Journal List > J Korean Acad Nurs > v.45(2) > 1003053

Park, Park, and Hwang: Effects of Cognitive Behavioral Therapy on Attention Deficit Hyperactivity Disorder among School-aged Children in Korea: A Meta-Analysis



This study was a meta-analysis designed to identify effects of Cognitive Behavioral Therapy (CBT) interventions in alleviating main symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among school-aged children in Korea.


Examination of several databases including Research Information Sharing Service, Korean Studies Information Service System, Data Base Periodical Information Academic and hand-searched article references, resulted in identification of 1,298 studies done between 2000 and 2013 of which 21 met the inclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and its trim-and-fill analysis.


Overall effect size of CBT intervention was large (g=1.08) along with each outcome of self-control (g=1.26), lack of attention (g=1.02), social skills (g=0.92), and hyperactivity (g=0.92). For heterogeneity, moderator analysis was performed, but no significant differences were found between the RCT (Randomized Controlled Trials) group and the NRCT (Non RCT) group. Also, meta-regression was performed using sample size, number of sessions, and length of session as predictors, but no statistically significant moderators were found. Finally, a funnel plot along with trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected.


Based on these findings, there is clear evidence that CBT intervention has significant positive effects on the main symptoms of school-aged children suffering ADHD. Further research is needed to target diverse age groups with ADHD along with more RCT studies to improve the effectiveness of the CBT intervention.

Figures and Tables

Figure 1

Flowchart of study selection.

Figure 2

Forest plots of the effects of CBT on ADHD children (random-effects model).

Figure 3

Effects of moderator variables.

Figure 4

Results of publication bias analysis.

Table 1

Descriptive Summary of Included Studies


RCT=Randomized controlled trials; NRCT=Non-randomized controlled trials; N/R=Not reported; SST=Social skill training; REBT=Rational emotive behavioural therapy; SCA=Self control approaches; PSA=Problem solving approaches; CM=Cognitive modeling; cCBT=Delivery of computerised CBT; MT=Multimodal therapy; AIT=Attention improved training; TAT=Think aloud training; SIT=Self instructional training; AT=Art therapy; CET=Cognitive enhancement training; ACRS=Abbreviated conners parent-teacher rating scale-revised; ADDES=The attention deficit disorders evaluation scale; ADS=ADHD diagnostic system; AES-C=Attention deficit hyperactivity disorder evaluation scale-children version; AHS=Attention deficit and hyperactivity rating scale; BBRS=Burks behavior rating scales; DTA=Diagnostic test of aggression; CTRS-28=Conners teacher rating scale-28; DS&DS/C=Digit span of K-WISC-III & digit symbol/coding; FAIR=Frankfurter aufmerksamkeits-inventar; K-ARS=Korean-ADHD Rating scale; K-CBCL=Korean-child behavior checklist; K-IOWA=Korean-IOWA conners rating scale; MESSY=Matson evaluation of social skills with youngsters; MFFT=Matching Familiar figures test; SCRS=Self-control rating scale; SSRS=Social skills rating system; STA=Stratified test of attention; P=Parent; T=Teacher; C,T=Children, teacher.


This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education and Technology (No.: NRF-20110022764).

This research was supported by Kyungpook National University Research Fund, 2013.


Appendix 1

Studies Included in Meta-Analysis

T=Thesis; J=Published journal article; ADHD=Attention Deficit Hyperactivity Disorder; CBT=Cognitive Behavioral Therapy.

Appendix 2

Quality Assessment of Studies Included in Meta-Analysis

Y=YES; N=No; N/R=Not-reported; ++=All or most of the criteria have been fulfilled; Where they have not been fulfilled the conclusions of the study or review are thought very unlikely to be altered; +=Some of the criteria have been fulfilled; Those criteria that have not been fulfilled or not adequately described are thought unlikely to alter the conclusions.


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