Occupational Experiences and Attributions of Typically Developing Adolescents

BACKGROUND

Understanding the occupational experience of typically developing adolescents and their attributions of strengths and difficulties is important for promoting their adaptive occupational participation.

OBJECTIVES

To explore the psychometric properties of the Self-Perception of Occupational Experiences for Teens (SPOT) interview, occupational experiences, attributions of strengths and difficulties, and strategies for managing challenges among typically developing adolescents.

METHODOLOGY

83 typically developing adolescents underwent the Self-Perception of Occupational experiences for Teens interview. Descriptive statistics and qualitative content analysis were used to analyze the data.

RESULTS

Acceptable to good internal consistency was found across all SPOT domains and scales and moderate correlations among all scales within the four domains. Descriptive analyses showed high ratings across domains, with social activities reported the most enjoyable and activities of daily living the least difficult. Leisure and social domains were the most frequently reported as strengths, while education was the most difficult. Emerged themes from qualitative analyses were internal attributes, external attributes, and motivation. Connecting with others and personal values were rated as most effective strategies for overcoming challenges.

CONCLUSIONS

Aligning interventions with adolescents' attributions and challenges may enhance their motivation and engagement, promoting adaptive participation.

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.

Conflicting Definitions of Self-Regulation in Occupational Therapy: A Scoping Review

AIMS

To understand how occupational therapy literature conceptualizes, discusses, describes, implies, and operationalizes self-regulation.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and JBI methodology guided the review. MEDLINE, Embase, CINAHL, PsychInfo and ERIC databases were searched with studies from 2000 - June 2023 deemed eligible. Two reviewers extracted data with results presented in figurative, tabular, and narrative synthesis. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklist for systematic reviews. Content analysis of construct descriptions was conducted.

RESULTS

A total 4159 articles were screened for eligibility, and eighty-one assessed at full text. Nine additional studies were retrieved through hand-searching. Sixty-four studies were included and underwent critical appraisal. Content analysis revealed five self-regulation constructs and associated terms in the occupational therapy literature, including self-regulation, executive function, emotion regulation, interoception and social-emotional learning.

CONCLUSIONS

Five distinct self-regulation constructs were analyzed in the occupational therapy literature, with various terms used to describe and define these. Self-regulation and executive function were often described as linked constructs. Similarly, lack of congruence between self-regulation measures, identified interventions and the underlying self-regulation construct was identified.

Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life

BACKGROUND

Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD.

OBJECTIVES

To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms.

METHODS

Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA).

RESULTS

Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality.

CONCLUSIONS

Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.

Reducing Driving Risk Factors in Adolescents with Attention Deficit Hyperactivity Disorder (ADHD): Insights from EEG and Eye-Tracking Analysis

Adolescents with attention deficit hyperactivity disorder (ADHD) face significant driving challenges due to deficits in attention and executive functioning, elevating their road risks. Previous interventions targeting driving safety among this cohort have typically addressed isolated aspects (e.g., cognitive or behavioral factors) or relied on uniform solutions. However, these approaches often overlook this population's diverse needs. This study introduces the "Drive-Fun" innovative intervention (DFI), aimed at enhancing driving skills among this vulnerable population. The intervention was tested in a pilot study including 30 adolescents aged 15-18, comparing three groups: DFI, an educational intervention, and a control group with no treatment. Assessments included a driving simulator, EEG, and Tobii Pro Glasses 2. Evaluation was conducted pre- and post-intervention and at a 3-month follow-up. Results indicated that the DFI group significantly improved in the simulated driving performance, attentional effort, and focused gaze time. The findings underscore that holistic strategies with personalized, comprehensive approaches for adolescents with ADHD are particularly effective in improving driving performance. These outcomes not only affirm the feasibility of the DFI but also highlight the critical role of sensor technologies in accurately measuring and enhancing simulator driving performance in adolescents with ADHD. Outcomes suggest a promising direction for future research and application.

"Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

Cognitive Functional Remote Group intervention for adults with attention deficit hyperactivity disorder: A feasibility study

Introduction

Attention deficit hyperactivity disorder among adults has been associated with deficits in executive functioning and poor quality of life. The purpose of this study is to examine feasibility of the Cognitive Functional Remote Group intervention among adults with attention deficit hyperactivity disorder.

Method

Mixed-method feasibility study. Five adults with attention deficit hyperactivity disorder received 16 weekly sessions of Cognitive Functional Remote Group.

Results

The target population was easily recruited and showed interest in the treatment. All participants completed the intervention and were moderately-very highly satisfied with different aspects of the intervention. Additionally, pre-post measures demonstrated high rates of clinically significant improvements in the quality of life measure and less so in executive functioning. Three central themes emerged from qualitative analyses of participants experiences relating to (a) Identity development through group process; (b) Occupation-based learning of self-awareness and cognitive functional strategies and (c) Feedback on group setting and content and relating to advantages and disadvantages of remote (Zoom) format.

Conclusion

This study supported Cognitive Functional Remote Group feasibility among adults with attention deficit hyperactivity disorder. Quantitative findings point to the responsiveness of quality-of-life measures. Qualitative findings suggest gains in identity development, awareness and acquisition of cognitive functional strategies through occupation-based learning in a telerehabilitation group therapy format. Further controlled studies are warranted.

Revisiting the dynamic comprehensive model of self-awareness: a scoping review and thematic analysis of its impact 20 years later

This study aimed to (1) describe the scope of research related to the Dynamic Comprehensive Model of Awareness (DCMA) (Toglia & Kirk, 2000); (2) identify themes and support for key model postulates; and (3) suggest future research directions related to this model. Using PRISMA scoping guidelines, 366 articles were reviewed, and 54 articles met our inclusion criteria. Selected studies were clustered into three themes: (1) the relationship between general and online self-awareness (50%); (2) interventions based on the model (41%); and (3) factors contributing to self-awareness (9%). Most studies were conducted with participants with acquired brain injury (BI) and traumatic BI (68%), most used a cross-sectional design (50%), and most intervention studies utilized a single-subject design (18%), followed by an experimental design (9%). This review provides evidence for the wide application of the DCMA across varying ages and populations. The need for a multidimensional assessment approach is recognized; however, stronger evidence that supports a uniform assessment of online self-awareness is needed. The intervention studies frequently described the importance of direct experience in developing self-awareness; however, few studies compared how intervention methods to influence general versus online self-awareness, or how cognitive capacity, self-efficacy, psychological factors, and context, influence the development of self-awareness.

Online and Intellectual Awareness of Executive Functioning in Daily Life among Adolescents with and without ADHD

OBJECTIVE

Executive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in "real-time" task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD.

METHODS

102 adolescents with (n = 52) and without (n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness.

RESULTS

Adolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent's ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls (p < .005).

CONCLUSIONS

Adolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.

Pilot Study of the Cognitive–Functional Intervention for Adults (Cog-Fun A): A Metacognitive–Functional Tool for Adults With Attention Deficit Hyperactivity Disorder

Importance: Adults with attention deficit hyperactivity disorder (ADHD) often experience chronic challenges in their life roles. There is a need for evidence-based occupational therapy interventions to help enhance their functioning.

Objective: To determine the preliminary effectiveness of the Cognitive–Functional Intervention for Adults (Cog–Fun A), a metacognitive–functional occupational therapy tool for the improvement of occupational performance (OP) and quality of life (QoL) in adults with ADHD.

Design: One-group pretest–posttest design with a 3-mo follow-up.

Setting: Community setting in Jerusalem, Israel.

Participants: Fourteen adults, ages 18–60 yr, with a valid diagnosis of ADHD and an indication of executive function (EF) impairment.

Intervention: Participants received 15 1-hr weekly sessions that addressed self-awareness of strengths and challenges through education and guided discovery as well as strategy acquisition and implementation within a context of occupational goal attainment.

Outcomes and Measures: The Behavioral Rating Inventory of Executive Function–Adult version, an adult ADHD QoL measure, the Canadian Occupational Performance Measure, and the Self-Regulation Skills Interview were administered.

Results: Twelve participants completed the intervention. Posttreatment scores revealed statistically significant improvements in EF, awareness, OP, and QoL. Gains in QoL showed a modest reduction at the 3-mo follow-up.

Conclusions and Relevance: The Cog–Fun A is a promising intervention for improving OP and QoL among adults with ADHD and should be investigated further.

What This Article Adds: The Cog–Fun A offers an effective nonpharmacological, metacognitive–functional, occupation-centered treatment option for adults with ADHD.