A Neuroaffirmative, Self-Determination Theory–Based Psychosocial Intervention for Adults With Attention-Deficit/Hyperactivity Disorder: Randomized Feasibility Study
Bibliographic record
Abstract
BACKGROUND: Neurodevelopmental disorders are complex and heterogeneous, creating challenges for treatment design. Multiple syndromes are associated with executive function (EF) deficits; however, theories of attention-deficit/hyperactivity disorder (ADHD) centralize a singular perspective of outcomes arising from EF impairments in adults. Deficit-based etiologies state ADHD-related EF impairments interfere with agentic self-development, perspectives that may inadvertently contribute to social stigma and influence neurotype dysphoria in ADHD identity construction. Challenges to this perspective highlight heterogeneity, context variability, the absence of a single EF deficit of origin, correlational neuroimaging data, and limited investigation into altered brain activity in ADHD research. Recommendations for psychosocial interventions primarily support cognitive behavioral therapy, which centers on a deficit-based etiology of ADHD and prioritizes symptom reduction and cognitive control of self-regulation as treatment outcomes-skills that require additional cognitive effort and may involve avoidance of emotional experiences to minimize negative affect. Transdiagnostic approaches are recommended to gain new insights into mental health challenges. Self-Determination Theory (SDT) presents a transdiagnostic approach that offers alternative outcomes by prioritizing basic psychological need satisfaction, which supports strong identity formation, motivation, and self-regulation. OBJECTIVE: This study examines the feasibility and effects of an SDT-based quality-of-life therapeutic intervention for adults with ADHD. METHODS: We aimed to recruit 30 participants aged 18 years or older with a confirmed diagnosis of ADHD and access to an internet connection. Participants were recruited from the Adult ADHD Clinic at the South West Yorkshire Partnership National Health Service Foundation Trust and allocated through 4-block randomization by a nonblinded researcher to either an 11-session therapeutic coaching intervention (n=11) or a control waitlist (n=9) condition. Feasibility was evaluated by pretreatment and posttreatment measurements of health-related quality of life (QoL), psychological distress, ADHD symptoms, ADHD-related QoL, self-reflection and insight, autonomous functioning, and individual outcome measures of impairment. Participants also responded to a qualitative feedback interview question on intervention value. RESULTS: Adherence was high for both intervention completion (10/11, 91.6%) and control condition completion (9/11, 81.8%). Results showed clinically significant improvement on measures of psychological distress, specifically in the subscales of problems (z=0.0; P=.01), nonrisk (z=2.0; P=.01), functions (z=5.0; P=.02), and well-being (z=6.0; P=.03), as well as ADHD symptoms (z=3.0; P≤.01), particularly inattention (z=3.0; P≤.01), outcomes not specifically targeted by the intervention. Additional clinically significant findings of improvement in QoL, specifically in outlook subscale (z=21; P=.67), reduction of distress in problems identified in the individual outcome measure and the need for self-reflection subscale of self-reflection for the control group (z=1.0; P=.05) indicate potential positive effectiveness despite the impact of COVID-19. Positive qualitative feedback on usefulness and transferability of the intervention was provided by 90% (20/23) of participants. CONCLUSIONS: This study suggests that a randomized controlled trial of an SDT-based psychosocial intervention with nondeficit-based outcomes for adults with ADHD is feasible and recommended. TRIAL REGISTRATION: ClinicalTrials.gov NCT04832737; https://clinicaltrials.gov/study/NCT04832737.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".