Low self-esteem in ADHD Low self-esteem in ADHD
Conditions
Interventions
The intervention used in this study is partly based on COMET, which is a widely used CBT-based protocol in clinical care used to improve self-esteem (Korrelboom et al., 2009) according to state-of-the
Currently, COMET has two protocols, one specifically for adults (aged 18+) and the other aimed at children and adolescents (aged 8-16). To ensure that our intervention is suitable for our target popul
ME’). The new protocol will incorporate text, exercises and homework that are more tailored to emerging adults, reflecting the challenges and transitions in this life stage. 
This revised protocol will consist of seven individual CBT sessions and each session will last 45 minutes. Therapists will help participants to recognize their strengths to improve their positive self
Participants are given homework after each session. 
To specifically address the needs of emerging adults, the new protocol incorporates these additions: identity and self-development (e.g., exercises that encourage participants to reflect on goals, val
Sponsors
Universiteit Leiden
Eligibility
Age
16 Years to 64 Years
Inclusion criteria
Inclusion criteria: To be eligible to participate in this study, participants must meet the following criteria:16-25 years old.ADHD diagnosis, that is confirmed by research team using the clinical interview MINI-S.Low self-esteem, determined through a structured and multi-step procedure to minimize subjectivity:- Referral by clinician. Clinicians from participating institutions identify potential participants. To ensure a uniform understanding of the study population and inclusion criteria, all cinicians receive specific training, including practical examples (i.e., short vignettes. The resrarcher(s) conduction the baseline assessment are also familiar with these training materials, so that the inclusion procedure is applied consistently.- Telephone screening. Two items from the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) are administered (“At times I think I am no good at all” and “All in all, I am inclined to think I am a failure”). A score of 3 (agree) or 4 (strongly agree) on either of these items is considered indicative of low self-esteem.- Baseline confirmation. During the baseline measurement, the full Rosenberg Self-Esteem Scale is administered. A cutoff score of < 15 is used as an objective reference point. This score is combined with a standardized clinical interview conducted by a trained researcher psychologist. At the ADHD section of the MINI-S at the baseline measurement, participants are asked by the researcher psychologist how their symptoms interfere with domains such as work, study, relationships, and self-esteem. If self-esteem is not mentioned, a follow-up question will be asked: “Many people with ADHD feel their symptoms affect their self-esteem, for example due to repeated negative feedback, feeling like they are not good at things, or failing short. Do you recognize this in yourself”? Based on the participant’s response, the trained researcher psychologist interviewer forms a professional, clinical impression of whether there are indicators of persistently low self-esteem (i.e., insecurity, fear of failure, strong reactions to criticism, perfectionism, distress related to ADHD symptoms). This clinical assessment approach is based on examples provided by the Diagnostic Interview for ADHD in Adults (DIVA-2-NL; Kooij & Francken, 2010). In all doubtful cases, the inclusion decision will be discusses in consensus meetings with the research team and supervisor, ensuring high inter-rater reliability.Pharmacological treatment for ADHD is allowed, but medication dose should be stabilized for a minimum of 4 weeks at baseline measurement (T0). Although changes in ADHD medication during the study are not preferred, they may occur in practice. Any such changed will be carefully documented
Exclusion criteria
Exclusion criteria: Concurrent psychopathology that requires immediate attention (e.g., severe depression, suicidal thoughts/risk of suicide (as determined by the referring therapist and/or research team). Undergoing any concurrent psychological treatment during the study, including any form of therapy for ADHD (e.g., CBT for planning skills). Psychoeducation completed prior to the study entry is allowed, but not during the study.Low self-esteem that directly stems from a traumatic experience, which would indicate the need for trauma-specific treatment. This will be determined by the referring therapist. If someone also suffers from low self-esteem due to the ADHD symptoms, an appropriate timing of each treatment will be discussed by the referring therapist and potential client. IQ < 80 assessed with two WAIS-IV subscales (Wechsler, 2008): Vocabulary and Block Design.Severe substance use (as determined by the referring therapist and/or research team).Confirmed Autism Spectrum Disorder (ASD) diagnosis. This also applies when the referring therapist indicates that an ASD diagnosis is very likely, even if it has not yet been established. Since ASD diagnostic procedures are time-consuming and fall outside the scope of this research project, formal ASD assessment will not be conducted withing this study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Self-esteemThe RSES (Rosenberg, 1965; Franck et al., 2008) is the golden standard questionnaire measuring self-esteem. One or two questions from this list will be used to assess if participants meet the inclusion criteria. Furthermore, participants will complete the full list on T0, T1 and T2 if participants take part in the study. The RSES consists of 10 items. Each item is scored on a 4-point scale (strongly agree, agree, disagree, strongly disagree). Scores are summed in a total score. Ecological Momentary Assessment (EMA; surveys on smartphone) will be used to explore self-esteem, emotions, and distress at random moments during a day, to assess the effects of the intervention on self-esteem in daily life. Participants are prompted 8 times a day, during one week before the intervention / waitlist control period and one week after the intervention / waitlist control period. Each prompt consists of 4 short questions on self-esteem (scale question 0-100: “How satisfied are you with yourself right now?”), emotions (MC) and valence of distress on 0-100 with the Subjective Units of Distress Scale (SUDS; Wolpe, 1969). | — |
Secondary
| Measure | Time frame |
|---|---|
| ADHD symptoms The “Zelf-rapportage vragenlijst over aandachtsproblemen en hyperactiviteit voor volwassenheid en kindertijd” will be used to measure symptoms of ADHD at T0, T1, and T2. This questionnaire consists of 23 items. Each item is scored on a 4-point scale (never/almost never, sometimes, often, very often), both for adulthood and childhood. At baseline, items are scored for both adulthood and childhood, but at T1 and T2 only for adulthood. Scores are summed in a total score, which will be used in this study. Anxiety symptoms The Dutch version of the Liebowitz Social Anxiety Scale will be used to measure social anxiety symptoms at T0, T1 and T2. The LSAS consists of 24 items, 13 items for social interaction situations and 11 items for performance. Each item is scored twice on a 4-point scale, once for the degree of fear and once for the frequence of avoidance. Scores are summed in a total score, with separate anxiety/avoidance subscales, and social interaction/performance subscales, which will all be used in this study. The Dutch version of the Brief Fear of Negative Evaluation will be used to measure fear of negative evaluation at T0, T1 and T2. The Brief FNE consists of 12 items. Each item is scored on a 5-point scale (not at all characteristic of me, slightly characteristic of me, moderately characteristic of me, very characteristic of me, extremely characteristic of me). Scores are summed in a total score, which will be used in this study. We will add the follow question: Do you believe you receive more/fewer negative evaluations compared to others?The Dutch version of the Fear of Positive Evaluation Scale will be used to measure fear of positive evaluation at T0, T1 and T2. The FPES consist of 10 items. Each item is scored on a 10-point scale (0 = not true at all; 9 = very true). Scores are summed in a total score, which will be used in this study. We will add the follow question: Do you believe you receive more/fewer positive eva | — |
Countries
Netherlands
Contacts
Public ContactB. E. Boyer
Universiteit Leiden
Outcome results
None listed