A Neuroaffirmative, Self-Determination Theory-Based Psychosocial Intervention for Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Feasibility Study.

backgroundNeurodevelopmental disorders are complex and heterogeneous, creating challenges for treatment design. Multiple syndromes are associated with executive function (EF) deficits; however, theories of attention-deficit/hyperactivity disorder (ADHD) centralize a singular perspective of outcomes arising from EF impairments in adults. Deficit-based etiologies state ADHD-related EF impairments interfere with agentic self-development, perspectives that may inadvertently contribute to social stigma and influence neurotype dysphoria in ADHD identity construction. Challenges to this perspective highlight heterogeneity, context variability, the absence of a single EF deficit of origin, correlational neuroimaging data, and limited investigation into altered brain activity in ADHD research. Recommendations for psychosocial interventions primarily support cognitive behavioral therapy, which centers on a deficit-based etiology of ADHD and prioritizes symptom reduction and cognitive control of self-regulation as treatment outcomes-skills that require additional cognitive effort and may involve avoidance of emotional experiences to minimize negative affect. Transdiagnostic approaches are recommended to gain new insights into mental health challenges. Self-Determination Theory (SDT) presents a transdiagnostic approach that offers alternative outcomes by prioritizing basic psychological need satisfaction, which supports strong identity formation, motivation, and self-regulation.

objectiveThis study examines the feasibility and effects of an SDT-based quality-of-life therapeutic intervention for adults with ADHD.

methodsWe aimed to recruit 30 participants aged 18 years or older with a confirmed diagnosis of ADHD and access to an internet connection. Participants were recruited from the Adult ADHD Clinic at the South West Yorkshire Partnership National Health Service Foundation Trust and allocated through 4-block randomization by a nonblinded researcher to either an 11-session therapeutic coaching intervention (n=11) or a control waitlist (n=9) condition. Feasibility was evaluated by pretreatment and posttreatment measurements of health-related quality of life (QoL), psychological distress, ADHD symptoms, ADHD-related QoL, self-reflection and insight, autonomous functioning, and individual outcome measures of impairment. Participants also responded to a qualitative feedback interview question on intervention value.

resultsAdherence was high for both intervention completion (10/11, 91.6%) and control condition completion (9/11, 81.8%). Results showed clinically significant improvement on measures of psychological distress, specifically in the subscales of problems (z=0.0; P=.01), nonrisk (z=2.0; P=.01), functions (z=5.0; P=.02), and well-being (z=6.0; P=.03), as well as ADHD symptoms (z=3.0; P≤.01), particularly inattention (z=3.0; P≤.01), outcomes not specifically targeted by the intervention. Additional clinically significant findings of improvement in QoL, specifically in outlook subscale (z=21; P=.67), reduction of distress in problems identified in the individual outcome measure and the need for self-reflection subscale of self-reflection for the control group (z=1.0; P=.05) indicate potential positive effectiveness despite the impact of COVID-19. Positive qualitative feedback on usefulness and transferability of the intervention was provided by 90% (20/23) of participants.

conclusionsThis study suggests that a randomized controlled trial of an SDT-based psychosocial intervention with nondeficit-based outcomes for adults with ADHD is feasible and recommended.

trial registrationClinicalTrials.gov NCT04832737; https://clinicaltrials.gov/study/NCT04832737.