Abstract

Background Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulties in maintaining attention, impulsivity and hyperactivity. The global prevalence of ADHD has been estimated in 5% in children and 2,5% in adults. Adults with ADHD suffer difficulties in daily with a significant impact in social, labor, family and couple relationship aspects, among others, leading them to consult mental health specialists. On the other hand, evidence-based therapy (EBT) is a method that endows therapeutic interventions with a scientific basis. That is, it allows different therapeutic approaches, such as psychotherapy and pharmacological treatments, to have the best available information about its effectiveness. EBT is an emerging field. Research has mainly focused on studying its effects in children. Therefore, this work is a systematic review of therapeutic approaches that used EBT criteria for adults ADHD. Aims To determine what EBT criteria have been used in studies of therapeutic approaches of adults ADHD between 2014 and 2018. Method & procedures This is an analytic-retrospective study. In this research, authors followed the PRISMA Declaration guidelines for reporting systematic reviews. Google Scholar, EBSCOhost and Web of Science (WoS) were used for search and data extraction. The searching process used the following keywords: psychotherapy, ADHD, treatment and adult. Duplicated and non-related articles were eliminated. The inclusion criteria were articles about adults ADHD, articles published between 2014 and 2018, English or Spanish languages, EBT criteria. The exclusion criteria were articles about ADHD in children or teenagers, bibliographic reviews, and studies that used pharmacological treatment as a unique intervention. The data collected was organized in Microsoft Excel. Analysis of selected data and the TBE criteria used in this systematic review were based on the recommendations made by Cuevas et al. (2017). Results & discussion A total of 17373 results were obtained within the initial search result. Subsequently, duplicated articles were eliminated, so 2496 were left. Then, during the screening stage, 2375 articles were removed, leaving 121. Finally, and for eligibility, 99 articles were excluded from those 121 articles because they did not meet our inclusion/exclusion criteria. Hence, 22 articles were selected for the current systematic review. These articles were analyzed using six criteria of EBT as follows: (i) control and experimental groups, (ii) inclusion and exclusion criteria of sample participants, (iii) randomized assignment, (iv) systematized techniques, (v) results with standardized measures, and (vi) the behavior expected to be modified by the intervention. Four of these criteria were found in all the selected studies (ii, iv, v, and vi). As a main result, articles about Behavioral Cognitive Therapy (BCT) and Mindfulness had all the EBT criteria. Control and experimental groups were declared in most of the studies. Nonetheless, inclusion and exclusion criteria vary across articles. Also, most of the articles manifested to have used manuals or protocols to guide their investigations (systematized techniques,). All the studies used standardized instruments to measure the results. Finally, most of the studies expected the reduction of ADHD symptoms as behavior to be modified. Some studies considered the omission of the control group as limitation. In other studies, randomization was not possible due to the reduced number of participants in the treatments. Conclusion Variability across studies and the combination of different therapeutic approaches made difficult to directly compare published works using EBT. However, according to this review, it can be affirmed that the therapeutic approaches such as Mindfulness and BCT, turned out to be more effective than the usual treatments, which usually only include pharmacological management and/or psychoeducation. More research including criteria for EBT is needed. That will allow to determine specific and comparable differential effects among the diversity of therapeutic approaches that seek to improve ADHD symptoms in the adult population. Keywords: ADHD, adults, attention deficit hyperactivity disorder, therapeutic approach, treatment