Adult Attention-Deficit/Hyperactivity Disorder and Comorbid Anxiety or Mood Disorders: Using Intraindividual Network Analysis and Cognitive-Behavioral Case Formulation for Targeted Intervention

Attention Deficit/Hyperactivity Disorder (ADHD) in adults is a major health concern, affecting 366.33 million globally and 19.86 million in the United States. ADHD is often considered a childhood disorder that children ultimately “grow out” of by adulthood. However, ADHD in adults has received increased attention due to its association with functional, occupational, and relational deficits, and comorbidity. Unfortunately, many studies treating adult ADHD exclude individuals with certain comorbidities. The present study sought to enhance and replicate the first wave of a hybrid treatment that uses standardized and idiographic measures and combines several treatment manuals for ADHD and comorbid disorders. The treatment consisted of 12-15 sessions of formulation-based, tailored, cognitive-behavioral (CB) and mindfulness-based treatment for anxiety or mood disorders. Participants were five adults diagnosed with ADHD and a comorbid mood or anxiety disorder. In addition to monthly standardized assessments, symptoms and distress or dysfunction were measured through ecological momentary assessment (EMA) self ratings three times a day. EMA results informed the development of an empirically based CB case formulation used for tailored (personalized) treatment planning for each participant. EMA data were also used to develop both concurrent and dynamic intraindividual network analyses (INA) for each of the two participants who completed 332 and 439 occasions of the individualized EMA self-ratings. Overall, the results of standardized measures demonstrated the effectiveness of the hybrid CB treatment for four of the five of the ADHD adults with comorbid mood or anxiety disorders. The analysis of the INA and EMA data on two participants provided information regarding the concurrent and dynamic relations between symptoms at pre- and post-treatment. Specifically, compared to pre-treatment, post-treatment networks of both participants were sparser, with weaker concurrent and lead-lag relations. Mediation analysis also identified several CB skills (i.e., homework assigned and practiced during the week) that partially explained the relations between certain triggers and distress. Overall, the present study 1) replicated the findings of the first wave of the hybrid ADHD protocol, 2) provided further evidence of the feasibility of utilizing more measurement occasions in EMA with some ADHD adults (i.e., 3 times daily), and 3) provided further evidence for the effectiveness of formulation-based, tailored, CB and mindfulness-based treatment for adults diagnosed with ADHD and a comorbid mood or anxiety disorder.

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