Treatment Outcomes in an Adult Attention Deficit Hyperactivity Disorder Clinic With a Focus on Executive Functioning and Sluggish Cognitive Tempo

Abstract

Executive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. Methods We implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data. Results Adults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale. Conclusions Adult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and "tailoring" through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.

A systematic review of interventions to support adults with ADHD at work—Implications from the paucity of context-specific research for theory and practice

“…Despite the strong evidence base as an intervention for affective disorders and preliminary evidence in interventions for children and adolescents with ADHD, there is limited research applying psychoeducation with ADHDers (Lukens and McFarlane, 2004 ; Dahl et al, 2020 ). Seven studies mentioned their use of psychoeducation typically combining it with another therapy or training (Wiggins et al, 1999 ; Hirvikoski et al, 2017 ; In de Braek et al, 2017 ; Bachmann et al, 2018 ; Hoxhaj et al, 2018 ; Gaur and Pallanti, 2020 ; Hartung et al, 2020 ). These studies indicated improvement in a range of outcomes including executive functioning, time management/organization skills, general functioning, and knowledge, as well as knowledge and coping in significant others.…”