ADHD in emerging adults

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent symptoms of inattention, impulsivity, and/or hyperactivity. Although ADHD commonly is diagnosed in childhood, its impairments often continue into adulthood. Emerging adults face unique challenges as they transition into more independent roles in their life, facing increased responsibilities such as higher education, entering the workforce, and managing more complex social relationships. For individuals with ADHD, these increased responsibilities can be overwhelming, for example due to their difficulties with organization, focus and time management. Consequently, this life transition can amplify challenges posed by core symptoms of ADHD, negatively impacting academic and professional success, as well as social relationships. 

In addition to the core symptoms of ADHD, many emerging adults with ADHD also experience (symptoms of) comorbid disorders, like anxiety and depression. These comorbidities complicate ADHD and further impair the overall functioning, leading to more difficulties in daily life. The interplay between anxiety and/or depression and ADHD forms a complex cycle in which each disorder exacerbates the other, making it even more difficult for emerging adults to achieve stability in academic, professional, or personal life.

Self-esteem is a crucial yet often overlooked transdiagnostic factor that connects ADHD and its comorbidities. Individuals with ADHD often face repeated failures in academic, work or social contexts, and receive more negative social feedback as compared to neurotypical peers, that can undermine their self-esteem. Low self-esteem can lead to the onset or exacerbation of comorbid disorders like anxiety and depression, as individuals start to internalize negative perceptions of themselves. In turn, low self-esteem can intensify ADHD symptoms, creating a negative vicious cycle that complicates effective treatment.

Improving self-esteem in ADHD treatment

To address this important but often overlooked factor, this current study focuses on improving self-esteem in emerging adults with ADHD. This study will evaluate the effectiveness of a Cognitive Behavioral Therapy program called Competitive Memory Training (COMET), which is aimed to improve self-esteem. COMET includes seven individual sessions and helps individuals to recognize their strengths, instead of only focusing on their weaknesses. By targeting self-esteem, we aim to break the cycle of negative thoughts and emotions that exacerbate ADHD symptoms and comorbid disorders.

In addition to the COMET program, this current study incorporates Ecological Momentary Assessment (EMA), to gather real-time data on participants’ thoughts, emotions, and behaviors in daily life. This approach offers valuable insights into how improvement in self-esteem impacts thoughts and emotions, yielding a more dynamic understanding of the role of self-esteem in relation to comorbidities. 

By combining a CBT program with real-time assessment, this study aims to provide an in-depth understanding of how self-esteem influences ADHD and its comorbidities. By addressing self-esteem, we seek to create a more comprehensive and holistic treatment approach that improves both ADHD symptoms and comorbid disorders. This will help emerging adults navigate their lives more effectively and learn to life with their ADHD. 

To conduct this study, we will recruit emerging adults with ADHD between 16-25 years in collaboration with several participating Dutch mental health care institutes.

• adhd
• cognitive behaviour therapy
• comorbidity
• self-esteem

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