A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with attention-deficit/hyperactivity disorder (ADHD)

•Briefly, we have two important findings:•First, we found that our CBT treatment, both with and without medication, resulted in significant improvements relative to baseline in ADHD symptoms, emotional outcomes as well as functional outcomes, consistent with our previous findings.•Second, this is the first study in China to compare CBT treatment efficacy both with and without medication. And we demonstrated that CBT can be effective in adults with ADHD with or without medicine, with no significant differences between groups on core symptoms and emotions. CBT combined with medication may be more effective on EF than CBT only whereas CBT only may be more effective on daily functions.•This study further proved that CBT is an effective treatment for adults with ADHD, both with and without medication. A combination of CBT and medication presented broader improvements in executive function than CBT alone, but not in clinical symptoms, which would be a scientific basis for clinical selection of treatment options based on patient characteristics and needs. The study aimed to explore whether cognitive behavioral therapy (CBT) combined with medication is superior to CBT alone in core symptoms, emotional symptoms, self-esteem as well as social and cognitive functions of adult attention-deficit/hyperactivity disorder (ADHD) patients. Samples from a previous RCT study and outpatient participants were all included. A total of 124 patients received 12 weeks of manualized CBT sessions, either with (n = 57) or without (n = 67) medication. Efficacy variables were evaluated at baseline and each week. Mixed linear models (MLM) were used to compare differences between the two groups in all of the above domains. Within-group comparisons showed that both groups had robust improvements in core ADHD symptoms, emotional symptoms and social functional outcomes. The CBT + M group presented more domains of improvement in executive functions than the CBT group. However, comparisons between groups didn't indicate the superiority of CBT + M in core symptoms, emotional symptoms and self-esteem. Instead, the CBT group showed a greater improvement in the physical domain of the WHOQOL-BREF than the CBT + M group. This study further indicated that CBT is an effective treatment for adults with ADHD. A combination of CBT and medication presented broader improvements in executive functions, but not in clinical symptoms, than CBT alone.