Symposia
ADHD - Adult
Traci Kennedy, Ph.D. (she/her/hers)
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Brooke Molina, PhD (she/her/hers)
Professor
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Sarah Pedersen, PhD
Associate Professor of Psychiatry and Psychology
University of Pittsburgh Department of Psychiatry
Pittsburgh, Pennsylvania
Young people with ADHD tend to experience heightened stress (Combs et al., 2015), but day-to-day, momentary stress has not been examined. Low self-awareness is also posited to contribute to ADHD symptoms (Barkley, 2015; Nigg, 2001). Self-monitoring via ecological momentary assessment (EMA) may even help improve momentary ADHD symptoms by increasing awareness of them (Kennedy et al., 2022).
Thus, in emerging adults with ADHD, we tested whether: 1) ADHD symptom severity improved as a function of symptom monitoring via EMA; 2) Lower in-the-moment symptom awareness predicted worse ADHD symptoms within person; and 3) Momentary stress predicted worse ADHD symptoms within person.
Method
Emerging adults with ADHD (N=72; age=18-21; 67% women; 75% White, 14% Black, 10% Asian American, 5% other races) completed 21 days of EMA, plus baseline and 3-week follow-up surveys and clinician-administered ADHD assessments. Participants completed up to 5 EMA prompts/day: 1 15 mins after waking, 3 semi-randomly, and 1 at bedtime. They rated ADHD symptom severity (0-100), awareness (BRIEF monitor items), and stress (1=not at all - 5=extremely) at each EMA prompt.
Results
Clinician-rated ADHD symptom severity decreased from baseline to follow-up, t(63)=-4.36, p< .001. Multilevel models with a random intercept and slopes adjusted for age, gender, race, income, student and ADHD medication status, EMA compliance, and daily ADHD medication use. Momentary ADHD symptoms declined over the 3 weeks, linear b = -.38, p< .001, quadratic b=.002, p=.001.
Within person, completing vs missing the prior EMA prompt predicted lower ADHD symptoms, b=-7.75, p< .001. This effect weakened across the 3-week EMA period (prompt completion X time: linear b=.21, p< .001, quadratic b=-.002, p=.01).
Participants’ symptom awareness increased over the course of EMA, b= .02, p< .01. Within person, completing vs missing the prior EMA prompt predicted greater symptom awareness, b= .65, p=.01; in turn, within person, worse symptom awareness than usual was associated with worse ADHD symptoms concurrently, b=-1.65, p< .001, and at the following prompt, b=-.02, p=.05.
Lastly, within person, higher stress than usual predicted worse ADHD symptom severity concurrently, b=1.50, p< .001, and at the next prompt, b=.69, p< .01.
Conclusions
In-the-moment stress and symptom awareness may contribute to emerging adults’ ADHD symptom severity throughout the day. Just-in-time mHealth interventions that target momentary symptom awareness and daily stress management may help improve real-world ADHD symptoms.