The effects of a Self-Alert Training (SAT) program in adults with ADHD

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD), a neuropsychiatric condition characterized by attention and impulsivity problems, is one of the most common behavioral disorders. The first line of treatment for ADHD is psychostimulant medication, but this has limited effectiveness, particularly in adults, and is often associated with adverse side-effects. Thus, it is imperative that new non-pharmaceutical approaches to treatment are developed. This study aims to evaluate the impact of a non-pharmacological Self-Alert Training (SAT) intervention on ADHD symptom prevalence, psychological and cognitive functioning, and on everyday functional impairment in adults with ADHD. Fifty-one adult participants with a current diagnosis of ADHD were randomized to either SAT or a Control Training (CT) program. They were assessed at baseline, immediately following the 5-week training period, and after 3-months using ADHD symptoms scales, as well as a series of neuropsychological tests and psychological questionnaires. Subjective ratings of everyday life attention and memory problems were also collected. The SAT group showed significant improvements in ADHD inattentive and impulsive symptoms, depressive symptoms and in self-efficacy ratings compared to the CT group at both post-training and at the 3-month assessment. Pre-post improvements in SAT participants on untrained cognitive tasks measuring selective attention and executive functions were also observed. Finally, the SAT group reported improved subjective ratings of everyday life attention at both assessment points. This pattern of results suggests that SAT may be beneficial in treating ADHD symptoms as well as psychological and cognitive impairments in adult ADHD. A large-scale randomized controlled trial (RCT) is needed.

Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

“…A number of studies have evaluated the efficacy of such interventions in the long-term, and demonstrated that it is maintained from 3 to 12 months after the end of the treatment (Safren et al, 2010 ; Salakari et al, 2010 ; Emilsson et al, 2011 ; Pettersson et al, 2014 ; Fleming et al, 2015 ; Salomone et al, 2015 ; Young et al, 2015 ; Cherkasova et al, 2016 ; Gu et al, 2017 ; Nasri et al, 2017 ), although the magnitudes of the reported effects are heterogeneous. The largest clinical trial so far published in the field found that groups receiving psychosocial therapy had superior outcomes to active control groups at follow-up only in the CGI measure, but not in ADHD symptoms (Philipsen et al, 2015 ).…”

Terapia Cognitivo-Comportamental para adolescentes com Transtorno de Déficit de Atenção e Hiperatividade: uma revisão sistemática de literatura

“…Em relação aos resultados obtidos pelas intervenções, destaca-se que, de maneira geral, todas apresentaram resultados positivos para redução dos sintomas do TDAH, bem como a redução de comorbidades como ansiedade, depressão e comportamento desafiador. De fato, a literatura apresenta diversos estudos que evidenciam os benefícios da TCC para indivíduos com TDAH, contribuindo tanto para a melhora dos sintomas do transtorno, como também para suas comorbidades (Salomone et al, 2015;Young et al, 2015). Conforme exposto, as principais dificuldades na implementação dessas intervenções referem-se a características comuns à fase da adolescência, tais como o receio de não ser aceito socialmente devido ao transtorno, a busca por maior autonomia para tomar decisões e um possível constrangimento com a participação dos pais.…”

Early Attentional Modulation by Working Memory Training in Young Adult ADHD Patients during a Risky Decision-Making Task

“…Working memory problems and impaired sustained attention are characteristic symptoms of ADHD [2,57]. Improvement of symptomatology by cognitive training and psychological interventions aimed to increase the correlation between sustained attention and arousal has been evalued several times in the recent past [58][59][60][61]. However, benefits for behavioral transfer effects to measures of fluid intelligence after several weeks of a computerized working memory treatment requiring high cognitive load could not be confirmed satisfactorily and raised questions about the controversial usefulness of such training [22,24,62].…”