ACT teaches individuals to observe and accept their thoughts and feelings without trying to change them, while committing to behaviors that align with their personal values.
By cultivating a more flexible and accepting relationship with ADHD-related challenges, ACT can improve functioning and quality of life.
Key Points
Rationale
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting 2-7% of the global population (Polanczyk et al., 2007).
Stimulant medicationsare considered a first-line treatment, especially for stronger cases in children and adolescents (Conners, 2002; Faraone et al., 2006).
Behavioral therapiesused in combination with medication appear to be superior to either treatment alone (Catala-Lopez et al., 2017). However, the utility of newercognitive-behavioral approacheslike acceptance and commitment therapy (ACT) for ADHD is still ambiguous and understudied (Faraone et al., 2006).
ACT has shown promise in treating various mental health issues likeanxiety, depression, chronic pain, and aggression (A-tjak et al., 2015; Byrne & Ghrada, 2019; Graham et al., 2016; Swain et al., 2013).
By fostering psychological flexibility through mindfulness, acceptance, cognitive defusion, self-as-context, values, and committed action, ACT aims to neutralize maladaptive psychological processes underlying distress and promote adaptive behavior (Hayes et al., 2006; Luoma et al., 2007).
Considering that ACT encourages broad and flexible behavioral repertoires, it may have utility for some of the challenges that may be seen in ADHD.
The present scoping review, therefore, aimed to synthesize the current research on the effectiveness of ACT approaches for treating individuals with ADHD. B
y providing an overview of this emerging literature, the review can inform clinicians about the potential applications of ACT and guide future studies to address gaps in the evidence base.
Method
Thisscoping reviewfollowed the Joanna Briggs Institute guidelines (Peters et al., 2015) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (Moher et al., 2009).
A comprehensive search was conducted across eight electronic databases: Medline, Embase, PsycInfo, ScienceDirect, PubMed, Emcare, Scopus, and Google Scholar, from inception to January 2021.
Using Boolean operators, truncation, Medical Subject Headings terms, wildcard features, and synonymic keywords, a broad search strategy was employed to capture all relevant studies.
The inclusion criteria were: 1) empirical studies reporting on ACT treatment for individuals with ADHD; 2) ACT as a standalone or adjunctive therapy based on at least 2 of the 6 core processes; 3) at least one outcome measure of treatment effectiveness; 4) quantitative, qualitative, mixed-methods, or case studies; 5) published in English. Exclusion criteria were: 1) non-empirical papers like reviews or book chapters; 2) non-English studies; 3) ACT techniques not clearly used.
A formal quality appraisal was not conducted, as is typical of scoping reviews. A narrative synthesis of the findings was performed using thematic analysis.
Results
Study Characteristics:
The 6 included studies were published between 2015-2020, with 2 each from Iran and Italy, and 1 each from the USA and UK. There were 4 experimental studies and 2 quasi-experimental designs.
Sample sizes ranged from 9 to 45 participants aged 8 to 23 years, totaling 142 individuals (63 males, 16 females). Three studies used a group therapy format and two used individual sessions, with varying treatment lengths.
Comparison of ACT with Other Treatments:
Two studies compared ACT to dialectical behavior therapy (DBT) and token economy plus parent training.
Bayat et al. (2019) found that 12 individual ACT sessions and DBT were both more effective than control in reducing ADHD symptoms and improving quality of life in 45 participants. DBT showed greater effects on ADHD symptoms at follow-up, while ACT outperformed DBT on quality of life measures.
Vanzin et al. (2019) evaluated a 9-month group ACT program adjunctive to token economy and parent training in 31 children.
Significant improvements were seen in parent-rated ADHD symptoms, impairments, and clinical severity, which held after controlling for medication use and demographics.
ADHD Symptoms Based on Pre-Post Designs:
Four studies examined pre-post changes in ADHD symptoms and associated outcomes using various designs.
Fullen et al. (2020) piloted a brief phone/video-delivered individual ACT manual to support psychosocial adjustment during COVID-19 lockdown in 12 adults. Three sessions led to improved mood, anxiety, coping, and treatment acceptability at 2-week follow-up.
Murrell et al. (2015) provided 8 weekly group sessions to 9 children with ADHD, learning disorders, and disruptive behaviors, finding behavioral improvements in a third of the sample.
Vanzin et al. (2020) assessed cognitive outcomes of a 9-month, 26-session group ACT program in 29 children compared to untreated ADHD controls, but found no significant benefits.
Gholipour et al. (2019) showed that 10 sessions reduced hyperactivity/impulsivity and academic procrastination in 16 adolescents.
Insight
This scoping review offers a synthesis of the developing research on ACT for ADHD, revealing some key insights:
Replication in larger samples with active control groups, long-term follow-up, analysis of mechanisms and moderators, and development of manualized protocols are important future directions to establish ACT as an empirically-validated option for ADHD management.
Strengths
The review had several methodological strengths:
Limitations
However, some limitations should be noted:
Implications
Despite the limitations, this review has important implications:
In sum, this scoping review suggests ACT is a promising therapy for ADHD that merits more rigorous research and clinical application. By providing an accessible overview and identifying key gaps, this review can stimulate further scientific inquiry and evidence-based practice regarding ACT for this impairing neurodevelopmental disorder.
References
Primary reference
Munawar, K., Choudhry, F. R., Lee, S. H., Siau, C. S., Kadri, N. B. M., & Sulong, R. M. B. (2021). Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review.Heliyon,7(8).https://doi.org/10.1016/j.heliyon.2021.e07842
Other references
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A-tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychotherapy and Psychosomatics,84(1), 30-36.https://doi.org/10.1159/000365764
Byrne, G., & Ghráda, Á. N. (2019). The application and adoption of four ‘third wave’ psychotherapies for mental health difficulties and aggression within correctional and forensic settings: A systematic review.Aggression and violent behavior,46, 45-55.https://doi.org/10.1016/j.avb.2019.01.001
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Conners, C. K. (2002). Forty years of methylphenidate treatment in Attention-Deficit/Hyperactivity Disorder.Journal of Attention Disorders,6(1_suppl), 17-30.https://doi.org/10.1177/070674370200601S04
Faraone, S. V., Biederman, J., Spencer, T. J., & Aleardi, M. (2006). Comparing the efficacy of medications for ADHD using meta-analysis.Medscape General Medicine,8(4), 4.
Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions.Clinical psychology review,46, 46-58.https://doi.org/10.1016/j.cpr.2016.04.009
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes.Behaviour research and therapy,44(1), 1-25.https://doi.org/10.1016/j.brat.2005.06.006
Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007).Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. New Harbinger Publications.
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
