An Exploratory Investigation of Goal Management Training in Adults With ADHD: Improvements in Inhibition and Everyday Functioning.

Daniel André Jensen,Jan Haavik,Anne Halmøy,Lin Sørensen,Jan Stubberud,Astri Johansen Lundervold

doi:10.3389/fpsyg.2021.659480

Abstract

Background: Adults with attention deficit/hyperactivity disorder (ADHD) are predominantly treated with medication. However, there is also a need for effective, psychologically based interventions. As ADHD is strongly associated with reduced inhibitory control, cognitive remediation approaches should be efficient. Goal management training (GMT) aims at enhancing inhibitory control and has shown positive effects on inhibitory control in non-ADHD patient groups. The aim of the current study was to explore whether GMT would specifically enhance inhibitory control in adults with ADHD, and if such an enhancement would lead to secondary improvements in self-reported everyday functioning.Methods: Twenty-one participants with ADHD (mean age: 39.05 years [SD 11.93]) completed the intervention and assessments pre-, post- and 6 months after the intervention. Measures included neuropsychological tests and self-report questionnaires pertaining to cognitive- and executive functioning, emotion regulation, quality of life, and ADHD symptoms.Results: Compared to baseline, the participants showed enhanced inhibitory control on performance-based measures at post-assessment and 6-month follow-up. The participants also reported increased productivity and reduced cognitive difficulties in everyday life at both assessments post-treatment, as well as improvements in aspects of emotion regulation and a reduction in the severity of core ADHD-symptoms at 6-month follow-up.Conclusion: Our exploratory study showed that GMT seems to specifically improve one of the core executive dysfunctions in ADHD, namely inhibitory control, with a positive effect lasting at least 6 months post-treatment. The adults with ADHD also reported improved self-regulation in their everyday life after completing GMT, providing strong arguments for further investigations of GMT as a treatment option for this group of adults.Clinical Trial Registration: The study is registered under ISRCTN.com (ISRCTN91988877; https://doi.org/10.1186/ISRCTN91988877).

Highlights

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting individuals of all ages with an estimated prevalence of 2.5–4.4% among adults (DSM5; Kessler et al, 2006; Simon et al, 2009; Badre, 2011; American Psychiatric Association, 2013; Polanczyk et al, 2014)
Many negative consequences of ADHD have been documented ranging from difficulties regulating automatic and controlled cognitive processes, including reading, in childhood (Capri et al, 2020; Mohammadhasani et al, 2020) to underachievement in work and education later in life (Biederman et al, 2006; Halmøy et al, 2009; Klein et al, 2012; Halleland et al, 2015), difficulties related to social functioning (Biederman et al, 2006; Klein et al, 2012), and even increased mortality (e.g., Dalsgaard et al, 2015)
Development of other treatment alternatives is, warranted. This is in line with the stated wishes of adults with ADHD, and with findings showing that patients who are offered treatment options in addition to pharmacotherapy are more satisfied with the health services they receive compared to adults without such options (Solberg et al, 2015)

Summary

Introduction

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting individuals of all ages with an estimated prevalence of 2.5–4.4% among adults (DSM5; Kessler et al, 2006; Simon et al, 2009; Badre, 2011; American Psychiatric Association, 2013; Polanczyk et al, 2014). There has been an increasing effort to develop psychologically based treatment alternatives for adults with ADHD (Kooij et al, 2010; Franke et al, 2018; Lopez et al, 2018; López-Pinar et al, 2018; Lam et al, 2019; Nimmo-Smith et al, 2020), most of which are based on cognitive-behavioral approaches Findings indicate that such interventions may lead to reductions in core symptoms, and further, that cognitive remediation interventions may improve the ability to organize everyday activities (e.g., Stevenson et al, 2002; De Crescenzo et al, 2017; Nimmo-Smith et al, 2020). The aim of the current study was to explore whether GMT would enhance inhibitory control in adults with ADHD, and if such an enhancement would lead to secondary improvements in self-reported everyday functioning

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Conclusion