JMIR Publications

ABSTRACT

Background:

Neurodevelopmental disorders are complex and heterogeneous, impacting efficacy in treatment design. Multiple syndromes are associated with executive function (EF) deficits, however theories of attention-deficit hyperactivity disorder (ADHD) centralise outcomes arising from impairments in EF for adult treatment. Transdiagnostic approaches are recommended to gain new insights on mental health challenges. Self-Determination Theory (SDT) is a transdiagnostic approach prioritising satisfaction of basic psychological needs and aims to enhance quality of life, identity formation, motivation, and self-regulation.

Objective:

This study examines the feasibility and acceptability of a randomised controlled trial to evaluate effectiveness of an SDT-based quality-of-life therapeutic intervention for ADHD adults.

Methods:

Recruitment aims were 30 adult participants aged 18+ with a confirmed diagnosis of ADHD and access to a computer or smartphone with an internet connection. Participants were recruited from the Adult ADHD Clinic at the South West Yorkshire Partnership NHS Foundation Trust and allocated through four block randomisation by a non-blinded researcher to an 11-session therapeutic coaching intervention (n=11) or control waitlist (n=9) condition. Feasibility was evaluated by pre- and post- measurements of health-related quality-of-life, psychological distress, ADHD symptomology, ADHD-related quality-of-life, self-reflection and insight, autonomous functioning, and per-session measure of participant impairment issues. Participants also responded to a qualitative feedback interview question on intervention value.

Results:

Of the seven measures, only two—the EQ-5D-5L (a brief measure of well-being) and the Index of Autonomous Functioning—failed to detect significant differences across assessment moments. All other measures related to symptomatology, well-being, impairment, and self-reflection detected significant changes. Most participants also provided positive qualitative feedback regarding the intervention's usefulness.

Conclusions:

The study suggests that a randomised controlled trial of a Self-Determination Theory-based intervention for adults with ADHD is feasible. Future research should focus on incorporating long-term adherence measures and exploring alternative outcome measures to enhance longitudinal assessment of treatment effects.