You are not alone – adolescents’ experiences of participation in a structured skills training group for ADHD

ADHD and Identity Formation: Adolescents' Experiences From the Healthcare System and Peer Relationships

OBJECTIVE

ADHD is often a lifelong condition, and has grown increasingly prevalent over the past few decades. Adolescence is a period characterized by the quest to develop a coherent identity, yet relatively little research has examined the relationship between ADHD diagnosis and identity. The purpose of this study was to explore the importance of experiences of the healthcare system and of peer relationships in the identity formation of adolescents with ADHD.

METHOD

This was investigated through semi-structured interviews with 10 adolescents (n = 8 females and 2 males) aged 15 to 18 years. An inductive thematic analysis was conducted within a narrative framework.

RESULTS

The results revealed seven main themes indicating that ADHD played a central role in the adolescents' self-narratives: (1) limited effect of Child and Adolescent Psychiatry (CAP) contact on identity formation, (2) the ADHD concept as meaning-making, (3) heterogeneity of the role of medication on identity formation, (4) negotiation of identity in relation to others, (5) varying degrees of acceptance in different relationships, (6) perceiving oneself as a troublemaker, and (7) relationship difficulties.

CONCLUSIONS

Overall, the diagnosis constituted an important narrative and symptoms of ADHD rather than the label of ADHD tended to be stigmatizing. Furthermore, medication affected identity, and some felt pressured to medicate to adhere to social norms. A common pattern was that adolescents set aside their individual identity in favor of their relational identity.

I've really struggled but it does not seem to work: adolescents' experiences of living with ADHD - a thematic analysis

BACKGROUND

In Attention-deficit/hyperactivity disorder (ADHD) the transition from childhood to adolescence encompass changes in symptom manifestation and related challenges. Given the potential negative impact of ADHD on adolescents, and the increased risk for dropping out from treatment, there is a need to understand more about how adolescents experience their condition. The aim of this study was to explore adolescents' perceptions of how it is to live with ADHD.

METHODS

Twenty adolescents (15-17 years old, 12 girls) diagnosed with ADHD who had completed a skills training group were interviewed. Data was analysed using thematic analysis.

RESULTS

Four themes emerged: 'I find it hard to regulate what I take in and what comes out', 'I've really struggled but it does not seem to work', 'ADHD impacts my vitality and my relationships', and 'I can be successful and things are getting better'.

CONCLUSION

Adolescents with ADHD experience problems with self-regulation with regards to cognitive, emotional and behavioural processes. They describe being either on or off. This difficulty to self-regulate is related to primary and secondary consequences such as stress, anxiety, loss of control, and by extension exhaustion, depressed mood, challenges in social interactions, self-accusations and a tendency of giving up. The experience of 'being on' has positive connotations of vigour and creativity. The challenges related to ADHD can to some extent be overcome with time for recovery, coping strategies, and medical treatment. Symptoms of ADHD can also decrease over time.

TRIAL REGISTRATION

This qualitative study was not pre-registered.

Experiences of change following a blended intervention for adults with ADHD and emotion dysregulation: a qualitative interview study

BACKGROUND

Emotion dysregulation commonly co-occurs with attention-deficit hyperactivity disorder (ADHD), leading to a range of negative outcomes. While psychological interventions have shown promise in bringing about positive changes in emotional and cognitive domains, there is still limited knowledge on the subjective experiences of change among the participants in these interventions.

AIM

The present study explores the experiences of adults with ADHD who had participated in a blended digital and face-to-face intervention aimed at improving emotion dysregulation. The study focuses on understanding their experiences of change and identifying contributors to change.

METHODS

A total of 9 adults with ADHD participated in individual semi-structured, in-depth interviews following their participation in the intervention. The interviews were analyzed using thematic analysis.

RESULTS

The thematic analysis resulted in three core themes. The first theme, 'perceiving change', represents changes that the participants experienced, with four subthemes: 1a) being in control, 1b) feeling aware, 1c) accepting oneself and one's emotions and 1d) gaining insight and knowledge. The second theme, 'supporting change', captures factors that supported the participants' changes, with five subthemes: 2a) acquiring skills, 2b) being in it together, 2c) therapist guidance, 2d) finding motivation 2e) putting it into practice. Lastly, the third theme, 'sustaining change', includes aspects important to maintain change, with two subthemes: 3a) working consistently and 3b) giving it time.

CONCLUSIONS

The findings show that the participants experienced various changes related to the management of their emotions following their participation in the intervention. Change was perceived as a multifaceted process, supported by internal factors such as motivation and engagement, along with external factors such as support from the other group members and the therapists. Taken together, the findings from the study could be important to the development of psychological interventions for adults with ADHD and may provide valuable knowledge to clinicians and policymakers.

TRIAL REGISTRATION

Registered on 21st November 2022 at ClinicalTrials.gov.

CLINICALTRIALS

gov ID: NCT05644028.

"It was very nice to be in a room where everyone had ADD-that's kind of VIP": Exploring clients' perceptions of group CBT for ADHD inattentive presentation

OBJECTIVES

This qualitative study explored the perceptions of adult clients participating in a new psychological treatment for attention-deficit/hyperactivity disorder inattentive presentation (ADHD-I, also called "attention deficit disorder", ADD). The study aimed to explore (i) what aspects of treatment the participants found to be helpful, and (ii) if there were areas that ought to be developed to make the protocol more useful to clients with ADHD-I.

METHODS

Participants were recruited from treatment groups following the protocol of cognitive-behavioral therapy for ADHD-I (CADDI), at three psychiatric outpatient units in Stockholm, Sweden. Individual semi-structured interviews, lasting on average 44,6 minutes, were conducted with 14 adults after the completion of CADDI. Interviews explored participants' perceptions of CADDI, its usefulness, and asked for suggestions for improvement. Interviews were conducted by independent interviewers and were transcribed verbatim. The text was analyzed using reflexive thematic analysis.

RESULTS

The analysis generated three themes: "Factors of importance for change", with the subthemes; the group, therapeutic components, structure of treatment, and motivation,"Gains in treatment", with the subthemes; insight and understanding, increased attention, and planning and acting, and "Challenges with ADHD-I and remaining needs", with the subthemes; ADHD as a lifelong condition, maintaining gains in treatment, and wish for further support.

CONCLUSIONS

Participants emphasized the importance of the group setting as a facilitator of therapeutic effects of increased understanding and self-acceptance. Further, they considered the practice of mindfulness to enhance attention and awareness of thoughts, feelings, and activities and considered the structure of treatment as supporting the work in therapy. These findings support the value of the group setting and confirm the usefulness of CADDI. However, participants were concerned about how to maintain gains of treatment after its termination and suggested follow-up sessions to improve the CADDI protocol.

TRIAL REGISTRATION

Preregistered at Clinical Trials: NCT05037903.

One year follow-up of participants in a randomised controlled trial of a CBT-based group therapy programme for adolescents diagnosed with ADHD

BACKGROUND

Adolescents with ADHD often struggle on many areas of their lives and have a high risk of adverse outcomes and negative life trajectories. Multimodal treatment including psychosocial interventions is recommended but evidence regarding effect of such interventions is still limited.

MATERIALS AND METHODS

This study was a follow-up study of adolescents participating in a randomised controlled trial (RCT) of a group intervention based on cognitive behavioural therapy (CBT). Participants were adolescents diagnosed with ADHD and still impaired by their symptoms after standard treatment including psychoeducation and medication. All participants were interviewed by telephone one year after inclusion, and outcome measures included both quantitative and qualitative measures.

RESULTS

There were 100 adolescents included in the study. We found no significant differences between treatment and control group on measures of ADHD-symptoms, self-efficacy, overall problems, global psychosocial functioning, or symptom severity at one-year follow-up. Still, participants in the intervention group reported on positive gains and that they learned a lot about ADHD and themselves.

CONCLUSIONS

The intervention delivered in this trial failed to show a treatment effect on symptom level when added to standard care. Participants did however report on positive gains and felt they learned a lot. More research is needed to explore how the programme and delivery of treatment might be improved, and which patients might benefit the most from this type of interventions.

"It's ok that I feel like this": a qualitative study of adolescents' and parents' experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training

BACKGROUND

Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants' in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants' experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.

METHODS

Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.

RESULTS

The analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.

CONCLUSION

The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.

Cognitive behavioural group therapy for adolescents with ADHD: a study of satisfaction and feasibility

BACKGROUND

Adolescents with ADHD are at increased risk of adverse outcomes and a negative life trajectory into adulthood. Evidence regarding treatment specifically tailored for the needs of this age group are still limited. High dropout rates, discontinuation of medication and treatment resistance are common issues in this population, and the patient perspective on new treatment options is therefore important. In this study, we aimed to investigate treatment satisfaction and feasibility of a group CBT program for adolescents with ADHD. We further aimed to identify any baseline characteristics predicting satisfaction.

MATERIALS AND METHODS

This study was part of a larger RCT of group CBT as add-on treatment for adolescents aged 14-18 years (Mean age 15.9 years, SD 1.3) with ADHD in Norway. Satisfaction and feasibility in the treatment group (n = 48) were measured by completion of an evaluation questionnaire, attendance of group sessions and a group-leaders checklist. Predictors of satisfaction were analysed using linear regression.

RESULTS

Overall satisfaction was very high with a significant age effect, the eldest participants being most satisfied. Attendance rate was high with few dropouts and medical adherence during the treatment period was good. Group-leaders generally self-evaluated adherence to treatment manual positively but addressing resistance towards homework as challenging.

CONCLUSIONS

The participants were very satisfied with the group CBT treatment. Treatment options that are accepted and well-liked by the targeted population have the potential of reducing resistance towards treatment, improving future health and adherence to medication. The program is considered suitable for a clinical setting and may represent a feasible treatment supplement for adolescent ADHD.

Pilot Study on the Effects of the Teaching Interpersonal Skills Program for Teens Program (PEHIA)

Background/Objective

Social skills are essential in adolescence, both for their relational dimension and for their influence on other areas of adolescent life, so it is essential to include Social skills in the formal education of students.

Method

This paper presents the results of an experimental mixed factorial design pilot study in which an Interpersonal Skills Training Program for Adolescents (PEHIA¹) was applied. The convenience sample consisted of 51 adolescents. An evaluation was carried out before and after the intervention, using the CEDIA (Adolescent Interpersonal Difficulties Assessment Questionnaire) and SAS-A (Social Anxiety Scale for Adolescents) questionnaires.

Results

The mixed factorial ANOVA show significant differences in the overall measures and in most of the subscales of both questionnaires, indicating that PEHIA is effectiveness, at least in the short term.

Conclusions

The results obtained in assertiveness, interpersonal relationships and public speaking suggest that the program is feasible and shows promising results in reducing anxiety. However, a larger scale study should be conducted.

SKILLS - A psychoeducational group programme for children with ADHD

Psychoeducation is regarded as a first line of intervention for attention-deficit/hyperactivity disorder (ADHD). Previous studies have been limited to psychoeducation for adult patients or parents of children with ADHD. Therefore, the aim of the present study was to investigate the acceptability and effectiveness of a psychoeducational group intervention for children with ADHD. The two-session psychoeducational intervention, SKILLS, was completed by 125 children (6-12 years) with ADHD and their parents. Self-ratings and parental ratings of ADHD symptoms, functional impairment and attitudes to diagnosis and treatment were collected before and after treatment. Post-treatment client satisfaction and parental responses to an open question about SKILLS were assessed. The data were analyzed using a combination of quantitative and qualitative (content analysis) methods. A majority of the participants expressed satisfaction with the group intervention. The intervention had no effect on symptoms and level of function, although the parents were more positive to their child's diagnosis after the intervention. The parents were positive to the group format and to the opportunity for their children to meet other children with similar symptoms. Parents wished for more interactive elements and more opportunities for children to share experiences. We concluded that the group intervention was accepted by most participants, although more activating exercises and opportunities for interaction between participants should be included. Since the intervention group was not compared with a control group, the results should be interpreted with caution. Future studies should use a randomized control treatment design and investigate the effect on adherence to later treatment.