Psychoeducational group intervention for intellectually able adults with autism and their close relations (Prisma) - an open feasibility study.

BACKGROUND: Autism spectrum disorder (ASD) in adulthood is associated with severe impairments in functioning and poor health, while ASD is also affecting close relations. Accessible first-line interventions addressing the complex clinical needs and care coordination are lacking. METHODS: This study investigated the feasibility and preliminary effects of a new psychoeducational intervention (Prisma) developed for intellectually able adults with ASD and their close relations in an outpatient setting. The manualized Prisma intervention consist of four weekly group sessions guided by trained group leaders and providing information about autism, support, and services. Feasibility was examined through treatment completion rate and group-level comparisons between intervention completers and non-completers (Student's t-test, Fisher's exact test, and Pearson's chi-squared test). Perceived treatment credibility was investigated by within-group comparisons of participant's self-ratings from pre-intervention to post-intervention, as well as by group leaders' ratings using an adjusted questionnaire. Treatment satisfaction was examined quantitatively regarding the session evaluations (Student's t-tests), as well as by a qualitative thematic analysis of participants' feedback. Preliminary efficacy was studied using paired t-tests (pre- and post-intervention). RESULTS: Completion rate was 77% (n = 71 of the 92 adults with ASD) and 73% (n = 69 of the 94 close relations), respectively. Participants considered Prisma to be an acceptable intervention indicated by increases in treatment credibility and expectations from pre- to post-intervention. The group leaders reported treatment credibility in the same range as the participants. Both autistic adults and their close relations reported good treatment satisfaction for each session, while the qualitative thematic analysis indicated that Prisma could be improved by enhancing active participation. This participant feedback will be used to further improve the intervention for an upcoming RCT. Preliminary analyses of effects showed promising results with an increase in knowledge of ASD and some indications for improvements in relationship quality, mental health, quality of life, acceptance of diagnosis and burden of care. CONCLUSIONS: Overall, results indicate that the Prisma is a feasible and acceptable first-line intervention in outpatient services. Randomized controlled trials are needed to further corroborate the evidence base of this novel intervention. TRIAL REGISTRATION: Clinicaltrials.org NCT0446097, retrospectively registered July 8th 2020.

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits.

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD. Methods: The study included 158 participants in three groups: (1) older adults (60-75 years of age) with ADHD (n = 42), (2) healthy controls of the same age (n = 58), and (3) younger adults (age 18-45 years of age) with ADHD (n = 56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests. Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels. Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.

Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits.

BACKGROUND: The notion that ADHD constitutes a heterogeneous disorder is well accepted. However, this study contributes with new important knowledge by examining independent effects of a large range of neuropsychological deficits. In addition, the study investigated whether deficits in emotional functioning constitute a dissociable component of ADHD. METHOD: The study included children with ADHD (n = 102; 7-13 years) and a control sample individually matched with regard to age and gender. The administered tasks were designed to tap into three different neuropsychological domains: executive functions (i.e., working memory, inhibition, and shifting), delay aversion, and reaction time variability. Parent ratings of emotion regulation and a test of emotion recognition were also included. RESULTS: Children with ADHD differed significantly from controls on all measures, except for delay aversion and recognition of disgust. No main effects of gender or interaction effects of gender and group were found. More importantly, executive functioning, reaction time variability, and emotional functioning all contributed independently to distinguishing between children with ADHD and controls. CONCLUSIONS: The current study supports the view of ADHD as a heterogeneous disorder related to multiple neuropsychological deficits. In addition, emotional functioning appears to be an area of importance for ADHD that needs to be incorporated into future theoretical models.

Computerized working memory training for adults with ADHD in a psychiatric outpatient context-a feasibility trial.

This study investigated the feasibility (treatment completion, and acceptability) and preliminary effectiveness of computerized working memory (WM) training in a psychiatric outpatient context for adults with ADHD. Self-ratings, neuropsychological tests, and clinician's assessments were performed pre- and post-Cogmed WM training, as well as at the 2-month follow-up, which included 24 (age M = 36.75 SD = 8.37) participants. Of the 24 participants, 16 (66.67%) completed the 25 sessions within 7 weeks. Completers reported high treatment credibility, but a few spontaneously reported feeling stressed because of the time-consuming nature of the WM training (n = 4). Preliminary effectiveness analyses indicate fewer cognitive difficulties and increased neuropsychological performance in non-trained tests that remained stable at follow-up. Future development of WM training paradigms could investigate ways of making the perception of training experience less demanding regarding being time-consuming. The indication of preliminary effectiveness merits further randomized controlled studies in a clinical context.

The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach is superior to ordinary treatment for achievement of goals and transfer effects in children with cerebral palsy and spina bifida - a randomized controlled trial.

PURPOSE: Children with cerebral palsy (CP) or spina bifida (SB) often have executive dysfunction affecting activity performance. With the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach, children find their own way to perform activities, using problem-solving strategies and meta-cognitive thinking. The present study aimed to investigate the effectiveness of the CO-OP Approach in children with CP or SB, compared with conventional rehabilitation, in achieving self-identified activity goals, and to explore any generalization and transfer effects. METHOD: Randomized controlled trial, CO-OP versus treatment as usual, 38 children (7-16 years) participated. Each child identified four goals (to study generalization and transfer, one remained untrained). Primary outcomes: Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Secondary outcomes assessed executive functions and self-rated everyday-life competence. RESULTS: Self-rated goal attainment (COPM) was significantly greater for both trained and untrained goals in the CO-OP group compared with the control group. The rating of observed performance (PQRS) was significantly higher for trained goals in the CO-OP group. The CO-OP group experienced fewer problems in everyday life after treatment. Executive functions did not differ significantly between groups. CONCLUSION: CO-OP is more effective than ordinary treatment in achieving both trained and untrained goals.IMPLICATIONS FOR REHABILITATIONCO-OP enables children with CP (MACS levels I-III) or SB without intellectual disabilities to reach self-identified goals.CO-OP shows transfer effects to new activities and situations, which may enhance children's self-efficacy.CO-OP is an important complement to conventional rehabilitation services for children with CP and SB.

Intervention with the CO-OP Approach leads to a transfer effect over time to untrained goals for children with cerebral palsy or spina bifida.

PURPOSE: This study aims to investigate whether the treatment effects, in terms of goal attainment, transfer effects and impact on executive functions, of an intervention in children with cerebral palsy or spina bifida using the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach are maintained over time, from immediately after the intervention to three months afterwards. METHOD: A three-month follow-up study, from an intervention using CO-OP. Thirty-four children (7-16 years) each identified four goals (one untrained to examine transfer) and participated in an eleven-session intervention. Assessments were performed at baseline, immediately after the intervention and at a three-month follow-up using the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Executive function and self-rated competence were assessed at the same timepoints. RESULTS: Statistically significant and clinically relevant improvements in goal achievement were demonstrated for both trained and untrained goals after the intervention and were maintained at follow-up. The clinically relevant improvement in untrained goals continued to increase until follow-up. Self-rated competence increased after the intervention and was maintained at follow-up. CONCLUSION: The CO-OP intervention was effective in achieving and maintaining the children's own goals over time. The transfer effect was confirmed by higher goal attainment for the untrained goals.

The children's self-defined goals were achieved after the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention and remained so at the three-month follow-up.The CO-OP Approach is useful for children with cerebral palsy or spina bifida.A transfer effect was demonstrated for untrained goals by both subjective and objective assessments.Using children's self-defined goals is effective.

Neuropsychological deficits in relation to ADHD symptoms, quality of life, and daily life functioning in young adulthood.

Attention-deficit/hyperactivity disorder (ADHD) is related to multiple neuropsychological deficits. However, most previous studies, especially studies of adult samples, have not taken the overlap between different neuropsychological deficits into account. In addition, the link between neuropsychological deficits and daily life functioning and quality of life needs to be further investigated. The aim was therefore to investigate the independent effects of executive deficits, delay-related behaviors and emotion dysregulation on ADHD symptom levels, daily life functioning, and quality of life in a non-clinical sample of younger adults. Results showed independent effects of all three neuropsychological deficits on the two ADHD symptom domains. With regard to daily life functioning and quality of life, bivariate relations were found to all three neuropsychological deficits. However, it was primarily the associations to executive deficits that remained significant when studying independent effects. Executive deficits were related to daily life functioning and quality of life also when controlling for ADHD symptom levels. Conclusively, this study shows that ADHD is related to multiple neuropsychological deficits, even in adulthood. Previous studies may have overestimated the importance of delay-related behaviors and emotion dysregulation for daily life functioning, as they have failed to control for the effects of executive deficits.

Internet-delivered cognitive behavioral interventions to reduce elevated stress: A systematic review and meta-analysis.

Background: Face-to-face cognitive behavioral therapy (CBT) is the most promising treatment to reduce stress, but access to CBT is limited. Internet-delivered CBT (ICBT) enables large-scale dissemination at low costs. Evidence suggests that ICBT can reduce stress in subclinical and mixed diagnostic samples, but less is known about the effect of ICBT in targeted samples suffering from elevated perceived stress or stress-related disorders. Objective: To investigate the efficacy of ICBT specifically aimed at reducing stress in adults with elevated perceived stress or stress-related disorders. Methods: We searched for randomized controlled trials comparing ICBT with a control group in PubMed, Web of Science, and PsycInfo between 2010 and 2021. A meta-analysis of 14 comparisons (total N = 1831) was performed, and Cohen's d was calculated to assess the difference between intervention and control groups at posttest for the primary outcome self-rated stress. Effects on secondary outcomes of anxiety and depression were also investigated. Results: The pooled mean effect size for self-rated stress at posttest was d = 0.78 [CI 95 % 0.66-0.90]. For anxiety and depression, the effects were d = 0.69 [95 % CI 0.52-0.86] and d = 0.65 [95 % CI 0.56-0.75] respectively. The heterogeneity of results between studies was overall low to moderate. Subgroup analyses were not conducted due to the limited number of studies eligible for inclusion. Conclusions: Results provide evidence of the efficacy of ICBT to reduce stress, anxiety, and depressive symptoms in adults suffering from elevated stress or stress-related disorders. Findings have important implications for the development of safe and evidence-based treatment guidelines in the face of a rapid digital expansion.This study was preregistered at Open Science Framework (osf.io) with DOI 10.17605/OSF.IO/BQAZ3.

Emotion dysregulation in adult ADHD: Introducing the Comprehensive Emotion Regulation Inventory (CERI).

INTRODUCTION: Previous research has shown that Attention-Deficit Hyperactivity Disorder (ADHD) is linked to emotion dysregulation, but we still do not know enough about the specific nature of this deficit. The aim of the present study was therefore to study emotion dysregulation in adult ADHD using a new self-rating instrument, the Comprehensive Emotion Regulation Inventory (CERI). METHODS: The study included 390 participants, both adults diagnosed with ADHD and a comparison group. The CERI was created based on Gross' process model of emotion. Unlike instruments already available, the CERI enables a detailed analysis of different strategies for regulating both positive and negative emotions and of the impact emotion dysregulation has on daily life. RESULTS: Results showed that the CERI has good psychometric properties, and a 5-factor solution was identified. Adults with ADHD differed from the comparison group with regard to how often they use different strategies, although effect sizes were small to medium. However, large effect sizes were found between ADHD and the comparison group with regard to problems implementing the use of various regulatory strategies and the negative impact on daily life functioning with regard to friendships, work/studies, or romantic relations. Within-group differences showed that adults with ADHD use the less advanced strategy suppression significantly more often compared to the more advanced strategies attentional deployment and reappraisal. CONCLUSIONS: The CERI appears to be a valuable instrument for gaining more in-depth insights into emotion dysregulation in adults with mental disorders. Future research needs to examine what aspects of emotion dysregulation are shared between different mental disorders and what aspects might be specifically related to ADHD.

A critical appraisal of the role of neuropsychological deficits in preschool ADHD.

The present study aimed at improving our understanding of the role of neuropsychological deficits in preschool Attention Deficit Hyperactivity Disorder (ADHD). The study included 52 children in the ADHD group and 72 controls (age 4-6 years). Both laboratory measures and teacher reports of executive deficits (i.e., working memory, inhibition, and shifting), delay-related behaviors (i.e., the preference for minimizing delay), and emotional functions (i.e., emotion recognition and regulation) were included. Variable-oriented analyses were complemented with person-oriented analyses (i.e., identifying the proportion of patients considered impaired). Results showed that the ADHD group differed from controls with regard to all measures of executive functioning and most measures of delay-related behaviors, but few differences were found for emotional functioning. A substantial subgroup (23%) of children with ADHD did not have a neuropsychological deficit in any domain. There were subgroups with executive or delay-related deficits only, but no pure emotional subgroup. The overlap between different neuropsychological deficits was much larger when teacher reports were used as opposed to laboratory measures. Regarding functional impairments, large mean differences were found between the ADHD group and controls. However, neuropsychological deficits were not able to explain individual variations in daily life functioning among children with ADHD. In conclusion, the present study identified some important methodological and theoretical issues regarding the role of neuropsychological functioning in preschool ADHD.

No effects of a long-term physical activity intervention on executive functioning among adolescents.

OBJECTIVES: We investigated whether a school-based physical activity intervention would lead to improvements in working memory, inhibition and cognitive flexibility in adolescents aged 13-15 years. METHODS: The adolescents at the active school (n = 108) participated in an intervention that included increased physical activity for 20 min/day, focused on aerobic activity with low cognitive demands for an entire school year. The adolescents at the control school (n = 59) received no extra physical activity. At the beginning (baseline) and end (follow-up) of the school year, the participants performed tests of executive function (working memory, inhibition and cognitive flexibility) and performed tests of physical fitness and health. RESULTS: There was no change in executive functioning at follow-up when comparing the schools. However, only 46% complied with the intervention. When non-compliers were excluded from the analyses, the results remained the same, except for a small but significant increase in working memory for the active school as compared to the control school. CONCLUSION: These results indicate that compliance with the intervention was low and that aerobic exercise with low cognitive load does not produce improvements in executive functioning.

No Long-Term Effect of Physical Activity Intervention on Working Memory or Arithmetic in Preadolescents.

We investigate if increased physical activity (PA) leads to enhanced working memory capacity and arithmetic performance, in a 2-year school-based intervention in preadolescent children (age 6-13). The active school (n = 228) increased PA (aimed at increasing cardiovascular fitness) from 2 to 5 days a week while the control school (n = 242) remained at 2 days. Twice a year, participants performed tests of arithmetic as well as verbal and spatial working memory. They also rated stress with a questionnaire at the start and at the end of the intervention. There was no beneficial development of working memory or arithmetic for the active school as compared to the control school. Furthermore, subgroup analyses revealed no favorable intervention effect for high/low baseline fitness, cognition or grit. Unexpectedly, a significant increase in self-rated stress was detected for the active school and this effect was driven by girls rather than boys and by the younger rather than older children. These results indicate that longtime high intensity PA does not lead to a beneficial development of working memory or arithmetic in preadolescent children.

Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence.

High levels of ADHD symptoms are related to severe negative outcomes, which underscore the importance of identifying early markers of these behavior problems. The main aim of the present study was therefore to investigate whether neuropsychological deficits in preschool are related to later ADHD symptoms and academic achievement, over and above the influence of early ADHD symptom levels. The present study is unique because it includes a broader range of predictors compared to previous studies and the participants are followed over time for as long as 13 years (i.e., ages 5-18 years). Preschool data included measures of executive functioning and reaction time variability as well as emotional reactivity and emotion regulation of both positive and negative emotions. When controlling for early ADHD symptom levels, working memory, reaction time variability, and regulation of happiness/exuberance were significantly related to inattention whereas regulation of happiness/exuberance and anger reactivity were significantly related to hyperactivity/impulsivity. Furthermore, working memory and reaction time variability in preschool were significantly related to academic achievement in late adolescence beyond the influence of early ADHD symptoms. These findings could suggest that it is possible to screen for early neuropsychological deficits and thereby identify children who are at risk of negative outcomes. Furthermore, our results suggest that interventions need to look beyond executive functioning deficits in ADHD and also target the role of emotional functioning and reaction time variability. The importance of including both the positive and negative aspects of emotional functioning and distinguishing between emotion regulation and emotional reactivity was also demonstrated.

Quick Delay Questionnaire: Reliability, validity, and relations to functional impairments in adults with attention-deficit/hyperactivity disorder (ADHD).

The Quick Delay Questionnaire (QDQ) is a self-report measure of delay-related behaviors in adults, and the present study aimed at investigating the psychometric properties of QDQ scores, how well they can discriminate between ADHD adults and both clinical and nonclinical controls, as well as their relations to measures of functional impairments. In the present study, QDQ ratings, a laboratory measure of delay discounting, and ratings of functional impairments were collected from adults diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 51), a clinical control group with other psychiatric disorders (n = 46), and a nonclinical control group (n = 105). Results showed that the QDQ scores showed adequate reliability. Adults with ADHD had higher scores compared with normal controls on both QDQ subscales, and they also reported higher levels of delay aversion than the clinical controls. Logistic regression analyses showed high specificity but low sensitivity when trying to discriminate between adults with ADHD and nonclinical controls. QDQ scores were not associated with a laboratory measure of delay discounting, but with functional impairments such as substance use, criminality, and money management. Our findings indicate that QDQ scores are reliable, but this instrument should be regarded as a complement rather than as a replacement for laboratory measures. The relatively low sensitivity of QDQ scores is in line with current models of heterogeneity stating that only a subgroup of individuals with ADHD has high levels of delay-related behaviors. Our findings further indicate that this subgroup may be at particularly high risk for problems in everyday life. (PsycINFO Database Record

Neuropsychological heterogeneity in preschool ADHD: investigating the interplay between cognitive, affective and motivation-based forms of regulation.

There is a trend toward diagnosing ADHD prior to school entry. Despite this, there is a lack of studies investigating ADHD in the preschool years, at least studies including a large range of different neuropsychological functions. Our knowledge of the independent effects of different neuropsychological functions in relation to preschool ADHD is therefore limited. In order to address this issue, the present study investigated cognitive, affective, and motivation-based regulation in relation to ADHD symptoms in 104 preschool children (age M = 67.33 months, SD = 10.10; 65 % boys). Results showed that these regulatory processes were all significantly related to ADHD symptoms and that most of these relations remained after controlling for comorbid conduct problems. Most previous preschool studies have only included cognitive regulation, and to some extent motivation-based regulation. By also including affective regulation, we were able to explain a larger proportion of the variance in ADHD symptoms. However, it should be noted that the amount of variance explained was still small in comparison with what has been found in previous studies of school-aged children. This finding could be taken as an indication that further studies examining the nature of preschool ADHD are needed, and that it may be necessary to look beyond the neuropsychological factors that have been linked to the disorder in older children and adults.

Functional impairments in attention deficit hyperactivity disorder: the mediating role of neuropsychological functioning.

Attention deficit hyperactivity disorder (ADHD) is associated with multiple neuropsychological deficits and the present study aimed to investigate to what extent these deficits are related to the functional impairments associated with the disorder. The results showed that all executive functioning deficits and reaction time variability acted as mediators in the relation between ADHD and academic achievement. However, only the effect of working memory for language skills, and the effects of reaction time variability and working memory for mathematics, remained significant when studying independent effects. Regulation of anger was a significant mediator for peer problems. Gender or symptoms of oppositional defiant disorder (ODD) or conduct disorder (CD) did not moderate these findings.