Gender Differences in Cognitive Behavioral Therapy Outcomes for Adolescents With ADHD: Examining the Impact of Internalizing Symptoms

Objective: This study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) for adolescents with ADHD, while focusing on gender differences and comorbid internalizing symptoms. Method: A quantitative secondary data analysis was performed on 200 adolescents aged 12 to 18 years who participated in randomized control trials in either the Netherlands or Norway. Results: Overall, CBT significantly reduced ADHD symptoms from pretest to posttest on parent measures; however, treatment response varied based on gender, internalizing symptoms, and treatment formats. Girls with elevated depression showed significantly smaller reductions in ADHD symptoms compared to boys with similar depressive profiles ( p = .02), even after controlling for baseline ADHD severity. Effect size analyses revealed that girls benefited from both CBT delivery formats, but symptom improvement was nearly twice as large in individual CBT ( d = 0.90, large effect) compared to group CBT ( d = 0.49, moderate effect). Conclusion: These findings suggest that depression may impact treatment response among girls, and that individual CBT may offer enhanced benefits for adolescent girls with ADHD.