Videoconference-Based Cognitive Behavioral Therapy in Medication-Treated Adults with Attention-Deficit/Hyperactivity Disorder: A Randomized, Assessor-Blinded, Controlled Trial

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that frequently persists into adulthood. Pharmacotherapies are effective but have side effects and dropout risks. Videoconference-based cognitive behavioral therapy (vCBT) has emerged as a promising intervention, particularly for improving treatment accessibility. This study aimed to evaluate the efficacy of vCBT in adults with ADHD compared to treatment-as-usual (TAU) using a randomized, assessor-blinded, controlled trial design. METHODS: Thirty participants (aged 18-65 years) with ADHD were randomly assigned to either the 12-session individual vCBT intervention as an adjunct to TAU or TAU group. The primary outcome was the change in the total score on the ADHD Rating Scale-IV (ADHD-RS-IV) with adult prompts by a blinded assessor at 12 weeks from baseline. Secondary outcomes included self-reported measures of ADHD symptoms using the Conners' Adult ADHD Rating-Self-Report, quality of life (QOL) using the Euro QOL 5 Dimension-5 Level, functional impairment using the Sheehan Disability Scale, depression, anxiety, and self-esteem. RESULTS: All of the participants received pharmacotherapy. Participants in the vCBT group (n = 15) demonstrated a significantly greater reduction in ADHD-RS-IV total score than those in the TAU group (vCBT -9.02 vs. TAU 0.84, p = 0.0007, effect size -1.46). Significant improvements in self-reported inattention, hyperactivity, impulsivity, QOL, and work/school performance were observed in favor of vCBT. CONCLUSION: This study highlights the efficacy of vCBT as a viable and accessible intervention for adults with ADHD, particularly in reducing core symptoms and enhancing QOL and functional outcomes. vCBT is an important alternative treatment, especially for patients who remain symptomatic after pharmacotherapy.