Goal-Striving and Pilot Goal Management Training in Adolescents with Attention-Deficit/Hyperactivity Disorder

Abstract

Goal-striving across academic, social, and psychological domains of life is associated with many positive outcomes. Unsuccessful goal pursuits increase the risk of engagement in health-risk behaviours, future vocational difficulties, and interpersonal challenges. Individuals with ADHD have difficulties in academic and interpersonal areas of life, with well-documented motivational and executive functioning (EF) challenges. Stimulant medications, the most used treatment for ADHD, do not target these challenges and few interventions offered to adolescents with ADHD appear to support goal-striving. Although research investigating motivational and EF difficulties in ADHD has determined that support is necessary for successful goal-pursuit, little is known about how motivation, EF, and other factors such as grit (i.e., task persistence) impact efforts made by adolescents with ADHD to work on their goals. The current dissertation focuses on the EF deficits and motivational insight of adolescents with ADHD, in service of best supporting youth in both everyday contexts and interventions. The work presented in Studies 1 - 3 sought to present a fulsome description of how goal-striving difficulties lead to the functional impairments noted in adolescents with ADHD (i.e., ineffective goal-striving), by describing the motivation and EF of adolescents with ADHD compared to their same-aged peers and emerging adults in university. The sample included adolescents aged 14 – 17 years with and without ADHD, as well as emerging adults aged 19 – 22 years; each group was approximately 50% female. Study 1 highlighted that adolescents, as compared with their emerging adult peers, appear to require more effort and support to work on their goals. However, adolescents with ADHD also endorse less interest towards their academic goals, demonstrate difficulty linking their immediate goals to their future ambitions, and do not apply flexibility to their goal-pursuit strategies. In Study 2, adolescents with ADHD endorsed significantly more EF challenges and less grit compared to their peers, suggesting that support for adolescents with ADHD must uniquely address these challenges. For all adolescents, more external motivation was associated with higher levels of EF challenge. When considering motivation across any kind of goal (i.e., academic and non-academic), adolescents with ADHD demonstrated both internal and external motivational styles. This may indicate that adolescents with ADHD demonstrate nuances in their motivation not captured in previous studies, such that they are not simply “less motivated” than their peers, but rather that their EF difficulties may lead to less internal motivation towards academic goals. Building upon this, Study 4 outlined how these groups regulate their motivation by attempting to create a fit between their motivational state and task strategies, an ability known as metamotivation. Generally, all groups reported their experiences of both high and low motivational states (e.g., interest, meaningfulness, boredom, frustration), and strategies that bolster their goal striving in response to those feelings. However, there was variability in the metamotivational insight held by participants, such that those with ADHD tended to have a harder time recognizing feelings of low motivation and strategizing for conflict between complex goals. Results from these studies supported the need for a goal-striving intervention targeted for adolescents with ADHD, for whom EF difficulties and motivational awareness appear to create barriers to their goals. The final study of this dissertation piloted a modified Goal Management Training intervention for adolescents with ADHD, providing preliminary evidence of the feasibility of this EF intervention. Six participants (Mage = 15 years, SD = 1.1; 2 females; 66% taking stimulant medication for ADHD management) demonstrated adherence and tolerance to the training, and for some participants there was reliable change in self-reported executive functioning, functional impairment, and tasks of inhibition/switching, as well as parent-rated executive functioning. All parents reported improvements in their adolescent’s functional impairment. All but two participants met the goal they had selected prior to training. Results show that further exploration of the benefits and effects of training is warranted, showing the potential for a goal-based intervention as a new direction for treatment of difficulties associated with ADHD. Overall, the studies presented in this dissertation demonstrate the possibility of integration various social and clinical psychological constructs and provides a framework for future larger-scale studies.