Tatja Hirvikoski

Objectives: It remains unclear how much parents with ADHD benefit from standard parenting interventions such as behavioral parent training (BPT). Our objective was to systematically review the literature on BPT aimed at adults with ADHD. As few studies with this focus were identified, we exploratively broadened our scope to quantitatively combine and qualitatively analyze studies of behavioral parenting interventions reporting parental ADHD characteristics. Method: A systematic review was conducted of studies evaluating BPT for (targeting) parents with ADHD. The broader literature was explored through meta-regressions and qualitative content analysis. Results: In the systematic review, five studies focusing on parents with ADHD were identified, including two randomized controlled trials. These studies used different strategies to facilitate parents’ BPT implementation: treating the parents’ ADHD or adapting the BPT itself for adults with ADHD. The number of studies was too small to meta-analyze but narratively suggested that BPT delivered with consideration of parental ADHD functioning and needs can be associated with, for example, increased positive parenting skills. None of our main meta-regressions (5–14 studies) associated parental ADHD with BPT outcomes beyond the trend level. The qualitative literature analysis (54 reports) suggested several ways to adapt the contents and delivery of BPT for parents with ADHD and their contexts. Conclusion: This study highlights the potential of tailoring BPT to adults with ADHD. It also emphasizes the need for further research to determine the efficacy of BPT for parents with ADHD and to identify which BPT-related, individual, and contextual factors influence their BPT engagement and outcomes.

Background: Autistic people are at an elevated risk of premature mortality; however, few studies have identified factors that explain this association. Co-occurring psychiatric conditions are a strong candidate, given that autistic people are at a high risk of such conditions and these conditions are broadly associated with premature mortality. Aims: We aimed to investigate the degree to which co-occurring psychiatric conditions are associated with premature mortality in autistic people. We explored these associations across sex and co-occurring other neurodevelopmental conditions. Method: We conducted a cohort study based on registry linkage. We identified 2 958 317 individuals born in Sweden from 1974 to 2004, including 70 546 (2.38%) individuals with an autism diagnosis. We identified diagnoses of 13 psychiatric conditions. The cohort was followed up from age 16 to age 46 at the oldest. We compared the risk of mortality (from all-causes, suicide, other external causes and natural causes) across autistic people with psychiatric conditions and (a) non-autistic people without psychiatric diagnoses; (b) autistic people without psychiatric diagnoses; and (c) non-autistic people with psychiatric diagnoses. We conducted separate analyses by sex and co-occurring neurodevelopmental conditions. Results: The mortality rate in autistic people with psychiatric conditions was 3.2 deaths per 1000 person-years, which was higher than that observed in non-autistic (0.27 deaths per 1000 person-years) and autistic people without psychiatric conditions (0.96 deaths per 1000 person-years). The relative risk of premature mortality was higher in autistic people with psychiatric conditions compared with both non-autistic (hazard ratio 13.85, 12.86–14.91) and autistic people (hazard ratio 3.44, 2.94–4.02) without psychiatric conditions and also exceeded the risk of premature mortality in individuals with psychiatric conditions alone (hazard ratio 1.47, 1.37–1.58). Similar patterns emerged across sex, intellectual disability and attention-deficit hyperactivity disorder. Conclusions: Co-occurring psychiatric conditions are a risk factor for premature mortality in autistic people. Timely detection and treatment of such conditions in autistic people may facilitate healthier, lengthier lives for autistic people.

High levels of parental stress and psychological inflexibility are common among caregivers raising children with neurodevelopmental disabilities. Navigator ACT is a group‐based treatment developed to increase psychological flexibility and reduce the impact of stress among parents of children with various disabilities (e.g., autism spectrum disorder, ADHD, intellectual disability, acquired brain injury). This two‐arm randomized controlled trial ( n = 137) was conducted in Sweden within outpatient disability services setting, and pre‐registered in the clinical trials register. To compare conditions, stressed and distressed parents were randomly assigned to either the ACT group ( n = 70) or treatment‐as‐usual (TAU, n = 67). In the ACT group, 83.3% completed the full course of treatment. Mixed‐model linear regression analyses indicated that ACT was significantly more effective than TAU in reducing self‐reported psychological inflexibility ( p < 0.002, d = 0.84) and parenting stress (p < 0.001, d = 0.38). These improvements were maintained at four‐month follow‐up. Parents in the ACT group also reported significantly greater improvements in their children's prosocial behaviors ( p < 0.05, d = 0.46). However, no significant group differences were observed in levels of parental depression, anxiety, mindfulness, or child's difficulties. ACT group treatment demonstrated promising outcomes in reducing psychological inflexibility and parenting stress in a mixed group of parents of children with different neurodevelopmental disabilities, suggesting that parent support interventions do not need to be specific to the child's diagnosis.

Background: Individuals with intellectual disabilities (ID) are disproportionately exposed to several risk factors for suicidality. However, no meta‐analysis has yet quantified the relative risk of suicide and self‐harm, including suicide attempts, within this population. The aim of this project was to bring together and synthesise the research on suicidality among individuals with ID. Methods: A systematic review and meta‐analysis was carried out. Medline, Embase, Web of Science and PsycInfo were searched from inception through 4 August 2025. Observational studies with a quantitative design, evaluating the relative risk of suicide or self‐harm, including suicide attempts, in individuals with and without ID, were included. Risk of bias was assessed using a shortened version of the Risk Of Bias In Non‐randomized Studies–of Exposure (ROBINS‐E) checklist. A random effects model was used to synthesise the results. Results: Eleven primary studies were included in the review ( n = 241 438). The level of ID severity was only presented in two articles. Compared to the general population, the pooled relative risk for death by suicide was 0.54 (95% CI 0.33 to 0.89, k = 6, I ² = 77%) and the relative risk for self‐harm was 3.16, (95% CI 2.3 to 4.35, k = 6, I ² = 89%). Conclusion: The findings suggest that individuals with ID have an elevated risk of self‐harm but a lower risk of dying by suicide compared to the general population. However, these results should be interpreted with caution due to the limited number of primary studies and substantial between‐study heterogeneity. Further, separate analyses of mild versus moderate‐to‐profound ID are warranted.

Background: An increasing number of young adults in Sweden are being granted support in daily living through social services. To enhance service planning and resource allocation for this growing group of young service users, we aimed to provide an overview of the social and health-related circumstances of young adults recently granted support in daily living. We had a particular focus on mental health service utilization and whether socio-demographic factors influence the use of care. Methods: Swedish nationwide register data were used to describe the sociodemographic characteristics and utilization of mental health services, including outpatient and inpatient care, treatment for suicidal behavior and pharmacological treatment. Sociodemographic predictors (sex, age, country of birth, education, and parental education) of mental health service utilization were explored using binary logistic regression. Results: All young adults (ages 18–29) granted support between 2017 and 2021 (N = 15,024; 49.2% female) were included. Unfavorable social circumstances were common, including truncated education, unemployment, and the need for financial assistance. Many had a history of psychiatric inpatient care (40.0%) and treatment for suicidal behavior (15.7%). The majority received psychiatric outpatient care (71.6%) and psychopharmacological treatment (73.9%) during their granting year. Common conditions for care included attention deficit hyperactivity disorder, anxiety and fear-related disorders, mood disorders, and autism spectrum disorder. Co-occurring conditions were prevalent. Utilization of mental health services was more common among females, particularly regarding treatment for suicidal behavior (adjusted OR 2.52; 95% CI 2.16–2.93). Higher educational level and being Swedish-born were associated with a greater likelihood of utilizing outpatient care and psychopharmacological treatment. In contrast, those born in Sweden were less likely than foreign-born to be admitted to inpatient care (adjusted OR 0.66; 95% CI 0.59–0.74). Conclusions: While social services recognize the support needs of this group of young adults, our findings suggest that sociodemographic characteristics such as sex, education level, and country of birth may facilitate or obstruct their access to mental health services. It is essential to coordinate efforts so that young adults with support in daily living can seek and access the mental health services they need. Clinical trial number: Not applicable.

[This corrects the article DOI: 10.2196/49305.].

TRANSITION is a structured behavioral and educational program to support young adults with mental, behavioral, and neurodevelopmental conditions transitioning into adulthood. This study investigated its feasibility as an add-on to regular daily living support in social services. A non-randomized single-arm mixed method design was used. Twenty-eight service users, aged 19-29, were enrolled to participate in the program for 20 weeks alongside their support workers. They rated their engagement and satisfaction and reported any adverse effects. Eighteen support workers received training in the program. A subsample of service users (n = 11) and support workers (n = 9) was interviewed about their experiences. Qualitative content analysis using an abductive approach and quantitative analyses with descriptive statistics was integrated and mapped to specific feasibility areas in a joint display. Service users completing the study (n = 26) generally rated satisfaction and engagement highly. While some service users experienced stress related to their participation, no serious adverse events were reported. Service users and support workers highlighted the program's clear structure and focus on specific goals as particularly valuable. The results indicate that TRANSITION is a feasible complement to regular support in social service settings. Further evaluation of the program is justified.Implications for rehabilitationThe TRANSITION program is a feasible add-on to regular support in daily living for young adults with mental, behavioral, and neurodevelopmental conditions.Support workers can deliver the program, although training, practice, and regular supervision are needed.Service users perceive that the program adds clarity and valued direction to their support.The program may help service users and support workers become more aware of the inherent benefits of user engagement in daily living support.

Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants’ understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module’s topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants’ autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: –0.13, 95% CI –1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363

Background: Parents of children with neurodevelopmental conditions (NDC) are at risk of experiencing elevated levels of parental stress. Access to robust instruments to assess parental stress is important in both clinical and research contexts. Objective: We aimed to evaluate the psychometric properties of a Swedish version of the Parental Stress Scale (PSS), completed by parents of 3- to 17-year-old children, with and without NDCs. Method: Main analyses were conducted on data from three independent samples: a community sample (n=1018), a treatment-seeking sample of parents of children with various disabilities (n=653), and a sample of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) who themselves reported varying ADHD symptom severities (n=562). Additional analyses were enabled by the use of data from a complementary test-retest sample (n=337). Results: The internal consistency of the PSS was good (Cronbach’s alpha, α=.87) and its test-retest reliability moderate (ICC=.66). The scale correlated in the expected direction with related constructs (r=.50–.56 in the community sample). An exploratory factor analysis found its internal structure to reflect two aspects of parental stress: Lack of Parental Rewards and Role Satisfaction (factor 1, α=.90) and Parental Stressors and Distress (factor 2, α=.85). The treatment-seeking parents of children with disabilities reported higher parental stress than community reference parents (p<.001; Cohen’s d=1.17). Moreover, we found that parents with high ADHD symptom severity reported higher parental stress than parents with low ADHD symptom severity (p<.001; d=0.39). Conclusion: In summary, we found evidence in support of the reliability and validity of the PSS, which overall was judged to be useful as a measure of parental stress in a Swedish context. In addition, our results underline the importance of considering parental stress and related needs in assessments and intervention planning involving families of children with NDCs.