reported for conduct problems, attention problems and behavioural symptoms index.
CBT plus parent/family training versus non-specific supportive therapy
No new evidence was found. NICE previously identified one low- to moderate-quality RCT of CBT with a parent/family training component compared to non-specific supportive therapy (Fehlings, Roberts, Humphries, & Dawe, 1991). This was a small study including 25 boys with ADHD. There were benefits for parent- and teacher-reported ADHD inattention and hyperactivity symptoms.
CBT plus parent/family training versus waitlist/usual care in children with ADHD and anxiety
No evidence for this comparison was identified in NICE, and a single new pilot RCT (Sciberras et al., 2018) was identified in the updated review. This study conducted in children with ADHD and anxiety compared CBT (Cool Kids program) and usual care over 12 weeks with assessments taken at 5 months (approximately 6 weeks post-intervention). The intervention was delivered to child-parent dyads. There was insufficient evidence to decide the benefit of CBT in this group of children given the very small sample size included.
CBT plus parent/family training versus CBT plus parent/family training
No evidence for this comparison was identified in NICE and one new small RCT was identified (Ahmadi et al., 2020). This RCT conducted in children with ADHD and co-occurring PTSD, compared reminder-focused positive psychiatry and trauma-focused CBT, both involving components with children and parents. Given the very low certainty of the outcome data in this study with very serious risk of bias and very serious imprecision, there was insufficient evidence to support or refute the use of either intervention for any outcome.
CBT + Parent/family training + organisation/school-based intervention (High intensity program) vs CBT + parent/family training + organisation/school-based intervention (Low intensity program)
New evidence was identified for a new comparison consisting of one RCT (Sibley et al., 2018) with a high risk of bias, conducted in adolescents with ADHD, comparing high-intensity and low-intensity summer treatment programs over 12 weeks. There was insufficient post-intervention data to analyse and determine the statistical significance of the outcomes reported.