Date Presented 04/05/19
Primary Author and Speaker: Adina Maeir
Contributing Authors: Libby Kastner, Ifat Velder Shukrun
PURPOSE: Adult ADHD is a prevalent neurocognitive health condition impeding occupational performance and quality of life (QoL) across the lifespan (Fayyad et al., 2017) . Adult Cognitive-Functional intervention (Cog-Fun A) adapted from paediatric Cog-Fun, focuses on promoting self-awareness and strategy acquisition to support participation in life roles (Maeir et al., 2018). The Cog-Fun has demonstrated effectiveness in children with ADHD (Hahn-Markowitz, J., Berger, I., Manor, I., & Maeir, A. 2017) but has not been studied in the adult population.
DESIGN: A pilot intervention, mixed methods study (registered clinicaltrials # NCT02681575) was conducted on 14 adults (ages 18-60) with a valid medical diagnoses of adult ADHD and executive functioning deficits as demonstrated by a score of 65 or above on one or more of the scales of the Behaviour Rating Inventory of Executive Function - Adult Version scales (BRIEF-A).
METHOD: The measures to assess the initial impact of Cog-Fun A on daily functioning were based on the cognitive-functional assessment battery recommended for use with adults with ADHD (Stern & Maeir, 2014). The measures included the Canadian Occupational Performance Measure (COPM), Adult ADHD QoL (AAQoL), BRIEF and Self Regulation Skills Interview (SRSI) to measure awareness and strategy behaviour before and after intervention. Quality of life was also measured at follow up three months after intervention. A semi-structured interview was administered after intervention to explore participants experience of the intervention.
RESULTS: Participants received 15 weekly individual sessions in Cog-Fun A. Results demonstrated significant gains on the COPM (p<. 000), AAQoL (p=.002), BRIEF (p=.007) Awareness (p=.002) and Strategy behaviour (p<.000). Adult ADHD QoL measured at 3 months follow-up demonstrated a small and non significant (p=.104) reduction in AAQoL from post intervention. Three central themes emerged from qualitative content analyses of post-intervention interviews: (1) Pros (e.g. individualized, precise naming of problems and strategies) and cons (e.g. effortful, requires time, and missing inclusion of significant others in treatment) of the treatment process; (2) non judgemental therapeutic relationship; and (3) Self identity and coherent understanding of ADHD in daily life.
CONCLUSION: Adults with ADHD demonstrate distinct challenges in functional cognition which negatively impacts their participation and QoL. Currently, this population is under-served by occupational therapy which has the potential to provide a unique contribution to their health and well being. Findings support the initial efficacy of occupational therapy using a cognitive-functional intervention model for adults with ADHD and impairments in executive functioning. Participants demonstrated significant gains in occupational performance and QoL as well as in self-awareness, strategy behaviour and executive functioning. Results suggest a potential reduction in ADHD related functional disability and improvement in health-related QoL. It is hypothesized that improved awareness, effective strategy behaviour and therapeutic relationship contributed to the positive occupational outcomes. The findings warrant further controlled studies to explore the potential impact of Cog-Fun A on adults with ADHD and deepen our understanding of the theoretical change mechanisms contributing to occupational performance and QoL.
References
Hahn-Markowitz, J., Berger, I., Manor, I., & Maeir, A. (2017). Impact of the cognitive-functional (Cog-Fun) intervention on executive functions and participation among children with attention deficit hyperactivity disorder: A randomized controlled trial. American Journal of Occupational Therapy, 71(5).
Fayyad, J., Sampson, N. A., Hwang, I., Adamowski, T., Aguilar-Gaxiola, S., Al- Hamzawi, A., ... & Gureje, O. (2017). The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9(1), 47-65.
Maeir, A., Traub-Bar Ilan, R., Kastner, L., Fisher, O., Levanon-Erez, N., & Hahn- Markowitz, J. (2018). An integrative cognitive functional (Cog-Fun) intervention model for children, adolescents and adults with Attention Deficit Hyperactivity Disorder (ADHD). In N. Katz & J. Toglia (Eds.), Cognition Across the Lifespan, 4th Edition. Bethesda, MD: AOTA Press
Stern, A., & Maeir, A. (2014). Validating the measurement of executive functions in an occupational context for adults with attention deficit hyperactivity disorder. American Journal of Occupational Therapy, 68(6), 719-728.
