Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective

Adult individuals with attention-deficit hyperactivity disorder (ADHD) have been suffering from this neurobiological and highly heritable disorder chronically since childhood. Resulting from their longstanding neuropsychological impairments, such as attentional problems, emotional instability, and disinhibition, they are familiar to a multiplicity of negative life outcomes and underachievement. Furthermore, a large part of this population suffers from psychiatric comorbidity. This accumulation of negative experiences has an impact on therapy-relevant factors such as the individual's self-esteem, self-efficacy, development of core beliefs/schemas, and coping strategies. Based on negative beliefs about the self, individuals confronted with difficult situations develop maladaptive coping strategies, for instance avoidance and procrastination. These strategies lead to maintenance and reinforcement of maladaptive beliefs, and as such they acquit themselves as schema-confirming. Captured in this vicious cycle, the individual sees her negative view of the self confirmed. The purpose of this paper is to illuminate these interactive factors that influence the aforementioned cycle in order to emphasize the cognitive behavioural interventions tailored to those factors on the basis of latest research. Furthermore, the authors want to attract notice to the resources people with ADHD are said to have, namely creativity and resilience. These postulated resources could be therapy-relevant by creating positive beliefs about the self, hence improving coping skills and breaking the vicious circle of negative appraisal. Taking into account personal resources and their fostering may be an important fundament for the treatment plan of adult ADHD. Information on the current state of research and theoretical approaches concerning the below-mentioned key words was gathered through MEDLINE, PsycINFO, PSYNDEXplus, and PubMed database

A Comparison of Cognitive-Behavioral Therapy and Pharmacotherapy vs. Pharmacotherapy Alone in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD)—A Randomized Controlled Trial

In the treatment of adult attention-deficit/hyperactivity disorder (ADHD) the importance of psychological interventions in combination with pharmacotherapy is widely accepted in contemporary clinical routine. The natural course of the disorder seems to justify additional psychological interventions because even in patients who are highly compliant to pharmacotherapy full remission is not always achieved. The aim of the present study was to analyze the contribution of psychotherapy to the treatment of adult ADHD patients. In a randomized controlled study, the efficacy of a combined treatment of psychotherapy with pharmacotherapy is compared to pharmacological intervention alone. After initiation and stabilization of treatment with methylphenidate (MPH) in all subjects randomization to the two different treatment conditions was done. Afterwards both groups underwent treatment for about 10–12 weeks, the experimental group receiving sessions of cognitive-behavioral therapy (CBT) whereas the control group only received medication and standard clinical management (SCM). ADHD symptoms differed statistically during time but not between the two different treatment conditions. This result was the same for the single ADHD symptoms—inattention, hyperactivity, impulsivity, and emotional symptoms—and also for impairment. Individual standardized ADHD specific CBT program was not able to outperform SCM

Self-beliefs, resources, and self-regulation in adult ADHD : psychotherapeutical relevance and implications

This dissertation aims to contribute to the developing research on adult ADHD in focusing on the role of self-beliefs, resources, and self-regulatory abilities. From childhood onwards, adults with ADHD have been afflicted with functional impairments in multiple domains of their life. Even though medication treatment addresses the core neurobiological symptoms of ADHD, many adults continue to suffer from residual symptoms and struggle with interpersonal, academic, and vocational difficulties. Living with this lifelong history of negative experiences and underachievement affects the formation of the individual’s self-esteem, selfefficacy, and gives rise to maladaptive coping strategies. In this work we aim to obtain a deeper understanding of those psychological factors in adults with ADHD that are closely linked to their self-beliefs, their ability to initiate and to pursue their goals (self-regulation), and their ability to apply effective coping strategies. Another focus lies on the specific resources people with ADHD possess, as they can be crucial to help improve the aforementioned self-beliefs and coping strategies. The first article Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective provides an overview of the current empirical findings and the theoretical state of knowledge with respect to self-beliefs and resources in adult ADHD: Schemas, self-esteem, self-efficacy, coping strategies, and resources. Based on the theoretical framework in the first article we conducted an empirical study to investigate self-esteem, self-efficacy and resources in adults with ADHD (article 2) in comparison to a healthy control group. Relationships between elevated psychological distress and the aforementioned factors were also surveyed. Adults with ADHD showed lower levels of self-esteem and self-efficacy and higher levels of general distress than the control group. With respect to the resources, the ADHD group showed lower values compared with the control group in some but not all of the resources. The following resources were equally well-marked in both groups: Family, leisure time, housing, ability to love, courage, and faith. The results of this study have important implications for the treatment of adult ADHD, suggesting that therapy programs for adult ADHD should include modules for enhancing self-esteem, self-efficacy, and fostering the patient’s resources. The third article explores self-regulation in adult ADHD. Self-regulatory abilities are of central importance for attaining personal goals. Yet the first article highlights that adults with ADHD often lack positive coping strategies and exhibit low self-efficacy, factors which interfere with the initiation and the pursuit of intentions. Why they have those difficulties in regulating their objectives and instead end up using maladaptive coping strategies such as procrastination is the question we tackle in the third article. In a first step, we compared self-regulatory abilities in adults with ADHD, such as 6 the inhibition of the volitional processes or the tendency for state orientation, with a healthy control group. We then scrutinized if adults with ADHD with increased attentional impairments displayed a larger tendency for state orientation compared to individuals with less pronounced attentional deficits. The results indicate that the ADHD group exhibited elevated values for volitional inhibition as well as for self-inhibition when compared to the control group. Regarding self-regulation, we found the variable self-motivation to be significantly reduced, which stands in contrast to the variables activation control or self-determination. Furthermore, in comparison to the controls the ADHD group showed higher values of prospective state orientation and state orientation subsequent to failure. Also, increased attentional impairment in adult ADHD is positively associated with processes of volitional inhibition and negatively associated with prospective action orientation. No significant relationship was found between higher levels of inattention and action orientation subsequent to failure. The final part of the dissertation juxtaposes the strengths and limitations of our conclusions and discusses possible implications for the psychotherapeutic interventions in adult ADHD

A Comparison of Self-Reported Emotional Regulation Skills in Adults With Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder

Objective: Emotion dysregulation has been described as a central feature of both borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD). The current study aims to compare emotion regulation among ADHD, BPD, and healthy controls (HC). Method: Eighty adults with ADHD, 55 with BPD, and 55 HC completed self-report assessments of ADHD and BPD symptoms, psychosocial functioning, and emotion regulation skills. Principal components analysis (PCA) was conducted on the emotion regulation items, followed by multivariate analyses of group differences in emotion regulation. Results: PCA yielded four components: “Being Aware of Emotions,” “Making Sense of Emotions,” “Modifying and Accepting Emotions,” and “Confronting Emotions With Self-Encouragement.” The last component best distinguished the two patient groups from the HC. No differences were found between adults with ADHD and BPD. Conclusion: Adults with ADHD and BPD report comparable difficulties in encouraging oneself to attend inner aversive experiences, without engaging in impulsive behavior