By Dorothy Bisbee, JD, PCC, Research Committee

Study Reviewed: Fleming, A.P., McMahon, R.J., Moran, L.R., Peterson, A.P., & Dreesen, A. (2014). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. Journal of Attention Disorders 2015, 19(3), 260-271. (Note: Access to the JAD is an ADHD Coaches Organization member benefit.)

Overview

Are you wondering whether skills training should play a greater role in your ADHD coaching practice? If so, this study should interest you.

The study compared the impacts of an eight-week group skills training program based on dialectical behavior therapy (DBT, described below), adapted to college students with ADHD, with the impacts of an ADHD skills handouts-only program. While the study was small (N=33), it was one of the first to use a randomized control trial (RCT) model with college students as subjects.

Results suggest that DBT group skills training combined with short individual coaching sessions may help college students with ADHD reduce inattentive symptoms, and improve executive functioning (EF), Quality of Life (QoL) and mindfulness. While the study was not designed to investigate the impact of ADHD skills handouts alone, results also indicate that, to a lesser extent, even skills handouts alone can help college students with ADHD to reduce inattentive symptoms and improve EF.

What Is DBT Skills Training?

DBT is a therapeutic approach developed by Dr. Marsha Linehan as a treatment for bipolar disorder. It combines cognitive behavioral therapy (CBT) and mindfulness/acceptance. In its pure form, it is administered by a team of therapists and involves group skill training, individual therapy, and as-needed skill coaching in four areas: Core Mindfulness, Interpersonal Effectiveness, Distress Tolerance, and Emotion Regulation. Therapists can obtain certification in DBT through dbt-ibc.org, and Dr. Linehan’s DBT Skills Manual, now in its second edition, is available for purchase. DBT group skills training has more recently been adapted for people with ADHD.

Study Design

Using reliable, validated surveys with a pretest-posttest and follow-up design, the authors examined the development of ADHD symptoms, EF, quality of life (QoL) and other areas in 33 college students with ADHD. Surveys were administered before the intervention, after it ended, and three months afterwards.

Half of the students were randomly placed in the experimental group, where they participated in DBT group skills training, supplemented by weekly 10-15 minute individual coaching calls to generalize skills. The weekly 90-minute group skills sessions followed this schedule:

  • Week 1: Group orientation and goal-setting; psycho-education & mindfulness
  • Week 2: Daily planner use; task chunking & prioritization
  • Week 3: Structuring environment; using social support
  • Week 4: Managing sleep, eating and exercise
  • Weeks 5 & 7: Generalizing and troubleshooting
  • Week 6: Emotion regulation (opposite action)
  • Week 8: Review; plan for high-demand periods
  • Booster Session, first week of next academic quarter: review and plan to maintain skills

The control group received 34 pages of skills handouts from Ari Tuckman’s 2007 book, Integrated Treatment for ADHD, covering the following:

  • Psycho-education about ADHD and EF
  • Organization
  • Planning
  • Time management
  • Structuring environment
  • Stress management

Key Findings

While the experimental group showed significantly greater improvement over the control group, participants both groups showed significant improvement in several areas, including:

  • ADHD inattentive symptoms as measured by the Barkley Adult ADHD Rating Scale-IV (BAARS-IV) (Barkley, 2011), and
  • EF as measured by the Brown ADD Rating Scales (BADDS) (Brown, 1996).

In addition, while the results were not as statistically significant, the experimental group showed improvement in:

  • QoL as measured by ADHD Quality of Life Questionnaire (AAQoL) (Brod, Johnston, Able, & Swindle, 2006) than the control group
  • Mindfulness, as measured by the Five Facet Mindfulness Questionnaire (FFMQ) (Baer, Smith, Hopkins, Kreitemeyer, & Toney, 2006)

Study Strengths and Limitations

Some of the study’s many strengths included:

  • Subjects were randomly assigned to experimental or control groups
  • Detailed baseline demographic and clinical data were reported
  • Validated, reliable instruments were used (several are listed below)
  • Pre-, post-, and 3-month follow-up surveys were given
  • The study was university-funded, and the authors had no conflicts of interest
  • Assessments were administered by interviewers blind to which group participants were in

Some limitations of the study were as follows:

  • The sample size was small
  • Most measures were self-report; grade point average (GPA) was the only objective measure (interestingly, the end GPA of the control group was slightly higher than that of the experimental group)
  • The principal investigator and the primary author provided the skills training for the experimental intervention, which could have led to some bias, and also which makes it impossible to rule out provider-specific impacts
  • Therapists, rather than coaches, provided the intervention (this is only a possible limitation on the applicability of the study to ADHD coaching)
  • There is no way to determine which parts of the DBT skills training were most central to the experimental group participants’ improvement
  • More details on the control group condition would have been helpful: the article does not state when, how or how often the self-help handouts were delivered, nor does it specify which 34 pages of Tuckman’s book were used

Conclusion

The study, while small and limited to college students, supports the idea that group skills training in areas like mindfulness[1], planning and emotional regulation can be helpful to ADHD coaching clients. It also indicates that self-directed use of handouts such as those in Tuckman’s book can help improve ADHD symptoms and EF. Larger studies are needed to confirm these findings. Hopefully, ADHD coaches will participate in this research.

Possibilities for Putting this Research Into Practice

Based on studies like this one, ADHD coaches may consider incorporating skill-training aspects of DBT into their practices. ADHD coaches may also explore the use of survey instruments like those used in this study to help clients deepen awareness or even measure progress. Finally, combining structured skills handouts with coaching may increase ADHD coaching efficacy.

[1] For a discussion of evidence supporting a mindfulness intervention can be even more efficacious than DBT, see Mindfulness and ADHD in the March 2015 edition of Circle.


DorothyBisbeeDorothy Bisbee, JD, PCC, CCMC, for the ACO Research Committee
This review was written as a service to ACO members represents the perspective of that author.
You can contact the author at www.dorothybisbee.com.