Multimodal treatment efficacy differs in dependence of core symptom profiles in adult Attention-Deficit/Hyperactivity Disorder: An analysis of the randomized controlled COMPAS trial

• Published in: Journal of psychiatric research 2022-07, Vol.151, p.225-234
• Main Authors: Selaskowski, Benjamin, Staerk, Christian, Braun, Niclas, Matthies, Swantje, Graf, Erika, Colla, Michael, Jacob, Christian, Sobanski, Esther, Alm, Barbara, Roesler, Michael, Retz, Wolfgang, Retz-Junginger, Petra, Kis, Bernhard, Abdel-Hamid, Mona, Huss, Michael, Jans, Thomas, Tebartz van Elst, Ludger, Berger, Mathias, Lux, Silke, Mayr, Andreas, Philipsen, Alexandra
• Format: Article
• Language: English
• Subjects: ADHD subtype presentations; Adults; Attention-deficit/hyperactivity disorder; Core symptoms; Methylphenidate; Psychotherapy
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2022.03.049

There is broad consensus that to improve the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD), the various therapy options need to be tailored more precisely to the individual patient's needs and specific symptoms. This post-hoc analysis evaluates the multimodal effects of first-line medication (methylphenidate [MPH] vs placebo [PLB]) and psychotherapeutic (group psychotherapy [GPT] vs clinical management [CM]) treatments on the ADHD core symptoms inattention, hyperactivity and impulsivity. For the two-by-two factorial, observer-blinded, multicenter, randomized controlled Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201), 419 outpatients with ADHD were considered for analysis. ADHD symptoms were assessed by blind observer-rated and patient-rated Conners Adult ADHD Rating Scales before treatment (T1), 13 weeks (T2) and 26 weeks (T3) after T1, at treatment completion after 52 weeks (T4), and at follow-up (130 weeks, T5). MPH was superior to PLB in improving symptoms of inattention at almost all endpoints (observer-rated T2, T3, T4, T5; patient-rated T2, T3, T4), while a significant decrease in hyperactivity and impulsivity was at first found after 6 months of treatment. CM compared to GPT decreased inattention and impulsivity in the early treatment phase only (observer-rated T2, patient-rated T2, T3). In conclusion, while MPH seems to have a direct and sustained effect on inattention, premature medication discontinuation should particularly be avoided in patients with hyperactive-impulsive symptoms. Also, especially in high inattention and/or impulsivity presentations, initial individual patient management might be beneficial. Consequently, considering individual core symptom profiles may enhance the efficacy of treatments in adult ADHD. •Methylphenidate persistently improved adult ADHD symptoms of inattention.•Reduction in hyperactivity and impulsivity after 6 months of methylphenidate intake.•Promoting treatment adherence important in hyperactivity/impulsivity presentations.