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

Benjamin Selaskowski; Christian Staerk; Niclas Braun; Swantje Matthies; Erika Graf; Michael Colla; Christian Jacob; Esther Sobanski; Barbara Alm; Michael Roesler; Wolfgang Retz; Petra Retz-Junginger; Bernhard Kis; Mona Abdel-Hamid; Michael Huss; Thomas Jans; Ludger Tebartz van Elst; Mathias Berger; Silke Lux; Andreas Mayr; Alexandra Philipsen

doi:10.1016/j.jpsychires.2022.03.049

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

J Psychiatr Res. 2022 Jul:151:225-234. doi: 10.1016/j.jpsychires.2022.03.049. Epub 2022 Apr 1.

Authors

Benjamin Selaskowski¹, Christian Staerk², Niclas Braun¹, Swantje Matthies³, Erika Graf⁴, Michael Colla⁵, Christian Jacob⁶, Esther Sobanski⁷, Barbara Alm⁸, Michael Roesler⁹, Wolfgang Retz¹⁰, Petra Retz-Junginger⁹, Bernhard Kis¹¹, Mona Abdel-Hamid¹², Michael Huss¹³, Thomas Jans¹⁴, Ludger Tebartz van Elst³, Mathias Berger³, Silke Lux¹, Andreas Mayr², Alexandra Philipsen¹⁵

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
² Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany.
³ Department of Psychiatry and Psychotherapy, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
⁴ Institute of Medical Biometry and Statistics, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
⁵ Psychiatric University Hospital Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland.
⁶ Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany; Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
⁷ Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
⁸ Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁹ Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
¹⁰ Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
¹¹ Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
¹² Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
¹³ Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
¹⁴ Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
¹⁵ Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany. Electronic address: alexandra.philipsen@ukbonn.de.

PMID: 35500450
DOI: 10.1016/j.jpsychires.2022.03.049

Abstract

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.

Keywords: ADHD subtype presentations; Adults; Attention-deficit/hyperactivity disorder; Core symptoms; Methylphenidate; Psychotherapy.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / drug therapy
Central Nervous System Stimulants* / therapeutic use
Combined Modality Therapy
Double-Blind Method
Humans
Methylphenidate* / therapeutic use
Treatment Outcome

Substances

Central Nervous System Stimulants
Methylphenidate