ADHD in adolescence : Evaluation of a structured skills training group and associated predictors of functional impairment

Sammanfattning: Attention-deficit/hyperactivity disorder (ADHD) is related to difficulties with self-control and functional impairment across several life domains. Cognitive behavioral therapy has been recommended for adolescents with ADHD, but evidence of its effectiveness remains scarce. Associated predictors of daily impairment for this age group also need further investigation. The overall aim of this thesis was to evaluate the effectiveness, acceptability, and experience of a structured skills training group (SSTG) for adolescents with ADHD, and to explore associated predictors of functional impairment in this group of patients. Study I was a randomized controlled trial where the SSTG, which was based on dialectical behavioral therapy, was compared to an active control group of psychoeducation (164 participants were included in the main analyses). In Study II (n = 128), potential treatment moderators were explored in order to investigate if certain subgroup(s) might have an effect from the SSTG. In Study III, the experience of participating in the SSTG was investigated in a qualitative interview study (n = 20). Study IV was a cross-sectional study including adolescents with (n = 164) and without (n = 106) ADHD, where associated predictors of impairment were explored. The findings from Study I suggested that the SSTG was not more effective than the control intervention. A majority did report benefits from the SSTG, indicating that the treatment was acceptable for the adolescents. In Study II, three moderators were identified (hyperactivity/impulsivity, conduct problems, and impairment of emotional dysregulation); participants with elevated symptoms of these moderators had a better effect from the SSTG than from the control intervention. In Study III, the participants expressed appreciation of meeting peers with ADHD and described a feeling of togetherness. Adaptations of the treatment were suggested, such as more practicing and discussions. In Study IV, inattention was identified as the strongest associated predictor of impairment in school and symptoms of psychiatric comorbidity contributed to the explained variance of daily impairment. In conclusion, the group format of the SSTG seemed to provide added value for adolescents with ADHD, but further adaptations of the treatment (e.g., more extensive practicing of skills) are warranted to enable improvements in daily functioning. More research is needed to establish the potential effectiveness of the SSTG for certain subgroups. School-based interventions more tailored for attentional deficits might be needed to improve academic functioning, and comorbid symptoms should be routinely assessed and treated in adolescents with ADHD.