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Psychosocial interventions for improving the physical health of young people and adults with attention deficit hyperactivity disorder: a scoping review

BMC Psychiatry volume 24, Article number: 569 (2024) Cite this article

Abstract

Background

Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD.

Methods

We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant).

Results

Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population.

Conclusion

Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field.

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Background

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterised by combinations of hyperactivity, impulsivity, and inattention, thought to affect 5.6% of 12-18 year olds and 2.58% of adults [1, 2]. Whilst traditionally thought of as a disorder of childhood, with a typical onset before the age of 12, it is now understood that symptoms can persist into adulthood and have a significant impact on many aspects of life, including physical health [3,4,5,6].

In respect to the links in research between ADHD and physical health, firstly there is a wealth of literature on the association between ADHD and higher rates of health risk behaviours, including smoking, alcohol abuse, substance misuse, risk-taking behaviour, self-harm, obesity and sleep disorders [6,7,8,9,10,11]. These findings are reproduced in studies using various methods including traits-based approaches, mendelian randomisation, case-control and longitudinal follow-up studies.

Secondly, there is a growing body of evidence demonstrating links between ADHD and non-communicable diseases. A large genetically informed Swedish registry study found that participants with ADHD were at higher risk for 34 out the 35 conditions studied compared to those without ADHD, including nervous system and respiratory disorders [12]. Other studies have also demonstrated high rates of neurological and respiratory disease, as well as gastrointestinal disorders and cardiovascular disease [13,14,15]. Furthermore, Stickley and colleagues [15] demonstrated that multimorbidity was predictive of whether study participants had ADHD. In respect to mortality, several longitudinal studies have noted increased mortality rates amongst people with ADHD. Whilst these appear to be driven by accidental and unnatural deaths, the cause remains contested [6, 16,17,18].

There have been various attempts to explain the inequalities in physical health outcomes for this population. It has previously been suggested that people with ADHD may be less likely to follow government recommendations on health promotion, even when controlling for socioeconomic status [19]. This is echoed in work by Cherkasova et al, who reported that the persistence of ADHD symptoms into adulthood mediated poorer functional outcomes [6]. However, the large sibling analysis study of DuRietz et al highlights the importance of genetic risk factors in the association between ADHD and physical health, supported by their finding that shared genetic factors explained 60-69% of the relationship between ADHD and respiratory, musculoskeletal and metabolic disorders in their sample [20].

There have been previous studies suggesting that some of the health risks in ADHD may be mitigated by appropriate treatment of ADHD using medication (e.g., meta-analyses demonstrating the efficacy of medication in improving sleep or substance misuse [7, 21, 22]). In addition to medication, psychosocial interventions are likely to be important in the prevention and mitigation of health risks in ADHD, when provided as part of a holistic approach. Importantly, psychosocial interventions can also constitute health promotion and support health autonomy, which may be of particular significance to young adults transitioning to adult care [23,24,25,26,27]. There is a small and heterogenous body of research examining the efficacy of psychosocial interventions in the management of physical health problems associated with ADHD [28,29,30,31,32,33]. However, this has not yet been synthesised to identify the nature and extent of existing research or indicate targets for future research and intervention development. This is a significant evidence gap given the poorer physical health of people with ADHD, which adversely affects quality of life and economic, social and health outcomes [34,35,36,37].

This scoping review aims to identify and describe existing psychosocial interventions for physical health in young people and adults with ADHD, including those in preliminary stages (e.g. feasibility trials).

Methods

Given the lack of previous reviews in this field, and the need to provide a broad overview of available evidence, a scoping review was chosen to identify psychosocial interventions addressing physical health in ADHD. Scoping reviews are suitable for identifying research gaps, summarising research findings, clarifying concepts, and making recommendations for future research [38]. This scoping review aimed to identify relevant literature using an inclusive approach incorporating different methodologies and reflecting varying levels of quality [39].

The review followed a five-stage process as described by Arksey and O'Malley: identifying the question, identifying relevant studies, study selection, charting the data and collating, summarising and reporting the results [40, 41]. We found no previous scoping reviews or systematic reviews examining this topic. We have reported our scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension checklist (see supplementary materials) [42]. We did not pre-register this review protocol.

Eligibility criteria

Studies were eligible for inclusion in the review if they met four key eligibility criteria: a population aged 16 years or older (or including substantial representation of this group), diagnosed with ADHD (either clinically diagnosed, self-reported, or using a standardised diagnostic measure) (population and context), the introduction of a form of structured psychosocial intervention within an experimental trial (concept) and the measurement of a physical health outcome (outcome).

In respect to defining the population of interest, we sought interventions that would be relevant to young people and adults, of a transition care age group (16-25 year olds). This age bracket is important for two reasons. Firstly, it is well-understood that ADHD care begins to decline for older adolescents, as medication adherence and service access decline [25, 26]. Secondly, the transition to adulthood is when adolescents begin to take responsibility for their own health and health behaviour, and therefore support around independent health management would be timely [23, 24, 27].

To meet the scoping review’s aim of identifying all interventions relevant to the population, we included studies of under 16s, and some studies of adults over 25 years old. This was the case where the proposed intervention had methods or findings that were clearly applicable to 16–25-year-olds. ‘Applicable’ in this context was defined as interventions that could be utilised in our population of interest without need for modification of the intervention itself. Given that this was a scoping review, we judged this was an appropriately inclusive approach to exploring a limited literature, with similar expanded definitions of age categories having been used in previous scoping reviews [43,44,45]. We did however exclude school-based interventions, (e.g., those which use a school or classroom-based approach in childhood) [46]. This was because our team considered that interventions set within classroom environments would not be replicable in young adults. Where inclusion criteria were borderline, decisions were made on a case-by-case basis and discussed by at least two reviewers (TND and JW).

For the purposes of this review, psychosocial interventions were defined as structured interventions that adopt a psychological, educational, or social framework. This definition was adapted from Ruddy and House, adapting the definition to include digital health interventions, which have taken prominence since the publication of their definition in 2005 [47,48,49]. In this review, we included search terms pertaining to psychotherapeutic interventions, behavioural interventions, digital interventions, peer/support groups, exercise-based interventions, and psychoeducational interventions.

Study outcomes were checked during the screening process to identify physical health outcomes. We defined physical health broadly as a chronic physical health problem and/or a current behaviour that confers a long-term physical health risk (e.g., unprotected sex, smoking). This definition was formed in collaboration with the Managing Young People with ADHD in Primary Care (MAP) study academic team and research advisory group (RAG) which was composed of people with lived experience [50]. Physical health outcomes included scales (e.g., sleep indices, health-related quality of life), objective measures (e.g., reductions in alcohol consumption, abstinence) and subjective measures (e.g., sleep diaries). Studies were excluded if there was no clear physical health outcome recorded in either the published paper or its supplementary materials. We deliberately did not pre-define specific physical health concerns in our search. This was because, in conjunction with our MAP study advisory team, we felt this would be a more appropriate approach for an initial exploration aimed at capturing the breadth of health problems being addressed. In pre-defining health problems, we considered there would be a risk of excluding studies which incidentally notes physical health outcomes.

Studies from the grey literature were excluded, as well as studies not written in the English language, due to resource limitations. We also excluded non peer-reviewed scientific literature (e.g. dissertations, preprints, conference proceedings). We did not exclude studies where participants received a biological therapy (e.g. medication, bright light therapy), if they also received a psychosocial intervention. This approach enabled a broad spread of relevant included studies and met the review’s objective of identifying feasible interventions.

Search strategy

The search strategy was developed with information specialists at the at the University of Exeter. Searches were performed using MEDLINE (1946 onwards), Embase (1974 onwards ) and PsycInfo (1803 onwards ), via the Ovid© platform.

Searching took place in two phases, to ensure adequate inclusion of young people/youths and adults (Fig. 1). In the first phase, we used our young people/youth search terms and our adult terms (search dates 7th October 2022 and 24th November 2022 respectively). The process of search design through the completion of title and abstract screening was from September 2022 to December 2022, with full-text inclusions from this search decided by January 2023.

Fig. 1
figure 1

Flow diagram of database searches, title/abstract screening and full text screening

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In order to ensure that we included publications relating to applicable interventions that were tested in a younger population (i.e. 13-17 year olds), a second phase included a search using adolescent search terms, conducted in February 2024, with title/abstract and full text-screening screening completed in March 2024. This search included literature published up until February 2024. Full details of all searches can be seen in supplementary materials.

ADHD search terms were adapted from the search terms used by the National Institute for Care and Health Excellence (NICE) in their development of ADHD guidance [51]. Search terms for psychosocial interventions were adapted from the search terms used by NICE in the development of their guidance for lower back pain and diabetes [52, 53]. These were adapted as appropriate for our search and are available in supplementary materials.

Study selection

The study selection process is highlighted in Figure 1. The first set of searches (young people/adults, October-November 2022) yielded 5258 results, and the second (adolescents, February 2024) 4293.

These studies were then screened by title and abstract independently by two reviewers (JW, TND), against inclusion criteria, with disagreements resolved by discussion. Where disagreements were not resolved, this was taken to the wider study team and MAP study principal investigator (PI) (AP). Citation chasing was also performed by examining references from relevant review and protocol studies to identify any further studies not found in our search.

This left 61 records for full-text screening. These were again double-screened (JW, TND), with disagreements resolved by discussion, and where necessary the wider study team, and principal investigator (AP), leaving 22 articles which were included at full-text screening. Reasons for full-text exclusions are given in Figure 1.

Data extraction and charting

Studies were collated using a data extraction form and shared spreadsheet in which the data could be recorded. This data extraction tool was piloted on five papers initially, reviewed and then used for all papers. These were single entered by researchers (JW, AM), with all entries were re-reviewed after first entry (JW). The data extraction tool can be found in supplementary materials.

The data extraction process used narrative synthesis to collate information on what the intervention was targeting (and rationale), what outcomes were measured and how these were measured. This involved extracting study details (i.e., title, author), study design (comparator, methodology), population characteristics (age, gender, location of study), intervention framing of study (i.e. rationale for intervention chosen), ADHD definition (e.g., meeting DSM-V criteria, clinically diagnosed ADHD), relevant additional inclusion/exclusion criteria, primary and secondary outcomes of the studies and measures used, physical health findings, attendance reporting and ADHD symptom findings. Where studies had noted qualitative feedback on the interventions used, this was also collated and charted under outcomes.

Data were then charted in tabular form, by physical health problem addressed, with the extracted details on the studies provided alongside this.

Results

Twenty-two studies met our inclusion criteria (Table 1). Physical health outcomes targeted or reported included sleep (seven studies), smoking (three studies), substance misuse (four studies), physical activity and/or weight (six studies) and more general/broad physical health outcomes (three studies). It should be noted that one study (Bjork et al.) covered two health outcomes (smoking, physical activity) [54]. Studies covered an overall age range of 11-65. Of these, eleven studies examined adolescents, ten studies examined adults (although four did not provide a precise age range), and one study examined both (14–30-year-olds) [55]. Only one included study had participants exclusively between 16-25, but this was a college-based study [56].

Table 1 An overview table of the studies, by health issue addressed
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In respect to ADHD concept, 14/22 studies were based on clinical diagnosis, whilst 6/22 were criteria based, 1/22 used self-reported ADHD and 1/22 used ‘documented’ ADHD (Table 1). Where studies reported gender (n=16), 10 studies were at least 50% female, ranging from a 32% to 83% male sample. 14/22 studies included a physical health outcome as a primary outcome or target, whilst 5/22 studies included physical health as a secondary outcome [55, 56, 60, 61, 74, 75]. 12/22 of the studies were of a psychotherapeutic or behavioural intervention, 4/22 of psychoeducation, 4/22 social/exercise interventions and 2/22 digital interventions. Most of the studies were conducted in the USA (8/22), followed by Sweden (5/22), the Netherlands (2/22) and Germany (2/22), with the others located in Brazil, Norway, Belgium, Denmark and China.

In respect to methodology, 13/22 studies were randomised controlled trials (RCTs) [56, 63, 66,67,68, 70, 75,76,77], 6/22 studies were single group (before and after) comparisons [54, 57, 59, 60, 69, 73], one study was secondary analysis of RCT data [58], one study compared a single-group pre/post intervention with a previous study data [74], and finally one study compared two groups before and after comparison (not RCT) [64]. Apart from one study which was unfunded [73], and one study which did not clarify its funding [54], 20/22 studies were funded from non-commercial sources.

Sleep

Sleep was examined as a health outcome in seven included studies, as described below in Table 2 [55, 57,58,59,60,61, 77]. All used different interventions, which can be broadly divided into psychoeducational interventions and psychotherapeutic interventions (e.g., adapted cognitive or dialectical behavioural therapy). One study examined primarily bright light therapy, however used psychoeducation around sleep in their methodology for both active arms and the placebo arm (hence its inclusion). Only one study included people with diagnosed sleep problems and ADHD, with the others including either a general ADHD population or those with self-reported sleep problems. Four of the studies included are completed or ongoing RCTs, with the rest being pilot/feasibility studies or single group intervention studies. Included studies had small sample sizes (three had fewer than 20 participants, only one had a sample size greater than 100) and covered a wide age range (13-63). Three studies suggested a rationale for their intervention within ADHD in relation to health needs; ADHD symptoms/executive dysfunction impacting on habits and sleep hygiene as the mechanism of sleep problems in ADHD [58, 59, 62] and delayed circadian rhythm/preference [58, 59]. Whilst Becker et al referenced problems of adolescence in sleep, they did not explain the rationale within ADHD [57]. Van Andel et al (RCT (melatonin versus placebo versus melatonin and bright light therapy, where all arms received psychoeducation) did not find improvements in sleep for any group [58]. Meyer et al (RCT) also did not find sustained improvements in sleep for either their behavioural or control (psychoeducation group) [55]. However, the single group intervention and pilot studies did find evidence supporting behavioural and psychosocial interventions, including pilot feasibility data from Keuppens et al RCT [77]. Results also demonstrated tolerability and feasibility of these sleep interventions in ADHD; all completed studies noted good attendance at and compliance with interventions, whilst Becker et al., Jernelov et al. and Keuppens et al. noted participants’ satisfaction with interventions. The subjective positive feedback received in Becker et al. included increased responsibility for health, working with a therapist and increased knowledge [57]. In Jernelov et al., feedback received was the use of routines and structure [59]. For Keuppens et al., thematic analysis generated themes for adolescents around having more control and independence around sleep, and that both parents and adolescents had better understanding of the impact of ADHD on sleep [77].

Table 2 Studies examining sleep as a health outcome
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Smoking

Smoking was examined as a health outcome in three studies, as presented in Table 3 [54, 63, 64]. These studies had an average sample size of 45 and covered both adolescents and adults. One of the studies was a randomised controlled trial (RCT), whilst the other two were a single-group intervention study and an ADHD vs non-ADHD single intervention study, neither with control groups. Two of the studies used psychoeducation, including components about smoking, whilst one of the studies used monetary incentives to encourage participants to stop smoking. In respect to mechanisms, two of the three studies suggested a rationale for their choice of intervention; targeting executive dysfunction in ADHD that may perpetuate smoking [54, 64] and mental health difficulties in ADHD precipitating poor health behaviour [54]. The results were variable. The two studies examining tobacco use (Kollins et al., Bjork et al.—non-randomised group trials) found no interventions with sustained effects, reporting that participants largely went back to smoking (irrespective of ADHD). Corona et al.’s study (also an RCT) found that the attitudes of participants towards substance misuse changed significantly following specific work around tobacco, however they did not examine tobacco use directly. Bjork et al and Corona et al both noted that participants generally adhered well to the intervention [54, 63]. In respect to specific positives of interventions, Björk et al. cite peer support dynamics in their group [54].

Table 3 Tables reporting studies on smoking
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Substance misuse

Outcomes related to alcohol and substance misuse were examined in four studies, as seen in Table 4 [65,66,67,68]. These all had relatively larger sample sizes (range=70-303) and were RCTs. They all included participants who had diagnosable substance misuse disorders, rather than subclinical problematic substance use, (in contrast to the studies of sleep). Two of the studies examined cognitive behavioural therapy (CBT) paradigms, whilst one study evaluated at motivational interviewing (MI) and behavioural action and one used both CBT/MI. Two studies identified a rationale for their choice of intervention; untreated ADHD symptoms being associated with poorer outcomes in substance use disorder [67, 68], and the challenges of people with ADHD within a college environment putting them at greater risk for long-term substance misuse [66]. All four studies (RCTs) reported significant improvements in measured outcomes with a psychotherapeutic intervention, including Riggs et al. and Thurstone et al. which found that behavioural therapy and medication had comparable effects in the treatment of substance use disorder in patients with ADHD [67, 68].

Table 4 Studies detailing alcohol and substance misuse
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Physical activity/weight

Studies reporting physical activity or weight outcomes were much more heterogenous in their design, including two RCT protocols, two completed RCTs and two single group interventions (Table 5). Studies in this category had generally small sample sizes (n<50), except Lindvall et al (N=120) [71] and comprised a younger adult demographic (11-30). Only two studies provided a rationale for intervention explicitly highlighting health in ADHD (both referencing poor health behaviour in ADHD) [54, 71]. All involved promoting physical activity, through structured exercise classes, wearable technology/social media and psychoeducation respectively. Furthermore, Schoenfelder et al. report qualitative feedback that the intervention increased awareness of activity levels and ADHD symptoms [69]. Both RCTs (Silva et al, Converse et al [56, 72]) reported improved physical functioning (Converse et al using a questionnaire, Silva et al using objective biometrics), as did both single group intervention studies (Schoenfelder et al finding an increase in step count, Bjork et al in weekly physical activity [54, 69]).

Table 5 Studies addressing physical activity interventions
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Unspecified physical health outcomes

Three studies examined unspecified physical health outcomes related to quality of life and did not fit well into other categories (Table 6) [73,74,75]. Enggaard et al. reported a study of adolescents with a comorbid physical health disorder, examining guided self-determination as a way of improving their engagement in physical healthcare, given the association of ADHD with physical comorbidity. They found that guided self-determination was effective in improving patients’ self-confidence in managing their conditions, and that adolescents were positively engaged in creating the self-management strategies. The second study examined effects of medication versus cognitive behavioural therapy in 124 young adults on core ADHD symptoms and secondarily recorded improvements in physical health as part of questions on the World Health Organisation (WHO) quality of life scale [78]. This study [74] did not identify a rationale for their intervention’s impact physical health. Thirdly, Geissler et al developed a modular treatment programme for adolescents with continual ADHD-related impairment (under routine care). Their rationale was the breadth of functional impairment faced by adolescents with ADHD, and the lack of related interventions. Their developed RCT protocol includes a health-related quality of life questionnaire as a secondary outcome, and their intervention includes a module on substance use [75].

Table 6 Studies addressing a component of physical health without a singular defined physical health problem
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Discussion

This scoping review aimed to identify psychosocial interventions that have been designed for physical health problems in ADHD, and which physical health problems they target. We found 22 studies of interventions which measured at least one physical health outcome, with 16 specifically targeting physical health outcomes. In the other studies, measures of physical health (including sleep quality or health-related quality of life measures) were included as secondary outcomes of interventions primarily targeting reduction of core ADHD symptoms [55, 56, 60, 61, 74, 75]. Included studies were grouped under five categories, dependent on the outcomes explored. These were sleep, smoking, substance misuse, physical activity/weight, and general health outcomes, utilising psychoeducational, behavioural and social paradigms (Table 1).

The main finding from this scoping review is a relative paucity of research into interventions targeting physical health outcomes in ADHD, and furthermore the lack of larger programmes of research aiming to address the health problems identified. Generally, the included studies lacked detail on the framing and theoretical basis both of individual health problems (who is affected, and how that health problem is quantified) as well as of health problems in ADHD in general (the 'mechanism' of ill health targeted by such interventions). Fortunately, there is some similarity amongst the identified literature explored in respect to the psychosocial interventions used and identified positive aspects of interventions, which may form a basis for the development of a more coherent evidence base in this field.

Framing of health problems

There is substantial heterogeneity in this literature in respect to how health problems were defined and measured, with variable inclusion criteria and outcome measures between studies. For example, when exploring sleep, some studies examined those with formal sleep diagnoses [58], whilst others specifically excluded those with diagnosed sleep problems [59, 62]. In relation to outcome measures, smoking was conceptualised in a different way by each of the studies included (attitudes to tobacco, carbon monoxide levels and self-reported reductions). Some studies used standardised quality of life measures, such as the WHOQL-BREF, SF-36, and KIDSCREEN-10 [56, 74, 75]. However, quality of life measures are of limited utility in assessing physical health outcomes, often being too broad and multi-factorial. We also note a recent scoping review finding that the SF-36 is frequently erroneously reported as a global measure of quality of life, which although Converse and colleagues did not do, highlights a wider problem with the misapplication of quality-of-life measures [79]. The heterogeneity of included studies’ outcome measures highlights the need for consensus in respect to measures used in assessing the physical health outcomes of populations with ADHD. It was interesting that three of the six studies that did not explicitly target a health problem used sleep outcome measures in behavioural interventions [55, 60, 61], which may highlight the importance of sleep to young people and families, and the impact poor sleep has on symptoms and functioning [80, 81].

Such extensive variability in inclusion criteria and outcome measurements limits both the clinical and academic applicability of studies’ findings. This variability is likely to result from the absence of a common framework that mechanistically relates ADHD and physical health outcomes.

Whilst there was some commonality in intervention modalities (e.g., behavioural interventions, educational interventions), authors tended not to explain clearly which mechanism within ADHD their health intervention was targeting, beyond a select few [54, 57,58,59, 62, 64, 66, 71, 73]. Challenges surrounding poor conceptual framework of mechanisms of ADHD in relation to health are alluded to in the discussions of some of the included studies [54, 58, 59, 64, 66, 67, 73]. As mentioned in the introduction, the ‘causal pathway’ of increased health risk in ADHD is likely to be complex and multifactorial, however a sound understanding and explicit logic model is an important basis for the development of preventative interventions in this population. Findings from this scoping review suggest that that clearer framing of the problem is required to properly develop interventions, through better definition of health problems with inputs from existing research and stakeholder perspectives (which may explain the currently disjointed view of this field) [82].

Positive aspects of interventions

Psychoeducation was common amongst health interventions studied, with 4/22 solely examining a psychoeducational intervention, and Meyer et al comparing a behavioural intervention with psychoeducation as control [55]. These studies tended to recruit younger participants who were ‘at risk of’ particular health problems, with only Bjork et al using psychoeducation in an adult context. This raises questions about where future research work should focus, primary or secondary prevention in young people and adults with ADHD.

‘Self-efficacy’ or independence over one’s health was also a concept referenced explicitly in the qualitative feedback from participants included in several of the studies we reviewed [57, 73, 77]. Furthermore, all the interventions in included studies all required commitment to interventions and required people to actively engage in their own care, the importance of which has been studied previously in patients with chronic conditions [83,84,85]. Self-efficacy is widely cited as being important in ADHD management [86, 87]. This is explicitly highlighted by Enggaard et al., who demonstrated that their guided self-determination intervention promoted efficacy and strategy formation amongst patients with ADHD [73].

Regular and consistent interventions (regular sessions, commitment to a regimen), were explicitly highlighted in the qualitative participant feedback on several interventions [59, 69]. This is particularly pertinent in ADHD, where difficulty with day-to-day structure and organisation is something that people highlight as a contributor to health and social outcome inequalities [88,89,90].

Peer dynamics were also referenced by several papers [54, 56]. Bjork et al. reported that participants found the peer support dynamic of such interventions useful, whilst Converse et al. reported that participants from an earlier survey used in the development of their intervention would have preferred a mixed ADHD/non-ADHD group [91]. From a brief review of the literature, the perspectives on peer support in adult ADHD have not yet been formally studied but could be looked at in future work. It should be noted that, in discussions about ADHD in online spaces, community and identity appear to be important themes in living with ADHD [87, 92].

If the literature in this field were more coherent, it would make it easier to explore facets of interventions in this field more rigorously, using methods such as intervention component analysis. This would be especially interesting given the findings of Meyer et al, which suggest comparable effects between psychoeducation and behavioural intervention [55].

Strengths and limitations

This study addresses a novel research question in the literature and our search strategy identified papers in line with research aims. By not defining physical health in our search strategy, we were able to identify a broad range of interventions, targeting for example sleep, smoking, alcohol/substance misuse, physical activity, weight, and physical comorbidity.

Limitations of our scoping review include challenges around defining population age range. Of the 22 studies included, only one study explicitly fell within the 16-25 age range [56]. Whilst it may have been preferable to strictly apply the lower age limit of 16 years, doing so would have risked losing studies with applicability to our 16-25 age group (e.g., Schoenfelder and colleague’s study of digital health, many of the sleep behavioural interventions) [57, 61, 69]. The same would apply to the upper age limit, where studies such as Björk et al would be excluded if a strict age basis was applied (despite this study having clear relevance to our question) [54]. Therefore, we adopted a pragmatic approach, informed by consultation with MAP study colleagues and our RAG. We accept that the interventions would likely have different effects than those reported by the studies, if they were to be repeated in a strictly 16-25 age group. This would be an important subject of future work, supported by framework development.

By defining ‘types’ of interventions we were interested in for our search (psychotherapeutic, behavioural, technological, support groups, exercise-based, psychoeducational) we may have inadvertently precluded the inclusion of other interventions in the field. However, to deliver the review with the resources available, and following consultation with our RAG, it was decided to prioritise an open approach to defining physical health problems, which came at the cost of being more restrictive in terms of types of intervention reviewed. As this research area matures, and concepts related to ADHD and physical health become more clearly defined, it will become easier to conduct evidence syntheses of literature on this topic.

Furthermore, it was notable that there were limited interventions surrounding established chronic physical disorders targeted at adults with ADHD, given the known associations of ADHD with chronic health problems [12, 14, 93]. However, this is likely because our search filters examining psychosocial interventions would not have been inclusive of tailored medical interventions (e.g. if a study were examining supporting people with ADHD and diabetes in their medication compliance). A focussed review of chronic disease management in ADHD in adults would be useful in exploring this important area.

Conclusion

This scoping review set out to identify existing psychosocial interventions for physical health in ADHD, with a focus on interventions applicable to a transition care age range (16-25 year olds). Findings demonstrate that whilst such interventions have been developed and reported, the small evidence base surrounding them limits their current application. Future work in this field needs to focus on the development of a conceptual framework for the origins of the physical health challenges and linked health inequalities we see in ADHD. Alongside this, more research is needed into creating standardising how health outcomes are measured and reported in ADHD research in this field, such that evidence can be better synthesised and ultimately realised into clinical applications.

Availability of data and materials

The datasets generated and/or analysed during the current study are available via the MEDLINE (https://www.nlm.nih.gov/medline/medline_overview.html), APA PsycInfo (https://www.apa.org/pubs/databases/psycinfo) and EMBASE (https://www.embase.com/) databases.

Abbreviations

ADHD:

Attention deficit hyperactivity disorder

CBT:

Cognitive Behavioural Therapy

DSM-V:

Diagnostic and Statistical Manual of Mental Disorders Fifth Edition

K-SADS-PL:

Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime

MAP:

Mapping ADHD services in Primary Care Study

NICE:

National Institute of Health and Care Excellence

RAG:

Research Advisory Group

RCT:

Randomised Control Trial

SF-36:

36-item Short Form Survey

WHO:

World Health Organisation

WHOQL-BREF:

World Health Organisation Quality of Life (Brief) Scale

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Acknowledgements

we would like to express our thanks to our public patient involvement group and research advisory group, who facilitated our approach to this important research topic. We would also like to thank Reviewer 2, whose detailed and thoughtful comments have greatly strengthened the content and form of this manuscript.

Funding

AP is funded by a National Institute for Health and Care Research (NIHR) Three Research Schools’ Mental Health Research Fellowship (located within the Exeter NIHR School for Primary Care Research (SPCR); Grant Reference Number MHF008). Tamsin Newlove-Delgado was funded by a NIHR Advanced Fellowship (NIHR300056) whilst undertaking this work. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

JW is supported by the NIHR Oxford Health Biomedical Research Centre (BRC)

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  1. 2.05 South Cloisters, 2.05 South Cloisters, St Luke’s Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK

    John Headley Ward, Audrey McBride, Anna Price & Tamsin Newlove Delgado

  2. Royal Devon University NHS Foundation Trust, Exeter, UK

    John Headley Ward

  3. Department of Psychiatry, University of Oxford, Oxford, UK

    John Headley Ward

  4. Oxford Health NHS Foundation Trust, Oxford, UK

    John Headley Ward

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JW was responsible for hypothesis generation, design of literature search, title/abstract screening, data extraction, analysis and manuscript preparation. AM was responsible for data extraction and manuscript preparation. AP was responsible for design of literature search and manuscript preparation, as well as project oversight. TND was responsible for title/abstract screening and manuscript preparation, as well as project oversight.

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Ward, J.H., McBride, A., Price, A. et al. Psychosocial interventions for improving the physical health of young people and adults with attention deficit hyperactivity disorder: a scoping review. BMC Psychiatry 24, 569 (2024). https://doi.org/10.1186/s12888-024-06009-2

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