Goal management training in adults with ADHD
Goal management training (GMT)* aims at enhancing inhibitory control and has been shown to improve executive functions in older adults and individuals with substance-use disorder, some of whom experience the same challenges as those with ADHD (Van Hooren et al, 2007; Alfonso et al, 2011; Stamenova & Levine, 2019). This study aimed to explore whether GMT would specifically enhance inhibitory control in adults with ADHD and if this would lead to secondary improvements in self-reported everyday functioning.
Participants for this study were either recruited through an existing study of ADHD in adults at the University of Bergen, Bergen, Norway (Halleland et al, 2012), or through local outpatient clinics in the municipality of Bergen. Inclusion criteria for the study were aged ≥18 years and a clinical diagnosis of ADHD. The GMT consisted of weekly 2-hour group sessions conducted during 9 consecutive weeks when possible and led by a clinical psychologist and a co-therapist. The sessions consisted of lectures, discussions and skill training intended to increase participants’ awareness of their own attention as well as their awareness of the skills and techniques included in GMT. Assessments were conducted pre-, post- and 6 months after the intervention, and measures included neuropsychological tests and self-report questionnaires pertaining to cognitive- and executive functioning, emotion regulation, quality of life and ADHD symptoms.
Performance-based tests of executive functions
A total of 36 potential participants volunteered for this study; however, only 21 participants completed the post-intervention and follow-up assessments. The majority of completers were male (n=12; 57.14%) and the mean (standard deviation [SD]) age was 39.05 (11.93) years. Participants showed a significant reduction from baseline to post-assessment in completion times of two conditions of an inhibitory control test (Ms=55.55 and 62.47 at baseline, Mdif =-4.48 and –8.64 for the third condition and fourth condition, respectively). These changes were maintained at follow-up 6 months later (Mdif =-5.60 and -9.33, respectively), thus showing improved efficiency in inhibitory control from baseline to post-assessment.
Participants’ achievement scores on the inhibition assessment increased at the follow-up assessment relative to baseline (M=19.38 at baseline, Mdif=2.12 at follow-up) and their performance on the assessment of executive functions of attentional control and cognitive flexibility also improved (M=72.03 at baseline, Mdif =-11.37 at follow-up). Furthermore, participants showed an improvement in general problem-solving by a reduction in deviation from the ideal time of a problem-solving exercise from pre- to follow-up assessment (M=352.71 at baseline, Mdif = -117.59 at follow-up). No significant changes occurred on the performance-based measures of executive function, and exploratory analyses investigating the effects of age and medication status showed no significant effects of these covariates (all p values ≥0.09).
Self-reported symptoms, quality of life and everyday functioning
With respect to secondary outcomes, a significant reduction of cognitive functioning difficulties in participants’ everyday lives was observed (M=61.41 at baseline, Mdif=-6.75 [p=0.001] and -7.61 [p<0.001] at post and follow-up assessment, respectively). Following GMT, the participants also reported a significant reduction of ADHD symptoms (M=46.97 at baseline, Mdif=-3.70 [p=0.015] and -5.28 [p<0.001] at post- and follow-up assessment, respectively) and increased quality of life (M=42.32 at baseline, Mdif=11.89 and 12.52 at post and follow-up assessment, respectively) with respect to functioning in school/work and everyday task accomplishment. With respect to overall quality of life, participants also reported a significant change (M=49.36 at baseline, Mdif=6.95 [p=0.022] and 8.24 [p=0.007] at post and follow-up assessment, respectively).
The authors noted that, although the results of this study should be interpreted with caution, the results suggest that the participants with ADHD adopted learned strategies and applied them in their everyday life 6 months after completing GMT. In contrast, due to four potential participants being excluded and 11 dropping out, the final number of participants included was lower than intended, and not in line with the power analysis conducted during this planning. Subsequently, the authors hypothesised that lower power in the statistical analyses may have contributed to negative results on effect measures of GMT, which may appear as a positive effect with a larger sample.
It was concluded by the authors that this study suggests GMT specifically improves inhibitory control in individuals with ADHD, with a positive effect lasting at least 6 months post-treatment. The adults with ADHD included in this study also reported improved self-regulation in their everyday life after completing GMT, and the authors highlight the need for further investigations of GMT as a treatment option for this group of individuals.
Read more about the effect of GMT in adults with ADHD here
*Goal management training (GMT) is a group-based metacognitive remediation programme with an emphasis on strengthening inhibitory and attentional control in participants
Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.
Alfonso JP, Caracuel A, Delgado-Pastor LC, et al. Combined goal management training and mindfulness meditation improve executive function and decision-making performance in abstinent polysubstance abusers. Drug Alcohol Depend 2011; 117: 78-81.
Halleland HB, Haavik J, Lundervold AJ. Set-shifting in adults with ADHD. J Int Neuropsychol Soc 2012; 18: 728-37
Jensen DA, Halmøy A, Stubberud J, et al. An exploratory investigation of goal management training in adults with ADHD: Improvements in inhibition and everyday functioning. Front Psychol 2021; 12: 659480.
Van Hooren SAH, Valentijn SAM, Bosma H, et al. Effect of a structured course involving goal management training in older adults: a randomised controlled trial. Patient Educ Couns 2007; 65: 205-213.
Stamenova V, Levine B. Effectiveness of goal management training® in improving executive functions: a meta-analysis. Neuropsychol Rehabil 2019; 29: 1569-1599.