JMIR Publications

ABSTRACT

Background:

Adults with Attention Deficit Hyperactivity Disorder (ADHD) often experience elevated stress levels and reduced quality of life (QoL), which can be partly linked to challenges such as alexithymia and rejection sensitivity dysphoria (RSD). Stress Autism Mate (SAM), a free self-guided mobile app originally co-created for autistic adults, may support stress management. The app aims to reduce daily stress by promoting stress recognition and coping through daily stress questionnaires, psychoeducational content, stress reduction tips, peer stories, podcasts, and in-app exercises.

Objective:

This mixed-methods pilot study explored the feasibility, usability, and preliminary outcomes of the SAM app in adults with ADHD.

Methods:

A quantitative study informed by single-case experimental design (SCED) principles was complemented by semi-structured qualitative interviews. Questionnaire data were collected from 22 adults with ADHD (77.3% female; Mage = 34.3 years) at four time points spaced four weeks apart: baseline, pretest, posttest, and follow-up. Linear mixed-effects models were used to evaluate changes in perceived stress, QoL, coping self-efficacy, stress recognition, alexithymia, and RSD. Qualitative data were analyzed using deductive thematic analysis guided by the User Experience Technology Acceptance Model (UX-TAM).

Results:

At posttest, significant increases were observed in stress recognition (d = 0.80) and coping self-efficacy (d = 0.34). At follow-up, only the effect on stress recognition remained (d = 0.82), while delayed improvements emerged in QoL (d = 0.38), alexithymia (d = –0.49), and RSD (d = –1.27). Perceived stress did not change at either time point. Participants reported high adherence and ease of use of the app but described difficulties translating increased stress awareness into adaptive coping behaviors. Most expressed a need for more stimulating, motivating, and personalized features to facilitate coping and sustain engagement.

Conclusions:

The SAM app appears feasible and usable for adults with ADHD, showing robust improvements in stress recognition and potential benefits for wellbeing over time. However, the app currently seems insufficient to support the implementation of effective coping strategies. Differences from previous SAM trials in autistic adults may reflect distinct executive functioning challenges. Future adaptations incorporating more personalized, just-in-time support (e.g., AI-driven) and more engagement-focused design features (e.g., gamification) may enhance effectiveness in this population.