Background: Cognitive behavioral therapy (CBT) for adult ADHD provides adaptive coping strategies targeting executive dysfunction and emotion regulation, processes underlying functional impairment. However, most research has prioritized symptom reduction over functional outcomes. This meta-analysis quantified CBT effects on global functioning, quality of life (QoL), and domain-specific functioning (social, occupational, educational), while examining moderators and the role of ADHD symptom change.

Method: We included 70 studies (5152 participants): 38 RCTs, four non-randomized trials, 24 single-arm trials, and four single-case designs. Random-effects meta-analyses estimated standardized mean differences for between-group and within-subject outcomes at post-treatment and follow-up. Risk of bias was formally assessed, and GRADE assessed evidence certainty.

Results: CBT produced moderate effects on global functioning at post-treatment (SMD = 0.47) that increased at follow-up (SMD = 0.67). QoL effects were smaller and non-significant at follow-up. Strongest effects were found for occupational functioning, effects on social functioning were moderate, and academic benefits were limited. Individual format and longer duration were associated with better outcomes. ADHD symptom improvement predicted QoL but not functioning.

Conclusions: CBT was associated with improvements in functioning (often the primary treatment concern), with moderate effects observed at post-treatment and some evidence of sustained effects at follow-up, particularly in directly targeted domains. The dissociation between symptom change, QoL, and functioning suggests that functional gains may not be fully explained by symptom reduction alone, although the mechanisms underlying these effects remain unclear. These findings support a more process-oriented perspective on CBT, while highlighting the potential relevance of directly targeting everyday functioning within psychological interventions. Risk of bias, self-report reliance, Western sample concentration, and short follow-ups (typically 3 months) warrant cautious interpretation.

Adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of adverse occupational outcomes and work-related mental ill-health. Yet, there is limited knowledge about how these difficulties are experienced by working adults with ADHD and few psychological interventions that target work-related mental health in this population. This thesis reports a four-year research project combining qualitative exploration with iterative development and controlled evaluation of a novel internet-delivered stress-management program based on cognitive-behavioral therapy (CBT).

Study I used semi-structured interviews with working adults with ADHD (n = 20) and qualitative content analysis to explore how participants understood the interplay between ADHD symptoms, workplace demands, and mental health. Participants described a working life characterized by sustained stress, persistent anxiety, impaired recovery, and repeated episodes of exhaustion, often compounded by emotional dysregulation and social hypersensitivity. They also reported limited access to healthcare support beyond pharmacological treatment of ADHD symptoms.

Study II translated these findings into Working with ADHD, a 12-module, internet-delivered cognitive-behavioral stress-management program with clinical support on demand. The intervention was tested in a single-arm open pilot trial (n = 36) with quality of life as the primary outcome. The program showed high adherence and large pre-to-post improvements across quality of life and multiple symptom measures. Participants’ feedback informed refinements to structure and content before large-scale evaluation.

Study III evaluated the revised program in a three-arm randomized controlled trial (n = 240) with a structurally matched mindfulness-based comparator and a waitlist control. Both active interventions outperformed the waitlist on quality of life and several symptom measures, with gains generally maintained at 12-week follow-up. No significant differences were observed between CBT and mindfulness at posttreatment; at 12-week follow-up, a single difference emerged for depressive symptoms, favoring mindfulness. Deterioration was rare, although most treated participants did not reach reliable improvement or recovery.

Overall, the findings deepen the understanding of work-related mental ill-health among adults with ADHD and support the feasibility and potential benefit of internet-delivered stress-management interventions in this population, while underscoring the need to optimize outcomes and clarify for whom, and under what conditions, digital support is most effective.

Background A multitude of studies have investigated, assessed, and debated the merits of self-assessment within medical education and related fields, yielding inconclusive results. This raises questions about the reliability of selfassessment as a tool for evaluating competency development. The objective of the current study was to investigate the self-assessment accuracy of psychology students regarding their performance in training for interviewing and communication skills. A novel assessment instrument was employed for this purpose. The main research questions were: (1) How accurate are students’ self-assessments of their performance in comparison to instructors’ ratings? (2) How well do these self-assessments align with perceived changes in skill development at both group and individual levels?

Methods The study was conducted in three phases to achieve the research objective. In Phase 1, 206 psychology students from the first three semesters of a 5-year master’s program at Stockholm University conducted 15-minute video-recorded interviews, which were rated by instructors using an 11-item assessment instrument. Data were analyzed using Exploratory Factor Analysis (EFA). Phase 2 included 173 second semester students conducting 15-minute video interviews. These were reviewed in small groups, with both students and instructors rating the interviews using the same instrument. The process was repeated after one week. Two Confirmatory Factor Analyses (CFAs) were conducted on instructors’ and students’ ratings to validate the three-factor model identified in Phase 1. In Phase 3, correlation analyses and paired-samples t-tests were conducted at both group and individual levels to address the research questions.

Results The findings indicated high self-assessment accuracy, reflecting strong self-assessment abilities among the students. Comparisons between instructor ratings and students’ self-assessments of skill progression demonstrated good overall alignment. The validated assessment scale developed in Phases 1 and 2 shows potential for application in various educational contexts.

Introduction: Clinical guidelines advise a multimodal approach to treating adult ADHD, combining pharmacological and psychological interventions. Although cognitive behavioral therapy (CBT) shows promise, the evidence base is still developing, and access to such treatment remains limited. As a result, stimulant medication remains the treatment of choice in many cases. Internet-delivered CBT (iCBT) offers a scalable way to increase access, but its effectiveness in reducing stress and improving functioning for adults with ADHD warrants further investigation.

Methods: In this randomized controlled trial, 240 working adults with ADHD were allocated to one of three conditions: a novel internet-based cognitive-behavioral stress management intervention, a mindfulness-based active comparator intervention, or a waitlist control. Both interventions were specifically designed with workplace functioning as a central focus and included content tailored to managing stress in occupational settings. The interventions lasted twelve weeks and included access to clinician support on demand. The primary outcome was quality of life, with secondary measures including perceived stress, exhaustion risk, depressive and anxiety symptoms, and core ADHD symptoms. Participants in the intervention conditions also provided open-ended written feedback on their experiences.

Results: Recruitment has concluded, and preliminary findings will be shared at the 34th EUNETHYDIS Annual Meeting in Bonn, 2025.

Conclusions: This trial extends previous research on the novel cognitive behavioral intervention for adults with ADHD by including both a mindfulness comparator and a waitlist control. Findings will help determine whether this scalable approach can improve quality of life and reduce stress and psychiatric symptoms for adults with ADHD, potentially supporting future development and clinical implementation.

Introduction: Adults with attention deficit hyperactivity disorder (ADHD) experience elevated stress, increased fatigue, and heightened vulnerability to mental health problems. They also face occupational challenges, including difficulties in the workplace. Despite growing awareness of adult ADHD, many individuals remain undiagnosed or lack access to evidence-based psychological treatment. Internet-based interventions offer a scalable solution to improve accessibility, but their effectiveness in addressing work-related mental health issues in adults with ADHD requires further investigation.

Methods: This randomized controlled trial enrolled 240 working adults with ADHD in one of three groups: an internet-based cognitive-behavioral intervention, an internet-based mindfulness intervention, or a waitlist control. The intervention groups participated in structured twelve-week interventions with clinical support on demand. The primary outcome measure was quality of life, with secondary outcomes assessing perceived stress, risk of exhaustion, depression, anxiety, and ADHD symptoms. Both interventions were compared against each other and the waitlist control. Participants in the intervention groups also provided qualitative feedback on their experiences.

Results: Recruitment is completed, and preliminary results will be presented at the 8th European Society for Research on Internet Interventions (ESRII) 2025 conference.

Conclusions: Previous research has shown potential benefits of the CBT intervention for adults with ADHD. This study expands on prior findings by comparing the intervention to both an active mindfulness comparator and a waitlist control. If effective, the CBT intervention could be implemented in clinical practice or offered as a standalone product, potentially contributing to improved mental health and occupational functioning for adults with ADHD.

Background: National and international guidelines advocate for a multimodal approach to treating adult attention-deficit/hyperactivity disorder (ADHD), combining pharmacotherapy with psychological interventions. While recent reviews support cognitive behavioral therapy (CBT) as a viable treatment for ADHD in adults, evidence remains limited. Another challenge is the availability of psychological interventions, with stimulants remaining the primary treatment choice for adults with ADHD. One promising approach to increasing access to psychological interventions is the dissemination of internet-delivered CBT.

Objective: This study evaluated the feasibility, acceptability, and effects of a guided web-based stress management program specifically designed for working adults with ADHD. The intervention aimed to enhance quality of life by addressing stress, exhaustion, anxiety, and depression, commonly experienced by this population.

Methods: Thirty-six participants took part in a single-arm open trial, with assessments before, during, and after the intervention. The intervention consisted of 12 modules based on CBT principles, focusing on executive functioning, stress management, and emotion regulation, with clinician support on demand. Primary and secondary outcomes included quality of life (Adult ADHD Quality of Life Scale [AAQoL]), perceived stress (Perceived Stress Scale [PSS-10]), exhaustion (Karolinska Exhaustion Disorder Scale [KEDS]), anxiety (Generalized Anxiety Disorder 7-item Scale [GAD-7]), depression (Patient Health Questionnaire [PHQ-9]), and ADHD symptoms (the World Health Organization Adult ADHD Self-Report Scale [ASRS]).

Results: Results indicated a statistically and clinically significant improvement in quality of life (Cohen d=0.84), and a reduction in ADHD symptoms (d=0.98), as well as statistically significant reductions in perceived stress (d=0.83), exhaustion (d=1.12), anxiety (d=1.70), and depression (d=1.25). Improvements were sustained at a 12-week follow-up. A clinically significant improvement in quality of life was observed in 36% (13/36) of participants. Participants reported high satisfaction with the program and the guidance. Adherence was high, with an overall assessment response rate of 84%, a mean of 78% of modules opened, and no explicit dropouts. Twelve of the 36 participants reported negative effects. Qualitative content analysis of participants’ written feedback revealed positive experiences and suggestions for improvement.

Conclusions: This study suggests promise for web-delivered interventions tailored to the needs of adults with ADHD, pending further research and development in controlled studies.

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder, affecting 2-7% of adults worldwide. Adults with ADHD face increased levels of stress and fatigue, frequently contributing to exhaustion. They are at higher risk for stressful life events and mental health issues, with a majority of meeting criteria for at least one comorbid psychiatric disorder. Additionally, adults with ADHD have more sickness absence days compared to controls, possibly twice or several times as many. Although research on assessing and treating adult ADHD is growing, many individuals remain undiagnosed and untreated due to lack of recognition, misconceptions, and limited access to psychiatric care. Internet-delivered interventions offer a promising solution for improving access to care and effec- tively disseminating psychological treatments. However, their efficacy for adult ADHD remains underexplored.

Methods: This study will involve 240 participants, randomly assigned to one of three conditions: Internet-based cognitive-be- havioral stress-management; Internet-based mindfulness stress-management; or a wait-list control. Participants in the intervention groups will engage in twelve-week, twelve-module programs, with clinical support available on demand. Both interventions have an explicit focus on workplace functioning, but differ in their content. The cognitive behavioral program is based on cognitive behavioral therapy (CBT) principles, including both tailored and transdiag- nostic applications. The mindfulness program is based on a well-established skills-training manual for adult ADHD. Outcome measures include self-reported quality of life (primary outcome), symptoms of ADHD, perceived stress, symptoms of exhaustion, depression, and anxiety. Additionally, participants from both intervention groups will be interviewed to explore their experiences with the programs.

Discussion: Previous research indicates a positive attitude toward internet-delivered psychological interventions among adults with ADHD. A previous single-arm open trial has also indicated the potential of the current cognitive-behavioral stress-management intervention. This study aims to further assess its efficacy by comparing it to an active control intervention, thereby accounting for the expectation of benefit and common factors of internet interventions. The additional inclusion of a wait-list control will help account for spontaneous improvement and regression toward the mean. If the cognitive-behavioral intervention shows further promise, it could be further developed and potentially disseminated more broadly, either through routine healthcare systems or as a product. Given the position of ADHD adults in the labor market and the costs of sickness absence for all social partners, demonstrating effective inter- ventions for this population could have significant socio-economic benefits, reducing both individual and societal burdens.

INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, affecting 2-7% of adults worldwide. Adults with ADHD experience heightened levels of stress and fatigue, and ADHD is likely to be an underlying factor in cases of exhaustion. Despite growing evidence on the assessment and treatment of adult ADHD, many patients remain underdiagnosed and undertreated, largely due to barriers such as lack of recognition, misunderstandings, and limited access to specialized care. Internet-delivered cognitive behavior therapy presents an opportunity for increasing access to psychological interventions, though the evidence for its efficacy remains underexplored for adult ADHD. METHODS A total of 240 participants will be recruited and randomly assigned to one of three conditions: Internet-based cognitive-behavioral stress-management (42%); Internet-based mindfulness stress-management (42%); or Wait-list control (16%). Participants in the intervention groups take part in twelve-module, twelve-week interventions with clinical support on demand. Outcome measures include self-reported quality of life (primary outcome measure), symptoms of ADHD, perceived stress, symptoms of exhaustion, depression, and anxiety. DISCUSSION The cognitive-behavioral stress- management intervention has shown promise in a previous single-arm open trial. In this study, we aim to further evaluate its efficacy by comparing it to an active mindfulness intervention and a wait-list control. This allows us to control for the expectation of benefit and common factors of internet interventions. Additionally, the inclusion of a wait-list control condition enables us to account for spontaneous improvement and regression toward the mean. Should the cognitive-behavioral intervention prove beneficial and efficacious, it could undergo further development and potentially be disseminated to a wider audience, either through routine healthcare or as a packaged product.

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder, affecting 2-7% of adults worldwide. ADHD adults experience elevated stress and fatigue. They face more stressful life events and are more disposed to mental health problems. Adults with ADHD also take more sick leave than those without the disorder, possibly double or more. Despite increasing research on ADHD in adults, many remain undiagnosed or untreated due to under-recognition and limited access to psychiatric care. Internet-based treatments may help bridge this gap by making psychological treatment more accessible, though their impact on adult ADHD remains underexplored.

Aims: This study aims to evaluate two internet interventions for managing work-related mental health issues – including stress, depression, and anxiety – among adults with ADHD.

Methods: The study will recruit 240 participants, randomly assigned to one of three groups: an online cognitive-behavioral intervention, an online mindfulness intervention, or a waitlist control. The intervention groups will complete twelve-week programs with clinical support on demand. Both interventions target work-related mental health, though they differ in their approach. The cognitive-behavioral program is based on cognitive behavior therapy (CBT) principles, while the mindfulness program is adapted from an ADHD manual. The primary outcome is quality of life, with secondary measures of ADHD symptoms, perceived stress, risk of exhaustion, depression, and anxiety. Participants will also provide qualitative feedback on their experiences.

Results: Recruitment to the study is ongoing. Preliminary results will be presented at the Swedish Conference of Clinical Psychology.

Discussion: A prior single-arm open trial has shown potential for the CBT intervention. This study will further assess the intervention's efficacy against an active comparator and a waitlist control. If effective, the program could be integrated into routine healthcare or offered as a product, potentially reducing the personal and societal burdens of adult ADHD.

Introduction: In the last few decades, the proportion of sickness absence due to psychiatric diagnoses has increased drastically. This can be attributed to several factors, including a transition from physical to psychosocial strain at work, and difficulties balancing full-time employment alongside family obligations. A population that may have certain difficulties balancing work, leisure, and family, is adults with attention deficit hyperactivity disorder (ADHD). Adults with ADHD are more stressed, more often on sick leave, and receive sickness absence recommendations to a greater extent than adults without ADHD. Thus, it is urgent to manage and prevent stress and other work- related mental illnesses in this population. This project evaluates the feasibility, acceptability, and effects of an internet-based cognitive- behavioral stress-management program, developed specifically for this at-risk population.

Method: The novel stress-management program is based on existing support and interventions for ADHD adults. It is also inspired by existing support and interventions for relevant psychological disorders based on cognitive behavioral therapy (CBT) principles. This includes both tailored and transdiagnostic CBT applications. The development includes thoroughly assessing previous research, including quantitative and qualitative studies, meta-analyses, and literature reviews. The most relevant and effective material is adapted to the internet format and the ADHD-adult population. Modules include information and exercises on: how ADHD symptoms affect work, leisure, and relationships; planning and prioritizing on and off the job; communication, assertiveness, and setting boundaries; sleep and recovery; and more. The program will be evaluated in a pilot study during the spring of 2023, revised, and later tested in a randomized controlled trial.

Results: At the time of writing, recruitment to the pilot study is about to begin. Preliminary results are expected to be presented at the 10th World Congress of Cognitive and Behavioral Therapies in Seoul.

Discussion: Despite the fact that many adults with ADHD are more stressed, more often on sick leave, and receive sickness absence recommendations to a greater extent than adults without ADHD, few studies have explored the possibility to manage and prevent these negative outcomes. This project will further the knowledge of possible ways to manage and prevent stress and other work-related mental illness among ADHD adults. If the internet-based CBT stress-management program shows promising results, it could quickly be made available to caregivers and/or the public, conceivably conserving considerable resources for individuals, employers, and society.