Tailored intervention for women with ADHD

Effectiveness of a Tailored Intervention for WomenWith Attention Deficit Hyperactivity Disorder (ADHD) and ADHD Symptoms: A Randomized Controlled Study by Sharon A. Gutman, Sheetala Balasubramanian, Maya Herzog, Elizabeth Kim, Hannah Swirnow, Yudis Retig, Samantha Wolff

By L. Salerno

Importance: Women with attention deficit hyperactivity disorder (ADHD) and ADHD symptoms may experience difficulty carrying out desired life roles and activities.

To determine whether a 7-wk tailored occupation-based intervention can reduce perceived stress and ADHD symptoms and enhance perceived performance of and satisfaction with daily roles and activities among women with ADHD.

Design, Participants and Intervention: Twenty-three participants ages 20–55 yr, English speaking, and with a self-reported diagnosis of ADHD have been randomized to intervention (n = 11) and control (n = 12) groups. The intervention was administered for 7 weeks in individual 1-hr sessions and addressed routine establishment, organization, time management, stress management, and sensory regulation in the home and community. The control group did not receive intervention or contact from the research team during the 7-wk intervention.

Outcomes and Measures:
Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, Perceived Stress Scale, and Canadian Occupational Performance Measure.

At 1-week postintervention, statistically significant differences were found between intervention and control groups in perceived stress (Z= –3.838, p < .000, d = –2.66), ADHD symptoms (Z= –3.605, p < .000, d = –2.17), and COPM Performance (Z= –4.074, p < .000, d = 3.04) and Satisfaction change scores (Z = –3.759, p < .000, d = 2.82).

Conclusion and Relevance:
A 7-week tailored intervention reduced perceived stress and ADHD symptoms and enhanced perceived performance of and satisfaction with desired occupational roles and activities in a sample of women with ADHD. Further research is warranted to determine whether the intervention can be useful to women with ADHD beyond the present sample. This intervention may offer an effective nonpharmacological option for women with ADHD symptoms.

Short comment
Despite the high prevalence of ADHD in adults, and greater knowledge about its presentation in adult population than in the past, ADHD is still a hidden disorder in girls and women, who are more likely to be misdiagnosed with depression and anxiety (Quinn & Madhoo, 2014). There is a large scientific evidence that highlights how women with ADHD tend to have difficulty maintaining and succeeding in employment, school, and parenting and spousal roles, and may fail to regulate internal and external stressors to maintain consistent emotional responses (Fuller-Thomson et al., 2016). Unlike men with ADHD who often rely on the partner or on other family members for assistance and compensation, women with ADHD tend to deal with the consequences of the disorder in isolation (Cortese et al., 2016). Although pharmacological treatment is effective in most cases, a proportion of drug responders can still experience an impairment in several life domains (Kooij et al 2019), therefore tailored nonpharmacological interventions addressing the unique needs of women with ADHD may be particularly useful for them.

This pilot study shows the effectiveness of 7-week intervention for women with ADHD that was tailored to each participant’s specific goals, desired roles and activities as well as recognized areas of difficulties. Such tailored intervention consisted of individual 1-hr sessions that took place in the home and in other settings (e.g. work, school etc.) in which participants carried out the role they considered important, and also included a part addressing the monitoring and regulation of internal and external sensory stimulation in order to avoid sensory overload. Indeed, as authors reported, many of the participants reported a high sensitivity to lights, noise, odors, and temperatures, but they did not understand how such stimuli could accumulate over the course of a day to affect mood and concentration. Therefore, they helped them to identify the specific environmental stimuli that caused symptoms such as headaches, and feelings of sensory overload and taught them how to modify their exposure to these stimuli.

Findings from this piece of research provide support for the importance of a tailored nonpharmacological intervention for women with ADHD, targeting the establishment of routines supporting the activities of desired roles, organization of the physical environment, time management, the monitoring and regulation of sensory overload throughout the day, and stress management.

Although some limitations should be taken into account, such as the small sample size and the self-reported ADHD diagnosis that should be addressed by future research, this pilot study is worth reading as provides some interesting insights on how to address some unique needs of women with ADHD.