People with ADHD have significantly poorer outcomes from standard NHS talking therapies, large cohort study finds

A retrospective cohort study used linked NHS Talking Therapies records for over three million adults in England treated between 2012 and 2022 Primary Study. Researchers identified 13,693 adults with diagnosed ADHD and compared their outcomes with a propensity-matched group of adults without an ADHD diagnosis. Both groups showed moderate-to-large improvements in depression and anxiety symptoms following therapy. But people with ADHD had significantly worse relative outcomes: reliable recovery was less likely (odds ratio 0.69, 95% CI 0.65–0.72) and reliable deterioration more likely (odds ratio 1.38, 95% CI 1.25–1.50), even after matching and adjustment.

Subgroup analyses testing whether known links between therapy outcomes and socio-demographic factors were modified by ADHD status found no strong evidence of an effect, but sample sizes for older adults and minority ethnic groups were too small to draw firm conclusions.

Standard talking therapies, designed around managing depression and anxiety, appear not to close the outcome gap for people who also have ADHD. The authors call for evidence-based guidelines to adapt mental health interventions for this group, and for a better understanding of how systemic barriers to diagnosis and care may be shaping these outcomes — a direct question for how NHS Talking Therapies services nationally identify and adapt pathways for patients with comorbid ADHD, rather than treating standard protocols as one-size-fits-all.