Evaluation of Group Cognitive Behavioral

Therapy for Adults With ADHD

Journal of Attention Disorders

Volume 12 Number 5
March 2009 434-441
2009 SAGE Publications
10.1177/1087054708314596
http://jad.sagepub.com
hosted at
http://online.sagepub.com

Jessica Bramham
University College Dublin

Susan Young
Alison Bickerdike
Kings College London

Deborah Spain
South London and Maudsley NHS Foundation Trust

Denise McCartan
Kings College London

Kiriakos Xenitidis
South London and Maudsley NHS Foundation Trust
Objective: A brief cognitive behavioral therapy (CBT) group intervention was designed to treat comorbid anxiety, depression, and low self-esteem and self-efficacy in adults with ADHD. It was hypothesised that participants would gain knowledge about ADHD, experience a reduction in comorbid symptoms, and benefit from the supportive aspect of group
treatment. Method: Participants in the study formed a CBT treatment group that attended six workshops and a waiting list
control group. The intervention was evaluated with measures assessing knowledge about ADHD, psychological symptoms,
and support received. The groups were compared using repeated measures ANOVAs. Results: The CBT group had significantly greater improvement on measures of knowledge about ADHD, self-efficacy, and self-esteem than the control group.
Participants evaluations of the sessions suggested that sharing personal experiences with other adults with ADHD was an
important aspect of the intervention. Conclusion: Brief CBT group treatments may be an acceptable and cost-effective
intervention for adults with ADHD. (J. of Att. Dis. 2009; 12(5) 434-441)
Keywords: adult ADHD; cognitive behavioral therapy; group treatment

DHD in adulthood has been associated with a range

of social and emotional sequelae including comorbid disorders such as anxiety, depression, personality
disorder, and substance abuse; academic underachievement, occupational problems, social interaction, and
relationship difficulties; low self-esteem; and poor selfidentity (Biederman et al., 1993; Brassett-Grundy & Butler,
2004; Nadeau, 1995; Ratey, Greenberg, Bemporad, &
Lindem, 1992; Weiss & Hechtman, 1993; Wender, 2000;
Young, 2000; Young, Toone, & Tyson, 2003). This may
especially be the case for individuals whose problems remain
undiagnosed until adulthood (Young, Bramham, Gray, &
Rose, 2008). As a result, many adults with ADHD will
have developed an interpersonal style that is interpreted
by others as negative and have experienced a lifetime of
434

adverse interactions. They report a long-standing awareness that they are different in some way and internalize
their difficulties, which in turn has a negative effect on
self-esteem (Young & Bramham, 2007).
Treatment for adults with ADHD typically follows a
pharmacological route that addresses the core symptoms
of inattention, hyperactivity, and impulsivity (Wilens,
Spencer, & Biederman, 2002). However, in controlled
studies of pharmacotherapy, 20% to 50% of adults are
considered nonresponders due to insufficient symptom
reduction or an inability to tolerate medication (Wender,
Authors Note: Address correspondence to Jessica Bramham, UCD
School of Psychology, University College Dublin, Newman Building,
Belfield, Dublin 4, Ireland; jessica.bramham@ucd.ie.

Bramham et al. / Cognitive Behavioral Therapy 435

1998). Moreover, adults who are considered responders

typically show a reduction in only 50% or less of the
core symptoms of ADHD (Wilens et al., 2002). Thus,
psychopharmacology is not entirely successful in treating ADHD symptoms in adulthood and adults may have
greater need than children to access alternative treatments to help them learn strategies and skills for coping
with functional impairments (Safren, Sprich, Chulvick,
& Otto, 2004). ADHD adults recognize these problems
as underachievement, organizational difficulties, poor
problem solving, relationship difficulties, low mood, and
poor self-esteem. They report a desire for psychological
treatment to improve their quality of life and level of
achievement (Young & Bramham, 2007). Adults with
ADHD also request further information about the disorder to make sense of their past, indicating a role for psychoeducational interventions (Young et al., 2008).
There is emerging evidence that psychological treatment may be beneficial for adults with ADHD (Safren,
2006), and it has already been demonstrated to improve
symptoms in childhood (MTA Cooperative Group,
1999). Wilens et al. (1999) reported that an open trial
of cognitive behavioral therapy (CBT) was effective in
improving the core symptoms and associated problems
of ADHD in 69% of the sample. However, there was no
control group or medication-only group, so it is difficult
to determine whether these changes were specifically
associated with the CBT intervention. This limitation
was addressed by Safren et al. (2005), who conducted a
randomized controlled trial comparing CBT plus continued psychopharmacology with continued psychopharmacology alone. At the outcome assessment, those who
were randomized to CBT had lower independently evaluated ADHD symptoms and global severity as well as
self-reported ADHD symptoms. Those in the CBT group
also had lower independent and self-reported anxiety,
lower independently rated depression, and a trend to
have lower self-reported depression.
This study sought to extend Safren et al.s (2005) finding of CBT affecting difficulties associated with ADHD
in adulthood. However, given that adults with ADHD
often feel isolated from their peers, it was hypothesised
that a group format would provide additional benefits
through enabling adults with ADHD to meet others with
similar difficulties. The group format also enables the
development of a supportive network whereby skills can
be rehearsed without judgment. A fixed-length closed
group seemed to be most suitable for adults with ADHD
who may also have difficulty committing themselves to
a process that they perceive as lengthy, as it will not satisfy their need for immediate gratification (Young,
2000). Two group treatment studies have also been

shown to be effective for adults with ADHD (Hesslinger

et al., 2002), even following a relatively brief intervention (Stevenson, Whitmont, Bornholt, Livesey, &
Stevenson, 2002). However, neither study used a control
group to evaluate the efficacy of the intervention against
medication alone.
The purpose of this study was to examine the client
acceptability and effectiveness of a brief CBT intervention for adults with ADHD. Participants attending group
workshops for adults with ADHD were compared with a
medication-alone control group. There were three aims
for the intervention and it was hypothesised that there
would be improvement in these areas for those receiving
CBT in comparison with controls: (a) psychoeducation
about ADHD; (b) development of psychological strategies to face future challenges with greater confidence
and expectations of achievement, that is, to improve selfesteem and self-efficacy; and (c) support through allowing individuals to meet others with the disorder.

Method
Study Design
Sixty-one Caucasian clients (40 males, 21 females)
diagnosed with ADHD in adulthood (based on DSM-IV
criteria) attended six consecutive ADHD workshop
series held at the Adult ADHD Service at the Maudsley
Hospital, London (CBT/medication group). The mean
age was 32.95 years (SD = 9.63). Fifty-nine of this group
were prescribed medication [N = 30: slow release
methylphenidate (18-54 mg); N = 21: immediate release
methylphenidate (5-30 mg); N = 5: atomoxetine (40-80 mg);
N = 2: venlafaxine (300 mg); N = 1: rispiridone (4 mg)],
and two participants elected to attend the group workshops before trying medication. The majority of the
group had not received any previous psychological intervention; four had received counseling in the past, two
had worked with an ADHD coach, and one had received
individual CBT from a clinical psychologist. One third
of participants dropped out during the course of treatment (N = 20) and did not complete the final set of measures. There were no significant differences between their
pre-treatment ratings compared with those who completed
the workshop series.
The CBT/medication group was compared with a
medication-only group made up of ADHD clients within
the same service and who were on the waiting list to
attend the CBT group workshops. Their mean age was
31.19 years (SD = 8.31). All were taking stimulant medication and were not receiving any other psychological
intervention. Questionnaires were posted to 110 clients

436 Journal of Attention Disorders

at the same times as data collection for the pre- and posttreatment ratings of the CBT/medication group. Thirtyseven Caucasian clients (21 males, 16 females; 34%)
returned both sets of questionnaires.
All participants were diagnosed with ADHD by a
consultant psychiatrist on the basis of a full psychiatric
interview, rating scales of childhood and current behavior
completed by an informant and the participant, a neuropsychological assessment, and consideration of school
reports where possible. Participants were offered the
group CBT intervention as part of the clinical service.
They were asked to complete measures for research purposes and gave consent for this information to be used in
evaluation of the treatment. No one declined to participate,
even though they were reassured that nonparticipation
would not affect the service they received in any way. It
took approximately 10 to 15 minutes to complete the questionnaires. They were completed by the CBT/medication
group at the beginning and end of each day of workshops. The control group completed the questionnaires at
home and returned them by mail.

Description of the CBT Workshop Series

The workshop series included three 1-day workshops
held monthly (i.e., 1 day per month over 3 months). The
groups were attended on average by 10 clients (range =
8-15). The sessions content included material from the
Young-Bramham Programme modules on inattention
and memory, impulsivity, frustration and anger, anxiety,
depression, social relationships, time management, problem solving, and preparing for the future (Young &
Bramham, 2007).
Session 1 (what it means to have ADHD) and Session
6 (the future with ADHD) mainly provided psychoeducation about the disorder. Psychoeducation is important
so that individuals develop an understanding of the core
and associated symptoms of ADHD and their presentation. It is particularly important in allowing the person
with ADHD to understand his or her behavior, therefore
repairing self-esteem. Understanding that the disorder
has a neurodevelopmental basis will allow clients to
begin to battle against the previous labels of lazy or stupid. The aim was to promote insight into the diagnosis of
ADHD, the meaning of the diagnosis, and the effect it
has on the individual (Weiss & Hechtman, 1993).
Session 2 (anger and frustration) was devised to
address the low frustration tolerance that can often lead
to explosive outbursts in adults with ADHD. Participants
were guided to learn to identify the internal cues for
anger, use coping self statements to inhibit open expression of anger, and generate a plan for responding and

having a contingency plan if one becomes too angry to

deal with the situation (Nadeau, 1995).
Session 3 (emotions and ADHD) was provided in view
of the high incidence of mood disorders in the ADHD
population. Adults with ADHD will have experienced a
history of failure in many aspects of their lives. The
cumulative effect of this is often low self-esteem and a
belief that the situation can never be changed (Murphy,
1998). The main emphasis of the CBT model is to encourage patients to help themselves and to emphasize selfefficacy in the future. The session focused on discovering
the connections between mood, thoughts, and behavior
and allowing participants to reexamine this cycle to
improve mood.
Session 4 (relationship skills) concerned problems
with inattention, impulse control, all-or-nothing thinking, and disorganization, all of which can affect ADHD
individuals ability to perform socially. Therefore, the
group setting was used to offer an opportunity to learn
more about social and interpersonal skills (DuPaul,
Ervin, Hook, & McGoey, 1998). The sharing of both
problems and coping strategies was used to generate a
larger number of potential interventions, and the group
provided a safe environment in which to practice verbal
and nonverbal communication skills techniques.
In Session 5 (time management and problem solving),
practical approaches to time management and problem
solving were provided, given the evidence that people
with ADHD need a structured and methodological
approach. Exercises were used to demonstrate specific
techniques for planning and problem solving.
Interest and motivation were maintained by applying and alternating a variety of techniques, including
individual and small group exercises, role-plays, modeling, group discussions, and didactic teaching using a
PowerPoint slide show. There were frequent breaks
during the workshops and detailed handouts were provided that contained exercises to complete within the
workshop or later at home to reinforce the techniques
presented.

Measures
Acceptability and feasibility of the intervention were
measured by attendance at the workshops and completion of evaluation forms at the end of each session. The
sessions were evaluated using six versions of the
Evaluation Questionnaire, where the first question
related to the specific session topic and seven subsequent
questions were more general (see Table 1). Participants
rated the following items on a scale from 0 (not at all) to
4 (a great deal).

Bramham et al. / Cognitive Behavioral Therapy 437

Table 1
Evaluation Questionnaire Items
#
1

2
3
4
5
6
7
8

Table 2
Total Evaluation Scores for Sessions

Item
Do you feel that you have learned more about ADHD
(frustration and anger, emotions and ADHD, social
relationships, time management and problem solving,
and preparing for the future)?
How useful was the information covered?
Was the content relevant to your experiences?
How well did you understand the techniques and strategies
suggested for dealing with your symptoms and problems?
How confident do you feel about using the techniques?
How likely are you to use these techniques?
How helpful was it to share your personal experiences
in a group?
Did you benefit from hearing about others experiences
and coping strategies?

Psychoeducation was assessed by a 20-item True/False

Knowledge Quiz (see the appendix), which was especially
devised for the study.
Psychological symptoms were assessed using measures of anxiety, depression, self-esteem, and self-efficacy
as follows:
Anxiety and depression subscale scores of the
Hospital Anxiety and Depression Scale (HADS;
Zigmond & Snaith, 1983). This is a widely used 14-item
self-report questionnaire that divides into two subscales
that measure anxiety and depression respectively. Two
reviews of the HADS support it for the purposes of clinical screening for both severity and case detection of
anxiety disorders and depression (Bjelland, Dahl, Haug,
& Neckelmann, 2002; Herrmann, 1997). It has been
reported to be reliable in relevant patient groups including those with a psychiatric history, in primary care, and
in the general population (Bjelland et al., 2002; Snaith &
Zigmond, 1994).
Total self-esteem score from Culture Free Self-Esteem
Inventory (Battle, 1981). This is a self-report inventory in
true/false format that assesses self-esteem and has been
standardized on a large sample in the United States. Its average internal consistency coefficients range from .81 to .93.
It correlates strongly with other measures of self-esteem
and self-concept, and cross-cultural studies have been
reported to demonstrate its cultural fairness (Battle, 1981).
Total score from General Self-Efficacy Scale (Schwarzer
& Jerusalem, 1995). This measure was devised to assess a
general sense of perceived self-efficacy to predict coping
with daily hassles as well as adaptation after experiencing all kinds of stressful life events. This scale has been

Mean Evaluation
Score (SD)

Topic
1. What does it mean to have ADHD (N = 61)
2. Coping with feelings of frustration
and anger (N = 61)
3. Coping with feelings of anxiety
and depression (N = 47)
4. Interpersonal relationships (N = 47)
5. Time management and problem solving (N = 42)
6. The future with ADHD (N = 42)

23.16 (3.92)
21.86 (5.57)
23.22 (4.11)
21.89 (3.77)
22.87 (4.91)
22.74 (6.05)

validated in 14 cultures in both adult and adolescent populations (Scholz, Gutirrez-Doa, Sud, & Schwarzer,
2002). Responses are made on a 4-point scale and there
is no cutoff score, but the total score can be used to evaluate change in perception of self-efficacy (Jerusalem &
Schwarzer, 1992).
Supportive function of the groups was evaluated using
the mean score across workshops for items from the
Evaluation Questionnaire that related to the experience
of sharing and hearing others experiences as part of a
group (items 7 and 8).

Statistical Analyses
To determine change over time by participants who
completed the workshop series, for each outcome variable, a repeated measures ANOVA was used with group
(CBT/medication vs. medication alone) as a betweensubjects factor and time as a within-subjects factor (baseline vs. outcome).

Results
Acceptability and Feasibility
Forty-one participants attended all three workshops, 6
people attended two workshops (5 people attended days
1 and 2; 1 person attended days 1 and 3), and 14 people
attended one workshop. There were no significant differences between the evaluation scores for the six sessions,
indicating that all aspects of the workshops were equally
valued (see Table 2), with clients generally rating that
they had learned a lot from them. Furthermore, several
clients requested future workshops on the topics of medication, substance misuse, sleep problems, and the positive aspects of ADHD.

Psychoeducation
There was a main effect of time, F(1, 75) = 17.80, p <
.001, and a main effect of group, F(1, 75) = 6.971, p = .010.

438 Journal of Attention Disorders

Table 3
Knowledge and Psychological Symptoms at Baseline and Outcome
for CBT/Medication and Medication-Alone Groups
CBT + Medication (N = 41)

Medication Alone (N = 37)

Measure [M (SD)]

Baseline

Outcome

Baseline

Outcome

Knowledge quiz
HADS anxiety
HADS depression
Self-efficacy
Self-esteem

15.05 (1.87)
13.05 (3.96)
8.02 (4.25)
21.51 (7.83)
14.56 (6.82)

16.76 (1.67)
10.12 (5.35)
6.27 (3.78)
24.78 (6.41)
21.15 (6.61)

14.94 (1.72)
12.92 (5.35)
7.25 (4.28)
22.72 (5.60)
14.64 (8.09)

15.14 (1.66)
11.47 (3.22)
6.31 (3.08)
20.75 (5.62)
16.00 (6.16)

Note: CBT = cognitive behavioral therapy; HADS = Hospital Anxiety and Depression Scale.

A significant interaction between time and group, F(1,

75) = 11.264, p = .001, indicated that the CBT/medication groups knowledge had improved more greatly at
outcome on the quiz (see Table 3).

Psychological Symptoms
For the HADS anxiety and depression variables, there
was a main effect of time [Anxiety: F(1, 75) = 8.265, p =
.005; Depression: F(1, 75) = 7.274] but no main effect of
group nor any interaction between group time. This indicates that at outcome, anxiety and depression symptoms
improved significantly from baseline for both groups
regardless of whether the participants had received CBT.
For the self-efficacy variable, there was a main effect
of neither group nor time, but there was a significant
interaction between group time, F(1, 75) = 16.228, p <
.001. This shows that improved outcome on this measure
depended on whether the participants had received CBT.
The total self-esteem score showed main effects of both
group, F(1, 75) = 4.461, p = .038, and time, F(1, 75) =
14.680, p < .001, and an interaction between group
time, F(1, 75) = 6.345, p = .014, indicating that selfesteem improved for both the CBT group and the
medication-alone group over time, but this improvement
was significantly greater for the CBT group.

Supportive Function
To evaluate whether any particular aspects of the intervention were more useful to participants, the total score for
each question included in the Evaluation Questionnaire was
examined separately, with particular focus on items 7 and 8
(see Table 4).
The scores suggest that, across the workshops, hearing
the personal experiences of others was valued most by the
participants. However, repeated measures analyses of variance (ANOVAs) did not indicate that this was significantly
greater than any other aspect, F(7, 2) = 4.267, p = .203.

Discussion
This study examined the feasibility, client acceptability, and effectiveness of a brief cognitive behavioral
group intervention for adults with ADHD. This treatment
was provided to clients attending a series of three group
workshops held 1 day per month for 3 months.
This study contributes to the evidence base for psychological intervention in adult ADHD. It is clear from both
the improvement on standardized measures of relevant
psychological symptoms and the feedback from those
who took part in the groups that CBT group intervention
for adults with ADHD is a worthwhile endeavor.
Moreover, it was shown that this could be achieved in a
brief cost-effective group intervention, which in turn may
reduce multiple presentations to psychiatric services and
their associated cost implications (Dalsgaard, Mortensen,
Frydenberg, & Thomsen, 2002; Young et al., 2003).
The groups were shown to be feasible and acceptable to
ADHD adult clients in this format. Although one third did
not complete all 3 days, this is consistent with rates reported
by a forensic outpatient service (Fox & Schaapveld, 2006)
but higher than that reported from studies including both
inpatients and outpatients (Gould, Mueser, Bolton, Mays,
& Goff, 2001). These workshops were held at a national
adult ADHD service, which receives referrals and provides treatment across the United Kingdom, and thus
many participants did not live locally and were required to
travel a considerable distance. For those who attended all
three workshops, these appear to have been well received
and the topics equally valued.
Outcome measures were selected to evaluate the three
primary objectives of treatment. All these objectives were
successfully met as shown by significant improvement in
knowledge, self-esteem, and self-efficacy in the combined
CBT/medication group compared with participants in the
waiting list medication-alone group. Both groups showed
improvement in symptoms of anxiety and depression.

Bramham et al. / Cognitive Behavioral Therapy 439

Table 4
Total Scores for Each Item
Evaluation Questionnaire Item

Mean Item
Score (SD)

1. Knowledge gained
2. Usefulness
3. Relevance
4. Understanding of techniques and strategies
5. Confidence in using techniques and strategies
6. Likelihood of using techniques and strategies
7. Helpfulness of sharing personal experience
8. Benefit of hearing others experiences

3.15 (1.06)
3.30 (0.68)
3.18 (0.95)
3.00 (0.93)
2.48 (1.12)
2.55 (1.09)
3.15 (1.06)
3.44 (0.91)

Change in self-esteem could be related to the increased

experience of success and control that took place over the
course of the workshops. In addition, in line with the
change in increased knowledge and understanding of
ADHD, this may reflect a change in attribution of etiology
for their difficulties. Adults with ADHD, who have not
been correctly diagnosed in childhood, may have experienced years of failure and rejection, which may have
become internalized (Young et al., 2008). It is possible
that a greater understanding of the neuropsychiatric mechanisms of the disorder allows these individuals to reattribute the blame for their difficulties externally and,
therefore, lessen its effect on self-esteem.
The finding of change over time for both groups, but
additional improvements in the CBT/medication group,
emphasizes the importance of a multimodal approach to
intervention. Stimulant medication has been demonstrated to be effective in this population. This helps
reduce problems associated with primary symptoms but
may also have a secondary effect on mood-related problems. CBT seems to be important in helping people with
ADHD understand their disorder, cope with their difficulties, and repair self-esteem.
There were clear benefits with regard to the group
experience. In their evaluation feedback, participants
reported that they had appreciated this aspect of the therapy as they felt that they had finally met people who have
had similar life experiences and who understood them.
This is consistent with the frequent reports of adults with
ADHD of feelings of isolation and of feeling misunderstood by others. The high degree of satisfaction related to

getting to know the other group members suggests that a

closed group format is valuable.
This study contributes to a small but growing evidence
base for CBT for adults with ADHD. Nevertheless, it is
not without its limitations. Pharmacotherapy was not
carefully matched between the CBT/medication and
medication-alone groups and it is possible that some
individuals changed medication during the intervention
period. Further research should specifically monitor medication changes or preferably include a CBT-only group
not prescribed medication.
Second, outcome assessments were self-reported and it
would have been useful to include information or ratings
from family or friends. Other studies of CBT for ADHD
(e.g., Safren et al., 2005) also employed clinician ratings
of change. This method would have been advantageous,
although it is practically more difficult in a group setting.
Third, the measures were administered by group facilitators, which may have led to socially desirable
responding. Further research would therefore benefit
from the involvement of an independent investigator who
is able to evaluate treatment outcomes and eliminate
potential biases.
Fourth, the study only examined posttreatment outcome and did not include a follow-up period to investigate maintenance of gains. It is possible that treatment
gains on measures reflected an immediate increase in
perception of self-efficacy and self-esteem after spending a day with individuals who had similar difficulties.
However, this inflation in scores may be short-lived;
therefore, a follow-up assessment seems warranted in
further studies.
The final and most challenging limitation is that the
study did not employ a randomized control design. It is
therefore difficult to conclude with confidence that the
group CBT intervention alone was the cause of change.
Further investigations should include a support group as
a control condition to determine the additive value of the
CBT component of the group workshops beyond their
supportive benefit.
Despite these limitations, the results suggest that brief
group CBT treatments may be a useful and cost-effective
means for adults with ADHD to impart psychological
strategies, repair self-esteem, and develop confidence for
future endeavors.

440 Journal of Attention Disorders

Appendix
Please circle the appropriate letter according to whether
you think the following 20 statements are true or false.
Please answer according to your knowledge of the disorder
in general, rather than relating the questions to yourself.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

ADHD is a disorder present from childhood.

ADHD is contagious.
People with ADHD find it difficult to follow rules.
ADHD symptoms can be treated with medication.
People with ADHD can never fulfill their potential.
People with ADHD are distractible.
People with ADHD have difficulties concentrating.
People grow out of ADHD but the rate varies
from person to person.
People with ADHD are less intelligent than the
normal population.
Whether you have ADHD depends on how
you were brought up.
More females than males have ADHD.
People with ADHD prefer short-term rewards
over long-term rewards.
People with ADHD have difficulties with self-restraint.
ADHD is a lifelong condition.
People with ADHD become bored more easily
than other people.
People with ADHD are likely to have additional
psychological problems.
People with ADHD rarely get tired.
ADHD is a problem of motivation.
People with ADHD find it difficult to
organize themselves.
People with ADHD are slow to understand instructions.

T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F
T/F

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Jessica Bramham is a lecturer in clinical neuropsychology at

the School of Psychology, University College Dublin. She is
a chartered clinical psychologist and clinical neuropsychologist. Her research interests include adulthood ADHD assessment and treatment, social cognition, and neuropsychiatry.
Susan Young is a senior lecturer in forensic clinical psychology at the Institute of Psychiatry, Kings College London,
Institute of Psychiatry. She is a chartered clinical and forensic
psychologist and a clinical neuropsychologist. Her research

interests include neurodevelopmental disorders and forensic

risk assessment.
Alison Bickerdike is a trainee clinical psychologist at the
Institute of Psychiatry, Kings College London. She has
been involved in evaluation of the group cognitive behavioural intervention at the Adult ADHD Service of the South
London and Maudsley NHS Foundation Trust.
Deborah Spain is a cognitive behavioral therapist at the Adult
ADHD Service of the South London and Maudsley NHS
Foundation Trust. She specializes in therapeutic intervention
with adults with neurodevelopmental disorders.
Denise McCartan is a trainee clinical psychologist at the Institute
of Psychiatry, Kings College London. Her research interests are
the neuropsychology of ADHD in adults and children, and memory and language functioning in temporal lobe epilepsy.
Kiriakos Xenitidis is a consultant psychiatrist at the Adult
ADHD Service of the South London and Maudsley NHS
Foundation Trust. He is also an honorary senior lecturer at the
Section of Brain Maturation of the Institute of Psychiatry,
Kings College London. His research interests include the
interface of ADHD with other neurodevelopmental disorders
in adulthood and forensic aspects of ADHD, autism, and intellectual disabilities.