3 - (SYM 15) Randomized Controlled Trial of a Cbt-based App for Adults with Adhd-related Challenges

Cognitive-behavioral therapy for adult ADHD (CBT-A) is an efficacious treatment for adults with ADHD such that practice guidelines developed in the United Kingdom and Canada recommend CBT-A for treatment for adults with ADHD and residual symptoms. However, CBT-A can be difficult for clients to access in the community due to low provider availability and the costly nature of mental health treatment. Furthermore, the success of CBT-A relies on clients practicing self-regulation skills in their daily lives and adults with ADHD may find it difficult to adhere to skills practice outside of sessions without additional supports. Mobile health (mHealth) apps are a promising tool for delivering cost-effective CBT at scale and supporting skills practice in daily life; however, the vast majority of mHealth apps available on the market have no empirical data supporting their efficacy and a recent review found that only 3% were based on CBT principles. To address this gap, we conducted a randomized, waitlist controlled trial (RCT) of a CBT-informed mHeath app for adults with ADHD. Adults who met study criteria including ADHD diagnosis according to structured interview (N = 154; ages 18–55 years) were randomized to either 8 weeks of access to a CBT-informed app or a waitlist condition. Participants completed self-report measures of ADHD symptoms, functional impairment, quality of life, and skill use at baseline, 4 weeks, and 8 weeks. Linear mixed-effects models with repeated measurements revealed significant group x time interactions for inattentive symptoms (η2 = .15), hyperactive-impulsive symptoms (η2 = .05), and ADHD-related quality of life (η2 = .04) in favor of the CBT-informed app group; however, these results did not extend to the measure of functional impairment. Changes in organizational, time management, and planning behaviors and ADHD-related cognitions partially mediated the association between treatment group and inattentive symptom changes. Within the app group, the number of app exercises completed was associated with greater reductions in inattentive symptoms. Participants who used a CBT-informed mHealth app reported significant symptom reduction and improvement in ADHD-related quality of life. Conclusions are limited by the waitlist control design and use of self-report measures; however, these findings suggest that CBT-A mHealth apps are a promising support for adults with ADHD worthy of further study—both as a stand-alone intervention and an adjunct to traditional CBT-A.