Mixed Methods Evaluation of the Guided Self-Determination intervention in adolescents with co-existing ADHD and medical disorder: Ph.d.-afhandling

Background
Attention deficit/hyperactivity disorder (ADHD) in adolescents is a common mental disorder and associated with impaired academic, social, emotional, and family functioning. Furthermore, adolescents with ADHD are at risk for suffering from a co-existing medical disorder (MD) such as asthma, allergy, diabetes, enuresis, epilepsy, incontinence, obesity, insomnia, or migraine. Living with ADHD is complex, and a co-existing MD presumably adds to that complexity. Studies argue that adolescents with co-existing ADHD and MD require special approaches to treatment and care. Adolescents strive for independence from their parents, and they make more independent decisions about their lives, which is likely to influence their diseasemanagement choices. It is therefore important to support adolescents in order to empower them in their management of co-existing ADHD and MD. Thus, there is a need to develop and evaluate the impact of an intervention supporting adolescents’ self-management of co-existing ADHD and MD. Guided Self-Determination (GSD) is an empowerment-based intervention that supports patients’ disease self-management by facilitating patient involvement and patient-centered care. The GSD intervention may be suitable for supporting adolescents’ self-management of co-existing ADHD and MD.

Aim
This PhD project consisted of three studies that aimed to:
• Explore adolescents’ perceptions of living with co-existing ADHD and MD
(Study 1). The findings of Study 1 formed the basis for the adaptation of the
GSD intervention to adolescents with co-existing ADHD and MD (GSDADHD-MD)
• Evaluate the impact of the GSD-ADHD-MD intervention on support from
nurses, support from parents, and the adolescents’ self-management of coexisting ADHD and MD (Study 2)
• Evaluate feasibility and acceptability of the GSD-ADHD-MD intervention
received by adolescents with co-existing ADHD and MD (Study 3)
Methods
Adolescents’ perception of living with co-existing ADHD and MD was explored in
a qualitive semi-structured interview study and included 10 adolescents with coexisting ADHD and MD (Study 1). The GSD-ADHD-MD intervention was
evaluated in an outpatient ADHD hospital clinic and an outpatient pediatric hospital clinic and included 10 adolescents with co-existing ADHD and MD. The impact of the intervention was evaluated in a mixed methods convergent study (Study 2).
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Feasibility of the intervention was evaluated on the basis of registration of the
adolescents’ recruitment, retention, and participation rates, and acceptability was
evaluated on the basis of semi-structured interviews with the adolescents (Study 3).
Results
The findings show that living with two disorders creates a dual task that cannot be handled by dealing with ADHD and MD separately. Evaluation of the GSD-ADHDMD suggests that the intervention may have an impact on self-management and support from nurses but not on support from parents. Additionally, the acceptability and feasibility of the intervention depended on the adolescents’ and the nurses’ use of the reflection sheets and the collaborative sessions.
Conclusion
The GSD-ADHD-MD intervention has the potential to improve adolescents’
management of co-existing ADHD and MD by helping them become aware of the
dual task and by supporting their active involvement in their outpatient visits.
However, some elements of the intervention were more feasible and acceptable than others; for this reason, the intervention needs further adjustments.