Ulf Jonsson

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 The transition to adulthood for young adults aged between 18-29 is increasingly characterized by stressors linked to risks for both short– and long term mental ill health. While a self-guided digital mental health intervention (DMHIs) holds promise as a means of support, there is a need to understand what content and features Swedish young adults and stakeholders consider the most important. OBJECTIVE Exploring Swedish interest holders’ perceptions of young adults’ user needs and priorities for content and features in a self-guided digital mental health intervention promoting their mental wellbeing during the transition to adulthood. METHODS We conducted four workshops with young adult high school students, young adults with long-term mental ill health issues and professionals (n=53) using a Nominal Group Technique (NGT). Thereafter, an expert panel of young adults (n=6) prioritized the findings from these workshops based on importance.. RESULTS The highest priorities were emotionally supportive content normalizing the ups and downs of the transition to adulthood, strengthening self‑compassion and mental health literacy, actively working towards preventing experiences of involuntary loneliness and self‑stigma. Ensuring anonymity and robust IT‑security was also viewed as fundamental for trust. In contrast, more advanced technological features, such as goal and reward systems, user-control and personalization, generative AI based support and built‑in games, were ranked lower. CONCLUSIONS This study identified key interest-group informed priorities for digital mental health interventions and translated them into a theory-informed design framework centered on supporting autonomy and user volition (“on my own terms”), competence and performance capacity (“I can handle this”), as well as relatedness and role habituation (“we’re in this together”). The findings highlight the importance of simplicity, practical skill-building for daily life, and connection with others to support usage among young adults.

Social services in Sweden are increasingly offering support to neurodivergent young adults in their daily living. Effective methods are needed to encourage young service users to actively engage in their support. This study aimed to (I) describe the process of co-producing a tool to facilitate service user engagement, and (II) explore the tool's feasibility. The co-production phase consisted of workshops with service users (n = 7) and support workers (n = 3) from three municipalities. Feasibility was assessed using a convergent mixed methods approach. Service users aged 18-29 (n = 15) and their support workers (n = 11) were invited to use the tool for four weeks. Service users completed pre- and post-measurements, and both service users (n = 12) and support workers (n = 8) were interviewed. Quantitative and qualitative findings were integrated using a narrative-weaving approach. The co-production phase resulted in a booklet containing questions that explored personal preferences. Despite implementation difficulties during the feasibility assessment, which led to a lower-than-expected completion rate (n = 10), both service users and support workers found the tool relevant and helpful. Co-production is a promising approach for enhancing service user engagement in this service setting. In further evaluation of the tool, organizational-level implementation barriers must be addressed.

Background: Recent reports point to a global and Swedish national mental health crisis among young adults. It is widely recognised that this phase of ‘emerging adulthood’ involves many challenges, stressors and uncertainties that can negatively impact mental health and well-being. In addition, these strains may be exacerbated by rapid contemporary changes in technological, societal and sociocultural contexts. Developing and tailoring interventions bolstering the mental well-being of young adults requires deeper insights into their lived experiences, self-perceived strengths and challenges. Aim: This paper has two interconnected purposes: Firstly, presenting relevant theories and theoretical perspectives at the individual, group and societal levels providing a rationale for theorised study propositions underpinning a situational analysis of Swedish young adults. Secondly, building on this theoretical foundation, the aim is to describe a protocol for a case study and situational analysis examining how Swedish young adults from Generation Z experience their transition to adulthood, its impacts on their mental health, describing their mental health literacy, occupational balance, and support needs. Method: This case study protocol outlines a holistic, single-case study design employing a flexible approach. Data will be collected in Sweden through focus groups and individual interviews with stakeholders, young adults, and their parents. Existing and available mental health and well-being promotion in Sweden will be mapped through online searches. The various data sources will initially be analysed separately using thematic analysis. Subsequently the subthemes and themes will be jointly analysed across participant groups using pattern matching in workshop formats. Conclusions: The results of this case-study are expected to generate new knowledge of the reasons underpinning the increase in mental ill-health among young adults in Sweden. This knowledge will subsequently inform the future co-production and core design features of a digital mental e-health intervention aimed at promoting mental well-being among Swedish young adults aged 18–29.

Background: Recent reports point to a global and Swedish national mental health among young adults. It is widely recognised that this phase of ‘emerging adulthood’ involves many challenges, stressors and uncertainties that can negatively impact mental health and well-being. In addition, these strains may be exacerbated by rapid contemporary changes in technological, societal and sociocultural contexts. Developing and tailoring interventions bolstering the mental well-being of young adults requires deeper insights into their lived experiences, self-perceived strengths and challenges. Aim: This paper has two interconnected purposes: Firstly, presenting relevant theories and theoretical perspectives at the individual, group and societal levels providing a rationale for theorised study propositions underpinning a situational analysis of Swedish young adults. Secondly, building on this theoretical foundation, the aim is to describe a protocol for a case study and situational analysis examining how Swedish young adults from Generation Z experience their transition to adulthood, its impacts on their mental health, describing their mental health literacy, occupational balance, and support needs. Method: This case study protocol outlines a holistic, single-case study design employing a flexible approach. Data will be collected in Sweden through focus groups and individual interviews with stakeholders, young adults, and their parents. Existing and available mental health and well-being promotion in Sweden will be mapped through online searches. The various data sources will initially be analysed separately using thematic analysis. Subsequently the subthemes and themes will be jointly analysed across participant groups using pattern matching in workshop formats. Conclusions: The results of this case-study are expected to generate new knowledge of the reasons underpinning the increase in mental ill-health among young adults in Sweden. This knowledge will subsequently inform the future co-production and core design features of a digital mental e-health intervention aimed at promoting mental well-being among Swedish young adults aged 18–29.

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.

Social skills group training is frequently used to support autistic children and adolescents in coping with everyday social demands and expectations. Meta-analytic studies suggest small to medium effect sizes. Effect moderators must be better understood to inform implementation and allow optimization of intervention protocols. Using data from two pragmatic randomized trials ( N = 241) of the KONTAKT™ social skills group training program as an add-on to standard care in clinical settings, we aimed to explore the moderating role of co-occurring attention-deficit hyperactivity disorder in children (7–12 years) and adolescents (13–18 years). Two distinct response criteria were defined based on the parent-rated Social Responsiveness Scale: reliable improvement (⩾25 points) and clinically relevant improvement (⩾10 points). Moderator analyses indicated that the intervention effect was moderated by co-occurring attention-deficit hyperactivity disorder and age group. Logistic regressions stratified by co-occurring attention-deficit hyperactivity disorder showed significant effects among those without attention-deficit hyperactivity disorder ( n = 63), both in terms of reliable improvement (odds ratio: 11.85, p = 0.002) and clinically relevant improvement (odds ratio: 10.00, p = 0.001). In contrast, no significant effects were observed in those with co-occurring attention-deficit hyperactivity disorder ( n = 178). Explorative analyses further stratified by age suggested significant effects in adolescents, but not children, with co-occurring attention-deficit hyperactivity disorder. The findings preliminarily suggest that autistic children with attention-deficit hyperactivity disorder may need other or additional support. Lay Social skills group training can help some autistic children and adolescents improve their social life. Still, the positive effects may be less clear for those who also have attention-deficit hyperactivity disorder. We used data from two previous projects evaluating the effects of a social skills group training program called KONTAKT™ as an addition to the common healthcare provided. Our study included 241 children (8–12 years) and adolescents (13–18 years). To determine whether the participants had improved their social skills, we used ratings provided by the parents before and after the training and 3 months later. We then explored if KONTAKT led to improvement for autistic children and adolescents with and without attention-deficit hyperactivity disorder. Autistic children and adolescents often struggle to understand others and express themselves in everyday social situations. These challenges can create barriers to well-being and future life chances. Social skills group training can improve social skills in some autistic youths, but not all will benefit equally from the training. It is therefore important to better understand whether some groups need more support or other forms of assistance. Many autistic children and adolescents also have attention-deficit hyperactivity disorder, which can make the training of social skills more complicated. We found that both children and adolescents can benefit from KONTAKT. Still, preadolescent autistic children with attention-deficit hyperactivity disorder did not seem to improve as a result of the training. Based on these findings, it is important to find additional strategies to support this specific group of autistic children in handling social situations.

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.

Depression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22–12.83), anxiety disorders (4.05; 1.77–9.27), suicidality (5.37; 2.28–12.66), and AUD (7.68; 2.59–22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21–0.95) and AUD in adulthood (0.18; 0.07–0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.