Self-beliefs, resources, and self-regulation in adult ADHD : psychotherapeutical relevance and implications

This dissertation aims to contribute to the developing research on adult ADHD in focusing on the role
of self-beliefs, resources, and self-regulatory abilities.
From childhood onwards, adults with ADHD have been afflicted with functional impairments in
multiple domains of their life. Even though medication treatment addresses the core neurobiological
symptoms of ADHD, many adults continue to suffer from residual symptoms and struggle with
interpersonal, academic, and vocational difficulties. Living with this lifelong history of negative
experiences and underachievement affects the formation of the individual’s self-esteem, selfefficacy,
and gives rise to maladaptive coping strategies.
In this work we aim to obtain a deeper understanding of those psychological factors in adults with
ADHD that are closely linked to their self-beliefs, their ability to initiate and to pursue their goals
(self-regulation), and their ability to apply effective coping strategies. Another focus lies on the
specific resources people with ADHD possess, as they can be crucial to help improve the
aforementioned self-beliefs and coping strategies.
The first article Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective
provides an overview of the current empirical findings and the theoretical state of knowledge with
respect to self-beliefs and resources in adult ADHD: Schemas, self-esteem, self-efficacy, coping
strategies, and resources.
Based on the theoretical framework in the first article we conducted an empirical study to investigate
self-esteem, self-efficacy and resources in adults with ADHD (article 2) in comparison to a healthy
control group. Relationships between elevated psychological distress and the aforementioned factors
were also surveyed. Adults with ADHD showed lower levels of self-esteem and self-efficacy and
higher levels of general distress than the control group. With respect to the resources, the ADHD
group showed lower values compared with the control group in some but not all of the resources.
The following resources were equally well-marked in both groups: Family, leisure time, housing,
ability to love, courage, and faith. The results of this study have important implications for the
treatment of adult ADHD, suggesting that therapy programs for adult ADHD should include modules
for enhancing self-esteem, self-efficacy, and fostering the patient’s resources.
The third article explores self-regulation in adult ADHD. Self-regulatory abilities are of central
importance for attaining personal goals. Yet the first article highlights that adults with ADHD often
lack positive coping strategies and exhibit low self-efficacy, factors which interfere with the initiation
and the pursuit of intentions. Why they have those difficulties in regulating their objectives and
instead end up using maladaptive coping strategies such as procrastination is the question we tackle
in the third article. In a first step, we compared self-regulatory abilities in adults with ADHD, such as
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the inhibition of the volitional processes or the tendency for state orientation, with a healthy control
group. We then scrutinized if adults with ADHD with increased attentional impairments displayed a
larger tendency for state orientation compared to individuals with less pronounced attentional
deficits. The results indicate that the ADHD group exhibited elevated values for volitional inhibition
as well as for self-inhibition when compared to the control group. Regarding self-regulation, we
found the variable self-motivation to be significantly reduced, which stands in contrast to the
variables activation control or self-determination. Furthermore, in comparison to the controls the
ADHD group showed higher values of prospective state orientation and state orientation subsequent
to failure. Also, increased attentional impairment in adult ADHD is positively associated with
processes of volitional inhibition and negatively associated with prospective action orientation. No
significant relationship was found between higher levels of inattention and action orientation
subsequent to failure.
The final part of the dissertation juxtaposes the strengths and limitations of our conclusions and
discusses possible implications for the psychotherapeutic interventions in adult ADHD.