5 - (SYM 2) Avoidant Automatic Thoughts in the Moment Are Associated with ADHD Symptoms and Task Avoidance: Investigation of Potential Intervention Target

The CBT field has focused heavily on the role of negative automatic thoughts in psychopathology; however, problematic positive thoughts have received much less attention. CBT clinicians treating adults with Attention-Deficit/Hyperactivity Disorder (ADHD) note the impact of problematic, non-negative thoughts in this population that accompany failure to use self-regulation skills (e.g., “I’ll have plenty of time to do that later.”; Knouse & Mitchell, 2015). Studies using self-report scales have found that frequency of such thoughts is associated with greater ADHD symptoms and avoidance and less use of effective coping (Knouse et al., 2019; Pickel & Toback, 2019; Dupaul et al., 2022). We reviewed the literature on negative automatic thoughts and further define this construct as avoidant automatic thoughts (AATs): spontaneously arising thoughts about delaying the start or end of an activity. In two studies (Study 1: 101 college students; Study 2: 106 community adults, Mage = 38.69) we used Ecological Momentary Assessment (EMA) to investigate the experience and correlates of AATs.

Participants completed baseline measures and EMA surveys across 6 days with frequency of 3 (Study 1, 1668 datapoints) or 5 (Study 2; 2439 datapoints) surveys daily. AATs were frequent daily occurrences for participants (Study 1: endorsed at 53% of moments; Study 2: 45%). We analyzed our data using multilevel modelling in R. When examining Level 1 predictors, we included grand means and variables centered within clusters to parse person- vs. moment-level variance.

As predicted, in both samples, baseline level of ADHD symptoms predicted greater momentary AAT, task avoidance, and negative affect. AATs at both the person and momentary levels predicted greater task avoidance. The relationship between momentary AATs and task avoidance did not depend on baseline ADHD symptoms in Study 1 (.22, n.s.); however, as hypothesized, the interaction was significant in Study 2 (.31, p < .01) such that ADHD symptoms strengthened the relationship between momentary AAT and avoidance.

Results suggest that AAT are particularly frequent daily occurrences for adults with elevated ADHD symptoms and that, for these adults, AATs may more strongly precipitate task avoidance. Our results begin to establish AATs as a novel CBT-relevant construct and a potential intervention target to help adults with ADHD better implement self-regulation skills in daily life.  

See also https://osf.io/2bmvc and https://osf.io/xdy4f for all pre-registered hypotheses, which will be included in the presentation.