New approach to the treatment of ADHD through internet and smartphones : from impairment to improvement

Sammanfattning: Background: Attention deficit hyperactive disorder (ADHD) is a common and disabling disorder, affecting 2-4% of the adult population worldwide. Pharmacological treatment is often the only available option, however medication is not sufficient for 50-70% of the adults. Thus, it is necessary to develop and evaluate complementary treatments. Although treatments such as cognitive and dialectic behavioral therapy (CBT and DBT) in the treatment ofADHD have been promising, they have each targeted different aspects of ADHD symptomatology, thus neither one has addressed the total variety of symptoms typically displayed in adults. Moreover, accessibility to these treatments is low. Aims: General aims of this thesis were to develop and evaluate the efficacy of new psychological interventions for adult ADHD, addressing a variety of common impairments associated with the diagnosis, with the intention to make these interventions accessible and available through internet. Methods: Three clinical trials were conducted. In study I, a randomized controlled trial (RCT; n=57), adults with ADHD or probable ADHD, with pronounced difficulties with inattention and organization, took part in an internet-based course on how to structure their everyday life with smartphone applications and online-tools and were compared to a wait-list control group. Study II, an uncontrolled study (n=18), evaluated the feasibility and preliminary effect of a novel treatment based on a combination of CBT and DBT. Study III, an RCT evaluating internetbased treatment for adults with ADHD (n=104), explored the efficacy of the combination treatment (ICBT) compared to an active and credible control group (internet-based applied relaxation training, IART) and to treatment as usual (TAU). Results: The intervention in study I showed large effects on attention and organization skills for participants in the intervention group. Moreover, the improvements on hyperactivity and depression severity were also significantly better compared to the wait-list condition. The combined group treatment in study II turned out to be feasible and beneficial with large reductions of ADHD symptoms and related problems such as depression and experienced stress. Reductions in ADHD symptoms were maintained up to 6 months after treatment. In study III, ICBT and IART were shown to be equally effective with moderate effects on ADHD symptoms compared to TAU up to one year after treatment. The only significant interaction between both treatments over time was for level of general everyday functioning, favoring ICBT. Satisfaction ratings were high in the ICBT group, however some of the participants experienced the treatment as stressful or overwhelming. Conclusions: The smartphone course, as well as the combination treatment administered in a group format, seems to be feasible and effective in improving ADHD symptoms and related problems. The internet-based combined treatment was also effective compared to treatment as usual and has the potential to increase accessibility and availability to treatment. Sustained effects were also found for the combination treatment (studies II-III) in the long term. However, future adjustments in content need to be made to enhance the specific effects on ADHD and related symptoms.