Date Presented 04/04/19
This study showed that a seven-week intervention reduced stress and ADHD symptoms and enhanced performance and satisfaction with desired occupational roles in a sample of 25 women with ADHD. Intervention addressed (a) routines supporting desired roles, (b) organization of physical environments, (c) time and stress management, and (d) regulation of sensory stimulation. The study provides pilot evidence that OT services can be considered as adjunctive to counseling and medication.
Primary Author and Speaker: Sharon Gutman
Additional Authors and Speakers: Sheetala Balasubramanian, Maya Herzog, Elizabeth Kim, Hannah Swirnow, Yudis Retig, Samantha Wolff
PURPOSE: The prevalence of adult ADHD varies from 4-6% and it is estimated that two-thirds of adult ADHD disorders begin in childhood. Researchers have suggested that the male-to-female prevalence ratio is inaccurate and that females experience ADHD at similar levels to males but are underdiagnosed. Studies have found that women with ADHD tend to have difficulty maintaining and succeeding in employment, school, and parenting/spousal roles. The ability to organize and implement tasks associated with each role, follow daily schedules and routines, prioritize and manage tasks in a timely manner, and regulate internal and external stressors to maintain consistent emotional responses may be difficult for women with ADHD. The purpose of this study was to assess a 7-week tailored occupation-based intervention for women with ADHD. Our research question asked whether a 7-week tailored intervention could enhance participants’ satisfaction with desired daily roles and activities, reduce ADHD self-reported symptoms, and reduce perceived stress.
DESIGN: This intervention effectiveness study used randomization and control. Twenty-five women who self-reported diagnoses of ADHD were recruited to participate and randomly assigned to either the intervention or control group. The intervention group received the 7-week intervention; the control group did not receive intervention. Recruitment was achieved through flyers posted in the community and in the meeting places of local support groups for women with ADHD. Inclusion criteria required participants to be 20-55, English-speaking, and self-report diagnoses of ADHD. Participants were excluded if they possessed a severe co-morbid condition such as an eating disorder, major depression, bipolar disorder, schizophrenia spectrum disorder, or substance use disorder.
METHOD: Both intervention and control groups completed three outcome measures pre- and post-intervention: (1) World Health Organization Adult ADHD Self-Report Scale, (2) Perceived Stress Scale, and (3) the Canadian Occupational Therapy Performance Measure (COPM). The ADHD and Perceived Stress Scales are self-report Likert scales. The COPM is a rating scale designed to be completed conjointly by a therapist and participant. The 7-week intervention consisted of individual 1-hour sessions that took place in the community environments in which participants carried out self-identified important roles. Intervention was based on a five-pronged approach: (1) establishing routines that support the activities of desired roles, (2) organizing the physical environment, (3) enhancing time management, (4) monitoring and regulating sensory overload, and (5) enhancing stress management. A Mann Whitney U test was used to detect between group differences.
RESULTS: At 1-week post-intervention, statistically significant differences, with large effect sizes, were found between intervention and control groups in perceived stress (Z=-3.838, p<.000, d=-2.66) and ADHD symptoms (Z=-3.605, p<.000, d=-2.17), and in COPM Performance (Z=-4.074, p<.000, d=3.04) and Satisfaction change scores (Z=-3.759, p<.000, d=2.82).
CONCLUSION: This study demonstrated that a 7-week tailored intervention reduced perceived stress and ADHD symptoms, and enhanced perceived performance of and satisfaction with desired occupational roles in a sample of women with ADHD. Because research has shown that women experience ADHD differently than men and may not be identified as meeting traditional ADHD diagnostic criteria, therapists should consider a client’s perceived self-assessment of ADHD symptoms during evaluation and goal setting. This study provides preliminary evidence that occupational therapy services could be considered as adjunctive to traditional psychological treatment and medication.
References
Cortese, S., Faraone, S. V., Bernardi, S., Wang, S., & Blanco, C. (2016). Gender differences in adult attention-deficit/hyperactivity disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 77(4), e421-8. doi:10.4088/JCP.14m09630
De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017). Pharmacological and non-pharmacological treatment of adults with ADHD: A meta-review. Evidence-Based Mental Health, 20(1), 4-11. doi:10.1136/eb-2016-102415
Fuller-Thomson, E., Lewis, D. A., & Agbeyaka, S. K. (2016). Attention-deficit/hyperactivity disorder casts a long shadow: Findings from a population-based study of adult women with self-reported ADHD. Child: Care, Health and Development, 42(6), 918-927. doi:10.1111/cch.12380
Hechtman, L., Swanson, J. M., Sibley, M. H., Stehli, A., Owens, E. B., Mitchell, J. T., . . . Abikoff, H. B. (2016). Functional adult outcomes 16 years after childhood diagnosis of attention-deficit/hyperactivity disorder: MTA results. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 945-952. doi.org/10.1016/j.jaac.2016.07.774
