Understanding and managing adult ADHD: Development and evaluation of an app and group psychoeducation workshops

Background: Approximately 2.5% of adults worldwide have Attention-Deficit/Hyperactivity Disorder (ADHD). Many adults with ADHD will experience co-occurring mental health difficulties, such as depression, anxiety, and suicidal spectrum behaviours. Psychoeducation and psychological interventions, such as third-wave Cognitive Behavioural Therapies like Acceptance and Commitment Therapy (ACT), are supportive in alleviating psychological distress experienced by adults with ADHD. However, there are systemic barriers to accessing ADHD-specific supports, such as ever-growing waiting lists and location-specific services. Online interventions may help increase accessibility. The Health Service Executive launched the National Clinical Programme (NCP) for ADHD in Adults in 2021. The Adult ADHD App, a psychoeducational smartphone app, and the Understanding and Managing Adult ADHD Programme (UMAAP), a six-week online psychoeducation with ACT intervention, were developed to provide accessible psychoeducation while adults with ADHD wait to access the NCP. Aims and Objectives: This research programme aimed to develop and evaluate the feasibility of the Adult ADHD App and UMAAP, with three objectives: a) assess their acceptability, b) assess their suitability and c) explore any evidence for preliminary effectiveness. Methods and Results: Study 1 used a modified Delphi method to identify adults with ADHD’s priorities for psychoeducational content and adaptations for online interventions. In the first round, 43 participants rated a list of potential topics and adaptations on a scale of ‘should not be included’ to ‘essential’ and were invited to provide any additional suggestions. Topics that did not achieve consensus and additional suggestions from participants were included in a second round of data collection. Twenty-six adults with ADHD completed the second round. Most topics were rated as essential. The highest-rated recommended adaptation was infographics. The findings were used to develop the psychoeducational content for the Adult ADHD App and UMAAP. Study 2 audited the usage and adherence data of the Adult ADHD App one year after its launch. Fourteen app users also participated in semi-structured interviews about the app’s acceptability and their experiences of engagement, which were analysed using reflexive thematic analysis. The audit of app analytics indicated that the app was downloaded over 18,000 times, with approximately 12,000 active users and 53% of those users returning to the app. Interview participants described the app as a trustworthy tool to learn about ADHD, with a variety of content. They identified potential modifications to improve the accessibility of the app, such as a new navigation structure or rewards system. There were contextual factors that influenced engagement. The app seemed to be more beneficial for individuals recently diagnosed or wondering if they have ADHD, while participants who had been diagnosed for some time sought a tool that would help them in moments of distress. Participants’ experiences of the public health system in Ireland appeared to affect how they responded to the app. Study 3 was a qualitative evaluation of the Understanding and Managing Adult ADHD Programme’s (UMAAP) feasibility for adults with ADHD. Forty-nine participants in the first five cohorts of UMAAP provided feedback on their experiences in open-ended survey questions after completing the intervention. Responses were analysed using reflexive thematic analysis. Participants reported that they learned many new concepts and ways of understanding their ADHD, which seemed to lead to a new awareness of their thoughts and behaviours. They also described becoming more accepting of their ADHD and fostering their self-compassion. The programme was at times overwhelming due to the level of content and density in slides and the accompanying guidebook. Struggling to complete the home practices led to feelings of guilt and shame in some participants. There were advantages and disadvantages to being an online intervention, such as increased flexibility in how participants engaged with UMAAP and feeling disconnected from other attendees. Study 4 quantitatively explored UMAAP’s feasibility. Participants were invited to complete measures of quality of life, psychological flexibility, self-acceptance, and knowledge of ADHD at baseline (n = 257), post-intervention (n = 157), and three months later (n = 96). Attendance and ratings of helpfulness and confidence in completing the home practices were collected for each session. Attendance was high, with an average of 84% across the programme. The mean helpfulness rating was 4.23 out of 5 and the total satisfaction score was within the ‘excellent’ range. Repeated measures ANOVAs indicated that scores of quality of life, self-acceptance, and knowledge of ADHD were significantly higher post-intervention, with effects maintained at the follow-up. While there was no significant difference in psychological flexibility scores post- intervention, there was a significant increase at the three-month follow-up. Conclusion: The findings from this research programme suggest that the Adult ADHD App and UMAAP are both feasible interventions for adults with ADHD in Ireland, with evidence of acceptability and preliminary effectiveness. There are some adaptations identified that would improve their suitability and further research is needed to understand their effectiveness, such as exploring effectiveness in reducing psychological distress or comparing outcomes to a control group. However, these are valuable supports given the dramatic increase in recognition of ADHD in adulthood and the need to provide accessible psychological interventions.