Study: Self-guided internet-delivered treatment can significantly reduce ADHD symptoms among adults

by

Although ADHD was orig­i­nal­ly con­sid­ered to be a dis­or­der of child­hood, it has been clear for years that it also impacts adults. At least 60% of chil­dren diag­nosed with ADHD strug­gle with symp­toms into adult­hood and the esti­mat­ed preva­lence of ADHD in adults is between 4 and 5%.

As with chil­dren and teens, med­ica­tion treat­ment is exten­sive­ly used to treat ADHD in adults. Although med­ica­tion is a core treat­ment for adult ADHD, and helps many indi­vid­u­als, many con­tin­ue to expe­ri­ence impair­ment and some expe­ri­ence adverse effects that pre­clude ongo­ing med­ica­tion treatment.

Although psy­cho­log­i­cal treat­ments for adult ADHD — either in com­bi­na­tion with or as an alter­na­tive to med­ica­tion — are rec­om­mend­ed, they are not broad­ly avail­able in rou­tine clin­i­cal prac­tice. As a result, rel­a­tive­ly few adults are offered psy­cho­log­i­cal-based ADHD treat­ment after being diagnosed.

Mak­ing evi­dence-based psy­cho­log­i­cal treat­ment for adult ADHD wide­ly avail­able would thus be extreme­ly help­ful. This issue was the focus of a recent­ly pub­lished paper [Ken­ter et al., (2023). A self-guid­ed inter­net-deliv­ered inter­ven­tion for adults with ADHD: Results from a ran­dom­ized con­trolled tri­al, over at Inter­net Inter­ven­tions.] The study was con­duct­ed in Norway.

Study design:

Par­tic­i­pants were 120 adults (mean age ~41; 80% female) with self-report­ed ADHD diag­no­sis. They were recruit­ed via infor­ma­tion post­ed on social media pages from the nation­al ADHD asso­ci­a­tion. This was thus a ‘con­ve­nience’ sam­ple as opposed to a sam­ple that was tru­ly rep­re­sen­ta­tive of Nor­we­gian adults with ADHD.

Sev­en­ty-two per­cent were tak­ing ADHD med­ica­tion and remained on it dur­ing the study. They were ran­dom­ly assigned to either a self-guid­ed inter­net deliv­ered inter­ven­tion (MyAD­HD, described below) or to the con­trol con­di­tion which pro­vid­ed online psy­choe­d­u­ca­tion about ADHD.

Par­tic­i­pants rat­ed their ADHD symp­toms using the Adult ADHD Self-Rat­ing Scale (ASRS) before treat­ment began, imme­di­ate­ly fol­low­ing the 7‑week treat­ment, and 3 months after treat­ment end­ed. Par­tic­i­pants also com­plet­ed the Adult ADHD Qual­i­ty of Life Mea­sure and a per­ceived stress scale; mea­sures of user sat­is­fac­tion and adher­ence were obtained.

Intervention and Control:

The inter­ven­tion was a short-term, struc­tured, self-guid­ed inter­ven­tion that par­tic­i­pants accessed via the inter­net. It includ­ed 7 mod­ules that par­tic­i­pants were instruct­ed to com­plete weekly.

The mod­ules focused on goal set­ting, aware­ness train­ing, inhi­bi­tion train­ing, emo­tion reg­u­la­tion, plan­ning and orga­niz­ing dai­ly life, self-accep­tance, and mak­ing a plan for the future. The main goals were to help par­tic­i­pants attain improved func­tion­ing in dai­ly liv­ing, pro­vide strate­gies for stress reduc­tion, reduce inat­ten­tion, and enhance par­tic­i­pants’ qual­i­ty of life.

Each mod­ule includ­ed text, audio, and video mate­ri­als instruct­ing par­tic­i­pants in the use of spe­cif­ic tech­niques. Mod­ules also includ­ed case vignettes and videos designed to help par­tic­i­pants make con­nec­tions between the mate­r­i­al being taught and their own lived expe­ri­ence. Mul­ti­ple mod­ules includ­ed home­work that had par­tic­i­pants prac­tice new skills in every­day sit­u­a­tions and to track their success.

On aver­age, about 5 of the 7 mod­ules were com­plet­ed by participants.

Par­tic­i­pants in the con­trol group com­plet­ed an online psy­choe­d­u­ca­tion pro­gram on adult ADHD in which they learned about ADHD symp­toms and man­age­ment strate­gies. Spe­cif­ic top­ics cov­ered includ­ed Under­stand­ing ADHD, Behav­ior Man­age­ment, Prob­lem Solv­ing, Emo­tion Reg­u­la­tion, and Self-Acceptance.

The over­ar­ch­ing goal was to help par­tic­i­pants devel­op a deep­er under­stand­ing of ADHD, how it impacts them, and how they can cope more effec­tive­ly with the chal­lenges that ADHD cre­ates. Although it cov­ered sim­i­lar con­tent to the MyAD­HD inter­ven­tion, it did not include the prac­tice exer­cis­es, videos, and audio files. It was thus like­ly to be expe­ri­enced as less engag­ing and action oriented.

Results:

Adults in the inter­ven­tion group report­ed sig­nif­i­cant­ly greater reduc­tions in ADHD symp­toms fol­low­ing treat­ment than con­trol par­tic­i­pants; these dif­fer­ences were main­tained at the 3‑month fol­low-up. The mag­ni­tude of the group dif­fer­ence was in the medi­um to large range.

Forty-five per­cent of inter­ven­tion par­tic­i­pants com­pared to only 10.8% of con­trol par­tic­i­pants report­ed a decline in symp­toms that was large enough to be con­sid­ered clin­i­cal­ly mean­ing­ful. At the 3‑month fol­low-up, the per­cent of inter­ven­tion par­tic­i­pants report­ing a clin­i­cal­ly mean­ing­ful reduc­tion in ADHD symp­toms had increased to 58%; for con­trol par­tic­i­pants, the fig­ure had increased to 15.2%.

Fur­ther, no adults in the inter­ven­tion group showed a mean­ing­ful increase in symp­toms from base­line to fol­low-up while this hap­pened for over 19% of adults in the con­trol group.

Qual­i­ty of life: Adults in the inter­ven­tion group report­ed a high­er qual­i­ty of life imme­di­ate­ly after treat­ment; although this was no longer evi­dent at the 3‑month fol­low-up. Con­trol par­tic­i­pants indi­cat­ed no com­pa­ra­ble gain in their qual­i­ty of life.

Stress: No sig­nif­i­cant effects for self-report­ed stress were found.

Treat­ment sat­is­fac­tion: Near­ly 80% of inter­ven­tion par­tic­i­pants report­ed that they were either sat­is­fied or very sat­is­fied with the self-guid­ed inter­ven­tion. Over 88% indi­cat­ed that they would rec­om­mend the inter­ven­tion to a friend.

Summary and implications:

Results of this study pro­vide ini­tial evi­dence that a self-guid­ed, inter­net-deliv­ered inter­ven­tion for adults with ADHD can be effec­tive. Three months fol­low­ing the inter­ven­tion, near­ly 60% of adults receiv­ing the inter­ven­tion report­ed a reduc­tion in core ADHD symp­toms that was large enough to be con­sid­ered clin­i­cal­ly mean­ing­ful. This is an encour­ag­ing finding.

On the oth­er hand, while qual­i­ty of life gains were report­ed imme­di­ate­ly after treat­ment end­ed, they were no longer evi­dent 3 months lat­er. Per­haps these gains would have per­sist­ed in the adults remained engaged in the inter­ven­tion thru boost­er ses­sions, but that is a ques­tion for sub­se­quent research.

While results from this study are encour­ag­ing over­all, there are sev­er­al lim­i­ta­tions to note. Most impor­tant­ly, all out­come data came from self-reports. The study would have been strength­ened con­sid­er­ably if reports from part­ners, friends, etc. had also been obtained and showed sim­i­lar findings.

It is also the case that all adults self-ini­ti­at­ed par­tic­i­pa­tion in the study by respond­ing to infor­ma­tion post­ed on the web. As such, they were not nec­es­sar­i­ly a rep­re­sen­ta­tive sam­ple of adults with ADHD, and the extent to which results obtained here would gen­er­al­ize to a tru­ly rep­re­sen­ta­tive sam­ple is unclear.

While address­ing these con­cerns in future work would be impor­tant, these are excit­ing results because this inter­ven­tion could eas­i­ly be made wide­ly avail­able, and thus address a sig­nif­i­cant need in the field. There would also not seem to be any risks asso­ci­at­ed with this treat­ment and it can be used in con­junc­tion with med­ica­tion as was the case for many par­tic­i­pants in the study.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context: