A self-guided Internet-delivered intervention for adults with ADHD: a protocol for a randomized controlled trial

Robin Maria Francisca Kenter, Astri J Lundervold, Tine Nordgreen, Robin Maria Francisca Kenter, Astri J Lundervold, Tine Nordgreen

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) in adulthood, with an estimated prevalence of 2-3%, is associated with several challenges in daily life functioning. The availability of evidence-based psychological interventions for adults with ADHD is still poor. Interventions delivered over the Internet on smartphones or personal computers may help to increase the availability of effective psychological interventions. The primary aim of this randomized controlled trial is to examine the efficacy of a self-guided Internet-delivered intervention on severity levels of ADHD symptomatology and quality of life.

Methods: We aim to include 118 participants with a self-reported ADHD diagnosis in a randomized controlled trial with two arms: 1) self-guided Internet-delivered intervention for coping with ADHD (N = 59); 2) self-guided online psychoeducation (control group, N = 59). After 3 months, the control group will be given access to the intervention. The primary clinical outcomes are inattention and quality of life. Secondary clinical outcomes are hyperactivity, stress and depression. Measures will be obtained at three time points: before (baseline), immediately after (8 weeks) and 3 months after the intervention. Uptake, usage, adherence and satisfaction will be explored.

Discussion: This RCT will provide valuable information on the clinical effectiveness of an Internet-delivered intervention for adults with ADHD. This study is, to our knowledge, one of the first randomized control trials that investigates the effects of a self-guided Internet-delivered psychological intervention in a fairly large group of adults with ADHD.

Trial registration: ClinicalTrials.gov, Identifier NCT04726813, January 27, 2021.

Keywords: Attention deficit hyperactivity disorder; Hyperactivity; Inattention; Internet-delivered self-help; Quality of life; Randomized controlled trial.

Conflict of interest statement

The authors have designed and created the Internet-delivered intervention, but derive no economic profit from it.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Flowchart RCT.

References

    1. Anastopoulos A.D., Langberg J.M., Eddy L.D., Silvia P.J., Labban J.D. A randomized controlled trial examining CBT for college students with ADHD. J. Consult. Clin. Psychol. 2021;89(1):21.
    1. Andersson G. Internet-delivered psychological treatments. Annu. Rev. Clin. Psychol. 2016;12:157–179.
    1. Andersson G., Titov N. Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry. 2014;13(1):4–11.
    1. Andersson G., Carlbring P., Titov N., Lindefors N. Internet interventions for adults with anxiety and mood disorders: a narrative umbrella review of recent meta-analyses. Can. J. Psychiatry. 2019;64(7):465–470.
    1. Braek D., Dijkstra J., Ponds R., Jolles J. Attention dysfunction and ADHD in adults: determinants and interventions. Neuropsych Publishers; Maastricht: 2009. Goal management training in adults with attention-deficit/hyperactivity disorder (ADHD): an intervention study; pp. 115–130.
    1. Cohen S., Kamarck T., Mermelstein R. Perceived stress scale. Measuring stress: A guide for health and social scientists. Vol. 10. 1994. pp. 1–2. 2.
    1. Collett B.R., Ohan J.L., Myers K.M. Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry. 2003;42(9):1015–1037.
    1. Devilly G.J., Borkovec T.D. Psychometric properties of the credibility/expectancy questionnaire. J. Behav. Ther. Exp. Psychiatry. 2000;31(2):73–86.
    1. Dymphie M., Dijkstra J.B., Ponds R.W., Jolles J. Goal management training in adults with ADHD: an intervention study. J. Atten. Disord. 2017;21(13):1130–1137.
    1. Edition F. Diagnostic and statistical manual of mental disorders. Am. Psychiatric Assoc. 2013;21
    1. Fantino B., Moore N. The self-reported Montgomery-Åsberg Depression Rating Scale is a useful evaluative tool in major depressive disorder. BMC Psychiatry. 2009;9 doi: 10.1186/1471-244X-9-26. Article 26.
    1. Faraone S.V., Biederman J., Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol. Med. 2006;36(2):159–165.
    1. Flobak E.S.N., Guribye F., Kenter R., Nordgreen T., Lundervold A. 2021. Designing Videos with and for Adults with ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Feedback. JMIR Preprints.
    1. Franke B., Michelini G., Asherson P., Banaschewski T., Bilbow A., Buitelaar J.K., et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur. Neuropsychopharmacol. 2018;28(10):1059–1088.
    1. Gibbins C., Weiss M. Clinical recommendations in current practice guidelines for diagnosis and treatment of ADHD in adults. Curr. Psychiatry Rep. 2007;9(5):420–426.
    1. Gjervan B., Nordahl H.M. The Adult ADHD Quality of Life Questionnaire (AAQoL): a new disease specific measure for assessment of ADHD. Nordic Psychology. 2010;62(1):24–36. doi: 10.1027/1901-2276/a000003.
    1. Hesslinger B., van Elst L.T., Nyberg E., Dykierek P., Richter H., Berner M., et al. Psychotherapy of attention deficit hyperactivity disorder in adults. Eur. Arch. Psychiatry Clin. Neurosci. 2002;252(4):177–184.
    1. Hirvikoski T., Waaler E., Alfredsson J., Pihlgren C., Holmström A., Johnson A., et al. Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial. Behav. Res. Ther. 2011;49(3):175–185.
    1. Jacobson N.S., Truax P. 1992. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.
    1. Jensen D.A., Halmøy A., Stubberud J., Haavik J., Lundervold A.J., Sørensen L. An exploratory investigation of goal management training in adults with ADHD: improvements in inhibition and everyday functioning. Front. Psychol. 2021;12
    1. Karyotaki E., Riper H., Twisk J., Hoogendoorn A., Kleiboer A., Mira A., et al. Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: a meta-analysis of individual participant data. JAMA Psychiatry. 2017;74(4):351–359.
    1. Kessler R.C., Adler L.A., Barkley R., Biederman J., Conners C.K., Faraone S.V., et al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol. Psychiatry. 2005;57(11):1442–1451.
    1. Kessler R.C., Adler L., Ames M., Demler O., Faraone S., Hiripi E., et al. The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol. Med. 2005;35(2):245–256.
    1. Knouse L.E., Safren S.A. Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorder. Psychiatric Clin. N. Am. 2010;33(3):497.
    1. Kooij J., Bijlenga D., Salerno L., Jaeschke R., Bitter I., Balazs J., et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur. Psychiatry. 2019;56(1):14–34.
    1. Kornør H., Hysing M. ASRS; 2011. Måleegenskaper ved den norske versjonen av Adult ADHD Self Report Scale, 1.1.
    1. Kroenke K., Spitzer R.L., Williams J.B. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16(9):606–613.
    1. Michielsen M., de Kruif J.T.C., Comijs H.C., van Mierlo S., Semeijn E.J., Beekman A.T., et al. The burden of ADHD in older adults: a qualitative study. J. Atten. Disord. 2018;22(6):591–600.
    1. Moëll B., Kollberg L., Nasri B., Lindefors N., Kaldo V. Living SMART—a randomized controlled trial of a guided online course teaching adults with ADHD or sub-clinical ADHD to use smartphones to structure their everyday life. Internet Interv. 2015;2(1):24–31.
    1. Nordby E.S., Gilje S., Jensen D.A., Sørensen L., Stige S.H. Goal management training for adults with ADHD–clients’ experiences with a group-based intervention. BMC Psychiatry. 2021;21(1):1–12.
    1. Nutt D., Fone K., Asherson P., Bramble D., Hill P., Matthews K., et al. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology. J. Psychopharmacol. 2007;21(1):10–41.
    1. Solberg B.S., Haavik J., Halmøy A. Health care services for adults with ADHD: patient satisfaction and the role of psycho-education. J. Atten. Disord. 2019;23(1):99–108.
    1. Spencer T., Biederman J., Wilens T. Pharmacotherapy of attention deficit hyperactivity disorder. Child Adolesc. Psychiatr. Clin. N. Am. 2000;9(1):77–97.
    1. Stamenova V., Levine B. Effectiveness of goal management training® in improving executive functions: a meta-analysis. Neuropsychol. Rehabil. 2019 Dec;29(10):1569–1599. doi: 10.1080/09602011.2018.1438294. Epub 2018 Mar 14. PMID: 29540124.
    1. Swales M.A., Heard H.L. Routledge; 2016. Dialectical behaviour therapy: distinctive features.
    1. Titov N., Dear B.F., Johnston L., McEvoy P.M., Wootton B., Terides M.D., et al. Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: a 12-month follow-up of a randomised controlled trial. PLoS One. 2014;9(2)
    1. Vidal R., Bosch R., Nogueira M., Gómez-Barros N., Valero S., Palomar G., et al. Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioral group therapy: a randomized controlled pilot study. J. Nerv. Ment. Dis. 2013;201(10):894–900.
    1. Watters C., Adamis D., McNicholas F., Gavin B. The impact of attention deficit hyperactivity disorder (ADHD) in adulthood: a qualitative study. Ir. J. Psychol. Med. 2018;35(3):173–179.
    1. Weiss M., Safren S.A., Solanto M.V., Hechtman L., Rostain A.L., Ramsay J.R., et al. Research forum on psychological treatment of adults with ADHD. J. Atten. Disord. 2008;11(6):642–651.
    1. Weiss M., Murray C., Wasdell M., Greenfield B., Giles L., Hechtman L. A randomized controlled trial of CBT therapy for adults with ADHD with and without medication. BMC Psychiatry. 2012;12(1):1–8.
    1. Wisting L., Johnson S.U., Bulik C.M., Andreassen O.A., Rø Ø., Bang L. Psychometric properties of the Norwegian version of the Patient Health Questionnaire-9 (PHQ-9) in a large female sample of adults with and without eating disorders. BMC Psychiatry. 2021;21(1):6.
    1. Yardley L., Morrison L., Bradbury K., Muller I. The person-based approach to intervention development: application to digital health-related behavior change interventions. J. Med. Internet Res. 2015;17(1)
    1. Zachariae R., Lyby M.S., Ritterband L.M., O'Toole M.S. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia–a systematic review and meta-analysis of randomized controlled trials. Sleep Med. Rev. 2016;30:1–10.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj