Self-beliefs, resources, and self-regulation in adult ADHD : psychotherapeutical relevance and implications

This dissertation aims to contribute to the developing research on adult ADHD in focusing on the role of self-beliefs, resources, and self-regulatory abilities. From childhood onwards, adults with ADHD have been afflicted with functional impairments in multiple domains of their life. Even though medication treatment addresses the core neurobiological symptoms of ADHD, many adults continue to suffer from residual symptoms and struggle with interpersonal, academic, and vocational difficulties. Living with this lifelong history of negative experiences and underachievement affects the formation of the individual’s self-esteem, selfefficacy, and gives rise to maladaptive coping strategies. In this work we aim to obtain a deeper understanding of those psychological factors in adults with ADHD that are closely linked to their self-beliefs, their ability to initiate and to pursue their goals (self-regulation), and their ability to apply effective coping strategies. Another focus lies on the specific resources people with ADHD possess, as they can be crucial to help improve the aforementioned self-beliefs and coping strategies. The first article Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective provides an overview of the current empirical findings and the theoretical state of knowledge with respect to self-beliefs and resources in adult ADHD: Schemas, self-esteem, self-efficacy, coping strategies, and resources. Based on the theoretical framework in the first article we conducted an empirical study to investigate self-esteem, self-efficacy and resources in adults with ADHD (article 2) in comparison to a healthy control group. Relationships between elevated psychological distress and the aforementioned factors were also surveyed. Adults with ADHD showed lower levels of self-esteem and self-efficacy and higher levels of general distress than the control group. With respect to the resources, the ADHD group showed lower values compared with the control group in some but not all of the resources. The following resources were equally well-marked in both groups: Family, leisure time, housing, ability to love, courage, and faith. The results of this study have important implications for the treatment of adult ADHD, suggesting that therapy programs for adult ADHD should include modules for enhancing self-esteem, self-efficacy, and fostering the patient’s resources. The third article explores self-regulation in adult ADHD. Self-regulatory abilities are of central importance for attaining personal goals. Yet the first article highlights that adults with ADHD often lack positive coping strategies and exhibit low self-efficacy, factors which interfere with the initiation and the pursuit of intentions. Why they have those difficulties in regulating their objectives and instead end up using maladaptive coping strategies such as procrastination is the question we tackle in the third article. In a first step, we compared self-regulatory abilities in adults with ADHD, such as 6 the inhibition of the volitional processes or the tendency for state orientation, with a healthy control group. We then scrutinized if adults with ADHD with increased attentional impairments displayed a larger tendency for state orientation compared to individuals with less pronounced attentional deficits. The results indicate that the ADHD group exhibited elevated values for volitional inhibition as well as for self-inhibition when compared to the control group. Regarding self-regulation, we found the variable self-motivation to be significantly reduced, which stands in contrast to the variables activation control or self-determination. Furthermore, in comparison to the controls the ADHD group showed higher values of prospective state orientation and state orientation subsequent to failure. Also, increased attentional impairment in adult ADHD is positively associated with processes of volitional inhibition and negatively associated with prospective action orientation. No significant relationship was found between higher levels of inattention and action orientation subsequent to failure. The final part of the dissertation juxtaposes the strengths and limitations of our conclusions and discusses possible implications for the psychotherapeutic interventions in adult ADHD.